Dr Nutmeg Hallett

Dr Nutmeg Hallett

Lecturer in mental health nursing.
Postdoctoral researcher within the Risk, Abuse and Violence research programme, focusing on violence prevention in mental health settings.

Location University of Birmingham


  • Thank you Carole. You are right, we are all just human. Even medical experts get it wrong sometimes when working with people with dementia because so much of it is trial and error.

  • Thank you Jan, I'm glad it has been helpful.

  • Thank you Terri, I am glad that there has been information that will be helpful for you.

  • Thank you for your feedback Linda. It is something that we have tried to address in the comments, but we will look at including the carer's perspective more formally next time.

  • Thank you Ruth.

  • Thank you, it is really heartwarming to hear that this course has been helpful.

  • I'm glad you liked the case study. We find that it is a useful way to get discussions started.

  • Dr Nutmeg Hallett replied to [Learner left FutureLearn]

    You are right Jennifer, that sometimes we trigger situations unintentionally, but you seem to have a good response to this. It is also worth apologising if you do something to upset someone, even if it is unintentional.

  • Thank you Kay for picking up the few positives there were. It is correct that he initially used the correct name, and sitting down was a good thing to do. It did all go downhill from there.

  • Thank you for sharing your experience Judy. Walking away can be a very effective form of de-escalation in the right situations. It is a very useful idea to think about how important the task is. As you say, leaving dentures in ocassionally probably won't do any harm and if it avoids an argument is good for everyone. It can become more of an issue if someone...

  • I am glad that the case study so closely resembles someone that you work with, and that you can put into action some of what you have learnt. I hope it is successful.

  • I am sorry that this has not provided the information you need Helen. As Lynn says we have been clear that we have not included how to manage physical aggression. We are aware that this is something that people would like more information about, but we did not feel that we could do it justice within the scope of this course. Physical aggression may sometime...

  • There is evidence to show that providing person-centred care for people with dementia can reduce agitation, which would save staff time. So I agree that there are lots of financial constraints, but actually improving attitudes and the culture of staff would probably be a cost effective exercise.

  • You are right Maureen. And as I have said in previous comments, taking a person-centred approach to care can often speed things up, it can reduce or eliminate the 'challenging behaviours' that take up staff time.

  • Thank you Jan, that is an interesting and insightful analogy.

  • Your experience Patricia is a very good example of how we often need to adjust our own expectations. If you expect something to take 10 minutes and it ends up taking 30, that is very frustrating, but if you start out thinking that it will take 30 minutes you feel less frustrated and it can even sometimes everything up!

  • Thank you for sharing your experience Antonia. It can be incredibly frustrating when someone gets stuck in a loop. Have you found ways of dealing with it at the time?

  • Absolutely Alexandru, it is vital to explain what is happening, even if the person doesn't respond.

  • I agree Steve, some people have an innate ability to be patient, but it is something that anyone can develop and improve. As a nurse there is a focus on constantly developing oneself not just in terms of knowledge, but also interpersonal skills. This is something that spills over into my personal life and makes all interactions easier.

  • It is true that a lot of what people discuss here is not just useful for people with dementia.

  • It sounds like you have found techniques that work very well for you. Is this something that took a lot of trial and error?

  • Yes, non-verbal communication both in terms of how we come across, and observing other people's non-verbal cues.

  • That is a very good point Jan, thank you for raising it. I myself have no idea what a cwtch is!

  • That sounds like an incredibly useful coping strategy. Anything that can help you empathise is good.

  • Yes, this can be particularly frustrating for carers. If you feel yourself getting frustrated it can be helpful to briefly step away from the person. It is good that you can remind yourself that it is unintentional.

  • Thank you for sharing this link Melissa. Using simulation of experiences is something that we use with our students and find particularly effective. It is much easier to empathise with someone if you have an idea of how the world is for them.

  • You are right Linda. A lot of 'challenging behaviour' is actually just people reacting to frustration or anger. If you can avoid the frustration, often the 'challenging behaviour' vanishes. Of course there will be times when frustration is unavoidable, then it is important to be calm and patient.

  • Thank you Melissa, your experience demonstrates the importance of honesty.

  • @LenaG I have worked in a few care homes / residential settings that have not had showers at all. I do agree that it is very important to look at all the risks, including psychological, but there are also sometimes constraints on what can be provided. As I have said in other comments, providing person centred care doesn't mean doing everything the way an...

  • @SteveB You raise an important issue, that an intervention or idea may work in one situation or setting, but could cause distress if something is different. There is a lot of trial and error when caring for people with dementia; sometimes you will try things that don't work and may cause upset but it is all part of the learning process.

  • @NicolaJames Thank you for sharing the link, this is a very interesting blog. And thank you all for sharing your ideas.

  • It is particularly noticeable when reading people's comments that there are some commonalities between experiences, but there are also lots of idiosyncrasies. And you are absolutely right Leonie, that there is a lot of overlap between working with people with dementia and working with people with many other conditions and diagnoses. Also Leonie, it is a common...

  • Thank you Leonie, it is very important to remember that this is Peter's home, and he has every right to feel secure and comfortable there.

  • I agree that it is important to work with individuals. However, what if Peter is at risk of falling and so a bath is a safer option? It is easy to blame the care home, particularly with Peter's case study, but sometimes they may be working in the person's best interest. Every story has more than one perspective and it can be really helpful to consider these...

  • Often homes have routines that seem to be set in stone, but a good home will allow for flexibility in timetables so that they can provide person-centred care.

  • 'All about me' sheets can be a really useful way of not only providing information that can inform person-centred care, but also to 'humanise' people. Meaning that it is easy to dehumanise the people living in residential settings, they can become tasks rather than people. Some written information about a person's likes, dislikes and history can act as an...

  • Thank you Monica, that is a very nice way of framing the issue, that the facility has a listening problem rather than Peter having communication problems.

  • Thank you for sharing Lynn. This is an excellent example of good practice. I wonder if you ever struggle balancing the time it takes to do this with the needs of the residential setting that you work in, or do you find that the approach you use actually saves time in the long run?

  • Also making sure that you give people time to answer, it can take much longer for people with dementia to process questions.

  • That is a lovely example of the importance of attempting to interpret what someone is trying to communicate Samantha. It can be very frustrating for both parties when attempts to interpret fail, but it is always important to try.

  • Thank you for sharing Kirsten. Distraction can be a very useful technique; it is rarely beneficial arguing with someone who has false beliefs.

  • Sometimes simply being present can be helpful for a person. So much interaction, particularly in residential settings, is goal-oriented, so just sitting with someone can be a refreshing change.

  • Thank you Jan, you make a very good point. Sometimes either/or questions can be too difficult to respond to. You seem to have found a way to manage these situations with your husband.