User Story: Learning by practice team members – [Health Care context]

In what situation? Learning trigger?

Mary is a practice nurse with a special interest in diabetes. She sees a 78 year old patient who is having a side effect that she thinks is due to a new tablet (medication) that the patient has just started taking for their diabetes. She is unsure if it is the tablet and whether the tablet should be stopped. She decides to see the patient again the following week.

 What happens? (Sequence of the main actions performed), With which tools and physical objects?, Which actors are involved?

  1. Mary decides to use the practice computer to look up the possible side effects of the new medication on the web site, BNF online. The side effect is listed under the medication but she is still unsure whether to stop the medication or not.
  2. Mary sends an email using the practice computer (and her NHS webmail email account ) to all of the practice diabetes team (the two GPs with a special interest and the two other practice nurses who also run the diabetic clinic). She asks them what they would do and if the new medication should be stopped.
  3. One of the GPs decides to phone the manufacturer and the other GP does a Google search. Both GPs reply to everyone on the initial NHS webmail email saying that the side effect is common and should settle down after a few weeks.
  4. The two practice nurses chat to each other over coffee in the staff room and agree that it appears to be a common side effect since they had also seen a patient with the same side effects and it settled down within a few weeks.
  5. Mary receives the NHS Webmail email from the GPs but has no communication from the two other practice nurses. Mary decides to wait and see what happens over the next few weeks.
  6. At her next visit to the patient, Mary explains that she has discussed this with her colleagues and she expects the side effect to settle down. She agrees with the patient that they will continue with the table for the moment and will review the decision again at their next meeting in 2 weeks’ time.
  7. During the next 2 weeks, the patient notices that the side effects do seem to be settling down. She keeps notes of this to show to Mary when she visits again.
  8. When Mary and the patient meet again they discuss the side effect, look at the notes and agree that it looks like the side effect was temporary and it is ok to continue taking the tablets.

The final result

  1. Mary initially responds to her learning needs by looking for information by accessing commonly used information resources that are readily available whilst consulting
  2. Mary responds to the lack of an answer to her learning needs by asking colleagues for information using trusted colleagues within the structure of the practice team, and using routine email contact system
  3. Mary feels that she has learned something from this experience (both from the information she found herself, from the responses her colleagues sent and ultimately from her observations with the patient).
  4. Both GPs also feel that they have learned something as they actively sought information about the side effect, found what they were looking for and felt confident in the answer they provided to Mary. Their confidence (in the answer and their learning) was enhanced by seeing that their fellow GP replied with the same opinion.
  5. The two other nurses have read the emails and related them to their own experience. Reading about their colleague’s dilemma, chatting about it over coffee and sharing their own experiences has helped them both to develop their understanding of this medication and its side-effects. However there is no record of their learning and their colleagues are unaware of it and the extra information they could have brought to the discussion.
  6. The patient feels she has learned something from this experience – she feels she understands more about side effects of medication and how they may be temporary, she feels like she had a role to play in helping to reach a judgement about whether the side effects were permanent. She found the note-taking useful and will think about using a similar self-monitoring approach for any other health issues she has. The patient’s learning is not written up or shared with any of the other people involved in the learning episode.


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