Category Archives: Blog

That’ll do. Seeya.

Hello. Thanks for dropping by. This will be the last post on attracted visitors from more than 100 countries

It is 10 years ago today when the post “Hello World!” jauntily announced the launch, and the “About” page outlined the rationale and vision for this nursing blog.

Since then there have been more than 200 posts published (they’re all listed here Those posts have yielded more than 190,000 words – that’s the length of a PhD thesis, twice 😳. Additionally, has been adorned with hundreds of images and embedded Tweets, and dozens of Prezi and SlideShare presentations, and a heap of YouTube and TikTok videos. The visual stuff is much more labour-intensive than writing.

How many hours have been poured into IDK. About a bajillion.

The decision to stop contributing to today was made a year ago. It is the right decision. I plan continue working full time for another 4ish years, but not beyond that. It is sensible to transition away from doing work-related things like maintaining the nursing blog, and spend more time and energy on non-work-related stuff.

I have enjoyed creating I’ll stop paying for the domain name in about a year, but the site will remain online in one form or another. I think WordPress will maintain a free version of the site with a different address (something like, but I’m not really sure. I am sure that the site is being archived by the WaybackMachine (here: and the National Library of Australia (here:

The best thing about having a nursing blog is that it gives an ordinary working nurse an extraordinary audience. The site has attracted over 190,000 views. That’s a big deal. I do lots of face-to-face education sessions, but those audience sizes are mostly around 10 at a time, and only occasionally larger than 30. Crowd sizes are a bit bigger at conferences, but even then it’s unusual to have more than 100 in a room. Is there any way to amplify your message and audience without going online?

There is context for this. Nurses have often lamented that their voice is not heard in the media, that they have been intentionally frozen out of conversations about health service planning/delivery, or that they are overlooked or ignored altogether. Social media gives Nurses an avenue to assert their voice in the public realm, but how many of us are accessing this opportunity? You have probably heard the Dalai Lama quote, “If you think you are too small to make a difference, try sleeping with a mosquito.” Nurses are the most numerous of clinicians. Try ignoring a swarm of mosquitoes. Make a buzz.

Reach & Readership

Who does reach?

The primary value – to me, anyway – has been the improved access to my workmates that the blog has provided.

  • Couldn’t get to the inservice? No worries, I’ve plonked a video version and the references here:
  • Want to revisit what we were chatting about last week? Easy. There’s a summary here:
  • Feeling stressed by nursing in a pandemic? Me too. Here’s how I frame it:
  • What you’ve achieved has been amazing. Check out the data:

Obviously it’s an unofficial, “back channel” kind of access (the sort of thing that makes managers nervous), but it’s been very valuable over the years. Every inservice education session should have a webpage for easy access to references and resources, shouldn’t it? It was incredibly helpful to have had the site already in place and fairly well known before the pandemic – it’s interesting to scroll through the contents page ( and note the increased emphasisis on posts about reflective practice and self compassion from early 2020.

Act locally. Echo globally.

For most of the posts I imagined the reader as a 3rd year nursing student or early-career Registered Nurse in FNQ. The actual readership was much-more geographically far-flung.

The site attracted visitors from more than 100 countries, the top 8 of which were Australia (about 47%), United States (about 28%), United Kingdom (about 9%), and Canada, New Zealand, India, Phillipines and Ireland (each between about 1 and 3%).

Top 8 countries visiting

Hits & Misses


Let’s start with the hits. That is, the five posts that attracted the most hits online, and the five posts that I am most proud of.

Sample of posts: 5 that attracted the most visits and 5 that I am most proud of

Interestingly, 4 of the 5 posts that attracted the most visits are instructive and/or have free, reusable templates, ie:

  • Using the Edinburgh Postnatal Depression Scale
  • Example of Nursing Curriculum Vitae
  • Mental State Examination: Looking, Listening and Asking
  • Sample Clinical Supervision Agreement – this page attracts most of the hits gets from the United States.

The “Nurse Can’t Take Pulse. Seriously.” post was a critique of the first episode of an Australian hospital-based TV series called “Pulse”. It attracted 17,000 hits in a couple of days, which was a bit of a surprise. Typically attracts about 2,000 hits a month. It was topical for about a week, then stopped being of interest, as evidenced by the paucity of hits since the year it was published.

The posts I am most proud of didn’t attract the most attention.

  • The Broken Leg/Psychosis Metaphor prolongs one of the many learnings I acquired from Greg Holland – the most skilled communicator/mental health nurse I have worked with
  • Emotional Aftershocks is too long, but it was cathartic to shine a light on the remarkably common nurse experience of being exposed to violence at work
  • Lalochezia is short, fun and is the blog post that my workmates speak of the most
  • Hand Hygiene and Mindful Moments is a pretty simple and not entirely original idea; it’s had pretty good acceptance and uptake amongst my workmates

The “Self Care/Compassion [combined]” section of the chart above is essentially the same post used in support of face-to-face education sessions (primarily, but not exclusively, for new graduate nurses). The post was repeatedly updated/refined to remain relevant. This was especially important during and after the pandemic arriving. The posts tallied together as one under the Self Care/Compassion heading are:
– 2013: Nurturing the Nurturers
– 2017: First Thyself
– 2019: Self Care: Surviving emotionally taxing work environments
– 2020: Clean Hands. Clear Head.
– 2022: Self Compassion: surviving and thriving in emotionally taxing work environments
If the site has any legacy at all, I hope it is recalled as a place where nurses showed care for nurses.


The posts that missed were the ones that attempted to enthuse, beguile or bully nurses into using social media more intentionally and actively. If you scroll through the contents page (here: you will see that nurse social media is a reoccurring theme of Anyway, those posts did not reach much of an audience, nor have I seen any large-scale change in Australian nurses embracing social media as a way to participate in the public conversation. I think it’s a lost opportunity for the profession. Why? Scroll back up and read paragraph 8 (the one that starts, “There is context for this”).

Daggy Stuff

I didn’t update the look of the website at all over its 10 years of existence. Sorry. I thought about it once, but couldn’t be bothered. It’s daggy.

Even though I articulated that “meta4RN” is a homophone that can be read as either “metaphor RN” or “meta for RN”, it didn’t really catch-on. It’s a bit daggy.

Although it was flattering to have heaps of people subscribe to the blog, I really wished they didn’t. Subscribers get the published version sent straight to their email address, which is bad for me. Why? Because I make an embarrassing amount of typos with every blog post. When I notice typos I can fix them online, but subscribers don’t get to see that. They only get to see the typo-ridden version that lands in their inbox. Daggy.

Also, email is so 20-something years ago. Who can be bothered with email anymore – it’s too daggy.

Daggy email pic source and context:

What’s Next?

I don’t know. There will be something, but I’m not sure exactly what it will look like. It will be less work-related, and more to do with cultivating activities that will sustain me when I get around to retiring in a few years.

I’m not sure what, if anything, I’ll do with my new website:

I do know that will not be a nursing blog like I’d like to visit other Australian nursing blogs though.

I’m not sure yet what I’ll be doing with all the other meta4RN-branded social media platforms, which are listed here: and here:


Thanks to everyone who has visited, interacted with or shared over the last 10 years. Your support has been very encouraging. Thank you.

As I did 10 years ago I would like to acknowledge and thank Ian Miller as a pioneer of this space. Ian’s blog inspired the launch of

Special thanks to my favourite human @StellaGRN for putting-up with me buggerising-about on the blog and related stuff for a decade. You’re very patient darling. Thank you.

Finally, thank you to my life-long partner Early-Waking Insomnia. I never would have found the time for without you.


That’ll do.

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

Paul McNamara, 24 September 2022

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Seeya 🙂

How to be a Journal Social Media Editor

Drawing on more than 5 years of experience as Social Media Editor for the International Journal of Mental Health Nursing, I hereby present an amateurish manifesto in two parts. Feel free to ignore it.
Version 1 (copy & paste from an email I sent on 7 December 2016)
Twitter is a hungry beast. IJMHN will feed it daily with scheduled Tweets promoting its papers/authors. IJMHN will be cautious about entering into conversation with individuals, and is unlikely to retweet much at all, other than an occasional RT of ACMHN tweets. The IJMHN’s standing as a peer-reviewed journal will not be compromised. The often-too-long-to-Tweet journal article titles will stripped of most of their jargon, and rephrased in accessible language that will readily understood by most clinicians and consumers. The goal is to make Tweets engaging and shareable, in the hope that it will drive more traffic to individual papers. 
Facebook will require less active input. About once a fortnight/month will be about right. Rationale = people generally have their social life on Facebook: occasional posts from a work-related site on an individual’s feed will be tolerated, too many posts would likely be construed as intrusive risking the “Like” button being deactivated.
The advantage of SoMe is that it’s all on public view. Feedback from other members of the IJMHN Board will be invited in the New Year.

Key Performance Indicators for a Journal Social Media Editor

Version 2 (in preparation for handing-over the social media editor role at the end of 2022)

First things first. Get your head around these three ways to use social media:

Personal Use.
Personal use of social media is where you share photos of your holidays with family and friends on services like Facebook or Instagram. You may engage in conversations with friends, strangers or public figures, but you will not be representing your profession or an organisation when you do so.
Professional Use.
Professional use of social media is based on your area of expertise and interests. This use of social media is when you share information with and interact with other individuals and organisations that have the same interests. Like you do at work, you will occasionally share aspects of your personal life, but you will be boundaried and cautious re this.
Official Use.
Official use of social media is where an organisation presents their brand and shares information online. @IJMHN = the International Journal of Mental Health Nursing on Twitter, for instance. Official use of social media will have a different tone and goal to personal or professional use of social media.

A Journal Social Media Editor’s personality and opinions take a backseat when they are driving the brand and content of the journal. Your performance is as public as your social media posts. Your key performance indicators (KPIs) are not a matter of opinion, they are quantitative (see below).

Twitter is a hungry beast. Feed twice daily.

Schedule tweets so that the journal’s Twitter account is as steady and reliable as a metronome.

For the majority of my time as Journal Social Media Editor I used the free version of Hootsuite to schedule Tweets. Mid-2021 the features I was accessing for free became available only to paid Hootsuite subscribers, so I switched to Tweetdeck. Tweetdeck has been fine, but you may want to see what other platforms are out there.

The content of the Tweets achieves interest, not random timing.

As the Social Media Editor of the journal you have a regularly updated library of the journal’s content at your disposal – that’s where the interest lies.

Unless you can find a way to get paid for achieving nothing tangible, a tweet without a link to an article is a poor return on your investment of time. Your primary KPI is the Altmetric Attention Score (more about that below), everything else is aesthetics. How much time do you want to spend on aesthetics each week/month/year?  

This Tweet below is a vanity Tweet. It might provide a transient frisson of feel-goodness, but it has all the nutritional and health benefits of fairy floss. It’s a rare distraction, not a regular thing.

One Sunday each month schedule tweets using these self-explanatory hashtags: #20YearsAgo #FromTheArchives @IJMHN Volume… & #10YearsAgo #FromTheArchives @IJMHN Volume… browse the 10/20 year old issue that most-closely corresponds with the current month, and select the most interesting/controversial titles, eg:

Be open to spotting patterns/trends, and sharing insights you stumble across. There won’t be many people keeping as close an eye on IJMHN articles as you. eg:

Schedule a run of Tweets to coincide with each new bimonthly issue, eg:

Keep an eye out for international days that have social media campaigns, and align articles with them if you can. eg:

If your journal also serves as the book of abstracts for a professional society, align the journal’s tweets with the society’s conference using the conference hashtag, eg:


I took over the Social Media Editor role late in 2016. It took until July 2021 to get access to the journal’s Facebook page. That’s a ridiculous delay, but as far as KPIs go it’s not such a big deal.

Facebook posts to a public page (not a personal account) attain a smaller Altmetric Attention Score than a Tweet. It plays a part in meeeting your KPI, but only a small part.

I’ve been using Facebook as an avenue to promote new open access articles primarily. That keeps the volume of posts fairly low, which I think is an important consideration if we don’t want to alienate Facebook followers. Why? Individual’s Facebook pages are primarily used for sharing photos, stories and other aspects of their personal life. If work-related info swamps this people will tend to unfollow or mute the page. Less is more.


After being the ugly-duckling of social media for many years, in the last couple of years LinkedIn has become a platform that is worthwhile using. I say this with confidence because of looking at referral data for the blog. LinkedIn never used to generate any significant traffic to before 2018. Since 2020 it has become the 4th largest referral source (behind Google, Twitter and Facebook).

Use LinkedIn the same way you use Facebook. Use your time efficiently and just copy and paste the same content. If you have the time/patience to tag the authors on LinkedIn that’s fair enough, BUT it won’t help you meet your KPI. LinkedIn does not generate an Altmetric score at all.


Forget it.

Insta is a visual platform and most journal articles are visually boring. Also, Insta posts don’t carry links, nor does Insta affect the Altmetric score (your KPI). Forget instagram.

Traps to Avoid
You will receive requests from people, including people on the editorial board/related organisations, to share info on their behalf (eg: recruiting for their projects etc). Ignore them all. That’s not the Social Media Editor’s job. How could you possible pick what’s ‘worthy’ of promoting and what isn’t? Also, it does not meet any of your KPIs. Forget it.
Don’t quarantine time to do social media stuff alone. Since January 2017 every Tweet, Facebook post and LinkedIn update has been written and scheduled on my ipad while I’ve been listening to music, half-watching TV (shows my partner likes, but I don’t), or filling-in time during the ad-breaks while watch sport on TV. Scheduling a social media post is not brain science or rocket surgery, it doesn’t require your undivided attention.   
Don’t get involved in an argument you can’t hope to win. Every now and then someone will respond to your social media post negatively. That’s fine. Just let it sit there. They are not talking to you the Journal Social Media Editor, they are talking to the author(s) of the journal article. It is not for you to defend or respond.
Things to Enjoy
This is a bit sad, but I’ve trained myself to get a little dopamine hit every time I “discover” a new article via Early View. I only check when it’s a good time for me: while on holidays I might not check for a few weeks, but otherwise I’ll have a sneak-peek every day or so when I’m not doing anything else especially important.

Enjoy the articles too. Unless you’re super-geeky you’re not going to read every word of every article, but you’ll read every abstract. You’ll look for, and find, insightful quotes, interesting data, and inspiring themes. Enjoy.

Opportunities to Explore

Social media platforms come and go. It will be surprising if the platforms being used in 2022 will have the same weight and functionality that they will in five years time. Stay flexible.

Blog posts present a relatively easy 3 points on the Altmetric Attention Score. At time of writing, and all remain available URLs. Setting up a basic website/blog takes minimal funding and expertise. Journal article authors could be invited to write a plain-language summary of the article together with a visually appealing dit of data and/or an author photo. Suggestion: if you do go down this path, make sure that the site will be compatible with embedding the Altmetric badge (for more info follow the button in the top-right corner here: That – at time of writing – means avoiding the most-readily-available/user-friendly wordpress platform.

Something I’ve thought about, but never sought opinion/permission from the editorial board, is emailing article authors at time of publication with tips on promoting their article via social media. That’s what I had in mind when I made the video below. The video is a bit too smart-arsey in tone and amateur in production for use, I reckon, especially considering that most authors for the IJMHN are not Australian and may not understand/could be offended by the irreverence/humour.

Primary KPI
The primary key performance indicator (KPI) for the success of failure of the social media strategy is via altmetric, as articulated in this journal article. Read up on how the Altmetric Attention Score is calculated – as the journal’s social media editor you’ll probably know and care it more than anyone else in the editorial board – do what you can to share the enthusiasm. I suggest gathering and reporting on the pre- and post- data to see what impact your strategies are having.
Secondary KPIs include
The number of social media interactions
The number/relevance of current social media platforms

The popularity of specific social media platforms will rise and fall over time: is the journal keeping up?

Similar question with different wording: Is altmetric measuring data from platforms that the journal is not using? If so, that’s a good indication that the journal is not keeping up.
The annual Impact Factor ?

There is debate in the literature on whether social media interaction leads to more citations. Do a search for yourself and stay abreast of contemporary data.

To my way of thinking if you were doing a thorough literature search, whether or not an article(s) had been shared on social media wouldn’t make much of a difference. I guess that the reality is that not every literature search will be thorough, and – thorough or not – what is cited in an any given article on a topic will rarely be 100% complete. If you accept those arguments as being plausible, would it not also be plausible that an article that already attracted a lot of attention would be more likely to come to the attention of researchers/authors?

But anyway, don’t rely on my arguments about plausibility. See if you can find contemporary evidence one way or another – fair dinkum stuff with a control group and quantitative data, not the namby-pamby opinions of a bloke with a blog (me).  
So What?
Look, being a Journal Social Media Editor won’t create world peace, rid the planet of poverty and starvation, or solve climate change. However, if the research and innovations your journal publishes contribute to the world being a better place, you will play an important role in amplifying the reach and readership of that work.

I’m pretty sure I’m the only person on the editorial board of IJMHN who does not have a PhD. If you’re capable and confident with using social media in an offical way, becoming a Journal Social Media Editor can add a bit of oomph to your curriculum vitae.

The main reward for being a Journal Social Media Editor for me was the knowledge acquired from the discipline of perusing all published research in my speciality’s main journal for the last 5 years. Some of my peers are doing great work; it is inspiring to read about it as soon as it’s published. Of course there are some subjects of research that don’t excite me much, but even skim-reading those articles looking for a tweetable quote has been informative and enlightening.


Too long; didn’t read? Fair enough.

In the grand tradition of see one, do one, teach one, just have a look at these sites instead:


What would you do different if you had your hands on those accounts? You should do that then, and see how it goes. 🙂

Further Reading (an embarrassingly self-referential, but mercifully short, reference list)

McNamara, P. (2017), Cairns Nurse on Journal Editorial Board

McNamara, P. & Usher, K. (2019), Share or perish: Social media and the International Journal of Mental Health Nursing. International Journal of Mental Health Nursing, 28(4), pp. 960-970

McNamara, P. (2022) Mental Health Nursing making an impact

McNamara, P. (2022), Happy anniversary IJMHN. International Journal of Mental Health Nursing, 31(4), pp. 767-771


Feel free to ignore this amateurish manifesto. I’m only writing it as a starting point, a handover-of-sorts, to the next IJMHN Social Media Editor.
As always, your feedback is invited in the comments section below.

Paul McNamara, 22 September 2022

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On RATs and Nice

A few months ago a half-formed idea about idea about continuing to take pandemic precautions, being kind to each other, and dumb luck began to take shape. The idea was in the context of my favourite human (@StellaGRN) testing positive to COVID-19, and me not.

Same precautions. Same knowledge-base/education. Same vaccination status. Same workplace. Same bedroom, bathroom, kitchen and sofa. Different results.

Follow the science. Hope for luck.

Follow the science. Hope for luck. (don’t do it the other way round)

I – a mental health nurse – didn’t get around to progressing that half-formed line of thought into something coherent. Then in early July I stumbled across a twitter thread by Trent Yarwood – an infection diseases physician. Trent articulated my half-formed ideas about following the science and hoping for luck (not the other way round) better than I could have.

With Trent’s permission, that Twitter thread has been copied and pasted below:

There’s plenty to be upset about in the pandemic.

It’s ruined our social lives, stuffed up our travel plans. More importantly, it’s killed millions of people, disabled some, forced people out of work and had a myriad of other effects.

You can make a pretty solid argument that the public health communication has been woeful. Frequently changing, late, technically complex, not always helpful.

You could equally talk about the incredible difficulty in communicating uncertainty about a rapidly changing situation, balancing the needs of “you told us this at 5pm Friday” vs “why did you wait the whole weekend to tell us this”.

You can (and people have) done entire careers’ worth of research on techniques for best practice in doing this sort of communication.

But the CHOs (and the talking heads) haven’t all done PhDs in risk comms, so they didn’t always get it right. Just like the advice which turned out to be not-entirely correct with the advancement of knowledge and time was – unless you are tin-foil-hatter – the best it could be at the time it was delivered.

But here’s a few questions to ponder.

Imagine you’re late for work. Is it because:
a) you didn’t leave early enough to have some slack
b) that dickhead in the volvo was in the right lane?

You’ve had a minor surgical procedure and the wound has gotten infected. Is it because:
a) Sometimes, Staph happens.
b) The surgeon must have done something wrong

Your washing machine has just broken and ruined your favourite 80s band t-shirt. Is it because:
a) it’s 10 years old and it’s had a good life
b) your landlord is a tightarse and bought dodgy-brand

What is your locus of control?

Is someone else (God, fate, other stupid dickheads) responsible for everything that happens in your life? Or do you make the best of what you have and sometimes, chance fucks you over?

If you’ve been through relationship counselling, you’ll know that they tell you that you can’t hope to change the other person, you can only change yourself. So is being angry at the dickheads “who gave you COVID” going to change the way they behave? Or is it just going to make you angry?

And finally, don’t forget it’s baked into the name. Pandemic: pan-demos – all of the people.

Railing against inevitability is a pretty sure way to make yourself miserable.

Of course this doesn’t mean we shouldn’t be doing what we can to reduce transmission. But take control of the things you can.

Get your third (or fourth) dose. Encourage your friends to do the same.

Physically distance. Stay home if you have symptoms.


Wash your hands

And finally, be nice to each other.

Isn’t the world shitty enough already?


Trent’s articulation of emotional intelligence (EQ) isn’t unique for someone with an Infectious Diseases (ID) and/or public health background. This is evidenced below by two tweets from BC (Before Covid) and one from AD (After Disaster).


End Notes

Sincere thanks to Trent Yarwood for permission to reproduce his Twitter thread. The original thread can be accessed here and is collated here. To find out more about Trent follow him on Twitter (@trentyarwood) and/or check-out his profile and articles on The Conversation.

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

Paul McNamara, 20 September 2022

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If I stay lucky…

If I stay lucky I should live another 20 or 30 years. I will be dead within the next 40 years.

If I stay lucky I will have a good death. Where I live, as of 1st January 2023 good deaths don’t need to rely on luck alone. Voluntary assisted dying will become a sanctioned option for those who meet the legal criteria [here].

If I stay lucky my death will be a bit like Queen Elizabeth’s recent death. I’ll be incredibly wealthy, I’ll die at a place of my choosing, I’ll be with people I’m related to, like or employ, and I will spend my last days doing things I value and enjoy.

If I stay lucky, when I see health professionals in my last year of life they’ll believe me when I say I’d rather choose the time and manner of my death than leave it to chance. If they look unsure or quizzical, I’ll use one of 2022’s favourite rejoinders and say, “Google it, mate.”

If I stay lucky, when the health professionals search “is paul mcnamara fair dinkum about voluntary assisted dying?” (or words to that effect) they’ll land on this blog page (archived here and here), and see the evidence below:

Life Membership Card, Exit International, 2013
Life Membership Certificate, Dying With Dignity Queensland, 2018

It’s a little bit funny…

I hope, like me, you enjoy the delicious paradox of becoming a life member of two organisations that focus on the right to die. It’s not hilarious, but it’s a little bit funny.

To make the information clear/overt:
– I became a life member of Exit International in 2013
– I became a life member of Dying With Dignity Queensland in 2018
– I wrote this open letter in support of voluntary assisted dying legislation in 2021
– I published the blog post you’re reading now in 2022

My convictions are not transient or ambiguous. It would be a little bit funny if my values were not respected. No need to agree with me. Just believe me.

Also, it would be a little be funny (funny peculiar, not funny ha-ha) if anyone confused this obviously personal blog post with anything to do with my job or employer. That would be a malevolent misrepresentation of the facts. Don’t do it. Be sensible. Be kind.

Google it, mate.

Exit International and Dying with Dignity are similar in that they both strongly advocate that the locus of control re end of life decisions should rest with the person, not any one else. However, the two well-established organisations have different views on how this should look. Want to know more? Google it, mate.

“Google it, mate.” Adam Bandt, National Press Club, Canberra, 13 April 2022

End Notes

That’s it. I only wrote this blog post to archive something personal somewhere public so it’s searchable/googleable in future. It should be clear that – apart from ensuring my choices are known and respected – this blog post does not seek to influence the opinions or actions of others.

Normally I invite feedback via the comments section below, but on this occasion I’m a bit wary. If, like me, you have a personal opinion that you feel compelled to make public, the comments section may serve that purpose. I agree to making all comments public, but have no intention to reply, mediate or elaborate.

Paul McNamara, 17 September 2022

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Body Image and Eating Disorders Awareness Week (#BIEDAW) 2022 @ Cairns Hospital Grand Rounds

Cairns Hospital Grand Rounds on Friday 9 September coincided with 2022’s Body Image and Eating Disorders Awareness Week (#BIEDAW). Understandably, it was planned that the session should focus on eating disorders.

Dr Janet Bayley, Consultant Psychiatrist with NQuEDS* was to present, but was unexpectedly unavailable. Janet passed the baton to Dr Sharmila Prakash, Consultant Psychiatrist with Cairns Hospital’s Consultation Liaison Psychiatry Service. Unfortunately, Sharmila also became unexpectedly unavailable. That’s where – Steven Bradbury style – I slid-in to be on the Cairns Hospital Grand Rounds program.

There were two other presenters on the theme of eating disorders at Grand Rounds. Consultant Nephrologist and Physician Dr Bibin George presented very interesting early data from an audit of Cairns Hospital eating disorder medical admissions. Psychiatric Registrar/Dual Advanced Trainee Dr Manjuka Raj presented early results from her research examing core competencies of staff involved in a new eating disorder service. There is a fair chance that each of these research projects will progress to publication in future – keep an eye out for them.

My presentation was not about hard data or research. It was an overview of the role that a Consultation Liaison Psychiatry Service has when a person is admitted to hospital as a medical patient because of problems associated with an eating disorder. For those interested the session was videoed:

Regular visitors to meta4RN will note that this presentation looks remarkably similar to this one: Consultation Liaison Psychiatry Service @ CHHHS Eating Disorder Forum. That’s because it is pretty-much the same presentation with a few tweaks.

So What?

A few dozen people go to Cairns Hospital Grand Rounds either in person or via Zoom. The meta4RN blog extends that reach. If you were not at Cairns Hospital Grand Rounds yesterday, and have an interest in the care of people admitted as medical inpatients because of an eating disorder, perhaps the video is worth a look.

Also, just in case I (or you) want to revisit or recycle any of the info in the presentation, here is the link to the Prezi.

Cairns Hospital Grand Rounds 9 September 2022


NQuEDS = North Queensland Eating Disorder Service. More info about NQuEDS here and here. Enquiries about referral should be directed to 1300 64 2255 (1300 MH CALL).

End Notes

That’s it. Thanks for visiting.

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

Paul McNamara, 10 September 2022

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EAT Target

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.


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.


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

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

Key Message

Nutritional Resuscitation is Time Critical


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. 🙂


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


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.

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

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Poster for 2022 FNQ/CHHHS Research and Innovation Symposium

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

Read all about it:

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
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.


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 site has been accessed.

results (data from April 2021 to August 2022)

The 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 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


Clinical Nurse Consultant
Consultation Liaison Psychiatry Service

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


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.

End Notes

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

Paul McNamara, 23 August 2022

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

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:

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

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)

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?

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

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Consultation Liaison Psychiatry Service @ CHHHS Eating Disorder Forum

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


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:

Thanks for visiting.

Paul McNamara, 12 August 2022

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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

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

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:

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

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