Lele, a 13-year-old with autism spectrum and mentally handicapped, had difficulty adapting to the new environment and learning mode after high school. He often lost his temper and hurt people around him to express his emotions. He was referred to Kwai Chung Hospital.
After following up through the "Integrated Model Nurse Clinic Pilot Project", the number of hospital admissions was greatly reduced, and his mood became more stable. He learned to be patient and express his ideas in an appropriate way; the workshops and parent-child relationship groups provided by the nurses helped his family and Teachers can also better understand Lele's psychology and help reduce the pressure of caring for patients.
In recent years, the demand for child and adolescent psychiatric services has increased. The average waiting time for new patients in the Kowloon West Cluster is about 96 weeks.
In addition to drug treatment, long-term nurse intervention can reduce the burden on doctors and improve the quality of specialist outpatient clinics.
Therefore, in 2018, the Hospital Authority launched the "Integrated Model Nurse Clinic Pilot Program" for children and adolescents. Nurses formulate a plan that meets the needs of the patient, start the nursing plan 12 weeks in advance, provide medical support after the doctor's diagnosis, and provide a series of assistance to patients and patients. Mental health services for family members.
Child and Adolescent Psychiatric Consultant Nurse Chen Jieping (right) shows Lele's mother (left) the props for teaching Leleshi.
(Photo by Liang Sixing)
The HA has launched a pilot project for integrated nurse clinics in seven clusters starting in 2018. Among them, the most populous Kwai Chung Hospital in the Kowloon West Cluster provides most integrated nurse clinics for child and adolescent psychiatric services.
Through the plan, patients can be evaluated by specialist nurses before seeing a doctor; after the doctor’s diagnosis, the nurses will continue to follow up on the patient’s condition, provide transitional services for the patient, and provide communication workshops for caregivers and family members to teach and help patients even after they are discharged from the hospital. Can also live a normal life.
Lele, who suffers from Autism Spectrum Disorder (ASD) and mildly mentally handicapped, deteriorated after entering middle school in 2020, his behavior deteriorated, his unfamiliar environment, coupled with adolescence change, made him feel anxious 、The temper is often uncontrollable, and it is particularly sensitive to some particularly negative words such as "NO", "cannot" or critical words, which affects emotions, and will beat people because of undesirable things happening around them.
Lele’s mother learned how to use props to help Lele relieve emotions and explain behaviors through parent workshops provided by the nurse clinic.
(Photo by Liang Sixing)
Lele mother: After the child participates in the plan, follow-up visits will be postponed from weekly to 9 weeks apart
Lele’s mother said, “I’ve never tried it before. At first, she went to see her private doctors on the fifth and sixth grades, and then she was promoted to junior high school. He knew how much he knew how much he knew, and he knew that he was anxious about other people... Talking is so bad, if you don’t know how to express it, you will suddenly feel depressed.” When the middle school was promoted to a special school, she pointed out that the teacher didn’t know how to deal with it. But he couldn't bear to intimidate him."
She especially pointed out that her son is very stubborn about the number "2". "If you go out to eat and eat, you have to sit on the 2nd table... If the answer is not "2", you don't like it." The son likes to cruise the river, but when the bus arrives There was no one going up or down when he was standing, and he would be very anxious again. He once tried to pat the passengers in front of him.
Lele entered the Accident and Emergency Department 6 times in six months. The most serious hospitalization time was that he had to stay in Caritas Medical Centre for more than 2 months. He was then referred to the nurse clinic of Kwai Chung Hospital. Her mood gradually stabilized and improved significantly. I see a doctor every week for follow-up visits. After receiving 9 months of nurse clinic services, I only need follow-up visits every 9 weeks.
Chen Jieping, a consultant nurse in the Child and Adolescent Psychiatric Department, explained how the nurse clinic handles child and adolescent psychiatric services.
(Photo by Liang Sixing)
Use white beans and black beans to teach sick children good and bad behaviors
Chen Jieping, a consultant nurse at the Child and Adolescent Psychiatric Department, pointed out that children with autism need "visual cues," and nurses will present abstract emotions as objects. Look at me, and you will understand first.” She said that nurses would use white beans and black beans to teach Lele what good behaviors and bad behaviors are. With a "black bean," he was immediately dissatisfied with kicking the table, but then slowly accepted that "it doesn't matter if you lose." He learned that as long as he took a deep breath, he could calm down and resume the game.
Lele’s mother said that after attending the nurse’s clinic workshop, she now knows how to carry the “Lak Lakka” with her to praise Lele’s good behavior. He clearly knows that his behavior is correct, so he will feel very happy and relieve anxiety.
"Ms. Chen will teach me how to do it, and she will be happy... I was so stressed when I saw her before." She described Lele, "I used to feel a headache, like taking a time bomb out of the street. Hmm. Knowing how often he will go to other people, and you will lose your temper when you think you’re different from each other.”
She pointed out that her son would often ask her "Humhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh)
Tang Wenhao, a senior nurse (psychiatric department) of Kwai Chung Hospital, shows the props "white beans, black beans" used in the treatment of Lele.
(Photo by Liang Sixing)
Parents and schools cooperate with each other to help recovery
Senior nurse (psychiatric) Tang Wenhao of Kwai Chung Hospital is in charge of the parent workshop group. He designed social story books for improving the skills of children’s problems. Using substantive appreciation and personalized props, he taught parents how to build high-quality children with emotionally ill children. Parent-child time, how to use appreciation to effectively encourage children.
Chen Jieping, a consultant nurse at the Child and Adolescent Psychiatric Department, further said that many patients are able to deal with emotions steadily through the assistance of drugs and nurses during hospitalization. Autistic patients are like Lele, with weaker expression skills. "In fact, this case is very difficult to handle, but it is better than expected. Because everyone cooperates, the school is willing to participate, and Mommy is willing to learn, which is better than expected ( (Rehabilitation progress) Good, it has been a year since I have been hitting us.”
The Hospital Authority had previously used questionnaires to interview parents of children and adolescent patients who had received intensive services from November 2019 to October 2020 to understand the changes in the stress index of parents before and after contact with the nurse clinic. 84% of parents felt that the stress was reduced, and the other 14% felt that the stress was increasing.
Chen Jieping explained that when parents come to the nurse's clinic, the nurse will explain in more detail the child’s condition and what will happen in the future. When the parents understand the condition of the disease, the worry will increase, which may make them feel stressed. , It takes a while to accept.
The nurse clinic will design "social stories" and props suitable for patients to meet the needs of children and adolescents.
(Photo by Liang Sixing)
Nursing clinics have great potential for the government to implement a long way to go