Participant verbatim quotes
| Transferring learning into practice | |
| Intentions to use learning | (…) it has made me make more of an effort to consciously go through their notes to remind myself what their family setup is and whether it looks like it might be appropriate to start engaging in that conversation, which is something I wasn’t necessarily making a concerted effort to do before the training. Breast CNS |
| Intentions to improve organisational practice | So (…) I’m really looking forward to our next [monthly nurse meeting] so I can share with the whole team what happened in the training day and just share some of the resources as well because I think there is an awful lot out there that we maybe haven’t been so aware of (…) I want to just try and make the other nurses (…) who are a bit more junior feel a bit more empowered to be able to initiate some of these conversations. Breast CNS One of my roles here (…) was with the development of our computer (…) and it’s made me realise we don’t have anything on there. Although we do family trees and we might write about the fact that people have children, we don’t have any reportable box on there that says ‘does this person have children under 18?’ or anything like that, so I’m now going to discuss that with the team and I’m going to take that away and say, ‘Right, this is something we need. Community PCNS |
| Barriers to implementing learning | So we have had [ethnic minority] patients that have died and they really do not accept death and dying, they really a lot of the time do not accept withdrawal. So that was very complex. If the parents and the adults aren’t accepting it, they (…) aren’t going to start preparing the children and the young people. Hospital PCNS (Pre-training) I know that if I need to have those conversations that’s going to be really difficult for me to do realistically and in terms of privacy it’s related to space in the cancer centre and how many rooms we have. Lung CNS (Pre-training) There is a bit about, at the moment, lots of changes going through the team, a bit of a lack of staffing level, so it is a bit sad but all the projects are on hold. So at the moment, the barrier would be that it’s not the right timing. Hospital PCNS |
| Learning into practice | The training enhanced the courage of my convictions to talk with [the patient] about her family and her daughter. It would have been so easy to shy away from this as it was just too painful. In the end, instead of being painful, it was probably the most meaningful, tender and most beautiful moment of my nursing career. Breast CNS (practice log extract) |
| Reactions to the training | |
| Contents and style | (…) it definitely suited me. I do like (…) that style of learning. I don’t want to be sat and talked to all the time with information, I want to participate and want to join in. Breast CNS I think just giving you the (…) overall background that this is something that’s really important and that you do need to plan for it and you do need the confidence to be able to go in and start conversations with people and not be sort of fearful about how things might go wrong. Community PCNS From the information delivered [and] from the learning from the day, I certainly feel (…) I can do better and (…) I can now also share practice with other colleagues and feel more confident, maybe in challenging others on how they approach supporting patients with children and become a better advocate (…) for services to improve and being available. Breast CNS |
| Interactive training | Just little tips from other people and case studies and scenarios and just how people manage different situations.(…) Yes, just learning from others really. It’s silly but it’s little things like, “Oh I say this to my patients,” and you think, oh yes, that’s a really good thing. Hospital Research Nurse I think actually [the mix of professional backgrounds] really complemented it because I got to see things from (Hospital CNSs’) perspectives and how hard their conversations are. Because we know that our patients have been given that information in clinics, sometimes a few weeks, sometimes a few years ago, it varies massively, but I hadn’t really heard first hand from those nurses around how that feels for them and how the conversations sometimes go and the complications that can come up as well. Community PCNS |
| Role-play | One of the CNSs doing the role-play at one point said (…) ‘How can I tell the child?’ and she said, ‘Can I just ask [the patient] how did you tell [your son] when you had your cancer diagnosis?” I thought, that’s quite powerful because almost what she was saying was ‘You’ve done this before, you’ve broken bad news to your children before’. That’s why the learning from your peers (when observing role-play) is quite often so powerful as well. Hospital PCNS I certainly didn’t feel that I managed it well at all, I really felt myself floundering (…) and that really disconcerted me actually (…) I would say probably for the rest of the day. Community PCNS |
| Resources and additional learning | So all the resources that were shared on the day were great and actually has made me think that I could improve the information I give to my patients and the support that they may get as well. Breast CNS I know there were some resources laid out, some booklets for children, bereavement support, but really we were not being explained the differences between them, they were only left on the table to have a look at and I was hoping that we would have had more explanation about what is what and how to use it as well. Hospital PCNS |
| Talking to children | I think also a lot has been said about convincing or helping a parent understanding what is important to talk to their children, but we have not got down to the practicality of what words do you use, what do you say based on their age. Hospital Palliative Care Clinical Nurse Specialist |