Nurses, Midwives, Medical Practitioners, Suicide and Stigma

Leave a reply

Trigger Alert – this blog contains info re suicide which may be unsettling for some people.

Alarming Data

Click to enlarge. To keep the data handy, save the image to your phone.

Click to enlarge. To keep the data handy, save the image to your phone.

A retrospective study into suicide in Australia from 2001 to 2012 uncovered these alarming four findings:

Female Medical Professionals 128% more likely to suicide than females in other occupations
(6.4 per 100,000 vs 2.8 per 100.000)

Female Nurses & Midwives 192% more likely to suicide than females in other occupations
(8.2 per 100,000 vs 2.8 per 100.000)

Male Nurses & Midwives 52% more likely to suicide than males in other occupations
(22.7 per 100,000 vs 14.9 per 100.000)

Male Nurses & Midwives 196% more likely to suicide than their female colleagues
(22.7 per 100,000 vs 8.2 per 100.000)

Data source: Milner, A.J., Maheen, H., Bismark, M.M., & Spittal, M.J. (2016) Suicide by health professionals: a retrospective mortality study in Australia, 2001–2012. Medical Journal of Australia 205 (6): 260-265

Suicide is a complex matter that does not lend itself to easy understanding or simple solutions. However, something we know about health professionals is that they know that there are mental health services and supports. Health professionals know that these services can be accessed by people who who are feeling suicidal. The data suggests that health professionals have an actual or perceived barrier to accessing these existing supports. I wonder what that barrier is.

Stigma?

Could it be that nurses, midwives and medical professionals suicide at a greater rate than the other occupations because of actual or perceived stigma? We have the peculiar privilege of providing care for strangers who are/have been suicidal, but perhaps we aren’t so good at extending that nurturing care to ourselves and each other.

I have a suggestion for health professionals. If you ever come across a colleague who says something derogatory or stigmatising about somebody experiencing mental health problems or suicidality , politely show them the data,. Save the chart above to your phone and show them that suicide is a bigger problem for nurses, midwives and female medical professionals than it is for people in other occupations. Say something like, “Suicide is an important issue for our colleagues too. Let’s both care for this patient like we would like to be cared for.”

You’re very welcome to share the chart above or this blog post with your colleagues – the short URL is https://meta4RN.com/stigma

There’s also a PDF version of the chart here: stigma

Hopefully, sometime down the track, the data will result in targeted support for the prevention of suicide by health professionals. However, we need not wait for our political masters, health bureaucracies and professional organisations before we walk-the-walk and talk-the-talk of fighting stigma.

If we see mental health/suicide stigma we should address it on the spot.

In the words of Lieutenant General David Morrison, “The standard you walk past, is the standard you accept.” As the data show, it is dangerous for nurses, midwives, medical professionals and other health professionals to accept stigma.

Support

It’s important to acknowledge that talking and thinking about suicide can be distressing. People in Australia can access support via:

Lifeline – 13 11 14

Suicide Call Back Service – 1300 659 467

MindHealthConnect www.mindhealthconnect.org.au

phone_hotline-40Outside of Australia and not sure where to get support? Google usually displays a red telephone icon and your country’s suicide support phone number when searching for a suicide-related topic.

End

That’s it. As always your comments are welcome in the section below.

Paul McNamara, 26th September 2016

The short URL for this page is https://meta4RN.com/stigma

Just in case you missed it above, here’s the original paper citation and link:
Milner, A.J., Maheen, H., Bismark, M.M., & Spittal, M.J. (2016) Suicide by health professionals: a retrospective mortality study in Australia, 2001–2012. Medical Journal of Australia 205 (6): 260-265

Mental State Examination: Looking, Listening and Asking

Leave a reply

Mental State Examination: Looking, Listening and Asking
By Paul McNamara @meta4RN
RGN (RAH), RPN (SAMHS), BN (Flin.), MMHN (USQ), Cert IMH (WCHN), CMHN, FACMHN
Adapted from the original work of Jenni Bryant @JenCLNinja
RN, RPN (NPC) RGN (BDH), MRN(MH), BN(UNE), MN (Research) (UoN), FACMHN

Every Australian undergraduate nurse is introduced to mental health and undertaking mental state examinations/assessments. However, only about one in every twenty nurses will specialise in working in mental health. For the majority of nurses (ie: those not working in mental health) undertaking a mental state assessment can often become a forgotten skill. This, in turn, deskills the nurse and disadvantages the patient – it’s not holistic care if mental health isn’t considered along with the medical/surgical/maternal aspects of care. As the adage says: there is no health without mental health.

If you’re not accustomed to incorporating mental state examinations (MSE) into your everyday role, it can feel a bit intimidating. Nurses I’ve worked with sometimes feel that they’re not adequately equipped to assess someone’s mental state. Of course they are – as long as they have a bit of emotional intelligence (self-awareness, self-regulation, social skills, empathy and motivation), and break down mental state examination to the three core skills that Jenni Bryant identified in her original powerpoint presentation: looking, listening and asking (adapted, online version available via www.slideshare.net/paulmcnamara).

This online version is in response to a few people requesting to have a print-friendly version (here: MSE), and/or something they’ll always have “in their pocket”, via internet-connected smartphones. The meta4RN.com website readily acknowledges that .edu and .gov websites have more credibility. However, many of those websites are not device-agnostic, so don’t render as well as meta4RN.com does on smartphones and tablets.

It’s a good habit to document a brief MSE for all your patients, not just those with a diagnosed mental illness. Mental state can and does change over a shift, day or week – it’s important to notice and communicate changes.

A comprehensive mental state assessment will include a full history: medical history, psychiatric history, medication history and personal history (developmental, relationship, education, employment, social). As history is static, there is no need to make this part of your “everyday” regular MSE.

A MSE is a snapshot as the person as they are at the time. A well-documented MSE conveys this impression for the reader. Using non-judgemental language, direct quotes of what the person says, and finding the right descriptors/adjectives makes for good MSE documentation. No need to worry about sentence construction. Dot points are fine.

Hopefully the following info will assist.

Mental Sate Examination (Looking, Listening and Asking)

General Description (Looking)

Level of Consciousness
drowsy, alert, sleeping, fluctuating

Appearance
grooming, makeup, posture, clothing, obvious physical deformities or characteristics

Behaviour
eye contact, rapport, level of activity (do you see psychomotor agitation or psychomotor retardation? if so, describe it), body language, mannerisms, specific activities

Speech (Listening)

Flow
smooth, hesitant, interrupted, staccato
easy to interrupt/redirect?
are responses prompt or delayed?

Rate
fast (pressured), slow, or unremarkable?

Volume
soft, loud/pressured, unremarkable.

Tone
flat, monotonous, restricted range, expressive

Continuity
the capacity to maintain a normal progression from one stream of thought to the next: over-inclusive, poverty, circumstantial, perservation or blocking?

Form
assess for abnormalities of form of speech, not form of thought eg stammer/stutter, dysarthia, expressive or receptive aphasia.

Clarity

Accent

Affect (Looking)

An objective assessment of facial and bodily expression of mood state.
Is affect appropriate to content? (congruent)
Assess the range, appropriateness, intensity and quality of affect
Rapid shift from one emotive response to another? (lability)

Some Useful Adjectives:

sad, tearful, angry, irritable, elated, euphoric, frightened, despondent, animated, expansive, cooperative, ingratiating, distressed, discouraged, anxious, hostile, guarded, anxious, calm, ambivalent, dysphoric, euthymic, suspicious, fatuous, bewildered, perplexed

Mood (Asking)

A subjective assessment of mood state:
How has your mood been lately?
How do you feel within yourself?
What has given you happiness, joy or enjoyment recently?
Are you a good person?
Have you been feeling guilty or sad?
If 10 is as good as you ever feel and 0 is as low as you go, where on the scale have you been over the last couple of weeks?

Neurovegetative signs and symptoms:
Sleep
Appetite
Irritability
Tearfulness
Energy
Motivation
Libido
Withdrawal

Thoughts (Asking & Listening)

Form
coherent? rational? sequential/linear?
amount – poverty, flight of ideas, vague
continuity of ideas – incoherent, blocking, circumstantial, tangential, irrelevant
disturbance in meaning or use of language – neologisms, word salad

Content
delusions, obsessions, compulsions, suicidal ideation, phobias, paranoia, preoccupations?
Do you feel safe here/at home?
Are you able to project your thoughts onto others?
Are other people able to insert ideas/thoughts into your head?

Perception (Looking, Listening & Asking)

Hallucinations = false sensory perception that occurs in the absence of a stimulus.
Can affect any of the senses:
Auditory
Visual
Olfactory
Tactile
Gustatory
Have you been experiencing any unusual sensations that you can’t easily explain?
Do you any special powers?
Sometimes when people are really stressed they hear voices/noises, but there’s nobody there. Has that ever happened to you?
You seem distracted by something I can’t see. Can you help me understand what you’re experiencing?

Ideas/delusions of reference
Do you have any unusual experiences when watching TV, or listening to music?
Do you ever feel that the TV has special messages just for you?

Illusion = misinterpretation of sensory stimulus
eg: responding to a pyjama top on a chair as if it were a cat; being startled by something out the corner of their eye.

Cognition (Asking & Listening)

Orientation
time, place, person, situation
Memory
Concentration
Attention
Clock Drawing Test [brief frontal lobe assessment]
please draw a large circle, then insert numbers to make it look like a clock.
now draw in the hands to show ten past eleven

MMSE: Mini Mental State Examination
– screening [ie: not diagnostic] tool for cognitive impairment – best for mild to moderate
– does not differentiate between delirium and dementia
– used to detect impairment, to follow course of illness, to monitor treatment response
– affected by education, intelligence, age, literacy, culture and inter-rater reliability

MMSE alternatives include:

MoCA: Montreal Cognitive Assessment
ACE-R: Addenbrooke’s Cognitive Examination
RUDAS: Rowland Universal Dementia Assessment Scale
KICA: Kimberley Indigenous Cognitive Assessment

Insight & Judgement (Asking & Listening)
Insight = to see one’s self as others do
Judgement = capacity to make reasoned decisions

Does the person recognise symptoms (eg: confusion, hallucinations) as symptoms?
Is the person aware that they are ill and understand the effects and implications?
Is the person seeking assistance/information or rejecting help?
Good, partial or poor? As evidenced by…

Risk (Asking & Listening)

Estimation of risk will be influenced by the person’s history (ie: previous experiences, behaviours and exposures) – the static factors.

Risk is best explored after rapport has been established, and the person knows that you are a safe, non-judgemental person. If somebody discloses intent/plans of harming themselves or others, thank them for trusting you, and let them know that it is too important a matter for just the two of you to handle alone. You’ll arrange for support.

The suggested questions below are for dynamic, “here and now”, factors only

Risk to Self
Do you still have “the fighting spirit”?
Do you ever think, “what’s the point in going on?”
What’s keeping you going?, what makes life worth living?
Have you thought you would be better off dead? How strong are these thoughts?
Have you thought of suicide?
Have you made a plan? [if “yes”, does the person have access to means?]
When would you do this?
What can I do to help you to stay safe?

Risk to Others
You seem pretty angry.
Are you able to express that anger safely?
Do you feel like acting on that anger?
Do you feel like hurting someone?
Are you safe to be around at the moment?
Am I safe with you? What about the other staff and patients here?
What can I do to help you to stay safe?

Alcohol, Tobacco & Other Drugs (Asking & Listening) 

Most substance abuse is contextual
Give “permission” for honest answers

“Sounds like you’ve had a lot of stress lately. How have you been coping?”
“You’ve got a lot of stuff going on at the moment… are you drinking or smoking more than usual?”
“In FNQ plenty of people use the bottle shop or a bit of choof or speed to try to manage stress. How about you?”

Quantity. Frequency. Recency. Route.

Substances:

  • Alcohol
  • Tobacco
  • Cannabis (choof, gunja, yarndi, weed, dope)
  • Amphetamines (speed, goey)
  • Methamphetamines (ice, crystal meth)
  • MDMA = methylenedioxymethamphetamine (ecstasy)
  • Opioids (codeine, morphine, methadone, heroin)
  • Benzodiazepines (benzos: diazepam, oxazepam, nitrazepam/moggies, temazepam/normies, alprazolam/xannies)
  • Hallucinogens (LSD, magic mushrooms)

End

That’s it. Hopefully you’ll find it as a handy memory-prompt/word-finder/confidence booster when providing holistic patient care.

There is a printer-friendly version here:
pdficon

There is a slideshow version here:
MSE

The short URL for this page is: meta4RN.com/MSE

As always, your feedback is welcomed in the comments section below.

Paul McNamara, 22nd July 2016

Example of Nursing Curriculum Vitae

3 Replies

A question this morning via Twitter from @BoxedUpHeart:

unnamedLooking for a nursing cv template if such a thing exists

Any ideas?

Ping the lads @TheNursePath @Inject_Orange @meta4RN

So, to answer the question, I’m sharing my CV online. The version I want you to look at is here as a PDF. pdficon

CV

Why do I want you to look at that version? It is because I’ve spent time formatting it to look pretty. Prettier than I can manage on this website. However, I thought I might as well dump the content of the CV on this page too – it’s nice to have more options than those that LinkedIn accommodates.

I won’t pretend for a moment that this is the ideal way to write a CV. In fact, I know I’ve been over-inclusive on mine – it’s far too long (not just a problem of being a nurse from the 80s). However, the headings may be useful to somebody, even if that somebody is  @BoxedUpHeart alone. So, with no further ado, here goes:

Paul McNamara

address [omitted from online version] Cairns Q 4870
phone [omitted from online version]
email [omitted from online version]
twitter @meta4RN
facebook facebook.com/meta4RN
youtube youtube.com/meta4RN

Curriculum Vitae is true and correct as at 12/06/16

Credentials

  • Registered General Nurse Certificate (Royal Adelaide Hospital)
  • Registered Mental Health Nurse Certificate (Glenside & Hillcrest Hospitals)
  • Bachelor of Nursing (Flinders University)
  • Authorised Mental Health Practitioner (as per S499 of the Mental Health Act 2000, Queensland)
  • Credentialed by the Australian College of Mental Heath Nurses Board of Credentialing since 2006
  • Master of Mental Health Nursing (University of Southern Queensland)
  • Certificate of Infant Mental Health (Child, Youth & Women’s Health Service of South Australia)
  • Current Registration with the Nursing and Midwifery Board of Australia (ID No: NMW0001444629)

Professional & Community Interests

  • Professional Social Media portfolio: meta4RN.com
  • Fellow, Australian College of Mental Health Nurses (ACMHN) since 2008
  • Member, Queensland Nurses Union
  • Social Media Facilitator, Australian Clinical Supervision Association, since February 2015
  • Member, Queensland Clinical Senate (2012 – 2014)
  • Member, QCPIMH National Perinatal Depression Initiative Steering Committee (August 2010 – June 2013)
  •  Member, Reference Group and Working Group of the Aboriginal and Torres Strait Islander Health Workforce Capacity Building – Perinatal Social and Emotional Wellbeing Project (October 2012 – June 2013)
  • Founder & Facilitator, ACMHN Perinatal & Infant Mental Health Nurse eNetwork (2011-2013)
  • Facilitator, ACMHN North Queensland Sub-Branch Email Network (2008 – 2009)
  • Adjunct Lecturer, James Cook University (2007 – 2008)
  • Inaugural Secretary, ACMHN Consultation Liaison Special Interest Group (2005–2007)
  • Founder & Facilitator, Mental Health Consultation Liaison Nurse Email Network (2002 – 2010)
  • Inaugural Member, Management Committee, Worklink Employment Support Group Inc. (1996 – 1999)

Awards

  • 2012: The Health Roundtable, Innovation Award – Quality Care Stream ($6000)
  • 2007: Australian College of Mental Health Nurses (Queensland Branch), Student Award for Clinical and Academic Achievement in Mental Health Nursing
  • 1996: Queensland Health, Quality Award for Excellence in Consumer Outcome Focus and Consumer & Caregiver Involvement (awarded to the Cairns MIT Team)

Publications

Peer Reviewed Journals

Happell, B., Wilson, R. & McNamara, P. (2014) Undergraduate mental health nursing education in Australia: More than Mental Health First Aid. Collegian (Royal College of Nursing, Australia) http://dx.doi.org/10.1016/j.colegn.2014.07.003

Wilson, R., Ranse, J., Cashin, A. & McNamara, P. (2014) Nurses and Twitter: The good, the bad, and the reluctant. Collegian (Royal College of Nursing, Australia) 21(2) 111-119 http://dx.doi.org/10.1016/j.colegn.2013.09.003

McNamara, P. & McCauley, K. (2013) ‘Precovery’: A proactive version of recovery in perinatal mental health. Australian Nursing Journal 21 (1) 38

McNamara, P., Bryant, J., Forster, J., Sharrock, J. & Happell, B. (2008) Exploratory study of mental health consultation-liaison nursing in Australia: Part 2 preparation, support and role satisfaction. International Journal of Mental Health Nursing 17 (3) 189–196

Sharrock, J., Bryant, J., McNamara, P., Forster, J. & Happell, B. (2008) Exploratory study of mental health consultation-liaison nursing in Australia: Part 1 demographics and role characteristics. International Journal of Mental Health Nursing 17 (3) 180-188

Usher, K., Foster, K. & McNamara, P. (2005) Antipsychotic drugs & pregnant or breastfeeding women: the issues for mental health nurses. Journal of Psychiatric & Mental Health Nursing 12 (6) 713–718

Acknowledgements & Contributions

De Costa, C. & Howat, P. (2007) Clinical cases in obstetrics, gynaecology and women’s health McGraw-Hill – acknowledged for contribution of case vignette/source material (page ix)

Elder, R., Evans, K. & Nizette, D. (2005) Psychiatric and Mental Health Nursing Elsevier, Sydney – contributions of case vignettes to this textbook (pages 370, 373, 374 & 415)

Other Publications

McNamara, P. (2014) A Nurse’s Guide to Twitter, Ausmed Education http://aus.md/tfn

McNamara, P. (2011) Perinatal mental health, O&G Magazine, The Royal Australian and New Zealand

College of Obstetricians and Gynaecologists, Vol 13, No 2, p. 56 (invited column)

McNamara, P. (2011) PND: what the experts say, Cairns Parenting Companion, Autumn (March) Issue, p. 10 (invited column)

McNamara, P. (1998: revised 2001, 2007 & 2008) That was bloody stressful: what’s next? (staff resource re stress management) Queensland Health Electronic Publishing Service (QHEPS) intranet: http://qheps.health.qld.gov.au/cairns/docs/12553.pdf

McNamara, P. (2003) ‘Movies, myths, mistakes’, The Cairns Post, 14 August, p.13 (invited guest column re common misrepresentations of schizophrenia)

McNamara, P. (2003) ‘Humanity to man’, The Cairns Post, 29 March, p.19 (invited guest column re men in nursing)

Conference Presentations (last 5 years only)

McNamara, P. (2015) Understanding and managing anxiety disorders. Presented at ‘Cairns Nurses Conference’, Ausmed Education, Cairns.

McNamara, P. (2015) Social media and digital citizenship for health professionals. Presented at ‘Cairns Nurses Conference’, Ausmed Education, Cairns.

McNamara, P. (2015) Social media for nurses and midwives. Keynote presentation at ‘Australian Nurses & Midwives Conference’, Australian Nursing & Midwifery Federation (Victorian Branch), Melbourne.

McNamara, P. (2015) Health professionalism and digital citizenship. Keynote presentation at ‘Primary Mental Health Care in the Digital Age’, Australian College of Mental Health Nurses, Canberra.

McNamara, P. (2014) Mental health in the general hospital. Presented at ‘Cairns Nurses Conference’, Ausmed Education, Cairns.

Happell, B., Wilson, R. & McNamara, P. (2013) Beyond bandaids: Defending the depth and detail of mental health in nursing education. Presented at ‘Collaboration and partnerships in mental health nursing, the 39th Annual International Conference of the Australian College of Mental Health Nursing, Perth.

McNamara, P. (2013) Turbocharging mental health nursing collaboration and partnerships: professional use of Twitter. Poster presented at ‘Collaboration and partnerships in mental health nursing, the 39th Annual International Conference of the Australian College of Mental Health Nursing, Perth.

McNamara, P. (2013) Omnipresent and always available; a mental health nurse on twitter. Plenary session at the 11th ACMHN Consultation Liaison Special Interest Group conference, Noosa.

McNamara, P. (2012) Deploying complex information via a QR Code. Presented at ‘Innovations Workshop and Awards’, The Health Roundtable, Sydney. [NB: recipient of 2012 Innovation Award, Quality Care Stream]

McNamara, P., Horn, F. & Dalzell, M. (2012) Developing, designing and deploying a perinatal mental health referral pathway. Poster presented at ‘The fabric of life’, the 38th Annual International Conference of the Australian College of Mental Health Nursing, Darwin.

McNamara, P. (2012) The nature of nurture: lessons from a baby, story of a saint. Opening plenary presentation at the 10th ACMHN Consultation Liaison Special Interest Group conference, Melbourne.

McNamara, P. (2011) Between the flags, but beyond the breakers; addressing perinatal mental health in calmer, deeper water. Presented at ‘Mental health nurses: swimming between the flags?’, the 37th Annual International Conference of the Australian College of Mental Health Nursing, Gold Coast.

Trott, R. & McNamara, P. (2011) Mental health interventions targeted at youth. Presented at ‘Nurturing, Providing, Gathering for Better Health’, the 2nd Indigenous Women’s Health Meeting of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), Cairns.

McNamara, P. (2011) Establishing a Perinatal Mental Health Service, presented at the Perinatal Mental Health Forum, Queensland Centre for Perinatal and Infant Mental Health, Brisbane, 30th November 2011.

McNamara, P. (2011) Research and data collection, presentation & facilitated discussion at the National Perinatal Depression initiative (NPDI) State & Territory Project Officer’s Meeting, Brisbane, 29th November 2011.

McNamara, P. (2011) Cairns perinatal mental health. Presented at ‘Stay connected, stay strong’, Indigenous Perinatal and Infant Mental Health Forum, Cairns, 25th May 2011.

Ryan, T., McNamara, P., Swain, T. & Brownlie, A. (2010) Playing nicely in the north: Developing clinical supervision in and for North Queensland. Presented at the 11th Annual Tropical Symposium of the North Queensland Branch of Australian College of Mental Health Nurses, Magnetic Island.

Haines, S., Henley, I., McNamara, P., Nizette, D., Porter, V. & Ryan, T. (2010) Great Expectations: Resourcing, reviving and reinventing clinical supervision in mental health nursing. Presented at the 11th Annual Tropical Symposium of the North Queensland Branch of Australian College of Mental Health Nurses, Magnetic Island.

Workshop Facilitation

McNamara, P. (2005-2013) Perinatal mental health. Multiple sessions at multiple sites meta4RN.com/links

Bailey, P. & McNamara, P. (2009-2014) Introduction to supervision. Queensland Centre of Mental Health Learning (QCMHL) one day clinical supervision workshop, QCMHL code QC8; multiple sites http://www.health.qld.gov.au/qcmhl/supervision_res.asp

Bailey, P. & McNamara, P. (2009-2014) Supervisor. Queensland Centre of Mental Health Learning (QCMHL) two day clinical supervision workshop, QCMHL code QC4; multiple sites http://www.health.qld.gov.au/qcmhl/supervision_res.asp

McNamara, P., Butterfield, C. & Mignacca, E. (2013) Engaging with social media. Australian College of Mental Health Nurses 39th International Mental Health Nursing Conference, Perth meta4RN.com/tweets

Casella, E. & McNamara, P. (2015) The use of Social Media in Nursing., Australian College of Nurses workshop, James Cook University, Cairns research.jcu.edu.au/cnmr/news-and-events/news/hits-for-nurses

Rayner, N. & McNamara, P. (2016) Supervising supervisor. Queensland Centre of Mental Health Learning (QCMHL) two day clinical supervision workshop, QCMHL code QC12
http://www.health.qld.gov.au/qcmhl/supervision_res.asp

Education

Certificate of Infant Mental Health 2012
Child, Youth & Women’s Health Service of South Australia
– 10 week course of lectures, tutorials & immersive learning

Master of Mental Health Nursing 2006
University of Southern Queensland
– High Distinction in all graded subjects; Grade Point Average (GPA) = 7.0
– Australian College of Mental Health Nurses (Queensland Branch), Student Award for Clinical and Academic Achievement in Mental Health Nursing

Bachelor of Nursing 1993 to 1995
Flinders University of South Australia
– six subjects awarded Distinction & one High Distinction; GPA = 5.86

Mental Health Nursing Certificate 1993 to 1994
South Australian Mental Health Service, at Glenside & Hillcrest Hospitals
– theoretical components structured on the tertiary education model
– successfully merged theory with practice during this eighteen month course
– placements included acute admission inpatient unit, slow- and fast- stream rehabilitation units
– forensic inpatient unit, and community based services

Graduate Nurse Certificate 1992 to 1993
Royal Adelaide Hospital
– a twelve month course to consolidate abilities in team management and clinical practice

Registered General Nurse Certificate 1988 to 1991
Royal Adelaide Hospital
– a three year course which provided the opportunity to apply theory in practice across a diverse range of speciality inpatient units

Employment History

Clinical Nurse Consultant
July 2015 – current
June 2013 – November 2014
July 2000 – August 2010
Consultation Liaison Psychiatry Service
Cairns & Hinterland Hospital & Health Service (based at Cairns Hospital)
– demonstrated professional leadership re mental health care in the general hospital setting
– significant contribution to the development of this role: it has become a highly respected & – valued component of Cairns Hospital’s multidisciplinary approach to care
– negotiated highly effective inter-department & inter-agency referral relationships
– proven capacity for innovation and a proactive approach to problem resolution
– contributions to the development of CL practice at state & national levels
– regular provision of inservice/staff education
– co-facilitation of QMCHL clinical supervision workshops
– regular provision of clinical supervision

Lecturer
December 2014 – June 2015 [temporary contract]
College of Healthcare Sciences
James Cook University
– Subject Coordinator: Mental Health – nursing undergraduate subjects NS3360/NS3361/NS3362 – revised and delivered lecture program
– revised teaching/learning activities and workbook for Professional Experience Workshops (PEWs)
– delivered PEWs for four cohorts of students
– recruited sessional staff to deliver PEWs across four JCU sites
– reviewed and revised exam content
– tutor for 1st year subject ‘Communication in Nursing and Midwifery’ HS1111
– tutor for 2nd subject ‘Law and Ethics for Nursing and Midwifery’ NS2015
– delivered lecture: ‘Social Media Use for Nurses and Midwives’

Clinical Nurse Consultant
August 2010 – June 2013
Perinatal Mental Health
Cairns & Hinterland Mental Health Service
– established and developed this newly-created position
– established outpatient clinical assessment and treatment across three sites
– developed and delivered a recurrent program of inservice education & half-day workshops to
clinical staff in the primary care sector, tertiary health sector & mental health services
– workshop evaluations (participator qualitative assessments) have been very positive
– established an online presence http://www.health.qld.gov.au/cairns_hinterland/html/pmh_referral_pathway.asp
– a number of conference presentations, including invited Opening Plenary Address at Australian College of Mental Health Nurses conference
– two publications
– 2012 Innovation Award, The Health Roundtable (Quality Care Stream)

Online Facilitator
Dec 2009 – Feb 2011 [part-time]
PrimEd/Medeserv
– Primed/Medeserv delivered much of the content to Queensland Health’s online education portal: the Clinician Development Education Service (CDES)
– Online Facilitator for three courses: Mental Health (QHLTH5209), Social Dysfunction (QHLTH5208) & Diagnostic and Pharmaceutical Processes (QHLTH5212)
– demonstrated ability to facilitate a positive learning environment across a number of subjects using information technology and asynchronous communication
–  very positive feedback on performance via the Education Services Manager

Nursing Professional Leader
October 2009 – June 2010 [0.4FTE temporary position]
Clinical Supervision
– appointed via Queensland Health Office of the Chief Nurse, position hosted by Cairns & Hinterland Mental Health Service
– co-facilitated workshops for Clinical Supervisees and Clinical Supervisors
– proven capacity to implement workplace initiatives that drive change
– demonstrated ability to collect and present workplace survey findings
– proven ability to move segments of the workforce towards best practice
– integration of Clinical Supervision with mental health nurse transition program
– alignment of Clinical Supervision with Authorisation as a Mental Health Practitioner
– reporting relationship with the Office of the Chief Nurse

Lecturer in Nursing
August 2008 – July 2009
School of Nursing, Midwifery & Nutrition
James Cook University of North Queensland
– Subject Coordinator for NS1211 Foundations of Nursing 1 (a 1st year undergraduate subjectthat had over 250 students enrolled in 2009, across four campuses and externally)
– developed, delivered and recruited guest lecturers for a program of lectures delivered via videoconference to campuses in Cairns, Townsville, Mount Isa & Thursday Island
– developed and delivered podcasts and slidecasts of lectures via the subject website
– created and maintained a dynamic subject website for student and staff access to subjectmaterials, discussion boards, grades and announcements
– developed and implemented a tutorial guide for the eight tutors teaching into this subject
– developed and implemented an assignment marking guide to promote inter-rater reliability
– elected to the School’s Strategic Planning Committee
– lectures and tutorials for mental health, crisis management and grief/communication subjects

Tutor/Laboratory Leader/OSCE Assessor
casual contracts: 2002 – 2003, 2005 – 2010
School of Nursing, Midwifery & Nutrition
James Cook University of North Queensland
– deliver components of the undergraduate nursing degree curriculum using a range of teaching methods
– utilised small group work in a tertiary, adult education setting
– assessment of written assignments, acquired skills and learning participation
– student appraisal of my teaching was overwhelmingly positive

Youth Health Nurse (Clinical Nurse)
1999 – 2000
School-Based Youth Health Nurse Program
Cairns District Community Health (based at Cairns High & Yarrabah State Schools)
– established this newly created position
– attracted appropriate resources, including recruiting & establishing clinical supervision
– demonstrated capacity to across sectors with a broad range of people
– delivering health promotion and curriculum support including an educative role

Nurse Educator
1997 – 1998 (12 month secondment)
Transitional Care Program
Cairns District Community Health
– established this newly created position
– targeted skills-development program in wound management & infection control
– provision of outreach education services to Nurses and Indigenous Health Workers in Yarrabah, Cooktown, Wujal Wujal, Hopevale and Laura

Case Manager (Clinical Nurse)
1995 – 1997 & 1998 – 1999
Mobile Intensive Treatment Team (MITT)
Cairns Integrated Mental Health Program
– founding team member of this successful team established as a QHealth pilot project
– demonstrated success through collecting and reporting on data
– in 1996 the team received the Queensland Health, Quality Award for Excellence in Consumer Outcome Focus and Consumer & Caregiver Involvement

Clinical Nurse Educator
casual contracts: 1996 & 1997
Department of Nursing Sciences
James Cook University of North Queensland
– proven ability to facilitate experiential learning and consolidate theoretical learning for Bachelor of Applied Science (Nursing) students
– utilised a creative and pragmatic approach to assist students to gain “hands on” experience in mental health & drug and alcohol services
– assessment of written and practical skills

Community Mental Health Nurse (Clinical Nurse)
after-hours on call: 995 – 1996
Psychiatric Emergency Team and Crisis Assessment & Treatment Team
Cairns Integrated Mental Health Program
– proven ability to assist clients requiring acute assistance on the teams which were the precursors to the Cairns & Hinterland Mental Health Service’s Acute Care Team (ACT)

Mental Health Nurse (Registered Nurse)
1993 – 1994
Glenside & Hillcrest Hospitals
South Australian Mental Health Service
– experiential learning across acute, forensic, rehabilitation & residential care inpatient units

Registered General Nurse
1992 – 1993
High Dependency/Intensive Care Units and Neurology/Neurosurgery Unit
Royal Adelaide Hospital
– experiential learning across a diverse range of clinical settings
– mentored student nurses and new graduates

Registered General Nurse
1991 – 1992
Miroma Nursing Home Pty Ltd

Registered General Nurse
1991 – 1992
Nurses Specialling Bureau

Student Nurse
1988 – 1991
Royal Adelaide Hospital
– experiential learning across a broad range of medical, surgical and speciality units
– as per the orthodoxy of hospital-based nurse education in a large teaching hospital, mentored student nurse peers and juniors

Warehouse Manager
Herbalife Australasia
” demonstrated capacity to provide leadership and deliver change

Sales Representative
Dairy Vale-Metro Cooperative Ltd
” proven capacity to engage with a diverse range of people

Accounts Clerk
Dairy Vale-Metro Cooperative Ltd

Referees

[omitted from online version]

END

So that’s it – that’s my CV. I’ll probably update the online version PRN… as the parable goes, there’s not much point in hiding one’s light under a bushel.🙂

As I said in the intro, this isn’t necessarily the way to present a nursing CV, but it’s an example you might be able get some ideas from. Do you have any suggestions re a nursing CV? If so, please feel free to share them via the comments section below.

Paul McNamara, 12th June 2016

Short URL: meta4RN.com/CV

The Last 40-Odd Weeks

4 Replies

This blog post has one purpose only.

It is to explain why I have been so uncharacteristically vague, and often distracted, for the last 40-odd weeks.

During that time many dozens of people (most of them uni students, but also friends, family and colleagues) have asked this question: “Are you still teaching at the uni?” My wishy-washy responses have been along these lines:
“Hopefully!”
“I’m not sure.”
or the hilariously inaccurate “Ask me again in a couple of weeks.”

FullSizeRender copy

Let me explain/elaborate by using a timeline:

1995: Started working for the health department full-time [see LinkedIn]

1996: Started working for the uni temporarily/part-time – an arrangement that continues sporadically over the years that follow [see LinkedIn]

May 2015: I’m working at the uni. Casual chat between senior uni colleague and I. Outcome = let’s think about the possibility of a shared position between the uni and the health department. There would be some benefits to both organisations. It’d be a pretty cool gig, I reckon.

June 2015: Senior uni colleague says “let’s do it!”. A meeting is held between senior uni colleague and a senior health department colleague. Verbal agreement established. The uni sends a contract to the health department. The first draft of the role description is drawn up by the uni and sent to the health department. The contract and position description cite an October 2015 start date.

July 2015: I’m back at the health department. I make sure that people who need to know about the new position coming know, and offer to help progress things along if I can. Funding’s an issue, of course, but there should be a way…

August 2015: I make occasional enquiries. Bureaucracies need processes and time. Be patient.

September 2015: More enquiries. It’s all about the paper-trail, funding, signatures. Be patient.

October 2015: My enquiries must be getting a bit too shrill. Emails are not answered. Phone calls are not returned. The intended start-date for the position passes.

November 2015: I’m getting anxious about the delayed start not leaving enough time for 2016 subject preparation. I start pulling on the very few levers that are available to me: someone who knows someone who knows someone will look into it. I rescheduled my December flights: if I happen to get this job I won’t have time to go to Japan in December. The teaching starts in January, and there needs to be subject preparation.

December 2015: The position is advertised. Yay!
My request for consideration of transfer at level so as to expedite the position starting in a timely manner is declined. Bugger.
I send in my application and hope for the best.

8th January 2016: Interviewed for the position. I was phoned after the interview and offered a 3 month secondment into the position. That’s weird. It’s funded for 5 years. I ask to think about it over the weekend.

8th-10th January 2016:  Consult with my wife and trusted friends. Consensus is that if I’m good enough to do the job for 3 months, it’s weird that I’m not good enough to do the job for the term of the contract. I find myself thinking of the refrain from Bob Dylan’s Ballad of a Thin Man:
Because something is happening here
But you don’t know what it is
Do you, Mister Jones?

11th January 2016: “Thank you very much for offering me a 3 month position. However, I applied for a 5 year position. I can only commit to the position if the organisation commits to me.” Nice try Paul. “We’ll let you know when we schedule another interview.”

18th January 2016: The uni teaching period starts. The subject is underway without the position being filled.

2nd February 2016: Interviewed for the position again.

2nd February – 31st March 2016: I hear nothing at all officially. Other people do. It makes its way along the health department grapevine that someone else has been successful. One of those whispers reaches me via a convoluted track. I’m disappointed, of course, but not surprised. Silence is the polar opposite of someone enthusiastically saying, “Congrats! We reckon you’ll be great! When can you start?”

1st April 2016 (no, not joking): An email from noreply@smartjobs.qld.gov.au that says “I wish to advise that on this occasion you have not been successful in obtaining the position.”

So that’s it.

I can drop the vague, unknowing responses to enquiries now. It’s a relief to know. It’s a relief to be able to be open and transparent again. I didn’t get the job that I was hoping for. Yes, of course I am disappointed. However, I am totally accepting of the obvious fact that there was another candidate for the position who is better credentialed, better prepared and/or more meritorious for the role.

Ricky Ponting wouldn’t feel bad if somebody said Don Bradman was a better cricketer than him. Same-same, but different. Not that I’m the Ricky Ponting of mental health nurse education. More like Boof Lehmann, I reckon.🙂

I am disappointed by how long the whole recruiting process took. The uni sent the contract and position description to the health department in June 2015. It’s taken the health department until April 2016 to fill the position. That’s longer than a human pregnancy.

IMG_7564

Despite being there for the courtship, conception and gestation, I now know it’s not my baby.

The other lesson I’ve taken from this is to cautiously self-monitor my behaviour at work (I’m a mental health nurse in a general hospital ). In clinical supervision we recognise that there are parallel processes: how a nurse treats a patient can be influenced by how the organisation treats the nurse. It is prudent that I be especially intentional and vigilant to treat my patients in a timely manner, and with the kindness and respect they deserve.

The last 40-odd weeks have been odd. Sorry about all my distractibility and wishy-washy responses to questions during that time. I hope this timeline/blog post explains it all.

End

That’s it. Thanks for reading.

Paul McNamara, 3rd April 2016

Short URL: http://meta4RN.com/40weeks

Nurses on the 2016 Australia Day Honours List

1 Reply

Extracting information from gg.gov.au/australia-day-2016-honours-lists, below are the Nurses named on the 2016 Australia Day Honours List.

Professor Mari Angela Botti AM
Member (AM) in the General Division of the Order of Australia
Melbourne, Victoria
For significant service to nursing, and to medical education, as an academic and author, and to pain management research.

Deakin University:
Alfred Deakin Professor in Nursing, School of Nursing and Midwifery, Faculty of Health, since 2012.
Epworth Chair of Nursing, since 2004 and Professor, School of Nursing and Midwifery, since 1998.
Coordinator, Bachelor of Nursing (Clinical Honours), since 2005.
Chair, Human Research Ethics Committee, current.
Executive Member, Quality and Patient Safety Strategic Research Centre, current.

Lecturer, School of Nursing, La Trobe University, 1988-1998 and Senior Tutor, 1986- 1988 and Sessional Clinical Teacher, 1985-1986.
Epworth Healthcare:
Chair in Nursing, Epworth/Deakin Centre for Clinical Nursing Research, Epworth HealthCare, since 2004 and Member, Human Research and Ethics Committee (HREC) and Chair, HREC Low Risk Sub-Committee.

Director, Alfred/Deakin Nursing Research Centre, Alfred Health, 1998-2010 and Deputy Chair, Human Research Ethics Committee and Board Member, Alfred Medical Research and Education Precinct (AMREP) and Member, Nursing Advisory Committee.

Member, Victorian Quality Council, 2004-2008.

Member, Victorian Policy Advisory Committee on Clinical Practice and Technology, 2005- 2006.

Member, External Review of Applications for DHS Public Health Research Projects, 2002-2003.

External Assessor, Research Project Grants Proposals, National Health and Medical Research Council (NHRMC) and Australian Research Council (ARC), since 2000.

Publications include:
Has published over 83 articles in refereed journals and 5 book chapters .

Professional Organisations include:
Member, Australian College of Nursing, since 1979.
Member, Cardiac Society of Australia and New Zealand, since 1992.
Member, Australian Pain Society, since 1992.
Member, International Association for the Study of Pain, since 2001.
Member, Health Services Research Association, Australia and New Zealand (HSRAANZ), since 2007.

Nursing roles include:
RN/Clinical Nurse Specialist, Coronary Care Unit, Royal Melbourne Hospital, 1984-1992 and Student/Clinical Nurse, Coronary Care Unit, 1981 and Clinical Nurse, Medical/Surgical/Intensive Care Unit, 1978-1980.
Student/Midwife, St Thomas’ and Guys Hospitals, London, UK, 1982-1984.

Paula Jean Penfold AM
Member (AM) in the General Division of the Order of Australia
Toowong, Queensland
For significant service to the community through support for people with Muscular Dystrophy, to child health ethical standards, and to medical research.

Service includes:

Founding and active member, Muscular Dystrophy Association of Queensland, since 1978.

Member, Human Research Ethics Committee, Queensland Children’s Health Services, Brisbane Royal Children’s Hospital, since 1980.

Senior Clinical Nurse and Research Assistant, Greenslopes Hospital, ‘for many years’.
Researched and co-authored several articles for theNeuroendocrine Research Unit, Greenslopes Hospital, 1991.

Management Consultant, Paula J Penfold and Associates, current.
Associate Fellow, Australasian College of Health Service Management, since 2013.

Kym Robina Stuart AM
Member (AM) in the General Division of the Order of Australia
Kedron, Queensland
For significant service to nursing through a range of voluntary roles throughout the developing world, particularly in Asia and the Pacific.

Service includes:

Volunteer Perioperative Nurse Surgical Assistant, Asia/Pacific Region, Open Heart International (formerly Operation Open Heart), since 1992.
Has attended 50 aid trips to a range of developing countries including: Mongolia, Vietnam, Vanuatu, Myanmar, and the Solomon Islands, Cambodia, Fiji, Papua New Guinea, Nepal and Rwanda.

Head, Operating Theatres, during all 20 trips to Papua New Guinea.
Fundraiser for, and collector of, various surgical instruments, equipment, clothes and books.

Professional service includes:

Clinical Nurse, Paediatric Cardiac Operating Theatre, Queensland Paediatric Cardiac Service, Lady Cilento Children’s Hospital, (formerly at Mater Children’s Hospital), since 2008.

Surgeon Assistant, and Nurse Specialist, Cardiac Operating Theatres, Sydney Adventist Hospital, 1990-2005 and was involved in the establishment of the Operation Open Heart project.

Awards and recognition includes:
Recipient, Cross of Medical Service Medal, Order of Logohu, Papua New Guinea, 2008, ‘for services to public health and the community through participation in Operation Open Heart.
Recipient, Paul Harris Award, Rotary International, 2007, ‘for contribution to international aid work’.

Kathleen Ellen Bright OAM
Medal (OAM) of the Order of Australia in the General Division
Moss Vale, New South Wales
For service to women, and to nursing.

Service includes:

Country Women’s Association of New South Wales:
State Vice-President, 2010-2012.
Group President, Wollondilly Group, 2003-2006.
Group Representative to State Executive, 2006-2009.
President, Moss Vale Branch, 2010-2012, 2002-2006.
Member, since 2002 and Member, Kiama Branch, ‘for many years’. Other community:

Vice-President, United Hospitals Auxiliary, Moss Vale Branch, since 2001.

Nursing:
Assistant Director of Nursing and Manager of Surgery, Princess Alexandra Hospital, Brisbane, 1992-1996.
Director of Nursing, Campbelltown Private Hospital, 1989-1991.
Director of Nursing and Area Advisor in Nursing, Liverpool Hospital, 1977-1989.

Fellow, Australian College of Nursing (formerly Royal College of Nursing Australia and New South Wales College of Nursing), current.
Fellow, The Institute of Nursing Administration of New South Wales and ACT.
Associate Fellow, Australian College of Health Services Administrators.

Narelle Gai Martin OAM
Medal (OAM) of the Order of Australia in the General Division
Kirribilli, New South Wales
For service to nursing, particularly palliative care for children.

Service includes:
Nursing Manager, ‘Bear Cottage’ Children’s Hospice, (affiliated with the Sydney Children’s

Hospital Network) since 2008; Registered Nurse, 2001 – 2008.
Registered Nurse, Children’s Hospital at Westmead, 1982 – 2001. Member, New South Wales Nurses and Midwives Association, since 2003.

Mark Cameron McDonald ASM
Ambulance Service Medal (ASM)
Stones Corner, Queensland

Mr McDonald commenced his career with the former Queensland Ambulance Transport Brigade, now the Queensland Ambulance Service (QAS), in Gatton as an Honorary Officer in January 1977 and has diligently served the community at locations throughout Queensland for more than 37 years. His unfailing commitment and dedication to excellence in patient care, education, training and continuous professional development has earned him the respect of the community, and his peers, as a role model in the field of the practise of paramedicine. He has contributed in a distinctive way to the development of the QAS during his career, including high level contribution to the introduction of the original Associate Diploma of Ambulance Studies, service planning, clinical education and student paramedic progression. He has continually demonstrated determination, resourcefulness, consideration and passion in the roles he has undertaken. As a critical care paramedic, registered nurse, educator, mentor and coach, Mr McDonald epitomises the best qualities and characteristics of what is expected of a professional ambulance paramedic, contributing valuably to the QAS, peer development and the Queensland community.

Captain K 
Australian Army
Distinguished Service Medal DSM)
For distinguished leadership in warlike operations as the Nursing Officer and Health Planner on Operation OKRA.

Captain K displayed outstanding leadership and dedication to duty as a Nursing Officer. She accepted, planned and executed the most difficult of medical responses and support tasks in extremely austere environments professionally and without fault. She directly contributed to the operational effects of the Special Operations Task Group. Her leadership is of the highest order and in keeping with the traditions of the Australian Army and the Australian Defence Force.

Captain Katrina Anne Kelly
Australian Army
Commendation for Distinguished Service
New South Wales
For distinguished performance of duties in warlike operations as the Nursing Officer to the United Kingdom-led mentoring mission to the Afghan National Army Officer Academy at Qargha, Kabul Afghanistan on Operations SLIPPER and HIGHROAD from July 2014 to January 2015.

Captain Kelly displayed exceptional professionalism and dedication to duty while providing immediate health support to Australian and Coalition Forces. Her level-headed actions following an insider attack at the Marshal Fahim National Defence University had a force multiplying effect which aided the critical treatment and extraction of fourteen casualties. Captain Kelly selflessly provided mental health and welfare support at Qargha which was above and beyond the scope of her prescribed duties and greatly assisted the wellbeing of Australian personnel.

Although not on the honours list, there is certainly another nurse worthy of a mention amongst this company:

Anne Carey
National Finalist (representing Western Australian)
Australian of the Year 2016
A nurse, midwife and medical warrior, Anne Carey has spent her life helping others – even when it has been at great personal risk. Anne has provided health care for remote communities in hospitals and clinics across Papua New Guinea, Northern Territory and Western Australian. As an Australian Red Cross aid worker in some of the world’s hotspots including Sudan, Kenya and most recently Sierra Leone, Anne leaves an impact on everyone she meets. During her time in Sudan, Anne and her colleagues came under attack, but while others left, they courageously stayed put to help the local residents. In Sierra Leone, she spent three assignments battling on the frontline against the deadly Ebola virus and was amongst the first volunteers to assist. Every day, she was taped into a personal protection suit, and while she may have looked inhuman in her all-white sterilised suit, thick rubber gloves and perspex goggles, Anne extended humanity with a simple touch and professional care that helped people understand they were not alone. Despite the death, fear and despair felt during the Ebola outbreak, Anne was a beacon of hope and continues the desperate fight to save the lives of people most in need.
Source: www.australianoftheyear.org.au/honour-roll/?view=fullView&recipientID=1379

Closing Notes

Please let me know if I missed any nurses or midwives. I’m happy to correct any oversights (not fully caffeinated yet).

Similarly, if you know of an online article that elaborates on the info above and/or has a photo of any of the Nurses on the 2016 Australia Day Honours List please let me know via the comments section below – I’d be happy to add a link to the article(s).

That’ll do for now..

Paul McNamara, 26 January 2016

Once Up, Twice Down (not as depressing as it sounds)

4 Replies

This week I made a discovery.

Just in the way Captain Cook “discovered” Australia, my “discovery” isn’t new to everyone. It’s just new to me.

While standing at a bank of lifts in the hospital I noticed that when an elevator arrived and was going up it would ding once, and ding twice when going down. Hashtag observation.

I was more excited by this than a grown-up should be. As I made my way through the hospital, I tested the other bank of lifts in Block D, then the lifts in Block C, Block B and Block A. Hashtag curious.

Cairns Hospital from the shipping channel

From L-R: Block A, Block B, Block C & Block D. Source: https://instagram.com/p/3VfQHYKB_a/

That’s science baby: make an observation, come up with a hypothesis, then repeatedly test it to see if holds true. As it happens, all of the hospital lifts beep once if they’re going up and beep twice if they’re going down. Sample size: 1 hospital, 5 banks of lifts. Hashtag sciency.

Naturally, I tweeted and facebooked about it. Hashtag share the love.

It seems that the one-up two-down audible alarm holds true unless the lifts/buildings are old and/or have lifts which do not announce their arrival with an audible sound at all. Hashtag stealthy.

Anyway, I’m still intrigued by my one-ding-up-two-dings-down discovery. For me it raises two questions and a hypothesis:

Question 1: What else is happening right in front of me that I’m not noticing?

Question 2: What other secret tips and tricks do vision-impaired people have that they’re not telling us?

Hypothesis: Even when the big stuff isn’t going all that well, there’s joy to be had in the small stuff.

End Notes

There is a fun discussion about this subject on Reddit, see “Life Pro Tips: Arriving elevator dings once if going up, twice if going down”

Do the lifts/elevators in your hospital/office/apartment beep once on the way up and twice on the way down? I’m keen to hear from you comments/responses are welcome in the space below.

Paul McNamara, 14th November 2015
Short URL: meta4RN.com/ding

Crisis? What Crisis?

2 Replies

I’m a nurse. Every day at work somebody is in crisis.

Every. Single. Day.

People have life threatening injuries and illnesses. People experience suicidal ideation and sometimes act on those thoughts. People experience delirium, dementia and psychosis – they lose touch with reality. People behave in unexpected and challenging ways.

All of these people are in crisis. They are having the worst day(s) of their life.

When you are part of the clinical team trying to help out these people it’s always useful to acknowledge and clarify the nature of the person’s crisis. It’s surprising what the individual’s perception of the crisis is. I’ve met a person who was desperately unwell – ICU unwell – who’s subjective crisis was that the cat was home alone without anyone to feed it. That was the crisis she wanted me to respond to. I’ve met quite a few people who need urgent medical/surgical interventions, but who perceive their biggest crisis as being unable to smoke a cigarette right now. I’ve had the peculiar privilege of spending time with people who have survived suicide attempts, who have experienced a crisis related to abuse, financial problems, relationship breakdown, and loss of job/role/independence/sense-of-self. An existential crisis in mind, body and spirit.

All of these people are in crisis. It is their crisis.

It is important to ascribe ownership. The nurse/midwife/physician/other clinician is not experiencing the crisis; they are responding to the crisis. We (the clinicians) have not been immunised against crises, but we do have the responsibility to do whatever we can to not get overwhelmed by them. Also, truth of the matter is, I’m not sure how long you would last if you responded to every day at work as an adrenaline-filled, too-busy-to-wee, emotional rollercoaster. That be the road to burnout and breakdown, my friend.

So, what do we do?

We use Jedi Mind Tricks, pithy sayings and clinical supervision. That’s what we do.

Clinical Supervision
I’ve written about clinical supervision before (here and here). Despite the name, it’s not about scrutiny. Clinical supervision is about reflecting on clinical practice with a trusted colleague, and asking simple questions of yourself: what did I do?; what were the outcomes?; how did I feel?; what lessons did I learn?.

The idea of clinical supervision is to acquire and refine clinical skills.

Pithy Sayings
A lot of us use and repeat pithy sayings such as the ED adage: “In the event of a cardiac arrest [or any other patient crisis for that matter], the first pulse you should take is your own.”

If you recognise your own anxiety you’re more capable of managing it. Intentional slow breathing is an excellent intervention for this. You can do it while you’re scanning the patient/file/environment.

Breath. Slowly.

It is not a crisis. A crisis is when there’s a fire, storm-surge, tsunami, earthquake or explosion that requires evacuation of staff and patients. If the hospital is not being evacuated it’s not a crisis. It’s just another day at work.

IMG_1099

Jedi Mind Tricks
The other thing I like to do when feeling anxious is impersonate a calm person. It’s like a Jedi mind trick. “This not the anxious nurse you’re looking for. This is a calm nurse.”

When impersonating a calm person  I conjure-up a person who was a CNC when I was a student nurse at the Royal Adelaide Hospital. Part of the apprenticeship model of nursing education at the time was to give students experience in RN roles. I had been thrown into the Team Leader role on a day when the neuro ward was especially busy. There were emergency admissions, a stack of post-op patients – two of whom were really unwell, a person dying in the side room, and an inexperienced unqualified overwhelmed drongo (me) coordinating the whole thing. We were in trouble. We needed more nurses and a proper team leader.

I sought-out the CNC – a smart-as-a-whip young woman not much older than me (i was quite youngish 25 years ago). The CNC spent all of about 5 minutes with me prioritising the ward’s workflow:

  • “First things first. No need to shower/clean anyone unless they’re incontinent.” There goes about 50% of the morning’s workload in an instant.
  • “Don’t bother with routine 4-hourly obs unless the person looks unwell. Only the post-op patients and the clinically unwell patients need their obs done.” There goes another 10% of the work.
  • “Let’s get Fiona (the most experienced and skilled nurse on the shift) to look after the two dodgy post-op patients and nobody else.” The biggest concern was instantly taken care of.
  • “Bring all the nurses in here (a cramped nurses station overlooking 2 bays of 6 patients each) and tell them the plan. Make sure they all drink water and coordinate their breaks.” Got it. To look after the patients you need to look after the nurses.
  • “After you’ve told the nurses the plan, tell the patients/visitors who aren’t critically unwell the plan. They’ll understand we’re abnormally busy if we tell them.” Open, honest communication? Who’d have thought?
  • “Slow down your breathing. Use your humour. You’ll be fine. Come and grab me if you need.” My racing thoughts slowed. Panic evaporated.

We, nurses and patients alike, had a good shift. All the vital stuff was done. It wasn’t a crisis. It was a day at work.

I haven’t seen that CNC (her name is Lee Madden) since 1992, but I think of her every now and then. Whenever I see a crisis unfolding or see/feel anxiety rising, I wonder, “What would a calm person do?” and conjure an image of Lee floating serenely into the space. I channel Lee’s reassuring smile and clear understanding of priorities, and do my best to behave in the way she modelled to an impressionable overwhelmed student nurse.

Crisis? What crisis? I’m impersonating a calm person.

IMG_1098

End

As always, you’re welcome to leave comments below.

Paul McNamara, 5th September 2015
Short URL: meta4RN.com/crisis