Tag Archives: clinical supervision

Clinical Care and Clinical Supervision

On Monday 17th September 2018 I’ll be presenting to the Cairns & Hinterland HHS palliative care team regarding clinical care and clinical supervision. It 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: http://prezi.com/gtsqjgs9zdby

This page serves as a one-stop directory to the online resources used to support the discussion, and as an easy way for me to find the presentation. 🙂

I’m recycling and combining a lot of old ideas for the session (there’s that self-plagiarist vs groovy remix of favourite old songs thing again), so this list below is ridiculously self-referential:

Care goes in. Crap goes out. Ian Miller @ The Nurse Path, 30 May 2017
thenursepath.blog/care-goes-in-crap-goes-out

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

First Thyself (the core source of info for the visual aspects of this presentation) meta4RN.com/thyself

Flowchart courtesy of Dr Alex Psirides (aka  on Twitter), ICU, Wellington, New Zealand, sourced here:

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

Joseph Heller quote from Catch-22 (1961):
“People knew a lot more about dying inside the hospital, and made a much neater, more orderly job of it. They couldn’t dominate Death inside the hospital, but they certainly made her behave. They had taught her manners. They couldn’t keep death out, but while she was in she had to act like a lady.”

Living Close to the Water (re #dyingtoknowday and emotional intelligence) meta4RN.com/water 

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

Sample Clinical Supervision Agreement (no need to reinvent the wheel – start with a wheel that works and tailor it to your needs) meta4RN.com/sample

Woody Allen quote from Without Feathers (1975)
“I’m not afraid of death; I just don’t want to be there when it happens.”

End

That’s it. Please feel free to play with the pretty prezi: prezi.com/gtsqjgs9zdby

Also, as always, please feel free to leave comments in the section below.

Thanks for visiting.

Paul McNamara, 2nd September 2018

Short URL: meta4RN.com/care

 

#WeNurses Twitter Chat re Communication and Compassion

On 21st December 2012 (Cairns time) nurses from the United Kingdom and Australia came together on Twitter using the #WeNurses hashtag. The planned Twitter chat was used to discuss issues raised by the much-publicised death of a nursing colleague – Jacintha Saldanha.

This curated version of the Twitter chat demonstrates nurses using social media in a constructive manner, and responding to the issues surrounding Jacintha’s passing with thoughtfulness and grace. This was in sharp contrast to the shrill, insensitive and ill-informed way the matter was discussed elsewhere on social media and in mainstream media in the UK and Australia.

I’ve used sub-headings in red to structure the chat as per the themes that emerged.

WordCloud created from the full transcript of the #WeNurses Twitter chat

Preliminary Information.
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Setting The Tone.
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Individualising Communication & Confidentiality.
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WiFi for Hospital Patients.
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Compassion.
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Prank Call.
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Targeted Crisis Support.
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Clinical Supervision (aka Peer Supervision, aka Guided Reflective Practice).
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Supportive Workplaces.
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Preventative/Early-Intervention Resources.
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The 6Cs (Care, Compassion, Competence, Communication, Courage & Commitment).
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Integrating Defusing Emotions into Clinical Practice.
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Farewells.
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Explanation

These Tweets were initially compiled using a social media aggregation tool called Storify
storify.com/meta4RN/communication-and-compassion

Unfortunately, Storify is shutting-down on 16 May 2018 and all content will be deleted.

I’m using my blog as a place to mimic/save the Storify pages I created and value.

End Notes

This archive of Tweets relate directly to two blog posts I wrote at the time. If you’re interested in elaboration re the context at the time, please visit these pages:
Questions of Compassion meta4RN.com/questions-of-compassion
WeNurses: Communication and Compassion meta4RN.com/WeNurses

As always, please use the comments section below for any feedback/questions.

Paul McNamara, 3rd April 2018

Short URL: meta4RN.com/Chat

@WePublicHeath

For the week Monday 27th January to Sunday 2nd February 2014 I was able to use the @WePublicHealth Twitter handle, thanks to the generosity of Melissa Sweet (aka @croakeyblog).


Here’s what happened:

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Explanation

These Tweets were initially compiled using a social media aggregation tool called Storify
storify.com/meta4RN/wepublichealth

Unfortunately, Storify is shutting-down on 16 May 2018 and all content will be deleted.

I’m using my blog as a place to mimic/save the Storify pages I created and value.

End

 

A big shout-out to Melissa Sweet. I am very grateful to Melissa for inviting a mental health nurse to have a stint on @WePublicHealth.

Melissa is a rockstar of public health and health social media in Australia. If you’re not familiar with her work read-up about Melissa here, and “croakey“, the social journalism project of which she is the lead editor, here. More info re @WePublicHealth, the rotated curation Twitter account that Melissa coordinates, here.

As always, please use the comments section below for any feedback/questions.

Paul McNamara, 2nd April 2018

Short URL: meta4RN.com/WePublicHealth

First Thyself

First Thyself – Surviving Emotionally Taxing Work Environments

On 28th April 2017 I’ll be presenting a session at the Ausmed “Breaking Point: Ice & Methamphetamine Conference” in Cairns. More info about the conference here: https://www.ausmed.com.au/course/ice-methamphetamine#overview

The nature of nursing will mean that we are likely to be are exposed to a range of challenges.

Feeling unsafe, witnessing violence, tragedy and dealing with trauma are some examples.

This emotionally taxing environment can result in tension with colleagues, family and friends.

This session will begin day two of the conference by creating an opportunity to discuss the following:

What are the professional implications of working in challenging areas of nursing and healthcare?

How can we maintain unconditional positive regard?

Why self-care matters and how to practice what we preach!

What’s all this then?

“First Thyself” 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/#

This page serves as a one-stop directory to the online resources used to support the discussion.

I’m recycling and combining a lot of old ideas for the session (there’s that self-plagiarist vs groovy remix of favourite old songs thing again).

Here is the online presentation: Prezi

Here are the resources and references used in the presentation:

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

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

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 prezi.com/skmu0lbnmkm5/first-thyself/#

Thanks for visiting. As always your comments are welcome.

Paul McNamara, 30 March 2017

Short URL: meta4RN.com/thyself

 

 

Nurses, Midwives, Medical Practitioners, Suicide and Stigma

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 a person 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 shows, it is dangerous for nurses, midwives, medical professionals and other health professionals to accept stigma.

alarmingdata

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

The Last 40-Odd Weeks

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

Crisis? What Crisis?

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.

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End

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

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