Digital Professionalism📱vs The Dinosaurs 🦕

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In a famous reddit exchange from about 7 years ago, this question was asked:

If someone from the 1950s suddenly appeared today, what would be the most difficult thing to explain to them about life today? 

Nuseramed replied: 

I possess a device, in my pocket, that is capable of accessing the entirety of information known to man. 

I use it to look at pictures of cats and get in arguments with strangers.

The response went viral.

The iPhone revolutionised how we use mobile phones. Although there were internet-connected phones years before the iPhone came along, it wasn’t until the iPhone was released (2007 in the US + Europe, 2008 in Australasia) that it started to become normal to access the internet while on the run, not just at a desk. Furthermore, the explosion of apps that followed the iPhone release made it clear that making phone calls and sending text messages were the least fun things you could do with a mobile phone. 

Which brings me to the point of this post. Smartphones don’t have to be used for looking at cat videos and getting into arguments with strangers. Smartphones can be a terrific asset to nursing work, but there’s sometimes a weird reluctance from nursing’s leaders to encourage or even permit their use. This reluctance was noted in a recent Journal of Advanced Nursing editorial:

I could wave my hands around and talk about why nurses should embrace, not avoid, using smartphones. It might be a bit abstract though.

We could ask more people to google “mHealth” so they can see their there’s a whole field of study about using smartphones in health care.

Instead, let’s just list a dozen real-life examples of how clinicians use smartphones at work:

  1.  

Google translate does not replace using an interpreter, but for occasional words or phrases it’s terrific, especially if you use the Voice or Conversation functions. 

Overcoming communication barriers often relies on creative solutions. If you can break the ice/engage the person using content you can access on your phone you absolutely would, wouldn’t you? 

In Australia the medication bible is MIMS. Having MIMS on your phone = being able to check on medication info quickly and easily wherever you are. There’s a free 7 day trial, then they’ll charge you $ome monie$ (I’m assuming/hoping it’s tax deductible for nurses, doctors and pharmacists). 

Mindfulness/stress-management can be much easier if there’s a framework and tools to guide you. The free and credible SmilingMind app does just that. 

Google maps is great for this sort of thing.

Calculating BMIs is a tad tricky with pen and paper. The Mediquations app does it for you. 

  1.  

Screening tools like the Edinburgh PND Scale don’t have to be paper-based. This one is on the Mediquations app. It calculates the score automagically, and the whole thing can be emailed to cut and paste into the electronic medical record, so the woman can track her changes/progress, and/or shared with others on the clinical team. 

In the last couple of years there has been a push towards making sure that people who experience suicidal thoughts have a safety plan. Some organisations have created forms for this sort of thing. That might be OK for the organisation, but how handy is it for the person? For most individuals it would be MUCH more handy having a shareable safety plan on your mobile phone. If you haven’t done so already, sus-out BeyondNow.

  1.  

I used to struggle with CPD documentation. With an app you can do it in real time, and readily access it PRN. I used to use the C4N app, but it was a bit clunky. The free Ausmed one is better. There are probably other CPD evidence-based record apps. Wouldn’t it be nice if ANMF and/or AHPRA provided their fee-payers with a free, easy-to-use, and fit-for-purpose CPD app? 

A previous blog post called “Phatic Chat: embiggening small talk” introduced this example of how Google maps can help bridge cultural and language barriers by demonstrating interest, openness and respect. 

  1.  

I must have been away the day they told us about Klienfelter’s syndrome in nursing school. This app makes me sound much smarter than I really am. 

  1.  

Accessing info online (eg https://www.nmsupport.org.au) is a legitimate way for nurses to improve the safety of their practice and to support each other. Why on earth would nursing’s leaders want to restrict ready information access? 

Score

That’s the end of the list of a dozen real-life examples of how clinicians use their smartphone at work. Here’s the score: 

Digital Professionalism📱= 12
The Dinosaurs 🦕 = 0

Snippily Sarcastic Suggestion

Does your nurse manager, nurse educator, university lecturer or clinical facilitator need to know about this stuff? 

Here 👉 [click link to open] 👈 is a PDF version of this blog post that you can print and mail or fax to them. After all, we wouldn’t want to risk using a modern digital technology like email, would we? 🙄 

End

Do you have other examples of Digital Professionalism? Please feel free to add them in the comments section below. 

Thanks for visiting. 

Paul McNamara, 2 November 2019

Short URL: meta4RN.com/mHealth

APA citation:  McNamara, P. (2019, November 2). Digital Professionalism📱vs The Dinosaurs 🦕 [Blog post]. Retrieved from https://meta4RN.com/mHealth

The 12 tweets used above are collated here: wakelet.com/@metaRN

References 

O’Connor, S. , Chu, C. H., Thilo, F. , Lee, J. J., Mather, C. and Topaz, M. (2019), Professionalism in a digital and mobile world: A way forward for nursing. Journal of Advanced Nursing. doi:10.1111/jan.14224

Rolls, K., Massey, D. & Elliott, R. (2019). Social media for researchers – beyond cat videos, over sharing, and narcissism. Australian Critical Care, Volume 32, Issue 5, 351 – 352 doi:10.1016/j.aucc.2019.07.004

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A tale of two hashtags

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Once upon a time (October 2019) two nursing conferences occurred almost back-to-back.

The 45th ACMHN International Mental Health Nursing Conference was held in Sydney from 8-10 October 2019. The conference hashtag was #ACMHN2019.

Over the week of the conference over 250 people used the hashtag on Twitter, there were 2,264 Tweets.

The 17th CENA International Conference for Emergency Nurses was held in Adelaide from 16-18 October 2019. The conference hashtag was #ICEN2019.

Over the week of the conference nearly 230 people used the hashtag on Twitter, there were 1751 Tweets.

Keeping Score

To be honest, I’m a little surprised. It is often pointed out that Australian Mental Health Nurses are an ageing bunch. I kind-of assumed that us old fogies would be out-Tweeted by our younger and more glamorous Emergency Nurse colleagues. Not that it matters, of course… we’re qualified, experienced and motivated specialist health professionals.

Of course we are much too mature to get caught-up in trivial competition.

Ahem.

2020 Rematch

Next year the 46th ACMHN International Mental Health Nursing Conference will be held on the Gold Coast from 14-16 October 2020 (source/more info: www.acmhn2020.com).

And, the 18th CENA International Conference for Emergency Nurses will also be held on the Gold Coast from 14-16 October 2020 (source/more info: www.icen.com.au). 

So, in 2020 two specialist groups of nurses will conferencing in the same place at the same time. Game on! 🙂 

Will the #ACMHN2020 or #ICEN2020 hashtag be the most used next October? Please feel free to leave your predictions, hopes or bets in the comments section below.

 

End

Thanks for visiting. 

Paul McNamara, 25 October 2019

Short URL: meta4RN.com/hash

 

Ye Olde Yahoo CL Nurse eMail Network

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Once upon a time (February 2002) there were a bunch of mental health consultation liaison nurses in Australia, New Zealand, and other places far, far away. They were separated geographically, but became connected via the magic of email.

Keep in mind it was 2002 – Google, Facebook, Twitter etc hadn’t made their mark back then, so starting a Yahoo email list was about as clever as we could get at the time.

In 2012-2013 our Ye Olde CL Nurse Yahoo eMail network [link] stopped being used, and we transitioned to the email platform hosted via the Australian College of Mental Health Nurses instead [link].  Anyway, today I stumbled across an old powerpoint presentation and poster re Ye Olde CL Nurse Yanoo eMail Network, and thought it would be nice to plonk them both online for nostalgic/historical purposes.

Here’s the powerpoint:

 

And here’s the text from the poster and a pic + PDF of the poster itself:

Consultation Liaison Nurses
Isolated Geographically. Connected Electronically.

The Mental Health Consultation Liaison Nurse Network aims to link peers for an exchange of information and ideas. Given the nature of this mental health sub-speciality, Nurses working in this field are usually pretty independent practitioners and often don’t have regular contact with peers who share CL Nurse experiences and interests

The email network originally spluttered to life in February 2002 and has gained momentum over subsequent years. The email network’s formation and development coincided with the formation and development of the Australian College of Mental Health Nurses (ACMHN) Consultation Liaison Special Interest Group (CLSIG). The email network is also promoted by the NSW/ACT Mental Health Consultation Liaison Nurses Association. The email network is maintained by the CLSIG, but the ACMHN and the CLSIG do not take responsibility for nor endorse opinions expressed through this network.

The email network is not moderated (ie: user’s comments are uncensored), but nuisance posts (abusive, racist, sexist, advertising etc) will not be tolerated. We take pride that the tone of the email network has been always casual, generous & supportive, and that it has attracted over 320 subscribers from at least nine countries.

No matter where you live & work, if you’re a Mental Health/Psychiatric Consultation Liaison Nurse you are very welcome to join our email network…

Here’s the PDF: 1008

One Last Thing

Just a reminder, this info is being released online in September 2019 purely for nostalgic and/or historical purposes. If you’re interested in an email network for consultation liaison nurses there is one, it’s just not the Ye Olde Yahoo one described here anymore. Instead, join the email network that is being hosted by the Australian College of Mental Health Nurses Consultation Liaison (CL) Special Interest Group (SIG): www.acmhn.org/home-clsig

End

Thanks for reading.

Paul McNamara, 27 September 2019

Short URL: meta4RN.com/email

Scale Fail

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Please do yourself a favour, and watch Old People’s Home For 4 Year Olds on ABC iView. Over five beautifully-filmed episodes, the program follows a social experiment that brings together elderly people in a retirement village with a group of lively 4-year-olds. It’s one of the most enchanting, life-affirming TV programs I’ve seen.

The kids and the grown-ups were equally adorable – each dyad (one older person and one 4 year old) seemed to bring-out the best in each other. It was delightful to watch. Fiona the kindergarten teacher/facilitator was incredible. She has amazing interpersonal skills. [BTW: does anyone know Fiona’s surname? – she deserves to be credited properly]

I only have one problem with the program: the way the 15-item Geriatric Depression Scale (GDS-15) was used/portrayed. It was a very good idea that there was some pre- and post-intervention testing, and it’s terrifically handy to be able to quantify the degree that people self-rate their mood. However, all the scales I’ve ever seen, including the GDS-15,  come with the disclaimer that they’re screening tools, not diagnostic tools. However, that’s not the way the GDS-15 was portrayed on this TV program.

Screenshot from approx. 47 minutes into Episode 5 showing the false dichotomy that 5 or below on GDS-15 = “not depressed” and 6 or above = “depressed”. Pfft! As if.

In the TV program the geriatricians referred to scores above 5 on the GDS as “depressed”. That’s not quite the way it works. The GDS-15 does not diagnose.

Four reasons why the GDS-15 is not a diagnostic tool:

  1. The GDS-15 asks for a “snapshot” of how the person has been feeling for the past week. As per the diagnostic frameworks used worldwide (DSM-5 and ICD-10) symptoms must be present for at least two weeks for depression to be diagnosed.
  2. The GDS-15 is a dumb screening tool. It won’t (and can’t) take social circumstances into account. Many of the symptoms of depression are also symptoms of grief/bereavement/significant recent stress. GDS-15 questions include:
    • “Have you dropped many of your activities and interests over the last week ?”
    • “Over the last week have you been in good spirits most of the time?”
    • “In the last week have you been feeling happy most of the time?”
    • “In the last week, have you preferred to stay at home, rather than going out and doing things?”
    • “In the last week have you been thinking that it is wonderful to be alive?”
      If your spouse died 10 days ago, not only would these questions be terribly insensitive, but your answers probably wouldn’t be very positive. That doesn’t mean you’re depressed. That means you loved your spouse. The GDS-15 screens for symptoms, not context.
  3. There’s more than one way to interpret the GDS-15 score. Which is the correct way? It depends who you ask:
    • As per the Royal Australian College of General Practitioners, “Although differing sensitivities and specificities have been obtained across studies, for clinical purposes a score >5 points is suggestive of depression and should warrant a follow up interview. Scores >10 are almost always depression.” [source]
    • As per an online version of the GDS-15 endorsed by the GDS-15 lead authors [source], the meaning of the scores are thus:
      0 – 4 = normal, depending on age, education, complaints
      5 – 8 = mild
      9 – 11 = moderate
      12 – 15 = severe
    •  As per the screenshot above, the geriatricians in Old People’s Home For 4 Year Olds set a cut-off line between “not depressed” and “depressed” at 5.5,
  4. The model of a dichotomy of “depressed” or “not depressed” does not reflect reality. You don’t suddenly get labelled “depressed” because you scored 6 on the GDS-15, and you aren’t suddenly deemed “not-depressed” because you scored 5 the next time you’re screened. In reality, clinically significant changes in mood tend to happen over weeks or months. Minor day-to-day fluctuations are just part of the human experience – not something to be pathologised.
    When it comes to mood, you don’t cross a line between “depressed” and “not depressed”. There is a line, but it’s a continuum. It’s a continuum that we all slide up and down. It’s just that people who experience depression travel further along the continuum than they would like.

Closing Remarks

Please don’t let my critique of the use of the Geriatric Depression Scale deter you from watching Old People’s Home For 4 Year Olds. It’s a terrific program based on a wonderful idea, which is articulated further on the Ageless Play website [here].

Something I do in my paid job and as part of my [unpaid] social media portfolio, is to challenge the myths and misunderstandings that happen around mental health matters. As I’ve argued previously [here], all I’m doing in this blog post is articulating my argument why we should resist the temptation to interpret screening tools as diagnostic tools.

End

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

Paul McNamara, 26 September 2019

Short URL: meta4RN.com/scale

Protecting Nurses and Patients

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Q: What do wearing gloves, using lifting machines, legislating ratios and clinical supervision have in common?

A: They’re all measures that protect nurses and their patients. 

Gloves

Back in ye olde days when I started nursing (the 1980s) the concept of “universal precautions” was introduced (source). In short, suddenly all body fluids were to be treated as potentially infectious. It didn’t matter if you arrived in hospital as a needle-sharing, sexually promiscuous, pus-and-rash stricken bleeding wreck, or a saintly and demure sex, drug and rock-and-roll avoidant 80 year old nun, we treated your body fluids the same. Amongst the changes this heralded was that gloves were to be worn whenever there was a risk of coming into contact with body fluids. It was a new way of working for older nurses and doctors. For newbies it was just standard practice: so much so, that in the mid 1990s the term “universal precautions” was replaced by “standard precautions” in Australia (source). 

My first (short lived, temporary) job as a RN was in a nursing home. I had to argue for gloves to be made readily available for the AINs, ENs and RNs. The initial response was along the lines of: [1] using disposable gloves for every encounter with body fluids will be expensive, [2] nurses can wash their hands if they come into contact with urine or faeces, and [3] do you REALLY think that any of these elderly people have been sharing needles or having unprotected anal sex to contract HIV? They came around, but at first the management just did not understand that universal/standard precautions were not just a nuisance cost, but actually an investment in protecting staff and residents/patients.

Lifting

When I was a student nurse I was often made to feel very warm and fuzzy inside. Not because of my sparkling wit and ruggedly handsome looks (🙄), not because of my enthusiastic and self-motivated approach to work, not because of my knowledge or skill, but because I was able to lift people easier than some of my more petite colleagues. Big boofy blokey nurses were handy to have around when patients need to hoisted up a bed, onto a barouche, or transferred between bed and chair. 

In the hospital I trained in there were a few lifting machines. The way I remember* it, there were about 3 of them for a 900 bed hospital. So, I was a bit incredulous when I first heard of a “No Lift Policy” in the mid-1990s. “As if!”, I thought, “It will be too slow and too expensive to be practical. It’ll never happen.” Anyway, I was wrong. The No Lift Policy was implemented, and has since been renamed and reframed as Safe Patient Handling. The change has been endorsed by employers and the nurses’ union alike. Nurses of my age/era often have back pain, but younger/newer nurses are now better protected. The purchase of safe patient handling equipment and expense of training is not just a nuisance cost, but actually an investment in protecting staff and patients.

Nurses who were students in the 1980s (ie: pre-No Lift Policy)

Ratios

When I was a student nurse it would be usual to be allocated 6-8 patients on either a morning or afternoon shift, and up to 16ish on night shift. On a ward of over 30 patients in a surgical or medical ward in a large acute hospital, it was pretty standard for one RN and 2 student nurses to run the whole thing overnight. #scarynostalgia 

In Australia the states of Victoria and Queensland have legislated nurse:patient ratios. Since July 2016 Queensland nurse:patient ratios have been credited with avoiding 145 deaths, 255 readmissions, and 29 200 hospital bed-days. Amazingly, ratios have been evaluated to save up to $81 million (source). Implementing ratios to stop nurses from burning-out over workloads and to improve quality of care is not just a nuisance cost, but actually an investment in protecting staff and patients.

Clinical Supervision 

In April 2019 a joint position statement was issued by the Australian College of Nursing, the Australian College of Mental Health Nurses and the Australian College of Midwives that Clinical Supervision is recommended for all nurses and midwives irrespective of their specific role, area of practice and years of experience (source). 

As articulated in the joint statement, there is consistent evidence that effective clinical supervision impacts positively on professional development, and retention of a healthy and sustainable workforce. There is also evidence that clinical supervision of health-care staff impacts positively on outcomes for service-users.

I expect to be still working full time in 5 years time, but not in 10. I hope that by the time I pull-up stumps clinical supervision becomes embedded in nursing practice. Clinical supervision is not just a nuisance cost, but actually an investment in protecting staff and patients. 

End Notes

*not a reliable source: I have the memory of a stoned goldfish

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

Thanks to Stella Green for giving permission to share our nearly-funny SMS.

Paul McNamara, 31 August 2019

Short URL meta4RN.com/protect

Share or Perish!

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

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

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

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

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

Figure 2 (below) plots 4 different data points. 

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

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

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

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

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

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

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

Closing Remarks

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

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

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

Don’t forget: Share or Perish! 

Citation 

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

End

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

Paul McNamara, 2 July 2019

Short URL: meta4RN.com/share

ieMR Liaison Psych Templates

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A Quick Explanation

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

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

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

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

Making ieMR auto-text/templates

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

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

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

Initial/Comprehensive Psychiatric Assessment

Review

Cognitive Screening results

End of Episode/Transfer of Care

End

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

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

Paul McNamara, 20 June 2019

Short URL: meta4RN.com/ieMR

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