Tag Archives: emotional intelligence

Snow White, Complex Trauma and Twitter

On Tuesday 4th December 2018 Naomi Halpern’s workshop “Working with Complex Trauma: The Snow White Model” was delivered at the Royal Brisbane and Women’s Hospital. I was amongst the small group of mental health nurses and social workers who joined the workshop via videoconference from Cairns Hospital. Here are my notes/tweets:

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What’s all this then?

Some people take notes in workshops using ye olde method of pen and paper. I’m not criticising – pen and paper are cute and quaint. But how on earth do they find their notes quickly and easily after the workshop has ended?.

I tweet my notes. They’re quickly and easily retrieved via phone, tablet or computer at anytime. Sometimes, if the presenter is OK with it, I collate workshop/conference tweets and plonk them all on my webpage for even quicker and easier future reference. That’s what this is all about.

Also, sometimes I have trouble explaining to other health professionals why I’m enthusiastic about Twitter for work-related stuff. It’s easier to show examples of how I use it, rather than just chin-wagging and flapping-about like a chook in a cyclone.

End

Sincere thanks to Naomi Halpern (aka @halpernnaomi1) for an engaging, informative workshop. For a single person to hold the attention and interest of those of us who were joining via videoconference for a whole day is very impressive. Also, I’m grateful to Naomi for agreeing to my request to collate these tweets here.

That’s it. As always, your feedback is welcome via the comments section below.

Paul McNamara, 8th December 2018

Short URL: meta4RN.com/SnowWhite

Diagnostic Overshadowing

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?

References

Happell, B. & Ewart, S. (2016). ‘Please believe me, my life depends on it’: Physical health concerns of people diagnosed with mental illness [online]. 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

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/shadow

Clinical Care and Clinical Supervision

On Monday 17th September 2018 I’ll be presenting to the Cairns & Hinterland HHS palliative care team regarding clinical care and clinical supervision. It is planned as an interactive session accompanied by visual cues to give the discussion a bit of structure. Consequently, the transcript/dialogue of the presentation can not be included here.  The visual presentation itself doesn’t use powerpoint slides. It uses the prettier (and free!) platform Prezi instead: http://prezi.com/gtsqjgs9zdby

This page serves as a one-stop directory to the online resources used to support the discussion, and as an easy way for me to find the presentation. 🙂

I’m recycling and combining a lot of old ideas for the session (there’s that self-plagiarist vs groovy remix of favourite old songs thing again), so this list below is ridiculously self-referential:

Care goes in. Crap goes out. Ian Miller @ The Nurse Path, 30 May 2017
thenursepath.blog/care-goes-in-crap-goes-out

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

First Thyself (the core source of info for the visual aspects of this presentation) meta4RN.com/thyself

Flowchart courtesy of Dr Alex Psirides (aka  on Twitter), ICU, Wellington, New Zealand, sourced here:

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

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

Joseph Heller quote from Catch-22 (1961):
“People knew a lot more about dying inside the hospital, and made a much neater, more orderly job of it. They couldn’t dominate Death inside the hospital, but they certainly made her behave. They had taught her manners. They couldn’t keep death out, but while she was in she had to act like a lady.”

Living Close to the Water (re #dyingtoknowday and emotional intelligence) meta4RN.com/water 

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

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

Sample Clinical Supervision Agreement (no need to reinvent the wheel – start with a wheel that works and tailor it to your needs) meta4RN.com/sample

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

End

That’s it. Please feel free to play with the pretty prezi: prezi.com/gtsqjgs9zdby

Also, as always, please feel free to leave comments in the section below.

Thanks for visiting.

Paul McNamara, 2nd September 2018

Short URL: meta4RN.com/care

 

Perinatal Mental Health Workshop Links + Resources 2018

When you’re doing education sessions, it’s handy to have the links/resources in one place. It makes info much easier to share.

This is a quick and dirty updated and cutdown version of a 2014 blog post called Perinatal Mental Health Workshop Links and Resources. Anyway, with no further ado:

Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline
It handy to know how to find the October 2017 guideline and companion documents
cope.org.au


Using the Edinburgh Postnatal Depression Scale

Tips for midwives, child health nurses, Indigenous health workers and other clinicians
meta4RN.com/epd

Perinatal Jargon Busting
If you haven’t already, get your head around the lingo, and maybe become Facebook friends with Perry Natal 🙂
meta4RN.com/jargon

Nurturing the Nurturers
Info about guided reflective practice/clinical supervision as a self-care mechanism for health professionals
meta4RN.com/nurturers

Nurses, Midwives, Medical Practitioners, Suicide and Stigma
This companion piece to “Nurturing the Nurturers” presents alarming data about the high suicide rate amongst nurses and midwives compared to other professions
meta4RN.com/stigma

Still Face Experiment
Edward Tronick’s demonstration of how infants respond to changes in interaction from primary caregivers is often cited in infant mental health education

Here’s Looking at You – Connecting with Bubs Our Way
This is a terrific video to use/share with parents-to-be or new parents.
The only people on screen and doing the talking are Aboriginal and Torres Strait Islanders, which makes a welcome change. 🙂

Circle of Security
The current “go to” model of attachment theory and affective neuroscience.
www.circleofsecurityinternational.com

Head to Health
Find the right Australian digital mental health resources for the family you’re working with (includes info sheets, websites, apps + helplines)
headtohealth.gov.au

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End

That’ll do for the quick and dirty 2018 version. You’re welcome to browse the more detailed 2014 version here, but be warned: there’s quite a few dud/dead links there now. 😦

You’re also very welcome to share this page, the resources above and/or leave a comment below.

Thanks for dropping-in.

Paul McNamara, 12 July 2018

Short URL: meta4RN.com/perinatal

Post Script

Whiteboard from the perinatal and infant mental health session with CQU Student Midwives on 13 July 2018

 

Diabetes and Emotional Health

This page is in support of an education session I’m doing at EXPOsing diabetes Cairns on Saturday 9th June 2018.

About

EXPOsing diabetes is a one-day educational event for people living with type 1 and 2 diabetes.

This event will equip you with the knowledge you need to live well with diabetes.

The day consists of interactive and engaging presentations from health professionals who work closely in the area of diabetes. You will come away from the day feeling more confident, motivated and more empowered to live well with your diabetes.
[Source: www.diabetesqld.org.au/get-involved/what’s-on/2018/june/exposing-diabetes-cairns.aspx]

Intro

Paul McNamara is a Fellow of the Australian College of Mental Health Nurses. He has been working in Cairns since 1995. Paul’s day job is providing mental health support and education to general hospital patients and staff.

Presentation

The presentation itself can be accessed via prezi.com/user/meta4RN or by clicking on the image below:


Key Messages, References + Further Info

The session is an oral presentation, so I don’t intend to replicate all of the content here.

Collated below are some of the key messages of the presentation, the references/evidence I’ve used, and how to access further info.

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“It’s a Fine Line” – Myth vs Reality meta4RN.com/fineline
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About 20% of us will experience mental health problems in any given year [source: 2007 National Survey of Mental Health and Wellbeing].

About 45% of us will experience mental health problems in our lifetime [source: 2007 National Survey of Mental Health and Wellbeing].

Up to half of us with diabetes will experience mental health problems in our lifetime [source: Diabetes Australia].

Anxiety and depression are the most common mental health problems [source: Mindframe].

Depression, anxiety and other mental problems are usually multifactorial. A good way to understand this is to consider the biopsychosocial model of mental health [source: Engel 1977].

Australia has introduced the idea of “stepped care” to respond to mental health matters [source: Northern Queensland Primary Health Network].

For information about prevention or early intervention with mental health problems, often the “best fit” will be online info via headtohealth.gov.au and/or via one of the apps available via the same website [source: Northern Queensland Primary Health Network].

If the online/app route doesn’t help, or if you’re experiencing symptoms of mental health difficulties, you should chat with your GP about it. S/he will discuss treatment and support options with you, which may include medication and/or referral to one of the local speciality services. It’s a good idea to book a longer appointment with your GP to discuss mental health stuff: neither you or your GP will want to feel rushed [source: Northern Queensland Primary Health Network].

If the above options haven’t helped, the mental health problem is complex, severe or urgent, it’s outside of business hours, and/or your questions would best be answered by a local specialist mental health professional, phone the Cairns Acute Care Team on 1300 64 2255 (1300 MH CALL) [source: Queensland Health].

End

Many thanks to Claire Massingham, Events Coordinator @ Diabetes Queensland for inviting me to present at EXPOsing diabetes Cairns. Thanks also to Endocrinologist Dr Luke Conway for making the suggestion to Claire.

A quick clarification: although this web page has info about how to access mental health support, it’s my personal web site. I can’t offer direct support or referrals from here. Please access further info and/or support via the options listed above.

That said, I welcome comments in the comments section below.

Thanks for visiting. 🙂

Paul McNamara, 2nd June 2018

Short URL: meta4RN.com/diabetes

 

 

 

#WeNurses Twitter Chat re Communication and Compassion

On 21st December 2012 (Cairns time) nurses from the United Kingdom and Australia came together on Twitter using the #WeNurses hashtag. The planned Twitter chat was used to discuss issues raised by the much-publicised death of a nursing colleague – Jacintha Saldanha.

This curated version of the Twitter chat demonstrates nurses using social media in a constructive manner, and responding to the issues surrounding Jacintha’s passing with thoughtfulness and grace. This was in sharp contrast to the shrill, insensitive and ill-informed way the matter was discussed elsewhere on social media and in mainstream media in the UK and Australia.

I’ve used sub-headings in red to structure the chat as per the themes that emerged.

WordCloud created from the full transcript of the #WeNurses Twitter chat

Preliminary Information.
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Introductions.
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Setting The Tone.
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Communication and Confidentiality.
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Social Media.
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Individualising Communication & Confidentiality.
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WiFi for Hospital Patients.
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Compassion.
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Prank Call.
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Targeted Crisis Support.
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Clinical Supervision (aka Peer Supervision, aka Guided Reflective Practice).
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Supportive Workplaces.
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Preventative/Early-Intervention Resources.
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The 6Cs (Care, Compassion, Competence, Communication, Courage & Commitment).
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Integrating Defusing Emotions into Clinical Practice.
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Farewells.
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Explanation

These Tweets were initially compiled using a social media aggregation tool called Storify
storify.com/meta4RN/communication-and-compassion

Unfortunately, Storify is shutting-down on 16 May 2018 and all content will be deleted.

I’m using my blog as a place to mimic/save the Storify pages I created and value.

End Notes

This archive of Tweets relate directly to two blog posts I wrote at the time. If you’re interested in elaboration re the context at the time, please visit these pages:
Questions of Compassion meta4RN.com/questions-of-compassion
WeNurses: Communication and Compassion meta4RN.com/WeNurses

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

Paul McNamara, 3rd April 2018

Short URL: meta4RN.com/Chat

My White Privilege

As far as I know it started with Cory Bernardi. On 31 January 2018 Cory wrote these two untruths, amongst others:
1. “The nursing and midwifery board, from 1 March this year, will insist their members acknowledge “white privilege” on demand.”
and
2. “Nurses must acknowledge white privilege and voice this acknowledgment [sic] if asked – which is compelled speech.” Source www.corybernardi.com/nursing_bruised_egos

Neither of these statements are remotely true.

When Cory and his political party repeatedly Tweeted the lie, I was really irritated that nurses were being intentionally misrepresented by non-nurses, and responded:

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Please do not trust me because I’m a nurse.
Please do not mistrust Cory because he’s a politician.
Please read the actual policy yourself.
Read it and make up your own mind. The relevant section is a one-pager:

Nursing and Midwifery Board of Australia (01/03/18) Code of conduct for nurses, via http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

See how it says nothing at all about white privilege? You’d think that would be the end of the story. But no.

A few weeks later another non-nurse started trotting out the same nonsense as Cory Bernardi. This time it’s a bloke called Graeme Haycroft chatting to Peta Credlin on SkyNews. Graeme was on TV representing an organisation called Nurses Professional Association of Queensland (NPAQ). He acknowledged that his organisation was the only one that was fighting the new code of conduct, and that the Australian Health Practitioners Registration Authority and all the mainstream nursing unions have agreed to it. Graeme also acknowledged that he was quoting from the glossary of the code, not the code itself. Nevertheless Graeme and Peta broadcast the lie that nurses and midwives would need to stop and discuss their white privilege with their Aboriginal and Torres Strait Islander patients, before providing any clinical care [source].

Doesn’t that sound unbelievable?

Well, that’s because it is.

Don’t trust me because I’m a nurse.
Don’t mistrust Graeme because he’s setting-up a business.
Read the actual policy yourself.

NPAQ describes itself as an alternative to the Queensland Nurses and Midwives Union, which is the Queensland branch of Australia’s largest union: the Australian Nursing and Midwifery Federation. At the end of the SkyNews segment it becomes clear what Graeme’s interest in this matter is. Remember, he’s not a nurse. He’s described as the founder of NPAQ. Graeme makes it very clear that he’s making a pitch for more members to join NPAQ instead of the union. It’s just that he’s misrepresenting the truth to do so. The little rascal.

OK, got it.

Graeme needs a lever to make his business work. That’s probably all we need to know about him and NPAQ.

But the lie is a contagion. The media is its vector.

The lie was spread on South Australia’s Today Tonight, it pops-up in news.com.au and affiliates  some UK papers, and via a Melbourne political blogger & illustrator who explained her understanding thus: “…nursing staff are required to acknowledge white privilege using dialogue & communication.”

Aha! Now I see the problem!
Yoda they are reading like.
Backwards talking are they.
Twisted are the words being.

The actual excerpt from the glossary (that is: the glossary, not the policy) reads “…cultural safety provides a de-colonising model of practice based on dialogue, communication, power sharing and negotiation, and the acknowledgment of white privilege.” Turning the words around backwards creates a slightly different meaning. That’s what Cory, Graeme and Peta have done. The little rascals.

Look, these people have pretty good language skills. I don’t think they’re stupid. I don’t think they’re making an naive error. I think their actions are intentional. I think they are intentionally misrepresenting a single phrase in the glossary as a policy instruction. I think they’re being loose with the truth. I reckon they’re as dodgy as.

Even if they not dodgy, they’re the wrong people to be commenting.

Cory Bernadi is not a nurse.
Graeme Haycroft is not a nurse.
Peta Credlin is not a nurse.
The various journalists who repeated the lie are not nurses.

Yet each of them have taken it upon themselves to speak on behalf of nurses and about nursing policies that nurses were consulted and collaborated on.

It’s infuriating!

I’ve been muttering into my iPad thinking/saying things like, “Keep your uninvited uninformed opinions to yourselves you irritating bunch of arseclowns!”

And that’s when the penny dropped.

That’s when I realised that Cory, Graeme, Peta and the journos were giving me a lesson in white privilege.

I was getting angry that these people dared to speak on my behalf, on my area of experience and expertise, without consulting with me or others from my nursing background.

How dare they?

It’s as if they don’t respect nurses. It’s as if they don’t really understand nurses, the nursing world view, our nursing political systems or our nursing culture.

I’m not used to shabby treatment like that. White blokes like me with a steady job don’t get much practise in being patronised, belittled or having our opinions hijacked in the mainstream media.

The mainstream media is much more likely to misrepresent Aboriginal and Torres Strait people (looking at you Sunrise). They’re not alone: refugees, Africans, Muslims and Asians cop their fair bit of flack too (looking at you Pauline Hanson). It goes further: women who dress too slutty or not sexily enough, or are too skinny, too fat, too bossy, or too opinionated will also cop it in the media – especially if they have one of those race or religion things going on as well.

But not me. I’m a white employed male. I don’t usually cop that crap.

What Cory, Graeme and Peta have done is they’ve given me a small taste of what it’s like to have your self-identity misappropriated and misrepresented. They’ve shown me what it’s like when non-nurses assume the voice of nurses. These three, and others, talking about- and over- nurses gives me a small taste of how disempowering and degrading it would be to have that happen all the time.

The discredited rants of Cory, Graeme and Peta will be a brief flash-in-a-pan, and I probably didn’t need to get angry. However, they have helped me to reflect. It has given me a small insight into how it must be a nagging irritation for those who often have their identities misappropriated and misrepresented.

I acknowledge that I have privileges as a white employed man. I don’t take those privileges for granted, and am grateful for my good fortune. #countingmyblessings

Although Cory, Graeme and Peta have amplified my insight, I don’t intend to thank them. I still think they’re as dodgy as.

 

Addit

NPAQ are trying a fear argument now (see Twitter). It needs rebuttal.

I was introduced to this definition of cultural safety as a student nurse (1988-1991). It’s a good fit for nursing. It’s a humble, nurturing mindset. Nurses understand that pain, nausea, kindness and cultural safety are all subjective patient experiences.

Wait. There’s more.

There are better credentialed and more articulate responses to this matter than mine,

Recommended references/readings include:

  1. Tara Nipe (25/03/18) On the matter of privilege (this is the blog that I wish I wrote: it’s much clearer and more succinct than mine)
  2. Joint statement by the Australian Nursing and Midwifery Federation, the Australian College of Nursing, the Australian College of Midwives and the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (23/03/18) Cultural safety: Nurses and midwives leading the way for safer healthcare 
  3. Ruth DeSouza via Melissa Sweet/croakey (26/03/18) Busting five myths about cultural safety – please take note, Sky News et al 
  4. Janine Mohamed, CEO @CATSINaM (24/03/18) Cultural safety matters – the conversation we need to keep having
  5. Media Watch (26/03/18) White privilege outrage
  6. Luke Pearson (24/03/18) The truth behind the Nursing Code of Conduct lie
  7. Sarah Stewart (29/03/18) Fake news and lies! Nurses, midwives and white privilege 

End

Thanks for reading.

As always your comments are welcomed in the section below.

Paul McNamara, 28 March 2013

Short URL: meta4RN.com/white

+update on 29/03/18 re typos + references/recommended reading

+update on 30/03/16 as rebuttal to NPAQ