Tag Archives: emotional intelligence

Voluntary Assisted Dying (a nurse’s open letter to their state member of parliament)

Dear Michael Healy MP

Thank you for being my local member to the Queensland parliament. I am not in the habit of writing to politicians, but feel compelled to do so on the matter of voluntary assisted dying. 

It is important to acknowledge the Premier’s advice that the matter be debated respectfully, it is a matter above politics, and that all members of the Queensland parliament will have a conscience vote. 

If you have already made a firm decision on how you will vote regarding Queenslanders having a choice to access voluntary assisted dying I do not expect to change your mind. 

If you have not made a firm decision I am hoping to leverage my experience and credibility as a Registered Nurse to influence you to vote in favour of the voluntary assisted dying laws.

My Context

I do not talk about death every day at work, but I can’t remember the last time a week at work passed without it being part of my conversation with patients and colleagues. Death is a part of life. Not the best part, but an inevitable part. Despite the social conventions to the contrary, it’s good to talk about death. 

Most of the patients I speak with have multiple comorbidities. The conversations I have with these people nearly always focus on quality of life, not quantity. The things they dread most tend to be loss of dignity, pain, and loss of control.

When these people say they would rather be dead than suffer unnecessarily I tell them that I understand and, if Queensland laws allowed, would be happy to support them in their choices. 

This stance is in keeping with the position statement of Australia’s largest trade union: the Australian Nursing & Midwifery Federation. 

I understand that there is some opposition to Queensland introducing voluntary assisted dying laws similar to those passed in Victoria, Tasmania, South Australia, Western Australia, the Netherlands, Belgium, Switzerland, Canada, New Zealand, Luxembourg, Colombia and some states in the USA. I would like to address some of these concerns below.

The Catholic Context

I see from your parliament profile that you identify as Catholic. I used to too.

I’m guessing, like me, it was a religion you were born in to. That’s the way religions work. There is not a high percentage of Lutherans in India. There is not a high percentage of Hindus in Germany. In the last couple of hundred years there have been lots of white Catholics who have arrived or been born in Australia. That’s an outcome of colonialism, not faith or truth.

It’s an accident that you and I were born into Australian Catholic families. It’s a choice on whether, as adults, you and I continue to subscribe to Catholic doctrines.

As the Archbishop of Brisbane, Mark Coleridge, said in February 2019, “I think we have to accept that our [the Catholic Church’s] moral authority and general credibility has been massively damaged.” I concur with the Archbishop.

Just as the Catholic church backed the wrong horse when they covered-up priests raping children, they’re backing the wrong horse when they say that competent adults who are within weeks or months of inevitable death can not decide to leave life in a way and a manner of their own choosing. The Catholic Church has form: in my lifetome they backed the wrong horse when it came to access to birth control, access to termination of pregnancy, and access to same sex marriage. You’d think a church with a congregation that has a reputation for gambling would be better at backing the right horse, wouldn’t you?

The AMA Context

The Autralian Medical Association is often the loudest doctor voice in Australia. Like the Victorian branch before it, the Queensland branch opposes voluntary assisted dying, but if the law is passed they want to be in charge of it. No, really, read the third paragraph here for yourself – it’s hilarious:

“The AMA’s position is that doctors should not be involved in interventions that are intended to end a person’s life but, if the government decides to legalise Voluntary Assisted Dying, the medical profession must be involved in developing legislation, regulations and guidelines which protect doctors, vulnerable patients and the health system as a whole.”

The Queensland AMA surveyed more than 1250 members. An overwhelming majority supported voluntary assisted dying, but the AMA Queensland President Professor Chris Perry said the survey was not a referendum on VAD.

Please do not rely on the AMA as the voice of doctors, please also be infomed by Doctors for Assisted Dying Choice.

I see from a recent speech of yours that you have a mate who is a surgeon. It would be worthwhile checking-in with your mate to see what they would think about operating on a patient who is terminally ill. My guess is that they’ll think it’s only a good idea if it improves quality of life.

Nearly every doctor I work with would support a competent adult to make their own informed treatment decisions, whether they agreed with the decision or not. That is the ptofessional, pragmatic and compassionate thing to do. That existing framework can accomodate patients who wish to discuss or access voluntary assisted dying.

The Nurse Context

Nurses are often excluded from public conversations about health matters, despite being the majority of the health workforce (344,941 of 625,228 using 2019 data, ie: nurses and midwives compromise over 55% of the clinical workforce).

This exclusion from the public conversation is even more surprising when we consider who the public trust. Australians have rated Nurses highest for ethics and honesty for 24 consecutive surveys (1994 to 2021).
Higher than doctors.
Higher than ministers of religion.
Higher than members of parliament.

Data Source: Roy Morgan Image of Professions Survey 2021. Finding No. 8691. Country: Australia. Available via http://www.roymorgan.com

So, what do nurses think about voluntary assisted dying?

“We support legislative reform so that competent adults who have an incurable physical illness that creates unbearable suffering shall have the right to choose to die at a time and in a manner acceptable to them and shall not be compelled to suffer beyond their wishes.” Australian Nursing Midwifery Federation (ANMF) (November 2019) Voluntary assisted dying position statement, page 2, no. 14 [PDF].

Naturally, as is the case with termination of pregnancy, the proposed framework entitles nurses and other clinicians who oppose voluntary assisted dying to decline participation. See 14.96 in Queensland Law Reform Commission (May 2021) A legal framework for voluntary assisted dying [PDF].

Nevertheless, this provision has not stopped some nurses speaking out stridently, eg: “Voluntary Assisted Dying is simply a euphemism for assisted suicide, or what Adolf Hitler called mercy killing.” Margaret Gilbert, Treasurer, Nurses’ Professional Association of Queensland (NPAQ), The Courier-Mail, March 23, 2021. Open access version here. This comment should be read in conjunction with Godwin’s Law. As with the Catholic church, it should be noted in NPAQ has form: in 2019 they advocated for paramilitary forces to be installed in hospitals instead of security guards, and in 2018 were aligned with the opinions of Cory Bernadi and Peta Credlin when they misinterpreted cultural safety with an obligation for white nurses to apologise to each of their Aboriginal and Torres Strait Islanders. The NPAQ does not represent the majority of nurses in Queensland, the Queensland Nurses and Midwives Union (QNMU) does.

In February 2021 the QNMU (the Queensland branch of the ANMF) asked members if they support in principal the legalisation of voluntary assisted dying in Queensland. Approximately 87% of respondents said ‘yes’. QNMU (10 June 2021) News.

Nurses have the unique role of caring for the person in life and in the first few hours of death. Nurses are at the bedside 24 hours a day, 7 days a week. Other professionals flit in and out, but nurses are the ones on the floor. We see life and death up-close and personal.

As Joseph Heller said in his classic 1961 novel Catch-22: “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.”

Heller was only half right. When we can, nurses make death act like a lady, but there are times when death is beyond the control of nurses and the rest of the clinical team. Sometimes death acts like the cruelest sadist you can imagine. Many nurses, like me, would have heard patients with a terminal illness say words to the effect of, “Please help me die. You wouldn’t let a dog suffer like this.”

There is no empathy in denying the patient relief in those circumstances.

It is only an outdated law that prevents us helping these patients.

It is only our parliamentarians who can change the legislation to be more humane. That’s where you come in Mr Healy.

End Notes

Sorry for publishing my letter online. Doing so is a bit shouty. However, the opponents of voluntary assisted dying (eg: the Catholic Church, the AMA, and NPAQ) have argued their case online. In 2021 online = the village square. This is too important an issue to ceed the village square to those who seek to control the life choices of others.

I do not seek to impose my beliefs on others, I only wish that people with a terminal illness have a choice. Whether people access voluntary assisted dying or not is none of my business. I would like to support them no matter their decision.

You can probably tell by the tacky website that I am not representing any organisation, and these opinions are my own. For elaboration on this division between employee and professional, please see number 13 on my 2012 introduction to this website: meta4RN.com/about.

Do you want to send your local Queensland MP an email on this topic? This link via Dying with Dignity Queensland will help you find the right person/email address, and – if required – give some tips

You are welcome to leave feedback via the comments section below.

Paul McNamara, 2 July 2021

Short URL meta4RN.com/VAD

Addit 3 July 2021

A postscript:
Michael Healy gave a very thoughtful and encouraging response to this open letter on his Facebook page. It’s worth reading: www.facebook.com/healycairns
Thank you Michael.

Mental Health in the General Hospital (video version)

A couple of weeks ago I was an invited speaker at the ANMF Vic Branch & NMHP Wellness Conference. The session was titled “Mental Health in the General Hospital”. Regular visitors to the meta4RN.com blog would have seen the accompanying web page to the presentation (here it is: meta4RN.com/ANMFvic).

This week the recording of the conference became available. I’ve snipped my session into a YouTube video and saved it here so it’s easy to find and share with those who have expressed an interest in seeing it (thanks Mum 🙂).

For reasons I don’t understand the video version of the presentation is blighted by a couple of static black boxes; these are not visible at all when viewing the actual Prezi. Mysterious. 🤷‍♂️

My noggin is a bit blurred/asynchronous when on screen – that would be due to the NBN being slowed to a crawl by copper wire, I guess. Fibre to the node, eh? 🙄

Those couple of things aside, it’s interesting (for me) to see the video version back. Yes, it’s a bit embarrassing, but it also shows me the sort of things I should try to improve for future presentations. Less face-touching, for instance. 😕 

Still image from the video. L-R: Eduardo D’Bull, Stone Woman by Ruth Malloch, Paul McNamara and Bessie D’Cow.

End

That’s it. No need to ramble any further – this blog post is all about the video (feat. Eduardo D’Bull and Bessie D’Cow). 📺 🐮 🐄

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

Paul McNamara, 29 May 2021 

Short URL meta4RN.com/vid

Mental Health in the General Hospital

On Friday 7 May 2021 I’ll be presenting at the ANMF Vic Branch & NMHP Wellness Conference. My session is tilted “Mental Health in the General Hospital”, and is followed by a session by Magda Szubanski!

I’m not making a fuss about presenting back-to-back with one of Australia’s most loved actors, although I may have mentioned it on Twitter…

and Facebook www.facebook.com

and Instagram www.instagram.com

and LinkedIn www.linkedin.com

But otherwise, I hardly it mentioned it all. 🙂

Anyway, this page is a place to link to the Prezi and the presentation content for the session. Because the presentation draws heavily on previous work I’ve done, the reference list is ridiculously self-referential.

Prezi https://prezi.com/p/mk9smhldjhnx/mental-health-in-the-general-hospital/

CLPS Nurses (WTF?)

A random sample of journal articles by/about Nurses working in an Australia Consultation Liaison Psychiatric Service (not pretending/trying to be an exhaustive list).

Dawber, C. (2013), Reflective Practice Groups for Nurses. International Journal of Mental Health Nursing, 22: 135-144. https://doi.org/10.1111/j.1447-0349.2012.00839.x

Harvey, S.T., Fisher, L.J. and Green, V.M. (2012), Evaluating the clinical efficacy of a primary care‐focused, nurse‐led, consultation liaison model for perinatal mental health. International Journal of Mental Health Nursing, 21: 75-81. https://doi.org/10.1111/j.1447-0349.2011.00766.x

McMaster, R., Jammali‐Blasi, A., Andersson‐Noorgard, K., Cooper, K. and McInnes, E. (2013), Research involvement, support needs, and factors affecting research participation: A survey of Mental Health Consultation Liaison Nurses. International Journal of Mental Health Nursing, 22: 154-161. https://doi.org/10.1111/j.1447-0349.2012.00857.x

McNamara, P., Bryant, J., Forster, J., Sharrock, J. and Happell, B. (2008), Exploratory study of mental health consultation‐liaison nursing in Australia: Part 2 preparation, support and role satisfaction. International Journal of Mental Health Nursing, 17: 189-196. https://doi.org/10.1111/j.1447-0349.2008.00531.x

Sharrock, J., Grigg, M., Happell, B., Keeble‐Devlin, B. and Jennings, S. (2006), The mental health nurse: A valuable addition to the consultation‐liaison team. International Journal of Mental Health Nursing, 15: 35-43. https://doi.org/10.1111/j.1447-0349.2006.00393.x

Sharrock, J. and Happell, B. (2002), The psychiatric consultation‐liaison nurse: Thriving in a general hospital setting. International Journal of Mental Health Nursing, 11: 24-33. https://doi.org/10.1046/j.1440-0979.2002.00205.x

Wand, T., Collett, G., Cutten, A., Buchanan‐Hagen, S., Stack, A. and White, K. (2020), Patient and clinician experiences with an emergency department‐based mental health liaison nurse service in a metropolitan setting. International Journal of Mental Health Nursing, 29: 1202-1217. https://doi.org/10.1111/inm.12760

“The 7 D’s”
Dementia
Delirium
Depression
Deliberate self-harm
Disturbed behaviour
Dangerous Diets
Dodgy drugs

McNamara, P. (2014) A mental health nurse in the general hospital, blog post published by ‘My Health Career’ on 12/05/14, retrieved 03/05/21 www.myhealthcareer.com.au

Other resources re CLPS Nurses in Australia

Top Tips for CL Nurses (PDF)

Australian College of Mental Health Nurses Consultation Liaison Special Interest Group (aka ACMHN CL SIG) acmhn.org/home-clsig

Pivot (verb)

A word that is more palatable than “change”, “adapt” and “survive”; came in to common use during the early days of the COVID-19 pandemic.

Distracted-boyfriend meme
– background/history wikipedia.org/wiki/Distracted-boyfriend_meme
– generator imgflip.com/memegenerator/Distracted-Boyfriend

The Other PPE

McNamara, P. (2020) Positive Practice Environment (the other PPE), blog post written 01/04/20, retrieved 03/05/21 meta4RN.com/PPE

Clean Hands. Clear Head.

McNamara, P. (2020) Clean Hands. Clear Head., blog post written 25/03/20 with an update on 08/12/20, retrieved 03/05/21 meta4RN.com/head

End Notes

Many thanks to Nursing and Midwifery Health Program Victoria and Australian Nursing & Midwifery Federation – Victorian Branch for inviting me to present.

Thanks to QR Code Monkey for providing a free, easy-to-use, QR code generator that allows for a logo to be inserted.

Something that pandemic has provided is ubiquitous uptake of QR codes, which makes this 2012 idea of deploying complex health information via a QR code more practical/relevant than ever. More info on this via the video below and/or ye olde blog post: meta4RN.com/QRcode

Thanks for visiting. As alway, feedback is welcome via the comments section below.

Paul McNamara, 3 May 2021

Short URL meta4RN.com/ANMFvic

Responding to Trauma

One of the things I use my blog for is as a “parking spot” for inservice presentations and the references used.

This is one of those blog posts.

Here’s the prezi:

Here are the references:

Australian Red Cross & Australian Psychological Society (2020). Psychological first aid: Supporting people affected by disaster in Australia.  3rd Edition.  www.redcross.org.au

Hildegard Peplau quote was completely made-up, but (to my mind, at least) it sums-up the vibe of Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing (1952) :
“The relationship is the therapy.”
NB: as far as I know, this not a Peplau quote, but [thanks Google] I see that it has been attributed to M. Kahn (1997). Between therapist and client: The new relationship 

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.”

Hurley, J. & Linsley, Paul. (2012). Emotional intelligence in health and social care: A guide for improving human relationships. Routledge.

Mental Health Coordinating Council (2013). Trauma-Informed Care and Practice:
Towards a cultural shift in policy reform across mental health and human services in
Australia, A National Strategic Direction, Position Paper and Recommendations of the
National Trauma-Informed Care and Practice Advisory Working Group, Authors: Bateman, J
& Henderson, C (MHCC) Kezelman, C (Adults Surviving Child Abuse, ASCA)

Tim Winton quote from Cloudstreet (1991):
““Life was something you didn’t argue with, because when it came down to it, whether you barracked for God or nothing at all, life was all there was. And death.”

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

One more thing

In doing this session previously it has popped-up that it can be distressing being unable to contact relatives from a blocked/private phone number. Here’s a tip:

From: Paul McNamara
Sent: Wednesday, 9 December 2020 17:00 PM
To: 0412345678@smsmessages.health.qld.gov.au
Subject: To send an SMS via QHealth email type your message in the subject space and send using the mobilephonenumber@smsmessages.health.qld.gov.au format. Also, you can copy & paste the message into ieMR, as I’ve done here.

More info on this theme @ Thinking Health Communication? Think Mobile. meta4RN.com/mobile

End

That’s it. As always you’re welcome to leave feedback via the comments section below.

Paul McNamara, 9 December 2020

Short URL: meta4RN.com/trauma

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

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

Part 4. An update for the 2021 version

The updated Prezi is here:

There’s an update to the reference list too:

Chen, R., Sun, C., Chen, J.‐J., Jen, H.‐J., Kang, X.L., Kao, C.‐C. & Chou, K.‐R. (2020), A Large‐Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID‐19 Pandemic. International Journal of Mental Health Nursing. doi.org/10.1111/inm.12796

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, with an update on 8 December 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.

Protecting Nurses and Patients

Q: What do wearing gloves, using lifting machines, legislating ratios and clinical supervision have in common?

A: They’re all measures that protect nurses and their patients. 

Gloves

Back in ye olde days when I started nursing (the 1980s) the concept of “universal precautions” was introduced (source). In short, suddenly all body fluids were to be treated as potentially infectious. It didn’t matter if you arrived in hospital as a needle-sharing, sexually promiscuous, pus-and-rash stricken bleeding wreck, or a saintly and demure sex, drug and rock-and-roll avoidant 80 year old nun, we treated your body fluids the same. Amongst the changes this heralded was that gloves were to be worn whenever there was a risk of coming into contact with body fluids. It was a new way of working for older nurses and doctors. For newbies it was just standard practice: so much so, that in the mid 1990s the term “universal precautions” was replaced by “standard precautions” in Australia (source). 

My first (short lived, temporary) job as a RN was in a nursing home. I had to argue for gloves to be made readily available for the AINs, ENs and RNs. The initial response was along the lines of: [1] using disposable gloves for every encounter with body fluids will be expensive, [2] nurses can wash their hands if they come into contact with urine or faeces, and [3] do you REALLY think that any of these elderly people have been sharing needles or having unprotected anal sex to contract HIV? They came around, but at first the management just did not understand that universal/standard precautions were not just a nuisance cost, but actually an investment in protecting staff and residents/patients.

Lifting

When I was a student nurse I was often made to feel very warm and fuzzy inside. Not because of my sparkling wit and ruggedly handsome looks (🙄), not because of my enthusiastic and self-motivated approach to work, not because of my knowledge or skill, but because I was able to lift people easier than some of my more petite colleagues. Big boofy blokey nurses were handy to have around when patients need to hoisted up a bed, onto a barouche, or transferred between bed and chair. 

In the hospital I trained in there were a few lifting machines. The way I remember* it, there were about 3 of them for a 900 bed hospital. So, I was a bit incredulous when I first heard of a “No Lift Policy” in the mid-1990s. “As if!”, I thought, “It will be too slow and too expensive to be practical. It’ll never happen.” Anyway, I was wrong. The No Lift Policy was implemented, and has since been renamed and reframed as Safe Patient Handling. The change has been endorsed by employers and the nurses’ union alike. Nurses of my age/era often have back pain, but younger/newer nurses are now better protected. The purchase of safe patient handling equipment and expense of training is not just a nuisance cost, but actually an investment in protecting staff and patients.

Nurses who were students in the 1980s (ie: pre-No Lift Policy)

Ratios

When I was a student nurse it would be usual to be allocated 6-8 patients on either a morning or afternoon shift, and up to 16ish on night shift. On a ward of over 30 patients in a surgical or medical ward in a large acute hospital, it was pretty standard for one RN and 2 student nurses to run the whole thing overnight. #scarynostalgia 

In Australia the states of Victoria and Queensland have legislated nurse:patient ratios. Since July 2016 Queensland nurse:patient ratios have been credited with avoiding 145 deaths, 255 readmissions, and 29 200 hospital bed-days. Amazingly, ratios have been evaluated to save up to $81 million (source). Implementing ratios to stop nurses from burning-out over workloads and to improve quality of care is not just a nuisance cost, but actually an investment in protecting staff and patients.

Clinical Supervision 

In April 2019 a joint position statement was issued by the Australian College of Nursing, the Australian College of Mental Health Nurses and the Australian College of Midwives that Clinical Supervision is recommended for all nurses and midwives irrespective of their specific role, area of practice and years of experience (source). 

As articulated in the joint statement, there is consistent evidence that effective clinical supervision impacts positively on professional development, and retention of a healthy and sustainable workforce. There is also evidence that clinical supervision of health-care staff impacts positively on outcomes for service-users.

I expect to be still working full time in 5 years time, but not in 10. I hope that by the time I pull-up stumps clinical supervision becomes embedded in nursing practice. Clinical supervision is not just a nuisance cost, but actually an investment in protecting staff and patients. 

End Notes

*not a reliable source: I have the memory of a stoned goldfish

Thanks for reading this far. As always, feedback is welcomed via the comments section below.

Thanks to Stella Green for giving permission to share our nearly-funny SMS.

Paul McNamara, 31 August 2019

Short URL meta4RN.com/protect

Thanks

This three-part blog post is in praise of Australian football and saying thanks.

AFLW Grand Final, Adelaide Oval, 31/03/2019. Photo by Bernie McNamara.

1. Responding to Compliments with Thanks.

Once upon a time I played a good game of footy. I was playing for my employer at the time, Dairy Vale, in a social match against dairy industry rival Golden North in Clare. My workmate and old school friend John Nolan was our ruckman – he was great at it. John spent all day tapping the ball down to the spot that I was running into. Consequently, I had the ball on the run a lot, which allowed me the time and space to amass a heap of kicks. I even kicked a goal on the run from a centre clearance. It’s the best game of footy I’ve ever played.

The game ended. Dairy Vale had won. The teams were walking off the ground. A friend (Michael Forde) approached and said something like, “Good game Mac. B.O.G.” I brushed the comment off. Nobody likes a bragger. Unexpectedly, Michael responded with a bit of irritation in his voice, saying something like, “When somebody gives you a compliment it’s good manners to say ‘thank you’.” I was a bit taken aback, and responded eloquently, “Umm. Yeah. Umm. Right. Sorry. Umm. Thanks.”

Anyway, Michael was right of course. To him it might have been a throw-away comment on a footy oval. To me it was a valuable life lesson. We were both about 20 years old at the time. I don’t know how Michael was so wise at that age, but it was something I remembered and practiced. Saying, ‘thank you’ to compliments, that is.

2. Self Esteem

Fast-forward 10+ years after playing that game of footy, and I have started work as a mental health nurse. At Glenside Hospital senior nursing staff encouraged junior nursing staff (as I was at the time) to facilitate group discussions and activities. I was asked to facilitate a group about self esteem. It went really well.

I told the John Nolan/Michael Forde story. Then we practiced giving and accepting compliments. Of course, saying ‘thank you’ is just the start; especially if you actually feel really shitty about yourself. So we started slow with shallow superficial stuff (haircuts, tans, shirts etc). That served as a practice run for more meaningful compliments. We took turns saying, “One of the things I really like/admire about you is…”, with the person receiving the compliment practicing saying ‘thank you’ without adding a disclaimer or self-depreciating comment. That can be really hard for some of us. Not everyone has accumulated the habit of saying ‘thanks’ as a way to acknowledge and accept a compliment.

We finished the session with our group of 2 mental health nurses and about 10 inpatient mental health consumers going out to the Glenside Hospital football oval (it used to be about here, I think). While there we learned and practiced a skill that none of us felt at all confident in: kicking a checkside goal. It took us all quite a few goes to get it right, but all of us in the group eventually kicked three checkside goals (three to prove that the first one wasn’t a fluke). We left the oval as happy, chatty, cohesive and confident as any winning sport team. It was a great session.

3. Giving Thanks.

In my current role I don’t do group work, but I still speak to people about their self-esteem, and occasionally find myself trotting-out the John Nolan/Michael Forde story. In mental health nurse parlance sharing life experience/stories like this is called ‘therapeutic use of self’. Even though I haven’t seen Michael or John for over 20 years, they’re part of my story, part of my self. I’m very grateful for my family and friends, past and present.

The other thing is the Adelaide Crows won the AFLW Grand Final today! They played a fantastic brand of team football in front of 53,034 people. It was a terrific, well-deserved win. Back in 2012 when the meta4RN blog started, in the About section I claimed that the blog would comment on how watching Adelaide play in the AFL can inform nursing clinical practice. The Adelaide Crow’s Grand Final winning Registered Nurse Deni Varnhagen has done a better job of telling that story than me:
 

.

Sincere congratulations to Deni and all the other Adelaide AFLW players. You’re a terrific team to watch, and have bought many people a lot of joy in the 2019 AFLW season. Thanks!

End

That’s it. As always please feel free to use the comments section below.

Paul McNamara, 31 March 2019

Short URL meta4RN.com/thanks