A thank-you for your MND nurse or ALS nurse: a photo as a jigsaw, with your note at the end

Written by the team behind Puzzlify. Puzzlify is our product, so weigh what follows with that in mind. We've tried to make this useful even if you never use it. We're not affiliated with any motor neurone disease (MND) or ALS service, MND care centre or network, ALS clinic or multidisciplinary clinic, neurology department, neuroscience unit, community neurology or palliative care team, GP practice, NHS trust, hospital, health system, hospice, MND or ALS charity or association, medicine, equipment or device maker, or neuroscience or palliative nursing professional body. Nothing here is medical, legal or privacy advice; for gift policies, appointments, equipment, medicines and care decisions, follow what your MND or ALS team, hospital, hospice or GP practice say.

If a nurse sat with you in the weeks after the words "motor neurone disease" or "ALS" were said out loud, and stayed with you while the rest of the world went quiet, that person did far more than an appointment. Maybe they were the person who sat at the kitchen table and asked what you wanted, before anyone talked about equipment or plans. MND and ALS nursing is careful, practical, deeply human work, and most of it happens quietly, between clinic days, in living rooms and on the phone.

This post is for thanking that MND nurse, ALS nurse, MND care coordinator, ALS clinic nurse, nurse specialist, or the small team around them. Most of the ideas below have nothing to do with our product. One of them is ours: turning a photo into a private digital jigsaw that ends with your note. We'll be honest about where it fits and where a card, a letter to the service lead, or an official compliments route is the better choice. And we'll say it plainly at the start: many people reading this are thanking a nurse after someone has died. Everything here is meant for that too.

Who we mean by "MND nurse" or "ALS nurse"

Job titles and services differ between countries, and even between neighbouring hospitals, and many families never quite know what to call the person who helped. They might have been:

• an MND nurse specialist or MND care coordinator in a hospital neurology service, an MND care centre or a regional network (UK and Ireland), often the person who knits together everyone else involved;
• a community or neurology nurse who visited at home as things changed, and who knew the house, the dog and the best chair by the window;
• an ALS clinic nurse, nurse coordinator or nurse practitioner in a multidisciplinary ALS clinic in the US or Canada, the steady face at each clinic day;
• a nurse in an MND or neurology service in Australia or New Zealand, often alongside association MND advisors;
• a palliative care or hospice nurse who supported someone with MND or ALS and their family, at home or in a hospice, often in the later stages;

We're talking about MND and ALS nursing, not the neurologist, the therapists, the dietitian or the charity advisor as the main focus (though each may deserve thanks of their own). If your thank-you is for the nurse who made a frightening condition more understandable and helped you or your family live as well as possible alongside it, you're in the right place.

Words first

Before any gift, write down what you want them to hear. MND and ALS nurses meet people at one of the hardest moments of their lives, and then walk alongside them through changes that can come quickly. They rarely hear, afterwards, what their presence meant. A specific sentence tells them the time mattered. People often write about:

• explaining things honestly and kindly, at a pace the person could manage, and never rushing a conversation;
• asking what mattered most to the person with MND or ALS, and keeping that at the centre of every plan;
• being the one who answered, or called back when they said they would, on the days when everything felt urgent;
• treating a partner, parent, son, daughter or close friend as part of the team, and noticing when the carer needed care too;
• making sure the person was still seen as themselves: their humour, their music, their garden;
• being there at the end, or in the days after, in a way the family will never forget.

You don't need to share symptoms, diagnoses, treatments, equipment, medicines or anything from the clinical record to make it specific. "Because of you, Dad was at home, in his own chair, with the football on and all of us around him" says everything that matters. A short letter that can go to the MND service lead, the neurology department manager, the hospice or the hospital's compliments team sits well alongside a personal note, so the thank-you reaches more than one person and can go on the nurse's record.

Who it suits

• People living with MND or ALS who want to thank the nurse who helped them stay in charge of their own choices.
• Partners and spouses thanking the nurse who treated them as a partner in care, not a visitor, and who helped them sleep a little easier.
• Adult children and close family thanking the nurse who looked after a parent, often while they juggled work, children and long journeys.
• Families after a death, thanking the nurse who helped someone stay comfortable and themselves, when, and only if, it feels right. There is no deadline for this kind of thank-you.
• Anyone whose MND or ALS nurse is retiring or moving on after years of looking after many families.

Skip a gift if there's an open complaint, a case under review, a disagreement about care, funding or eligibility, or if the service's rules don't allow personal gifts to staff. In those cases a formal compliment through the official channel is the better route. And skip it entirely if putting it together feels like too much right now. Caring is exhausting, and grief takes the time it takes. A thank-you next year, or the year after, is still a thank-you.

Gift policy and good timing

Most NHS trusts, hospitals, health systems, community services and hospices have clear gift rules for clinical staff. Check them. Many ask staff to refuse money and personal gifts from patients and families; some allow cards and letters only, and steer anything more toward a donation to a staff fund or charity. Never tie a thank-you to appointments, home visits, phone calls, referrals, equipment, care packages or funding, prescriptions, care decisions or plans, or letters for work, insurance, benefits or housing. A gift is a thank-you for care already given, not a way to ask for something next or to influence what you're offered. Please don't send food or flowers as a gift to a clinic, ward, hospice or nurse's base unless the team clearly welcomes it. A card left with reception or the team office is the safer choice. Use the official service, hospital, hospice or practice email only, and don't hunt for personal social media accounts.

Good moments to send it:

• after a moment the nurse helped make possible: a family wedding attended, a trip to the coast, a birthday at home, a last match at the ground, a grandchild's first visit;
• when your nurse retires, changes role or moves to another service;
• for families, a while after a funeral, when you feel ready, whether that's weeks, months or years later;
• Global MND/ALS Awareness Day (21 June), or ALS Awareness Month in May in some countries, if your team marks it, or an ordinary week with no occasion at all.

Avoid any moment tied to an ongoing complaint or a pending decision. There's no deadline.

Why a jigsaw can fit

So much of MND and ALS nursing is invisible when it works. The nurse listens, explains, co-ordinates, checks in, follows up and reassures, and then the real living happens elsewhere: at home, in the garden, on the sofa with the dog, at a family table that kept being laid for everyone.

A jigsaw made from a photo of life as it was lived lets them see, piece by piece, something their care helped protect: a favourite view from the back door, a beach the family went back to one more time, a garden in flower, a football scarf on a chair, a shelf of records, a dog asleep in the sun, two cups of tea on a windowsill. It can be solved in a quiet ten minutes between visits or at the end of a long day, which is roughly how busy community and neurology teams find their breaks.

It isn't a replacement for a handwritten card, and it doesn't pretend to speak for the NHS, any hospital, any hospice or any charity. It's a small, private way of showing them a picture they helped make possible, when the rules allow.

Choosing the photo, with consent and care

Photos linked to a life-limiting condition are deeply personal. Go gently.

• Ask the people in it. If the photo shows you, a partner, a parent or a child, check everyone is happy for it to be shared, even privately. For under-18s, get a parent's or guardian's clear yes, and ask older children and teenagers themselves too.
• If the person with MND or ALS is in the picture, they come first. While they're able to say, make sure they're happy with how they're shown. After a death, talk it through with close family first; some people find a photo of the person comforting to share, others would rather choose a place or an object.
• Choose a picture from life, not from care. A day out, a garden, a holiday view, a pet, a family meal, a child's drawing, a favourite chair, a walking route.
• Never use a clinical image: no hospital or care beds, no wards, no hoists or wheelchairs as the subject, no breathing masks or ventilators, no feeding tubes, no communication aids or eye-gaze screens, no medicine boxes, syringes or pill organisers, no letters, charts or care plans. These belong to the person and to the clinical record, not to a gift.
• Never photograph clinics, wards, hospices, other patients or staff at work, or screens without clear permission from them and from the service. Don't include notice boards, whiteboards or other people in the background.
• Be careful with identity cues. Avoid photos that show names, appointment letters, prescription labels, equipment delivery notes, medical alert cards, blue badges or parking permits, staff badges, house numbers or car plates.
• Faceless options are often the kindest: walking boots by the door, a hat on a garden bench, a kite in the sky, a sunset over the sea.

The aim is a picture that feels like a good ordinary day, not like a home visit.

Getting a good JPG

Phone photos are usually fine. A few habits make the puzzle nicer to solve:

• take several shots and pick the sharpest;
• use daylight and skip the flash;
• if your phone saves HEIC, export or share a JPG;
• scan old prints instead of photographing them under a lamp;
• send the original file, not a compressed chat preview.

Bright colours and clear shapes are easier to solve.

Privacy, an optional PIN, and saying it's from you

Look closely before you upload. Crop or choose another photo if it shows:

• appointment letters, prescription bags or labels, equipment delivery notes or forms with names, NHS, hospital or insurance numbers;
• a phone, tablet or computer screen showing messages, results or a care app;
• hospital, hospice or clinic logos, staff ID badges or lanyards, uniforms with names;
• other people who haven't agreed to be in it;
• house numbers, street signs, blue badges or car plates.

You can add an optional PIN so only the person you choose can open the puzzle. Send the PIN separately, written in the card or in a second short message.

Tell them the link is from you. Healthcare staff are rightly wary of unexpected links. A one-line message helps: "This is a thank-you puzzle from the Harris family. You were Mum's MND nurse in 2025. The PIN is in the card." Send it through a route the service is happy with: the team office, the official service, hospital or hospice email, reception, or a card left for the team. Don't go looking for personal social media accounts.

How many pieces?

Times vary with the photo. For a thank-you, finishing beats difficulty; 48 or 80 is a gentle middle.

The leaderboard: only for an MND or ALS team

If you're thanking a whole team (the nurse, the care coordinator, the therapists, the administrator who always found a way to fit you in), you can turn on the leaderboard so everyone solves the same picture. Check with the service lead first; some teams prefer no shared games on work devices, and some staff can only use their own phones on breaks under workplace rules. Keep it light and optional, never a contest. For one person, leave the leaderboard off. After a bereavement, a shared leaderboard may feel wrong to some families; a single private puzzle is always fine.

A few note ideas

The note appears when the last piece goes in, so keep it short and warm:

• "You helped him stay himself right to the end. This is his garden, still full of his roses. Thank you, from all of us."
• "Every call answered, every question taken seriously, never once rushed. This is the beach we got back to, because of you."
• "For treating me as part of the team when I was so frightened for her. From both of us, with love."
• "You've looked after so many families like ours. Enjoy your retirement. This is the view from the bench where Dad liked to sit."

Write it as you'd say it.

How to make one (about a minute of setup)

1. Open Puzzlify's puzzle maker in a browser: https://puzzlify.app/en/puzzle-maker/
2. Upload the photo (JPG works best).
3. Choose a piece count for how much quiet time they might have.
4. Add your thank-you note and, if you like, a PIN and a leaderboard (only after checking the service's staff gift rules).
5. Preview for free. When you're happy, publish the link with one credit and send it through the channel the team prefer.

Honest pricing and notes

The preview is free, so you can see exactly what the puzzle looks like before paying anything. You only pay when you publish the link: one credit is €3.99, three credits are €8.99, and Plus is €14.99 a year for ten credits. If you're thanking several people (an MND nurse, a hospice nurse and a speech and language therapist, say), three credits works out cheaper per puzzle; for one thank-you, one credit is enough. If you'd like to see it first, the free preview is here: https://puzzlify.app/en/puzzle-maker/

The person who receives the link doesn't need an account, an app or a printer. It opens in a normal web browser on a phone, tablet or computer. Photos are not used to train AI and are not shared with third parties.

This is a digital jigsaw you play on a screen. It isn't a cardboard puzzle in the post, a printed product or a public puzzle board. It's also not puzzlify.io (a chess site), Puzzlit, Puzzly or Puzzify, which are different things with similar names. If they'd rather have something to keep, a handwritten card is often the thing teams pin up in the office for years.

Keep the gift within the service's staff gift rules. If personal gifts aren't allowed, use the official compliments route or make a donation, and skip the link. Never tie a thank-you to appointments, visits, equipment, funding, care decisions, medicines or letters.

Other ways to say thank you (no Puzzlify needed)

1. A handwritten card with one specific sentence, left at the team office, the hospice reception or handed to clinic reception.
2. A letter to the service lead, department manager or hospice, or a compliment through the hospital's, trust's or hospice's official feedback form, naming the nurse so it reaches their record and any staff recognition scheme.
3. A donation to a staff fund, the hospice, or an MND or ALS charity the team supports, with a note telling them you did it. Some families ask for this in place of funeral flowers.
4. Sharing your experience, if and when you feel ready: some services, hospices and MND or ALS charities welcome carers and families willing to join a patient and carer panel, a support group or a peer-support scheme.
5. A drawing or short card from a child or grandchild, which teams often treasure more than anything bought.
6. A short update months or years later, by card or through the team office, saying how the family is doing. Nurses in this field rarely hear how life carries on afterwards, and it can mean a great deal.

Whatever you send, the most important part is the sentence that sounds like you.

Written by the team behind Puzzlify. Not affiliated with any MND or ALS service, MND care centre or network, ALS clinic, neurology department, community neurology or palliative care team, NHS trust, hospital, health system, hospice, MND or ALS charity or association, medicine, equipment or device maker, or neuroscience or palliative nursing professional body; not medical, legal or privacy advice. For gift policies, appointments, equipment, medicines and care decisions, follow your MND or ALS team, hospital, hospice or GP practice.