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Connecting, learning and reflecting through COVID-19 – Michelle Angelone

As a mother of two young children, Michelle Angelone has always prioritised her role as a mum over any professional opportunity. She is passionate about her career, her nursing role – and fulfilment within her job, however she held back when it came to growing her own potential.

In this week’s Nightingale Blog, Michelle tells us about her nomination for the Nightingale Challenge, a lack of confidence – and how she might just have received the boost she needed from some inspiring, like-minded individuals.

I started my career in adult nursing but didn’t feel the fulfilment and job satisfaction that I anticipated it would bring – something was missing, especially in terms of use of interpersonal skills to form meaningful therapeutic relationships and walk alongside the client in their journey. I didn’t want to nurse people solely to health; I wanted to nurse people in a way that maximised their potential as humans, in whatever shape or form that was to the individual. I transferred to learning disability nursing and immediately felt at home – this was the service user group I would work with as a vocation.

I qualified as a learning disability nurse 12 years ago. I spent some time developing my skills in an inpatient setting before transferring to the community. This role involves assessment of clients to provide many forms of support including health education and promotion, physical and mental health needs, complex life limiting needs, continence needs, behaviour support, epilepsy management, training and delegation to non-registered staff, care management, safeguarding investigating officer and working as part of the multiprofessional team in partnership with a range of disciplines. In today’s climate I feel very fortunate not only to have permanent employment, but to be honoured to support a group of service users who trust us to be part of their journey and support them right through to end of life care. Being a community learning disability nurse isn’t just a ‘job’, it’s a privilege.

I enjoy the variety, surprises and fulfilment that each day brings. No two service users are the same, likewise, no two days are the same in this role! To be able to provide support that may seem relatively trivial to many but in fact helps initiate significant change or progress for the individual, is so rewarding in this profession. Take the example of a person with severe challenging behaviour, non-verbal communication, autism, and Attention Deficit Hyperactivity Disorder (ADHD). Add in a language barrier for both them and their family. Their behaviour is becoming more unmanageable with unpredictable and intense physical aggression. Blood tests are required prior to altering of medication to support behaviour management alongside therapeutic intervention from the behaviour support team. They are fearful of bloods being taken and not consenting to same.

My role involved establishing a therapeutic relationship, familiarity and trust with the service user which then allowed for desensitisation and eventually venepuncture for blood monitoring with their consent – this in itself carried increased risk as the services user was very unpredictable and could strike out aggressively at any time whilst sharps were in use. Throughout the process it was of utmost importance to also gain the trust of their parent who was becoming unwell as a result of the situation. This demanded intense use of interpersonal skills and a variety of communication methods to ensure effective communication and understanding, breaking through a language barrier. My own self-awareness and knowledge of cultural differences ensured a professional approach exhibiting mutual respect. The long term result has been successful management enabling them to remain at home and prevent inpatient admission, alongside significant improvement in the parent’s wellbeing. The parent is no longer isolated from services or support as a therapeutic relationship has been established. They now seek me out before crisis point and make contact regularly to update how the family are coping, which has become vital in monitoring the situation. I thoroughly enjoy being visible, assessing the family’s situation through use of a range of interpersonal skills, highlighting any concerns, ensuring a proactive approach to future interventions, and being the advocate that ensures that – despite the service user’s range of additional needs – they are supported to achieve optimum wellbeing in ways that are important to them. Careful management of this case is the very essence of person centred care provided by a learning disability nurse.

Being a mum

Having two young children, I have always prioritised being a mum over any professional opportunity that came my way. When my manager approached me with the nomination for the Nightingale Challenge Programme, I was immediately certain that it wasn’t for me – I was ‘just a mum’. However as my manager sternly reminded me of my potential, and obvious need to grow in confidence, I thought what could go so wrong?

If I can master the challenges of raising a headstrong, chalk-and-cheese duo, why can’t I work alongside a bunch of nurses who all want to see each other succeed? Maybe my lack of confidence might just receive the boost it needs if the group boasts some inspiring, like minded individuals. I’m pleased to confirm that to date this has indeed been the case and I have connected with some lovely personalities that I can network with personally, and, more importantly, professionally. I have grown in confidence as an autonomous practitioner, advocating for and empowering service users. I have developed networks in collaboration with other professionals to enhance my accountability and developed critical thinking skills enabling me to challenge practices and make decisions without probing additional support. I continue to seek out further opportunities for development and commence the Post Graduate Diploma Specialist Nursing Course in Community Learning Disability Nursing in September 2020.

Building networks

Despite the pandemic ceasing face to face engagements with the Nightingales, technology has allowed us to keep in touch via Zoom calls and a Whatsapp group. I have been able to build networks with some of the Nightingales from my directorate on a personal level and we regularly check in with each other to see how we are coping and share helpful suggestions for finding ways to wind down or switch off from the constant pressures faced. I have continued to apply skills and learning from the Nightingale programme to my practice during the pandemic.

My manager and several colleagues were redeployed to the Northern Trust’s swabbing team, leaving myself and another nurse to prioritise care delivery and needs of service users within the locality. One particular service user was unfortunately given a palliative medical diagnosis. Under normal circumstances due to the complexity of their diagnosis, needs and learning disability, it would have been extremely difficult to meet their needs within their own home. Nursing care would have been much better placed to support them however due to restricted admissions as a result of Covid19, coupled with the person’s learning disability and rapidly deteriorating condition, it was decided, in conjunction with the service user and the multi-disciplinary team, that the least distressing option for them would be to remain at home to receive end of life care. This brought a lot of challenges to our nursing team however we were determined to think outside the box and facilitate person centred care at the most vulnerable stage of this person’s life.

Covid-19 has been unsettling for most, but for those with a learning disability and associated conditions such as autism, it can be overwhelming. The changes to their daily routine and restrictions on everyday events, the difficulties processing a pandemic and its consequences, processing that the face behind the masks and Personal Protective Equipment is still the staff that have always cared for them, and numerous other challenges have tested the resilience of both staff and service users in recent months. As well this, the service user faced the challenge of not only understanding and accepting their palliative diagnosis but also processing their rapid rate of decline and skill loss. This was not the sort of ‘challenge’ I anticipated when accepting the Nightingale Challenge, nonetheless, I was determined to deliver care to the best of my ability. The case was discussed and reassessed via weekly Zoom meetings between various professions ensuring collaboration and working in partnership to facilitate a shared vision. New skills were delegated by Community Learning Disability Nursing to support staff who would not normally deliver nursing care in their roles. The service tended to the service user twice daily and prioritised supporting staff throughout by offering reassurance and guidance.

I was able to demonstrate leadership that demanded sensitivity, professionalism, negotiating, critical thinking, using clinical judgement to evaluate and inform rapid decision making, influencing, teaching, and above all compassion to ensure the person received high quality end of life care. By advocating for them throughout Covid-19 they were able to pass away peacefully and dignified in the comfort of their own home, surrounded by family and the staff who cared so dearly for them. Palliative care nursing communicated the value of having community learning disability nurses involved with a unique set of skills to support this person’s needs in a way that respected not only the their diagnosis but their learning disability throughout. To have facilitated and been part of this experience, not to mention during a global pandemic, has without a doubt been the most challenging yet rewarding learning experience of my career. Through a collective leadership approach I witnessed staff in a variety of roles, demonstrating care underpinning the Health and Social Care Values For All. Covid-19 has allowed our service to reassess how we deliver care. Collective and compassionate leadership transformed the negativity surrounding a pandemic into a positive demonstration of how person centred care can be delivered, even in the most challenging of times.

Covid-19 has not only taught me a range of leadership skills to enhance my professional development, but also resilience. I felt at times like I was firefighting – juggling home schooling, adapting to new ways of life which my children struggled to cope with, and the pressures of a full time nursing post during a pandemic. It’s a contest I hope never to compete in again. However on reflection, I realise I have learnt that I can afford to be a little less rigid and structured, I don’t need to always plan in advance to the smallest detail, the world has continued to spin in this madness and sometimes you just have to live for the day as tomorrow isn’t certain. I’m grateful for the support I have received throughout the last few months from my manager and nursing colleagues, together we have carried each other and learnt just how important our values are as a nursing team. I have also learnt that a little bit of ‘me time’ isn’t selfish as you can’t be all things to everybody when under pressure. You can’t pour from an empty cup – but a hot cuppa and some chocolate helps!

In learning disability nursing we walk beside our service users, we become their advocates, their voices. We are a community that look past the disability to promote ability. I am forever grateful for our service users who teach me every day how to become a better person and above all a better nurse. I wish that we could all see the world through their eyes – I am truly blessed to be a learning disability nurse.

Michelle Angelone, Community Learning Disability Nurse, East Antrim

Michelle is one of 27 Northern Trust nurses and midwives taking part in the Nightingale Challenge launched by Nursing Now – a programme of the Burdett Trust for Nursing to improve health globally in collaboration with the International Council of Nursing and the World Health Organisation. The campaign encourages healthcare employers to support at least 20 nurses and midwives to develop their leadership skills during the 2020 International Year of the Nurse and Midwife.

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