Zoe Butler, winner of the Guidelines for Nurses-sponsored Andrew Parker Student Nurse Award at the RCNi Awards 2017, explains how her Hot potato project is raising awareness of mental wellbeing in young people and destigmatising mental illness
Read this article to learn more about:
- holistic care and the importance of considering a patient’s wishes, needs, and fears
- young peoples’ perception of mental health and mental illness, the importance of mental wellbeing, and the need for signposting to support patients at the earliest stage when experiencing problems
- how the Hot potato project can help healthcare professionals destigmatise mental health and break down barriers when supporting young people with mental illness.
What is holistic care and why is it important?
Holistic care considers the physical, social, spiritual, emotional, and cultural impacts on an individual’s health. A great emphasis is put on holistic care in pre-registration nurse training. However, it is often difficult to put the concept of holistic care into practice because mental and physical health have been viewed as two separate entities for such a long time. By engaging in holistic care, we can help to uphold a patient’s dignity—the relationship between the patient and nurse is based upon respect, trust, and mutuality; decision-making processes are shared when creating goals to meet the patient’s needs. This approach can increase our understanding of the impacts of an intervention on a patient’s life because the patient is encouraged to express how they feel, enabling us to collaboratively problem solve.
If student nurses are able to develop skills and expand understanding of care beyond their specific field of nursing practice it will be possible to begin breaking down the segregation of mental and physical health, allowing the true application of holistic care. The Nursing and Midwifery Council Standards for pre-registration nursing education state that a newly registered graduate nurse should be able to work with a patient, and their carers and families, to assess physical, emotional, psychological, social, cultural, and spiritual needs and risks in a person-centred and systematic way, and together develop a comprehensive personalised plan of nursing care.1 To assist in achieving this competency, the majority of universities adopt a multi-field approach to teaching, with many care modules being taught to all nursing fields. With the demands of care changing and people’s health needs becoming more complex, the need for a service-wide collaborative approach to holistic care has never been more pressing.
The hot potato topic that is mental health
As part of my ongoing nurse training, armed with my vision to challenge barriers surrounding mental health awareness and care provision, I developed the Hot potato project. The ultimate goal of the project is to give service users, along with their families and carers, the opportunity to express fears, concerns, and ideas surrounding their mental health and wellbeing. The inspiration for the project came after a young lady in my local community took her own life. This young woman was a member of a local youth group, for which I volunteer—the resulting distress experienced by her fellow group members and members of other local youth groups highlighted the severe lack of confidence young people have regarding their ability to discuss mental health and illness, both with their peers and healthcare professionals. From subsequent discussions, the youth groups identified that young people failed to identify the impacts of mental wellbeing upon their overall health. It also became apparent that young people are reluctant to access services in times of need or when crisis point is being reached.
When discussing this, the youth groups considered that there was a lack of care, support, and compassion from peers, relatives, and health professionals when it came to discussing mental health, thereby creating a stigma surrounding the topic of mental wellbeing. Many believed ‘mental health’ directly correlated to ‘mental illness’, making people in this age group reluctant to access support from healthcare providers due to fears of discrimination, misunderstanding, and stigmatisation.
By creating a safe environment for young people to express opinions regarding mental wellbeing, and explore their understanding of keeping mentally healthy, the Hot potato project aimed to address any associated miscommunications and fears. As one of the young people said, ‘We are addressing the hot potato topic that is mental health.’ By giving young people a voice, narratives from the project could also be shared with healthcare professionals to help them understand barriers faced by young people when tackling mental health issues.
How the Hot potato project helped young people
The project initially focused on documenting the narratives of young people from several local youth groups, who discussed the general misunderstanding between mental wellbeing and mental illness. After exploring what they felt defined mental wellbeing in a series of workshops, it became clear that more education was needed about the symptoms of mental illness along with signposting to support at the earliest stage when experiencing problems.
The narrative approach used in the first stage was integral to receiving the honest and open responses that were necessary for the aims of the project to be achieved; consequently, I continued with this approach throughout the project. I contacted local mental health services and met many young people accessing child and adolescent mental health services (CAMHS) to discuss their experiences. After providing separate workshops to these groups of individuals that explored their thoughts surrounding the care they had received, they agreed to meet the youth groups involved earlier in the project. It was a very humbling experience when everyone came together to share their experiences and opinions. The young people accessing CAMHS had previously expressed deep feelings of misunderstanding from their peer group—this opportunity gave them the chance to feel not only heard by their peers, but also fully supported and understood. After gaining consent, I documented the experiences of both the CAMHS and youth groups as combined narratives and developed focus groups: the young people that had engaged with CAMHS were able to answer questions and give feedback to the other group members; all of the group members were able to explore what it means to maintain good mental health.
In these focus groups, the young people shared a strong voice to be advocates for upholding the mental wellbeing for their age group. The experience of being involved enabled them to consider a more holistic approach to their wellbeing. Many individuals fed back that the project had enhanced their insight into the importance of maintaining their health and looking after themselves, with the activities during the workshops providing coping mechanisms and ideas of how to achieve this. Based on this feedback, I thought there was a valuable opportunity for the stories from the focus groups to be used to help the wider population of young people and to be used as an educational resource for healthcare professionals, to improve understanding of how to achieve holistic assessment of young people experiencing mental illness.
With collaboration from a local writer and the youth members, we created 40 monologues, combining the stories of the young people and providing a message highlighting the importance of maintaining mental wellbeing and signposting individuals who may be experiencing symptoms of mental illness. After much campaigning the project received funding from The Sir John Fisher Foundation, a local charity, enabling the filming of the monologues and production of a DVD resource that has been distributed to every school in Cumbria to help raise awareness. With the project focusing on the educational and preventative aspect of mental wellbeing, the DVD explores how young people feel they are misunderstood by healthcare professionals and also gives the young people the opportunity to give their own perceptions of mental health and its stigmas. This resource has been used by universities to help educate the future healthcare workforce about mental health issues. The DVD should help healthcare students to reassess negative attitudes surrounding mental health and adopt a more considered approach when caring for people accessing services.
Andrew Parker Student Nurse Award
I nominated the project for the Andrew Parker Student Nurse Award to showcase the amazing resilience of the young people involved with the project; and because the project highlights an innovative approach to care, which I felt needed to be shared with fellow practitioners. Undertaking this project helped me to truly understand what holistic care means, and the importance of considering all of the patient’s wishes, needs, and fears. It also helped me to develop the ability to communicate with consideration, compassion, and empathy, to allow patients to feel comfortable discussing what are often difficult and uncomfortable subjects.
The experience of applying for and being awarded the Andrew Parker Student Nurse Award has been very uplifting and inspiring. The RCNi awards as a whole celebrate the best of nursing practice and recognise the positive changes continually being made within healthcare. My advice to anyone considering an application for the RCNi Andrew Parker Student Nurse Award next year is to think how your work has demonstrated innovation, or how your contributions have positively impacted the care for patients. Focusing on the positive changes made can help to develop your ideas further and allow you to consider where you see your work progressing in the future.
In terms of the Hot potato project, I aim for its principles to be used to inform national guidance on how patient narratives can be used to help interventions to be more person centred. Furthermore, the principles underlying the Hot potato project can be used to help develop a national scheme within schools that utilises workshops to break down the barriers and stigmas surrounding mental health awareness for young people.
Nursing and Midwifery Council. Standards for pre-registration nursing education. London: NMC, 2010. Available at: www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-pre-registration-nursing-education.pdf