Knife crime: teaching young people the skills they need to help save lives
The nurses and students breaking down barriers to help educate and protect young people
The team of nurses and students breaking down barriers to help educate and protect young people
A team of nursing students and newly qualified nurses is teaching life-saving skills to 11-25-year-olds at risk of being affected by gang violence.
Their sessions for young people cover what to do if someone is bleeding from a stab or gunshot wound or is unconscious.
The team – Izzy Howes, Munira Patel, Aoife Scanlan, Rachel Moisan and Charlotte Green – is part of the StreetDoctors youth action movement, which enables healthcare volunteers to empower young people to deal with increasing youth violence.
Sessions held in youth clubs, schools and young offender institutions
As StreetDoctors North East London, the team teaches at referral units (schools for children who aren’t able to attend a mainstream school, in some cases because they have been excluded), youth offending institutes, youth clubs and schools, receiving referrals from local authorities, youth workers and youth justice teams.
‘We describe what happens each time you lose a pint of blood. We then tell them what to do if they come across someone bleeding or with a knife wound’
Izzy Howes, newly qualified nurse and StreetDoctors North East London volunteer
Groups can range from two or three young people to larger groups of 12, with the vast majority being young men. The participants include young offenders who have committed a crime and young people identified as at-risk and recognised as being involved in gang activity.
Ms Howes, who is just about to start her first post as a registered nurse in the paediatric critical care unit at the Royal London Hospital, started volunteering with the charity while at City, University of London.
‘We deliver a “bleeding session” in which we talk about the major organs, what they do in the body and how much blood there is in the body,’ she says. ‘We describe what happens each time you lose a pint of blood. We then tell them what to do if they come across someone bleeding or with a knife wound and get them to practice on each other.
‘Young people have the opportunity to share stories and ask questions they have never felt able to before, which we welcome,’ she adds. ‘Some cannot wait to talk about something that happened to them or a family member.’
Knife crime: the facts
- According to Home Office statistics, there were 39,818 knife crimes in England and Wales (excluding Greater Manchester due to a recording issue) in the year to September 2018, compared with 23,945 in the year to March 2014
- Office for National Statistics figures show that the number of fatal stabbings in England and Wales in 2018 was the highest since records began in 1946, with 285 deaths by a knife or sharp instrument. Those stabbed to death were predominantly young men aged 18-24
- Police have recorded a surge in knife possession offences in England involving women and girls. There were 1,509 offences recorded in 2018, a 73% increase from 2014, according to data obtained by the BBC through freedom of information requests
The long-term consequences of stab wounds
The nurses ask participants which part of the body they think is a safe place to stab someone. ‘They have lots of answers – bum, hand, lower leg,’ says Ms Howes. ‘They think that if it’s not in a major organ, it is safe. And they are really surprised about the potential long-term consequences.
‘They know you can die if you are stabbed in the heart, but are shocked by the effect of a knife wound on a person’s quality of life.
‘Not only do we talk about catheters and stoma bags, we take them with us. This really makes the young people sit up and take note.’
‘Every young person in the session, even the 11–year-olds, will be affected by knife crime in some shape or form’
The session can be combined with training on what to do if people are conscious and breathing, such as placing them in the recovery position.
Participants are also taught cardiopulmonary resuscitation (CPR) so they know what to do if someone is unconscious and not breathing.
‘This is the place for young people to talk about fears and concerns’
Occasionally, it can be difficult to engage young people in the session. The nurses work to overcome this by asking the group lots of questions and making the session as interactive as possible.
‘It forces them to come out of their shell, says Ms Howes. ‘We make it a safe space and nothing is taboo. We tell the young people that if they have any concerns or fears, this is the place to talk about it.
‘Every young person in the session, even the 11–year-olds, will be affected by knife crime in some shape or form, knowing people who have died or been seriously hurt. It used to shock me,’ she adds.
‘I thought I would be going into a room with people who did not want to listen, but I have been pleasantly surprised at how much they want to know.
‘Young people really care about the violence on our streets. It is their reality, and nine out of ten young people want to know what to do in that situation. The need for this training and the willingness of the young people to learn is all there.’
Knowledge and skills could stop more lives being lost
The StreetDoctors nurse team is in an advantageous position to engage with at-risk young people because their experience in practice gives them credibility.
‘We have lots of real stories of young people arriving in hospital with knife wounds to back up what we are saying. We are not just someone who has come in to lecture them,’ says Ms Howes.
For Aoife Scanlan, a third-year children’s nursing student at City, University of London, and co-leader of the North East London StreetDoctors team, it was an experience on placement that prompted her to volunteer.
‘I helped treat a 15-year-old boy with abdominal stab wounds,’ she recalls. ‘I remember the shock from hearing what had happened. His injuries were not life-threatening but there was a lot of blood on the floor, chairs and bed.
‘The doctors and nurses were rushing around getting theatres ready and the situation felt very tense, although the scariest part was how young the boy looked, he wasn’t very big or tall - he was just a child.
‘This patient got to a hospital in time, however others are not so fortunate,’ she adds. ‘I joined StreetDoctors to help teach life-saving skills to people who may be able to help if there has been a stabbing, which could stop more lives being lost on the street.
‘These children are human beings – not just statistics.’
‘I often wish that the young man who lost his life had made it to the session’
Newly qualified nurse Izzy Howes, a StreetDoctors North East London team member, describes a recent teaching session:
‘About six months ago, I was teaching a session in north London. We were expecting three young men, accompanied by their caseworkers, but only two turned up.
They took a while to engage, but about halfway through they started asking lots of questions and it was clear they ended up enjoying it.
‘Towards the end, one became distracted on his phone and his mates were calling up to him from the street through an open window. We rounded up the session, got some great feedback from them, packed up our kit and left.
‘Less than 50 metres away, there was a young man lying on the ground receiving CPR from a paramedic. There were several police cars and ambulances and the whole area was being cordoned off.
‘I rushed off to a night shift but later received an email from one of the caseworkers telling me that the young man receiving CPR on the street was a mate of the young person who became distracted in our session.
‘He was also the missing person from our session. He was just 17 and had been stabbed in the heart and died instantly. I often wish that the young man who lost his life had made it to the session. Perhaps there would be one less tragic loss to knife crime and youth violence.’
Non-judgemental approach helps nurses gain trust
Nurses seem to be able to gain the trust of young people more easily than other professions, Ms Scanlan says. ‘A lot of the kids do not trust authority figures, whether it is the police, teachers or anyone older than them.
‘We have to help them get past their preconceived ideas, some even being that if they call the police or an ambulance, their phones will be tracked.’
‘StreetDoctors was initially for medical students but the charity realised the importance of the different perspective that nurses can provide’
Munira Patel, third-year adult nursing student and StreetDoctors team member
Ms Howe adds: ‘They trust us because as nurses we are non-judgemental. We treat everyone the same. The young people we meet are amazing, they really inspire us.
‘It also makes a difference that we are young. We are more relatable and seem more approachable. You don’t want young people to feel they are coming in to be told off. I want it to be about having the conversation so that they feel more empowered in the situations they find themselves in.’
- RELATED: Should nurses have a legal duty to raise concerns about young people at risk of involvement in knife crime?
Munira Patel, a third-year adult nursing student at City, University of London, adds: ‘Being part of this team and organisation has made us realise how important it is to have a multidisciplinary approach in all aspects of health and social care.
‘StreetDoctors was initially only for medical students but the charity realised the importance of the different perspective that nurses can provide. We want to show how different and dynamic we are as nurses so that they open more teams to student nurses across the country.’
How nurses became part of the StreetDoctors story
StreetDoctors volunteer and youth engagement manager Rebecca Long says: ‘StreetDoctors North East London are an incredibly driven team. Despite being one of the smallest, they have taught an impressive number of young people in their first year of running, with more than 150 young people learning life-saving skills.
'StreetDoctors began in 2008 when two medical students in Liverpool started teaching vital life-saving skills to young people at risk of violence,’ says Dr Long. ‘They recruited a small number of their peers to support them with teaching sessions.
'As StreetDoctors grew, the model of starting volunteer teams within medical schools was an easy one to replicate. But a review of StreetDoctors’ work in 2017 found we were only scratching the surface regarding the number of young people who could benefit from attending our sessions.
Multidisciplinary team members learn from each other
'It was a natural progression to expand our volunteer cohort to include other healthcare professionals familiar with emergency first aid. Following successful London-based pilots in 2018, which included trainee nurses and paramedics joining existing teams and starting new ones, StreetDoctors is now at the exciting stage of all our volunteer teams becoming multidisciplinary.
'We are growing teams that reflect the diversity of careers and skills sets within the NHS, with volunteers and young people learning from each other in our endeavour to end youth violence.'
StreetDoctors North East London and all other teams are currently recruiting new volunteers ahead of a national training day on October 26 2019. More information, including how to volunteer, can be found on the StreetDoctors website.
The North East London StreetDoctors nursing student team were finalists in the Andrew Parker Student Nurse Award category at the RCNi Awards 2019.
Break down barriers between people in uniform and young people
Evaluation forms at the end of each session show excellent feedback from young people and their caseworkers. The feedback shows:
- 93% of young people who have attended the sessions understand the fatal consequences of violence.
- 93% know what to do when someone is bleeding or unconscious.
- 86% agree that they would be more willing and able to act if first aid is needed.
And it is not just the young people who benefit. The volunteer work, the nurses say, has improved their nursing skills, making them better listeners, better able to adapt to situations and more empathetic.
‘Our philosophy revolves around the butterfly effect and how small actions can lead to a hopefully bigger change’
‘Getting to know young people outside of the news and A&E has highlighted to us the various factors that impact health,’ says Ms Patel.
‘We've realised that all of the young people we have met in our sessions have a story to tell or have had something in their young life leading them to make the choices they make. We understand that events leading up to a violent traumatic injury are multi-faceted.
‘This has helped us to not judge the situation and show more empathy and understanding about concerns a victim may have when recovering from their injuries that they might not necessarily vocalise, such as stomas.
‘By building relationships with young people on a comfortable and non-intrusive level, barriers between people in uniform and young people are broken down.’
Inspire young people to opt for healthcare careers
At present, the team is working to recruit some more members from the new cohort of nursing students at City, University of London, to ensure its work is sustainable.
The team members also talk about their experiences in practice to try to inspire some of the young people they encounter to pursue careers in healthcare.
‘As nurses, we need to contribute to stop the epidemic of gang-related trauma injuries, and not just treat the consequences in hospitals, says Ms Patel.
‘Our philosophy revolves around the butterfly effect and how small actions can lead to a hopefully bigger change, whether that is by making someone reconsider carrying a weapon to a person potentially saving someone's life.’
Elaine Cole is RCNi special projects editor