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Nurse's Role in Hospital Care for Suicidal Teenagers with Traumas |
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Stockholm This hospital unit is completed by a phone line where we can assist professionals confronted to suicides in their work. We also provide as well emergency consultations for individuals (family, close relations, patient him or herself. . .), doctors or social workers. The crisis unit for teenagers, receives young people from 16 to 22 years old who have tried to commit suicide or who have suicidal ideas. The admission is made on a voluntary basis after an assessment interview with the teenager. For these young persons in crisis, the unit represents a space of treatment and psychic elaboration which, after four weeks at most, results in out-patient care. In 1997, the average period of stay was 18 days. The ambulatory psychotherapical follow up, organised from our unit, represents the best guarantee against very frequent recurrences in that category of the population. This crisis work is based, among other things, on daily psycho-dynamical interviews with doctors and nurses. It is maybe worthwhile to specify that the functioning as well as the results of this unit are assessed by the “Institut Universitaire de Medecine Sociale et Preventive” in Lausanne. After the first assessment, a year after the opening, one could already confirm what the staff have noticed in its practical work: the high frequency of traumas in the life of these youngsters. Although the number of teenagers who fitted exactly in the research protocol was small, this fist report stated that 58% had been victims of physical violence and 48% of physical interference including 29% who had undergone rape and 15% who were victims of incest. Thus stood the question, for us nurses of the specifics of our role in dealing with such patients. We came to the conclusion that the major feature of our role is the ability to ensure a relational continuity with the teenagers throughout their stay at the unit. This relational continuity, in space and time, is supposed to help the patient to develop a feeling of secureness with the others, thanks to a structuring environment which in turn can lead to the possibility for the him or her to feel more secure inside, and help the emergence of thoughts and affects linked to the trauma. This relational continuity will enable the revelation of the trauma. This revelation is always difficult, for the teenager has to free him or herself from a secret which has been weighing for a long time on his or her actions, thoughts, affects and relations to the others. The teenager chooses then the person he or she will speak to (often a nurse) as well as the timing, the setting (formal or non formal), and talks about what he or she had to go through. The patient has to feel immediately believed and recognised in this part of the secret. When the chosen interlocutor is a nurse, he or she then becomes a facilitator of the speech, like an ambassador to the psychiatrist and sometimes to the family. If the young person decides to speak about it with people around him or her, it can be done in a collective framework, which is thought over with the social worker in charge of relations with the family. The nurse has then to decide what type of attitude, what type of listening, what type of support to be adopted when faced with such a revelation. Two extremes are to be avoided. Adopt a much too passive attitude which can lead to a bigger lack of confidence vis vis the adult and could even be perceived as a sort of complicity. React, on the other hand, in a very emotional and hyperactive way, with the risk of identifying him or herself with the traumatised teenager, thus reinforcing the effects of the trauma. We feel that the nurse must find the right place between these two opposite poles. This profoundly empathic attitude is aimed at allowing a multidirectional development: It is supposed to help the patient identify the confusion of thoughts, the confusion of contradictory emotions (shame, guilt, anger, violence, fear, but also desires and impulses linked to adolescence which can be a source of ambivalence and guilt). This attitude has to allow the young person to begin a reconciliation with his or her body which at that time is perceived as something bad. We have to pay a great deal of attention to the various expressions of the body (headaches, stomachaches, agitation, eating disorders). These symptoms, which the nurse is directly in contact with, can be a way of initiating the relationship with the staff, a way of attracting their attention, of expressing suffering and a linking it with the trauma. We also have the feeling that the major role of the nurse, thanks to the numerous talks and the relationship woven with the patient in complement to the doctor, is to allow the person to become the actor of his or her own history, and not only the object of someone else’s listening. The nurse has to avoid the story being used as a seduction tool. By choosing a regulation mode not too “free” and not too restricted, the professional can help the teenager to develop an emotional meaning to its story telling. We should never allow ourselves to be put in a “voyeur” position by the adolescent. We have now to turn to the role of the nurse in the group. When several youngsters who have undergone a trauma find themselves in our unit, the staff has to make sure to maintain group dynamics and a therapeutical framework. Although the group can help the young person to reduce his or her feelings of solitude and uniqueness, the nurse has to see to it that the group of patients does not form itself around an identity of “traumatised persons” where the aggressor and sex are satanised. Permanent interactions between patients and nurses, daily groups organised by nurses where attendance is mandatory enable such progress. We finally have the feeling that the key word of our role as nurses with these young persons is a type of help that allows the expression of the trauma and of the intra-psychic conflicts which result from it, and not the expulsion of these conflicts. |
