Tag Archives: communication

Complimentary Criticism

This week I attended the Aboriginal and Torres Strait Islander Cultural Practice Program –  a one day workshop facilitated by Stan Savo. Stan is a Cultural Capability & Workforce Advisor and he does his job terrifically well. He’s an engaging, upbeat and authentic bloke, who delivered many pearls of wisdom on the day. This blog post is about just one of them.

Passive vs Active Communication

Stan spoke about it not being uncommon for Aboriginal and Torres Strait Islander people, especially those who are from a rural/remote area and find themselves in a big hospital, to be disinclined to openly disagree with staff, or to nod or passively agree just to get an uncomfortable conversation over and done with.

Although it sounds counter-intuitive at first, Stan said it’s not necessarily a bad sign if an Aboriginal/Torres Strait Islander person expresses frustration or anger with you. He said something like, “If they are growling at you maybe it’s because they think you can do better, and they want you to know. Maybe it’s a good thing.”

Rupture and Repair

It was timely information for me. An Aboriginal man I’ve been working with was really angry with me the day before the workshop. He was a bit sweary (it wasn’t abuse, it was lalochezia) and clearly frustrated, but he was making sense. He said I should have seen him more promptly than I did after he had let a nurse on the ward know he was having an increase in psychiatric symptoms. I apologised, and we shook hands at the end of the session, but he was still cranky with me. I was worried that I had buggered-up our therapeutic relationship. Rapport and trust take time and effort to establish, but can be lost quickly and easily.

I saw him again yesterday, and we chatted for nearly an hour. Our conversation was half about clinical stuff, and half about non-clinical stuff (“non-clinical conversation” also known as “yarning” in Aboriginal/Torres Strait Islander terms, or “phatic chat” in whitefella way). In keeping with the rupture-and-repair nature of relationships, our therapeutic relationship had a rupture on Tuesday and was repaired on Friday. Just as Stan Savo said, being growled at isn’t necessarily a bad thing.

White Middle-Class Reframe

How does a white middle class nurse like me feel OK about being growled at? It feels bad, and sometimes a little scary, when someone gets angry with you. Here comes a white middle-class reframe (it’s probably the whitest thing you will read today):

I like restaurants. A lot.

If I go to a new restaurant and the food/service is a bit underwhelming, I pay the bill, leave, never go back again, and if anyone asks about the restaurant I’ll probably tell them not to bother.

However, if it’s one of my favourite Cairns restaurants, it’s a different matter.

For example, I’ve probably been to Mondo about a million times in the last 20-something years. On a couple of those million occasions my favourite dish (Sizzling Mexican Fajitas!) has been not up to scratch. On both occasions I let the wait staff and kitchen staff know that today’s fajitas were not at the usual standard. It’s a bit uncomfortable, but it’s important. I care about Mondo’s Sizzling Mexican Fajitas being good. Even if it’s a rare occasion, if they’re not good I want to make sure that staff know that there’s been a slip-up. It’s a bit awkward, but in reality – even though I’m not on their payroll – I’m helping helping the Mondo quality assurance program.

I don’t complain about dud meals in restaurants I don’t care about. I just don’t go there anymore.

I do complain about dud meals in restaurants I care about. I want to go back, so offering an honest critique is an investment in their quality.

Complimentary Criticism

Here’s the thing:

Criticism can be complimentary, in both senses of the word: it’s free and it’s an expression of approval. Approval, as in, “I know you can do better, and I’m encouraging you to do so.”

If someone is growling at us, let’s resist the reflex to get defensive or hurt, and listen for helpful suggestions. This is especially important in the tricky business of crossing cultural barriers, where often we don’t even know what we don’t know.

One Last Thing

Stan Savo’s workshop was full of pearls of wisdom. This blog post has honed-in on just one of them. However, I know it wasn’t Stan’s closing message. This was:

End

Thanks for reading this far. As always, your feedback is welcome in the comments section below.

Paul McNamara, 23 November 2019

Short URL meta4RN.com/cc

Recommended Reading

Geia, L., Hayes, B. & Usher, K. (2013) Yarning/Aboriginal storytelling: Towards an understanding of an Indigenous perspective and its implications for research practice, Contemporary Nurse, 46:1, 13-17, DOI: 10.5172/conu.2013.46.1.13

Queensland Health (2014) Aboriginal and Torres Strait Islander patient care guideline https://www.health.qld.gov.au/__data/assets/pdf_file/0022/157333/patient_care_guidelines.pdf 

Queensland Health (2015) Sad News, Sorry Business: Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying (version 2) https://www.health.qld.gov.au/__data/assets/pdf_file/0023/151736/sorry_business.pdf

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License

 

Conversations, not just citations, count: Social Media and the International Journal of Mental Health Nursing

This page serves as a place to collate the Prezi, YouTube video, abstract and list of references, data sources and visuals used for a presentation at the 44th ACMHN International Mental Health Nursing Conference.

Click on the pic to access the Prezi

Presenter Introductions

Paul McNamara is CNC with the Consultation Liaison Psychiatry Service at Cairns Hospital. Paul is also Social Media Editor of the International Journal of Mental Health Nursing.

Kim Usher is Professor and Head of School at the School of Health, University of New England. Kim is also Chief Editor of the International Journal of Mental Health Nursing.

Abstract

Traditionally the impact and reach of a specific journal article has been estimated through the measurement of how many times it is cited elsewhere in scholarly literature. Sometimes years could pass between conducting the original research, writing and refining drafts, submitting and reviewing manuscripts, the article being published, and subsequent researchers including this citation in their published reference list. The resulting time lag means that citations are a retrospective measurement of research impact.

There is however an alternative measure of research impact; a metric that is more immediate. This alternative does not rely on the passive hope that other people will see and share research findings, but allows interested parties to play a hand in generalised and targeted promotion of a published piece of research.

Charlene Li famously described social media not as a technology, but as a conversation (Israel, 2009). Now these online conversations can be quantified, and offer “real‐time” feedback to researchers/authors about the impact and reach of their published research.

In order to support these claims, we will provide an overview of the International Journal of Mental Health Nursing social media strategy. Altmetric data will be presented to demonstrate the measurable effects of this strategy. General information and specific examples will be shared so that researchers, authors, and the institutions that support their work, are exposed to strategies they could use to contribute to future Altmetric scores. In doing so, conference delegates who attend this presentation will be equipped with knowledge on how to improve the impact and reach of their publications on social media, and further their understanding of why this matters.

References, Data Sources + Presentation Visuals

Altmetric attention scores re top 5 IJMHN articles, data as at 18/09/18:

  1. Do adult mental health services identify child abuse and neglect? A systematic review https://wiley.altmetric.com/details/23964454
  2. Mental healthcare staff well‐being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions https://wiley.altmetric.com/details/30485876
  3. An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings https://wiley.altmetric.com/details/31986204
  4. Lethal hopelessness: Understanding and responding to asylum seeker distress and mental deterioration https://wiley.altmetric.com/details/17878566
  5. How many of 1829 antidepressant users report withdrawal effects or addiction? https://wiley.altmetric.com/details/43387887

Altmetric attention scores re IJMHN impact from July 2015 to June 2018, MS Excel spreadsheet data courtesy of Kornelia Junge, Senior Research Manager, Wiley.

Altmetric logo via https://www.altmetric.com/about-us/logos/ (retrieved 06/10/2018)

CrossRef data re IJMHN most-cited articles based on citations published in the last three years, via https://onlinelibrary.wiley.com/journal/14470349 (retrieved 04/10/2018)

Hootsuite logo via https://hootsuite.com/about/media-kit (retrieved 06/10/18)

IJMHN. (03/01/17). The @IJMHN 2017 New Year resolution is to refresh our Twitter home page and Tweeting practices. Watch this space! 🙂 [Tweet]. Retrieved from https://twitter.com/ijmhn/status/816202247604301824?s=21

International Journal of Mental Health Nursing, October 2018, volume 27, issue 5, cover image via https://onlinelibrary.wiley.com/doi/pdf/10.1111/inm.12395

Israel, S. (foreward by Li, C.). (2009). Twitter Ville: How businesses can thrive in the new global neighborhoods. New York: Portfolio.

Tweet activity examples as at 06/10/18

  1. Combining #eMentalHealth intervention development with human computer interaction (HCI) design to enhance technology‐facilitated recovery for people with depression and/or anxiety conditions Amalie Søgaard Neilsen + @RhondaWilsonMHN https://twitter.com/ijmhn/status/1036177022811340800?s=21
  2. Meeting the needs of young people with psychosis: We MUST do better Editorial by @Michael_A_Roche @debraejackson @KimUsher3 + Wendy Cross https://twitter.com/ijmhn/status/1033277919865593858?s=21
  3. Literature review of trauma-informed care: Implications for mental health nurses https://twitter.com/ijmhn/status/1029110510569091072?s=21

Twitter data re IJMHN activity from July 2015 to June 2018 via http://www.twitonomy.com/profile.php?sn=IJMHN (retrieved 20/10/18)

Twitter data re IJMHN impact from July 2015 to June 2018 via https://analytics.twitter.com/user/IJMHN/home (retrieved 09/10/2018)

Twitter logo via https://about.twitter.com/en_us/company/brand-resources.html (retrieved 06/10/18)

Video Version

The YouTube version of the presentation (slightly different to the conference version) can be viewed below and/or shared using this URL: https://youtu.be/vWSI3u4O2Bc

Presentation Tweets

Using Hootsuite, these Tweets using the conference hashtag (#ACMHN2018) were scheduled to be sent during the presentation. Look Mum! No Hands!

 

Citation

To cite this page:
McNamara, P. (2018). Conversations, not just citations, count: Social Media and the International Journal of Mental Health Nursing. Retrieved from https://meta4RN.com/count

To cite the presentation abstract:
McNamara, P. & Usher, K. (2018). Conversations, not just citations, count: Social Media and the International Journal of Mental Health Nursing. International Journal of Mental Health Nursing, Volume 27, Issue S1, Page 31 onlinelibrary.wiley.com/doi/full/10.1111/inm.12539

End

That’s it. Thanks for reading this far down the page. You’re probably the only one who’s bothered. 🙂

In keeping with the theme of the presentation, I’d be grateful if you share the page with your social networks.

As always, questions and feedback are welcomed via the comments section below.

Paul McNamara, 15 October 2018

Short URL meta4RN.com/count

Update: 20 October 2018

There was a flat spot in the original presentation where I struggled to convey clarity and sustain interest. In an effort to overcome this, I deleted a couple of slides from the original Prezi, modified another, and added the data/chart below. Thank you for your helpful critique and suggestions @StellaGRN.

Update: 27 October 2018

The Tweets that were scheduled to coincide with the presentation have now been embedded in the post.

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

 

BridgeBuilders

BridgeBuilders is about encouraging more collaboration + less silos in health care.

There’s a cool Canadian band called Arcade Fire. One of the things that makes them cool is their eclectic and varied instrumentation.

Track two is standard guitar-driven rock. Track five features mandolin, recorder and banjo. The song that follows features piano accordion, trombone and hurdy-gurdy.

Arcade Fire’s frontman was asked about how decisions about instrumentation were made. He replied that it wasn’t about individual musicianship or ego. Decisions about who played what instrument were made by what made the song sound best. He said that the band members were all in service to the song.

Replace the musicians with clinicians, instruments with our varied skill sets, and the song with the patient.

We’re all in service to the patient.

When we get it right the GP, the mental health nurse, the emergency doctors and nurses, and the allied health clinicians aren’t individuals trying to be solo rock stars.

When we get it right we’re playing together as a band. That’s the way to make the health service sing.

Source

Reblogged from bridgebuilders.vision

End Notes

  1. Shout-out to Edwin Kruys (@EdwinKruys on Twitter) for inviting my post to BridgeBuilder (@Bridg3Builders on Twitter).
  2. If you haven’t done so already, visit bridgebuilders.vision and have a look around, and read the BridgeBuilders story. Healthcare needs all the bridge builders it can get! 
  3. I didn’t really mean to duplicate the post here, but when I clicked on the “reblog” button it created an uneditable and undoable link with only half the text. It made no sense, so I deleted it. This link-back is to correct my failed experiment with reblogging, but still spread the word re BridgeBuilders as far and as wide as I can.
  4. How good are Arcade Fire?

Paul McNamara, 3rd July 2018

 

 

 

Developing, designing and deploying a perinatal mental health referral pathway

Abstract

Mental health nurses have the skills to collaborate with primary health providers, work side-by-side with tertiary health providers, and provide support and information to those who experience mental health difficulties and their families. But how do we communicate this? How do we make it easy for referrers and consumers to find the ‘best fit’ for identified needs? How do we promote collaborative care? How do we reach our audience?

This poster presentation is the third iteration of a referral pathway that has undergone the usual quality improvement measures of consultation and review. The poster is also a showcase for collaboration: the content was gathered in collaboration with service providers and consumers; this information was then organised, revised and presented in collaboration with a graphic designer; the completed pathway was then deployed, reviewed and made accessible in collaboration with a web designer.

This perinatal mental health referral pathway does not purport to be a template for others, but may serve as one example of how to develop, design and deploy accessible information about local service options. The poster presentation hopes to serve as a starting point for those who are interested in articulating a service’s relationship to the consumer and other agencies. The poster also demonstrates a clinically relevant use for Quick Response (QR) Code – please bring your smart phone if you intend to view the perinatal mental health referral pathway.

NB: This 2011 Version is redundant. NOT for clinical use. Please use only as an example.

Printable/downloadable PDF version here: referralpathwayworkflow2011

Reference/Citation

McNamara, P., Horn, F. & Dalzell, M. (2012) Developing, designing and deploying a perinatal mental health referral pathway. Poster presented at ‘The fabric of life’, the 38th Annual International Conference of the Australian College of Mental Health Nursing, Darwin. http://dx.doi.org/10.1111/j.1447-0349.2012.00878.x

or, if you want to cite/see the journal entry

McNamara, P., Horn, F. & Dalzell, M. (2012) Developing, designing and deploying a perinatal mental health referral pathway. International Journal of Mental Health Nursing, volume 21, issue S1, pages 16-17. http://dx.doi.org/10.1111/j.1447-0349.2012.00878.x

Notes

This flowchart first began to be mapped-out in 2010, the version above was finalised in November 2011, and presented at a mental health nursing conference in October 2012. The workflow and the position that developed/supported it became redundant in 2013.

My versions were smudged pencil on paper versions. Freya Horn, now working as Graphic Artist at www.designerinyourpocket.com.au, turned it into the legible and attractive flowchart you see above. Thanks Freya!

There is some optimism about money flowing back in to perinatal mental health services in Australia. With that in mind, I’m releasing this old work from my USB drive to my website. Hopefully it will save others wasting time “reinventing the wheel”. Updating the wheel will be required, of course, but there’s no need to start from scratch. 🙂

Just to reiterate: This 2011 Version is redundant. It is NOT for clinical use. Please use only as an example for how you/your local service may want to might develop a map of the local referral pathway and workflow.

End

That’s it. Hopefully this will be of interest/use to someone in future.

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

Paul McNamara, 14th June 2018

Short URL: meta4RN.com/pathway

Sex Essentials – The Fairy Tale

On Friday 18 May 2018 the Cairns Sexual Health Service hosted their seventh Sex Essentials education day for nurses, GPs, youth workers, allied health, Aboriginal and Torres Strait Islander health workers, educators and community workers. These annual education days are famous in FNQ and beyond for being energetic and fun. Each Sex Essentials day has a different theme, the 2018 theme was “The Fairy Tale”.

Regular visitors to meta4RN.com know that I’m a fan of taking health education beyond the classroom/conference walls by using social media. While readily acknowledging that there’s no way to capture the whole day on a web page, hopefully this collation of Tweets gives a taste of the creative, inspiring, fun and educational event that was Sex Essentials – The Fairy Tale:

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More info re #SMACC (Social Media and Critical Care) here.
More info re #FOAMed (Free Open Access Meducation) here.
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This is not an exaggeration. For example, watch this short presentation about how FNQ is home to Australia’s first Hep-C free prison here.
Vimeo

AVHEC 2017 – Darren Russell “Keynote 11 – Eliminating Hepatitis C – The Cairns Experience” from ASHM on Vimeo.

8.

You know what bear means, right? If not, have a quick read here.
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Sincere thanks to Max for an excellent keynote presentation, and agreeing to this Tweet being in the public domain.
Also, my mistake: that should read cisgender/cisgendered.
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URL to the How Much Do You Know? podcasts: eastsidefm.org/howmuchdoyouknow
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URL to Cairns Sexual Health Service: www.health.qld.gov.au/cairns_hinterland/html/shealth
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This session was facilitated by psychologist Suzanne Habib, and drew on the lived experience and generous wisdom of three remarkable people who shared their stories and answered our (sometimes a bit dumb) questions.
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Finishing-Up

For the sake of posterity, here are pics of the program.

Morning

Afternoon
Also for posterity, and by way of thanks to the slightly crazy, but very fun, staff of Cairns Sexual Health Service, here is the way the day started:

More info re Cairns Sexual Health Service here.

Visit the their Facebook page for more photos and info re future Sex Essentials days – health education done right.

End 

As always, comments are welcome in the section below.

Paul McNamara, 19 May 2018

Short URL: meta4RN.com/sex

#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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Introductions.
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Setting The Tone.
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Communication and Confidentiality.
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Mobile Phones.
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Social Media.
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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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Finishing-Up: Key Learnings.
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Closing Remarks.
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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

The Hearing-Voices/Car-Driving Metaphor

A while ago I met a lady who had a fantastic way of describing and understanding her experience of auditory hallucinations/psychosis. It goes a bit like this:

My body’s a car. I’m the driver.

In the back seat are the voices. They’re like naughty kids, always chatting away amongst themselves. Often they’re taunting me. 

Usually I can just ignore them and get on with driving the car.

However, every now and then the voices get real loud.

It’s distracting. Driving becomes difficult and that’s when I’m most likely to drive badly or, if I’m unable to concentrate properly, I could even crash the car. 

It’s pretty scary, but I usually don’t have to come into hospital at that point. I just need more support to get control back, and maybe a change to my medication. 

The worst time for me is when the voices get so distracting that I can’t focus on driving at all. I turn to the voices in the back seat and try to get them to shut up. But they’re like naughty kids yelling and jumping around the car, and I can’t get them to stop. 

I take my seatbelt off and turn to face them, then somehow – I don’t even notice it happening – one of the voices will slip into the driver’s seat and take over control of driving the car.

Thats when it gets REALLY dangerous.

I’m not out of control – it’s worse than that – I have lost control entirely. I haven’t even got my hands on the steering wheel anymore, and I can’t reach the brakes. 

That’s when I need to come into hospital.

At the time I met this lady she was make a tentative recovery from one of these acute episodes of psychosis. On admission she had been experiencing command auditory hallucinations, paranoid delusions, racing thoughts and suicidal ideation.

When we met the intensity of these symptoms was settling. The lady’s articulate insight helped us both communicate effectively when she had a relapse in symptoms. To keep her safe we needed to stop her from leaving the hospital, and provide an increased level of supervision/support. To get a shared understanding of this I was able to return to the lady’s metaphor:

I’m worried that you’re at risk of losing control of the car again. What I’m planning to do is take the keys away for now, and hand them back to you when you’re safe to drive again. 

That’s a good way to think about using the Mental Health Act – it’s a mechanism to decrease risk/stop people from a foreseeable crash if they’ve lost the capacity to drive. 

However, the real story here is about the intelligence, insight and articulate communication of a young woman who experiences symptoms of psychosis.

An impressive person, and a fantastic metaphor. 

Hopefully other people will be able to make use of this lady’s metaphor as a way to understand psychosis/hearing voices. 

car
End

Thanks for visiting. As always your comments/feedback is welcome below.

Paul McNamara, 20th February 2017.

Short URL: meta4RN.com/car

Hand Hygiene and Mindful Moments

Nurses and other health professionals are expected to attend to hand hygiene about eleventy seven times a day. The WHO and HHA recommend 5 moments for hand hygiene: before touching a patient, before clean/aseptic procedures, after body fluid exposure/risk, after touching a patient, and after touching patient surroundings. 57.4% of Australia’s nurses/midwives are hospital/ward-based [source], they’re doing A LOT of hand hygiene. 

On top of that, while they’re going about their business and busyness, ward-based nurses are interrupted 10 times an hour [source]. Yep, every 6 minutes there’s something or somebody distracting us from our tasks and thoughts. Dangerously disorderly much? Hopefully that doesn’t happen to neurosurgeons, commercial airline pilots, tattoo artists or Batman.
Especially Batman. 

batman

Pro-Tip: most of us can not do this at work. Only respond to distractions with face-slapping if you are Batman.

So, here’s the idea: if you’re going to do hand hygiene dozens of times a day anyway, don’t just do it for your patients: do it for yourself too. We’re not cold callous reptilian clinicians, we’re educated warm-blooded mammals who do emotional labour. We need to nurture ourselves if we are to safely continue to nurture others.

poster1

5 moments for hand hygiene & head hygiene!

Turn the 5 moments of hand hygiene into mindful moments. Make the 5 moments for hand hygiene 5 moments for head hygiene too. Yes, clean hands save lives – let’s not forget that clear heads save lives too!

Come up with a process/script that works for you, maybe something a bit like this: 

Mindful Moment (The 30-Second Handrub Version) 

  1. Step towards the pump bottle with intent. This is my mindful moment. I’m taking a brief break. 
  2. Squirt enough to squish. 
  3. The rub is slippery at first. Frictionless fingers feel fine.
  4. Feel the product texture and temperature. The rub is cooler than the air. The rub is cooler than my fingers. It feels nice. 
  5. Start with cleaning. The first half of my hand hygiene routine is about rubbing stuff off. Let the stuff I want to get rid of float away. 
  6. Move on to restoration, healing. The second half of my hand hygiene routine is about rubbing in resilience and health. Let the stuff that sustains me seep into my skin. 
  7. Check in on the breathing. The slower and deeper the better. If the breathing or the brain are running too fast, slow down and repeat steps 5 and 6. 
  8. There’s no rush. Slowly scan the surroundings. With any luck someone from infection control is watching. 
  9. Smile.
  10. Breathing slowly, its time let the air rinse off the residue. 
  11. One more slow breath. Its time to get back to work. 

Mindful Minute (The 60-Second Handwash Version)

  1. Step towards the sink with intent. This is my mindful minute. I’m taking a brief break. 
  2. Let the water flow.
  3. Feel the water flowing over both hands. The water’s warmer than the air. The water’s warmer than my fingers. It feels nice. 
  4. Add soap. It’s slippery. Frictionless fingers feel fine.
  5. Start with cleaning. The first half of your hand hygiene routine is about washing stuff away. Let the stuff you need to get rid of flow down the drain. Let it flow away. 
  6. Move on to restoration, healing. The second half of my hand hygiene routine is about rubbing in resilience and health. Let the stuff that sustains me seep into my skin. 
  7. Check in on the breathing. The slower and deeper the better. If the breathing or the brain are running too fast, slow down and repeat steps 5 and 6. 
  8. There’s no rush. Slowly scan the surroundings. With any luck someone from infection control is watching. 
  9. Smile.
  10. Breathing slowly, its time rinse both hands. 
  11. Breathing slowly, its time to thoroughly dry both hands together. 
  12. Throw the towel in the bin.
  13. One more slow breath. Its time to get back to work. 
poster2

Clean hands save lives. Clear heads save lives too!

Acknowledgements & Context

This is not my original idea. I first stumbled across the idea of combining hand hygiene with head hygiene via Ian Miller‘s November 2013 blog post “mindfulness during handwashing”: http://thenursepath.com/2013/11/18/mindfulnurse-day-8/. I’ve been using the idea myself and suggesting it to colleagues and students ever since. When I left the clinical environment for a few months, I found myself really missing intentionally punctuating my day with mindful moments. Since returning to clinical practice I’ve come to appreciate the strategy even more than I did when I first started using it 3 years ago.

So why am I blogging about it too? Why now? Well, on Monday I attended the Australasian College for Infection Prevention and Control 2016 conference to chat about Twitter [link to that presentation here. Also, check-out the #ACIPC16 hashtag here and here]. Luckily I was there for the opening plenary sessions, and was pleasantly surprised at the emotional/psychological literacy that was being displayed and advocated for. The opening presentations by Peter Collignon, Mary Dixon Woods and Didier Pittet all went to some lengths to emphasise the importance of emotional intelligence, constructive communication and building relationships. It was really impressive stuff; giving the hand hygiene and mindful moments idea a remix is my way to give recognition/thanks to the #ACIPC16 conference delegates and organisers.

How to win friends and influence people: https://twitter.com/emrsa15/status/800495292642508801

How to win friends and influence people: https://twitter.com/emrsa15/status/800495292642508801

Just so you know, a quick google search reveals that others have also thought of using hand hygiene as a mindful moment, eg this paper:

Gilmartin, Heather. (2016) Use hand cleaning to prompt mindfulness in clinic: A regular prompt for reflection could reduce distraction. BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i13 (Published 04 January 2016)

and this video:

There are others too. Do you think using hand hygiene as a mindful moment could become mainstream?

5mindfulmoments

End

That’s it. As always your comments are welcome via the space below.

May you hands be clean and your head be clear! 🙂 

Paul McNamara, 26 November 2016

Short URL: meta4RN.com/hygiene

The Broken Leg/Psychosis Metaphor

Preamble

Below is a metaphor I heard in 1994 via an impressive man called Greg Holland. Greg is retired now, but when I met him he was a CNC with a public community mental health service. Even after all the years that have followed, Greg remains one of the most skilled communicators and mental health nurses I’ve ever worked with.

Greg was talking with a couple of young fellas who had been diagnosed with schizophrenia. Greg was explaining the importance of trying to avoid relapses of psychosis. The key messages for these young blokes was to keep taking the prescribed medications, and stay away from things that make psychosis more likely: things like cannabis, amphetamines or heaps of alcohol. That’s when Greg used this metaphor (his verbal version was shorter than my written version, but the general story is the same):

The Broken Leg/Psychosis Metaphor

If you accidentally broke your leg skateboarding or playing football, you’d have to have your leg in plaster for about 6 weeks. You would have to be really careful with it during that time, and it would probably get really uncomfortable and itchy most days. Then, if there were no complications, after 6 weeks you’d be able to get the plaster cast off, and start building up your strength in that broken leg. A physio might recommend some exercises, but you probably wouldn’t get back to playing football or skateboarding for a few months. Rehabilitation takes a bit of time and effort, but as a young fit man you’ll make a full recovery. No worries.

If you broke the same leg again, it might be more of a big deal. You might need surgery, and they might need to strengthen the bone with steel plates or rods and screws. Sometimes people need to have external fixation: metal devices that are screwed into the bones, but sit outside the body, above the skin to stabilise the fractures. It will be messier, more painful, take longer to get out of hospital, and your leg muscles will get pretty weak. You’ll probably make a full recovery still, but it will just take more time and effort.

If you break your leg a third time, the orthopaedic nurses and doctors are going to think you’re either really unlucky or stupidly reckless. They’ll suggest that you stop skateboarding and playing football altogether. Your leg will get operated on, and the fractures will get stabilised, but the recovery will be really slow. You could end-up with a bit of a limp.

If you keep on breaking the same leg over and over again, say five, six, seven times, you will definitely end up with a limp. Might need a walking stick or something.

If you break the same leg often enough and bad enough you’ll probably end up lame: permanently disabled and unable to walk. You’ll wish you’d listened to the orthopaedic nurses and doctors, and had never gone back to skateboarding or playing football.

It’s kind of the same with psychosis.

If you lose touch with reality once or twice you’ll probably make a full recovery.

But if you keep on having psychotic episodes your brain might develop a bit of a “limp” – it will still work, but not as good as it used to work.

If you have lots of psychotic episodes you might end up disabled and unable enjoy life to the fullest. You’ll wish you’d never gone back to smoking gunja or getting pissed.

That’s why I’m working with you to prevent or cut down on psychotic relapses. Does that make sense to you?

End

I really like the broken leg/psychosis metaphor. I use a shortened version of the above script a fair bit at work, and people usually respond well to it. I’m very grateful to Greg Holland for introducing the analogy to me. It’s a good metaphor that I hope that others will find useful to use/adapt in their clinical practice too.

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

Paul McNamara, 17th November 2016

Short URL: meta4RN.com/leg