Caring for students' health needs: a unique interdisciplinary team of health professionals and education support staff provides a comprehensive health service for Lincoln University's student population.

As a primary health care team working in a tertiary setting, Student Health & Sup port offers care to students at Lincoln University, Canterbury. The students are a diverse group, including nearly 2000 international students, 2200 domestic students, with 25 percent of the total student population aged 25 and over. The team cares for a diversity of students. This includes working alongside international students to understand their beliefs about health and illness, their cultural practices and their use of traditional medicines. Our interdisciplinary team consists of three part-time (two full-time equivalents) primary health care (PHC) nurses--Fiona Gould, Jeanie Sanford and Chris Davie--a doctor, a clinical psychologist, a mental health nurse--Rachael Higgins--the international student adviser and the co-ordinator of inclusive education (disability support). This combination of tertiary health and support professionals working together as a single team is unique in New Zealand. The doctor: nurse ratio is also unusual but an integral part of our model of practice. The nurses value working independently, offering student consultations, on-campus health promotion and providing clinical guidance to the wider student support team. The clinical psychologist and mental health nurse provide support, guidance and counselling for all kinds of issues, including coping with life on campus and in a new country, white balancing home, work and study.

The international student adviser offers practical support about things such as insurance claims, visa issues, accommodation, worries about family at home or other situations, including academic appeals.

The inclusive education co-ordinator offers support strategies to lessen the impact of illness, injury or disability which may affect learning or formal assessments during the year.

The interdisciplinary team is shifting from the biomedical model of curing towards an holistic model of care. Our model of care endeavours to promote teamwork, which strengthens interdisciplinary practice relationships, and centres on supporting needs identified by the student. The advantages of an interdisciplinary team model of practice on campus include: co-ordination and continuity of care; accessibility and availability for the who[e campus community; collaboration between campus services; and strong links with community resources and speciality mental health services.

Challenges of our care model

The challenges associated with this model of practice include the fact that most students are familiar with the biomedical model of care and don't yet fully understand how our service works; because of the small team there is some isolation from professional bodies and limited cover during leave periods; and speciality mental health services have been slow to recognise the mental health skills and experience within our team when we have liaised with them. Medical and nursing consultations increased by 39 percent between 2004 and 2005, with 1000 more students on the register last year, compared to 2004. This increase has had a direct impact on clinical staff. We have had to take a creative approach to working more effectively. This approach has become one of the strengths of our service, as staff members commit to sharing knowledge and expertise for the benefit and growth of the whole service.

Student Health & Support offers two distinctive nursing roles: primary health care and mental health. One is a generalist role, the other a specialist role, but both focus on providing acute care to enhance students' wellness. An essential aspect of both roles is advocacy for students, who usually present acutely and are often unsure of what to do next. The ability of the nurses to read these situations well and to arrange prompt and appropriate follow-up care or support within the wider team is essential.

Another key has been the development of strong professional relationships across the campus with other support and academic staff, including the Halls of Residence, Teaching and learning, English language Studies, Student Services, Recreation Centre and the Lincoln University Student Association (LUSA). Through these campus-wide relationships, effective care plans can be negotiated that balance the requirements of the university with the needs of the student. The role of the PHC nurses focuses on the range of acute and chronic health needs seen in general practice. The PHC nurses are often the first point of contact for students and are instrumental in developing care plans.

The nurses initiated a range of health promoting activities on campus last year. Each new student was offered a free nursing health check consultation. Through these consultations, vital health information was collected and information was shared to enhance students' understanding of their health. This free health check helped raise the profile of the service, leading to increasing use of the service.

In July an ambitious meninigococcal B (MeNZB) campaign was launched, involving a campus-wide approach to ensure students were fully informed of the programme, could receive vaccinations at suitable times and would return for all three doses before the end of the academic year. An evening vaccination clinic offered an espresso or hot chocolate, accompanied by a string quartet. One student asked if the string quartet had been arranged to drown out the sounds coming from the vaccination clinic! During the campaign weeks, first- and second-year lecturers put overheads up at the beginning of each lecture. At the lunchtime clinics students were given soup and a roll to compensate for where they had chosen to spend their lunchtime. Accommodation staff organised competitions with prizes, including an iPod and a digital camera. Later in the campaign, during LUSA's annual "Welfare Week", our service offered free sexual health and cervical screening appointments and also displayed MeNZB information.

As the campaign neared completion, 80 percent of eligible students had received all three vaccinations. Nationally, this was among the highest rates for youth in the tertiary setting. An orientation programme for new English language and foundation studies' students is a requirement of the Code of Pastoral Care for International Students. As part of this and to support our international student adviser team member, the nurses offered a health education programme each semester.

Another of the team's health promotion activites was a sexual health quiz night for first-year halls of residence students, which the team doctor compered, supported by the nurses. These activities demonstrate our team's enthusiasm to trial new initiatives and make a difference in health promotion on campus.

Conservative estimates indicate that approximately 30 percent of all consultations in PHC relate directly to mental health. (1) This is significant in the tertiary setting as students face issues relating to living independently for the first time. Risk factors include age-related risk-taking behaviours, eg alcohol and drug use, sexual encounters; international students are facing the realities of life in a foreign country and are attempting to achieve cultural integration, there may be family and personal pressures to achieve academic excellence; and there can be the manifestation of compulsive behaviours, including eating disorders. One or a combination of these factors often culminate in students presenting in crisis. Appropriately skilled staff able to work collaboratively are essential in this situation.

During 2004, a review was undertaken focusing on achieving the best structure and resourcing to meet the increasing demands for mental health care on campus. A recommendation to employ a mental health nurse who would work in partnership with a clinical psychologist was accepted. This professional combination could offer a complementary skill mix, providing psycho-education, early intervention, crisis management and therapeutic counselling. It would also mirror the existing case management model of practice of the doctor and PHC nurses.

The role of the mental health nurse is to meet the mental health needs of an increasingly diverse client base, including providing acute assessments for 'at risk' students and supervising or monitoring medication requirements; to provide a safe and consistent service, where students do not fall through the gaps; to develop a culture of interdisciplinary and collegial collaboration in the care of clients, including liaising with district health board and non-governmental mental health services, and to provide a service that is contemporary in both its methodologies and practices for clients and practitioners, eg external professional clinical supervision and the development of appropriate new policies and procedures.

When a student presents to the mental health nurse, the nurse undertakes an initial triage appointment and may then refer the student to the doctor to consider pharmacotherapy or to secondary community mental health services. During the crisis phase, the mental health nurse develops an individual care plan with the student to assist them in their recovery, offers psycho-education to improve the student's understanding of their specific triggers, discusses available treatment options and collaborates with other team members to monitor progress. The nurse also liaises closely with academic and accommodation staff.

Once the initial crisis has subsided, the student is referred to the clinical psychologist for therapeutic counselling to work through the issues that underlay the event. Often these are chronic conditions such as clinical depression or anxiety and obsessive-compulsive disorders. Anecdotal feedback from students, staff and team members has been positive, supporting this model which provides acute mental health care combined with short-to-medium term therapeutic counselling.

Since the mental health nurse position was established in March 2005, the generalist PHC nurses, doctor and clinical psychologist have not been as directly involved in initial crisis assessment. This has eased their acute workload. Cross-referrals to the mental health nurse have come from all team members.

As a nurse, the experience of working with students, as they regain or learn to take control of their lives and futures, is challenging and rewarding. We must balance the intricacies of psychological care with the need for thorough and well documented physical assessments.

Working within an interdisciplinary team presents particular challenges, including the need to clearly define practice boundaries, the ability to communicate well with other team members and, most importantly, the ability to listen and respond to the needs of the students. In doing this, nurses encourage and empower students as they regain their health and direction.

Many tertiary students are facing developmental challenges and, as nurses on campus, we have the opportunity to help them negotiate these challenges safely. If a student has faced a mental health crisis, we can help them address their risk factors and, through regular evaluation of their care plan, can help boost their resilience to a relapse.

In sexual health, nurses play an essential role as patient educators, advocates, and support persons. (2) This is certainly true in the student health environment, where nurses have a unique opportunity to educate students on contraceptive options. Ready access to contraceptives provides students with choices. Commending students for taking responsibility around contraception encourages them to maintain control of their sexual health and wellness during a crucial stage in their lives.

Our experience at Student Health & Support demonstrates that the PHC, including mental health, needs of the campus community can be best met by an interdisciplinary team open and willing to learn, teach and support each other and their clients.

References

(1) Sainsbury Centre for Mental Health. (2006) Policy Paper: The Future of Mental Health: a Vision for 2015. London: Sainsbury Centre for Mental Health.

(2) Lindberg, C.E. (1997) Emergency contraception: the nurse's role in providing postcoital options. Journal of Obstetric Gynaecological and Neonatal Nursing; 26: 2, 145-52.

Louisa Davidson, RN, PGDipHeSci(Dist), PGCertNurs(Dist) is the manager and a PHC nurse at Student Health & Support, Lincoln University, Canterbury.