Day 5 in Birmingham we woke up, we walked to BCU, and took a stop at Costa coffee for our morning energy to prepare for the long day. Our first lecture we spoke to a registered adult nurse and specialist community public health nurse (school nurse), Samantha Parry. Now she is a senior lecturer and expert. We learned that school nurses are based in the community unlike the U.S. where they work for only the school. They focus on the health and well being of children and their families. They tailor their services to underprivileged families to ensure equity which results in improvement of their education experience. Registered nurses who have completed their degree can apply to take a SCPHN (specialist community public health nursing) training. School nurses are based in hubs that allow them to be involved in the community. I learned so much about this profession that I will definitely be incorporated into my research because of their large focus on underprivileged communities.
They have a heavy safeguarding focus which is protecting children from abuse or threats and risks outside the home. Gang related instances, including selling drugs, are common in young people especially men. School nurses help connect families with many services including domestic violence, mental health, care support groups, and charity’s. In the Safeguarding record, they can document all their concern for the children. For instance documenting abuse or violence. This allows the different health services to all be informed of the child’s concerns. Some of the other services they direct the family too are food banks, which have increased due to the increase in food poverty. Also, chat health is a service connecting low income families with medical professionals to receive the best advice. School nurses are trained in mental health services which I believe our school nurses need more training in to help connect with students on a deeper level. They also try to connect students to services which are free due to the NHS. Unfortunately some mental health services have a 2 year wait list. People who have money are able to see health services quicker. Therefore, there is still a disparity between socioeconomic status affecting the accessibility of healthcare.
Health visitors deal with children from birth to 5 years old. Then when they reach school age they easily transfer over to school nurses to make sure their care is continued. It seems to me the UK has better communication between services and an easier process in transferring information from one system to another, but this is something the United States struggles with. Also from my experience our school nurses only really assess you if you are feeling unwell at school and send you home if you are. Their school nurses seem to be more similar to our social workers and counselors that connect students with different services.
For the lower socioeconomic status communities they have a very diverse assessment tool to assess financial needs. They refer children to services, for example baby banks provide clothes, diapers, formula, etc. They have uniform banks for children’s school uniforms. They ask for donations from supermarkets and stores. It takes a community to help grow a child, so they try to all work together to provide as much as possible.
Some of their frameworks for their system includes NMC, the nursing and midwifery council, which is the governing body that puts out the standards the nurses must follow. They basically regulate the practice. Also the healthy child program where health visitors and school nurses are implemented into the school systems. They use the Bronfenbrenner model which targets holistic care. As well as a framework called MECC, making every contact count, focuses on how to help most effectively and early intervention. All these techniques are parts of preventative care that is one of the best strategies to ensure better health outcomes and can be incorporated more into the states.
Although they have all these free services there are also many downfalls. For instance there are not enough NHS dentists therefore oral health is a massive problem. Low socioeconomic status has a decay in dental health, which can also delay their speech and language because only people who can pay for dental care have consistent care. As well as school nurses suggest referral for specialists. However these referrals can take over a month, and then the specialist sometimes refers them to someone else causing more waiting. There is also a nursing burnout including with school nurses. Lack of funding in school nursing causing a huge shortage. She said a main thing needed is more evidence based research to show the progress made by this profession to get more nurses into this profession.
Our next lecture of the day, after lunch, we spoke to a mental health nursing student and an expert registered mental health nurse. The student specializes in forensic nursing which I find extremely interesting and something I am interested in specializing in. First the lecturer gave us a brief history to explain the diversity and the vast growth of the population of different immigrants. They believe that 30 to 50 thousand people have moved to Birmingham the past few years which is really amazing.
They spoke about the fentanyl epidemic that is very prominent in the U.S and also growing in the UK which has a major impact on mental health. And how mental health illness is not always genetic. The body is changed by our experiences and circumstances like trauma, prejudice or privilege, childhood adversity or safety which is the focus of mental health nurses that they are trying to understand. Intergenerational trauma is also important because these bodily changes can be passed on.
We learned about different specialists in mental health one including Dr.Joanna Moncreiff, a psychiatrist, who focuses on misuse and misrepresentations of psychiatric drugs. She believes they should be used as the last result due to damaging effects of long use. I think this is something that should be implemented more into the U.S. because we tend to throw drugs immediately at mental health illnesses, instead of trying to use natural remedies, talking therapy, and other non drugs techniques to help improvement. The UK has a Mental Health act of 1993 as their framework of deciding to put patients into the hospitals for treatment and drugs against their will. They also spoke about how nurses here make the decision to have their patient evaluated by the psychiatrist or psychologist which is a big decision. Since in the U.S. it is not free, the patients tend to make that decision in who they see.
We also learned about “power threat meaning framework” and how it is a framework that focuses on people’s experiences of power and how they respond to its threat. It recognizes the various common patterns in the ways that people respond to threats. “It is not what Is wrong with you, it is what has happened to you,” is a quote from an American organization that this framework also focuses on. They also explained how mental health illnesses are most prominent in minorities which is something we talk about a lot in our program at Pitt. As nurses “Very often who we are and what we do is just about the mental health style, not about what we might want. We uphold it but we wouldn’t wanted to be treated by it.” When the instructor said this I found it to be an extremely prominent problem in the mental health profession, and it is something we need to explore more.
We ended the day with a tour of the Windrush history. “Windrush” comes from the name of the ship the Jamaican immigrants took to the UK. They came over to do the jobs lacked in the UK after the war, like nursing, factories, and more. We spoke to a nurse who worked in the middle 1900s who rose in the ranks of the National Health service. She explained how when they came they had a rude awakening and received a great amount of racist treatment. She always wanted to do nursing and she went to night school to get her degree. She was a practical nurse, then got her registered nursing degree, then psychiatric nurse training, and finally decided to become a midwife. We then went on the black heritage walking tour. Our tour guide took us around the city and explained the black history to different monuments around Birmingham. During the tour we went to the main library and saw the “Free Exhibition” Intended for Jamaica. There is a great amount of Jamaican history here in the UK that I enjoyed learning more about. We ended the night with a delicious meal at a Jamaican restaurant. I loved learning so much more about nursing here and I can’t wait for tomorrow.
Founder of Birmingham, but used money from slave labor to begin the industry.
Chamberlin Square