Tag Archives: secondary trauma

Positive Practice Environment (the other PPE)

At this point in time (the beginning of April 2020) PPE is popping-up in news and social media feeds frequently. Understandably, with the outbreak of the #COVID19 pandemic, clinicians are much more conscious of Personal Protective Equipment (PPE) than usual. Even crusty old mental health nurses like me have revisited and refreshed our knowledge on PPE.

That’s sensible. It’s also sensible to acknowledge that there’s more than one type of PPE.

Positive Practice Environment (PPE)

Today some nurses who work on a ward receiving patients suspected/confirmed to have COVID-19 identified elements that are contributing to their ward working well. Although there’s still some anxiety, of course, generally it is a PPE (positive practice environment). Some of the things nursing staff identified were:

  1. Team Nursing. The RNs highlighted this as a part of the PPE. In a team you never feel like it’s your burden to bear alone, there’s someone to check with donning and doffing personal protective equipment, and there’s always someone to help if you’re in the isolation room and need something extra.
  2. Communication. Communciation within the nursing team, and between the nursing staff and senior medical staff is much better than usual. Regular meetings both formal and informal are really helpful.
  3. Working Smarter. For example: before entering an isolation room, call the patient on their bedside/mobile phone to see if they need anything extra. Similarly, making an arrangement with the patient that they can buzz or phone if they need anything. Increased use of phone = decreased frequency of entering isolation room = decreased use of personal protective equipment.
  4. Getting Smarter. Asking questions and brainstorming solutions. Everyone acknowledges that they aren’t experienced or experts in pandemics, and that collaborative care is the only way to problem-solve the way forward. Patients generate solutions too
  5. Staying Focused. There is so much information swirling about regarding COVID-19, that it is important to limit the sources and exposure. We need to trust the health department that employs us to give us the correct information at the correct time. We can’t afford the time or mental/emotional energy to look at everything that’s out there.
  6. Downtime is Sacred. When everything at work seems to have a COVID-19 twist to it, it’s important to shield against overload. Strategies include:
    • Don’t watch the news, watch a movie.
    • Be careful how much time we spend in the social media echo chamber.
    • Switch off social media and the TV and listen to music.
    • Ask friends and family not to use “the C word” around you.

Downtime is Sacred.

Three Final Thoughts

One
It’s not just about wearing PPE (as in personal protection equipment) it’s about creating a PPE (as in positive practice environment) too. Nobody pretends for a moment that there are not more and/or better ideas than those above, but being intentional about both lots of PPE is helping.

Two
What’s more contagious: COVID-19 or anxiety?

Three
I can’t believe that it’s been less than 2 months since the term “COVID-19” was first coined. It has infected nearly every news article and conversation since 11 February 2020.

End

That’s it. Thanks for reading.

As always your feedback is invited via the comments section below.

Paul McNamara, 1 April 2020

Short URL meta4RN.com/PPE

Clean Hands. Clear Head.

Part 1. Clean Hands. Clear Head.

“Clean Hands. Clear Head.” is an animation of a mindfulness script that distills the content of my 2016 blog post “Hand Hygiene and Mindful Moments” into a short (less than 2 minutes) video. The voice part was recorded on an iPhone at a hospital sink #authentic. The visuals were done on Prezi.

Here’s a link to the Prezi version of “Clean Hands. Clear Head.” prezi.com/jehramlhdkcm

Addit 29/03/20: to my surprise, some people want a text version. I won’t write out the whole thing (too long, a bit dull), but below are some key phrases:

This is my mindful moment.
The anxiety and tension will be washed away.
I will rub in the resilience and kindness that sustains me.
After 20 seconds or so I will pretend I’m TayTay, and shake it off. 🙂
I will smile, then will intentionally slow my breathing.
Me and my hands will be safe.

Feels free to use/modify PRN. I would be grateful for source attribution as “meta4RN.com/head”
Just in case it’s handy here is a PDF: CleanHandsClearHead
And here is a MS Word version: CleanHandsClearHead

Part 2. Surviving Emotionally Taxing Work Environments. March 2020 version.

On a related topic, for the last few years I’ve facilitated many hour-long, interactive sessions called “Self Care: Surviving Emotionally Taxing Work Environments.” for my fellow nurses at the hospital where I work. As at March 2020, I’m not confident that we’ll have an opportunity to meet face-to-face as a group all that often, so I’ve tweaked the session, tried to cut-down on the rambling, and have switched from hour-long interactive, to 20 minutes of well-intentioned, a tad-amateurish, youtube video embedded below:


Self Care: Surviving Emotionally Taxing Work Environments. March 2020 version.
(video, 20 mins)

Here’s a link to the Prezi version of “Self Care: Surviving Emotionally Taxing Work Environments. March 2020 version”: prezi.com/xcejt9pgd0b3

Part 3. References & Resources.

I’m recycling and combining a lot of old ideas for the March 2020 version of  “Self Care: Surviving Emotionally Taxing Work Environments.” Self-plagiarism? Nah – it’s a groovy remix of some favourite old songs. Regular visitors to meta4RN.com may recognise the repetition, and be quite bored with me using the website as a place to store updated versions of old stuff. Sorry about that, but it’s just so damn convenient. 🙂

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

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

Australian Government (24 March 2020) Coronavirus (COVID-19) current situation and case numbers
www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert

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

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

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

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

Employee Assistance Service (via Benestar – the company that CHHHS contracts out to)
benestar.com

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

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

Lai. J, Ma. S, Wang. Y, et al. (23 March 2020) Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open.
jamanetwork.com/journals/jamanetworkopen/fullarticle/2763229

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

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

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

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

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

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

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

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

End

Thanks for visiting. Let’s join the kindness pandemic to offset some of the crap that goes with the COVID19 pandemic.

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

Stay safe.

Paul McNamara, 25 March 2020

Short URL: meta4RN.com/head

Creative Commons Licence
Clean Hands. Clear Head. by Paul McNamara is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Self Care: Surviving emotionally taxing work environments

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

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

Printed handouts are so last century.

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

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

Here is the online presentation: Prezi

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

End

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

Thanks for visiting. As always your comments are welcome.

Paul McNamara, 22 February 2019

Short URL: meta4RN.com/SelfCare

 

 

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

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

 

#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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Mobile Phones.
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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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Finishing-Up: Key Learnings.
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Closing Remarks.
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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

First Thyself

First Thyself – Surviving Emotionally Taxing Work Environments

On 28th April 2017 I’ll be presenting a session at the Ausmed “Breaking Point: Ice & Methamphetamine Conference” in Cairns. More info about the conference here: https://www.ausmed.com.au/course/ice-methamphetamine#overview

The nature of nursing will mean that we are likely to be are exposed to a range of challenges.

Feeling unsafe, witnessing violence, tragedy and dealing with trauma are some examples.

This emotionally taxing environment can result in tension with colleagues, family and friends.

This session will begin day two of the conference by creating an opportunity to discuss the following:

What are the professional implications of working in challenging areas of nursing and healthcare?

How can we maintain unconditional positive regard?

Why self-care matters and how to practice what we preach!

What’s all this then?

“First Thyself” 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/#

This page serves as a one-stop directory to the online resources used to support the discussion.

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).

Here is the online presentation: Prezi

Here are the resources and references used in the presentation:

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

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

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 prezi.com/skmu0lbnmkm5/first-thyself/#

Thanks for visiting. As always your comments are welcome.

Paul McNamara, 30 March 2017

Short URL: meta4RN.com/thyself