Monthly Archives: August 2021

CLovid Communication

This blog post aims to clarify how the clinicians on one Consultation Liaison (CL) Psychiatric Service communicate with general hospital inpatients who are being nursed in isolation during the COVID-19 pandemic.

Why? 

There has been some confusion re nomenclature of how we provide mental health assessment/support to hospitalised people in isolation . Hopefully by describing the pros and cons of the methods we’ve tried to date we’ll clear-up any misunderstandings. 

CLovid Communication options: 1. Videoconference. 2. In-Room (featuring Jelena Botha in PPE). 3. Face-To-Face through a window. 4. Phone.

1. Videoconference Review
ie: using an online videoconferencing platform that works on both the clinician’s computer and the patient’s own device

Pros:

  • No risk of infection transmission
  • When it works there is reasonably good eye contact and exchange of facial expressions and other non-verbal communications, leading to opportunities for engagement/establishing rapport 
  • Since mid-late 2020, nearly all clinicians and many (most?) consumers are familiar with videoconferencing 

Cons:

  • In my clinical practice videoconferencing for these reviews has been mostly unsuccessful. Cross-platform incompatibility and limitations to what the devices/bandwidth that hospital inpatients in isolation have access to have been problematic.
  • At our end, clinical workplaces do not provide access to the same platforms our patients typically use (eg: FaceTime, Video Chat on Facebook or WhatsApp).
  • The technology was getting in the way of the therapeutic relationship, not enhancing it.
  • For these reasons, we pretty-much gave up on trying to videoconference hospital inpatients in isolation back in April/May 2020. 

2. In-Room Review 
ie: in full PPE – face mask, goggles/face shield, gown and gloves

Pros:

  • Physical proximity is standard practice: Clinical staff and the people we care for are familiar with this 
  • Reasonably good eye contact and partial exchange of non-verbal communication, leading to opportunities for engagement/establishing rapport

Cons:

  • PPE obscures facial expressions, thereby inhibiting rapport/assessment
  • An extra clinician(s) using PPE resources
  • With no disrespect to my CLPS clinical colleagues, we’re generally not as well-drilled with donning and doffing as the specialist nursing and medical teams, creating potential risk of infection transmission

3. Face-To-Face Review 
ie: through the window/glass door panel, using phones for easy/clear auditory communication

Pros:

  • Good eye contact and exchange of facial expressions and other non-verbal communication, leading to opportunities for engagement/establishing rapport
  • No risk of infection transmission
  • Low-tech, easy to organise
  • Well received by nearly every hospitalised person in isolation that my team has seen from March 2020 to August 2021

Cons:

  • Reminds me of prison-visit scenes in American movies

4. Phone Review 
ie: speak to the person on their personal mobile or bedside phone, no visual contact

Pros:

  • No risk of infection transmission
  • Low-tech, easy to organise 
  • It’s the go-to method of communication for community mental health intake clinicians/services (ie: thought to be a good-enough tool for most triage and sub-acute presentations; may be familiar to the clinician or consumer)
  • Some people find emotional expression easier without the intimacy/intrusion of eye contact

Cons:

  • Assessment and rapport may be limited
  • Not thought to be adequate for acute or high-risk presentations

And The Winner Is…

Number 3: Face-To-Face Reviews, ie: where the clinician and person in isolation chat through the window/glass door panel, using phones for easy/clear auditory communication. 

It’s cheap, easy and effective. We use it nearly every time when there’s someone in a negative-pressure/isolation room. We’ve saved dozens, maybe hundreds, sets of PPE, and we’ve reduced the likelihood of becoming potential super-spreaders. 

Why Does It Matter?

Like just-about every other specialist mental health nurse on the planet, my clinical practice is influenced by Hildegard Peplau. Back in the 1950s dear old Aunty Hildegard had the audacity to tell nurses that, done right, the nurse-patient relationship = therapy [source]. About 60 years later neuroscience caught up with nursing theory and showed us that Peplau was right: strong relationships and strong attachments help brains heal by building new neural pathways [source]. 

A specialist mental health nurse is, amongst other things, a psychotherapist and a relationship focussed therapist [source]. A face-to-face review, even if has to be through glass, helps establish rapport and build a therapeutic relationship. 

CLovid Acknowledgements

Consultation Liaison Psychiatry Service is a bit of a mouthful, so it’s usually abbreviated to “CL”. CL = mental health in the general hospital

Back in March 2020 John Forster, a CL Nurse in Melbourne, accidentally coined the portmanteau “CLovid” by combining “CL” and “covid” as a typo. 

That’s why I’m calling this blog post “CLovid Communication”. 

Please forgive people like me who take delight in silly things like an accidental neologism. There’s been a fair bit of CLovid in the last eighteen months, and there’s more to come. Staying vigilant to the small joys and moments of lightheartedness is a survival skill. 

Thanks also to Jelena Botha, CL CNC (who arrived on my team just in time for the global pandemic 😳), for allowing me to use her PPE pic.

Further Reading

Cozolino, L. (2006/2014) The Neuroscience of Human Relationships: Attachment and the Developing Social Brain. New York, W. W. Norton & Company. [Google Books]

Hurley, J. and Lakeman, R. (2021), Making the case for clinical mental health nurses to break their silence on the healing they create: A critical discussion. International Journal of Mental Health Nursing, 30(2): 574-582. https://doi.org/10.1111/inm.12836

Peplau, H. (1952/1991) Interpersonal relations in nursing. New York: Putnam. [Google Books

Santangelo, P., Procter, N. and Fassett, D. (2018), Seeking and defining the ‘special’ in specialist mental health nursing: A theoretical construct. International Journal of Mental Health Nursing, 27(1): 267-275. https://doi.org/10.1111/inm.12317

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What have I missed from this description of CLovid communication? Please add your on-the-job experiences and lessons in the comments section below.

Paul McNamara, 14 August 2021 

Short URL meta4RN.com/CLovid

A Nurse’s Digital Identity

I am a nurse who uses social media a lot. It is my loudest voice.

If you want to see what a nurse’s digital identity looks like, grab your phone and sus-out this QR code.

My role and ambitions are mid-range. As a student nurse I thought it would be cool to be a Nurse Educator or Clinical Nurse Consultant – I’ve achieved that. I have never aspired to one of those senior management/academic gigs. The downside to that lack of ambition is the limited opportunities to set agendas that drive broad change. In fact, even getting ideas heard or considered is difficult at times.

[insert sound of trumpets going “TooDa-TooDa” here] Social media to the rescue!

And, (this is the main point of this blog post), it is OK for nurses to use social media. Actually, it’s not just OK, USING SOCIAL MEDIA IS RECOMMENDED FOR NURSES AND MIDWIVES.

Don’t believe me?

Read on.

In the ‘National Nursing and Midwifery Digital Health Capability Framework‘ there is a section specifically about being online, as below:

1.3 Digital Identity
Nurses and midwives use digital tools to develop and maintain their online identity and reputation.

This section has four parts – feel free to tweet your favourites 🙂

Digital Identity 1.3.1: Maintains a professional development record demonstrating innovation, reflecting upon skills and experience to help monitor professional identity.

You could use a free app or website for that, for example:

Or just keep it all online via the ANMF Continuing Professional Education portal

Digital Identity 1.3.2: Understands the benefits and risks of different ways of presenting oneself online, both professionally and personally while adhering to the NMBA social media policy.

The policy uses slightly more formal language (read it for yourself here), but can be accurately summarised as “Even if you’re prone to being a dickhead at times IRL, when you’re representing yourself as a nurse online don’t be a dickhead.” If you do be a dickhead online occasionally (to err is human, blah blah blah), be sure to proactively delete and/or apologise.

It is MUCH more simple to keep your private and professional social media identities separate. Create a social media portfolio using the same name on your work name badge/AHPRA registration just for work-related stuff. That’s what I’ve done here linktr.ee/meta4RN Look, I know I’ve overdone it (#tryhard), but that was intentional too. I created the meta4RN social media portfolio at a time when the “prevailing wisdom” (“prevailing ignorance”, more like it 🙄) amongst hospital and university influencers was that social media is bad. Some of these people are still impersonating Grandpa Simpson and shaking their fist at the cloud. And the internet. And social media.

Digital Identity 1.3.3: Understands that online posts can stay in the public domain and contribute to an individual’s digital footprint.

If you want an example of how online posts stay in the public domain, visit/search for The Wayback Machine or Trove (part of the National Library of Australia).

Digital Identity 1.3.4: Recognises that their professional digital footprint, where it exists, should showcase their skills, education, and professional experience.

This is where things like LinkedIn or an online Curriculum Vitae (overdue for an update) come in handy.

Don’t hide your light under a bushel. If you’re a nurse please celebrate your achievements – if we don’t, who will?

My (univited) advice to nurses and midwives is this: Don’t be afraid of social media. Be intentional.

Reference

Australian Digital Health Agency, 2020. National Nursing and Midwifery Digital Health Capability Framework. Australian Government: Sydney, NSW.
nursing-midwifery.digitalhealth.gov.au


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Thanks for visiting the meta4RN.com website/blog. Be sure to use the QR Code above or this link to see other arms of my m̶a̶g̶n̶i̶f̶i̶c̶e̶n̶t̶ m̶e̶t̶a̶4̶R̶N̶ ̶s̶o̶c̶i̶a̶l̶ ̶m̶e̶d̶i̶a̶ ̶e̶m̶p̶i̶r̶e̶ try-hard professional social media portfolio (aka professional digital identity).

As always, your feedback is welcome via the comments section below.

Paul McNamara, 5 August 2021

Short URL meta4RN.com/ID