Author Archives: Paul McNamara

About Paul McNamara

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

Share or Perish!


 

About a decade ago, the old academic refrain to ‘publish or perish’ was updated to ‘be cited or perish’. A couple of days ago we published a paper arguing for a new call-to-arms: ‘share or perish’.

The truth is not too many people are perishing in the academic space. However, there is a pretty good indication that publishing in a journal that has a social media strategy makes a difference.

Want evidence? Have a look at these excerpts from our paper that compares the 18 months before the appointment of a social media editor for the International Journal of Mental Health Nursing (IJMHN) with the 18 months after that appointment.

First piece of evidence is in Figure 1 (below). Data from Twitonomy collated in 6‐monthly increments shows that after appointment of an IJMHN social media editor there was a 13½‐fold increase in tweets, and a 16‐fold increase in shared URLs.

Figure 1. Twitter Activity before and after the commencement of IJMHN social media editor on 01/01/17. Data from Twitonomy collated in 6‐monthly increments.

Figure 2 (below) plots 4 different data points. 

It shows that Impressions increased from an average of 118 per day to 2839 per day. That’s a 24-fold increase on how many Twitter accounts potentially saw an @IJMHN Tweet each day. 

Retweets increased from an average 62 retweets every 6 months to over 2140 retweets every 6 months. That’s a 35-fold increase in the number of time @IJMHN Tweets were shared – a remarkable increase in audience reach.

Similarly, the ‘likes’ that @IJMHN attracted increased from 45 times every 6 months to 2083 every 6 months. That’s a 46-fold increase in people acknowledging or showing approval to @IJMHN Tweets.

Most importantly, the number of times people clicked on the link (URL) of an IJMHN paper increased markedly too. It jumped from 129 to 2960 link clicks recorded every six months – a 23‐fold increase.

Figure 2. Twitter Impact before and after the commencement of IJMHN social media editor on 01/01/17. Data from Twitter Analytics collated in 6‐monthly increments.

The final data point I’ll present here is the Altmetric Attention Score (AAS), as shown in Figure 3 (below). The AAS increased from an average of 490 to 1317 every 6 months. This equates to an 169% increase in online attention and activity for IJMHN.

Figure 3. Altmetric Attention Score and Number of Articles published before and after the commencement of IJMHN social media editor on 01/01/17. Data from Altmetric collated in 6‐monthly increments.

Closing Remarks

This simplified summary of the paper misses some of the data and the description of context, the social media strategy and the reporting method. Please see the original paper for more info [link].

Want to find out more about how some of this stuff is measured? Start here: https://wiley.altmetric.com/details/62929297

Please share the link to this blog and/or to our paper about stage one of the International Journal of Mental Health Nursing social media strategy.

Don’t forget: Share or Perish! 

Citation 

McNamara, P. and Usher, K. (2019), Share or perish: Social media and the International Journal of Mental Health Nursing. International Journal of Mental Health Nursing, online from 30/06/19, volume and issue yet to be allocated [I’ll update this when it’s in an issue]
DOI: https://doi.org/10.1111/inm.12600
URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/inm.12600 

End

As always, feedback is welcomed via the comments section below.

Paul McNamara, 2 July 2019

Short URL: meta4RN.com/share

ieMR Liaison Psych Templates

A Quick Explanation

In the hospital that I work in we use ieMR. I’m a fan of ieMR, even though it has made the bad art of gingerbread women/men, genograms and other diagrams obsolete (more about that here: meta4RN.com/picture).

Car vs Bike Wounds: even an illustration that completely lacks artistic merit can convey a lot of information more effectively than a page full of text.

One of the reasons I like ieMR is that it accommodates auto-text/templates, which – in turn – assists clinicians to document with better consistency and more structure than they might have otherwise. When we have students on placement I used to send them MS Word versions of my ieMR templates, and assist them to get get them set-up on their ieMR account. That’s become a bit tricky to do since my hospital has shifted to Office365, so I am liberating the templates onto this blog page simply to circumnavigate that problem.

I’ve made it clear from the very beginning that this website does not represent the opinions of anyone else or any organisation (see number 13 here: meta4RN.com/about). So, just as a reminder, I’m putting the templates here because emailing them to students as word documents doesn’t work anymore. It’s not a recommendation for you. It’s not my employer’s idea. It’s fine if you don’t like the templates. It’s fine if you never use them yourself. I’m doing this simply for the convenience of me and the students I work with, that’s all.

Making ieMR auto-text/templates

To set-up ieMR auto-text/templates It’s easiest to get someone who knows how to sit with you for 2 minutes to show you. Really, about 2 minutes is all it takes.

In the absence of a helpful human there’s videos (eg: here) and PDFs (eg: here) to guide you. Or just google your question – some hospitals have their help info behind their firewall, but many do not.

That’s all the explanation I want to give. The prime purpose of this blog post is to share the content for easy copy and paste, so let’s get on with it…

Initial/Comprehensive Psychiatric Assessment

Review

Cognitive Screening results

End of Episode/Transfer of Care

End

That’s it. I’ve only just realised now that the formatting doesn’t carry across to ieMR. Bugger.

Please let me know via the comments section below if you know how to overcome that problem easily. BTW: as you can probably tell by this very basic-looking website, i’m not a coder or computer whiz. If there’s a fix it’ll need to be pretty straight forward for me to get it right :-).

Paul McNamara, 20 June 2019

Short URL: meta4RN.com/ieMR

Creative Commons Licence
This work is licensed under a Creative Commons Attribution-ShareAlike 2.5 Australia License.

10 Delirium Misconceptions

This table/info extracted from Oldham et al (2018) is too handy not to share:

PDF version [easy to print]: 10DeliriumMisconceptions

Text version [just putting it here so that it’s searchable; hello google :-)]

1.
Misconception: This patient is oriented to person, place, and time. They’re not delirious.
Best Evidence: Delirium evaluation minimally requires assessing attention, orientation, memory, and the thought process, ideally at least once per nursing shift, to capture daily fluctuations in mental status.
2.
Misconception: Delirium always resolves.
Best Evidence: Especially in cognitively vulnerable patients, delirium may persist for days or even months after the proximal “causes” have been addressed.
3.
Misconception: We should expect frail, older patients to get confused at times, especially after receiving pain medication.
Best Evidence: Confusion in frail, older patients always requires further assessment.
4.
Misconception: The goal of a delirium work-up is to find the main cause of delirium.
Best Evidence: Delirium aetiology is typically multifactorial.
5.
Misconception: New-onset psychotic symptoms in late life likely represents primary mental illness.
Best Evidence: New delusions or hallucinations, particularly nonauditory, in middle age or later deserve evaluation for delirium or another medical cause.
6.
Misconception: Delirium in patients with dementia is less important because these patients are already confused at baseline.
Best Evidence: Patients with dementia deserve even closer monitoring for delirium because of their elevated delirium risk and because delirium superimposed on dementia indicates marked vulnerability.
7.
Misconception: Delirium treatment should include psychotropic medication.
Best Evidence: They are best used judiciously, if at all, for specific behaviours or symptoms rather than delirium itself.
8.
Misconception: The patient is delirious due to a psychiatric cause.
Best Evidence: Delirium always has a physiological cause.
9.
Misconception: It’s often best to let quiet patients rest.
Best Evidence: Hypoactive delirium is common and often under-recognized.
10.
Misconception: Patients become delirious just from being in the intensive care unit.
Best Evidence:  Delirium in the intensive care unit, as with delirium occurring in any setting, is caused by physiological and pharmacological insults.

Source/Reference

Oldham, M., Flanagan, N., Khan, A., Boukrina, O. & Marcantonio, E. (2018) Responding to Ten Common Delirium Misconceptions With Best Evidence: An Educational Review for Clinicians. The Journal of Neuropsychiatry and Clinical Neurosciences, 30:1, 51-57.
doi.org/10.1176/appi.neuropsych.17030065

End

This is the least original blog post I’ve written. All I’ve done is transpose a table from this paper.

Why bother? So I can quickly and easily share it at work. I have conversations about this stuff a lot, especially misconceptions 1, 7 and 8. It’s handy to have an accessible and credible source to support these discussions.

That’s it. Visit the journal article yourself for elaboration about the misconceptions and evidence of delirium: doi.org/10.1176/appi.neuropsych.17030065

Paul McNamara, 18 April 2019

Short URL meta4RN.com/10Delirium

 

Thanks

This three-part blog post is in praise of Australian football and saying thanks.

AFLW Grand Final, Adelaide Oval, 31/03/2019. Photo by Bernie McNamara.

1. Responding to Compliments with Thanks.

Once upon a time I played a good game of footy. I was playing for my employer at the time, Dairy Vale, in a social match against dairy industry rival Golden North in Clare. My workmate and old school friend John Nolan was our ruckman – he was great at it. John spent all day tapping the ball down to the spot that I was running into. Consequently, I had the ball on the run a lot, which allowed me the time and space to amass a heap of kicks. I even kicked a goal on the run from a centre clearance. It’s the best game of footy I’ve ever played.

The game ended. Dairy Vale had won. The teams were walking off the ground. A friend (Michael Forde) approached and said something like, “Good game Mac. B.O.G.” I brushed the comment off. Nobody likes a bragger. Unexpectedly, Michael responded with a bit of irritation in his voice, saying something like, “When somebody gives you a compliment it’s good manners to say ‘thank you’.” I was a bit taken aback, and responded eloquently, “Umm. Yeah. Umm. Right. Sorry. Umm. Thanks.”

Anyway, Michael was right of course. To him it might have been a throw-away comment on a footy oval. To me it was a valuable life lesson. We were both about 20 years old at the time. I don’t know how Michael was so wise at that age, but it was something I remembered and practiced. Saying, ‘thank you’ to compliments, that is.

2. Self Esteem

Fast-forward 10+ years after playing that game of footy, and I have started work as a mental health nurse. At Glenside Hospital senior nursing staff encouraged junior nursing staff (as I was at the time) to facilitate group discussions and activities. I was asked to facilitate a group about self esteem. It went really well.

I told the John Nolan/Michael Forde story. Then we practiced giving and accepting compliments. Of course, saying ‘thank you’ is just the start; especially if you actually feel really shitty about yourself. So we started slow with shallow superficial stuff (haircuts, tans, shirts etc). That served as a practice run for more meaningful compliments. We took turns saying, “One of the things I really like/admire about you is…”, with the person receiving the compliment practicing saying ‘thank you’ without adding a disclaimer or self-depreciating comment. That can be really hard for some of us. Not everyone has accumulated the habit of saying ‘thanks’ as a way to acknowledge and accept a compliment.

We finished the session with our group of 2 mental health nurses and about 10 inpatient mental health consumers going out to the Glenside Hospital football oval (it used to be about here, I think). While there we learned and practiced a skill that none of us felt at all confident in: kicking a checkside goal. It took us all quite a few goes to get it right, but all of us in the group eventually kicked three checkside goals (three to prove that the first one wasn’t a fluke). We left the oval as happy, chatty, cohesive and confident as any winning sport team. It was a great session.

3. Giving Thanks.

In my current role I don’t do group work, but I still speak to people about their self-esteem, and occasionally find myself trotting-out the John Nolan/Michael Forde story. In mental health nurse parlance sharing life experience/stories like this is called ‘therapeutic use of self’. Even though I haven’t seen Michael or John for over 20 years, they’re part of my story, part of my self. I’m very grateful for my family and friends, past and present.

The other thing is the Adelaide Crows won the AFLW Grand Final today! They played a fantastic brand of team football in front of 53,034 people. It was a terrific, well-deserved win. Back in 2012 when the meta4RN blog started, in the About section I claimed that the blog would comment on how watching Adelaide play in the AFL can inform nursing clinical practice. The Adelaide Crow’s Grand Final winning Registered Nurse Deni Varnhagen has done a better job of telling that story than me:
 

.

Sincere congratulations to Deni and all the other Adelaide AFLW players. You’re a terrific team to watch, and have bought many people a lot of joy in the 2019 AFLW season. Thanks!

End

That’s it. As always please feel free to use the comments section below.

Paul McNamara, 31 March 2019

Short URL meta4RN.com/thanks

Zap!

Once upon a time a man was tasered by police. He found it invigorating and helpful.

Describing the event, he said words to the effect of, “I have never felt more alive!”. He explained that for the duration of event and for a fair while after experiencing the pain of a taser, he stopped thinking about the pains and concerns that usually preoccupy his thoughts and feelings. Because he found being tasered so helpful, he asked whether we – the mental health service – would administer ECT.

We thought he was joking.

He told us he wasn’t.

The conversation lead to me to do some… ahem… research* which yields this interesting comparative data:

Brief Elaboration + Data Sources

▶️ ECT (electroconvulsive therapy) delivers somewhere between 180 to 480 volts to the body [source]. ECT is only administered after the person has been given a short-acting general anaesthetic (eg: propofol) and muscle relaxant (eg: suxamethonium).

▶️ Although Taser generates up to 50,000 volts in an open air arc, it is thought to typically deliver approximately 1200 volts to the body [source]. People who are “treated” with Taser are not administered anaesthetic or muscle relaxants beforehand, However, it is thought that at least some of the people who are zapped with a Taser have been self-administering substances that may convey some anaesthetic and/or muscle relaxant properties.

▶️ AED (automated external defibrillator) delivers 3000 volts to the body in a short, sharp burst [source]. As with Tasers, those treated with AEDs are not usually administered anaesthetic medications or muscle relaxants beforehand.

So What?

What does this data tell us?

On one hand, not a hell of a lot. An AED discharges its high voltage very quickly (about a tenth of a second), whereas a Taser will stay active for anywhere between 5 and 30 seconds, depending on the model/voltage. Over a course of ECT treatment the comparatively low voltage dose will be usually repeated at least half-a-dozen times, sometimes twice that number. So, despite the discrepancies amongst the voltages delivered at the body, because of site, anaesthetic, duration and repeat-dose differences we’re not actually [cliché warning] comparing apples with apples.

What is interesting to note is that there’s not much contention about using electricity as medicine in an AED. In fact, there’s great support to have AEDs more readily available in shopping centres, on commercial planes and in airports, at sporting grounds etc. By comparison, there’s a whole lot of contention regarding the use/misuse of Tasers and ECT, despite them using much lower voltages than AED.

I don’t feel confident enough in the facts to wade into an argument about ECT, other than to note that I’ve met some people who tell me it’s the only thing that has stopped them from staying so profoundly depressed that they wished they were dead. Not everyone who has a been treated with ECT describes a positive experience, of course –  I believe them too.

What about the Taser bloke?

We let Taser-bloke down easily. It was good to be able to tell him about the differences in voltages. We explained that nobody administers ECT without anaesthetic anyway, so he would not get the distracting alternative pain that he was seeking. We thanked him for the interesting question. He seemed to be OK with our answer.

End Notes

By “research*”, in this instance I actually mean “googling for a couple of minutes”. The “…ahem…” prefix is the international signifier of this not-so-scholarly research approach. That is, for god’s sake, please don’t take this blog post too seriously. Store it in the #FunFacts/trivia/let’s-have-an-argument-for-the-fun-of-it part of your brain, not in the scholarly/clinical/sensible part of your brain.

As always, your feedback/thoughts are welcomed in the comments section below.

Paul McNamara, 28 February 2019

Short URL: meta4RN.com/zap

Graphic Text
I’m happy for this – or any of the above – to be cut and paste into your work, but please include the URL so people can read the explanatory notes; it’s a bit deceptive otherwise.

A comparison:
▶️ ECT (electroconvulsive therapy) 180 to 480 volts
▶️ Taser approx 1200 volts
▶️ AED (automated external defibrillator) 3000 volts
meta4RN.com/zap

Creative Commons License
Zap! by Paul McNamara is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Based on a work at meta4RN.com/zap.

Self Care: Surviving emotionally taxing work environments

The nature of nursing will mean that we are likely to be are exposed to a range of challenges. It’s not unusual for nurses to witness aggression, feel unsafe, have first-hand exposure to other people’s tragedies, and to deal with the physical and emotional outcomes of trauma. This emotionally taxing environment can be pretty stressful. It’s something we should talk about.

I’m often asked to talk about this sort of stuff at inservice education sessions. This page is a 2019 update to support those sessions.

Printed handouts are so last century.

“Self care: Surviving emotionally taxing work environments” 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/#

I’m recycling and combining a lot of old ideas for the 2019 sessions. Self-plagiarism? Nah – it’s a groovy remix of some favourite old songs. Regular visitors to meta4RN.com may recognise the repetition, and be quite bored with me using the website as a place to store updated versions of old stuff. Sorry about that. I’ll pop-up a new and original post in coming days.

Here is the online presentation: Prezi

Here are the resources and references used in the presentation: (because I’m recycling old ideas this list is ridiculously self-referential).

Australian College of Mental Health Nurses [www.acmhn.org], Australian College of Nursing [www.acn.edu.au], and Australian College of Midwives [www.midwives.org.au] (2019) Joint Position Statement: Clinical Supervision for Nurses + Midwives. Released online April 2019, PDF available via each organisation’s website, and here: ClinicalSupervisionJointPositionStatement

Basic Life Support Procedure
https://qheps.health.qld.gov.au/__data/assets/pdf_file/0030/607098/pro_basiclifesprt.pdf

Dymphna (re the patron saint of mental health nurses) meta4RN.com/amazing

Eales, Sandra. (2018). A focus on psychological safety helps teams thrive. InScope, No. 08., Summer 2018 edition, published by Queensland Nurses and Midwives Union on 13/12/18, pages 58-59. Eales2018

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

Employee Assistance Service (via Queensland Health intranet)
qheps.health.qld.gov.au/hr/staff-health-wellbeing/counselling-support

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

Queensland Health. (2009). Clinical Supervision Guidelines for Mental Health Services. PDF

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

That was bloody stressful! What’s next?
Web: meta4RN.com/bloody
QHEPS: https://qheps.health.qld.gov.au/__data/assets/pdf_file/0038/555779/That-was-bloody-stressful.pdf

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: http://prezi.com/0ysapc6z9aqg

Thanks for visiting. As always your comments are welcome.

Paul McNamara, 22 February 2019

Short URL: meta4RN.com/SelfCare