To give you a little introduction about me, I am the first specialised dental nurse working to support patients with learning disabilities at Guy’s and St Thomas’ Hospital.
My role was created following a service review and is intended to help assist patients with certain behaviours that may cause challenges during their dental visits. It was identified that there was a need for a learning disability nurse within the dental directorate to support the patients and their families during their pathway. As adults, patients with behavioural challenges and learning disabilities have historically been supported by the medical learning disability nurse on an ad-hoc basis.
Within this role, my responsibilities are:
- Providing chairside nursing with learning disability patients.
- Arrange and chairside best interest meetings.
- Staff training.
- Create social stories.
- Develop easy-read leaflets.
- Provide oral hygiene visits.
- Organise complex multidisciplinary treatment cases.
- Carry out telephone clinic before and after general anaesthetic appointments.
The Trust and dental directorate aim to support learning disability patients and offer them access to the best care and treatment, showing that as one united team. We provide a smooth and supportive treatment pathway. Our aim is to ensure our patients are treated as individuals, ensuring better outcomes and support to the patients and their families navigating complicated NHS systems.
I have been in this post for three years, and in that time, I have gained vast amounts of experience working with this patient group, from the patients, their families, and carers. I feel it is important to impart my knowledge to the directorate because this relevant information can be adapted and utilised in the wider community.
Working as part of a larger team under the main learning disability nursing team I also have established links with the ears nose and throat department, vaccinations, gynaecology, ophthalmology, podiatry and cardiology departments. These are just a few of the teams whom we have carried out joint cases with successfully, supporting holistic care for our patients.
Many skills are necessary to be successful in this post. One important quality is being a good communicator, for example, using open body language and gestures when communicating with patients.Another example is being friendly and approachable which allows patients and their families to feel they can talk and relate to you. Lastly, a good quality is remaining relaxed and optimistic during challenging times with a patient, offering them a sense of stability.
You need to be forward thinking when planning care in the dental surgery to ensure items you may need are available. You may only get one chance to leave the surgery to get essential equipment such as a scaler, disposable toothbrushes and materials in case a restoration is required, so that the rest of the appointment can be used supporting the patient.
Being a good team player as well as a leader is also essential. You need to be able to advocate for the patient and ensure the wider team understand the patient’s wants and needs in order to support them.
In a role such as this you need to be very proactive – but with a side of creativity! Creativity can be helpful to get to know your patients, their likes and dislikes and finding fun and interesting ways to interact with them. An example I have used in the past is creating a quiz on the tube map for a patient who likes the London Underground, so their next visit is a new fun experience.
My qualifications that support this role are TQUK level two Certificate in Understanding Autism and Makaton level one and level two, which helps me communicate with non-verbal patients who use Makaton.Additionally, I have post qualifications in oral health, fluoride application and special care and sedation training.
By far my favourite part of the job is supporting a patient throughout the process of having a general anaesthetic for treatment from start to finish. Firstly, the patient attends an assessment appointment with a consultant dentist. At this appointment, I get to know the patient by engaging with them, their family or carers and utilising a hospital passport. It is also helpful to talk to them in a relaxed environment, asking questions such as:
- Things they like and dislike.
- Who brushes their teeth? What is being used?
- What things do they do in their spare time?
- And their interests.
If the patient needs to have a general anaesthetic I show and explain the next steps, demonstrating how it will work on the day by using props. This illustrates the process of the general anaesthetic using picture stories and I try to introduce them to members of the team who they might see on the day. It is also helpful to show them items we use, for example, the mask they will use on the day to help the patient go to sleep. Following on from the initial assessment I call the patients before the appointment, checking in and going over the process ready for the day and working out who’s coming with the patient. This also allows the patient, parents and carers to ask questions about the procedure.I also run through the logistics of the day to prevent anxiety regarding any aspects of the day as much as possible.
On the day of the visit, I meet the patient and support everyone present through the process, explaining how it will all work. I will introduce members of the team, and explain who they are. I guide them throughout the visit and aim to keep all present calm, relaxed and informed. It is important to have good communication with the patient, family and team throughout the procedure. After the operation, I carry out a follow-up phone call a week later, checking in on the patient, their healing, and any other outcomes. It is vital to get feedback about what went well for the patient overall and if anything could be improved to support other patients in the future.
Items I use during the appointment to support a more holistic and relaxed environment include sensory ceiling lights, relaxing music, an iPad, fidget toys and soft toys. I have recommendations for oral hygiene adaptations such as non-foaming/no flavour toothpaste and disposable toothbrushes which are useful items to have handy to show the patient.
Going forward, there are exciting plans for more teaching and CPD sessions and a dental nurse-led clinic. The plan is for me to be assessing patients with a learning disability there and creating their own dental personal passports to support them in accessing dental treatment and care. This will work towards promoting and creating health equality within this patient group and support long-term dental needs, in every way we possibly can!