You are expected to support your answers with reference to relevant literature. You should include one Reference List for the whole Assessment, at the end of your answer paper. (This is not included in word count)
Examples from mental health clinical practice, PCV (Patient & Carer Voices) or examples of good/bad practice from literature are expected in your answers for Part 1. They are not expected for your answers for Part 2, but they are acceptable.
Working in Partnership with Service Users and Carers.
Part 1 – Long answer questions.
750 maximum word count for each question.
On your ‘answer paper’ just write ‘Part 1, Q1, & 2, to indicate which question you are answering.
Questions:
- Critically explore challenges to caring for transgender patients and identify potential ways to address these in practice, in the context of health inequalities and discrimination. You are required to include relevant evidence-based literature UK preferably, key legislation, and policies, along with examples from mental health clinical practice or examples from literature in mental health practice to support your arguments. (750 words).
- “Nursing and communication are changing rapidly because of digital technology” (Patient & Carer Voices, Communication Workshop). Using this citation as a starting point, critically reflect on the impact of using digital technology on communication in the context of the therapeutic relationship between nurses and patients/carers. You are required to include evidence-based literature UK preferably, along with examples from mental health clinical practice or examples from literature in mental health practice to support your arguments. (750 words).
Please go to next page for Part 2 of the assessment 2
Part 2 – Transcript Analysis.
Read the following transcript which relates to the clinical situation described below: Young Person’s Sickle Cell Anaemia Clinic. Attending are the following people – Lloyd, a 15-year-old boy of African-Caribbean origin, previously diagnosed with Sickle Cell Anaemia and described in clinical notes as ‘significantly autistic’; in the care of his grandparents, Rose and Henry Stewart (RS and HS).
Staff present – Band 5 nurse Lynn Harding (LH), Student Nurse Zahra Hussain (ZH).
It is the end of the clinic – the MDT has arranged for Lloyd to have longer appointments at the end of the day when it is less busy, less likely to be overstimulating, in order to meet his needs.
LH 1-“Ok Student Nurse Hussain, I want you to pay close attention to
this next patient and watch how I manage him. More to the point, watch how I manage the grandparents. (Band 5 Nurse calls across the deserted waiting room) – “Mr and Mrs Stewart, do you want to come in please?” (After several minutes talking to their grandson Lloyd, who appears agitated, Mr and Mrs Stewart walk across to the consulting room, with Mrs Stewart holding his hand. They take seats in the consulting room, where a radio is playing in the background. Lloyd sits behind his grandmother, facing the rear wall of the room, away from the nurses.)
LH 2- (Speaking to the grandparents) “Well, shame that took a while, reduces the time we have for the appointment, but never mind. Do you want to tell us what is happening with Lloyd?”
RS 1 “Hello again Nurse Harding. I didn’t know that you would be here today, we were expecting to see Nurse Owusu as usual.”
LH 3 “Yes, well, she had to go home earlier, some sort of family emergency, allegedly anyway, so you’ve got me. Is that a problem? No? Good, let’s crack on, shall we?”
RS 2 “It’s just that…”
LH 4 “Let me guess – your grandson prefers Nurse Owusu? Well, he would wouldn’t he, but this is the NHS, you get what you’re given; you want choice, you go private. Now, as I said, please tell me what has been happening with Lloyd and let’s try not to have a repeat of the last time I saw you in clinic.”
RS 3 “Well, we can try, Lloyd will you show…”
LH 5 “With respect Mrs Stewart, I’d prefer it if you would tell me what has been going on, otherwise we’ll be here until tomorrow morning waiting for Lloyd. As it is, we go out of our way to give you the last appointment of the day, as well as extra time because of his, what do we call it now, ‘neu-ro-di-vergence’, but best not to push it too far eh? So, tell me, how’s his symptom control, anyone able to rein him in a bit yet, get him to take some responsibility for his behaviour?”
RS 4 (Mrs Stewart pauses, obviously composing herself. Mr Stewart has turned to take Lloyd’s hand, as Lloyd, though still seated, is beginning to become increasingly restless.) “Before we go any further, Nurse Harding, would you please turn off the radio? The less noise we have, the better for Lloyd.”
LH 6 (At this point ZH gets up and turns the radio off – LH looks sternly at her.) “Well, that’s very nice of Student Nurse Hussain isn’t it? Hopefully Lloyd will calm down a bit now. So, Mrs Stewart, how’s he been?”
RS 5 “Lloyd has been working hard with Nurse Owusu and he has been completing diaries recording his pain and other symptoms. He has been practising reading these aloud so that he can tell you what has been happening, so Lloyd, do you want to turn around and…”
LH 7 (Looks at student nurse, raising her eyes) “Look Mrs Stewart, the problem with self- recordings of symptoms is just that – they are self-recordings. Far better to allow the experts to be the judge of symptom severity. Let’s save us all some time and aggravation by you just telling me what you have seen and me and the student here will tell you what it means and what we can do next. We’re only trying to help you know, but sometimes you need to help us to do that.” At this point, Mr Stewart and Lloyd get up and leave the room. Lloyd is clearly agitated, repeating loudly the same phrase over and over “Nurse Owusu, please please, Nurse Owusu please please!”
RS 6 (Calmly but obviously controlling her anger) “Look, Nurse Harding…”
LH 8 “Woah there Mrs Stewart, don’t talk to me in that tone – I’m already minded to call Security to keep an eye on Lloyd there in case he kicks off in the waiting area. One of the advantages of these special privileges though I guess – no-one else out there for him to hurt if he does, though you’d be liable for any damages to fixtures and fittings. But if you’re going to get all assertive on me then there’s nothing to stop me calling them for you as well.”
RS 7 (Still calm, but forceful and also making eye contact with ZH) “Nurse Harding – Lloyd has completed symptom diaries since the last appointment – it took Nurse Owusu a lot of time and patience to convince him to do this and we have all tried hard to encourage him. He has been very diligent about it. The diaries show that alongside his usual episodes of pain, which the medicine sometimes fails to control properly, in the last two weeks he has been reporting a constant pain in his shoulder. It is now beginning to keep him awake at nights. We think he may have fractured it when he fell off his bike recently and he wanted to tell…”
LH 9 (Interrupting) “Want and need are two very different things Mrs Stewart. If you are worried that he needs an x-ray, why not just take him to A&E like you would with any normal kid? Seems like we might need to do a Safeguarding referral, if that’s been going on for two weeks and neither you nor the parents have done anything about it. Student Nurse Hussain…” At this point, there are loud noises outside, door slamming and Mr Stewart shouting. Mrs Stewart quickly leaves the Consulting Room.
LH 10 “Student Nurse Hussain, call Security now – the number is 121!”
ZH 1 “Er, yes, ok, er, what do I tell them?”
LH 11 “Blimey, what do they teach you these days? Give me the phone, go out there and see what’s going on.”
ZH 2 (Having looked outside, comes back in to the room) “They’ve gone, Nurse Harding, there’s no-one there.”
LH 12 “Typical! Right, I hope you have learned something from this – I told you to watch how I dealt with them. Firstly, note that it’s the grandparents who were with him today, not the parents. If his condition is so severe, why are they not here? We get all kinds of excuses, unsympathetic employers won’t allow time off etc etc, but seriously, farming out care to the grandparents like that, you have to wonder about the quality of the parenting. Typical of the estate they live on.
Secondly, pain relief – they could have mentioned anything about symptoms, but what did they mention – pain relief. You have to watch sickle cell patients when they get older, always trying to get more pain relief. It’s a contradiction really, evidence shows black people can actually tolerate more pain, but culturally, that community does like to abuse drugs – prevent it happening while they’re young, that’s what I say, it’s in their best interests. Speaking of which, when you think about it, he probably doesn’t really have the capacity to speak for himself anyway.
Thirdly – did you see the splitting going on there, ‘us and them’? They like Nurse Owusu because she’s black, same as them. In my opinion she spends too much time with them, it’s favouritism, just reverse racism if you ask me. Just because you’re not white yourself, Nurse Zahara, don’t get taken in by it. Treat everyone the same, I say, we all bleed the same colour blood so no need for treating anyone any different. Firm but fair, that’s me. Watch and learn, people will thank you for it in the end. Oh, and we won’t do a Safeguarding referral, too much paperwork, but we’ll tell the GP that they should refer him for a non-urgent X-ray. Probably not necessary, but just in case eh?”
END OF TRANSCRIPT
The codes ( LH, RS, ZH and HS) can be used in your answer to illustrate sections of the transcript you are referring to.
Your answers should make reference to relevant UK evidence-based literature. Answers should be in narrative form; bullet points are not acceptable.
The word count limit for Part 2 is 1500 words.
On your ‘answer paper’ just write ‘Part 2, Q1’, (etc) to indicate which question you are answering.
Questions:
- Considering the whole of the Transcript, critically consider which communication skills/strategies Staff Nurse Harding could have used to achieve a better outcome. (recommended word count – 600 words)
- Critically consider issues of stigma and discrimination in the transcript, identifying examples of these concepts and in addition identifying possible consequences of the same. (300 words)
- In the transcript, Mrs Stewart tries to advocate for her grandson. Critically consider how her role doing this would differ from that of a paid advocate. (300 words)
- Imagine that you are the student nurse in this scenario.
