Tag Archives: COVID19

Liaison in the Time of #COVID19

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This page is an accompaniment to a brief presentation at the Inaugural ACMHN Consultation Liaison Special Interest Group online webinar via zoom – it is just a place to plonk things that I’ll talk about in case anyone wants to clarify anything for themselves.

So, here goes:

As noted on a previous blog post, Queensland’s population is much bigger than Australia’s smaller states/territories, but falls a long way short of Australia’s two largest states. 

 

Queensland’s population size compares better to New Zealand, Ireland, Norway and Singapore than other Australian states and territories.

 

All the data below is true as of 1 August 2020 (as you probably know, 1st of August = the Horses Birthday in Australia).

 

It is interesting to compare the number of Covid-19 cases across similar-sized populations. Obviously there are many differences between the populations too – not the least of which is land area – so I’m doubtful that a proper epidemiologist or public health professional would put much stock in this comparison. That disclaimer aside, it is noted that Queensland has a larger population than New Zealand – which is held-up as a shining-light of Covid-19 control – but, to date, has a lower incidence of Covid-19 positive people.

 

I’m not sharing the data about number of Covid-19 deaths as a macabre version of State of Origin or the Bledisloe Cup. It’s not a competition. It’s certainly not a game. Thousands of families across the world are in mourning. That said, isn’t it interesting how low Singapore’s death rate is compared to that of Ireland and, to a lesser extent, Norway? Both New Zealand and Queensland have been very fortunate to date in limiting the number of deaths.

 

Comparing the number of new cases of Covid-19 in the last 24 hours (as at 01/08/20) is also interesting.

 

In the session there will be mention of the “Clean Hands. Clear Head.” strategy to embed anxiety-management into everyday clinical practice. More info about his via the blog post and video of the same name: meta4RN.com/head

 

Also in the session there will mention of “Positive Practice Environment (the other PPE)” Again, there is more info about this via a blog of the same name: meta4RN.com/PPE

 

Finally, here is a link to the Prezi that was used to make the video. My understanding is that all these pretty Prezis will stop working at the end of 2020 when everyone stops using flash (just letting you know in case you’re looking at this page in 2021).

 

End

That’s it. I hope some of this info is of interest. As always, you’re welcome to leave feedback via the comments section below.

Paul McNamara, 3 August 2020

Short URL: meta4RN.com/zoom

One. Step. Beyond.

Stories on the TV that speak of the mental health impacts of COVID-19/other issues nearly always end with words to the effect of, “And if this has raised any issues for you help is always available. Phone Lifeline on 13 11 14.”

In keeping with Mindframe media guidelines, it’s good that help-seeking information is included in these stories, but it doesn’t cater for the full spectrum of mental health problems.

Lifeline, for example, is a crisis support line, akin to lifesavers plucking people from the dangerous surf. It’s vital, but it’s not a “one size fits all” service (nor should we expect it to be).

Anyway, most of us would rather early intervention/prevention rather than crisis intervention. It’s better to learn how to swim than rely on someone saving you from drowning.

 

The Stepped Care Model of Mental Health

Self Portrait 26/04/20

The Stepped Care model aims to ensure that people have streamlined access to the right services for their needs over time, and as their needs change. There is more information about this available from more reputable sources than my blog, eg:  Northern Queensland Primary Health Network, Connect to Wellbeing, or your local public health network.

A short, amateurish, overview is this:

If you’re on the lowest (blue) step, you’re doing OK. Keep those healthy relationships and habits going.

If you’re on the second-lowest (green) step you probably should be more intentional about protecting your social and emotional wellbeing. Chat to people you love/trust, and see if any of the digital resources at Head To Health match where you’re at.

If you’re on the middle (yellow) step it’s definitely time to connect with someone. If you’re a Nurse or Midwife that could be NMSupport in the first instance,  if you’re in North Queensland you may consider contacting Connect to Wellbeing. Elsewhere you may need to google or go via healthdirect re equivalent services.

If you’re on the second-top (orange) step, don’t muck-about: make a double appointment to see your GP. S/he won’t necessarily reach straight for the prescription pad. The GP may discuss making a Mental Health Treatment Plan, which should include your goals  and – if you and your GP agree it’s worth a try – a referral to a specialist mental health professional.

If you’re on the top (red) step you will almost certainly want to make contact with your local mental health service. In Queensland phone 1300 64 2255 (1300 MH CALL). Outside of Queensland you should be able to track-down your local service via healthdirect.

One. Step. Beyond.

This blog post was inspired by chatting with hospital colleagues who were not familiar with the Stepped Care Model of Mental Health. Many thanks to these terrifically impressive people who are definitely NOT heroes: they’re just everyday compassionate, creative, funny, clever and skilled health professionals who – in a crisis – will go one step beyond to support the people who need it.

One last thing. If, like me, you have a foot one step beyond your usual step, perhaps the jaunty Madness (1979) song “One Step Beyond” will provide temporary distraction and cheer. 🙂

End

Thanks very much for visiting. As always your feedback is welcome in the comments section below.

Paul McNamara, 30 July 2020

Short URL meta4RN.com/step

An end of April #COVID19 snapshot (Queensland perspective)

The chart below shows confirmed cases of #COVID19 as at 4.30pm (GMT/UTC + 10:00h) on Thursday 30/04/20. The chart sourced via www.covid19data.com.au

I’m not sharing this info as a macabre version of State of Origin or the Bledisloe Cup. It’s not a competition. It’s certainly not a game. Thousands of families across the world are in mourning.

Nevertheless, it is useful to have a benchmark of how we are faring. To give us perspective it’s useful to compare progress across areas/populations. As per the list below, Queensland’s population size compares better to New Zealand, Ireland, Norway and Singapore than other Australian states and territories.

Population Comparison (Australian states/territories + selected countries, small to large)
Northern Territory 245,000
Australian Capital Territory 428,000
Tasmania 535,000
South Australia 1.75 million
Western Australia 2.63 million
New Zealand 4.82 million
Ireland 4.94 million
Queensland 5.11 million
Norway 5.37 million
Singapore 5.85 million

Victoria 6.63 million
New South Wales 8.12 million

So What?

Hopefully, the encouraging data in this chart serves as an anxiolytic for Queensland health workers and their patients. That’s the intent.

End

That’s it. If you know an anxious Queenslander please share this information with them.

Paul McNamara, 1 May 2020

Short URL meta4RN.com/qld

Supporting Nurses’ Psychological and Mental Health

An editorial by Jill Mabel and Jackie Bridges published on 22 April 2020 in Journal of Clinical Nursing explores the evidence regarding supporting nurses’ psychological and mental health during #COVID19.

Q: Why nurses?
A: Nurses are at the bedside 24 hours a day, 7 days a week. In previous pandemics/epidemics nurses experienced more occupational stress and resultant distress when compared to other professions.

And – little known fact – even when there isn’t a pandemic to deal with, nurses are more prone to suicide than most employed people. The authors are in the UK, but it’s the same in Australia.

Although there are lessons to be learned from SARS, MERS and Ebola, overall the evidence for supporting nurses’ psychological and mental health wellbeing during a pandemic is not very strong.

That disclaimer out of the way, here comes my interpretation of the key points from the paper:

1. Keep Maslow’s Hierarchy of Needs in Mind.
Starting at the base isn’t basic. It’s essential.
Start with
– hydration
– nutrition
– rest and recovery
– shelter from the storm

2. Safety is vital.

For
#COVID19 that means that PPE is a non-negotiable need (don’t take my word for it, see Maslow’s hierarchy above).

3. Prioritise wellbeing.
Organisations that ask nurses to care for people who are #COVID19 suspected/positive should ensure that nurse wellbeing is a priority.
Q: How?
A: Insist on breaks, and – this often goes against the nursing culture/habits – make sure that nurses quarantine time for mutual support.
Q: Mutual support? What’chu talkin’ ’bout, Willis?
A: meta4RN.com/footy

4. Individual Support PRN.
Individual support should be available for nurses too.
Q: What sort of support?
A: It’s not one size fits all. It depends on what step you’re on.

Self Portrait 26/04/20

On the lower steps, support via trusted, loving family and friends might be all that’s required. That, and being intentional about self care.

5. Self-Care.
If you’re getting stressed on the boss’s time, you should try to get de-stressed on the boss’s time too. It doesn’t have to take hours, you might be able to make regular snack-sized self-care part of your everyday nursing practice.

6. Positive Practice Environment.
Good communication, a collegial multidisciplinary team, creative and collective problem-solving,and working as a team can go a long way towards dampening anxiety.
There’s more than one kind of PPE.
Aim for a Positive Practice Environment.

7. Time Out.
Embed safe places in the workplace. Something like a NOvid room would do the trick.

8. Supportive Senior Staff.
Last, but not least, senior nurses and other people in the hospital hierarchy should make themselves more available and visible than ever.
Care goes in. Crap comes out.

End

That’s the summary of the key messages I took from the Journal of Clinical Nursing editorial. Check it out yourself via doi.org/10.1111/jocn.15307

Many thanks to Jackie Bridges (one of the paper’s authors) for giving positive feedback regarding the original Twitter thread. This blog post is a replica of that thread, just with most typos corrected.

Thanks for reading. As always you’re welcome to leave feedback and/or add your own ideas in the comments section below.

Paul McNamara, 26 April 2020

Short URL: meta4RN.com/COVID19

Positive Practice Environment (the other PPE)

At this point in time (the beginning of April 2020) PPE is popping-up in news and social media feeds frequently. Understandably, with the outbreak of the #COVID19 pandemic, clinicians are much more conscious of Personal Protective Equipment (PPE) than usual. Even crusty old mental health nurses like me have revisited and refreshed our knowledge on PPE.

That’s sensible. It’s also sensible to acknowledge that there’s more than one type of PPE.

Positive Practice Environment (PPE)

Today some nurses who work on a ward receiving patients suspected/confirmed to have COVID-19 identified elements that are contributing to their ward working well. Although there’s still some anxiety, of course, generally it is a PPE (positive practice environment). Some of the things nursing staff identified were:

  1. Team Nursing. The RNs highlighted this as a part of the PPE. In a team you never feel like it’s your burden to bear alone, there’s someone to check with donning and doffing personal protective equipment, and there’s always someone to help if you’re in the isolation room and need something extra.
  2. Communication. Communciation within the nursing team, and between the nursing staff and senior medical staff is much better than usual. Regular meetings both formal and informal are really helpful.
  3. Working Smarter. For example: before entering an isolation room, call the patient on their bedside/mobile phone to see if they need anything extra. Similarly, making an arrangement with the patient that they can buzz or phone if they need anything. Increased use of phone = decreased frequency of entering isolation room = decreased use of personal protective equipment.
  4. Getting Smarter. Asking questions and brainstorming solutions. Everyone acknowledges that they aren’t experienced or experts in pandemics, and that collaborative care is the only way to problem-solve the way forward. Patients generate solutions too
  5. Staying Focused. There is so much information swirling about regarding COVID-19, that it is important to limit the sources and exposure. We need to trust the health department that employs us to give us the correct information at the correct time. We can’t afford the time or mental/emotional energy to look at everything that’s out there.
  6. Downtime is Sacred. When everything at work seems to have a COVID-19 twist to it, it’s important to shield against overload. Strategies include:
    • Don’t watch the news, watch a movie.
    • Be careful how much time we spend in the social media echo chamber.
    • Switch off social media and the TV and listen to music.
    • Ask friends and family not to use “the C word” around you.

Downtime is Sacred.

Three Final Thoughts

One
It’s not just about wearing PPE (as in personal protection equipment) it’s about creating a PPE (as in positive practice environment) too. Nobody pretends for a moment that there are not more and/or better ideas than those above, but being intentional about both lots of PPE is helping.

Two
What’s more contagious: COVID-19 or anxiety?

Three
I can’t believe that it’s been less than 2 months since the term “COVID-19” was first coined. It has infected nearly every news article and conversation since early February 2020.

End

That’s it. Thanks for reading.

As always your feedback is invited via the comments section below.

Paul McNamara, 1 April 2020

Short URL meta4RN.com/PPE

Clean Hands. Clear Head.

Part 1. Clean Hands. Clear Head.

“Clean Hands. Clear Head.” is an animation of a mindfulness script that distills the content of my 2016 blog post “Hand Hygiene and Mindful Moments” into a short (less than 2 minutes) video. The voice part was recorded on an iPhone at a hospital sink #authentic. The visuals were done on Prezi.

Here’s a link to the Prezi version of “Clean Hands. Clear Head.” prezi.com/jehramlhdkcm

Addit 29/03/20: to my surprise, some people want a text version. I won’t write out the whole thing (too long, a bit dull), but below are some key phrases:

This is my mindful moment.
The anxiety and tension will be washed away.
I will rub in the resilience and kindness that sustains me.
After 20 seconds or so I will pretend I’m TayTay, and shake it off. 🙂
I will smile, then will intentionally slow my breathing.
Me and my hands will be safe.

Feels free to use/modify PRN. I would be grateful for source attribution as “meta4RN.com/head”
Just in case it’s handy here is a PDF: CleanHandsClearHead
And here is a MS Word version: CleanHandsClearHead

Part 2. Surviving Emotionally Taxing Work Environments. March 2020 version.

On a related topic, for the last few years I’ve facilitated many hour-long, interactive sessions called “Self Care: Surviving Emotionally Taxing Work Environments.” for my fellow nurses at the hospital where I work. As at March 2020, I’m not confident that we’ll have an opportunity to meet face-to-face as a group all that often, so I’ve tweaked the session, tried to cut-down on the rambling, and have switched from hour-long interactive, to 20 minutes of well-intentioned, a tad-amateurish, youtube video embedded below:


Self Care: Surviving Emotionally Taxing Work Environments. March 2020 version.
(video, 20 mins)

Here’s a link to the Prezi version of “Self Care: Surviving Emotionally Taxing Work Environments. March 2020 version”: prezi.com/xcejt9pgd0b3

Part 3. References & Resources.

I’m recycling and combining a lot of old ideas for the March 2020 version of  “Self Care: Surviving Emotionally Taxing Work Environments.” 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, but it’s just so damn convenient. 🙂

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

Australian Government (24 March 2020) Coronavirus (COVID-19) current situation and case numbers
www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert

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

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

Employee Assistance Service (via Queensland Health intranet)
qheps.health.qld.gov.au/hr/staff-health-wellbeing/counselling-support

Employee Assistance Service (via Benestar – the company that CHHHS contracts out to)
benestar.com

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

Lai. J, Ma. S, Wang. Y, et al. (23 March 2020) Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open.
jamanetwork.com/journals/jamanetworkopen/fullarticle/2763229

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

End

Thanks for visiting. Let’s join the kindness pandemic to offset some of the crap that goes with the COVID19 pandemic.

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

Stay safe.

Paul McNamara, 25 March 2020

Short URL: meta4RN.com/head

Creative Commons Licence
Clean Hands. Clear Head. by Paul McNamara is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.