Tag Archives: mental health

10 Delirium Misconceptions

This table/info extracted from Oldham et al (2018) is too handy not to share:

PDF version [easy to print]: 10DeliriumMisconceptions

Text version [just putting it here so that it’s searchable; hello google :-)]

1.
Misconception: This patient is oriented to person, place, and time. They’re not delirious.
Best Evidence: Delirium evaluation minimally requires assessing attention, orientation, memory, and the thought process, ideally at least once per nursing shift, to capture daily fluctuations in mental status.
2.
Misconception: Delirium always resolves.
Best Evidence: Especially in cognitively vulnerable patients, delirium may persist for days or even months after the proximal “causes” have been addressed.
3.
Misconception: We should expect frail, older patients to get confused at times, especially after receiving pain medication.
Best Evidence: Confusion in frail, older patients always requires further assessment.
4.
Misconception: The goal of a delirium work-up is to find the main cause of delirium.
Best Evidence: Delirium aetiology is typically multifactorial.
5.
Misconception: New-onset psychotic symptoms in late life likely represents primary mental illness.
Best Evidence: New delusions or hallucinations, particularly nonauditory, in middle age or later deserve evaluation for delirium or another medical cause.
6.
Misconception: Delirium in patients with dementia is less important because these patients are already confused at baseline.
Best Evidence: Patients with dementia deserve even closer monitoring for delirium because of their elevated delirium risk and because delirium superimposed on dementia indicates marked vulnerability.
7.
Misconception: Delirium treatment should include psychotropic medication.
Best Evidence: They are best used judiciously, if at all, for specific behaviours or symptoms rather than delirium itself.
8.
Misconception: The patient is delirious due to a psychiatric cause.
Best Evidence: Delirium always has a physiological cause.
9.
Misconception: It’s often best to let quiet patients rest.
Best Evidence: Hypoactive delirium is common and often under-recognized.
10.
Misconception: Patients become delirious just from being in the intensive care unit.
Best Evidence:  Delirium in the intensive care unit, as with delirium occurring in any setting, is caused by physiological and pharmacological insults.

Source/Reference

Oldham, M., Flanagan, N., Khan, A., Boukrina, O. & Marcantonio, E. (2018) Responding to Ten Common Delirium Misconceptions With Best Evidence: An Educational Review for Clinicians. The Journal of Neuropsychiatry and Clinical Neurosciences, 30:1, 51-57.
doi.org/10.1176/appi.neuropsych.17030065

End

This is the least original blog post I’ve written. All I’ve done is transpose a table from this paper.

Why bother? So I can quickly and easily share it at work. I have conversations about this stuff a lot, especially misconceptions 1, 7 and 8. It’s handy to have an accessible and credible source to support these discussions.

That’s it. Visit the journal article yourself for elaboration about the misconceptions and evidence of delirium: doi.org/10.1176/appi.neuropsych.17030065

Paul McNamara, 18 April 2019

Short URL meta4RN.com/10Delirium

 

Self Care: Surviving emotionally taxing work environments

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

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

Printed handouts are so last century.

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

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

Here is the online presentation: Prezi

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

End

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

Thanks for visiting. As always your comments are welcome.

Paul McNamara, 22 February 2019

Short URL: meta4RN.com/SelfCare

 

 

Diagnostic Overshadowing

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

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

Validating understandable and proportionate emotions is important.

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

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

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

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

The lived experience

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

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

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

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

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

Questions for Reflection

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

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

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

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

References

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

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

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

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

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

PDF version

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

Citation

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

End Notes

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

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

Paul McNamara, 15 December 2018

Short URL meta4RN.com/shadow

 

 

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

Your Ordinary is Extraordinary

“I have come to learn that it is fundamental for mental health nurses to establish relationships of trust and provide care to people who are in need, setting aside any bias or prejudice. What this means is that, as mental health nurses, you are championing human rights on a daily basis by simply doing your jobs. It must seem so ordinary to you as you go about your lives, but your ordinary is extraordinary.
Sharina Smith
Communications and Publications Officer
Australian College of Mental Health Nurses
September 2018

Cite in text
(Smith, 2018. p. 2)

Cite in reference list
Smith, S. (2018, September). Welcome. ACMHN News. Spring 2018 edition. Australian College of Mental Health Nurses: Canberra.

Context

I was flicking through the most recent edition of ACMHN News, themed “mental health and human rights”, one last time before consigning it the recycling bin. Sharina Smith is editor of the publication, and always offers a short “welcome” column introducing the content. Stopping my trip to the bin, the three sentences quoted above jumped off the page.

It’s instructive to have someone from an unrelated field (in Sharina’s case marketing and communications), examine mental health nursing through their lens of education and experience. Sharina’s comments shine a spotlight on an incredibly important part of our work that we often take for granted.

Just as the paper of the magazine deserves to be recycled, so do Sharina’s observations about human rights and mental health nursing. That’s the purpose of liberating the excerpt above from the printed page to the internet.

End

Sincere thanks to Sharina Smith, and all the office staff at ACMHN. Your ongoing support of Australian mental health nurses is very much appreciated.

Find out more about ACMHN here: www.acmhn.org

Paul McNamara, 10 November 2018

Short URL meta4RN.com/ordinary

#ACMHN2018 on Twitter

Information from and about ACMHN’s 44th International Mental Health Nursing Conference went well beyond the walls of the Cairns conference venue, and bounced around the world via social media.

Over the week of the conference more than 320 separate Twitter accounts used the #ACMHN2018 hashtag. There were over 2,750 tweets. 40 or so (less than 50, anyway) of the conference delegates, keynote speakers and sponsors were using the #ACMHN2018 hashtag – the content they generated was shared by over 250 people not in attendance. Many thanks to the relatively small percentage of conference participants who have amplified mental health nursing’s voice and values.

Free access to the #ACMHN2018 data and content is online,

One last thing. People are already talking about next year’s conference in Sydney using the #ACMHN2019 hashtag. Will you be part of the conversation?

End

That’s it. I’ve done detailed dissections of conference tweeting previously. This time I’m just dropping the info that was published in the ACMHN “Tuesday Times” on 30/10/18.

Short and sweet. 🙂

If you’re after more info about the conference content, I suggest that you browse the #ACMHN2018 tweets via this link, or the conference abstracts via this link.

Paul McNamara, 31 October 2018

Short URL: meta4RN.com/ACMHN2018

 

Conversations, not just citations, count: Social Media and the International Journal of Mental Health Nursing

This page serves as a place to collate the Prezi, YouTube video, abstract and list of references, data sources and visuals used for a presentation at the 44th ACMHN International Mental Health Nursing Conference.

Click on the pic to access the Prezi

Presenter Introductions

Paul McNamara is CNC with the Consultation Liaison Psychiatry Service at Cairns Hospital. Paul is also Social Media Editor of the International Journal of Mental Health Nursing.

Kim Usher is Professor and Head of School at the School of Health, University of New England. Kim is also Chief Editor of the International Journal of Mental Health Nursing.

Abstract

Traditionally the impact and reach of a specific journal article has been estimated through the measurement of how many times it is cited elsewhere in scholarly literature. Sometimes years could pass between conducting the original research, writing and refining drafts, submitting and reviewing manuscripts, the article being published, and subsequent researchers including this citation in their published reference list. The resulting time lag means that citations are a retrospective measurement of research impact.

There is however an alternative measure of research impact; a metric that is more immediate. This alternative does not rely on the passive hope that other people will see and share research findings, but allows interested parties to play a hand in generalised and targeted promotion of a published piece of research.

Charlene Li famously described social media not as a technology, but as a conversation (Israel, 2009). Now these online conversations can be quantified, and offer “real‐time” feedback to researchers/authors about the impact and reach of their published research.

In order to support these claims, we will provide an overview of the International Journal of Mental Health Nursing social media strategy. Altmetric data will be presented to demonstrate the measurable effects of this strategy. General information and specific examples will be shared so that researchers, authors, and the institutions that support their work, are exposed to strategies they could use to contribute to future Altmetric scores. In doing so, conference delegates who attend this presentation will be equipped with knowledge on how to improve the impact and reach of their publications on social media, and further their understanding of why this matters.

References, Data Sources + Presentation Visuals

Altmetric attention scores re top 5 IJMHN articles, data as at 18/09/18:

  1. Do adult mental health services identify child abuse and neglect? A systematic review https://wiley.altmetric.com/details/23964454
  2. Mental healthcare staff well‐being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions https://wiley.altmetric.com/details/30485876
  3. An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings https://wiley.altmetric.com/details/31986204
  4. Lethal hopelessness: Understanding and responding to asylum seeker distress and mental deterioration https://wiley.altmetric.com/details/17878566
  5. How many of 1829 antidepressant users report withdrawal effects or addiction? https://wiley.altmetric.com/details/43387887

Altmetric attention scores re IJMHN impact from July 2015 to June 2018, MS Excel spreadsheet data courtesy of Kornelia Junge, Senior Research Manager, Wiley.

Altmetric logo via https://www.altmetric.com/about-us/logos/ (retrieved 06/10/2018)

CrossRef data re IJMHN most-cited articles based on citations published in the last three years, via https://onlinelibrary.wiley.com/journal/14470349 (retrieved 04/10/2018)

Hootsuite logo via https://hootsuite.com/about/media-kit (retrieved 06/10/18)

IJMHN. (03/01/17). The @IJMHN 2017 New Year resolution is to refresh our Twitter home page and Tweeting practices. Watch this space! 🙂 [Tweet]. Retrieved from https://twitter.com/ijmhn/status/816202247604301824?s=21

International Journal of Mental Health Nursing, October 2018, volume 27, issue 5, cover image via https://onlinelibrary.wiley.com/doi/pdf/10.1111/inm.12395

Israel, S. (foreward by Li, C.). (2009). Twitter Ville: How businesses can thrive in the new global neighborhoods. New York: Portfolio.

Tweet activity examples as at 06/10/18

  1. Combining #eMentalHealth intervention development with human computer interaction (HCI) design to enhance technology‐facilitated recovery for people with depression and/or anxiety conditions Amalie Søgaard Neilsen + @RhondaWilsonMHN https://twitter.com/ijmhn/status/1036177022811340800?s=21
  2. Meeting the needs of young people with psychosis: We MUST do better Editorial by @Michael_A_Roche @debraejackson @KimUsher3 + Wendy Cross https://twitter.com/ijmhn/status/1033277919865593858?s=21
  3. Literature review of trauma-informed care: Implications for mental health nurses https://twitter.com/ijmhn/status/1029110510569091072?s=21

Twitter data re IJMHN activity from July 2015 to June 2018 via http://www.twitonomy.com/profile.php?sn=IJMHN (retrieved 20/10/18)

Twitter data re IJMHN impact from July 2015 to June 2018 via https://analytics.twitter.com/user/IJMHN/home (retrieved 09/10/2018)

Twitter logo via https://about.twitter.com/en_us/company/brand-resources.html (retrieved 06/10/18)

Video Version

The YouTube version of the presentation (slightly different to the conference version) can be viewed below and/or shared using this URL: https://youtu.be/vWSI3u4O2Bc

Presentation Tweets

Using Hootsuite, these Tweets using the conference hashtag (#ACMHN2018) were scheduled to be sent during the presentation. Look Mum! No Hands!

 

Citation

To cite this page:
McNamara, P. (2018). Conversations, not just citations, count: Social Media and the International Journal of Mental Health Nursing. Retrieved from https://meta4RN.com/count

To cite the presentation abstract:
McNamara, P. & Usher, K. (2018). Conversations, not just citations, count: Social Media and the International Journal of Mental Health Nursing. International Journal of Mental Health Nursing, Volume 27, Issue S1, Page 31 onlinelibrary.wiley.com/doi/full/10.1111/inm.12539

End

That’s it. Thanks for reading this far down the page. You’re probably the only one who’s bothered. 🙂

In keeping with the theme of the presentation, I’d be grateful if you share the page with your social networks.

As always, questions and feedback are welcomed via the comments section below.

Paul McNamara, 15 October 2018

Short URL meta4RN.com/count

Update: 20 October 2018

There was a flat spot in the original presentation where I struggled to convey clarity and sustain interest. In an effort to overcome this, I deleted a couple of slides from the original Prezi, modified another, and added the data/chart below. Thank you for your helpful critique and suggestions @StellaGRN.

Update: 27 October 2018

The Tweets that were scheduled to coincide with the presentation have now been embedded in the post.