Journal of Psychiatric and Mental Health Nursing, 1994, 1, 12W

Clinical notice board Editors: Harry Wright’ & Martin Brown

Llandrindod Wells, P O ~ S LD1 SHF, Wales

Psychological and family-centred nursing in the local community

The Mid Essex Child and Family Guidance Service is the secondary specialist component of the overall child, adolescent and family mental health services of the District. It is designed to serve this function by offering a continuum of consultation to fellow professionals and assessment and treatment to chil- dren, adolescents and their families with emotional, behavioural and associated educational difficulties. The Service is multi-agency, multi-disciplinary and community based. It is provided by Health, Education and Social Services.

Specialist nursing was first introduced and devel- oped into the Mid Essex Child and Family Guidance Service 4.5 years ago. Up until then the team com- prised of child and adolescent psychiatrists, child psychotherapists, clinic social workers and educa- tional therapists, all working closely with col- leagues in the primary health care network, e.g., general practitioners, health visitors, school nurses, teachers, paediatricians and educational psycholo- gists.

The introduction of specialist nursing was a cre- ative clinical innovation that attended to a specific client group of families whose needs seemed to fall between the Child and Family Guidance Service and Social Services. The disturbance in these fami- lies did not necessitate Social Services intervention, nor were the families able to utilize a more formal psychotherapeutic intervention. However such families were considered to show an ability to gain some real and useful insight into their difficulties and thus regain some choice over the direction of their lives through a process of more active engage- ment over real life day-to-day issues with an appro- priate professional who had both an adequate understanding of psychodynamic process and a specific expertise in applying this. Some readers may be familiar with the psychosocial nursing model as practiced at the Cassel Hospital (Richmond, Surrey, UK). This is a hospital thera-

peutic community. It was envisaged that nursing in this way could be developed in the local community with children and their families.

The core nursing function involves work with families in the ‘here and now’ setting of their own homes, where the child’s behaviour and difficulties in family relationships can be observed and inter- preted within the context of daily family life. Nurses sharing their observations and understand- ing with parents leads us to start thinking about how we can work on the problems together and formulate a nursing care plan that makes sense for all. Doing things with families is particularly useful where initially parents and children are unable to put things into words. The focus of an activity, eg., playing a board game or cooking provides a natural platform for tensions to emerge. This along with the developing relationship between the nurse and the family allows family members and nurses to say things that may otherwise remain unsaid. Knowledge of human growth and development coupled with a psychodynamic understanding is necessary to enable painful feelings to be faced and fragile relationships to be nursed gradually back to health.

I came to Mid Essex in June 1989 to pioneer this specific nursing role and this led, 2 years later, to the appointment of my colleague, Mrs Vuokko Forster. I had previously worked at the Cassel Hospital for 8 years and latterly with the Richmond Fellowship Voluntary Mental Health Organization. Mrs Forster was a Health Visitor for 6 years before joining our team. We both come from a general nursing background.

As well as working in the family home we work alongside other team members in ongoing work with families within the clinic setting. We do joint assessment work with Health Visitors and Community Psychiatric Nurses when appropriate and offer consultation to professionals in other agencies.

Our work with Health Visitors has been a major source of development and we have recently

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finished running our first course for local Health Visitors entitled ‘Emotionally Speaking’. The course was run one afternoon a week for 10 weeks. The aim was to help health visitors gain psycho- therapeutic skills in work with parents and children.

Developing a whole new discipline within a long- standing team of professionals has indeed been challenging work. The reward has and continues to be, being able to see very marked improvements in the quality of life for children and their parents who have been able to utilize our particular exper- tise.

ANN SIMPSON Mid Essex Child and Family Guidance Service,

2 London Road, Braintree, Essex, England

A note from Harry about the Clinical Notice Board

The Clinical Notice Board of this new Journal offers nurses and others the chance to write in brief about their work. We wish to encourage estab- lished authors and new writers to describe the often exciting work undertaken by themselves and their colleagues. This is an international Journal, so we want to receive contributions from throughout the world.

For new writers it is a chance to develop writing skills without needing to comply with rigorous

standards appropriately established for the acade- mic and research papers that we publish. Our edi- torial policy is to offer contributors as much help as possible with their writing, in order to ensure publi- cation from practitioners throughout the profes- sion. Our particular aim is to encourage nurse practitioners to publicize their work. I share the concerns expressed by many of my clinical nurse colleagues that the work of clinicians risks being displaced by nurse researchers. We wish to see arti- cles that describe innovations in nursing practice that have due regard for the effectiveness of that practice, including new methods of developing and managing clinical work, and of engaging clinical practice with social policy changes.

For articles submitted to the Clinical Notice Board this would mean giving an outline of results that have been observed, descriptions of how the practice has affected the service, or an illustration of any outcome measures applied to the clinical work.

We want to make Clinical Notice Board as inter- esting and responsive as possible, so articles that contain brief histories illustrating the applied method, and those that reply to or develop previous articles will be particularly welcome. Try to convey the excitement and interest you find in your work. We want to develop Clinical Notice Board as a lively forum for ideas that nurses can use, as a focus to debate and learn from innovative practice.

If you have an article that you want to submit, send it to Harry Wright at the address above.

Journal of Psychiatric and Mental Health Nursing, 1994,l