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Nurse leads project to help young people at risk of knife crime

An emergency department sister is behind a project to teach life-saving skills to young people most at risk of serious violence in London

An emergency department sister is behind a project to teach life-saving skills to young people most at risk of serious violence in London

  • ED nurses urged to go beyond usual safeguarding and get to know young knife victims
  • YourStance volunteer clinicians teach life support, CPR and haemorrhage control to under-25s
  • Aim is to pass on life-saving skills that might make a difference until paramedics arrive

A training session by the YourStance project, in which nurses and doctors work with young
people deemed at risk of violence in north and east London. Picture: Helen Rigby

Growing rates of youth violence mean many emergency department (ED) staff around the UK regularly witness the shocking legacy of knife injuries on children and teenagers.

At Barts Health NHS Trust in London, 1,824 young people aged under 25 received emergency care for stab wounds in its Royal London Hospital major trauma centre between 2004 and 2014.

Of these, 172 (10%) were under 16 and 861 (47%) were aged between 16 and 19. The other 791 (43%) were in their early twenties.

Sister worried about compassion burnout

Emergency department sister Ana Waddington, who is behind a project called YourStance that sends volunteer clinicians into London prisons to teach basic life support, CPR and haemorrhage control to groups of under-25s in an effort to stem youth violence
Ana Waddington

Royal London Hospital children’s ED sister Ana Waddington says she felt a sense of helplessness and frustration and wanted to do something positive to reach this group of young people.

Ms Waddington noticed what seemed to be a ‘generally negative attitude’ towards such young people, who she believes are often criticised for being involved in violent clashes although the reasons for violence are complex and societal.

Given the frequency of these young people presenting at the ED, she worried that she and her colleagues might experience compassion burnout. Ms Waddington set out to address this issue.

Many injuries could have been treated by the victim’s peers

In October 2018 she set up YourStance, a project that sends volunteer clinicians into London prisons to teach basic life support, CPR and haemorrhage control to groups of under-25s.

Ms Waddington says she has seen many injuries that could have been treated at the scene by the victim’s peers, and wants to pass on life-saving skills that may make a difference before emergency medics can reach the patient.

So far a number of practical workshops have been held at two institutions in London – to young men at Pentonville Prison and also at Feltham Prison, which is for young offenders.

47%

of knife injuries in under-16s occur within a 1km-5km radius from home between 4pm and 6pm on school days.

Source: Barts Health NHS Trust doctors’ 2018 research study

‘They respond well to being taught skills'

‘They respond well to being taught skills, they love the practical element – at first they are standoffish, but as soon as we get into the group stages they get into it,’ says Ms Waddington.

She says many of the young people who present with minor injuries in ED often return later with much more serious ones.

‘I couldn’t count how many young people come through the door and then return later,’ she says. ‘An individual comes in with not that big an injury and is likely to reattend with more severe injuries.'

'We are seeing more stabbings, gunshot wounds, blunt force injuries and use of axes and batons’

‘We do know that as a whole over half the injuries we see in people under the age of 25 are knife-related, and we know there has been an increase over the past five years.

‘At Royal London we are seeing more stabbings, gunshot wounds, blunt force injuries and use of axes and batons.’

The youngest person Ms Waddington has seen die as a result of youth violence was 14.

‘These are the ones who haunt me the most,’ she says. ‘The waste – it is heartbreaking.’


Learning to give CPR at a YourStance workshop. Picture: Helen Rigby

During a YourStance teaching session, volunteer clinicians have frank conversations with the young people about the effects of knife injuries.

1,012

admissions to hospital of youths aged 10-19 due to assaults with a knife or sharp object in 2017-18 in England.

Source: NHS England

‘They are all shocked,’ says Ms Waddington. ‘Especially when we tell them stories of people getting colostomy bags or tracheostomies, or having to forever go in and out of hospital for blood transfusions.'

‘They think if they get stabbed in the hand they will be safe, but we tell them, “No, you could die if we give you blood and it can’t clot.” They are very shocked by these things.

‘Some even approach staff afterwards, inspired to find out more about their career options in medicine, which is why it’s good that different clinicians from different specialties are there to talk to them,’ Ms Waddington adds.


A skills demonstration at a YourStance session. Picture: Helen Rigby

‘The skills sessions are so rewarding, and good for building their self-esteem.’

Ms Waddington says nurses need more support to know how to deal with the victims of youth violence, and not just at major trauma centres, which often have more resources and staff with more experience.

'Lots of nurses say they don't know what to do'

‘After I spoke at a recent paediatric conference, nurses came up to say they are seeing these young people in their district hospitals and they don’t know what to do.

‘It is important as nurses that we understand the pathways our hospital has for youth violence.’

For the past five years the Royal London Hospital has had access to a service provided by the youth charity St Giles Trust. Its youth workers offer support in hospitals and the community to reduce the number of young victims of knife attacks returning to hospital with further injuries.

Ms Waddington says: ‘Sometimes as clinicians we are not the right people to speak to the young people affected, and these types of services can be that saving grace.’

285

people died due to knife crime in England and Wales in the year to March 2018, highest since 1946.

Source: Office for National Statistics

Her tip for nurses dealing with anyone who has come through the doors with a knife injury is to carry out normal safeguarding, but to give them a little more time if possible.

'Treat them as an individual, not as a perpetrator'

‘If you have the chance, sit down and try to get to know them, treat them as an individual not as a perpetrator, and give them a chance to open up and trust you.’

Ms Waddington says the YourStance project is already growing and has had interest from a number of other prisons and youth centres in recent months.

She is keen for anyone who would like to become involved to contact her through Twitter at the YourStance page @yourstancebls or her own Twitter page, @alwaddington

‘People want to know healthcare is engaging with communities’

Royal London Hospital lead nurse for violence reduction in emergency care and trauma Michael Carver feels there are often ‘silos’ of people working in the area of violence reduction.

‘My biggest focus is to improve links with other services – a lot of what I do is networking and making people aware of services.’

39,818

knife crimes in England and Wales (excluding Greater Manchester) in year to September 2018, against 23,945 in year to March 2014.

Source: Home Office

Mr Carver says he often gets involved with victims of youth violence when there is a need to coordinate services to the benefit of a young person in hospital.

Vital work to help combat youth violence

He believes the YourStance project is doing vital work to help combat youth violence, which he believes feeds into a larger duty for healthcare providers.

‘People want to know healthcare is engaging with communities and taking active steps to teach people.

‘It is much better for us as a hospital to have a presence in delivering good, useful teaching to young people to empower them to make the right decisions, and potentially prevent something from happening, than to provide the excellent care that we do.'

‘We are teaching life-saving skills, which is empowering'

‘Prevention is better than cure,’ he says. ‘It is a cliché but it’s true.

‘We are teaching people invaluable, life-saving skills which is empowering – it is exactly the sort of thing that hospitals should be doing to reach out to their communities.’

Because of the political and media spotlight on youth violence, Mr Carver says it is a good time for healthcare managers and clinical commissioning groups to ensure services are in place at NHS trusts.

‘If people want help and services, this is the perfect time to ask for them.’


Stephanie Jones-Berry is a senior news reporter 

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