Seeing the emotional distress of teenagers on placement promoted children’s nursing editor, Danielle, to realise that her training should do more to equip her to offer the best possible care to adolescent service users
Influenced by the kind, compassionate and intelligent nurses of my secondary school, I decided to become a children’s nurse, and as much as I love looking after babies and children, my passion has always been to care for adolescents and their specific healthcare needs.
As a teenager I used to hide in the “san” (sanatorium…the Mallory Towers terminology for nurses’ office or medical centre). Other teenagers caught on and did the same.
”We could escape a variety of issues in that sterile, safe room”
We could escape a variety of issues in that sterile, safe room, with books and beds and medication.
You could miss mealtimes if food was your fear, take your insulin without other people knowing, be hidden from bullies or a break up, or that teacher who gave you grief.
Girls could casually collect the morning after pill on a Monday break time - or worst a pregnancy test - without their parents knowing.
For me, feeling unhappy in my own skin and a world apart from the lithe, beautiful, long blonde hair and blue eyed girls was the cause.
I used to feign headaches and stomach aches but the anxieties I had around school made these phantom symptoms a self-fulfilling prophecy and one day, my parents were made aware of just how frequently I admitted myself to the san.
”The anxieties I had at school made my phantom symptoms a self-fulfilling prophecy”
The non-judgemental, big-hearted school nurses were my first point of call, and I believe as student nurses we are too for many, many young people.
I have most enjoyed my placements which are of a transitional nature: assessment units, emergency departments and triage, because of the fast pace and the variety but also because I meet far more young people in these settings than in a ward environment.
Although many teens come in with broken bones, medical illnesses and your regular accidents and emergencies, there is a subculture not often seen in the young children with bumped heads or pyrexia: mental health.
The first time I saw self-harm in its rawest, truest form I knew that sutures were useless in healing their emotional pain.
At 15, no young person should look me in the eyes and say they want to die, that they know by doing what they did they could have died and that they feel stupid and useless for failing to end their own life.
A nurse made me taste activated charcoal- a treatment for overdose, before administering it to my patient. When they then had to drink 400ml, there was an inside joke between registered staff, that it tasted so vile they wouldn’t be so ‘attention-seeking’ and ‘silly’ to do it again.
”How would they feel if their GP referred to their stress as appointment-blocking?”
And then of course there is the animosity of those nurses who see teenagers who aren’t physically bleeding out on the table as bed-blockers, an insidious phrase.
How would they feel if their GP referred to their stress as appointment-blocking? A “come back when you’re actually sick” type- dismissal?
These types of attitudes I believe do not come from spite but from a lack of education.
Children’s nurses are often not mental health nurses but unfortunately when a crisis leads to an admission we are often the first professional the young person will speak to, we then contact the CAMHS workers or SHARP teams.
Being the first point of call is a responsibility that should not be placed on those who are inadequately trained. By this I cannot speak for registered nurses and healthcare professionals who may have undertaken training days in adolescent mental health but for students who, like myself, may (and this really happened) encounter an unpredictable patient hearing voices during the first week of their first year placement and had only had perhaps one lecture slot on mental health in young people throughout their training, where the focus was on eating disorders.
”I feel that children’s nurse education has to give us much more”
I feel that children’s nurse education has to give us much more.
In the same way we have an algorithm for a resus situation, we should have a procedure that caters exclusively for those in mental distress. I have had many lectures in managing violence and aggression but never one how to talk to someone intent on taking their own life.
There is a lot of fear and stigma around mental health and without training we are often scared to say something in case it is offensive, triggering, unhelpful or completely the wrong terminology.
For example, when admitting a patient who had taken a concoction of 48 prescription pills snaffled from their parents’ medicine cabinet, I phrased the usual “would your child like any oral medication from a syringe, spoon or tablet?” as “do you have any issues swallowing tablets?”.
Once that phrase left my lips I was waiting for a f-word at least but luckily with a wicked character even during a low moment the patient rather sarcastically gave me an “obviously not” with a cheeky grin.
Thankfully my pun was excused.
But the fact that children’s nurses are ill-equipped to deal with mental health simply cannot be.