Monthly Archives: August 2022

EAT Target

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This blog post is to simply share the content, JPEG and PDF of a poster that will be presented at the FNQ (Far North Queensland)/CHHHS (Cairns and Hinterland Hospital and Health Service) Research and Innovation Symposium on 16 September 2022.

EAT Target (Eating disorder planned Admission via Transit lounge)

Background and Rationale

It was observed there was a prolonged delay in commencing nasogastric feeds for some people who had a planned admissions via the Cairns Hospital Transit Lounge for nutritional resuscitation in relapse of an eating disorder.

Delayed nutritional resuscitation in eating disorders increases refeeding risk, decreases medical stability, may cause health deterioration, and delays safe hospital discharge.

Method

To address the concerns re delayed nutritional resuscitation, a nurse- and dietitian-led response was discussed, solutions were brainstormed by the presenters, and the “EAT Target” was proposed (EAT = Eating disorder planned Admission via Transit lounge).

Since that brainstorming session the EAT Target has been refined and drafted as a workplace instruction named “Initiation of nutrition for patients with Eating Disorders admitted via Transit Lounge.” This is expected to be implemented in August/September 2022.

Results (ie: content of new time-critical work instruction)

⏰ On admission to transit lounge obtain baseline observation including lying and standing BP and HR, 12 lead ECG, IV cannula, routine bloods and baseline height.

⏰ Liaise with medical team for admission. Aim for timely charting of medications including IV thiamine and PRN anxiolytics to assist with NG tube insertion if appropriate.

⏰ Insertion of Nasogastric tube (pending medical order) within 2 hours of presentation either at transit or in General Medical ward depending on bed availability.

⏰ Confirm position of NG tube as per clinical guidelines (ie: low risk patients can have placement confirmed by pH strip, and may not need to proceed to x-ray).

⏰ Liaise with Dietitian to document NG feeding regime within 2 hours of presentation. For after-hours presentations please follow Initiation of Nutrition for Patients with Eating Disorders (ADULT) General Medical and Mental Health Teams.

⏰ Liaise with Consultation Liaison Psychiatry Service CNC via ext 66175. Aim for nursing care plan, clarification regarding AIN special etc within 2 hours of presentation.

⏰ Commence NG feed within 3 hours of admission to Transit lounge (NB: ensure IV thiamine is administered prior to NG feed).

⏰ Offer resource plus if NG feed is delayed beyond the 3-hour mark.

⏰ Enter “orders” on ieMR for nursing care as per QuEDS guidelines: QID Lying and standing BP/ pulse, QID BGL & 2am BGL monitoring, Daily ECG, Weight – Monday and Thursday.

Evaluation

⏰ Quantitative
Pre- and post- comparison data re time taken for NGT insertion and commencement of feeding.

⏰ Qualitative
Feedback from inpatients with the lived experience of planned admission for nutritional restoration in eating disorder.

Key Message

⏰ Nutritional Resuscitation is Time Critical ⏰

Acknowledgements

Dozens of staff on the CHHHS multidisciplinary team collaborate to provide safe, timely care to people experiencing eating disorder relapse. The CHHHS values of compassion, accountability, integrity and respect are embedded in our practice together. It is a pleasure to work with you.

Mental Health and ATODS Nursing Director kindly funded this poster for the 2022 Cairns and Hinterland Hospital and Health Service Research and Innovation Symposium. Thanks Gino. 🙂

Presenters

The presenters are a collaboration of medical nurses with an interest in caring for people with eating disorders, together with a specialist dietitian and two specialist mental health nurses.

⏰ Rekha Thomas, RN, BN, Grad Cert
Clinical Nurse, General Medical Unit, Cairns Hospital

⏰ Nicolle Hogan, RN, BN, Grad Cert
Nurse Unit Manager, General Medical Unit, Cairns Hospital

⏰ Emma Coleman, APD, NEDC
Dietitian, North Queensland Eating Disorder Service (NQuEDS) & Cairns Hospital

⏰ Jelena Botha, RN, BN, Grad Cert, MMHN
Clinical Nurse Consultant, Consultation Liaison Psychiatry Service, Cairns Hospital

⏰ Paul McNamara, RN, BN, MMHN, FACMHN
Clinical Nurse Consultant, Consultation Liaison Psychiatry Service, Cairns Hospital

eattargetposterDownload

Citation

Thomas, R., Hogan, N., Coleman, E., Botha, J. & McNamara P. (2022, September 16). EAT Target [Poster presentation]. 2022 Cairns and Hinterland Hospital and Health Service Research and Innovation Symposium, Cairns, Queensland, Australia. https://cairns.health.qld.libguides.com/chhhs-researchsymposium

End Notes

I’m home with time on my hands recovering from a minor procedure. That’s why there’s been a flurry of online activity. Don’t worry. I’ll be back at work soon, and will stop cluttering-up the internet then.

Observation: it’s MUCH easier to spruik about work-stuff when you’re not busy and tired doing work-stuff. 🙂

Technical note: the poster above (and this one from yesterday) was made using Apple Pages on an iMac from about 2017ish. The formatting was pretty easy, but took me quite a few hours. I don’t think I could earn a living out of it. I would have to drop my hourly rate to about 50 cents.

That’s it. Thanks for visiting. As always, feedback is welcome via the comments section below.

Paul McNamara, 24 August 2022

Short URL meta4RN.com/EAT

Poster for 2022 FNQ/CHHHS Research and Innovation Symposium

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The 2022 FNQ (Far North Queensland)/CHHHS (Cairns and Hinterland Hospital and Health Service) Research and Innovation Symposium is scheduled for Friday 16 September.

https://cairns.health.qld.libguides.com/chhhs-researchsymposium/home

Read all about it: cairns.health.qld.libguides.com/chhhs-researchsymposium/home

This blog post is to simply plonk online the content, JPEG and PDF of a poster that will be presented at the symposium (share or perish!).

@CairnsHelp (brocures are so last century)

key message Share & Connect with Local Support Services

how? search for “CairnsHelp” as one word
or go to linktr.ee/CairnsHelp
or access @CairnsHelp via social media
or scan the QR code

background & rationale

Wouldn’t it be handy for clinical staff and the people they support if there was a comprehensive list of community support agencies in one easy-to-access, easy-to-share place?

Using a free social media platform (linktree) a comprehensive list of support agencies – not just health-specific – has been collated in one place.

Phone numbers and links to agency websites are provided.

The list is reviewed/updated twice a year and PRN. Uptake and use of the site is measured and reported on to determine whether it is of use to the Cairns community.

method

After a cautious small trial in April 2021, application was made via the CHHHS Mental Health & ATODS Leadership meeting in May 2021 to amplify the trial.

In August 2021 the CHHHS Executive approved further roll-out via a lanyard swing-tag QR Code.

Since early 2022 the emphasis has shifted away from the QR code to simply suggesting that people search for “CairnsHelp” as one word.

To determine impact and usefulness of the strategy, data has been gathered on how often the linktr.ee/CairnsHelp site has been accessed.

results (data from April 2021 to August 2022)

The linktr.ee/CairnsHelp site has been accessed over 2700 times; nearly 23% click through to a listed site.

75% of site access is direct/via QR code, 19% is via Google, and 6% is via other search engines or social media.

79% of site access is on a mobile device, 21% is via desktop.

evaluation & implications for practice

The linktr.ee/CairnsHelp site has had a modest amount of uptake in its first seventeen months of use.

As it has required only a modest amount of time to establish and share the site and minimal funding support, this is – to date – a reasonable return on investment.

Further monitoring of uptake will be required to determine whether or not this innovative idea is worth sustaining.

thank you for funding the swing tags and poster

CHHHS Mental Health and Alcohol Tobacco & Other Drugs Service

presenter

Paul McNamara BN MMHN FACMHN
Clinical Nurse Consultant
Consultation Liaison Psychiatry Service

CHHHS (Cairns and Hinterland Hospital and Health Service) Research and Innovation Symposium, 16 September 2022

cairnshelpposterDownload

Citation

Look, I’m under no illusions that this poster is in competition with highfalutin peer-reviewed academic publications, but conference posters are citable (is that even a word?) PRN. Thus:

McNamara P. (2022, September 16). @CairnsHelp (brocures are so last century) [Poster presentation]. 2022 Cairns and Hinterland Hospital and Health Service Research and Innovation Symposium, Cairns, Queensland, Australia. https://cairns.health.qld.libguides.com/chhhs-researchsymposium

End Notes

That’s it. As always, feedback is welcome via the comments section below.

Paul McNamara, 23 August 2022

Short URL meta4RN.com/symposium

Supporting the person diagnosed with a personality disorder who presents to the Emergency Department following intentional self-harm

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About eighteen months ago I was invited to contribute a chapter to a book on Mental Health in Emergency Care. The chapter was to be named “Supporting the person diagnosed with a personality disorder who presents to the Emergency Department following intentional self-harm”.  

Pretty-much straight away I asked Enara Larcombe to co-produce/co-write the chapter with me. Co-production is in keeping with the “nothing about us without us” idea (which has gained a lot of buy-in from senior mental health nurses). My reasons for asking were:

  • It’s good manners
  • It would improve the contribution
  • It would be difficult to write on the subject without including learnings I’ve acquired when working with Enara

As it turns out, in the process of collaboration Enara became the lead author of the chapter. Enara did the lion’s share of the literature search, and contributed some fantastic lived-experience insights. Enara certainly earned lead authorship. After lots of to-ing and fro-ing between us, Enara and I proudly sent off our chapter about a year ago.

The key points of the chapter are:

  • Borderline personality disorder is often misunderstood, and many people who have been given this diagnosis feel that it has stigmatised their care in the hospital and health system. 
  • Intentional self-harm is a complex phenomenon; it does not always indicate a wish to die. 
  • Nurses and other emergency care professionals are well placed to provide both physical and mental health care to the person who presents following intentional self-harm. 

 The learning outcomes we hope the chapter will assist with are:

  • Improve your understanding of the diagnosis of borderline personality disorder and what this means for the person. 
  • Articulate the differences and similarities between a suicide attempt and non-suicidal self-harm. 
  • Describe examples of stigma that the person who self-harms experiences and consider how this might impact on practice. 
  • Identify nursing interventions and practices that are helpful to the person who self-harms.   
  • Describe the communication and interpersonal skills that can be deployed to support the person who intentionally self-harms/who has been diagnosed with borderline personality disorder. 

So What?

Today I learned that the book with our chapter is available for pre-purchase.

Shit is getting real homies.

From the info available on the website, it looks like our chapter has been renamed from “Supporting the person diagnosed with a personality disorder who presents to the Emergency Department following intentional self-harm” to “Emergency Department: Person with personality disorder presenting with deliberate self-harm”.

I prefer the kinder, more respectful “Supporting the person diagnosed with..” bit, but anyway…

Anyway, I’m pleased-as-punch to be a co-author of a chapter in a book. Not perfoming at quite the same level as Tim Winton or JK Rowling, but for me it’s still a big deal.

Chapter Reference

it’s a pain-in-the-arse citing chapters in reference lists, so in the interests of encouraging you to read and cite the chapter, let’s keep it copy-and-paste easy:

APA
Larcombe, E. & McNamara, P. (2022) Emergency Department: Person with personality disorder presenting with deliberate self-harm. In P. Marks (Ed), Mental Health in Emergency Care, (pp. 131-143), Elsevier

Harvard
Larcombe, E & McNamara, P 2022, ‘Emergency Department: Person with personality disorder presenting with deliberate self-harm’, in P. Marks (ed), Mental Health in Emergency Care, Elsevier (pp. 131-143)

MLA
Larcombe, Enara & McNamara, Paul. “Emergency Department: Person with personality disorder presenting with deliberate self-harm.” Mental Health in Emergency Care, edited by Peta Marks, Elsevier, 2022, pp. 131-143

Q & A

Q: Mental Health in Emergency Care will be on the bookshelves in about three months. Is it the perfect Christmas gift?
A: Yes. Yes it is the perfect Christmas gift. 🙂

Q: How much money do you make for each copy sold?
A: Zero dollars and no cents. 😦

Q: Huh?
A: Academic publishing puts a value on everything except the content creators. ikr

Q: Why skite in August about a book that is not available until November?
A: Because I intend to mothball this website in September. It’s now or never.

Q: Why skite about it all?
A: I was a scrape-through-average student at school. That was a LONG time ago, but still… being published suprises and delights me.

Q: So, do you admit that you’re just bragging?
A: I admit that I don’t hide my light under a bushel. I’ve written about this before [see A Nurse’s Digital Identity]. Get on board. Don’t be mean.

Q: Where do I find out more about the book?
A: www.elsevierhealth.com.au/mental-health-in-emergency-care-9780729544214.html

End Notes

Many thanks to Peta Marks for inviting the chapter contribution; huge thanks to Enara Larcombe for co-producing it.

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

Paul McNamara, 22 August 2022

Short URL meta4RN.com/chapter

Consultation Liaison Psychiatry Service @ CHHHS Eating Disorder Forum

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Next month there is an Eating Disorder Forum at Cairns Hospital. Amongst the teams presenting is the Consultation Liaison Psychiatry Service (CLPS). This blog post aims simply to serve as an easy-to-find landing spot for the CLPS presentation.

Here is the link to the presentation (on Prezi).

The session is designed to be a narrative. Relying mostly on screenshots of what ieMR file entries* look like, the presentation is just a prop to keep the narrative of the presentation on-topic. The main themes are:

  • the role of the Consultation Liaison Psychiatry Service (spoiler alert: it includes consultation and liaison)
  • an illustration of some of the things that are covered in a consultation with the person experiencing an eating disorder
  • understanding the person’s strengths, vulnerabilities and goals
  • ensuring care is person-centred
  • what collaboration and liaison looks like in this context
  • understanding that the person is relying on a network of individuals and services
  • emphasising the importance of communication between teams and across settings
  • separate the person from the eating disorder (that’s where the Mean Girls thing comes in – zoom in to the Prezi for elaboration)
  • practical support to the nursing team
  • when applicable/appropriate, delegation of tasks to AINs (more about that here)
  • managing transference and countertransference
  • minimising ruptures and conducting running-repairs in relationships between and within teams

ieMR file entries*

Worried about confidentiality? Relax. The patient’s name is ‘Kerry Test Test Codesettest‘. Kerry is not a person. Kerry is a sandbox to play in when practicing or illustrating how ieMR can be used.

Video Version

End

That’s it for this pretty-underwhelming blog post. As said at the beginning, it’s really just an easy way to find this link: https://prezi.com/view/vl5K2u4ilHNZ8TLySlpI/

Thanks for visiting.

Paul McNamara, 12 August 2022

Short URL: meta4RN.com/psych

Addit.

Due to unplanned staff absences coinciding with Body Image and Eating Disorders Awareness Week, this session was tweaked and revised for Cairns Hospital Grand Rounds on Friday 9 September 2022.

More about that via meta4RN.com/BIEDAW

Nursing in the Tropics: Experience the Lifestyle! (circa 2002)

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Today on Twitter, out of the blue, Mick Blair reminded me of a twenty-year-old poster.

Sometime in the early 2000s (2001 or 2002, I think) my local health service went on a recruitment drive titled, “Nursing in the Tropics: Experience the Lifestyle!”.

The poster featured ten nurses.

Nine of the nurses are female and doing stuff.

One of the nurses is male and just standing around not obviously participating in a task. That nurse is me. However, to be fair, I may have been reflecting on-, or planning for-, something important. I don’t know. It was a long time ago. Don’t judge me man. 😬

Anyway, I was pleased to be reminded of the campaign poster today, and wanted to plonk it here on the website for nostalgia’s sake and so I can find it again PRN.

Nursing in the Tropics: Experience the Lifestyle! Cairns Health Service District poster (circa 2002)

One More Thing

The “Nursing in the Tropics: Experience the Lifestyle!” campaign ran its course many years ago. There is a fresher, funkier campaign in its place. Check out the Cairns and Hinterland Hospital and Health Service (CHHHS) #HealthUpNorth hashtag on social media, and/or check out the CHHHS careers page: cairns-hinterland.health.qld.gov.au/careers

I’ve been working here since the mid-90s (actually working, not just standing there like I am in the poster), and it’s good. The people are what makes it great, but the climate and user-friendliness of living in a compact city with world-class attractions and an international airport on its doorstep help too. Working in Cairns was, and remains, a quality of life decision that I’ve never regretted.

End Notes

That’s it. As always, feel free to leave feedback via the comments section below.

Sincere thanks to Mick Blair for the tweet/nostalgia trip. 🙂

Paul McNamara, 8 August 2022

Short URL: meta4RN.com/tropics

When a nurse in the know writes a book you probably should read it.

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Coral Wilkinson has been a Registered Nurse for over 30 years. We’ve crossed clinical paths a lot, especially during Coral’s stints as a Clinical Nurse Consultant and Nurse Navigator for older persons, and when she was working on the Aged Care Assessment Team. Coral is one of those very capable and kind characters – the sort of person who lifts the standard and reputation of nursing.

In recent years Coral has started an organisation called See Me Aged Care Navigators which is described as ‘the human compass you need to guide and support you through Australia’s aged care system’. As an adjunct to the organisation and its informative website, Coral has written a book aimed at the adult children of older people in need of support, who are a bit unsure on what services are available and how to access them.

When a nurse in the know writes a book you probably should read it. Especially if it’s about something as mysterious and baffling as Australia’s aged care system. There’s a lot of experience, knowledge and acquired practical wisdom in this book. I am sure that the information provided will assist readers to understand and negotiate complex pathways to care.

More Info

More about Coral Wilkinson here: www.seemeacn.com.au/about-us

More about Coral’s book, ‘My Parents Are Ageing, What The Heck Do I Do?’ (and how to get your hands on a copy) here: www.seemeacn.com.au/thebook

End

That’s it. This blog post is short, sharp, and breezy.

And an overt plug for My Parents Are Ageing, What The Heck Do I Do? by Coral Wilkinson 🙂

Paul McNamara, 2 August 2022

Short URL meta4RN.com/read