Monthly Archives: February 2021

Clinical Supervision Starter Kit

There is a lot of information about clinical supervision as it applies to nurses and midwives,. Wouldn’t it be handy if someone curated the key stuff you need as clinical supervision “starter kit” in one place? That’s the thought I woke up with this morning, so here goes:

Introducing Clinical Supervision

I’ll probably do a few presentations re clinical supervision. To keep everything in the same place, here is a link to the Prezi: https://prezi.com/view/Dqdh9x5Blc8XGB7tk0IO/

YouTube version of the presentation is embedded below:

Six Cool Things To Check-Out

1. Australian College of Nursing, Australian College of Mental Health Nurses and Australian College of Midwives (April 2019) Joint Position Statement: Clinical Supervision for Nurses and Midwives [PDF] JointPostionStatement

2. Queensland Health (October 2009) Clinical Supervision Guidelines for Mental Health Services [PDF] QHGuide2009

3. Queensland Centre for Mental Health Learning [QCMHL] (February 2021) Clinical Supervision Training [Website] if that link does not work, below are PDFs re each of the three courses:
a. Best Practice Models of Supervision (1 day introduction to clinical supervision) [PDF] Beginner
b. Supervisor (2 day workshop re core supervisor competencies) [PDF] Intermediate
c. Supervising Supervisors (2 day workshop to develop advanced skills) [PDF] Advanced

4. McNamara, P. (September 2014) Sample Clinical Supervision Agreement [Website] [MSWord]

5. Queensland Centre for Mental Health Learning [QCMHL] (September 2020) Clinical Supervision Resources [Website] if that link does not work, use this: [ArchivedWebsite]

6. Australian Clinical Supervision Association (January 2020) Clinical Supervision Resources [Website] if that link does not work, use this: [ArchivedWebsite]

End of the Start

To my way of thinking, the info above is a comprehensive “starter kit” for nurses and midwives who are new(ish) to clinical supervision.

Below I’ll add links to other info that may be of interest. This list certainly will not be exhaustive, but hopefully will be interest to people like me (a nurse in Queensland).

Selected Further Reading

Cutcliffe, J.R., Sloan, G. and Bashaw, M. (2018), A systematic review of clinical supervision evaluation studies in nursing. International Journal of Mental Health Nursing, 27(5): 1344-1363. https://doi.org/10.1111/inm.12443 

Dawber, C. (2013), Reflective Practice Groups for Nurses: A consultation liaison psychiatry nursing initiative: Part 1 – the model. International Journal of Mental Health Nursing, 22(2): 135-144. https://doi.org/10.1111/j.1447-0349.2012.00839.x

Dawber, C. (2013), Reflective Practice Groups for Nurses: A consultation liaison psychiatry nursing initiative: Part 2 – the evaluation. International Journal of Mental Health Nursing, 22(3): 241-248. https://doi.org/10.1111/j.1447-0349.2012.00841.x

McNamara, P. (since 2012) various blog pages Clinical Supervision
https://meta4RN.com/?s=clinical+supervision

White, E., & Winstanley, J. (2010). A randomised controlled trial of clinical supervision: selected findings from a novel Australian attempt to establish the evidence base for causal relationships with quality of care and patient outcomes, as an informed contribution to mental health nursing practice development. Journal of Research in Nursing, 15(2), 151–167. https://doi.org/10.1177/1744987109357816

End Notes

It’s likely I’ll add to the “Selected Further Reading” section over time. If you think there’s an important journal article/other resource that belongs here please let me know via the comments section at the bottom of the page.

Thanks for visiting.

Paul McNamara, 21 February 2021

Short URL meta4RN.com/sup

(Yes – it’s intentional that the short URL uses “sup” as the shortened version of the far-too-long to say or text “what’s up?”. Spot the middle-aged man pathetically trying to be cool.)

Ye Olde Antiemetic Sniffing of Alcohol Swabs

When I was a student nurse back in the 1980s at the Royal Adelaide Hospital, one of the Registered Nurses shared a trick with managing nausea. It was pretty simple:

  1. Rip open an alcohol swab (“proper” nurses always had some in their pocket, along with scissors, a multi-coloured pen, and about eleventy-seven other things).
  2. Advise the patient to hold the alcohol swab close to their face, and breath in the fumes through their nose.
  3. Assuming (hoping) that there’s a PRN order for it, scoot off to gather a Metoclopramide* (Maxalon) vial and injecting equipment, but don’t crack the vial.
  4. On your return to the bedside, ask whether they are still feeling nauseous and, if so, would they like an IM injection to take the nausea away.

Result = about half the time, maybe a bit more, the nausea had resolved just by sniffing the alcohol swab.

Ye Olde Tradition vs Evidence-Based Practice

I did a quick whip-around a couple of the wards at the hospital where I work today. A couple of nurses had heard of this trick, but most hadn’t. So, is it just nursing folklore/a tradition, or is it evidence-based?

Nurses have noted “that it just works” for a while (Spencer 2004).

A 2002 study found that inhaling alcohol was just as effective as standard treatment in post-op patients (Merritt, Okyere &  Jasinski).

In a study of women undergoing outpatient gynecologic laparoscopic procedures (n = 100), postoperative nausea resolved quicker using 70% inhaled isopropyl alcohol (ie: the content of a typical swab) compared with intravenous ondansetron (Winston, Rinehart, Riley, Vacchiano & Pellegrini, 2003).

Anderson and Gross (2004) conducted a small (n = 33) trial, and found that alcohol, peppermint and saline (as a placebo) were equally efficacious. They speculated that the controlled breathing may be more important than the scent.

A 2018 review of two random controlled trials (n = 226) concluded that inhaling alcohol was effective for mild to moderate nausea in non-pregnant emergency department patients (Lindblad, Ting & Harris).

Finally, a recent randomized, placebo-controlled trial study (n =115) found that inhaling alcohol was significantly more effective than placebo, and those inhaling alcohol were much less likely to require other antiemetic medication (Candemir, Akoglu, Sanri, Onur & Denizbasi, 2021).

*Metoclopramide

The way I remember it, metoclopramide was the only antiemetic medication available back in the 1980s. I’m pretty sure that ondensetron wasn’t invented then (I don’t recall hearing about it), or maybe it just wasn’t  an affordable option at the time.

So What?

I’d imagine that I’ve missed a number of published studies. It’s just my blog dude – not bloody Cochrane Review.

All I wanted to do was see if there had been much research about Ye Olde Antiemetic Sniffing of Alcohol Swabs.

As shown above, there’s been a bit, but certainly nothing like the numbers of patients you’d have if you were trying to get a medication to market. Yet, as none of the studies listed above found unwanted ill-effects, and nearly all of them found that inhaling an alcohol swab was a useful antiemetic, maybe I should do as my senior colleague did back in the 1980s, and spread the word.

Spread The Word

To manage nausea:

  1. Rip open an alcohol swab.
  2. Advise the patient to hold the alcohol swab close to their face, and breath in the fumes through their nose.
  3. Give them a few minutes, then return to see if it’s been effective.
  4. If it hasn’t, progress to treatment as usual.
  5. Keep score. There’s probably a research paper in this for you/your ward.

End

That’s it for this blog post.

Do you have any other “secret” nursing tips and tricks that should be shared? If so leave a message via the comments section below… maybe you’d like to write a guest post on the blog (it has a couple of thousand visitors most months).

Paul McNamara, 8 February 2021

Short URL: meta4RN.com/swab

References

Anderson, L. & Gross, J. (2004) Aromatherapy with peppermint, isopropyl alcohol, or placebo is equally effective in relieving postoperative nausea. Journal of PeriAnesthesia Nursing, 19(1), pp 29-35. https://www.sciencedirect.com/science/article/pii/S1089947203003071

Candemir, H., Akoglu, H., Sanri, E. Onur, O. & Denizbasi, A. (2021). Isopropyl alcohol nasal inhalation for nausea in the triage of an adult emergency department. The American Journal of Emergency Medicine, 41(1), pp. 9 – 13. https://www.ajemjournal.com/article/S0735-6757(20)31172-4/fulltext

Lindblad, A., Ting, R. & Harris, K. (2018). Inhaled isopropyl alcohol for nausea and vomiting in the emergency department. Canadian family physician Medecin de famille Canadien64(8), 580. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189884

Merritt, B., 0 Okyere, C. & Jasinski, D. (2002) Isopropyl Alcohol Inhalation: Alternative Treatment of Postoperative Nausea and Vomiting, Nursing Research, 51(2), pp 125-128. https://journals.lww.com/nursingresearchonline/Abstract/2002/03000/Isopropyl_Alcohol_Inhalation__Alternative.9.aspx

Spencer, K. (2004). Isopropyl Alcohol Inhalation as Treatment for Nausea and Vomiting, Plastic Surgical Nursing: 24(4), pp 149-154. https://journals.lww.com/psnjournalonline/Abstract/2004/10000/Isopropyl_Alcohol_Inhalation_as_Treatment_for.5.aspx

Winston, A., Rinehart, R., Riley, G., Vacchiano, C. & Pellegrini, J.(2003) Comparison of inhaled isopropyl alcohol and intravenous ondansetron for treatment of postoperative nausea. AANA (American Association of Nurse Anesthetists) Journal, 71(2), pp. 127-32. https://pubmed.ncbi.nlm.nih.gov/12776641