10 Delirium Misconceptions

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

PDF version [easy to print]: 10DeliriumMisconceptions

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

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

Source/Reference

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

End

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

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

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

Paul McNamara, 18 April 2019

Short URL meta4RN.com/10Delirium

 

Thanks

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

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

1. Responding to Compliments with Thanks.

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

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

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

2. Self Esteem

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

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

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

3. Giving Thanks.

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

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

.

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

End

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

Paul McNamara, 31 March 2019

Short URL meta4RN.com/thanks

Zap!

1 Reply

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

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

We thought he was joking.

He told us he wasn’t.

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

Brief Elaboration + Data Sources

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

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

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

So What?

What does this data tell us?

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

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

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

What about the Taser bloke?

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

End Notes

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

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

Paul McNamara, 28 February 2019

Short URL: meta4RN.com/zap

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

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

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

Self Care: Surviving emotionally taxing work environments

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

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

Printed handouts are so last century.

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

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

Here is the online presentation: Prezi

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

End

Please have a play with the pretty Prezi: http://prezi.com/0ysapc6z9aqg

Thanks for visiting. As always your comments are welcome.

Paul McNamara, 22 February 2019

Short URL: meta4RN.com/SelfCare

 

 

Nurses on the 2019 Australia Day Honours List

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Extracting information from www.gg.gov.au/australia-day-2019-honours-list, below are the Nurses named on the 2019 Australia Day Honours List.

Janice Maree Ablett OAM
Medal (OAM) of the Order of Australia in the General Division
Drouin, Victoria
For service to the community through alcohol and drug dependence groups.

Service includes:

Founder and President, The Ice Meltdown Project, since 2014.
Endorsed Enrolled Nurse, current.

Awards and recognition include:
Nominee, Victorian Local Hero Australian of the Year, 2018.

******************************************** 

Sanchia Kaye Aranda AM
Member (AM) in the General Division of the Order of Australia
Alexandria, New South Wales
For significant service to community health, particularly to cancer control and nursing.

Service includes:

Chief Executive Officer, Cancer Council Australia, since 2015.
Deputy Chief Executive Officer, Cancer Services and Information, NSW Cancer Institute,
2011-2015
Director of Cancer Nursing and Research, Peter MacCallum Cancer Centre, 2001-2015.
Special Professor, School of Nursing, University of Nottingham, UK, 2004-2010.
Head, Department of Nursing, University of Melbourne, 2006-2011 and Deputy Head, 1997-2001.
Associate Professor, Palliative Care Nursing, Centre for Palliative Care, 1997.

President, Union of International Cancer Control, since 2016 and Board Member, since 2010.
President, International Society of Nurses in Cancer Care, 2006-2010 and Board Member, 1992-2012.
Board Member, International Collaboration on Cancer Reporting, since 2016.
Member, National Cancer Expert Reference Group, Commonwealth Department of Health.
Member, Oncology Clinical Committee, National Health and Medical Research Council, since 2016 and Member, Palliative Care Research Working Committee, 2004-2008.
Member, Data and Research Advisory Committee, Cancer Australia.
Member, Cancer Monitoring Advisory Group,
Australian Institute of Health and Welfare, since 2015.
Reviewer, Australian Research Council.

Awards and recognition includes:
Honorary Professor, Susan Wakil School of Nursing and Midwifery, University of Sydney
Honorary Life Fellow, Cancer Nursing Society of Australia, 2017.
Recipient, Distinguished Merit Award, International Society of Nurses in Cancer Care, 2016.
Distinguished Fellow, Peter MacCallum Cancer Centre, 2013
Recipient, Nursing Excellence Award, Cancer Nursing Society of Australia, 2009.
International Fellow, American Academy of Nurses, 2009.
Bonnie Bullough Lecture, School of Nursing, University of Buffalo, USA, 2006.
Royal Tiffany Lectureship, Royal Marsden Hospital, UK, 2001.
Recipient, International Award for Contributions to Cancer Care, US Oncology Nursing Society, 2001.

********************************************

Jan Maree Becker AM
Member (AM) in the General Division of the Order of Australia
Yandina Creek, Queensland
For service to community health through neonatal organisations, and to aviation.

Service includes:

Neonatal organisations:
Founder, Midwife Vision, current.
Instructor, Neonatal Resuscitation, Dar es Salaam, Tanzania, current.
Clinical Midwife, Amana Hospital, Dar es Salaam, Tanzania, current.
Nurse, Buderim Private Hospital, July 2013.
Former Nurse, Nelson Polytechnic, Nelson, New Zealand.
Former Registered Nurse, Renal and Plastic Ward, Tauranga, New Zealand.
Former Midwife, King George V Hospital/Royal Prince Alfred Hospital.
Former Midwife, Neonatal Intensive Care, John Spence Nursery, King George V
Memorial Hospital/Royal Prince Alfred Hospital.
Former Midwife, Kimbe Maternity, Papua New Guinea.
Chair, Cherish Foundation and Deputy Chair, Finance and Audit Committee.

Aviation:
Board Member and Treasurer, Helicopter Association International, since 2015.
Co-Founder and Chief Executive Officer, Becker Helicopters, since 1996.

Awards and recognition include:
Outstanding Alumnus, University of Sunshine Coast, 2017.
Recipient, Telstra Queensland Business Women’s Owner Award, 2014.
Recipient, National Telstra Medium Business Awards, 2013.
Recipient, Queensland Premier’s Innovation Export Award, 2012

******************************************** 

Victoria Anne Caton CSC
Conspicuous Service Cross (CSC)
New South Wales
For outstanding devotion to duty in the field of Defence nursing and personnel support.

Lieutenant Commander Caton demonstrated outstanding devotion to duty as a Nursing Officer and Member Support Coordinator. Her dedication to supporting injured and ill members of the Royal Australian Navy in their return to the workforce or assisting with their transition to civilian life when they can no longer serve, has directly contributed to the wellbeing of these members and their families during times of significant stress.

******************************************** 

Doseena Fergie OAM
Medal (OAM) of the Order of Australia in the General Division
Dalyston, Victoria
For service to community health.

Service includes:

Woor-Dungin:
Member, Aboriginal Advisory Committee, current.
Past Treasurer and Committee Member, up until 2016.

Healesville Indigenous Community Services Association:
President, 2009-2014.
Founding Member, 2009.

First 1000 Days Australia:
Councillor, current.

Founding Member, Boorndawan Willam Healing Service.

Founding Member, Mullum Mullum Indigenous Gathering Place.
.
Australian Catholic University, Melbourne:
Lecturer & Early Career Researcher – speciality: Indigenous Health and Culture, current.
Lead, Building Cultural Capacity Project – current.

Australian Nursing and Midwifery Federation:
Member, Victorian Branch, current.

Inaugural Fellow, Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, since 2016.

Department of Health, Victoria:
Executive Member, Eastern Metropolitan Region ‘closing the health gap plan’, 2009-2013.

Eastern Health:
Clinical Care Coordinator, Indigenous Health Team, Yarra Valley Community Health, 1999-2010.
Founder,’Good Food, Great Kids’, Indigenous Community Nutrition Project, 2002-2004, Awardee, Excellence in community engagement, Victorian Public Healthcare Award, 2007.

Awards and recognition includes:
Citizen of the Year, Yarra Ranges Council, 2017.
Inductee, Victorian Honour Roll of Women, 2016.
Awarded, Churchill Fellowship, 2016.
NAIDOC Eastern Metropolitan Region Indigenous Elder Award, 2011.
Yarra Ranges Council Acknowledgement for Health and Wellbeing Work Award, 2010.
Victorian State Nurse Excellence Award, 2009.
Australian Thanksgiving Day Award, 2007 for work in the Indigenous community.
NAIDOC Community Recognition Certificate, 2007.
NAIDOC Community Award, 2005.

******************************************** 

Dulcie Gladys Flower OAM, AM
Member (AM) in the General Division of the Order of Australia
New South Wales
For significant service to the Indigenous community, and to the 1967 Referendum Campaign.

Service includes:

Aboriginal Medical Service Cooperative Limited at Redfern:
Board Member, since approx. 2002.
Former Registered Nurse.
Involved in the establishment of the Cooperative, July 1971.

Former Board Member, National Aboriginal and Torres Strait Islander Women’s Alliance.
Activist for Indigenous rights, health and social welfare, ongoing.

Campaigner, 1967 Referendum (on the proposal to include Aboriginal people in the census,
and to allow the Commonwealth government to make laws for Aboriginal people).

Honorary Member, New South Wales College of Nursing.
Former Board Member, Carers New South Wales.
Board Member, Bangarra Dance Theatre, for 9 years from establishment.
Has served on a range of expert committees and working panels at the local, state and
national level.

Awards and recognition include:
Awarded the Medal of the Order of Australia, 1994.

******************************************** 

Sally Anne Garratt OAM
Medal (OAM) of the Order of Australia in the General Division
Victoria
For service to nursing.

Service includes:

Nursing:
Founder, Clinical Support Unit, Caulfield General Medical Centre, 2001.
Associate Professor of Gerontic Nursing, La Trobe University, since 2001.
Member, Australian Association of Gerontology, 1987-2006.
Consultant, Aged Care Home Care Implementation, Singapore, Hong Kong, Japan, 1996-1997.
Former Board Member, Australian Centre for Evidence Based Aged Care.
Former Consultant, Montefiore, Royal Freemasons’, Bundoora Aged Care, Vision Australia.

Dementia Australia:
Board Member, current.
Author, Understanding Dementia Care and Sexuality in Residential Facilities, 2010.

Australian College of Nursing:
Victorian Chair, 2000-2004.
Representative, National Aged Care Alliance Committee, 2000.
Member, Collegian Editorial Panel, 2 years.

Royal Melbourne Institute of Technology (RMIT):
Associate Dean, Faculty of Nursing, 1995-1997.
Associate Professor Gerontological Nursing, 1992-1997.
Head, Department of Community and Mental Health Nursing, 1987-1995.
Head, Department Primary Health Care Practice, 1995.
Vice Dean, School of Nursing, Phillip Institute of Technology (prior to merger with
RMIT)

Awards and recognition include:
Distinguished Member, Australian Association of Gerontology, 2005.
Distinguished Life Fellow, Australian College of Nursing, 2004.
Fellow, Australian College of Nursing, 1980.
Doctor of Nursing (Honoris Causa), La Trobe University.
RMIT Quality and Improvement Award.
Honorary Member, Alzheimer’s Australia (Tasmania)
Florence Nightingale Scholarship.
W.K. Kellogg Foundation Scholarship.
Centaur Memorial Scholarship for Nurses.

******************************************** 

Glyndia Joyce Gee OAM
Medal (OAM) of the Order of Australia in the General Division
Kerang, Victoria
For service to the community of Kerang.

Service includes:

Co-ordinator, Winter Wonderland Debutante Ball, since 1990.
Volunteer Canteen Manager, Kerang Christian College, 2013-2018 (720 hours per year for 5 years)
Canteen Volunteer, Kerang Technical High School, since 2004.
Volunteer Treasurer, Kerang Community Centre, from August 2018.
Canteen Volunteer, St Joseph’s Primary School in Kerang, approximately 1995-2012.
Secretary, Kerang Karate Club, for 10 years.
Volunteer, St Vincent de Paul Society Op Shop Kerang, current.
Past Member, Kerang Show Society Committee.
Life Member, Kerang Highland Dance Society.
Registered Nurse, Barham Hospital, since 1999.

Victorian State Emergency Service:
Controller, Kerang Unit, since 2017.
Volunteer, since 1999.

Awards and recognition includes:
Recipient, Senior Citizen of the Year, Gunnawarra Shire Council, 2017.
Life Member, Winter Wonderland Debutante Ball Committee.
National Medal, for service to Victorian State Emergency Service.
Nellie McGillray Award, for bedside manner in nursing, 1998.

******************************************** 

Dawn Gilchrist OAM
Medal (OAM) of the Order of Australia in the General Division
Mount Hawthorn, Western Australia
For service to community health.

Mrs Gilchrist is a Yamatji woman.

Service includes:

Early Years and Parent Support Coordinator, Wadjak Northside Community Group, since 2016.

Australian Red Cross (WA) 2009 -January 2016:
Community Development Manager.
Team Leader, Personal Helpers and Mentors (PH & M).
Manager, Regional Office.

WA Country Health Services, Goldfields:
Regional Aboriginal Health Promotion Coordinator, 2007-2009.
Regional Aboriginal Health Coordinator, 2003-2007.

Coordinator, Aboriginal Health, East Perth Public and Community Health Unit, Royal Perth Hospital, 1995-January 2003.
Lecturer/Tutor, School of Nursing, Curtin University of Technology, 1991-1995.
Former Federal Aboriginal Board Member, Churches of Christ.
Registered Nurse, Perth Aboriginal Medical Service, 1988-1992.

Awards and recognition includes:
Meritorious Award, Red Cross, 2015.
Vice-Chancellors List, Curtin University.
NAIDOC Karlkurla Award, Aboriginal & Torres Strait Islander Employee Section (Kalgoorlie) 8 July 2013.

******************************************** 

Lynette Noelle Grubwinkler AM
Member (AM) in the General Division of the Order of Australia
Queensland
For significant service to international eye health initiatives as a clinical consultant,
and to ophthalmic nursing.

Service includes:

Eye Care:
Ophthalmic Advisor and Volunteer, Youth with a Mission Medical Ships (YWAM), Fiji and Papua New Guinea, since 1998.
Clinical Advisor and Volunteer, East Timor Eye Project, National Eye Centre, Dili, Timor Leste, 2017-2018.
Clinical Consultant, Fred Hollows Foundation New Zealand, National Eye Centre, Dili, Timor Leste, 2015-2016.
Clinical Consultant, Lighthouse for Christ Eye Hospital, Mombasa, Kenya, May 2006.

Australian Ophthalmic Nurses Association, Queensland Branch:
Former Executive Committee Member.
Member, current.

Member, International Development Group, Royal Australian and New Zealand College of
Ophthalmologists, current.

Professional:
Ophthalmic Nurse, Northside Eye Specialists and Queensland Eye Hospital, Brisbane.

******************************************** 

Nicole Danielle Johnston OAM
Medal (OAM) of the Order of Australia in the General Division
Barton, Australian Capital Territory
For service to nursing.

Service includes:

Clare Holland House:
Palliative Aged Care Nurse Practitioner, since 2014.
Nurse, Home Based Palliative Care Community Service, 2003-2007.
Nurse, ACT Hospice.

Canberra Hospital:
Palliative Care Nurse Practitioner, 2010-2014.
Nurse, Calvary ACT, 2003-2007.

Registered Nurse, since 1989.
Member, Palliative Care Australia, current.

Education:
Guest Lecturer, Australian Catholic University.
Guest Lecturer, University of Canberra.
Co-Author and Contributor, BMJ Supportive and Palliative Care Journal.

******************************************** 

Colin Bruce Lott OAM
Medal (OAM) of the Order of Australia in the General Division
Watanobbi, New South Wales
For service to the community through a range of roles.

Service includes:

St John Ambulance New South Wales:
Assistant Commissioner – Operations, since 2012.
Regional Superintendent, 2004-2012.
Former Divisional Superintendent.
Former Regional Nursing Officer.
Former Regional Staff Officer.
Former Divisional Nursing Officer.
Member, St John Council of New South Wales, current.

Professional:
Chief Inspector, Tuggerah Lakes Local Area Command,
New South Wales Police Force, since 1987.
Registered Nurse, Emergency Department, Hornsby Hospital, since 1999.

Awards and recognition includes:
Recipient, Commander of the Order of St John, 2013 (Admission, 2000; Officer, 2009).
Recipient, 1998 – Fourth Bar to the St John Service Medal, St John Ambulance New
South Wales, 2014 (First Bar, 1998; Second Bar, 2003; Third Bar, 2008).
Recipient, 12 Year Service Medal, St John Ambulance New South Wales, 1993.
Inductee, Honorary Life Membership, St John Ambulance New South Wales, 1992.
Recipient, Certificate of Merit, St John Ambulance New South Wales, 1991.

******************************************** 

Helen Frances MacArthur OAM
Medal (OAM) of the Order of Australia in the General Division
Broome, Western Australia
For service to community health.

Service includes:

Nursing: Community Health Nurse Manager, Broome Community Health, 2005-2016.
School Health Nurse, Broome, 1994-2005.
Community Nurse, Gordon Downs, 1976-1980.
Former Registered Nurse Midwife, Halls Creek Hospital, 1980-1982.
Former School Health Nurse, Halls Creek Community Health, 1983-1994.

Broome Bird Observatory:
Volunteer, since 1994.
Former Chairman, 8 years.

Awards and recognition include:
Western Australia’s Children’s Hero Award, National Association for Prevention of Child Abuse and Neglect, 2009.

******************************************** 

Elizabeth Anne Mason AM
Member (AM) in the General Division of the Order of Australia
Northern Territory
For significant service to nursing, and to the community of the Northern Territory.

Service includes:

Charles Darwin University (previously Northern Territory University):
Head, School of Nursing, 1997-2000.
Past Senior Lecturer, Department of Nursing.
Chair, Academic Board, 2001-2003.
Member, Academic Board, 2000-2006.
Founder and Curator, Nursing Museum, since 1987.

Federation of College Academics:
National Executive, 1986-1990.
President, Northern Territory Branch, 1989-1991
National Council Member, 1984-1991.

President, Unions NT, 2000-2004.

Museums Australia:
National Council Member, 2013-2015.
Honorary Secretary and Treasurer, Northern Territory Branch, since 2003.

Community roles:
Board Member, Anglicare Northern Territory, 2009-2016.
Member, Northern Territory Anzac Community Advisory Committee, 2012-2013.
Member, Advisory Council of the Ageing, Northern Territory Government, 2006-2008.
Honorary Secretary and Public Officer, History Society of the Northern Territory, since 2003.
Honorary Secretary, Northern Territory Euthanasia Society, since 2006.

Awards and recognition includes:
Recipient, Lifetime Achievement Award, Unions NT, 2010.
Life Member, National Tertiary Education Union, 1997.
Fellow, Royal College of Nursing Australia, 1981-1998.
Recipient, Centenary Medal, 2003.

******************************************** 

Beverly Rose Morton OAM
Medal (OAM) of the Order of Australia in the General Division
Birdsville, Queensland
For service to the community.

Service includes:

Community
Betoota Race Club and Social Club:
Treasurer, 2011-2016.
Secretary, 1995-2010 and 1980-1991.
Inaugural Member, 1979.
Life member.

Member, Boulia Bedourie Birdsville Branch, Isolated Children’s Parents Association, 1982-2012.
Various Officer Bearer positions, Mount Isa School of the Air, Isolated Children’s Parents Association, 1985-1995.
Member, Priority Country Area Programme, 1987-1995.
Secretary, Birdsville Social Club, 1978-1990.

Health
Birdsville Health Clinic:
Nurse and community based worker, 2005-2014.
Administration officer, 2013-2014.

Advocate, Local Ambulance Committee, 2002-2011.

Awards and recognition includes:
Recipient, Citizen of the Year, Diamantina Shire Council, 1989.
Senior Sporting Administrator Award, 2013, 2004 and 1998.
Recipient, Centenary Medal, ‘for distinguished service to the community’, 2001.

******************************************** 

Holly Louise Northam OAM
Medal (OAM) of the Order of Australia in the General Division
Fadden, Australian Capital Territory
For service to medicine through a range of roles.

Service includes:

Director, ShareLife, five years.
Helped establish the Australian Organ and Tissue Authority.

ACT Health:
Organ and Tissue Donor Coordinator, since 2002.
Involved with the Restorative Justice Program.
Founding Member and Director, Donor Families Australia, since 2011.

Faculty of Health, University of Canberra:
Assistant Professor, Critical Care Nursing, 2010.
Senior Lecturer.
Course Convenor, Bachelor of Nursing.

Awards and recognition includes:
Donor Families Australia Award, 2016.
Special Commendation, University of Canberra Nurse’s Society, 2013.
Ben Wiseman Award for Healthcare, ACT Chief Minister’s Awards for Organ Donation Awareness, 2010.
Churchill Travelling Fellowship, 2006.

******************************************** 

Kerry Ann Peart OAM
Medal (OAM) of the Order of Australia in the General Division
Victoria
For service to nursing.

Service includes:

Co-ordinator, Barwon Health Midwifery Group Practice, since 2012.
Inaugural Program Director, Bachelor of Midwifery Course, Griffith University, 2010-2012.
Former Coordinator, Graduate Diploma of Midwifery Program, University of Ballarat.
Member, Australian College of Midwives, current.
Registered Midwife, Nursing and Midwifery Board of Australia, Australian Health Practitioner Regulatory Agency, since 1977.
Author,’Managing Labour Pain Safely‘, research paper

******************************************** 

Joan Janice Ryan OAM
Medal (OAM) of the Order of Australia in the General Division
Marrickville, New South Wales
For service to nursing.

Service includes:

Royal Prince Alfred Hospital:
First designated Palliative Care appointment in New South Wales, 1988.
Palliative Care Clinical Nurse Consultant, current.
Founder, Death Review, 2009.
Rural and Remote Palliative Care Nurse Forum.

Palliative Care New South Wales:
Member, Management Committee, since 2004.
Chair, Education Sub-Committee, current.
Chair, Awareness and Communications Sub-Committee, current.

Nursing – General:
Palliative Care Nurse Consultant, Head and Neck Multidisciplinary Team, Chris O’Brien Lifehouse, since 2000.
Member, NSW Nurses and Midwives Association, since 1994.
Executive Member, Australasian Palliative Link International, current.
Palliative Care Nurse Consultant, International Education Programs, Timor-Leste, Nauri, Sri Lanka, India, Singapore, Thailand, Malaysia.
Former Contributor, NSW Health Education and Training Institute.
Former Lecturer, School of Nursing, Sydney University.
Lecturer and Advisor, Australian College of Nursing, Palliative Care, current.
Presenter, Palliative Care Nurses Australia Conference, Asian Pacific Forums and Montreal Whole Person Conferences, Canada.

Awards and recognition include:
International Nurses Award, 2011.
Quiet Achiever Award, Palliative Care New South Wales, 2010

******************************************** 

Dawn Leonie Thorp AO
Officer (AO) in the General Division of the Order of Australia
Myrtle Bank, South Australia
For distinguished service to nursing, and to medicine, in the field of haematology, as an expert clinician and mentor.

Service includes:

Mentor, South Australian BloodSafe Programme, SA Health, since 2002.

Member, World Federation of Haemophilia Nurses Committee, 1996-2002.

Former Co-Founder, Australian Haemophilia Nurses Group.
Former Member, Australian Society of Transfusion.
Former Council Vice President, Haemophilia Foundation Australia.
Former Contributor, Apheresis Graduate Certificate Curriculum, University of Adelaide.

Leukaemia Foundation Australia:
Coordinator, establishing South Australian Branch, 1999.
Volunteer, since 2002.

Australian Haemophilia Nurses Group:
Co-Founder, since 1988.
Former Inaugural Chairman, 6 years.

Australian and New Zealand Society of Blood Transfusion:
Co-Author, Guidelines for the Administration of Blood Components Transfusion, 2004.
Member, since 1993.
Former Member, Science Subcommittee.

Australian and New Zealand Apheresis Association:
Former Coordinator, Guidelines Working Group.
Former Member, Guidelines for Education Working Party.
Former Foundation Member.

Royal Adelaide Hospital:
Nurse Consultant, Haematology Unit, 1983-2002.
Apheresis Nurse, 1977-1983.
General Nurse, 1960 and 1969-1977.

Awards and recognition include:
Dawn Thorp Annual Oration, Central Adelaide Local Health Network, 2015.
Life Member, Australian & New Zealand Society of Blood Transfusion, 2003.
Recipient, Jennifer Ross Award, Haemophilia Foundation Australia, 1999.
Life Membership, Haemophilia Foundation of South Australia, 1998.
Life Governor, Haemophilia Foundation Australia, 1995.

********************************************

Diane Esma Twigg AM
Member (AM) in the General Division of the Order of Australia
Subiaco, Western Australia
For significant service to nursing through a range of leadership, education and
advisory roles.

Service includes:

School of Nursing and Midwifery, Edith Cowan University:
Executive Dean, since 2016.
Professor of Nursing and Head of School, 2009-2016.
Published more than 40 peer reviewed research papers.

Australian College of Nursing:
Former Representative, Nursing Leadership Bank of Experts, International Council of Nurses.
President, 2005-2007.
Vice-President, 2003-2005.
Former Board Member.
Fellow, since 2003.
Member, since 1995.

Commonwealth Department of Health:
Former Australian College of Nursing Representative, Health Care Efficiency Advisory
Committee, National Health Performance Authority.
Member, representing the Council of Deans of Nursing and Midwifery, National Nursing and
Midwifery Education Advisory Network.

International Congress on Innovations in Nursing:
Organising Committee Member, current.
Founder, 2003.

Western Australia Health:
Board Member, Child and Adolescent Health Services, since 2017.
Former Acting Chief Nurse.

Sir Charles Gairdner Hospital:
Executive Director of Nursing Services, 1995-2008.
Research Consultant, Centre for Nursing Research, current.

Health – other:
Executive Director of Nursing Services, North Metropolitan Health Service, 2002-
2005 and 2007-2008.
Former Deputy Presiding Member, Nursing and Midwifery Board of Western Australia.
Midwife, since 1979.
Nurse, since 1974.

Awards and recognition includes:
Inductee, Lifetime Achievement Honour Roll, Western Australian Nursing and Midwifery
Excellence Awards, 2017.

********************************************

Lydia Ann Visintin OAM
Medal (OAM) of the Order of Australia in the General Division
Camperdown, New South Wales
For service to nursing.

Service includes:

Clinical Nurse Consultant, Melanoma Institute Australia, since 2016.

Royal Prince Alfred Hospital:
Clinical Nurse Consultant (Melanoma), since 2006.
Nursing Unit Manager, 2000-2006.
Registered Nurse, since 1990.

********************************************

Kathryn Rosemary Woolridge OAM
Medal (OAM) of the Order of Australia in the General Division
Belmont, Queensland
For service to nursing.

Service includes:

Northern Territory Remote Health:
Remote Area Nurse, 2011.
Continuous Quality Improvement Facilitator, 2010-2011.
General Practice Nurse, 2008-2009.

Other:
Committee Member, Queensland Chapter, Australian College of Nursing, since 2007.
Registered Nurse and Team Manager, Northern Territory Emergency Initiative, 2007-2008.
Clinical Nurse, Community Hospital Interface Program, 2006.
Community and Primary Health Nurse, Roxby Downs Health Service, 2000-2005.

Awards and recognition includes:
Excellence Award for Nursing Clinical Practice, South Australian Nursing and Midwifery Federation, 2005.
Recipient, Australia Day Citizen of the Year Award, Roxby Downs City Council, 2002.
Certificate of Commendation Cyclone Larry Response, 2006.

********************************************

End

Please let me know via the comments section below if I missed any nurses on the 2019 Australia Day Honours List. I’m happy to correct any oversights.

Paul McNamara, 26 January 2019

Short URL: meta4RN.com/Honours2019

Diagnostic Overshadowing

8 Replies

Consultation liaison psychiatry services (CLPS) are, typically, based in a general hospital setting to provide the dual services of mental health clinical assessment/treatment and clinician support/education. The clinical and education roles overlap – a lot.

A significant part of the CLPS job is undiagnosing mental illness. Undiagnosis is often correcting a misdiagnosis, and also serves to validate the emotions and experiences of people (Patfield, 2011; Lakeman & Emeleus, 2014). It is not unusual for CLPS to be asked to see somebody who is emotionally overwhelmed or dysregulated. Sometimes this is in the context of mental health problems often in the context of significant stress. Naturally, we do not want to ‘psychiatricise’ the human condition. Of course, you cry when you are sad, and of course you are anxious when, like Courtney Barnett in ‘Avant Gardener’, you are not that good at breathing in. Of course, you’re frustrated when you are in pain or do not understand what’s going on.

Validating understandable and proportionate emotions is important.

It is equally important to make sure that somebody who has experienced mental illness previously does not have every presentation to the hospital/outpatient clinic seen through that lens. That is called “diagnostic overshadowing”; which is a significant problem.
Diagnostic overshadowing is where physical symptoms are overlooked, dismissed or downplayed as a psychiatric/ psychosomatic symptom. It must be one of the most dangerous things that happen in hospitals.

The President of the Royal Australian and New Zealand College of Psychiatrists, Professor Malcolm Hopwood, said in May 2016, “I sometimes think that the worse thing a person can do for their physical health is to be diagnosed with a mental health disorder.” Prof Hopwood cited stigma and discrimination in the health sector as contributing problems to early mortality amongst people with mental health problems.

People, hospital clinical staff included, are often shocked when they find out that people diagnosed with mental illness die between 10 and 25 years younger than the general public. Although suicide is a contributing factor to high mortality rates amongst this part of the community, it is alarming to note that the overwhelming majority – 86% – of people with mental health problems who had a premature death did not die from suicide (Happell & Ewart, 2016).

About 60% of people who experience mental health problems experience chronic physical health problems too. Poor mental health is a major risk factor for poor physical health, and vice versa (Harris et al, 2018).

The lived experience

Diagnostic overshadowing happens outside of hospitals too. In the example below, understandable and proportionate human emotions were misinterpreted as psychopathology. The cascade of events that followed makes for a sobering read:

Eight years ago I was diagnosed with bipolar affective disorder (BPAD) and recovered enough to commence a PhD. Unable to obtain travel insurance for a conference due to my diagnosis, I disclosed the reason to my supervisor. Unfortunately, he began to see all stress (normal to a PhD student) as BPAD symptoms and decided I was incapable of completing the PhD and progressively began to discriminate against me. My mental health started to decline. I imagine this must have validated his belief that I was an unsuitable student.

I received some help from the university, with an advisor indicating that my supervisor was undermining my work. The advisor was promoted. Despite not knowing me, his replacement did not believe my account and disagreed with my psychiatrist’s assessment of my mental state. Other staff and graduate students joined the belief that I could not cope, alienating me from the entire department.

After almost 18 months of fighting, I was once again depressed and felt defeated. I left the degree and lost my scholarship. It was one of the hardest things I have done. After, I was unable to gain employment; overqualified for most positions, lacking experience for the rest, and no references. After five months of constant rejections and lingering grief from losing the PhD, my self-worth and coping ability were so diminished, I made a very serious suicide attempt. I was so distressed that I could not see another solution.

Seven months later and I still have no paid employment. I have been undertaking volunteer work to regain some meaning in my life and have set myself up for the long-term with a new field of study. However, this does not pay the bills, and living like this is taking its toll. Sometimes I do not know where my next meal will come from, I have lost friends because of their attitude towards mental illness, and have withdrawn from health-related activities because of a lack of finances. Most days I cope and can find meaning in what I do, some days are much harder.

Questions for Reflection

Assuming that you – the person reading this – is a health professional, we have some questions we would like you to reflect on.

Have I ever witnessed a person’s mental health history influence how their presenting complaint was investigated or treated?

How does my workplace prevent mental health stigmatising and diagnostic overshadowing?

What can I do to support good holistic patient care without falling into the trap of diagnostic overshadowing?

References

Happell, B. & Ewart, S. (2016). ‘Please believe me, my life depends on it’: Physical health concerns of people diagnosed with mental illness. Australian Nursing and Midwifery Journal, 23(11), 47.

Harris, B. Duggan, M. Batterham, P. Bartlem, K. Clinton-McHarg, T. Dunbar, J. Fehily, C. Lawrence, D. Morgan, M. Rosenbaum, S. (2018). Australia’s mental health and physical health tracker: Background paper. Australian Health Policy Collaboration issues paper no. 2018-02, Melbourne, AHPC.

Lakeman, R. & Emeleus, M. (2014). Un-diagnosing mental illness in the process of helping. Psychotherapy in Australia, 21(1), 38-45.

Patfield, M. (2011). Undiagnosis: An Important New Role for Psychiatry. Australasian Psychiatry, 19(2), 107–109.

Seriously mentally ill ‘die younger’. (2016, May 10). SBS News. Retrieved from https://www.sbs.com.au/news/seriously-mentally-ill-die-younger

PDF version

A one page PDF version [suitable for printing] is available here: DiagnosticOvershadowing

Citation

McNamara, P. & Callahan, R. (2018). Diagnostic Overshadowing. News, Summer 2018 edition (published December 2018), Australian College of Mental Health Nurses, page 17.

End Notes

The article above is a tidied-up version of a blog post that Bec and I collaborated on in October 2018 (see meta4RN.com/shadoworiginal). This is not called self-plagiarising, it’s more like doing a studio version of a demo tape. 🙂

Many thanks to Sharina Smith for encouraging us to submit the article to ACMHN News.

Paul McNamara, 15 December 2018

Short URL meta4RN.com/shadow

 

 

Snow White, Complex Trauma and Twitter

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On Tuesday 4th December 2018 Naomi Halpern’s workshop “Working with Complex Trauma: The Snow White Model” was delivered at the Royal Brisbane and Women’s Hospital. I was amongst the small group of mental health nurses and social workers who joined the workshop via videoconference from Cairns Hospital. Here are my notes/tweets:

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What’s all this then?

Some people take notes in workshops using ye olde method of pen and paper. I’m not criticising – pen and paper are cute and quaint. But how on earth do they find their notes quickly and easily after the workshop has ended?.

I tweet my notes. They’re quickly and easily retrieved via phone, tablet or computer at anytime. Sometimes, if the presenter is OK with it, I collate workshop/conference tweets and plonk them all on my webpage for even quicker and easier future reference. That’s what this is all about.

Also, sometimes I have trouble explaining to other health professionals why I’m enthusiastic about Twitter for work-related stuff. It’s easier to show examples of how I use it, rather than just chin-wagging and flapping-about like a chook in a cyclone.

End

Sincere thanks to Naomi Halpern (aka @halpernnaomi1) for an engaging, informative workshop. For a single person to hold the attention and interest of those of us who were joining via videoconference for a whole day is very impressive. Also, I’m grateful to Naomi for agreeing to my request to collate these tweets here.

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

Paul McNamara, 8th December 2018

Short URL: meta4RN.com/SnowWhite