Tag Archives: consultation liaison psychiatry service

Body Image and Eating Disorders Awareness Week (#BIEDAW) 2022 @ Cairns Hospital Grand Rounds

Cairns Hospital Grand Rounds on Friday 9 September coincided with 2022’s Body Image and Eating Disorders Awareness Week (#BIEDAW). Understandably, it was planned that the session should focus on eating disorders.

Dr Janet Bayley, Consultant Psychiatrist with NQuEDS* was to present, but was unexpectedly unavailable. Janet passed the baton to Dr Sharmila Prakash, Consultant Psychiatrist with Cairns Hospital’s Consultation Liaison Psychiatry Service. Unfortunately, Sharmila also became unexpectedly unavailable. That’s where – Steven Bradbury style – I slid-in to be on the Cairns Hospital Grand Rounds program.

There were two other presenters on the theme of eating disorders at Grand Rounds. Consultant Nephrologist and Physician Dr Bibin George presented very interesting early data from an audit of Cairns Hospital eating disorder medical admissions. Psychiatric Registrar/Dual Advanced Trainee Dr Manjuka Raj presented early results from her research examing core competencies of staff involved in a new eating disorder service. There is a fair chance that each of these research projects will progress to publication in future – keep an eye out for them.

My presentation was not about hard data or research. It was an overview of the role that a Consultation Liaison Psychiatry Service has when a person is admitted to hospital as a medical patient because of problems associated with an eating disorder. For those interested the session was videoed:

Regular visitors to meta4RN will note that this presentation looks remarkably similar to this one: Consultation Liaison Psychiatry Service @ CHHHS Eating Disorder Forum. That’s because it is pretty-much the same presentation with a few tweaks.

So What?

A few dozen people go to Cairns Hospital Grand Rounds either in person or via Zoom. The meta4RN blog extends that reach. If you were not at Cairns Hospital Grand Rounds yesterday, and have an interest in the care of people admitted as medical inpatients because of an eating disorder, perhaps the video is worth a look.

Also, just in case I (or you) want to revisit or recycle any of the info in the presentation, here is the link to the Prezi.

Cairns Hospital Grand Rounds 9 September 2022

NQuEDS*

NQuEDS = North Queensland Eating Disorder Service. More info about NQuEDS here and here. Enquiries about referral should be directed to 1300 64 2255 (1300 MH CALL).

End Notes

That’s it. Thanks for visiting.

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

Paul McNamara, 10 September 2022

Shirt URL meta4RN.com/BIEDAW

CLovid Communication

This blog post aims to clarify how the clinicians on one Consultation Liaison (CL) Psychiatric Service communicate with general hospital inpatients who are being nursed in isolation during the COVID-19 pandemic.

Why? 

There has been some confusion re nomenclature of how we provide mental health assessment/support to hospitalised people in isolation . Hopefully by describing the pros and cons of the methods we’ve tried to date we’ll clear-up any misunderstandings. 

CLovid Communication options: 1. Videoconference. 2. In-Room (featuring Jelena Botha in PPE). 3. Face-To-Face through a window. 4. Phone.

1. Videoconference Review
ie: using an online videoconferencing platform that works on both the clinician’s computer and the patient’s own device

Pros:

  • No risk of infection transmission
  • When it works there is reasonably good eye contact and exchange of facial expressions and other non-verbal communications, leading to opportunities for engagement/establishing rapport 
  • Since mid-late 2020, nearly all clinicians and many (most?) consumers are familiar with videoconferencing 

Cons:

  • In my clinical practice videoconferencing for these reviews has been mostly unsuccessful. Cross-platform incompatibility and limitations to what the devices/bandwidth that hospital inpatients in isolation have access to have been problematic.
  • At our end, clinical workplaces do not provide access to the same platforms our patients typically use (eg: FaceTime, Video Chat on Facebook or WhatsApp).
  • The technology was getting in the way of the therapeutic relationship, not enhancing it.
  • For these reasons, we pretty-much gave up on trying to videoconference hospital inpatients in isolation back in April/May 2020. 

2. In-Room Review 
ie: in full PPE – face mask, goggles/face shield, gown and gloves

Pros:

  • Physical proximity is standard practice: Clinical staff and the people we care for are familiar with this 
  • Reasonably good eye contact and partial exchange of non-verbal communication, leading to opportunities for engagement/establishing rapport

Cons:

  • PPE obscures facial expressions, thereby inhibiting rapport/assessment
  • An extra clinician(s) using PPE resources
  • With no disrespect to my CLPS clinical colleagues, we’re generally not as well-drilled with donning and doffing as the specialist nursing and medical teams, creating potential risk of infection transmission

3. Face-To-Face Review 
ie: through the window/glass door panel, using phones for easy/clear auditory communication

Pros:

  • Good eye contact and exchange of facial expressions and other non-verbal communication, leading to opportunities for engagement/establishing rapport
  • No risk of infection transmission
  • Low-tech, easy to organise
  • Well received by nearly every hospitalised person in isolation that my team has seen from March 2020 to August 2021

Cons:

  • Reminds me of prison-visit scenes in American movies

4. Phone Review 
ie: speak to the person on their personal mobile or bedside phone, no visual contact

Pros:

  • No risk of infection transmission
  • Low-tech, easy to organise 
  • It’s the go-to method of communication for community mental health intake clinicians/services (ie: thought to be a good-enough tool for most triage and sub-acute presentations; may be familiar to the clinician or consumer)
  • Some people find emotional expression easier without the intimacy/intrusion of eye contact

Cons:

  • Assessment and rapport may be limited
  • Not thought to be adequate for acute or high-risk presentations

And The Winner Is…

Number 3: Face-To-Face Reviews, ie: where the clinician and person in isolation chat through the window/glass door panel, using phones for easy/clear auditory communication. 

It’s cheap, easy and effective. We use it nearly every time when there’s someone in a negative-pressure/isolation room. We’ve saved dozens, maybe hundreds, sets of PPE, and we’ve reduced the likelihood of becoming potential super-spreaders. 

Why Does It Matter?

Like just-about every other specialist mental health nurse on the planet, my clinical practice is influenced by Hildegard Peplau. Back in the 1950s dear old Aunty Hildegard had the audacity to tell nurses that, done right, the nurse-patient relationship = therapy [source]. About 60 years later neuroscience caught up with nursing theory and showed us that Peplau was right: strong relationships and strong attachments help brains heal by building new neural pathways [source]. 

A specialist mental health nurse is, amongst other things, a psychotherapist and a relationship focussed therapist [source]. A face-to-face review, even if has to be through glass, helps establish rapport and build a therapeutic relationship. 

CLovid Acknowledgements

Consultation Liaison Psychiatry Service is a bit of a mouthful, so it’s usually abbreviated to “CL”. CL = mental health in the general hospital

Back in March 2020 John Forster, a CL Nurse in Melbourne, accidentally coined the portmanteau “CLovid” by combining “CL” and “covid” as a typo. 

That’s why I’m calling this blog post “CLovid Communication”. 

Please forgive people like me who take delight in silly things like an accidental neologism. There’s been a fair bit of CLovid in the last eighteen months, and there’s more to come. Staying vigilant to the small joys and moments of lightheartedness is a survival skill. 

Thanks also to Jelena Botha, CL CNC (who arrived on my team just in time for the global pandemic 😳), for allowing me to use her PPE pic.

Further Reading

Cozolino, L. (2006/2014) The Neuroscience of Human Relationships: Attachment and the Developing Social Brain. New York, W. W. Norton & Company. [Google Books]

Hurley, J. and Lakeman, R. (2021), Making the case for clinical mental health nurses to break their silence on the healing they create: A critical discussion. International Journal of Mental Health Nursing, 30(2): 574-582. https://doi.org/10.1111/inm.12836

Peplau, H. (1952/1991) Interpersonal relations in nursing. New York: Putnam. [Google Books

Santangelo, P., Procter, N. and Fassett, D. (2018), Seeking and defining the ‘special’ in specialist mental health nursing: A theoretical construct. International Journal of Mental Health Nursing, 27(1): 267-275. https://doi.org/10.1111/inm.12317

End

What have I missed from this description of CLovid communication? Please add your on-the-job experiences and lessons in the comments section below.

Paul McNamara, 14 August 2021 

Short URL meta4RN.com/CLovid