City Nurses

Principal Investigator

Professor Len Bowers RMN PhD City University City University Philpot St Whitechapel London E1 2EA United Kingdom

+44 (0)20 7040 5824 L.Bowers@city.ac.uk Personal web page

Collaborators

Background

Generally, serious mental illness first strikes during a person’s teens or early twenties. This is a difficult life stage for any individual as it is then that they are developing a role in life and society and forging their ideals. As they negotiate this development young people are known to be rebelliousness and risk taking. Young people often feel alienated from society, misunderstood, self conscious and awkward. At the same time, however, they may be trying to negotiate their first serious emotional relationships and having their first sexual experiences. Altered perceptions, impaired thinking, sensitivity to criticism and social stigma mark serious mental illness. Therefore, young people with serious mental illness have a more difficult time. It is perhaps not surprising that these young people reject standard psychiatric services the most.
We know that the younger people with serious mental illness are: more likely to commit suicide; more likely to refuse the medication that can ameliorate their condition; more likely to relapse. When they do relapse this often results in conflict, as they have to be brought into hospital and treated against their will. Symptoms can make people confused and frightened. In this situation young people are more likely to: react and fight back against what they perceive to be the threat; become more involved in violent incidents at home and in hospital; abscond from care and need police intervention to return. In short, their relationship with statutory psychiatric services are often poor and hampered by conflict and misunderstanding. Additionally, the type of services provided and the manner in which they are given are not always suited to the younger patient and their needs.

Aims

The 'City Nurses' project aims to improve the service offered to young people (under 35 years of age) with a serious mental illness, increase their engagement and use of that service, and decrease conflict between them and the professional service providers

Methods

Two City Nurses have been employed for three years. City Nurses are highly qualified and experienced psychiatric nurses who possess additional qualifications and expertise. They are working both on the hospital wards and in the community, carrying out therapeutic work with young people with a serious mental illness aimed at increasing their therapeutic engagement with services. In the community the City Nurses have a small caseload of young people who they work with to achieve the above goals. In the hospital wards the City Nurses are working with staff, assisting them to identify and address the needs of young people. In this they are providing ward based education, the modelling of skills, supervision of others, in order to achieve highly therapeutic, low conflict nursing care to young people in the acute phase of their illness.

Findings

Statistically and clinically significant decreases in conflict occurred on the first two study wards, with falls in aggression, absconding, and self-harm. Ward atmosphere improved and nurse-patient interaction rates increased. There was no significant change in containment method use. Phase two is now complete and data analysis is ongoing.

Conclusions

Preliminary indications are positive.

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