Author Archives: Paul McNamara

About Paul McNamara

Nurse, educator & social media enthusiast. Loves AFL (Go Adelaide!), hates cotton wool. More info at meta4RN.com

She ignored her emotions while labelling his corpse #8WordStory 

Look. I’m a terribly busy and important person.

I barely have time to write this blog post, let alone satisfy my lazily-never-pursued fantasy of writing a novel.

Luckily, the Queensland Writers Centre offered a solution: the eight word story.

Eight words is the perfect length for somebody with the attention span of a stoned goldfish (eg: me).

Yesterday, one of my eight word stories was published by the Queensland Writers Centre. Published on electronic billboards, that is. Billboards that grace the busy roads, roundabouts and motorways in and around Brisneyland.

Billboard at Bowen Bridge Road, Hertson

The story published was one of three stories I submitted on Twitter for the #8WordStory project.

THREE whole stories! That’s TWENTY FOUR words, you know! #TypistCramp

Intentionally, all three of the stories relate to my work experiences. When writing these stories I was ambitious to be ambiguous. When there are only eight words to write, the reader needs to be able to bring their imagination to the story.

Interestingly, the story that was the most ambiguous of the three is the one that made it to the billboards.

#8WordStory x3

She ignored her emotions while labelling his corpse. [source]

I wrote this remembering my experiences of being with patients during the last hours of their life and for the first hours of their death. Nursing’s unique role of caring for a person’s body both in life and death is rarely spoken about or acknowledged. It’s one of those peculiar privileges of nursing.

The story is ambiguous enough for people to project their own meaning (eg: Lea’s tongue-in-cheek Tweet). I’m cool with that.

Impersonating a calm person, the nurse continued working. [source]

I was thinking of a young medical ward RN who had just intervened when a patient tried to harm himself. We had a quick “corridor consult”. She asked a couple of unanswerable questions, shed a couple of tears, wiped her eyes, washed her hands, then assumed her usual energetic and positive demeanour.

One minute there’s a crisis. Next minute it’s business as usual.

Hold and contain three things: the crisis, the patient, your emotions (not necessarily in that order).

The midwife didn’t smile until he heard crying. [source]

About 1 in every 60 Australian midwives is a male. I thought it would be more interesting and ambiguous to cite that minority in this story.

Crying is usually considered in a negative light in mainstream society, but midwives know crying as a sign of life.

Billboard on Lutwyche Road, Lutwyche

My 15 minutes 8 words of fame.

Billboard on Beaudesert Road, Moorooka

The story provides the frame. The imagination does the work.

Billboard on Logan Road, Upper Mount Gravatt

Finishing-Up

Why don’t you give an #8WordStory a go too? Submit yours via Twitter or web page.

Big shout-out to the Queensland Writers Centre for this great initiative.

Thanks for reading this far. As always, feedback is welcome via the comments section below.

End

Paul McNamara, 3rd November 2017

Short URL: meta4RN.com/8WordStory

Social Media and Digital Citizenship: A CL Nurse’s Perspective

This post is a companion piece to my keynote presentation at the 5th Annual Queensland Consultation Liaison Psychiatry Symposium “Modern Approaches in CL Psychiatry”, on 2nd November 2017,

The function of this page is to be a collection point to list references/links that will be mentioned in the presentation. The Prezi is intended as an oral presentation, so I do not intend to include a full description of the content here.

Click on the picture to see the Prezi

Bio/Intro (you know speakers write these themselves, right?)

Paul McNamara is a CL CNC in Cairns.

Paul has been dabbling in health care social media since 2010. He established an online portfolio in 2012 which includes Twitter, Facebook, Instagram, YouTube and a Blog.

In 2016 Paul was appointed to the Editorial Board of the International Journal of Mental Health Nursing specifically because of his interest in social media.

This morning’s presentation “Social Media & Digital Citizenship: A CL Nurse’s Perspective” aims to encourage the converts, enthuse the curious, and empower the cautious.

Disclaimer/Apology/Excuse

Regular visitors to meta4RN.com will recognise some familiar themes.

Let’s not call it self-plagiarism (such an ugly term), I would rather think of it as a new, funky remix of a favourite old song.

Due to this remixing of old content I’ve included lots of previous meta4RN.com blog posts on the reference list.

This, in turn, makes the reference list look stupidly self-referential. #TrumpBrag

 

Anyway, with that embarrassing disclosure out of the way, here is the list of references and links cited in the Prezi prezi.com/user/meta4RN

References + Links

Altmetric Attention Score [example] https://wiley.altmetric.com/details/23964454

Australian College of Nursing (n.d.) Social media guidelines for nurses. Retreived from http://www.rcna.org.au/WCM/…for_nurses.pdf

Australian Health Practitioner Regulation Agency. (2014, March 17). Social media policy. Retrieved from http://www.ahpra.gov.au/News/2014-02-13-revised-guidelines-code-and-policy.aspx

Casella, E., Mills, J., & Usher, K. (2014). Social media and nursing practice: Changing the balance between the social and technical aspects of work. Collegian, 21(2), 121–126. doi:10.1016/j.colegn.2014.03.005

Facebook. (2015). Facebook logo. Retrieved from https://www.facebookbrand.com/

Ferguson, C., Inglis, S. C., Newton, P. J., Cripps, P. J. S., Macdonald, P. S., & Davidson, P. M. (2014).  Social media: A tool to spread information: A case study analysis of Twitter conversation at the Cardiac Society of Australia & New Zealand 61st Annual Scientific Meeting 2013. Collegian, 21(2), 89–93. doi:10.1016/j.colegn.2014.03.002

Fox, C.S., Bonaca, M.P., Ryan, J.J., Massaro, J.M., Barry, K. & Loscalzo, J. (2015). A randomized trial of social media from Circulation. Circulation. 131(1), pp 28-33

Gallagher, R., Psaroulis, T., Ferguson, C., Neubeck, L. & Gallagher, P. 2016, ‘Social media practices on Twitter: maximising the impact of cardiac associations’, British Journal of Cardiac Nursing, vol. 11, no. 10, pp. 481-487.

Instagram. (2015). Instagram logo. Retrieved from https://help.instagram.com/304689166306603

Li, C. (2015). Charlene Li photo. Retrieved from http://www.charleneli.com/about-charlene/reviewer-resources/

lifeinthefastlane. (2013). #FOAMed logo. Retrieved from http://lifeinthefastlane.com/foam/

My Tweets = my lecture notes. Other people’s Tweets also = my lecture notes. 🙂

McNamara, P. (2017, October 16) Delirium risks and prevention. Tweets re the guest lecture by Prof Sharon Inouye at Royal Brisbane and Women’s Hospital (and Cairns via videolink) collated on Storify. Retrieved from https://storify.com/meta4RN/delirium-risks-and-prevention

McNamara, P. (2016, November 18) Twitter is a Vector (my #ACIPC16 presentation). Retrieved from https://meta4RN.com/ACIPC16

McNamara, P. (2016, October 21) Why on earth would a Mental Health Nurse bother with Twitter? (my #ACMHN2016 presentation). Retrieved from https://meta4RN.com/ACMHN2016

McNamara, P. (2016, October 15) Learn about Obesity (and Twitter) via Nurses Tweeting at a Conference. Retrieved from  https://meta4RN.com/obesity

McNamara, P., & Meijome, X. M. (2015). Twitter Para Enfermeras (Spanish/Español). Retrieved 11 March 2015, from http://www.ausmed.com.au/es/twitter-para-enfermeras/

McNamara, P. (2014). A Nurse’s Guide to Twitter. Retrieved from http://www.ausmed.com.au/twitter-for-nurses/

McNamara, P. (2014, May 3) Luddites I have known. Retrieved from http://meta4RN.com/luddites

McNamara, P. (2013) Behave online as you would in real life (letter to the editor), TQN: The Queensland Nurse, June 2013, Volume 32, Number 3, Page 4.

McNamara, P. (2013, October 25) Professional use of Twitter and healthcare social media. Retrieved from http://meta4RN.com/NPD100

McNamara, P. (2013, October 23) A Twitter workshop in tweets. Retrieved from http://meta4RN.com/tweets

McNamara, P. (2013, October 1) Professional use of Twitter. Retrieved from http://meta4RN.com/poster

McNamara, P. (2013, July 21) Follow Friday and other twitterisms. Retrieved from http://meta4RN.com/FF

McNamara, P. (2013, June 29) Thinking health communication? Think mobile. Retrieved https://meta4RN.com/mobile

McNamara, P. (2013, June 7) Omnipresent and always available: A mental health nurse on Twitter. Retrieved from http://meta4RN.com/twit

McNamara, P. (2013, January 20) Social media for nurses: my ten-step, slightly ranty, version. Retrieved from http://meta4RN.com/rant1

Moorley, C., & Chinn, T. (2014). Using social media for continuous professional development. Journal of Advanced Nursing, 71(4), 713–717. doi:10.1111/jan.12504

Nickson, C. P., & Cadogan, M. D. (2014). Free Open Access Medical education (FOAM) for the emergency physician. Emergency Medicine Australasia, 26(1), 76–83. doi:10.1111/1742-6723.12191

Nursing and Midwifery Board of Australia (2010, September 9) Information sheet on social media. Retrieved from http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2F3224&dbid=AP&chksum=qhog9%2FUCgKdssFmA0XnBlA%3D%3D

Office of the eSafety Commisioner (2017). eSafety logo. Retrieved from https://www.esafety.gov.au

Read, J., Harper, D., Tucker, I. and Kennedy, A. (2017), Do adult mental health services identify child abuse and neglect? A systematic review. International Journal of Mental Health Nursing http://onlinelibrary.wiley.com/doi/10.1111/inm.12369/abstract

Screenshot 1 “Trump: Twitter helped me win but I’ll be ‘restrained’ now” from http://money.cnn.com/2016/11/12/media/donald-trump-twitter-60-minutes/

Screenshot 2: “Melania Trump rebukes her husband “all the time” for Twitter use” from http://www.cbsnews.com/news/donald-trump-melania-trump-60-minutes-interview-rebukes-twitter-use/

The Nurse Path (facebook) https://www.facebook.com/theNursePath

Tonia, T., Van Oyen, H., Berger, A., Schindler, C. & Künzli, N. (2016). International Journal of Public Health. 61(4), pp 513-520. doi:10.1007/s00038-016-0831-y

Twitter. (2015). Twitter logo. Retrieved from https://about.twitter.com/press/brand-assets

Wilson, R., Ranse, J., Cashin, A., & McNamara, P. (2014). Nurses and Twitter: The good, the bad, and the reluctant. Collegian, 21(2), 111–119. doi:10.1016/j.colegn.2013.09.003

Wozniak, H., Uys, P., & Mahoney, M. J. (2012). Digital communication in a networked world. In J. Higgs, R. Ajjawi, L. McAllister, F. Trede, & S. Loftus (Eds.), Communication in the health sciences (3rd ed., pp. 150–162). South Melbourne, Australia: Oxford University Press

End 

Finally, a big thank you to the organisers of the 5th Annual Consultation Liaison Psychiatry Symposium, especially Stacey Deaville for suggesting this session, and Dr Paul Pun for pulling on all the right strings.

That’s it. As always your comments are welcome.

Paul McNamara, 19th October 2017

Short URL: meta4RN.com/CLPS

Phatic Chat: embiggening small talk.

Small talk is a big deal.

Small talk is the oil that keeps the machinery of interpersonal relationships running smoothly.

Small talk even has its own name. It’s called “phatic chat”.

Phatic chat has been described as “A type of speech in which ties of union are created by a mere exchange of words”  by Bronislaw Malinowski (no relation to Barry Manilow). This is why I think it’s important that us health professionals be intentional about phatic chat.

Every, “Hello. My name is…” and “How are you today?” serves to create a working relationship between people. Health professionals rely on working, therapeutic relationships.

Academics (god bless their cotton socks) have even gone to the effort of researching and naming 12 functions of phatic communication (source):

(1) breaking the silence
(2) starting a conversation
(3) making small talk
(4) making gossip
(5) keeping talking
(6) expressing solidarity
(7) creating harmony
(8) creating comfort
(9) expressing empathy
(10) expressing friendship
(11) expressing respect
(12) expressing politeness

When we think about phatic chat in the health care setting, it’s not just a social lubricant, we can also see it as a stand-alone form of therapy. Think of phatic chat as the nonspecific factors of psychotherapy

BTW: “nonspecific factors of psychotherapy” an actual thing, let me google that for you: here

Phatic chat/the nonspecific factors of psychotherapy show the person that there is someone who is interested in them and their concerns. It helps people feel understood, accepted and respected. In my current gig – providing mental health support in the general hospital – I often get told by patients how good it is to be nursed by someone who is good at phatic chat.

It’s easy to imagine, isn’t it? Who would you rather attend to your vital signs, IV antbiotics, wound dressings, and pain relief in hospital: a friendly person who chats and listens, or someone unfriendly and officious who just goes about the tasks at hand? There’s more than one way to prime an IV line.

It sounds simple, and (to my ear anyway) pretty patronising. However, it’s clear that many clinicians do not routinely engage in phatic chat.

You may already know the story of Kate Grainger. Briefly, for those who don’t, Kate was a doctor in the UK who tweeted her experience of living with a terminal illness. One of the many observations she made was that it was refreshing, but actually pretty unusual, for hospital staff to introduce themselves by name and role when they came to see you in your hospital bed. That observation lead to this tweet:

That simple idea has been one of Kate’s greatest legacies (she died in 2016).

If you’re not familiar with the #hellomynameis story, I urge you to visit the hellomynameis.org.uk website for more info.

#hellomynameis = a very successful campaign promoting phatic chat in healthcare

I live and work a long way from the UK. Although I don’t wear a #hellomynameis badge, I borrow heavily from the idea that phatic chat is important, and toss-in a few more Aussie-fied ways to go about using it in the hospital setting. As argued above, phatic chat is important for building relationships and can be therapeutic in and of itself. Sometimes to be culturally safe you need to try a little harder to facilitate trust and rapport. With that in mind. here’s 4 ideas that usually (not always) work for me:

One

“Are you Cyril? G’day my name is Paul McNamara, I’m a nurse with the psych team here at the hospital. Is it OK if we sit down and have a bit of yarn?”

Two

Shaking hands is a respectful thing to do. I always offer a handshake when introducing myself to patients (they’re often surprised!).

Don’t worry infection control peeps, I’ve got that covered: meta4RN.com/hygiene

Three (this is my second favourite: I stole it from Professor Ernest Hunter)

Make a cup of tea for the patient. Even if they say “no thanks”, let them know that you’re making one for yourself anyway, so are happy to make them one while you’re at it. Take instructions on how the person likes it . Apologise if you make it too hot/strong/weak or spill it. Sip yours when they’re talking: if for no other reason, it let’s them know you’re not about to interrupt.

This might be the best journal article ever written by a psychiatrist:
Hunter, E (2008) The Aboriginal tea ceremony: its relevance to psychiatric practice. Australasian Psychiatry, 16:2, doi: 10.1080/10398560701616221
Despite the paper’s title, the same demonstrations of humbleness, politeness and respect work for whitefellas too.

Four (this is my favourite: I made this one up myself)

I nearly always use when Google Maps when introducing myself to people who have come to the hospital from out of town. “Oh you’re from Aurukun? I’ve been to Wujal Wujal, Laura and Hope Vale, but I’ve never been there. Do you mind if we use this map on my phone to see where you live?” It’s nearly always a great way to break the ice, especially when meeting with someone from a different culture. It sets the right tone of showing that you’re interested and approachable.

I’m lucky to work in a place where I meet with Aboriginal and Torres Strait Islander people all the time. By getting the Aboriginal/Torres Strait Islander person to show me around their community on a map, I’m acknowledging/demonstrating that they know stuff that I don’t know, and I’m prepared to learn from them. Sometimes I’m a bit more skilled at using the Google map app on my phone, so I get to show the person how I can be helpful, in a kind and respectful way. It probably doesn’t hurt that we’re both looking at the map together and working on the same task (it demonstrates that we can work together, and you don’t want to rush into making a heap of eye contact with someone you’ve just met). While we’re using the app to find their house, the local school, favourite fishing or camping spot, and other landmarks we’re getting to know each other a bit. I’m not left in that clumsy position of being accidentally too pushy, too intrusive, too task-orientated.

Spending a few minutes establishing rapport is what phatic chat is all about. The phone/map app is just a prop, but it’s a great prop.

In Closing

That’s it.

A while back I had a gig educating uni students. One of the best tricks-of-the-trade when in a uni lecturer role is to introduce people to words they have not heard before. This makes you look cleverer than you really are, and lends an illusion of credibility.

So, with that in mind, my call-to arms for health professionals is this:

Let’s embiggen phatic chat!
It’s a perfectly cromulent thing to do. 🙂

Acknowledgement

The phrase/notion of “phatic chat” as a defence against the forces that seek to turn nurses into unempathetic box-ticking robots came to my attention via Professor Eimear Muir-Cochrane’s keynote presentation at the ACMHN 39th International Mental Health Nursing Conference, held in Perth, Western Australia, 22nd-24th October 2013.

Storify of the keynote here: storify.com/meta4RN/zero

Follow Professor Eimear Muir-Cochrane on Twitter here: @eimearmuirc

End

As always your thoughts/feedback is welcome in the comments section below.

Paul McNamara, 12th October 2017

Short URL https://meta4RN.com/phatic

 

 

Nurse can’t take Pulse. Seriously.

This week in Australia ABC TV screened Episode 1 of a new medical drama called “Pulse“. It is said to be inspired by a true story of a transplant patient who became a doctor. Sounds cool, right? Well, it isn’t. From my perspective it’s pretty crappy, even for TV fiction. I started my career as a nurse in 1988. I’m not fond of nurses being ignored or misrepresented. Pulse does both. In spades.

Following are four reasons why I can’t take Pulse seriously (complete with Episode 1 timings, for those who want to check via iView):

1.  The cast. 

See how in the cast photo there are nine doctors and two nurses?

source: http://www.tvtonight.com.au/2017/06/gallery-pulse.html – I’ve added the labels

How does that compare to the actual health workforce in Australia?

In 2014 there were 610,148 registered health practitioners. Over half of these (352,838) were nurses or midwives – over 3 times the size of the next largest group [source: www.aihw.gov.au/workforce]. So, if we put gender-mix aside for a moment (about 90% of Australia’s nurses are female, about half of our new doctors are female) this would be a more accurate visual representation of what a real-life Australian health drama cast photo should look like:

source: http://www.tvtonight.com.au/2017/06/gallery-pulse.html – I’ve duplicated the original and added the labels

2. The patient is critically unwell, but the nurses are nowhere to be seen.   

At about 7:00 into Episode 1 there is a large group of doctors (no nurses) at the bedside of a patient. One doctor asks (referring to the patient), “What’s her oxygen saturation?” Another doctor looks around bewildered and is the prompted by yet another doctor to use the oximeter. He does and (instantly!) announces that O2Sa is 88% (this is spookily low for most people).

The fact is that nurses are the ones who are usually at the bedside, and are the ones who monitor the progress/deterioration of a patient, including measuring vital signs regularly. This monitoring would have been very frequent in someone who has low oxygen sats. The nurses would have the info on hand, and most likely would have been discussing care options with the doctors. Maybe the Pulse scriptwriters haven’t heard about multidisciplinary health teams, and don’t know that Australia’s largest union is the Australian Nursing and Midwifery Federation (ANMF) [source: anmf.org.au].

3. When you do finally see/hear the voice of a nurse it’s just two gossipy snippets. 

At about 8:40 the nameless character listed in the credits as “Scrub Theatre Nurse” (played by Lara Lightfoot), stands around doing nothing while the doctors perform surgery. Her role seems to be solely to deliver these two consecutive bits of dialogue:

“I heard from the head of department there’s an MVA that didn’t make it upstairs. There may be a potential donor.”

“The head of surgery is retiring, right? Guess they’ll be looking for a replacement.”

It’s important to note that Scrub Theatre Nurse is not depicted as actually doing anything (other than gossiping). For the non-nurses out there, please be reassured that your tax dollars are not being wasted on employing nurses to just stand around in operating theatres doing bugger-all. The roles and skills of peroperative nurses are many and varied: visit the Australian College of Perioperative Nurses website www.acorn.org.au and/or follow their link to “A day in the life of a preoperative nurse“.

Logo from @ACORN_org Twitter page

4. The only other two lines of nurse dialogue portray her as an unprofessional unethical antisocial bitch 

Carol Little RN (played by Penny Cook) has just two lines of dialogue, as below:

At about 13:00 Carol Little RN says to Dr Tabb Patel (in front of the patient and another doctor): “This time do not catheterise the cliterous, intern.” Lead character Dr Frankie Bell (correctly) advises the intern that female catheterisation is usually a nurse’s role and that the nurse was bullying him. Carol Little’s behaviour is not just a breach of common decency, but also of about 27 different aspects of the codes of conduct and ethics that set the standards for all health care workers, nurses included.

At about 17:30 lead character Dr Frankie Bell enquires on the whereabouts of a man who was meant to be receiving haemodialysis. In reply Carol Little RN gets her only other line of dialogue: “Do I look like a fucking concierge?” Is that verbal abuse or just lalochezia? The former, I think.

It’s interesting that Australians have voted nurses as the most ethical and honest profession for 23 consecutive years (1994-2017) [source: www.roymorgan.com], but the Pulse scriptwriters think otherwise.

Winding-Up

Look, Pulse is just TV fiction. The hilariously fanciful depiction of lead character Dr Frankie Bell leaving hospital to jump on her bicycle and visit the home of a dialysis patient who didn’t show-up for treatment, then stay at his bedside overnight after he receives a kidney transplant is evidence enough of creative imaginations at work. Pulse is not pretending to be a documentary. It is very clearly just another hospital TV drama. An old formula, acted well, shot beautifully, just scripted awfully.

I guess it’s not really all that important whether people watch Pulse or ignore it in the big scheme of things. My bias is such that I’d rather watch Australian TV than imported shows – it’s good for us Aussies to hear our own voices and see our own stories on the telly. However, this isn’t anything like an Australian story. Bananas in Pyjamas does a better job of portraying an Australian reality.

I will not bother watching any more episodes of Pulse because it insults nurses and nursing. Nevertheless, we should give credit where credit is due. In one simple seven-word sentence the Pulse scriptwriters managed to capture the sentiment of what it feels like to be a nurse who is angry about their skills being misunderstood, underestimated and devalued:

Dialogue scripted for the character Carol Little RN in Episode 1 of “Pulse”

End

Thanks for reading my first outing as a television critic. As always, your feedback is welcomed in the comments section below.

Paul McNamara, 22nd July 2017

Short URL: meta4RN.com/pulse 

 

First Thyself

First Thyself – Surviving Emotionally Taxing Work Environments

On 28th April 2017 I’ll be presenting a session at the Ausmed “Breaking Point: Ice & Methamphetamine Conference” in Cairns. More info about the conference here: https://www.ausmed.com.au/course/ice-methamphetamine#overview

The nature of nursing will mean that we are likely to be are exposed to a range of challenges.

Feeling unsafe, witnessing violence, tragedy and dealing with trauma are some examples.

This emotionally taxing environment can result in tension with colleagues, family and friends.

This session will begin day two of the conference by creating an opportunity to discuss the following:

What are the professional implications of working in challenging areas of nursing and healthcare?

How can we maintain unconditional positive regard?

Why self-care matters and how to practice what we preach!

What’s all this then?

“First Thyself” is planned as an interactive session accompanied by visual cues to give the discussion a bit of structure. Consequently, the transcript/dialogue of the presentation can not be included here.  The visual presentation itself doesn’t use powerpoint slides. It uses the prettier (and free!) platform Prezi instead: prezi.com/skmu0lbnmkm5/first-thyself/#

This page serves as a one-stop directory to the online resources used to support the discussion.

I’m recycling and combining a lot of old ideas for the session (there’s that self-plagiarist vs groovy remix of favourite old songs thing again).

Here is the online presentation: Prezi

Here are the resources and references used in the presentation:

Emotional Aftershocks (the story of Fire Extinguisher Guy & Nursing Ring Theory) meta4RN.com/aftershocks

Football, Nursing and Clinical Supervision (re validating protected time for reflection and skill rehearsal) meta4RN.com/footy

Hand Hygiene and Mindful Moments (re insitu self-care strategies) meta4RN.com/hygiene

Lalochezia (getting sweary doesn’t necessarily mean getting abusive) meta4RN.com/lalochezia

Nurse & Midwife Support nmsupport.org.au  phone 1800 667 877
– we have specifically targeted 24/7 confidential support available

Nurses, Midwives, Medical Practitioners, Suicide and Stigma (re the alarming toll of those who undertake emotional labour) meta4RN.com/stigma

Nurturing the Nurturers (the Pit Head Baths and clinical supervision stories) meta4RN.com/nurturers

Spector, P., Zhiqing, Z. & Che, X. (2014) Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies. Vol 50(1), pp 72-84. www.sciencedirect.com/science/article/pii/S0020748913000357

Zero Tolerance for Zero Tolerance (a reframing of reducing aggression) meta4RN.com/zero

It’s OK if you forget everything about today’s talk, just don’t forget that there is 24 hour support available via 1800 667 877 or https://nmsupport.org.au

End

Please have a play with the pretty Prezi prezi.com/skmu0lbnmkm5/first-thyself/#

Thanks for visiting. As always your comments are welcome.

Paul McNamara, 30 March 2017

Short URL: meta4RN.com/thyself

 

 

The Hearing-Voices/Car-Driving Metaphor

A while ago I met a lady who had a fantastic way of describing and understanding her experience of auditory hallucinations/psychosis. It goes a bit like this:

My body’s a car. I’m the driver.

In the back seat are the voices. They’re like naughty kids, always chatting away amongst themselves. Often they’re taunting me. 

Usually I can just ignore them and get on with driving the car.

However, every now and then the voices get real loud.

It’s distracting. Driving becomes difficult and that’s when I’m most likely to drive badly or, if I’m unable to concentrate properly, I could even crash the car. 

It’s pretty scary, but I usually don’t have to come into hospital at that point. I just need more support to get control back, and maybe a change to my medication. 

The worst time for me is when the voices get so distracting that I can’t focus on driving at all. I turn to the voices in the back seat and try to get them to shut up. But they’re like naughty kids yelling and jumping around the car, and I can’t get them to stop. 

I take my seatbelt off and turn to face them, then somehow – I don’t even notice it happening – one of the voices will slip into the driver’s seat and take over control of driving the car.

Thats when it gets REALLY dangerous.

I’m not out of control – it’s worse than that – I have lost control entirely. I haven’t even got my hands on the steering wheel anymore, and I can’t reach the brakes. 

That’s when I need to come into hospital.

At the time I met this lady she was make a tentative recovery from one of these acute episodes of psychosis. On admission she had been experiencing command auditory hallucinations, paranoid delusions, racing thoughts and suicidal ideation.

When we met the intensity of these symptoms was settling. The lady’s articulate insight helped us both communicate effectively when she had a relapse in symptoms. To keep her safe we needed to stop her from leaving the hospital, and provide an increased level of supervision/support. To get a shared understanding of this I was able to return to the lady’s metaphor:

I’m worried that you’re at risk of losing control of the car again. What I’m planning to do is take the keys away for now, and hand them back to you when you’re safe to drive again. 

That’s a good way to think about using the Mental Health Act – it’s a mechanism to decrease risk/stop people from a foreseeable crash if they’ve lost the capacity to drive. 

However, the real story here is about the intelligence, insight and articulate communication of a young woman who experiences symptoms of psychosis.

An impressive person, and a fantastic metaphor. 

Hopefully other people will be able to make use of this lady’s metaphor as a way to understand psychosis/hearing voices. 

car
End

Thanks for visiting. As always your comments/feedback is welcome below.

Paul McNamara, 20th February 2017.

Short URL: https://meta4RN.com/car

The problem is the date, not the day

Back in the olden days only birds tweeted.

In 1994 we didn’t have social media with which to share, Like or Tweet about every outrage du jour. Those were the days when if you had a strong opinion about something in the news, the only way for an ordinary person to join the public conversation was thus:

  1. Find a piece of nice paper
  2. Succinctly write your thoughts on an issue
  3. Find an envelope
  4. Buy a stamp
  5. Mail your letter off to the local newspaper
  6. Then wait to see whether it is published as a Letter to The Editor.

Crazy, right?

Who would bother?

tiserdate

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tiser1

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tiser2

I want to reprise that old Letter to the editor here for two reasons:

1. The Headline is Wrong

The Editor of the Advertiser put the wrong headline on my letter: It should have read “Inappropriate date”, not “Inappropriate day”. It’s totally appropriate to have a day to celebrate being Australian and to celebrate prominent, successful Australians (e.g.: Nurses on the Australia Day Honours List). Of course it’s ridiculous to hang onto January 26th. It’s inevitable that the date will change when Australians get around to electing a progressive government again.

The problem is the date, not the day.

Let’s not throw the baby out with the bathwater.

We can celebrate the people on the Australia Day Honours List without celebrating the date.

2. Long Weekends are Good

When i wrote the letter in 1994 it was the first time that the Australia Day public holiday was tied to January 26th. Before then it used to be the closest Monday. I was doing shift work at the time (12 hour shifts, 2 on/2 off @ Glenside Hospital, Adelaide), so wasn’t directly affected by long weekends. Nevertheless, I still knew a good thing when I saw it: consecutive days off work are a great way celebrate our good fortune of being Australian.

When we consciously de-couple ourselves from the current date, let’s re-couple our national day to a weekend. What a great way to celebrate Australia’s most valuable assets – our environment, climate and accent on leisure.

icea

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As alway, your comments/feedback are welcome. Please use the comments section below.

Paul McNamara, 26 January 2017

Short URL: meta4RN.com/ChangeTheDate 

Twitter Hashtag: #ChangeTheDate