Tag Archives: mental health

Blatant Self-Promotion

Ever written an article about yourself as an act of blatant self promotion?

I have. Here it is:

ijmhn-photo

Paul McNamara, photograph by Vera Fitzgerald

Cairns Nurse on Journal Editorial Board

Cairns CNC Paul McNamara has recently been appointed to the editorial board of the International Journal of Mental Health Nursing (IJMHN). IJMHN is now in its 26th volume, and has built a solid reputation over the last quarter century. The journal’s impact factor of 1.943 is a great achievement.

Paul was specifically invited to join the board to help develop and drive a social media strategy for IJMHN. “I’ve been very active in using social media in a professional sense for the last few years, and have presented at conferences and published about health professionals using social media.”, says Paul. “I guess that’s what caught the attention of the IJMHN Editor in Chief.”

“Twitter is my favourite platform for work-related social media. I think it will be the best fit for IJMHN. Twitter allows information to be shared with the whole world. If it’s good enough for the Pope, the US President and the Australian Prime Minister, maybe it’s good enough for mental health nurses too.”, joked Paul. “Twitter is where the influencers are. As US marketing guru Charlene Li said, ‘Twitter is not a technology. It’s a conversation. And it’s happening with or without you.’ It’s a professional trait of Mental Health Nurses to want to be part of the conversation.” When asked about other social media platforms, Paul said, “We’ll keep an eye on what develops: nothing is static on the internet. Facebook is too big to ignore, so we’ll certainly have a look at smartening-up IJMHN’s presence there too.”

Traditionally the success or failure of a journal article was measured by citations. The only way authors/researchers knew if their work was being read was when other authors referenced their paper. Now that IJMHN is purely an online publication (with an iPhone/iPad app), there is another metric that can be used – how often the article is shared on social media.

Social media can help drive visibility and brand awareness of the journal, and raise awareness of Mental Health Nursing’s work and contributions. For the first time in history, nurses have unmediated access to the public conversation via social media. “Social media provides a terrific opportunity for all health professionals to share and acquire information. It’s a fun way to do professional development.”, Paul said. “It’s also a good way to let people know who we are and what we do.” When asked for a recommendation about using social media, Paul said, “Just be aware that some of your patients, some of your colleagues, and some of your managers will Google your name. Make sure you’re in control of what they’ll find. Don’t be afraid. Be intentional. Make your digital footprint your CV.”

Paul’s professional digital footprint is built around the homophone “meta4RN”, which can be read as either “metaphor RN” or “meta for RN” – try Google or go to meta4RN.com to see what it’s all about.

And follow @meta4RN and @IJMHN on Twitter!

End

This blatant piece of self-promotion could possibly also be included in a newsletter/magazine, but it’s one of those publications that’s organisation/member-specific. That means only a certain group of people will see it, and it will remain unknown to those not part of the organisation. A bit secretive, eh?

Maybe a modern reworking of the biblical “don’t hide you light under a bushel” thing could be, “don’t just do stuff – blog about it!”

Or maybe not.

As always your comments/feedback is welcome below.

Paul McNamara, 9th January 2017.

Short URL: https://meta4RN.com/IJMHN

Mental Health and Cognitive Changes in the Older Adult

This afternoon I’m presenting at Ausmed’s Cairns Nurses’s Conference. The title of the presentation is “Mental Health and Cognitive Changes in the Older Adult”.

The only real point of this blog post is to leave a copy of the powerpoint presentation online, so that those attending the conference can revisit the slides PRN. Here it is:

And here’s the spiel from the Ausmed website
www.ausmed.com.au/course/cairns-nurses-conference

Mental Health and Cognitive Changes in the Older Adult

As we get older, the likelihood of undergoing alterations to brain function is high. This may include normal neurodegenerative changes as well as abnormal deteriorations. Separating normal from dysfunctional degeneration when screening and assessing an older adult is essential for quality nursing care planning. This session will look at:

  • What are normal age-related changes to the brain and consequent behavioural signs?
  • How are these changes different to the onset of mental health disorders such as schizophrenia, psychosis or bipolar disorder?
  • Age appropriate assessment tools for effective mental health assessment
  • Benefits of brief psychosocial interventions
  • What practical behavioural strategies may improve outcomes for a person with a mental health disorder and cognitive changes?

About the presenter:

Paul McNamara has extensive experience providing clinical and educative mental health support in general hospital and community clinical settings. He holds hospital-based, undergraduate and post-graduate qualifications, is Credentialed by the Australian College of Mental Health Nurses (ACMHN), and has been a Fellow of the ACMHN since 2007. Paul is a very active participant in health care social media, and is enthusiastic about nurses embracing “digital citizenship” – more info via his website http://meta4RN.com

ausmed16

End

That’s it. Short and sweet.

I hope this is of some use/interest to those who are attending the conference, and (maybe) some people who are not able to get along.

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

Paul McNamara, 15 December 2016

Short URL: https://meta4RN.com/Ausmed16

 

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

Why on earth would a Mental Health Nurse bother with Twitter? (my #ACMHN2016 presentation)

This post is a companian piece to my oral presentation at the Australian College of Mental Health Nurses 42nd International Mental Health Nursing Conference, 25 – 27 October 2016, Adelaide Convention Centre (the conference hashtag is #ACMHN2016). The function of the online version is to be a collection point to list references.

The Prezi is intended as an oral presentation, so I do not intend to include a full description of the content here.

Regular visitors to meta4RN.com will recognise some familiar themes. Let’s not call it self-plagarism (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 previous meta4RN.com blog posts on the reference list (which, in turn, makes the reference list look stupidly self-referential).

abstracts

Anyway, with that embarrassing disclosure, here is the abstract and list of references  for the Prezi “Why on earth would a Mental Health Nurse bother with Twitter?

Abstract

Have you ever heard someone say something like, “Twitter doesn’t interest me – I don’t care what Justin Bieber had for breakfast”? Those people speak that way because they don’t understand the difference between personal, official and professional use of Twitter or social media more generally. Data will be presented about nurses using Twitter in a constructive, professional way, with the aim of allaying the fears of those in the pre-contemplation phase, and encouraging those in the contemplation and action phases. In recognition of nursing being a predominantly female profession, a feminist argument will be introduced that aligns the use of social media with empowerment. It will be argued that Twitter can enable and ennoble mental health nurses to engage with people beyond the “walled gardens” of our work silos, our profession, and our conference. Participants will be encouraged to have their mobile phone/tablet/laptop turned on and in use during the presentation, in the hope that we will have a shared conversation on the subject. Why on earth would a mental health nurse bother with Twitter? Answers and challenges will be available to those who attend this presentation and/or follow the conference hashtag #ACMHN2016.

References

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

Citizen Kane DVD cover. (n.d.). Retrieved from http://www.currentfilm.com/dvdreviews4/citizenkanedvd.html

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/

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 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

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

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

New South Wales Nurses and Midwives Association [nswnma]. (2014, July 30). Women now have unmediated access to public conversation via social media for 1st time in history @JaneCaro #NSWNMAconf14 #destroythejoint [Tweet]. Retrieved from https://twitter.com/nswnma/status/494313737575096321

New South Wales nurses and Midwives’ Association. (2014). NSW Nurses & Midwives Association logo. Retrieved from http://housingstressed.org.au/wp-content/uploads/2011/08/NSWNMA.png

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

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

Wall Media. (2015). Jane Caro photo. Retrieved from http://wallmedia.com.au/jane-caro/

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

WordPress. (2015). WordPress logo. Retrieved from https://wordpress.org/about/logos/

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.

YouTube. (2015). YouTube logo. Retrieved from https://www.youtube.com/yt/brand/downloads.html

Citations

If there’s anything here of use, you can either cite this web page as:

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

or, if you’re pulling info direct from the abstract, use the more academic-sounding citation that’s in the IJMHN (the ACMHN journal):

McNamara, P. (2014) Why on earth would a Mental Health Nurse bother with Twitter? (presentation, ACMHN’s 42nd International Mental Health Nursing Conference Nurses striving to tackle disparity in health care 25 – 27 October 2016, Adelaide Convention Centre). International Journal of Mental Health Nursing, Vol 25, Issue S1, Pg 34. doi: 10.1111/inm.12771

End 

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

Paul McNamara, 21st October 2016

What can Mental Health Nurses learn from the Amazing Story of a Catholic Patron Saint? (my #ACMHN2016 conference poster)

Welcome to the online companion to my poster presentation at the Australian College of Mental Health Nurses 42nd International Mental Health Nursing Conference, 25 – 27 October 2016, Adelaide Convention Centre.

If you have 6 minutes to spare, please watch the YouTube version:

“What can mental health nurses learn from the amazing story of a catholic patron saint?” was initially submitted as an #ACMHN2016 oral presentation, but accepted as a conference poster. So, instead of updating and reworking the YouTube presentation (as I had planned), I started again. I’m not sure that the poster meets the brief (well, abstract) as well as an oral presentation would have, but anyway…

Abstract

Mental health nursing has a long tradition of story-telling as a tool for developing relationships, undertaking mental state assessment and informing clinical practice. This presentation aims to add to mental health nursing’s discourse about “how we do business”, and add another layer of cultural diversity to our narrative and identity. A review of the literature regarding a catholic patron saint called Dymphna has been undertaken. This will be summarised and presented in a manner in keeping with philosopher Alain de Botton’s proposal that religious teachings should not be trusted to the religious alone – they can be re-purposed and re-mixed to inform atheists too. The historical and mystical story of a 7th century European teenage martyr and saint will be aligned to 21st century Australian language and values. Dymphna’s tale takes unexpected twists and turns which will raise questions about Australia’s appetite for innovative models of mental health care, and whether more could be done to promote mental health nursing as a profession and an identity. This presentation will appeal to those interested in consumer-focused mental health care, innovative alternatives to mainstream care, celebrating mental health nursing, and amazing stories.

amazingstoryposter2

References

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

McNamara, P. (2013, 14 May) Dymphna: The Amazing Story of a Catholic Patron Saint. Retrieved from meta4RN.com/dymphna

McNamara, P. (2013, 20 May) Should May 15th be International Mental Health Nurse Day? Retrieved from meta4RN.com/may15

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

Image References

In an effort to engage conference delegates in the story of Dymphna, the poster has been made in a colourful quasi-comic style. At time of writing this (a fortnight before the conference starts),  I feel a bit anxious that someone will misinterpret the effort to visually engage people as trivialising the subject. This is a bit of a worry, because Dymphna’s story includes nasty stuff, not the least of which includes threatened incest, family violence and two people being beheaded. Even Donald Trump would know that these are not topics to be trivialised.

Although I don’t treat Dymphna’s story with the same reverence as The Pope, I do hold the stories I learnt as a catholic schoolboy with a nostalgic affection. My telling of Dymphna’s story is through the prism of a happily-lapsed-catholic, and with the words of Kirsch [see reference list above] ringing in my ears: “This narrative is without any historical foundation, being merely a variation of the story of the king who wanted to marry his own daughter, a motif which appears frequently in popular legends.” Dymphna’s amazing story is a centuries-old remix of a made-up myth. It’s not the news.

Le martyre de sainte Dymphne et de saint Gerbert (Martyrdom of St Dymphna and St Gerebernus), Seghers Gérard (1591-1651) http://www.photo.rmn.fr/archive/09-524783-2C6NU09M4JRG.html

Le martyre de sainte Dymphne et de saint Gerbert (Martyrdom of St Dymphna and St Gerebernus), Seghers Gérard (1591-1651) http://www.photo.rmn.fr/archive/09-524783-2C6NU09M4JRG.html

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

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

The Technical Stuff

The poster was made using Apple Pages running on a 2011 iMac.

The poster was made for non-commercial reasons, and full attribution has been given to the authors/works used to inform/illustrate the poster. I expect the same in return, so “What can mental health nurses learn from the amazing story of a catholic patron saint?” by Paul McNamara is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Creative Commons License

There’s a description of how the video was made here: meta4RN.com/Dymphna 

Citations

You can either cite this web page as:

McNamara, P.  (2016, 11 October) What can mental health nurses learn from the amazing story of a catholic patron saint? Retrieved from http://meta4RN.com/amazing

or, if you’re pulling info direct from the abstract, use the more academic-sounding citation that’s in the IJMHN (the ACMHN journal):

McNamara, P. (2016) What can mental health nurses learn from the amazing story of a catholic patron saint? (poster, ACMHN’s 42nd International Mental Health Nursing Conference Nurses striving to tackle disparity in health care 25 – 27 October 2016, Adelaide Convention Centre). International Journal of Mental Health Nursing, Vol 25, Issue S1, Pg 34. doi: 10.1111/inm.12771

End

I’ll leave a copy of the PDF here (amazingstoryposter2) just in case I need it one day. Things are much easier to find/share when they’re online.

Previous visitors to my website will know that I’ve covered the Dymphna story previously back in 2013. It’s not self-plagiarising if it’s referenced, is it? It’s more like a funky new remix. 🙂

If you’re at the conference, please say howdy if you see me skulking about, and/or share this web page or your pics of the poster using the #ACMHN2016 hashtag.

As always, your comments are welcome below.

Paul McNamara, 11th October 2016.

 

Mental State Examination: Looking, Listening and Asking

Mental State Examination: Looking, Listening and Asking
By Paul McNamara @meta4RN
RGN (RAH), RPN (SAMHS), BN (Flin.), MMHN (USQ), Cert IMH (WCHN), CMHN, FACMHN
Adapted from the original work of Jenni Bryant @JenCLNinja
RN, RPN (NPC) RGN (BDH), MRN(MH), BN(UNE), MN (Research) (UoN), FACMHN

Every Australian undergraduate nurse is introduced to mental health and undertaking mental state examinations/assessments. However, only about one in every twenty nurses will specialise in working in mental health. For the majority of nurses (ie: those not working in mental health) undertaking a mental state assessment can often become a forgotten skill. This, in turn, deskills the nurse and disadvantages the patient – it’s not holistic care if mental health isn’t considered along with the medical/surgical/maternal aspects of care. As the adage says: there is no health without mental health.

If you’re not accustomed to incorporating mental state examinations (MSE) into your everyday role, it can feel a bit intimidating. Nurses I’ve worked with sometimes feel that they’re not adequately equipped to assess someone’s mental state. Of course they are – as long as they have a bit of emotional intelligence (self-awareness, self-regulation, social skills, empathy and motivation), and break down mental state examination to the three core skills that Jenni Bryant identified in her original powerpoint presentation: looking, listening and asking (adapted, online version available via www.slideshare.net/paulmcnamara).

This online version is in response to a few people requesting to have a print-friendly version (here: MSE), and/or something they’ll always have “in their pocket”, via internet-connected smartphones. The meta4RN.com website readily acknowledges that .edu and .gov websites have more credibility. However, many of those websites are not device-agnostic, so don’t render as well as meta4RN.com does on smartphones and tablets.

It’s a good habit to document a brief MSE for all your patients, not just those with a diagnosed mental illness. Mental state can and does change over a shift, day or week – it’s important to notice and communicate changes.

A comprehensive mental state assessment will include a full history: medical history, psychiatric history, medication history and personal history (developmental, relationship, education, employment, social). As history is static, there is no need to make this part of your “everyday” regular MSE.

A MSE is a snapshot as the person as they are at the time. A well-documented MSE conveys this impression for the reader. Using non-judgemental language, direct quotes of what the person says, and finding the right descriptors/adjectives makes for good MSE documentation. No need to worry about sentence construction. Dot points are fine.

Hopefully the following info will assist.

Mental Sate Examination (Looking, Listening and Asking)

General Description (Looking)

Level of Consciousness
drowsy, alert, sleeping, fluctuating

Appearance
grooming, makeup, posture, clothing, obvious physical deformities or characteristics

Behaviour
eye contact, rapport, level of activity (do you see psychomotor agitation or psychomotor retardation? if so, describe it), body language, mannerisms, specific activities

Speech (Listening)

Flow
smooth, hesitant, interrupted, staccato
easy to interrupt/redirect?
are responses prompt or delayed?

Rate
fast (pressured), slow, or unremarkable?

Volume
soft, loud/pressured, unremarkable.

Tone
flat, monotonous, restricted range, expressive

Continuity
the capacity to maintain a normal progression from one stream of thought to the next: over-inclusive, poverty, circumstantial, perservation or blocking?

Form
assess for abnormalities of form of speech, not form of thought eg stammer/stutter, dysarthia, expressive or receptive aphasia.

Clarity

Accent

Affect (Looking)

An objective assessment of facial and bodily expression of mood state.
Is affect appropriate to content? (congruent)
Assess the range, appropriateness, intensity and quality of affect
Rapid shift from one emotive response to another? (lability)

Some Useful Adjectives:

sad, tearful, angry, irritable, elated, euphoric, frightened, despondent, animated, expansive, cooperative, ingratiating, distressed, discouraged, anxious, hostile, guarded, anxious, calm, ambivalent, dysphoric, euthymic, suspicious, fatuous, bewildered, perplexed

Mood (Asking)

A subjective assessment of mood state:
How has your mood been lately?
How do you feel within yourself?
What has given you happiness, joy or enjoyment recently?
Are you a good person?
Have you been feeling guilty or sad?
If 10 is as good as you ever feel and 0 is as low as you go, where on the scale have you been over the last couple of weeks?

Neurovegetative signs and symptoms:
Sleep
Appetite
Irritability
Tearfulness
Energy
Motivation
Libido
Withdrawal

Thoughts (Asking & Listening)

Form
coherent? rational? sequential/linear?
amount – poverty, flight of ideas, vague
continuity of ideas – incoherent, blocking, circumstantial, tangential, irrelevant
disturbance in meaning or use of language – neologisms, word salad

Content
delusions, obsessions, compulsions, suicidal ideation, phobias, paranoia, preoccupations?
Do you feel safe here/at home?
Are you able to project your thoughts onto others?
Are other people able to insert ideas/thoughts into your head?

Perception (Looking, Listening & Asking)

Hallucinations = false sensory perception that occurs in the absence of a stimulus.
Can affect any of the senses:
Auditory
Visual
Olfactory
Tactile
Gustatory
Have you been experiencing any unusual sensations that you can’t easily explain?
Do you any special powers?
Sometimes when people are really stressed they hear voices/noises, but there’s nobody there. Has that ever happened to you?
You seem distracted by something I can’t see. Can you help me understand what you’re experiencing?

Ideas/delusions of reference
Do you have any unusual experiences when watching TV, or listening to music?
Do you ever feel that the TV has special messages just for you?

Illusion = misinterpretation of sensory stimulus
eg: responding to a pyjama top on a chair as if it were a cat; being startled by something out the corner of their eye.

Cognition (Asking & Listening)

Orientation
time, place, person, situation
Memory
Concentration
Attention
Clock Drawing Test [brief frontal lobe assessment]
please draw a large circle, then insert numbers to make it look like a clock.
now draw in the hands to show ten past eleven

MMSE: Mini Mental State Examination
– screening [ie: not diagnostic] tool for cognitive impairment – best for mild to moderate
– does not differentiate between delirium and dementia
– used to detect impairment, to follow course of illness, to monitor treatment response
– affected by education, intelligence, age, literacy, culture and inter-rater reliability

MMSE alternatives include:

MoCA: Montreal Cognitive Assessment
ACE-R: Addenbrooke’s Cognitive Examination
RUDAS: Rowland Universal Dementia Assessment Scale
KICA: Kimberley Indigenous Cognitive Assessment

Insight & Judgement (Asking & Listening)
Insight = to see one’s self as others do
Judgement = capacity to make reasoned decisions

Does the person recognise symptoms (eg: confusion, hallucinations) as symptoms?
Is the person aware that they are ill and understand the effects and implications?
Is the person seeking assistance/information or rejecting help?
Good, partial or poor? As evidenced by…

Risk (Asking & Listening)

Estimation of risk will be influenced by the person’s history (ie: previous experiences, behaviours and exposures) – the static factors.

Risk is best explored after rapport has been established, and the person knows that you are a safe, non-judgemental person. If somebody discloses intent/plans of harming themselves or others, thank them for trusting you, and let them know that it is too important a matter for just the two of you to handle alone. You’ll arrange for support.

The suggested questions below are for dynamic, “here and now”, factors only

Risk to Self
Do you still have “the fighting spirit”?
Do you ever think, “what’s the point in going on?”
What’s keeping you going?, what makes life worth living?
Have you thought you would be better off dead? How strong are these thoughts?
Have you thought of suicide?
Have you made a plan? [if “yes”, does the person have access to means?]
When would you do this?
What can I do to help you to stay safe?

Risk to Others
You seem pretty angry.
Are you able to express that anger safely?
Do you feel like acting on that anger?
Do you feel like hurting someone?
Are you safe to be around at the moment?
Am I safe with you? What about the other staff and patients here?
What can I do to help you to stay safe?

Alcohol, Tobacco & Other Drugs (Asking & Listening) 

Most substance abuse is contextual
Give “permission” for honest answers

“Sounds like you’ve had a lot of stress lately. How have you been coping?”
“You’ve got a lot of stuff going on at the moment… are you drinking or smoking more than usual?”
“In FNQ plenty of people use the bottle shop or a bit of choof or speed to try to manage stress. How about you?”

Quantity. Frequency. Recency. Route.

Substances:

  • Alcohol
  • Tobacco
  • Cannabis (choof, gunja, yarndi, weed, dope)
  • Amphetamines (speed, goey)
  • Methamphetamines (ice, crystal meth)
  • MDMA = methylenedioxymethamphetamine (ecstasy)
  • Opioids (codeine, morphine, methadone, heroin)
  • Benzodiazepines (benzos: diazepam, oxazepam, nitrazepam/moggies, temazepam/normies, alprazolam/xannies)
  • Hallucinogens (LSD, magic mushrooms)

End

That’s it. Hopefully you’ll find it as a handy memory-prompt/word-finder/confidence booster when providing holistic patient care.

There is a printer-friendly version here:
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There is a slideshow version here:
MSE

The short URL for this page is: meta4RN.com/MSE

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

Paul McNamara, 22nd July 2016

Nurses with Cred

Last week, after a fair bit of a nudge, Australia’s federal government made the National Review of Mental Health Programs and Services available. This infographic from the report caught my eye:

That nursing is the largest single component of Australia’s mental health workforce isn’t a surprise. What is a bit unsettling is that the big bubble with 19,048 in it is mislabeled as “Total mental health nurses”.

That’s not true.

Working in mental health does not make you a mental health nurse, in the same way as driving through Bathurst does not make you a racing car driver. Just because you have a basic licence and you are in the right setting, it doesn’t mean you have the skills to perform safely at a high standard. It doesn’t mean you have cred.

As per AHPRA’s Nursing and Midwifery Board there is no registration category for a specialist mental health nurse, there are only these types of registration:

  1. Registered nurse
  2. Enrolled nurse
  3. Midwife

Compare this with types of registration listed by AHPRA’s Medical Board (sub-speciality fields and full range of speciality titles not included):

  1. Addiction medicine
  2. Anaesthesia
  3. Dermatology
  4. Emergency medicine
  5. General practice
  6. Intensive care medicine
  7. Medical administration
  8. Obstetrics and gynaecology
  9. Occupational and environmental medicine
  10. Ophthalmology
  11. Paediatrics and child health
  12. Pain medicine
  13. Palliative medicine
  14. Pathology
  15. Physician
  16. Psychiatry
  17. Public health medicine
  18. Radiation oncology
  19. Radiology
  20. Rehabilitation medicine
  21. Sexual health medicine
  22. Sport and exercise medicine
  23. Surgery

Medicine and nursing do not correlate on every detail of specialisation, but still… why such a big disparity between the two in terms of registration? Australians have rated Nurses as the most ethical and honest profession each year for 21 years in a row (1994-2015) [source], but I wonder if the public is aware of a problem with nursing specialities not being given the similar recognition as medical specialities.

Midwives have made their speciality distinctly different in the eyes of the public and other health professionals. I am sure it is a comfort for many expectant parents to know that the person guiding you through pregnancy, labour, childbirth and early parenthood is a qualified specialist and is acknowledged and registered as such.

However, people receiving support/treatment for a mental health condition will not necessarily have a specialist mental health nurse providing that service. It’s quite the opposite of midwifery – the nurse providing care may have no specialised qualifications in mental health. I wonder how service users and the people who love them feel about that.

I’ve been a medical, surgical and high-dependency/ICU nurse, and have worked closely with Midwives. I can tell you with confidence that mental health nursing is as different from general nursing as midwifery is. There are some transferable skills, of course, but midwifery, general nursing and mental health nursing each have a completely different model of care, and a very different way of working with people.

It’s not all doom and gloom though: the Australian College of Mental Health Nurses (ACMHN) have a process to credential suitably qualified and experienced mental health nurses.  In the absence of AHPRA being able to discriminate the difference between a general nurse and a mental health nurse, ACMHN are essentially saying, “Leave it to us. We will tell you who is a mental health nurse and who is not.” To be credentialed by the ACMHN, applicants must demonstrate that they:

  1. Hold a current licence to practice as a registered nurse within Australia
  2. Hold a recognised specialist / post-graduate mental health nursing qualification
  3. Have had at least 12 months experience since completing specialist / postgraduate qualification OR have three years experience as a registered nurse working in mental health
  4. Have been practicing within the last three years
  5. Have acquired minimum continuing professional development points for education and practice
  6. Are supported by two professional referees
  7. Have completed a professional declaration agreeing to uphold the standards of the profession. [source]

QHcredential_Page_27There’s more good news: Queensland Health has set targets to work towards a fully qualified, fully credentialed mental health nursing workforce. I wonder if other state health departments are thinking about implementing a similar strategy. It might be important: a program staffed entirely by Credentialed Mental Health Nurses was described as “one of the most innovative services ever funded” [source].

Credentialing + Ability = Credibility.

Credentialed Mental Health Nurses have Cred.

One last thing. It is encouraging that mental health is not the only nursing speciality in Australia that is setting the standard, for saying, “We the specialist nurses will tell you who is a specialist nurse and who is not”.  Under the Credentialing for Nurses initiative, currently there are six specialty nursing organisations working collaboratively to develop consistent, evidence based, recognition for specialist nurses:

  1. Australian College of Operating Room Nurses
  2. Australian College of Children and Young People’s Nurses
  3. Australian College of Mental Health Nurses
  4. College of Emergency Nursing Australasia
  5. Gastroenterological Nurses College of Australia
  6. Palliative Care Nurses Australia

Every speciality area of nursing,  every healthcare organisation, and every patient needs the same thing: Nurses with Cred.

End

That’s it, as always your comments are welcome.

Paul McNamara, 28th April 2015

Short URL: http://meta4RN.com/cred

References

Australian College of Mental Health Nurses, 2015: Credentialing for Practice Program

Corderoy, Amy. (2015, 25th April). Innovative mental health program falling victim to funding freeze. Sydney Morning Herald

Credentialing for Nurses

National Mental Health Commission, 2014: The National Review of Mental Health Programmes and Services. Sydney: NMHC

Roy Morgan Research. (2015, 28th April). Roy Morgan Image of Professions Survey 2015: Nurses still easily most highly regarded. Finding No. 6188