Do Children and Young People Want and Need from Nurses (and Therapists?)

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© Springer Nature Switzerland AG 2020
Laurence Baldwin (ed.)Nursing Skills for Children and Young People’s Mental Health

2. What Do Children and Young People Want and Need from Nurses (and Therapists?)

Leanne Walker1  

Derbyshire Healthcare NHS Foundation Trust, Derbyshire, UK



Leanne Walker

2.1 Introduction

Within the field of children and young people’s mental health, consulting children and young people in what it is that they want and need within their healthcare is a growing area (Royal College of Nursing 2014: 6). In more recent years, it has gained increasing momentum. The field is progressively moving towards collaborative practice with not just children and young people, but also with their families and carers. Perhaps sometimes as adults, we can lose sight of what it is that children and young people want and need in healthcare settings. Often, this is not done on purpose; we just grow older and further away from childhood. At times we can make assumptions based on what we think it is that children and young people want and need. Sometimes, these are correct, sometimes not, and when they are not it is often not due to bad intent. Of course, the only true way of knowing what children and young people want and need from nurses and therapists is to ask them. Those with lived experience often know what went well and what did not go so well in their care and this should be used to invoke change in practice and within services. Additionally, it is important to consult a broad range of children and young people and hold in mind those that are hard or harder to engage, as they can offer valuable insights (Claveirole 2004: 258). Certainly it is essential to remember that what one child or young person might want or need, another might not. Likewise, what works well in one area of the country might not in another (Care Quality Commission 2018a: 5). Cultures, of course, differ.

2.2 Lived Experience

It goes without saying, within and outside of healthcare, we are all distinct individuals with varying needs (Royal College of Nursing 2003: 2). Although we can look at experiences and collate themes, it is important that we never lose sight of this individuality. This chapter will use lived experience supported by academia, policies and reports to explore what it is that children and young people want and need from nurses and therapists. However, as previously implied, individuality suggests there can never be a ‘routine’ approach as what works for one person may not work for another (Sellman 2011: 20) and this should be kept in mind throughout. Firstly, I shall look upon my own lived experience within Child and Adolescent Mental Health Services (CAMHS), before moving on to other lived experience. Having accessed CAMHS as a teenager, I have my own opinions around what it is that children and young people want and need from nurses and therapists. Of course, I am just one person and this is only my own singular experience. I had my first appointment at CAMHS at age 15, prior to this, I didn’t even know CAMHS existed. I didn’t stay in the service long, but shortly was re-referred and then I didn’t leave the service as a service user until after my 19th birthday. To put it simply, my first experience of the service was bad (and short lived fortunately) but I didn’t know it was poor at the time, as I had nothing to compare it with. I didn’t know it was supposed to be, or even could be any different. To me, the worker I saw felt patronising, showed little empathy and I was made to feel as if my problems were minimal in comparison to others. Ultimately, I became disengaged and left feeling unheard and frustrated. During the time period that I accessed CAMHS, I worked with a range of professionals within a range of settings including 1 to 1 and group. At 15, as a young person sat in front of a mental health professional (any professional for that matter), I didn’t know what it was that I wanted or needed from these individuals. I took whatever I was given to be what I thought I needed. I assumed whatever I was told to be the truth or the right way of doing something, because after all, they were the experts. That is the way I saw it then. It was only after I’d been in the service for a while and seen a few different professionals that I could begin to see what I not only wanted but needed from the people I was working with. It was only in hindsight after leaving the service and reflecting on my experiences as a whole, that I was able to draw out the fundamental elements that I needed in order to move forward and progress within my life.

I doubt that any of the themes in this chapter will come as a surprise. I hope to cement some of the key qualities of nurses and therapists. These can, in an ever-changing environment at CAMHS, be overlooked or overshadowed by other matters. For me, most of what I needed evolved around the individual worker’s personality and attitude. Being able to connect with the person I was working with was the single most important factor. In my own experience, genuine connection equalled progress, with no exception. Establishing a good working relationship came alongside other key components—time and space. I needed the worker to give me enough time, in order to build a relationship, to then feel able to share all the difficult things I was struggling with. I shall discuss these components and more, in further detail later on in the chapter. Next are some thoughts from Danni around her own lived experience.

2.3 Reflections from Lived Experience

As my own lived experience comes purely from a community setting, the chapter turns to Danni who brings a different perspective. As a young person, Danni was admitted into an inpatient unit and here she reflects on her own personal experience.

In mental healthcare, one of the most significant skills a nurse can possess is to care. As young individuals require nurture and time to explain what is distressing them and guidance that recovery can be an achieved aspiration. As it can be an especially frightening time, being admitted into hospital no matter the distance from a child or young person’s home. This is due to being in unfamiliar surroundings, with unfamiliar people who are also poorly and may act or display behaviours that could trigger or distress other young people within that hospital setting. Personalised daily goals supported my recovery, that were encouraged by nursing staff. Each day, I would document an improvement to view that I was slowly moving forward. This supported my recovery as it enabled me to slowly adjust to my situation, instead of frightening myself with a larger picture that did not feel achievable.

The balance between being treated as a child or as an adult is extremely important, especially whilst being an adolescent. This is because a young person requires additional support in certain areas, such as maintaining safety, yet requires additional independence. Nursing staff always addressed me with a realistic, but fair attitude. This skill is significantly important to adopt as young individuals commonly act against advice or support due to their age, not just their illness. Maintaining this attitude is important as nurses hold responsibility over their patients care and may in certain situations take away advantages due to a situation that has occurred, yet there needs to be flexibility within this to ensure that these measures have been taken correctly.

Utilizing an empathetic approach is paramount within mental health nursing. Children and young people do not always understand the situation in which they are placed and this can cause a high proportion of distress. Communicating with young people on their level and conversing with them in an array of activities that they enjoy, enables a therapeutic relationship with young people to develop. This supports nurses to analyse further into any factors that could be influencing young individuals mental health, such as: family, relationships, finance etc.

Danni’s reflection draws out that accessing mental health services can be a scary time for children and young people. However, for a nurse or a therapist, the setting is their everyday job, so perhaps the awareness of this can be unintentionally lost. Having now had my own experience of working within CAMHS (as an expert by experience) I have found myself understanding how easy it is to lose sight of the smaller things which make a huge difference simply because, as a member of staff, they become routine. Danni also highlights the importance of balance between being treated as a child, adolescent or young adult. Interestingly, it appears the core to Danni’s reflection centre around interpersonal skills of the nurse or therapist; being caring, nurturing and empathic.

2.4 What Is It That Children and Young People Want and Need? Key Themes

Although the nursing field is one that has changed and does change over time, it appears certain elements remain the same, such as the need to be caring and having passion for the role (Peate 2012). When it comes to what children and young people want, Collins et al. (2017: 163) found personal attributes are favoured over information and skill sets. If there was a choice, for example, between the qualities of a physical CAMHS building and individuals qualities, from the above experiences already and from my experiences of others, children and young people care less about environmental issues such as room design, and more about things such as ‘Can I open up to this person?’, ‘Is this person nice?’, etc.

This chapter now turns to the key themes drawn out from collective experience, my own, experiences of fellow young people who became friends, family, work colleagues, acquaintances, children and young people from a range of mental health settings including inpatient and community. They have been collated into the following headings: Consistency, Being Given Time, Working Relationship, Communication, Interpersonal Skills, Participation, Flexibility and Continuance of Care/Good Transitions. In no order of importance, they shall now be discussed in more depth, using examples to illustrate.

2.5 Consistency

Whether this is in regard to community CAMHS or inpatient, consistency is a very important aspect to children and young people and a lot of the time is highly valued. This usually relates to consistency in terms of having a single named worker, as opposed (or preferably) to say having appointments in the same place, at the same time every week (although some consistency in this way can be important too). Of course, it is inevitable that people are off work from time to time and as a whole this is generally accepted. It is common knowledge that we all get ill or need to take a holiday. It’s when children or young people see a different worker time and time again with little or no explanation that it becomes an issue. Perhaps this highlights transparency as important also, in terms of offering a simple explanation if this is to be the case such as ‘there is a lot of staff illness at the moment…’. There can be a frustration in not having an explanation.

Having consistency in terms of worker is important to children and young people for a multitude of reasons. Firstly, seeing someone new all of the time, for example for every appointment or every other appointment, often means they have to retell their story time and time again. Of course, this is not only repetitive and somewhat tiresome, but also can be traumatic, such as having to relive bad experiences so the new worker can understand. Secondly, having to explain everything all over again can also sometimes mean little is actually gained from the session, as the bulk of the time is taken up retelling. From my experiences, children and young people want to see someone who really knows who they are, what they have experienced and what they are currently experiencing. Someone who can pick up where they last left off. Perhaps this is because that one person will then have a more in-depth understanding, not just of the child or young person but of their circumstances and the wider impact of happenings within their life. Thirdly, only so much can be gathered from reading a child or young person’s notes and sometimes perhaps these notes can lack in the real emotion and feelings of an individual or situation. Of course, if there is no consistency, there is also the matter of opening up to essentially what is a stranger at every appointment, which can be a huge difficulty in itself and not just for child or young person. This point links nicely to ‘time’ as another key component which shall be discussed following an example from Hannah, a young person who has accessed mental health services.

Once a young person has created a bond with a worker, it’s incredibly important to their support system. Consistency is key. However, it’s important to appreciate that they may not ‘click’ with the first worker they meet. It took me meeting 5 or 6 different psychologists before I found one I was comfortable speaking to. Once I found that person, I felt I could be a lot more open and productive during our sessions. While I appreciate that resources are often limited, allowing a young person flexibility to find the best source of support for them, but to then give them consistency when things are working, should be a key principle of their care.

2.6 Being Given Time

Here, in this context, being given time is being taken to mean a period of getting to know the child or young person that an individual is working with. In some circumstances or for some children or young people, opening up and feeling able to talk to someone they have just met can be easier than talking to someone who they perhaps know better. However, for many children and young people they need time to get to know the person they are working with so they become more than a stranger. For many, it is hard to tell the entirety of life struggles and experiences to a near complete stranger and there are little other circumstances when this is expected in life. For some children and young people, this could mean a few additional sessions to what is seen as expected. For others this could be a bit of time talking about hobbies and free time instead of diving straight into difficulties. For others, learning small pieces of information about the person they are working with can be of benefit. This doesn’t have to be personal, it could be about their job role, or time they have worked in the service for Hannah puts it like this:

For me personally, being given time was crucial and in reality I needed months of this. After being in the service for a few weeks, discharge was being spoken about. It wasn’t that I was ready to leave the service, it was that I hadn’t felt able to speak about things that had felt difficult yet. I’d had a change in worker and hadn’t been able to reach a place where I was to feel comfortable in talking. It wasn’t until I was given a bit more time, that I was able to trust the person I was working with and then felt able to speak more openly. Time for me was the difference between leaving the service without treatment and having treatment which changed my life completely.

The themes discussed so far, consistency and time, go hand in hand with the third to be discussed here, developing a working relationship.

2.7 Working Relationship

It can be argued that without a good working relationship with the child or young person, little therapeutic work can take place (Ungar et al. 2017: 278). It can be hoped that with consistency and time, a working relationship would develop but that is not necessarily always the case. Other components have been found to be of importance such as the notion of ‘mentalisation’ (Fuggle et al. 2013: 109). Sometimes a relationship comes naturally, just as some people in life we instantly get on with, but sometimes a therapeutic relationship requires a little more work. As previously stated, in my own experiences establishing a good working relationship was of upmost importance. Although it is assumed that anyone within the nursing or therapeutic profession can be trusted, it sometimes can be an area of difficulty for example, conflicting wants and needs such as that of confidentiality and when it needs to be breached (Sellman 2011: 18). This in turn can impact the working relationship. Children and young people need clarity of what kinds of information will need to be passed onto who. If information has to be passed on to a safeguarding team and the child or young person does not want it to and was not aware such information had to be, this can lead to feelings of mistrust (Sellman 2011: 18). Children and young people need nurses and therapists to take time to establish a good working relationship with foundations of trust which includes a level of honesty and/or transparency. Lastly, here is a reflection from Danni following her experiences within an inpatient unit.

Young people require good working relationships with nurses as the comforts that they are accustomed to (home, family, friends, belongings) are taken away and are set upon in a routined approach to aid their recovery. This approach however can prevent or slow down recovery. Young people need these relationships to support them with their wider needs as well as therapy for their mental well-being. They require support in wider aspects of well-being, such as maintaining their safety as they are vulnerable due to their illness. They also require support to live a healthy lifestyle, possess healthy relationships and develop living skills such as cooking and budgeting to enhance independence and recovery and reduce the risk of relapse.

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Apr 18, 2020 | Posted by in NURSING | Comments Off on Do Children and Young People Want and Need from Nurses (and Therapists?)

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