RCN Nurse of the Year 2020: using CPR sessions to tackle the youth knife crime epidemic
Ana Waddington set up the YourStance outreach programme to educate vulnerable young people as well as healthcare professionals
- Alarmed by rising knife injury cases, emergency department sister Ana Waddington set up an organisation to support young people at risk
- YourStance workshops teach young people what to do when someone is stabbed, including how to perform CPR and basic life support
- Revolutionary approach brings young people and health professionals together, and should be replicated across the health sector, say judges
An emergency nurse dedicated to helping vulnerable young people deal with the impact of youth violence has been named the RCN Nurse of the Year 2020 in the International Year of the Nurse and Midwife.
Royal London Hospital emergency department sister Ana Waddington felt a sense of helplessness with the increasing presentations of young people with knife-related wounds and the potentially devastating outcomes, so set up an organisation to educate and engage those at risk.
Taking sessions to young offender institutions and youth clubs
She used her own time and money to set up YourStance, which teaches young people at risk of serious youth violence cardiopulmonary resuscitation (CPR), basic life support and haemorrhage control, and also educates them about the potential consequences of knife-related injuries.
Run by a 150-strong group of volunteer nurses, doctors and paramedics from across the capital, YourStance targets hard-to-reach 13-25 year olds living in the London boroughs of Tower Hamlets, Hackney and Islington.
‘Ana’s work teaching young people what to do after someone has been the victim of knife crime should be replicated across the health sector’
Yvonne Coghill, RCN vice president and chair of the RCNi Nurse Awards 2020 judging panel
Having established community links, the organisation runs sessions in prisons, pupil referral units, outreach programmes and youth clubs.
The RCNi Nurse Awards judges were impressed by Ms Waddington’s determination to save and improve the lives of young people, and create opportunities for them to build better relationships with the wider community.Find out about the rest of our RCNi Nurse Awards 2020 winners
Combatting youth violence and compassion fatigue
At the hospital where Ms Waddington works, 1,824 young people aged under 25 received emergency care for stab wounds between 2004 and 2014.
She saw how vital chances to save lives were being missed, as bystanders at the scene of the violence did not know how to save or stabilise victims.
She also felt a growing misunderstanding of the causes of serious youth violence and wanted to find a way to combat the growing compassion fatigue among her emergency department (ED) peers.
Ms Waddington told judges she was spurred into action by one particular young patient.
‘He came in with an arterial bleed and his friends had not put pressure on the wound,’ she recalls. ‘This simple technique done on the scene would have saved his life. I was concerned young people in high-risk groups did not have access to education that may save their or their friends’ lives during an emergency situation.’
She contacted local authorities and offered to start teaching young people and YourStance was born.
‘I started by taking a mannikin into Feltham Young Offender Institution, but the project has been my life for the past two years,’ says Ms Waddington.
RCN deputy president Yvonne Coghill, chair of the awards judging panel, says: ‘I was totally blown away by Ana. Her work teaching young people what to do after someone has been the victim of knife crime is revolutionary and should be replicated across the health sector.
‘Ana is so professional, innovative and hardworking. She deserves to be named RCN Nurse of the Year.’
The realities of knife injury
Until receiving a grant this summer from Barts Charity (which supports Barts Health NHS Trust hospitals, including the Royal London), Ms Waddington funded YourStance by working extra bank shifts. She still spends her days off developing the project, supported by five healthcare colleagues who also spend most of their days off supporting YourStance.
The YourStance team had delivered 23 sessions and reached more than 400 young people before the start of the COVID-19 pandemic.
‘By educating vulnerable young adults we open up a door. By talking to them frankly about our own jobs, we also offer them an opportunity to discuss entering the healthcare world, a possibility they might never have considered’
Ana Waddington, RCN Nurse of the Year 2020
Their workshops offer young people an opportunity to have frank discussions about the realities of serious injuries caused by knife or gunshot wounds, and give healthcare professionals a chance to learn about the young people's circumstances.
The sessions are already having an impact. ‘Recently our ED received a patient who had a tourniquet, which had prevented his significant injury from being a terminal one,’ said Ms Waddington. ‘He had advised bystanders on how to do this from attending our sessions.’
Informed choice and myth-busting: what our youth workshops cover
Chantelle Lesforis, a children’s community nurse in Tower Hamlets, became involved with YourStance after a friend recommended she volunteer for a workshop held at Pentonville Prison.
‘I have a background working with charities so I wanted to support the organisation, both as a health professional in workshops and with coordinating and administrative duties.
‘The sessions offer young people skills to make informed choices and an opportunity to explore their own experiences around serious youth violence and responding to a casualty.
‘We bust myths, particularly around reluctance to intervene – they worry they will be sued if they break some ribs – and not wanting to do mouth-to-mouth, which is actually no longer taught in basic life support.
Helping a friend who has been stabbed
‘We also discuss myths around “safer” areas for stabbing, by sharing our expertise and knowledge of visceral injuries, internal bleeding and speed of bleeding.
‘In some cases, young people have verbalised guilt in not knowing how to help a friend or victim and the impact this has had on them.
‘Someone who received outreach training on how to stop a bleed implemented it for a friend after he was stabbed.
‘Seeing the benefits and getting feedback firsthand highlights the importance of the work we do for young people. But the sessions have also given me a better understanding of the vast vulnerabilities that young people face as both victims and bystanders of serious youth violence.’
Shared experience: finding common ground between staff and young people
The course has improved the young participants’ knowledge of injuries and how to treat them, but it also has provided an opportunity to discuss how healthcare workers can improve the way we treat this specific patient group, says Ms Waddington.
She supports this by delivering teaching sessions on serious youth violence to healthcare staff in her own time, where she also addresses compassion fatigue.
‘I realised that we, as healthcare professionals, did not know these young people’s stories and what had led to them becoming a victim,’ says Ms Waddington.
‘We share a lot in common with our young people,’ she said. ‘I noted this at the first session when a young person asked me directly what it felt to see someone die. He asked because he had held his brother in his arms, and was experiencing post-traumatic stress as a result.
‘We talked about it openly, and as a result have had him referred to services.’
Practical information on how to respond in an emergency
During that session, she also found ‘a huge appetite for healthcare knowledge’.
‘By giving up our own time to educate vulnerable young adults we open up a door,’ she says.
‘By talking to them frankly, in a non-judgemental way about our own jobs, what we see and the consequences of these injuries, we also offer them an opportunity to discuss entering the healthcare world, a possibility they might never have considered.’
Feedback from the young people has been positive and they report greater confidence in their ability to help in an emergency situation.
One who attended a workshop in Pentonville Prison said: ‘I genuinely believe it was necessary for the future as I may be able to apply these skills and be of help. I am grateful.’
Another said: ‘I was present when my friend was trying to remove a knife from a wound to help someone. He felt like he didn’t know what to do. But now you have taught us what to do.’
A safe space for young people to engage with emergency teams
Ana Waddington also created a six-week curriculum for 20 young people in alternative education at a local pupil referral unit. Metropolitan Police Service officers, London Ambulance Service staff and trauma surgeons take part, sharing their skills and perspective.
Metropolitan Police Service acting sergeant Helen Lowes and sergeants Geraldine Evans and Dara Ley joined YourStance’s six-week programme at the pupil referral unit. Acting sergeant Lowes writes:
‘We were acutely aware many of the young people were potentially wary of the police, so we kept the session informal and wore plain clothes and anyone who did not wish to take part was able to leave.
‘We also gave them the opportunity to ask questions before the session started so they could engage with us in a way that they had largely never done before – as human beings rather than a uniform. All the pupils engaged.
Explaining what we do can break down barriers
‘For one activity we asked the young people to write down what their considerations or actions would be at a knife injury scene. We used this to show them how similar our objectives would be – saving life. We could see it from each other’s perspective and it opened a dialogue about police actions, the questions we ask and the actions we take.
‘It allowed us to see how explaining our actions, where possible, when arriving on scene can really break down the barriers and hostility sometimes present.
‘We were also able to speak to young people about their experiences with knife crime, and learn how we can engage with them to prevent it.
‘YourStance has created a safe space for these young people. For us, this forum has allowed for open and honest conversations that would otherwise not have taken place.
‘Feedback from both the pupil referral unit and YourStance showed we vastly improved our relationship with the young people. One pupil later approached us to ask about police cadets.
‘Some were very open about personal experiences of youth violence and we could engage on a personal level not always possible on the scene of an incident.
‘It undoubtedly helps that Ana and her team are trusted by the young people.’
How healthcare professionals engage with knife injury patients
Ms Waddington’s colleagues have also witnessed the impact of the project.
Royal London Hospital consultant in paediatric emergency medicine Tessa Davis says: ‘We see young people come in practically every day with stab wounds and knife injuries, at their most vulnerable and unwell, and it is hard to get the context of what the young person’s life is like and what led them to that,’ she says.
‘We focus on the medical issues at the time but YourStance allows us to go into the community to engage with young people at a time and place where they are comfortable.
‘It breaks down barriers and gives us that context and that impacts on how we as healthcare professionals talk to them and think about knife crime.’
‘YourStance now connects the Royal London Hospital to its communities. It is seen as the hospital’s public health approach to this crisis’
Gillian Laird, practice development nurse and award nominator
Ms Waddington’s nominator, practice development nurse Gillian Laird, says YourStance has realised Ana’s goals ‘to open a conversation with young people, to empower and share knowledge with them’.
‘Because of her, YourStance now connects the Royal London Hospital to its communities. It is seen as the hospital’s public health approach to this crisis.’
What the YourStance project can achieve as support grows
Ms Waddington hopes that winning the award will raise the profile of YourStance, attract more volunteers and see it replicated in other areas.
‘Becoming the RCN Nurse of the Year is a huge privilege,’ she says. ‘I hope it will show other nurses that there are a vast number of opportunities out there, and if you have a passion for an idea, you can do it.
‘So much work has gone into building this project, and my entire team deserve this unbelievable recognition, but we did not start the project for that.
‘What we hope is that this award and the recognition of its significance, of its importance, is noted and more people become involved to share their skills and help young people affected by what is now deemed an epidemic.
‘We need to do better for our young people, and this project is something we can all get behind.’
Our Innovations in Your Specialty award
Ana Waddington won the RCNi Nurse Awards Innovations in Your Specialty category, sponsored by Impelsys, before being chosen from all our category winners for the coveted RCN Nurse of the Year title.
Impelsys executive vice-president Stefan Kendzierskyj, who was on the category judging panel, says: ‘The finalists were an amazing collection of entries driven by passion, leading-edge projects and visible positive impacts.
‘It was very hard to select a winner but Ms Waddington’s YourStance demonstrated leadership and an innovative approach.
‘The direct impact of saving lives is clear. Young people are able to react on the scene and reduce fatalities and the significance of injuries. It’s a great initiative.’
Find out more
Elaine Cole is RCNi special projects editor