Tag Archives: education

Saint Dymphna and The Zombies – a mental health nurse’s perspective

On Friday 19 June 2020 I presented “Saint Dymphna and The Zombies – a mental health nurse’s perspective” at the James Cook University/Cairns Hospital Ground Rounds virtually (ie: via zoom).

The session was initially scheduled to coincide with the Feast Day of Saint Dymphna – 15 May. However, the COVID-19/coronavirus thing put paid to any semblance of crowd gatherings, so the Grand Rounds program was postponed. When the Grand Rounds resumed they were moved out of the auditorium, and (like many things in 2020) went online.

The session has been videoed, please feel free to watch the watch the presentation below.

This page also serves as a  collection point for the references and resources used in the presentation.

Saint Dymphna

Info and references re the amazing story of Saint Dymphna has been collated previously on two of my blog posts, here: meta4RN.com/amazing and here: meta4RN.com/dymphna. For the sake of completeness the list of references used is replicated below:

Catholic Online (n.d.) St. Dymphna. Retrieved from www.catholic.org/saints/saint.php?saint_id=222

Catholic Saints Info (2016, 27 July) Saint Dymphna. Retrieved from catholicsaints.info/saint-dymphna

de Botton, A. (2011, July) Alain de Botton: Atheism 2.0 [Video file] Retrieved from www.ted.com/talks/alain_de_botton_atheism_2_0

Franciscan Mission Associates. (n.d.) The Story of St. Dymphna. Retrieved from franciscanmissionassoc.org/prayer-requests/devotional-saints/st-dymphna/story/ 

Goldstein, J.L. & Godemont, M.M.L. (2003) The Legend and Lessons of Geel, Belgium: A 1500-Year-Old Legend, a 21st-Century Model. Community Mental Health Journal. 39: 441. doi: 10.1023/A:1025813003347

Ireland’s Eye (n.d.) Saint Dymphna. Retrieved from www.irelandseye.com/irish/people/saints/dympna.shtm

Jay, M. (2014, 9 January) The Geel question. Retrieved from aeon.co/essays/geel-where-the-mentally-ill-are-welcomed-home

Kirsch, J.P. (1909). St. Dymphna. In The Catholic Encyclopedia. New York: Robert Appleton Company. Retrieved from New Advent: www.newadvent.org/cathen/05221b.htm

Novena (n.d.) Feast of St. Dympna. Retrieved from novena.com/2013/05/15/feast-of-st-dymphna/

Openbaar Psychiatrisch Zorgcentrum (OPZ) – Geel website www.opzgeel.be/en/home/htm/intro.asp

Rabenstein, K.I. (1998) Saint of the day. Retrieved from www.saintpatrickdc.org/ss/0515.shtml

Wikipedia (2016, 21 September) Dymphna. Retrieved from en.wikipedia.org/wiki/Dymphna

The Zombies

Photo of zombie nurses source: Roberts, A. (2015, 9 March) Zombie nurses raise funds for international medical exchange, ABC Capricornia
www.abc.net.au/local/photos/2015/03/09/4193789.htm

Established in 2010, the Australian Health Professional Registration Agency (AHPRA) does not recognise any Nursing specialities [source], but recognises 23 specialities in Medicine and over 60 sub-specialities [source].  

Lakeman, R. and Molloy, L. (2018), Rise of the zombie institution, the failure of mental health nursing leadership, and mental health nursing as a zombie category. International Journal of Mental Health Nursing, Volume 27, Issue 3, pp. 1009-1014. doi.org/10.1111/inm.12408

Principal area of main job for Australian Nurses (top five):
1️⃣ Aged Care
2️⃣ Medical
3️⃣ Surgical
4️⃣ Peri-Operative
5️⃣ Mental Health
[Australian Institute of Health and Welfare (2016, June 9). Nursing and midwifery workforce 2015, web report: source]

There are over 22,000 nurses working in mental health settings in Australia [Australian Institute of Health and Welfare (2020, January 30). Mental health services in Australia, web report: source]. It is not known how many of them hold specific undergraduate or postgraduate qualifications in mental health. There are no mechanisms in place to prevent a nurse with no specialist mental health qualifications working in a specialist mental health setting.

There are over 3,200 members of the Australian College of Mental Health Nurses [ACMHN 2017-2018 Annual Report: source]  – this equates to approx 14.5% of the nurses working in mental health settings. From my involvement with ACMHN, I am confident that nearly all members either hold or are  working towards a specialist qualification in mental health.

There are 1235 nurses who are credentialed (ie: peer reviewed and confirmed to have appropriate qualifications and experience, participation in clinical supervision, and contribution to the profession) by the Australian College of Mental Health Nurses [ACMHN 2019 Media Kit, source] – about 5.5% of the total.

58% of the nurses working in mental health settings are aged 45+, 33% are aged 55+ [Australian Institute of Health and Welfare (2020, January 30). Mental health services in Australia, web report: source].

Hildegard Peplau (1909-1999) is to Mental Health Nursing what Florence Nightingale (1820-1910) is to General Nursing [source].

End

Thanks for showing an interest in the presentation.

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

Paul McNamara, 20 June 2020

Short URL: meta4RN.com/zombies

 

 

 

Self Care: Surviving emotionally taxing work environments

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

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

Printed handouts are so last century.

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

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

Here is the online presentation: Prezi

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

End

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

Thanks for visiting. As always your comments are welcome.

Paul McNamara, 22 February 2019

Short URL: meta4RN.com/SelfCare

 

 

Diagnostic Overshadowing

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

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

Validating understandable and proportionate emotions is important.

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

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

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

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

The lived experience

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

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

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

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

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

Questions for Reflection

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

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

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

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

References

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

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

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

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

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

PDF version

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

Citation

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

End Notes

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

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

Paul McNamara, 15 December 2018

Short URL meta4RN.com/shadow

 

 

Diagnostic Overshadowing [original, now updated]

Source: I had a black dog, his name was depression https://youtu.be/XiCrniLQGYc

I work in a general hospital doing mental health clinical work and education. The two roles overlap. A lot.

A significant part of the job is undiagnosing mental illness. It’s not unusual for us to be asked to see somebody who is emotionally overwhelmed or dysregulated. Sometimes this is in the context of mental health problems, often it’s in the context of significant stress. We don’t want to psychiatricise the human condition. Of course you cry when you’re sad. Of course you’re anxious when, like Courtney Barnett in ‘Avant Gardener‘, you’re not that good at breathing in. Of course you’e frustrated when you’re in pain and/or don’t understand what’s going on.

It’s important to validate understandable and proportionate emotions.

It’s equally important to make sure that somebody who has experienced mental health problems previously doesn’t have every presentation to the hospital/outpatient clinic seen through that lens. That’s called “diagnostic overshadowing”. It’s a real problem.

Diagnostic overshadowing is where physical symptoms are overlooked, dismissed or downplayed as a psychiatric/psychosomatic symptom. It must be one of the most dangerous things that happens in hospitals. The President of the Royal Australian & New Zealand College of Psychiatrists, Professor Malcolm Hopwood, said in May 2016, “I sometimes think that the worse thing a person can do for their physical health is to be diagnosed with a mental health disorder.”

It often comes as a shock to people when they find out that those diagnosed with mental illness die between 10 and 25 years younger than the general public. The next shock comes when discovering suicide accounts for only about 14% of premature death. [source: ‘Please believe me, my life depends on it’: Physical health concerns of people diagnosed with mental illness]

It’s a big deal. About 60% of people who experience mental health problems experience chronic physical health problems too. Poor mental health is a major risk factor for poor physical health, and vice versa. [Source: Australia’s mental and physical health tracker 2018]

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

Questions for Reflection

Assuming that you – the person reading this blog post – is a nurse, midwife or other health professional, I have some questions I’d like you to reflect on.

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

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

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

End

Sincere thanks to Bec (aka @notesforreview on Twitter) for giving permission to share her tweets re mental health stigma and diagnostic overshadowing. Her first-hand account is a powerful cautionary tale.

Paul McNamara, 1st October 2018

Short URL meta4RN.com/shadoworiginal

Update as at 15th December 2018

Bec and I tidied-up this blog post and it’s now been published.

See meta4RN.com/shadow

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:

1.

More info re #SMACC (Social Media and Critical Care) here.
More info re #FOAMed (Free Open Access Meducation) here.
2.

3.

4.

5.

6.

7.

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.
9.

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.
10.

11.

12.

13.

14.

15.

URL to the How Much Do You Know? podcasts: eastsidefm.org/howmuchdoyouknow
16.

URL to Cairns Sexual Health Service: www.health.qld.gov.au/cairns_hinterland/html/shealth
17.

18.

19.

20.

21.

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.
22.

23.

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

Delirium Risks and Prevention

Tweets re the guest lecture by Prof Sharon Inouye at Royal Brisbane and Women’s Hospital (and Cairns via videolink) on 16th October 2017.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

Explanation

These Tweets were initially compiled using a social media aggregation tool called Storify https://storify.com/meta4RN/delirium-risks-and-prevention

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

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

Paul McNamara, 10th March 2018

Short URL: meta4RN.com/delirium

Social Media and Digital Citizenship: A CL Nurse’s Perspective

This post is a companion piece to my keynote presentation at the 5th Annual Queensland Consultation Liaison Psychiatry Symposium “Modern Approaches in CL Psychiatry”, on 2nd November 2017,

The function of this page is to be a collection point to list references/links that will be mentioned in the presentation. The Prezi is intended as an oral presentation, so I do not intend to include a full description of the content here.

Click on the picture to see the Prezi

Bio/Intro (you know speakers write these themselves, right?)

Paul McNamara is a CL CNC in Cairns.

Paul has been dabbling in health care social media since 2010. He established an online portfolio in 2012 which includes Twitter, Facebook, Instagram, YouTube and a Blog.

In 2016 Paul was appointed to the Editorial Board of the International Journal of Mental Health Nursing specifically because of his interest in social media.

This morning’s presentation “Social Media & Digital Citizenship: A CL Nurse’s Perspective” aims to encourage the converts, enthuse the curious, and empower the cautious.

Disclaimer/Apology/Excuse

Regular visitors to meta4RN.com will recognise some familiar themes.

Let’s not call it self-plagiarism (such an ugly term), I would rather think of it as a new, funky remix of a favourite old song.

Due to this remixing of old content I’ve included lots of previous meta4RN.com blog posts on the reference list.

This, in turn, makes the reference list look stupidly self-referential. #TrumpBrag

 

Anyway, with that embarrassing disclosure out of the way, here is the list of references and links cited in the Prezi prezi.com/user/meta4RN

References + Links

Altmetric Attention Score [example] https://wiley.altmetric.com/details/23964454

Australian College of Nursing (n.d.) Social media guidelines for nurses. Retreived from http://www.rcna.org.au/WCM/…for_nurses.pdf

Australian Health Practitioner Regulation Agency. (2014, March 17). Social media policy. Retrieved from http://www.ahpra.gov.au/News/2014-02-13-revised-guidelines-code-and-policy.aspx

Casella, E., Mills, J., & Usher, K. (2014). Social media and nursing practice: Changing the balance between the social and technical aspects of work. Collegian, 21(2), 121–126. doi:10.1016/j.colegn.2014.03.005

Facebook. (2015). Facebook logo. Retrieved from https://www.facebookbrand.com/

Ferguson, C., Inglis, S. C., Newton, P. J., Cripps, P. J. S., Macdonald, P. S., & Davidson, P. M. (2014).  Social media: A tool to spread information: A case study analysis of Twitter conversation at the Cardiac Society of Australia & New Zealand 61st Annual Scientific Meeting 2013. Collegian, 21(2), 89–93. doi:10.1016/j.colegn.2014.03.002

Fox, C.S., Bonaca, M.P., Ryan, J.J., Massaro, J.M., Barry, K. & Loscalzo, J. (2015). A randomized trial of social media from Circulation. Circulation. 131(1), pp 28-33

Gallagher, R., Psaroulis, T., Ferguson, C., Neubeck, L. & Gallagher, P. 2016, ‘Social media practices on Twitter: maximising the impact of cardiac associations’, British Journal of Cardiac Nursing, vol. 11, no. 10, pp. 481-487.

Instagram. (2015). Instagram logo. Retrieved from https://help.instagram.com/304689166306603

Li, C. (2015). Charlene Li photo. Retrieved from http://www.charleneli.com/about-charlene/reviewer-resources/

lifeinthefastlane. (2013). #FOAMed logo. Retrieved from http://lifeinthefastlane.com/foam/

My Tweets = my lecture notes. Other people’s Tweets also = my lecture notes. 🙂

McNamara, P. (2017, October 16) Delirium risks and prevention. Tweets re the guest lecture by Prof Sharon Inouye at Royal Brisbane and Women’s Hospital (and Cairns via videolink) collated on Storify. Retrieved from https://storify.com/meta4RN/delirium-risks-and-prevention

McNamara, P. (2016, November 18) Twitter is a Vector (my #ACIPC16 presentation). Retrieved from https://meta4RN.com/ACIPC16

McNamara, P. (2016, October 21) Why on earth would a Mental Health Nurse bother with Twitter? (my #ACMHN2016 presentation). Retrieved from https://meta4RN.com/ACMHN2016

McNamara, P. (2016, October 15) Learn about Obesity (and Twitter) via Nurses Tweeting at a Conference. Retrieved from  https://meta4RN.com/obesity

McNamara, P., & Meijome, X. M. (2015). Twitter Para Enfermeras (Spanish/Español). Retrieved 11 March 2015, from http://www.ausmed.com.au/es/twitter-para-enfermeras/

McNamara, P. (2014). A Nurse’s Guide to Twitter. Retrieved from http://www.ausmed.com.au/twitter-for-nurses/

McNamara, P. (2014, May 3) Luddites I have known. Retrieved from http://meta4RN.com/luddites

McNamara, P. (2013) Behave online as you would in real life (letter to the editor), TQN: The Queensland Nurse, June 2013, Volume 32, Number 3, Page 4.

McNamara, P. (2013, October 25) Professional use of Twitter and healthcare social media. Retrieved from http://meta4RN.com/NPD100

McNamara, P. (2013, October 23) A Twitter workshop in tweets. Retrieved from http://meta4RN.com/tweets

McNamara, P. (2013, October 1) Professional use of Twitter. Retrieved from http://meta4RN.com/poster

McNamara, P. (2013, July 21) Follow Friday and other twitterisms. Retrieved from http://meta4RN.com/FF

McNamara, P. (2013, June 29) Thinking health communication? Think mobile. Retrieved https://meta4RN.com/mobile

McNamara, P. (2013, June 7) Omnipresent and always available: A mental health nurse on Twitter. Retrieved from http://meta4RN.com/twit

McNamara, P. (2013, January 20) Social media for nurses: my ten-step, slightly ranty, version. Retrieved from http://meta4RN.com/rant1

Moorley, C., & Chinn, T. (2014). Using social media for continuous professional development. Journal of Advanced Nursing, 71(4), 713–717. doi:10.1111/jan.12504

Nickson, C. P., & Cadogan, M. D. (2014). Free Open Access Medical education (FOAM) for the emergency physician. Emergency Medicine Australasia, 26(1), 76–83. doi:10.1111/1742-6723.12191

Nursing and Midwifery Board of Australia (2010, September 9) Information sheet on social media. Retrieved from http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2F3224&dbid=AP&chksum=qhog9%2FUCgKdssFmA0XnBlA%3D%3D

Office of the eSafety Commisioner (2017). eSafety logo. Retrieved from https://www.esafety.gov.au

Read, J., Harper, D., Tucker, I. and Kennedy, A. (2017), Do adult mental health services identify child abuse and neglect? A systematic review. International Journal of Mental Health Nursing http://onlinelibrary.wiley.com/doi/10.1111/inm.12369/abstract

Screenshot 1 “Trump: Twitter helped me win but I’ll be ‘restrained’ now” from http://money.cnn.com/2016/11/12/media/donald-trump-twitter-60-minutes/

Screenshot 2: “Melania Trump rebukes her husband “all the time” for Twitter use” from http://www.cbsnews.com/news/donald-trump-melania-trump-60-minutes-interview-rebukes-twitter-use/

The Nurse Path (facebook) https://www.facebook.com/theNursePath

Tonia, T., Van Oyen, H., Berger, A., Schindler, C. & Künzli, N. (2016). International Journal of Public Health. 61(4), pp 513-520. doi:10.1007/s00038-016-0831-y

Twitter. (2015). Twitter logo. Retrieved from https://about.twitter.com/press/brand-assets

Wilson, R., Ranse, J., Cashin, A., & McNamara, P. (2014). Nurses and Twitter: The good, the bad, and the reluctant. Collegian, 21(2), 111–119. doi:10.1016/j.colegn.2013.09.003
https://www.sciencedirect.com/science/article/pii/S1322769613000905

Wozniak, H., Uys, P., & Mahoney, M. J. (2012). Digital communication in a networked world. In J. Higgs, R. Ajjawi, L. McAllister, F. Trede, & S. Loftus (Eds.), Communication in the health sciences (3rd ed., pp. 150–162). South Melbourne, Australia: Oxford University Press

End 

Finally, a big thank you to the organisers of the 5th Annual Consultation Liaison Psychiatry Symposium, especially Stacey Deaville for suggesting this session, and Dr Paul Pun for pulling on all the right strings.

That’s it. As always your comments are welcome.

Paul McNamara, 19th October 2017

Short URL: meta4RN.com/CLPS

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

Learn about Obesity (and Twitter) via Nurses Tweeting at a Conference

If you read this I guarantee that you will learn 4 things in 5 minutes:

  1. How obesity works
  2. How Twitter at a healthcare conference works
  3. How an aggregation tool like Storify can add value to Twitter content
  4. How nurses can be simultaneously generous, incisive and funny

 

Small sample of conference Tweets. Click to see the whole story

Small sample of conference Tweets. Click to see the whole story: https://storify.com/meta4RN/obesity-personal-or-social-responsibility

So What?

Sometimes I have trouble explaining to health professionals how Twitter works at conferences. It’s easier to show an example, rather than just chin-wagging and flapping-about like a chook in a cyclone. That’s why I have created this example: https://storify.com/meta4RN/obesity-personal-or-social-responsibility

Haven’t I Seen This Before?

Maybe. Back in 2013 this example was buried about halfway through a long blog post called #ICNAust2013: Looking Back at a Nursing Conference through a Social Media Lens, At time of writing this self plagiarising (yet again!) post, the original post has been read 578 times, and the Storify version has been viewed 595 times. You may be one of the lucky few to have seen it before. 🙂

Huh? I Don’t Get It.

Follow this link: https://storify.com/meta4RN/obesity-personal-or-social-responsibility, take 5 minutes to read through the collated Tweets, and then you’ll get it. Promise.

End

As always, you’re very welcome to leave feedback/suggestions/questions in the comments section below.

Paul McNamara, 15 October 2016

Short URL: https://meta4RN.com/obesity

 

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