Queensland’s #COVID19 Comparative Advantage

New Zealand has attracted praise for its management of COVID-19, and rightly so. As at the beginning of October where the pandemic is spreading at an alarming rate in many places (see the WHO dashboard), New Zealand has kept the rate of infections low.

It’s interesting as a Queenslander to compare our numbers with New Zealand. Although geographically New Zealand and Queensland are very different, the size of our populations is very similar.

How has Queensland fared with coronavirus compared to New Zealand?

Good. Really good. Here’s the data as at 1st October 2020:

	Queensland	New Zealand
Population (million)	5.2	5.1
Total Confirmed COVID-19 Cases	1157	1492
COVID-19 Deaths	6	25
Active COVID-19 Cases	4	53
New COVID-19 Cases Last 24 Hours	0	12

Maybe that data has a bigger impact as a chart. Actually let’s make that two charts:

ONE

Comparing Queensland and New Zealand Population size, COVID-19 Deaths, Active COVID-19 Cases and New COVID-19 Cases as at 01/10/20

 TWO

Comparing Queensland and New Zealand Total Confirmed COVID-19 Cases as at 01/10/20

As I’ve mentioned in previous blog posts in May 2020 and August 2020, I’m not sharing this info as a macabre version of the Bledisloe Cup. It’s not a competition. It’s certainly not a game. There have been over a million deaths, and there are more to come: countless families across the world are in mourning. I’m sharing this because – like nearly other health professional in Queensland – I do not take my good fortune for granted.

They have all done an amazing job 👍

— Kate K (@KittyKat_TT) September 26, 2020

The Disclaimer

I’m not an epidemiologist, nor do I have any qualifications or experience in public health. It’s easy to imagine that people who do have that background rolling their eyes and slapping their foreheads at this amateurish, dumb comparison between two populations without taking all the demographic, geographic, climatic and social variables into account.

I’m not pretending to be an expert in this stuff, I am just sharing raw data and counting my blessings. I hope it gives other Queenslanders some reassurance and pride too.  That’s the aim.

Data Sources

Queensland population www.qgso.qld.gov.au/statistics
New Zealand population www.stats.govt.nz/topics/population
Queensland COVID-19 info www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/current-status/statistics (data extracted on 01/10/20)
New Zealand COVID-19 info www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-current-situation/covid-19-current-cases (data extracted on 01/10/20)

End

Thanks for visiting. As always, you are welcome to leave feedback in the comments section below.

Paul McNamara, 2 October 2020

Short URL: meta4RN.com/compare

One. Step. Beyond.

Stories on the TV that speak of the mental health impacts of COVID-19/other issues nearly always end with words to the effect of, “And if this has raised any issues for you help is always available. Phone Lifeline on 13 11 14.”

In keeping with Mindframe media guidelines, it’s good that help-seeking information is included in these stories, but it doesn’t cater for the full spectrum of mental health problems.

Lifeline, for example, is a crisis support line, akin to lifesavers plucking people from the dangerous surf. It’s vital, but it’s not a “one size fits all” service (nor should we expect it to be).

Anyway, most of us would rather early intervention/prevention rather than crisis intervention. It’s better to learn how to swim than rely on someone saving you from drowning.

 

The Stepped Care Model of Mental Health

Self Portrait 26/04/20

The Stepped Care model aims to ensure that people have streamlined access to the right services for their needs over time, and as their needs change. There is more information about this available from more reputable sources than my blog, eg:  Northern Queensland Primary Health Network, Connect to Wellbeing, or your local public health network.

A short, amateurish, overview is this:

If you’re on the lowest (blue) step, you’re doing OK. Keep those healthy relationships and habits going.

If you’re on the second-lowest (green) step you probably should be more intentional about protecting your social and emotional wellbeing. Chat to people you love/trust, and see if any of the digital resources at Head To Health match where you’re at.

If you’re on the middle (yellow) step it’s definitely time to connect with someone. If you’re a Nurse or Midwife that could be NMSupport in the first instance,  if you’re in North Queensland you may consider contacting Connect to Wellbeing. Elsewhere you may need to google or go via healthdirect re equivalent services.

If you’re on the second-top (orange) step, don’t muck-about: make a double appointment to see your GP. S/he won’t necessarily reach straight for the prescription pad. The GP may discuss making a Mental Health Treatment Plan, which should include your goals  and – if you and your GP agree it’s worth a try – a referral to a specialist mental health professional.

If you’re on the top (red) step you will almost certainly want to make contact with your local mental health service. In Queensland phone 1300 64 2255 (1300 MH CALL). Outside of Queensland you should be able to track-down your local service via healthdirect.

One. Step. Beyond.

This blog post was inspired by chatting with hospital colleagues who were not familiar with the Stepped Care Model of Mental Health. Many thanks to these terrifically impressive people who are definitely NOT heroes: they’re just everyday compassionate, creative, funny, clever and skilled health professionals who – in a crisis – will go one step beyond to support the people who need it.

One last thing. If, like me, you have a foot one step beyond your usual step, perhaps the jaunty Madness (1979) song “One Step Beyond” will provide temporary distraction and cheer. 🙂

End

Thanks very much for visiting. As always your feedback is welcome in the comments section below.

Paul McNamara, 30 July 2020

Short URL meta4RN.com/step

An end of April #COVID19 snapshot (Queensland perspective)

The chart below shows confirmed cases of #COVID19 as at 4.30pm (GMT/UTC + 10:00h) on Thursday 30/04/20. The chart sourced via www.covid19data.com.au

Source: http://www.covid19data.com.au

I’m not sharing this info as a macabre version of State of Origin or the Bledisloe Cup. It’s not a competition. It’s certainly not a game. Thousands of families across the world are in mourning.

Nevertheless, it is useful to have a benchmark of how we are faring. To give us perspective it’s useful to compare progress across areas/populations. As per the list below, Queensland’s population size compares better to New Zealand, Ireland, Norway and Singapore than other Australian states and territories.

Population Comparison (Australian states/territories + selected countries, small to large)
Northern Territory 245,000
Australian Capital Territory 428,000
Tasmania 535,000
South Australia 1.75 million
Western Australia 2.63 million
New Zealand 4.82 million
Ireland 4.94 million
Queensland 5.11 million
Norway 5.37 million
Singapore 5.85 million
Victoria 6.63 million
New South Wales 8.12 million

So What?

Hopefully, the encouraging data in this chart serves as an anxiolytic for Queensland health workers and their patients. That’s the intent.

Compared to many countries Australia and New Zealand are doing very well with the whole #COVID19 thing.
Reminder: If you’re 20 points up before half time in the Bledisloe Cup don’t start celebrating victory. Stick with the game plan. #COVID19nz #COVID19au https://t.co/x2zctvY4qc

— Paul McNamara (@meta4RN) April 25, 2020

End

That’s it. If you know an anxious Queenslander please share this information with them.

Paul McNamara, 1 May 2020

Short URL meta4RN.com/qld

Supporting Nurses’ Psychological and Mental Health

An editorial by Jill Mabel and Jackie Bridges published on 22 April 2020 in Journal of Clinical Nursing explores the evidence regarding supporting nurses’ psychological and mental health during #COVID19.

Q: Why nurses?
A: Nurses are at the bedside 24 hours a day, 7 days a week. In previous pandemics/epidemics nurses experienced more occupational stress and resultant distress when compared to other professions.

And – little known fact – even when there isn’t a pandemic to deal with, nurses are more prone to suicide than most employed people. The authors are in the UK, but it’s the same in Australia.

Although there are lessons to be learned from SARS, MERS and Ebola, overall the evidence for supporting nurses’ psychological and mental health wellbeing during a pandemic is not very strong.

That disclaimer out of the way, here comes my interpretation of the key points from the paper:

1. Keep Maslow’s Hierarchy of Needs in Mind.
Starting at the base isn’t basic. It’s essential.
Start with
– hydration
– nutrition
– rest and recovery
– shelter from the storm

2. Safety is vital.
For #COVID19 that means that PPE is a non-negotiable need (don’t take my word for it, see Maslow’s hierarchy above).

3. Prioritise wellbeing.
Organisations that ask nurses to care for people who are #COVID19 suspected/positive should ensure that nurse wellbeing is a priority.
Q: How?
A: Insist on breaks, and – this often goes against the nursing culture/habits – make sure that nurses quarantine time for mutual support.
Q: Mutual support? What’chu talkin’ ’bout, Willis?
A: meta4RN.com/footy

4. Individual Support PRN.
Individual support should be available for nurses too.
Q: What sort of support?
A: It’s not one size fits all. It depends on what step you’re on.

Self Portrait 26/04/20

On the lower steps, support via trusted, loving family and friends might be all that’s required. That, and being intentional about self care.

5. Self-Care.
If you’re getting stressed on the boss’s time, you should try to get de-stressed on the boss’s time too. It doesn’t have to take hours, you might be able to make regular snack-sized self-care part of your everyday nursing practice.

6. Positive Practice Environment.
Good communication, a collegial multidisciplinary team, creative and collective problem-solving,and working as a team can go a long way towards dampening anxiety.
There’s more than one kind of PPE.
Aim for a Positive Practice Environment.

7. Time Out.
Embed safe places in the workplace. Something like a NOvid room would do the trick.

Source: https://twitter.com/WestSuffolkPsyc/status/1251807004731064329?s=20

8. Supportive Senior Staff.
Last, but not least, senior nurses and other people in the hospital hierarchy should make themselves more available and visible than ever.
Care goes in. Crap comes out.

End

That’s the summary of the key messages I took from the Journal of Clinical Nursing editorial. Check it out yourself via doi.org/10.1111/jocn.15307

Many thanks to Jackie Bridges (one of the paper’s authors) for giving positive feedback regarding the original Twitter thread. This blog post is a replica of that thread, just with most typos corrected.

Thanks for reading. As always you’re welcome to leave feedback and/or add your own ideas in the comments section below.

Paul McNamara, 26 April 2020

Short URL: meta4RN.com/COVID19

Positive Practice Environment (the other PPE)

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

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

Positive Practice Environment (PPE)

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

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

Downtime is Sacred.

Three Final Thoughts

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

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

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

🚨 BREAKING 🚨

“We now have a name for the #2019nCoV disease:

COVID-19.

I’ll spell it: C-O-V-I-D hyphen one nine – COVID-19″

–@DrTedros #COVID19 pic.twitter.com/Kh0wx2qfzk

— World Health Organization (WHO) (@WHO) February 11, 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

Diabetes and Emotional Health

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

About

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

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

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

Intro

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

Presentation

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

Key Messages, References + Further Info

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

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

.
“It’s a Fine Line” – Myth vs Reality meta4RN.com/fineline
.

About 20% of us will experience mental health problems in any given year [source: 2007 National Survey of Mental Health and Wellbeing].

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

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

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

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

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

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

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

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

End

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

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

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

Thanks for visiting. 🙂

Paul McNamara, 2nd June 2018

Short URL: meta4RN.com/diabetes

 

 

 

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

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

 

Dear Australian Student Nurses (a letter of encouragement, with data and a song)

Dear Australian Student Nurses yet to be offered a Graduate Nurse position,‬

‪Take heart. We need you.‬

Here’s the evidence:

Source: Australia’s Future Health Workforce – Nurses Detailed report, August 2014, pg. 37 https://www.health.gov.au/internet/main/publishing.nsf/Content/34AA7E6FDB8C16AACA257D9500112F25/$File/AFHW%20-%20Nurses%20detailed%20report.pdf

In related news, ‪about 8.000ish new nurses graduate in Australia every year [2014 info: source].

3501 of Australia’s nurses and midwives are aged 70+. ‬

17,089 of Australia’s nurses and midwives are aged 65+.

39% of Australia’s nurses/midwives are aged 50+ (not that there’s anything wrong with that).

Source: Nursing and Midwifery Board of Australia Registrant Data, Reporting period: 1 April – 30 June 2016, pg. 8 http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD16%2f21646&dbid=AP&chksum=t4OGdyru9MwpHjKdC5SBeA%3d%3d

Look, I don’t really know what I’m talking about. I was in your position in 1991, and I remember it feeling daunting then. I have no real idea what it’s like to be a new grad in Australia in 2016/2017, and don’t have any detailed understanding of Graduate RN hiring processes around the country. With that disclaimer out of the way, here’s my 2 cents worth:

1. Nurses graduate in packs, but retire one by one. Today there are about 8000 freshly minted Australian RNs wondering if they’re going to get a gig. I don’t know how many of existing RNs are on the verge of retirement, but the demographic info in the table above would suggest at least 8000 will retire within the next year. Have you read the small print in the ‘Modelling Results’ chart above? The last sentence reads, “The major contributing factor to this result is that workforce exits exceed new entrants from 2016 onwards.” [page 37] Be patient. The jobs will become available.

2. If it’s practical to chase the work (ie: go rural/remote) do so. You’ll pick-up some deadly skills, and will be a better future employment prospect than someone who hasn’t worked as a RN.

3. Have you heard the cliché re not waiting for Mr/s Right, and being comfortable with Mr/s Right-Now? Same with your first few RN jobs: anything will do to get your foot in the door. Don’t knock back an unappealing gig. Quitting is quicker/easier than applying.

4. You know that other cliché “It’s not what you know, it’s who you know”?
It’s not quite accurate.
It’s who you ARE, and who knows it.
If you’re well suited to a particular speciality/hospital/ward make sure that it’s not a secret. Make sure you’re friendly with all staff, but be especially sure that the senior staff (the people with their hands on the levers) know that you’re an asset. If they know you’ll make their workplace better, they’ll be keen to grab you when the funding/positions allow.

5. This one is the important one. It’s REALLY disheartening to spend 3+ years working towards something, and then find out that that something isn’t there where you expected it to be.
The fragile self-confidence of a novice RN isn’t geared-up for a kick in guts like that.
It’s not just a disappointment, it’s an injury to the ego.
Be kind to yourself.
Don’t spend all your money at Dan Murphy’s.
Do fun stuff despite feeling crap.
The data tells us that there are RN gigs in the pipeline. Do whatever it takes to be sure that you’re ready when your opportunity arrives.

6. Expect to experience grief emotions. You probably remember the Kübler-Ross 5 stages thing, as a quick reminder: denial, anger, bargaining, depression and acceptance. Anger and depression are uncomfortable, but very understandable, emotions. Find a safe way to express them (pro-tip: resist the temptation to spray paint swear words on your university or local hospitals).

7. On bad days, have another look at the chart at the top of the page. Australia’s health system needs you!

8. Find things that help you stay optimistic. Music works for me. Just in case it works for you too, here’s a song of determination and defiance. Turn it up!

End

This blog post is yet another example of blatant self plagiarism doing a funky remix of previous work. It started out as a short Facebook post, which turned into a conversation. The original is here: https://www.facebook.com/meta4RN/posts/1353685884664226:0

As always, feedback/corrections/additions are welcome in the comments section below.

Paul McNamara, 4 December 2016

Short URL meta4RN.com/letter

Hand Hygiene and Mindful Moments

Nurses and other health professionals are expected to attend to hand hygiene about eleventy seven times a day. The WHO and HHA recommend 5 moments for hand hygiene: before touching a patient, before clean/aseptic procedures, after body fluid exposure/risk, after touching a patient, and after touching patient surroundings. 57.4% of Australia’s nurses/midwives are hospital/ward-based [source], they’re doing A LOT of hand hygiene. 

On top of that, while they’re going about their business and busyness, ward-based nurses are interrupted 10 times an hour [source]. Yep, every 6 minutes there’s something or somebody distracting us from our tasks and thoughts. Dangerously disorderly much? Hopefully that doesn’t happen to neurosurgeons, commercial airline pilots, tattoo artists or Batman.
Especially Batman. 

Pro-Tip: most of us can not do this at work. Only respond to distractions with face-slapping if you are Batman.

So, here’s the idea: if you’re going to do hand hygiene dozens of times a day anyway, don’t just do it for your patients: do it for yourself too. We’re not cold callous reptilian clinicians, we’re educated warm-blooded mammals who do emotional labour. We need to nurture ourselves if we are to safely continue to nurture others.

5 moments for hand hygiene & head hygiene!

Turn the 5 moments of hand hygiene into mindful moments. Make the 5 moments for hand hygiene 5 moments for head hygiene too. Yes, clean hands save lives – let’s not forget that clear heads save lives too!

Come up with a process/script that works for you, maybe something a bit like this: 

Mindful Moment (The 30-Second Handrub Version) 

1. Step towards the pump bottle with intent. This is my mindful moment. I’m taking a brief break. 
2. Squirt enough to squish. 
3. The rub is slippery at first. Frictionless fingers feel fine.
4. Feel the product texture and temperature. The rub is cooler than the air. The rub is cooler than my fingers. It feels nice. 
5. Start with cleaning. The first half of my hand hygiene routine is about rubbing stuff off. Let the stuff I want to get rid of float away. 
6. Move on to restoration, healing. The second half of my hand hygiene routine is about rubbing in resilience and health. Let the stuff that sustains me seep into my skin. 
7. Check in on the breathing. The slower and deeper the better. If the breathing or the brain are running too fast, slow down and repeat steps 5 and 6. 
8. There’s no rush. Slowly scan the surroundings. With any luck someone from infection control is watching. 
9. Smile.
10. Breathing slowly, its time let the air rinse off the residue. 
11. One more slow breath. Its time to get back to work. 

Mindful Minute (The 60-Second Handwash Version)

1. Step towards the sink with intent. This is my mindful minute. I’m taking a brief break. 
2. Let the water flow.
3. Feel the water flowing over both hands. The water’s warmer than the air. The water’s warmer than my fingers. It feels nice. 
4. Add soap. It’s slippery. Frictionless fingers feel fine.
5. Start with cleaning. The first half of your hand hygiene routine is about washing stuff away. Let the stuff you need to get rid of flow down the drain. Let it flow away. 
6. Move on to restoration, healing. The second half of my hand hygiene routine is about rubbing in resilience and health. Let the stuff that sustains me seep into my skin. 
7. Check in on the breathing. The slower and deeper the better. If the breathing or the brain are running too fast, slow down and repeat steps 5 and 6. 
8. There’s no rush. Slowly scan the surroundings. With any luck someone from infection control is watching. 
9. Smile.
10. Breathing slowly, its time rinse both hands. 
11. Breathing slowly, its time to thoroughly dry both hands together. 
12. Throw the towel in the bin.
13. One more slow breath. Its time to get back to work. 

Clean hands save lives. Clear heads save lives too!

Acknowledgements & Context

This is not my original idea. I first stumbled across the idea of combining hand hygiene with head hygiene via Ian Miller‘s November 2013 blog post “mindfulness during handwashing”: http://thenursepath.com/2013/11/18/mindfulnurse-day-8/. I’ve been using the idea myself and suggesting it to colleagues and students ever since. When I left the clinical environment for a few months, I found myself really missing intentionally punctuating my day with mindful moments. Since returning to clinical practice I’ve come to appreciate the strategy even more than I did when I first started using it 3 years ago.

So why am I blogging about it too? Why now? Well, on Monday I attended the Australasian College for Infection Prevention and Control 2016 conference to chat about Twitter [link to that presentation here. Also, check-out the #ACIPC16 hashtag here and here]. Luckily I was there for the opening plenary sessions, and was pleasantly surprised at the emotional/psychological literacy that was being displayed and advocated for. The opening presentations by Peter Collignon, Mary Dixon Woods and Didier Pittet all went to some lengths to emphasise the importance of emotional intelligence, constructive communication and building relationships. It was really impressive stuff; giving the hand hygiene and mindful moments idea a remix is my way to give recognition/thanks to the #ACIPC16 conference delegates and organisers.

How to win friends and influence people: https://twitter.com/emrsa15/status/800495292642508801

Just so you know, a quick google search reveals that others have also thought of using hand hygiene as a mindful moment, eg this paper:

Gilmartin, Heather. (2016) Use hand cleaning to prompt mindfulness in clinic: A regular prompt for reflection could reduce distraction. BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i13 (Published 04 January 2016)

and this video:

There are others too. Do you think using hand hygiene as a mindful moment could become mainstream?

End

That’s it. As always your comments are welcome via the space below.

May you hands be clean and your head be clear! 🙂 

Paul McNamara, 26 November 2016

Short URL: meta4RN.com/hygiene

These words have been in my head and they needed to come out (a blog post about suicide)

Trigger Alert – this blog contains info re suicide which may be unsettling for some people.

Guest Post: Stevie Jacobs has contributed this guest post to meta4RN.com

Stevie Jacobs is the pen name of a newly-minted Enrolled Nurse. The person behind Stevie is smart, experienced in life and has some awesome insight into the world of the student and new graduate nurse.

You can follow Stevie Jacobs on Twitter: @SJWritesHere

Stevie has contributed to other nurse blogs, including the excellent site Injectable Orange, by Jesse Spurr.

These words have been in my head and they needed to come out
(a blog post about suicide)

I am ‘Pro choice’.

I am a patient advocate.

I am a person advocate.

I support euthanasia.

I am pretty much of the opinion that if you have all the facts, figures and feelings figured out then you can go ahead and do pretty-much whatever you like. Even if it’s ‘bad’ for you. I can provide you with action plans and phone numbers and personal support, however ultimately, the choice my friend, is yours.

So when someone wants to kill themselves/suicide/take their own life (however you want to put it) what does my head feel about that? I’m not talking about obligations as a Health Care Professional, I’m talking about obligations as a human being. I can provide you with an ear to bend, a shoulder to lean on, I can find you professional help if you want, I can tell you that I don’t think you’re in a safe space and I want to get more support. For both of us. I can do all that. What I am stuck with is that if euthanasia is assisted suicide and I’m OK with that (OK meaning I won’t physically stop you nor judge you), does that mean I am ‘OK ‘ with someone’s suicide? Both have the same ending:, the removal of pain through the death of a person. I don’t know how my heart or my head feel about that.

Robin Williams was 63. That’s a long time to be living in pain. Yes, there are medications and therapies and support groups, but what if that starts to feel just all too much? That living is just all too much, a bit like ‘diabetic burnout’, where the person with diabetes basically gets fed up with ‘managing’ their diabetes and becomes unwell. That can happen with all chronic diseases. That can happen with mental health issues. Yes, some people have a depressive episode, it’s self-limiting and then they never have another one. Wonderful. For others, it just keeps on coming back, more painful than before.

To someone who is experiencing suicidal thoughts, suicide I can seem to be a rational method of pain relief. It’s the ultimate pain reliever for the person experiencing the thoughts.

For those left behind it can be devastating.

I can’t make up my mind. Do I have the ‘right’ to stop someone from suicide? I’m on the fence. The boundaries get blurred. I’ve experienced anxiety & depression, I’ve experienced suicidal thoughts & been ‘suicidally depressed’, I’ve had a family member suicide and I’ve known someone I followed on Twitter suicide. Which is a really fucking weird experience, quite frankly. Grief for someone who you ‘know’, but don’t ‘know’. 101 ‘What ifs?’. I could ‘see’ that something wasn’t right, but aside from checking in and offering an ear what else could I do? I’m at peace with those choices now, no longer haunted by ‘what ifs’. I’m sure that is not the same for their family and friends. I realised that what has stayed in my head is a photo of themselves they posted shortly before it happened. It’s their eyes. Their eyes haunt me. I can see something in their eyes I’ve seen time and time again. In my face. In the faces of others. I know those eyes so well. However good your mask is it’s in the eyes.

So, what to do? Who am I to tell anyone what to do? There isn’t really a clear answer. I think it’s really important to keep checking in on people: RU OK? I have RUOKed a few people and I will keep doing it. If it’s a ‘No’, and they express some ideas that worry you, it’s OK to ask “Do you have a plan?” If it’s a ‘Yes’, what then? Especially if you just don’t believe them. That’s trickier ground to navigate. I’m no expert on this. There are links at the end of this from people who are.

RU OK? It’s just a simple question. A simple, lifesaving question. I was on another planet from OK, and someone who barely knew me asked me that question.

It was like a thunderbolt.

It made me stop and think and choose to get help to make living less painful. Choosing to get help is hard. Getting help can be harder. What’s even harder is acknowledging that choosing to live is a conscious effort. It’s an effort. Accepting that medications and therapy and exercise and diet changes and avoiding triggers are now part of your life is an effort.

In time I hope that life will once again become effortless, but it might not.

Finally, after years of effort, I now think I am OK with that.

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Post Script 1:

I wrote the above post a little while back. Normally when I have said all I have to say on a subject it doesn’t pop back in to my head. This post did. If I am honest, I have only scratched the surface. I have more to say. The way I write usually is like a good vomit on a night out: it all comes out in one go and it’s done and dusted and you’re up and dancing again. The other way I write is a bit more like a gastro bug: on and off with a bit of dry retching when you just can’t get it out. Then you’re done and you feel better.

Paul told me the ‘meta’ point of meta4RN is ‘talk about what you’re talking about’. So I guess that’s what I’m doing here. Rereading the above, reflecting on it and trying to work out quite what it is that I still feel I want to say.

We need to talk about mental health. We need to talk about suicide. We need to do it in a safe, appropriate and open way, but we do need to talk about it. Talking about it is hard. Talking about it can be terrifying for anyone. Talking about it when you’re a health professional is really damn hard. There are so many ‘what ifs’. What if they ‘lock me up’? What if they don’t? What if they think I’m not fit to practice? What if I lose my job? What if my colleagues find out? What if I have to be treated in the same hospital that I work in? What if…

I want to talk about how it feels to have suicidal thoughts. I want to talk about how it feels to be suicidally depressed. I’m not sure how to do that. I know that there are media guidelines for discussing suicide. As someone who is trying to describe a ‘lived experience’, I decided the best way for me to write was to let it all come out uncensored, and then give it to Paul to edit it using some of those guidelines and make it ‘safe’. I am in a safe enough space now to be brutally honest about how those suicidal thoughts feel, and far away enough from those thoughts to be able to talk about them without feeling ‘triggered’.

I can only speak for myself. For me there is a distinction between having suicidal thoughts and being ‘suicidal’ or ‘suicidally depressed’, as I have referred to it in the past. The thing about ‘suicidal thoughts’ is that the longer you have them the more rational they seem. For me suicidal thoughts are more of a hypothetical notion; it’s not something I am going to carry out. It’s an icy calm IF. IF things don’t get better, IF that was to happen, IF there isn’t another way out, IF the pain becomes unbearable, IF.

I know exactly how I would kill myself. I know exactly how I would spend the jackpot from a lottery win. I know exactly what I would get done if I had free access to plastic surgery. It’s all hypothetical.

It’s hypothetical. Until it’s not. Until I am suicidally depressed. Until I am in pain. Until the self-loathing I carry around with me every day takes over. Until I truly believe that the people in my life would be better off without me. Until I can’t see any way out aside from that way. And that place is not icy calm. It’s a messy, clinging on to something, anything to get through hour after hour, painful, emotional swamp. I feel emotionally swamped. I can’t think in a straight line. I can’t sleep. I can’t eat. The anxiety eats at my stomach. The panic attacks feel like I am dying of a heart attack. The after effects of which last for days. And nothing, nothing stops the pain. That’s how suicidal feels like for me. I know, however, that it is not what it looks like to other people. People see what they want to see. Even people who are trained to see more. I am brilliant at hiding it. I know how to put on my mask and polish up my armour. It is exhausting.

There are cracks in my armour, sometimes the mask slips. My fellow walking wounded can see though them, but for the most part the people I see every day wouldn’t know. I can make people feel so good about themselves. I can make people cry with laughter. Then, the second I am alone, the pain floods over me and I can barely breathe. I keep coming back to pain. It’s about pain. Not control, nor attention seeking, nor escape; in that moment it is about wanting that pain in my heart to stop. To. Stop.

It’s a horrendous place to live to be honest. It’s a half life. I had to choose to live better. To live for me. To get help – medications, counselling, CBT, exercise, diet. It’s a conscious choice. And what helped me make that choice was being asked ‘RU OK?’

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Post Script 2:

So, turns out it’s not a verbal gastro bug. It’s verbal C.Diff. The words just keep coming out.

I think I need to make it clear that I am talking about a period of over 10 years. I need to make it clear that I am talking about the past. I might write ‘I know’, but I suppose really it is ‘I knew’. Deciding to share this is a decision that has been easy, but it is a decision that I have made because these words have been in my head and they needed to come out. There are more things I could say, about specific attempts, specific feelings. However, I don’t want to share them. I think that’s OK.

I need to make it clear that I support ‘RUOK’ & WHO suicide prevention strategies. I need to make it clear that if you judge me negatively based on what I have written or if it changes your opinion of me, then that’s your thing, not mine. I’m not asking for agreement or understanding, but I do ask for kindness.

I was asked recently what the best thing in my life is right now. Aside from Nursing, the answer is the people in it. I know that my people love me, and accept ‘me’, and that’s enough.

Black Dog Institute Healthy Living Study is a program to help those experiencing suicidal thoughts manage them: http://www.blackdoginstitute.org.au/public/research/participateinourresearch/index.cfm

End.

Short URL:  meta4RN.com/guest02

Many thanks to Stevie Jacobs for sharing this gutsy piece of writing. Your sensitive, constructive feedback is welcomed in the comments section below.

It’s also important to acknowledge that talking and thinking about suicide can be distressing. People in Australia can access support via:

Lifeline – 13 11 14

Suicide Call Back Service – 1300 659 467

MindHealthConnect www.mindhealthconnect.org.au

Outside of Australia and not sure where to get support? Google usually displays a red telephone icon and your country’s suicide support phone number when searching for a suicide-related topic.

This guest blog post has a companion piece, which I have imaginatively called “A Blog About A Blog About Suicide” – the link is here: meta4RN.com/mindframe

Paul McNamara, 23rd September 2014