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Last Updated: Sunday, 18 November 2007, 00:17 GMT
Inside Medicine: Parkinson's disease nurse
Carolyn Noble
'I knew nothing about Parkinson's when I started the job'
In a series focusing on medical specialties, the BBC News website meets Carolyn Noble, who talks about being a Parkinson's Disease Nurse Specialist (PDNS).

Her role is to help treat and support people with the progressive neurological disorder through their illness.

WHAT IS YOUR JOB?

I am a PDNS specialist working in Peterborough and the surrounding areas.

I have a small team - a Parkinson's support nurse and a physiotherapist.

Sometimes you run out of answers and this is when I have to support people in the best way possible and help them to make choices about treatments and therapies
Carolyn Noble

The work involves seeing people soon after they have been diagnosed and supporting them throughout the course of the condition.

I aim to reduce any fears people may have by helping them to understand what is happening to them and to enable them to resume control over their lives.

A lot of my role is focused on improving understanding of the part that medication can play in alleviating some of the symptoms of Parkinson's which affects movement, swallowing and speech.

WHAT IS THE MOST COMMON PROBLEM?

I usually get called to see people who have run into problems such as falling and urinary tract or chest infections.

Even something as common as constipation can bring about a rapid deterioration of the Parkinson's symptoms and may mean a hospital admission.

But although Parkinson's Disease is the most common reason for seeing people, I also get involved with managing some of the rarer conditions which have some similarities with Parkinson's - Progressive Supra Nuclear Palsy (PSP) and Multiple System Atrophy (MSA).

Both of these conditions progress much more rapidly than Parkinson's and are less responsive to treatment.

HOW DO YOU DECIDE TREATMENT?

If you asked someone with Parkinson's what they value most about the PDNS I am certain they would say they particularly appreciate they have someone who really understands and listens to them.

I usually determine what is affecting the person most of all and this may include difficulties with mobility, swallowing and speech problems.

I also uncover any sleep disturbances, emotional issues and problems with anxiety and depression.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

The hardest thing about my job is knowing that even though you do your best to help people, inevitably in time the condition will deteriorate and they will become much worse.

Sometimes you run out of answers and this is when I have to support people in the best way possible and help them to make choices about treatments and therapies.

It is very humbling when people who are really struggling still thank you for just being there.

WHAT IS YOUR MOST SATISFYING CASE?

I remember one particular man who had been diagnosed with Parkinson's when he was only 40-years-old.

His confidence crumbled, his marriage broke down and he eventually lost his job. He had very low self esteem and was desperate to find happiness again.

All of this was having a detrimental effect on his Parkinson's and was creating a vicious circle which he felt helpless to break.

Illustration of the brain. Photo credit: John BavosiI/Science Photo Library
Patients can have difficulties with mobility, swallowing and speech

I arranged to see him regularly and helped him to change the way he viewed his problems and enabled him to realise how he could approach his problems in a more helpful way.

He started going out again and his confidence improved.

He was very aware of his lack of confidence in social situations and this was mainly because he was very self-conscious of having Parkinson's.

Over a period of a few months we worked on improving his self esteem and confidence and he managed to make a speech at a local event in front of many people. He also stood up in front of a big audience and sang.

WHY DID YOU CHOOSE THIS SPECIALITY?

I chose this specialty because I wanted to become an expert in one condition and really make a difference to this particular group of people.

I was working as a nurse in the community before taking this job and knew a little about many conditions, but I wasn't particularly expert in anything.

I think this is what makes a difference to people because they appreciate your depth of knowledge.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?

I would not change anything, because this has been the most rewarding thing I have ever done and I have learned so much from the people I have helped over the years.

It has made me view life differently and I now seize every opportunity that comes my way with both hands, because none of us know what we might have to face in the future.

WHICH SPECIALTY WOULD YOU HAVE GONE INTO IF NOT YOUR OWN?

I really wanted to specialise in something, rather than being a 'generic' nurse. The speciality didn't really matter, but I was also very interested in tissue viability and wound care.

I knew nothing about Parkinson's when I started the job, but the opportunity seemed too good to miss.

HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?

Nurses are taking on more and this includes things like prescribing medication.

I have just set up my own clinics in the community and people are being transferred from the consultant's care to my clinic until their condition reaches more complex phases, when they will be transferred back to the consultant's care.

I also want to ensure that everyone has access to educational groups and support networks to promote more effective self care.

Most people want to remain as independent as possible for as long as possible and this is achieved through knowledge of managing the condition.

CV - Carolyn Noble
1978: Qualified as a Registered General Nurse (RGN)
1981: Qualified as a midwife
1981-3: Worked as school nurse
1990-1995: Worked as a community nurse
1995: Qualified as a Parkinson's Disease Nurse Specialist and Neuro Rehab Co-ordinator (manage two services - Parkinson's Specialist Nursing Service and Neuro Rehab Team - for clients with traumatic brain injury.)




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