Working in new ways

Ryan Rukas, Clinical Nurse Specialist, Midlands Partnership NHS Foundation Trust

I am a current fellow on the inspire improvement programme. I am the clinical nurse specialist for the Community Complex Care Team at Midlands Partnership NHS Foundation Trust. We are a large complex care team who mainly care for children with complex health care needs within their own homes. As a team we provide the day to day care of the child with the clinical oversight of a band 6 children’s nurse. I have been on my Inspire Improvement journey for approaching 6 months now and I cannot believe the change in myself as a nurse. If someone had told me a few years ago that I would be using ‘Evoke Cards’ ( with a family to enable them to get their full feelings and thoughts about my team across to me, I would never have believed them. I wouldn’t have even known what ‘Evoke Cards’ were!

These cards were first introduced to me by Jo Odell from FoNS. I remember being asked to choose 2 cards to explain how I felt at that moment. The pictures just caught my eye and ‘evoked’ a response from me that I didn’t actually know I was capable of. Looking back, it was because they were so easy to use and there is always a picture I could relate to. I bought a set for the team and they are now used every week for supervision and study days and sometimes during a general office discussion I get them out. They never fail to evoke a response in one way or another.

I then decided to use the cards when undertaking a young person and family review. These reviews are usually a pretty standard affair where I ask the child and family how things are with the team and more often than not I get the same answers from them as I did six months before. Not this time. I had pre-warned the family that this review was going to be different and they were intrigued to know what it was that would be happening. I spread the cards out on the young person’s bed and the family decided they would like to use the picture side rather than the words. (I have found that most people prefer the pictures to the words, one carer has previously said that the picture evokes ‘a feeling within them and makes them want to talk about it’.)

The young person chose two cards:

The young person explained that they felt their care package was a bit muddy and felt a bit rough around the edges at times. They went on to explain they felt locked in. This was a picture of a prison cell in their eyes and they felt as though they were a prisoner in their own home. This became very emotional for the young person’s mum and resulted in a conversation around ‘How can we help to overcome this feeling’?

What a feeling to be in that situation with this family. They had never opened up like this before and I know them very well. The review continued and we talked about all things to do with the care package and how we were going to improve things. The young person even offered to write a carer job advert, as we were specifically advertising for a person to care for them. We concluded by choosing cards again. This is what the young person chose and here are their comments: ‘Get through the gates and let’s see where we end up’.

I have never had a review like this before. An emotional rollercoaster is the best way I can think of describing the hour or so I was there. This was a great experience for me and the family and shows how being creative can really bring out a person’s emotions and true feelings in a completely open and honest way.

This approach is certainly something I will be using with other families and I am considering using it during an initial assessment to gather some ideas around how the family and young person are feeling about having carers in their home assisting with the care of the young person. I am hoping this will enable me to make their care even more personalised than it already is.

Ryan is an Inspire Improvement Fellow. Visit his ‘Current Fellow’ page for more information. Inspire Improvement is supported by the Burdett Trust for Nursing.

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