Abstract
Introduction
It has been many years since the advent of the Quality Protects initiative and subsequent statutory guidance introducing the role of the designated nurse for looked after children (DSCF, 1998), yet there has been no formal review and little empirical data to evidence its impact. As a practising nurse consultant for looked after children and care leavers, I was interested in understanding how they experienced health care by looked after children’s nurses in a social care setting.
Context
These notes explore some initial findings from qualitative research I recently undertook with a group of six looked after children and care leavers, which focused on their experiences as patients; they were able to give their perspective, identifying what factors are important and helpful and also those that are not. As part of the analysis the evolving role of the nurse in social care was emphasised by the children and young people as being supportive in both a short- and long-term context. It is hoped that the material, findings and any subsequent publication will contribute to the existing knowledge base within the emerging and growing area of nursing looked after children and care leavers in a social care setting.
Objectives
This study had three main objectives:
to explore how relationships between looked after children and care leavers and the nurses who work with them are formed and developed in a social care setting; to generate empirical data from interviews with looked after children and care leavers and formulate analysis that contributes to the body of professional knowledge; to identify factors that are raised through the interview process and how these contribute to understanding the experience of looked after children and care leavers in relation to this form of specialist nursing.
Methodology
I chose to use the Free Association Narrative Interpretive method (FANI) (Hollway and Jefferson, 2012) as it allows for quiet reflective spaces as well as conversation during the interview. This type of approach seemed to best fit with my questions and allowed me to intervene if participants were finding the process difficult since it involved a free flowing conversational style. The method also encourages reflection on the data produced from the interviews. This facilitated a thematic analysis based on the data presented in the interviews rather than by interpretation or by my own thoughts and interests.
Research design and participants
Three current looked after children and three current care leavers (two males and four females) were interviewed on two separate occasions. They were aged between 14 and 24 years and all were in the care of the same inner London local authority.
Given the age and background of the respondents, I also provided some creative material and offered the option of drawing and writing in order to make the process more child-friendly and informal. I have already used this method in action research groups and found that it generates useful additional data, while also putting the respondents at ease in interviews.
Literature review
There is a gap in the literature related to the function of specialist nurses for looked after children and care leavers and its impact on outcomes for this group, despite this being a statutory role. There are no studies focusing specifically on looked after children’s experiences of designated nursing. It is clear that my field of practice is relatively new and in many ways unexplored, evaluated or understood. Hill and colleagues (2002) identified its emergence as a new specialty; Eichler (2011) has described referral and management practices that improve access to services for looked after children and care leavers in a service evaluation context. Other authors have attempted to look at the implementation of policies and national guidance (Emery, 2006; Mather, 2002) and nationally in the UK there has been country-specific literature generated in relation to skills and competencies of nurses in these roles (NHS Scotland, 2009). Despite the lack of research or literature, it has been widely acknowledged in the professional network that looked after children’s nurses have made a significant impact and improvement on the health outcomes for patients (Department of Health, 2011; Pearce, 2010; SCIE/NICE, 2010). There is also emerging evidence on the impact of looked after children’s specialist nurses pragmatically working with designated doctors to achieve engagement from adolescents in their health assessments (Devincenzi and Dickinson, 2015).
Findings
What are the experiences of LAC/YP of specialist nursing in a social care context?
Every young person spoke about all of their interactions with the nurse in an overwhelmingly positive way. They described feeling relaxed, able to talk, and being valued and respected by the nurses. They attributed all of this to the nurse’s ability to make them feel comfortable and talk to them on their level. The practical aspects of how the nurses delivered the service were the most important factor in determining how engaged the young people felt in making decisions about their health care. Of most value was selecting a place and time of their choosing and making the health assessment process about them rather than attending a health appointment with pre-set questions. Without exception they described how a conversational style with the nurse, who was not obviously filling in a form, was the most important aspect of their engagement: There are no time limits. They don’t have another appointment to go to or someone waiting to see them. They had made time and space to see us in our time.
What does it mean to a looked after child or young person to work with nurses?
All of the young people spoke about the positive impact of having a consistent health professional involved with them throughout their care journey. They valued highly the idea that there was someone available to them to answer health questions and saw this as being essential, even after leaving care: I’m leaving care. I’ve had 18 social workers, one nurse; I know who I’d go to if I needed help and it’s the nurse.
What meaning do young people make of this experience?
What interested me most about the narrative that was consistent across all the interviews is the degree of young people’s trust and positive high regard for the nurses. There was an idea that even though you only saw the nurse once a year, she or he was available and accessible at all times and the young people placed great importance on this. The following brief quotation sums up what really matters: ‘It’s not about meaning or logic – just being there.’
What can this tell us about the care experience and the role of nursing?
The findings are fully supportive of the role of nursing in enhancing good relationships with health professionals and the care network. The following comments relate to a young person accessing the GP: You can’t have a relationship with a form or a screen when you’re 14 and in need of someone to listen. I didn’t feel like I was just an appointment in someone’s diary; I felt like a person.
Conclusion
While it is too soon to draw full conclusions from the interview data, what emerges is a positive account of how three looked after children and three care leavers experienced being cared for by looked after children’s nurses. Cutting across the findings is a central theme in the young people’s narratives about the emotional impact of being looked after and their experiences while there.
This small study illustrates the impact of nursing and also the challenges faced by designated nurses, both in terms of connecting with these young people and persuading the system to help them. What signs and/or problems do the general nursing workforce need to look out for and what can they do to help? An important aim was for the voice of looked after children and care leavers to be heard.