Improving the nursing care of children and young people who self-harm

Latif A, Carter T, Rychwalska-Brown L et al (2017) Co-producing a digital educational programme for registered children’s nurses to improve the care of children and young people admitted with self-harm. Journal of Child Health Care. doi: 10.1177%2F1367493517697853.

Aim

To co-produce, with children and young people (CYP) and registered children’s nurses, a digital education programme to improve nurses’ knowledge, attitudes and confidence in the care of CYP injured through self-harm.

Methods

Multiple data collection methods were chosen to facilitate a co-productive approach to developing the programme over two workshops. 

Nurses’ priority-setting workshop: a theoretical sampling frame was used to recruit registered children’s nurses (n=7). Using an adapted Delphi technique, registered children’s nurses’ perspectives of the challenges of caring for a child or young person being treated for self-harm were gathered through iterative cycles of discussion until consensus was reached on priorities for learning needs.   

CYP for e-learning workshop: four CYP, all female, average age 15, who had received inpatient care for self-harm in the previous 12 months from child and adolescent mental health services (CAMHS) took part. The workshop was facilitated by the research team, including one registered mental health nurse, and an emotional health and well-being worker. Storyboards were used to capture CYPs’ perspectives of what should be included in the education programme for nurses. CYP reflected on their experiences of being an inpatient.

Findings

Priorities for learning needs identified by the registered children’s nurses were:

•  Assessing and managing risk
•  Communication with CYP and their families
•  Supervision of CYP
•  Knowledge of pathways for self-harm

In their workshop, CYP produced three themes for inclusion in the digital programme: 

• Understanding self-harm and pathways
• Effective communication
• Assessing risk and managing safety

Conclusion

Recruitment of CYP was a challenge due to the sensitive nature of the issues and ethical safeguards. However, the study adds to knowledge regarding the needs and experiences of CYP as inpatients cared for by registered children’s nurses. It also demonstrates the feasibility of using research methods to co-produce learning packages for nurses in this area.

Involving children and young people with mental health problems in improving healthcare 

Latif et al’s (2017) paper is a valuable addition to knowledge in this field: it highlights the need to improve the education of registered children’s nurses regarding the care of children and young people with physical health problems related to self-harm, and shares experiences of co-productive research methods with CYP about sensitive health issues. 

There is no undergraduate programme approved by the Nursing and Midwifery Council to produce registered nurses in CYP’s mental health. This issue is familiar to mental health clinicians and educators, who have raised concerns about quality of care resulting from a lack of suitably trained nurses and safe staffing levels (McDougall 2016).

It is broadly acknowledged in the UK that children’s nurses and school nurses feel ill-equipped to deal with CYP mental health issues. For instance, in a qualitative study, children’s nurses thought CYP with certain mental health problems should be nursed somewhere else (Buckley 2010), which raises questions about the impact of stigma concerning mental health.

Educators, registered nurses and CYP need to work together to strengthen CAMHS themes in education programmes for undergraduate children’s and mental health nurses. Despite routine service user involvement in curriculum development and delivery (Rhodes 2012), the inclusion  of CYP is rarely reported. 

Latif et al (2017) offer insights into conducting participatory research with young people who may be vulnerable and are rightly protected by ethical frameworks and/or gatekeepers. They highlight recruitment as the main challenge. This is common and is a difficult problem to overcome in research with CYP, as seen in similar participatory studies (Kendal et al 2017).

However, here it is demonstrated that ethical research methods that support meaningful engagement can include potentially vulnerable CYP. This population has the right to be heard on what their preferences are for nursing care. Expert-by-experience insight informs a co-productive approach about intervention and maximises the potential for outcomes that are important to CYP. 

References

• Buckley S (2010) Caring for those with mental health conditions on a children’s ward. British Journal of Nursing. 19, 19, 1226-1230.
• Kendal S, Pryjmachuk S, Welsby H et al (2017) Prioritising young people's emotional health support needs through participatory research. Journal of Psychiatric and Mental Health Nursing. doi: 10.1111/jpm.12373.
• McDougall T (2016) Child and adolescent mental health inpatient nursing: a call for action. British Journal of Mental Health Nursing. 5, 1, 10-14.
• Rhodes C (2012) User involvement in health and social care education: a concept analysis. Nurse Education Today. 32, 2, 185-189.

 Linda Milnes is associate professor of children and young people’s nursing at the school of healthcare, University of Leeds. Sarah Kendal is head of division (mental health nursing, learning disability nursing and occupational therapy), at the school of human and health sciences at the University of Huddersfield.

Reviewed on behalf of the RCN's Research in Child Health community.