Body Image and Eating Disorders Awareness Week (#BIEDAW) 2022 @ Cairns Hospital Grand Rounds

Cairns Hospital Grand Rounds on Friday 9 September coincided with 2022’s Body Image and Eating Disorders Awareness Week (#BIEDAW). Understandably, it was planned that the session should focus on eating disorders.

Dr Janet Bayley, Consultant Psychiatrist with NQuEDS* was to present, but was unexpectedly unavailable. Janet passed the baton to Dr Sharmila Prakash, Consultant Psychiatrist with Cairns Hospital’s Consultation Liaison Psychiatry Service. Unfortunately, Sharmila also became unexpectedly unavailable. That’s where – Steven Bradbury style – I slid-in to be on the Cairns Hospital Grand Rounds program.

There were two other presenters on the theme of eating disorders at Grand Rounds. Consultant Nephrologist and Physician Dr Bibin George presented very interesting early data from an audit of Cairns Hospital eating disorder medical admissions. Psychiatric Registrar/Dual Advanced Trainee Dr Manjuka Raj presented early results from her research examing core competencies of staff involved in a new eating disorder service. There is a fair chance that each of these research projects will progress to publication in future – keep an eye out for them.

My presentation was not about hard data or research. It was an overview of the role that a Consultation Liaison Psychiatry Service has when a person is admitted to hospital as a medical patient because of problems associated with an eating disorder. For those interested the session was videoed:

Regular visitors to meta4RN will note that this presentation looks remarkably similar to this one: Consultation Liaison Psychiatry Service @ CHHHS Eating Disorder Forum. That’s because it is pretty-much the same presentation with a few tweaks.

So What?

A few dozen people go to Cairns Hospital Grand Rounds either in person or via Zoom. The meta4RN blog extends that reach. If you were not at Cairns Hospital Grand Rounds yesterday, and have an interest in the care of people admitted as medical inpatients because of an eating disorder, perhaps the video is worth a look.

Also, just in case I (or you) want to revisit or recycle any of the info in the presentation, here is the link to the Prezi.

_{Cairns Hospital Grand Rounds 9 September 2022}

NQuEDS*

NQuEDS = North Queensland Eating Disorder Service. More info about NQuEDS here and here. Enquiries about referral should be directed to 1300 64 2255 (1300 MH CALL).

End Notes

That’s it. Thanks for visiting.

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

Paul McNamara, 10 September 2022

Shirt URL meta4RN.com/BIEDAW

Supporting the person diagnosed with a personality disorder who presents to the Emergency Department following intentional self-harm

About eighteen months ago I was invited to contribute a chapter to a book on Mental Health in Emergency Care. The chapter was to be named “Supporting the person diagnosed with a personality disorder who presents to the Emergency Department following intentional self-harm”.  

Pretty-much straight away I asked Enara Larcombe to co-produce/co-write the chapter with me. Co-production is in keeping with the “nothing about us without us” idea (which has gained a lot of buy-in from senior mental health nurses). My reasons for asking were:

• It’s good manners
• It would improve the contribution
• It would be difficult to write on the subject without including learnings I’ve acquired when working with Enara

As it turns out, in the process of collaboration Enara became the lead author of the chapter. Enara did the lion’s share of the literature search, and contributed some fantastic lived-experience insights. Enara certainly earned lead authorship. After lots of to-ing and fro-ing between us, Enara and I proudly sent off our chapter about a year ago.

The key points of the chapter are:

• Borderline personality disorder is often misunderstood, and many people who have been given this diagnosis feel that it has stigmatised their care in the hospital and health system. 
• Intentional self-harm is a complex phenomenon; it does not always indicate a wish to die. 
• Nurses and other emergency care professionals are well placed to provide both physical and mental health care to the person who presents following intentional self-harm. 

 The learning outcomes we hope the chapter will assist with are:

• Improve your understanding of the diagnosis of borderline personality disorder and what this means for the person. 
• Articulate the differences and similarities between a suicide attempt and non-suicidal self-harm. 
• Describe examples of stigma that the person who self-harms experiences and consider how this might impact on practice. 
• Identify nursing interventions and practices that are helpful to the person who self-harms.   
• Describe the communication and interpersonal skills that can be deployed to support the person who intentionally self-harms/who has been diagnosed with borderline personality disorder. 

So What?

Today I learned that the book with our chapter is available for pre-purchase.

Shit is getting real homies.

• 

  _{Mental Health in Emergency Care
  https://www.elsevierhealth.com.au/mental-health-in-emergency-care-9780729544214.html}

• 

From the info available on the website, it looks like our chapter has been renamed from “Supporting the person diagnosed with a personality disorder who presents to the Emergency Department following intentional self-harm” to “Emergency Department: Person with personality disorder presenting with deliberate self-harm”.

I prefer the kinder, more respectful “Supporting the person diagnosed with..” bit, but anyway…

Anyway, I’m pleased-as-punch to be a co-author of a chapter in a book. Not perfoming at quite the same level as Tim Winton or JK Rowling, but for me it’s still a big deal.

Chapter Reference

it’s a pain-in-the-arse citing chapters in reference lists, so in the interests of encouraging you to read and cite the chapter, let’s keep it copy-and-paste easy:

APA
Larcombe, E. & McNamara, P. (2022) Emergency Department: Person with personality disorder presenting with deliberate self-harm. In P. Marks (Ed), Mental Health in Emergency Care, (pp. 131-143), Elsevier

Harvard
Larcombe, E & McNamara, P 2022, ‘Emergency Department: Person with personality disorder presenting with deliberate self-harm’, in P. Marks (ed), Mental Health in Emergency Care, Elsevier (pp. 131-143)

MLA
Larcombe, Enara & McNamara, Paul. “Emergency Department: Person with personality disorder presenting with deliberate self-harm.” Mental Health in Emergency Care, edited by Peta Marks, Elsevier, 2022, pp. 131-143

Q & A

Q: Mental Health in Emergency Care will be on the bookshelves in about three months. Is it the perfect Christmas gift?
A: Yes. Yes it is the perfect Christmas gift. 🙂

Q: How much money do you make for each copy sold?
A: Zero dollars and no cents. 😦

Q: Huh?
A: Academic publishing puts a value on everything except the content creators. ikr

Q: Why skite in August about a book that is not available until November?
A: Because I intend to mothball this website in September. It’s now or never.

Q: Why skite about it all?
A: I was a scrape-through-average student at school. That was a LONG time ago, but still… being published suprises and delights me.

Q: So, do you admit that you’re just bragging?
A: I admit that I don’t hide my light under a bushel. I’ve written about this before [see A Nurse’s Digital Identity]. Get on board. Don’t be mean.

Q: Where do I find out more about the book?
A: www.elsevierhealth.com.au/mental-health-in-emergency-care-9780729544214.html

End Notes

Many thanks to Peta Marks for inviting the chapter contribution; huge thanks to Enara Larcombe for co-producing it.

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

Paul McNamara, 22 August 2022

Short URL meta4RN.com/chapter

CLovid Communication

This blog post aims to clarify how the clinicians on one Consultation Liaison (CL) Psychiatric Service communicate with general hospital inpatients who are being nursed in isolation during the COVID-19 pandemic.

Why? 

There has been some confusion re nomenclature of how we provide mental health assessment/support to hospitalised people in isolation . Hopefully by describing the pros and cons of the methods we’ve tried to date we’ll clear-up any misunderstandings. 

CLovid Communication options: 1. Videoconference. 2. In-Room (featuring Jelena Botha in PPE). 3. Face-To-Face through a window. 4. Phone.

1. Videoconference Review
ie: using an online videoconferencing platform that works on both the clinician’s computer and the patient’s own device

Pros:

• No risk of infection transmission
• When it works there is reasonably good eye contact and exchange of facial expressions and other non-verbal communications, leading to opportunities for engagement/establishing rapport 
• Since mid-late 2020, nearly all clinicians and many (most?) consumers are familiar with videoconferencing 

Cons:

• In my clinical practice videoconferencing for these reviews has been mostly unsuccessful. Cross-platform incompatibility and limitations to what the devices/bandwidth that hospital inpatients in isolation have access to have been problematic.
• At our end, clinical workplaces do not provide access to the same platforms our patients typically use (eg: FaceTime, Video Chat on Facebook or WhatsApp).
• The technology was getting in the way of the therapeutic relationship, not enhancing it.
• For these reasons, we pretty-much gave up on trying to videoconference hospital inpatients in isolation back in April/May 2020. 

2. In-Room Review 
ie: in full PPE – face mask, goggles/face shield, gown and gloves

Pros:

• Physical proximity is standard practice: Clinical staff and the people we care for are familiar with this 
• Reasonably good eye contact and partial exchange of non-verbal communication, leading to opportunities for engagement/establishing rapport

Cons:

• PPE obscures facial expressions, thereby inhibiting rapport/assessment
• An extra clinician(s) using PPE resources
• With no disrespect to my CLPS clinical colleagues, we’re generally not as well-drilled with donning and doffing as the specialist nursing and medical teams, creating potential risk of infection transmission

3. Face-To-Face Review 
ie: through the window/glass door panel, using phones for easy/clear auditory communication

Pros:

• Good eye contact and exchange of facial expressions and other non-verbal communication, leading to opportunities for engagement/establishing rapport
• No risk of infection transmission
• Low-tech, easy to organise
• Well received by nearly every hospitalised person in isolation that my team has seen from March 2020 to August 2021

Cons:

• Reminds me of prison-visit scenes in American movies

4. Phone Review 
ie: speak to the person on their personal mobile or bedside phone, no visual contact

Pros:

• No risk of infection transmission
• Low-tech, easy to organise 
• It’s the go-to method of communication for community mental health intake clinicians/services (ie: thought to be a good-enough tool for most triage and sub-acute presentations; may be familiar to the clinician or consumer)
• Some people find emotional expression easier without the intimacy/intrusion of eye contact

Cons:

• Assessment and rapport may be limited
• Not thought to be adequate for acute or high-risk presentations

And The Winner Is…

Number 3: Face-To-Face Reviews, ie: where the clinician and person in isolation chat through the window/glass door panel, using phones for easy/clear auditory communication. 

It’s cheap, easy and effective. We use it nearly every time when there’s someone in a negative-pressure/isolation room. We’ve saved dozens, maybe hundreds, sets of PPE, and we’ve reduced the likelihood of becoming potential super-spreaders. 

Why Does It Matter?

Like just-about every other specialist mental health nurse on the planet, my clinical practice is influenced by Hildegard Peplau. Back in the 1950s dear old Aunty Hildegard had the audacity to tell nurses that, done right, the nurse-patient relationship = therapy [source]. About 60 years later neuroscience caught up with nursing theory and showed us that Peplau was right: strong relationships and strong attachments help brains heal by building new neural pathways [source]. 

A specialist mental health nurse is, amongst other things, a psychotherapist and a relationship focussed therapist [source]. A face-to-face review, even if has to be through glass, helps establish rapport and build a therapeutic relationship. 

CLovid Acknowledgements

Consultation Liaison Psychiatry Service is a bit of a mouthful, so it’s usually abbreviated to “CL”. CL = mental health in the general hospital. 

Back in March 2020 John Forster, a CL Nurse in Melbourne, accidentally coined the portmanteau “CLovid” by combining “CL” and “covid” as a typo. 

That’s why I’m calling this blog post “CLovid Communication”. 

Please forgive people like me who take delight in silly things like an accidental neologism. There’s been a fair bit of CLovid in the last eighteen months, and there’s more to come. Staying vigilant to the small joys and moments of lightheartedness is a survival skill. 

Thanks also to Jelena Botha, CL CNC (who arrived on my team just in time for the global pandemic 😳), for allowing me to use her PPE pic.

Further Reading

Cozolino, L. (2006/2014) The Neuroscience of Human Relationships: Attachment and the Developing Social Brain. New York, W. W. Norton & Company. [Google Books]

Hurley, J. and Lakeman, R. (2021), Making the case for clinical mental health nurses to break their silence on the healing they create: A critical discussion. International Journal of Mental Health Nursing, 30(2): 574-582. https://doi.org/10.1111/inm.12836

Peplau, H. (1952/1991) Interpersonal relations in nursing. New York: Putnam. [Google Books] 

Santangelo, P., Procter, N. and Fassett, D. (2018), Seeking and defining the ‘special’ in specialist mental health nursing: A theoretical construct. International Journal of Mental Health Nursing, 27(1): 267-275. https://doi.org/10.1111/inm.12317

End

What have I missed from this description of CLovid communication? Please add your on-the-job experiences and lessons in the comments section below.

Paul McNamara, 14 August 2021 

Short URL meta4RN.com/CLovid

Mental Health in the General Hospital (video version)

A couple of weeks ago I was an invited speaker at the ANMF Vic Branch & NMHP Wellness Conference. The session was titled “Mental Health in the General Hospital”. Regular visitors to the meta4RN.com blog would have seen the accompanying web page to the presentation (here it is: meta4RN.com/ANMFvic).

This week the recording of the conference became available. I’ve snipped my session into a YouTube video and saved it here so it’s easy to find and share with those who have expressed an interest in seeing it (thanks Mum 🙂).

For reasons I don’t understand the video version of the presentation is blighted by a couple of static black boxes; these are not visible at all when viewing the actual Prezi. Mysterious. 🤷‍♂️

My noggin is a bit blurred/asynchronous when on screen – that would be due to the NBN being slowed to a crawl by copper wire, I guess. Fibre to the node, eh? 🙄

Those couple of things aside, it’s interesting (for me) to see the video version back. Yes, it’s a bit embarrassing, but it also shows me the sort of things I should try to improve for future presentations. Less face-touching, for instance. 😕 

Still image from the video. L-R: Eduardo D’Bull, Stone Woman by Ruth Malloch, Paul McNamara and Bessie D’Cow.

End

That’s it. No need to ramble any further – this blog post is all about the video (feat. Eduardo D’Bull and Bessie D’Cow). 📺 🐮 🐄

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

Paul McNamara, 29 May 2021 

Short URL meta4RN.com/vid

Mental Health in the General Hospital

On Friday 7 May 2021 I’ll be presenting at the ANMF Vic Branch & NMHP Wellness Conference. My session is tilted “Mental Health in the General Hospital”, and is followed by a session by Magda Szubanski!

I’m not making a fuss about presenting back-to-back with one of Australia’s most loved actors, although I may have mentioned it on Twitter…

Magda Szubanski and I are presenting back-to-back.
No biggie. I’m not making a fuss about it or anything. 😬https://t.co/vwQ5XEyAm5 pic.twitter.com/XeO7dKE0GB

— Paul McNamara (@paulmcau) March 22, 2021

and Facebook www.facebook.com

and Instagram www.instagram.com

and LinkedIn www.linkedin.com

But otherwise, I hardly it mentioned it all. 🙂

Anyway, this page is a place to link to the Prezi and the presentation content for the session. Because the presentation draws heavily on previous work I’ve done, the reference list is ridiculously self-referential.

Prezi https://prezi.com/p/mk9smhldjhnx/mental-health-in-the-general-hospital/

CLPS Nurses (WTF?)

A random sample of journal articles by/about Nurses working in an Australia Consultation Liaison Psychiatric Service (not pretending/trying to be an exhaustive list).

Dawber, C. (2013), Reflective Practice Groups for Nurses. International Journal of Mental Health Nursing, 22: 135-144. https://doi.org/10.1111/j.1447-0349.2012.00839.x

Harvey, S.T., Fisher, L.J. and Green, V.M. (2012), Evaluating the clinical efficacy of a primary care‐focused, nurse‐led, consultation liaison model for perinatal mental health. International Journal of Mental Health Nursing, 21: 75-81. https://doi.org/10.1111/j.1447-0349.2011.00766.x

McMaster, R., Jammali‐Blasi, A., Andersson‐Noorgard, K., Cooper, K. and McInnes, E. (2013), Research involvement, support needs, and factors affecting research participation: A survey of Mental Health Consultation Liaison Nurses. International Journal of Mental Health Nursing, 22: 154-161. https://doi.org/10.1111/j.1447-0349.2012.00857.x

McNamara, P., Bryant, J., Forster, J., Sharrock, J. and Happell, B. (2008), Exploratory study of mental health consultation‐liaison nursing in Australia: Part 2 preparation, support and role satisfaction. International Journal of Mental Health Nursing, 17: 189-196. https://doi.org/10.1111/j.1447-0349.2008.00531.x

Sharrock, J., Grigg, M., Happell, B., Keeble‐Devlin, B. and Jennings, S. (2006), The mental health nurse: A valuable addition to the consultation‐liaison team. International Journal of Mental Health Nursing, 15: 35-43. https://doi.org/10.1111/j.1447-0349.2006.00393.x

Sharrock, J. and Happell, B. (2002), The psychiatric consultation‐liaison nurse: Thriving in a general hospital setting. International Journal of Mental Health Nursing, 11: 24-33. https://doi.org/10.1046/j.1440-0979.2002.00205.x

Wand, T., Collett, G., Cutten, A., Buchanan‐Hagen, S., Stack, A. and White, K. (2020), Patient and clinician experiences with an emergency department‐based mental health liaison nurse service in a metropolitan setting. International Journal of Mental Health Nursing, 29: 1202-1217. https://doi.org/10.1111/inm.12760

“The 7 D’s”
Dementia
Delirium
Depression
Deliberate self-harm
Disturbed behaviour
Dangerous Diets
Dodgy drugs

McNamara, P. (2014) A mental health nurse in the general hospital, blog post published by ‘My Health Career’ on 12/05/14, retrieved 03/05/21 www.myhealthcareer.com.au

Other resources re CLPS Nurses in Australia

toptipsforclnursesDownload

Top Tips for CL Nurses (PDF)

Australian College of Mental Health Nurses Consultation Liaison Special Interest Group (aka ACMHN CL SIG) acmhn.org/home-clsig

Pivot (verb)

A word that is more palatable than “change”, “adapt” and “survive”; came in to common use during the early days of the COVID-19 pandemic.

Distracted-boyfriend meme
– background/history wikipedia.org/wiki/Distracted-boyfriend_meme
– generator imgflip.com/memegenerator/Distracted-Boyfriend

The Other PPE

McNamara, P. (2020) Positive Practice Environment (the other PPE), blog post written 01/04/20, retrieved 03/05/21 meta4RN.com/PPE

Clean Hands. Clear Head.

McNamara, P. (2020) Clean Hands. Clear Head., blog post written 25/03/20 with an update on 08/12/20, retrieved 03/05/21 meta4RN.com/head

End Notes

Many thanks to Nursing and Midwifery Health Program Victoria and Australian Nursing & Midwifery Federation – Victorian Branch for inviting me to present.

Thanks to QR Code Monkey for providing a free, easy-to-use, QR code generator that allows for a logo to be inserted.

Something that pandemic has provided is ubiquitous uptake of QR codes, which makes this 2012 idea of deploying complex health information via a QR code more practical/relevant than ever. More info on this via the video below and/or ye olde blog post: meta4RN.com/QRcode

Thanks for visiting. As alway, feedback is welcome via the comments section below.

Paul McNamara, 3 May 2021

Short URL meta4RN.com/ANMFvic

Are there smartphone apps specifically for people who experience eating disorders?

Q: Are there smartphone apps specifically for people who experience eating disorders?
A: Yes. Three*
1. Rise Up + Recover www.recoverywarriors.com/app
2. Recovery Record – RR www.recoveryrecord.com
3. MindShift www.anxietycanada.com/resources/mindshift-cbt

Q: Is this the shortest blog post in the history of humans?
A: No. Please read on for elaboration, geeky stuff and a disclaimer (look for the red asterisk* below).

Elaboration

Recently I was chatting with someone who experiences an eating disorder and was asked whether there were any apps specific to their circumstances. I was a bit busy at work, and only had time to to check-out Australia’s digital mental health hub Head To Health, and found nothing specific to eating disorders there. A few things pop-up on a google search, but when you’re a health professional you need to be careful about prescribing digital technologies. As articulated in editorials, letters, journal articles and blogs, health professionals have a responsibility to do no harm, and provide credible, evidence-based information if giving advice re apps, websites or other digital technologies.

Geeky Stuff

Fairburn and Rothwell (2015, p. 1038) took a systematic approach to clinical appraisal of eating disorder apps, and concluded, “The enthusiasm for apps outstrips the evidence supporting their use.” Ouch.

But that was way back in 2015, some people are still giving eating-disorder-specific app development a go, and digital therapeutics evolve quickly, so I thought it was worth doing a search of credible sources anyway.

After searching Head To Health, later (in my own time boss) I had a look at the Queensland Eating Disorder Service (QuEDS) resource page, the Butterfly Foundation website, and the Eating Disorders Victoria site and couldn’t find recommendations for apps. I then signed-up for ORCHA (“the world’s leading health app evaluation and advisor organisation“) and did a search there – that yielded poor results. Searching ORCHA for “eating disorder” was too broad and yielded a list of food/diet-related apps. Searching ORCHA for “anorexia nervosa” yielded two apps that had a green rating – one was a NHS/UK-only app, and when I clicked the other one on the App Store the top review spoke about their weight-loss. It might be a good app, but I’m afraid to share it here. That sort of thing would probably be laughed-off with an eye roll by someone who is living with an eating disorder and is in a good head space, but could really throw a spanner in the works for someone who isn’t in a good head space. The mortality rate of eating disorders is a worry, so primum non nocere.

Then I stumbled into the Centre for Eating and Dieting Disorder (CEDD) website and found a resource called “Navigating Your Way to Health” and, lo and behold, found this on page 33:

Using apps can be a handy way of helping you in your journey to recovery. We’ve listed some FREE apps here that might be useful. The following apps have been designed to help people with eating disorders to empower you to be in control of your recovery.
> Rise Up + Recover 
> Recovery Record – RR 
> recoveryBox 
> MindShift 

Disclaimer*

Although it was listed in the resource above, I left the recoveryBox app off my list at the top of the page because as at 09/08/20 (today) their website isn’t working. The app is still available on the App Store, but as the website is out of action, I’m guessing the app isn’t being updated any more. “Navigating Your Way To Health” was published in 2016 and, as noted above, digital therapeutics evolve quickly. It seems they devolve quickly too.

I’m pretty confident this is credible information as of right now, but who knows what reviews are underway or what apps are in development? Not me. For all I know there will be a fantastic Australian app co-produced by consumers/survivors, clinicians and academics tomorrow. I hope so. Just in case, check in on CEDD if you’re reading this after 09/08/20.

As noted in my recent blog post regarding the stepped care model (“One. Step. Beyond.” meta4RN.com/step) the concept of “one size fits all” doesn’t apply in mental health recovery. On the same theme, apps can be a useful addition to other strategies and useful for maintenance/relapse prevention. They should not be relied on alone if someone is experiencing significant symptoms of poor health.

I won’t pretend for a moment to have any special insight into what is a useful app for people who are experiencing an eating disorder, and don’t really have the time, skill-set or funding to undertake an independent review. I do trust the credibility of CEDD though, and if they say these apps are OK, who am I to say otherwise?

As originally noted in September 2012 (see number 13 here: meta4RN.com/about), the views and opinions I express here or on related social media portals do not represent the views of my employer. That really should be taken for granted, but anyway…

One last thing in this section: I don’t have any financial/other ties to any of the organisations or apps named above.

References

Daya, I., Hamilton, B. and Roper, C. (2020), Authentic engagement: A conceptual model for welcoming diverse and challenging consumer and survivor views in mental health research, policy, and practice. International Journal of Mental Health Nursing, 29(2): 299-31.
doi: 10.1111/inm.12653

Fairburn, C.G. and Rothwell, E.R. (2015) Apps and eating disorders: A systematic clinical appraisal. International Journal of Eating Disorders, 48: 1038-1046.
doi: 10.1002/eat.22398

Ferguson, C., Hickman, L., Wright, R., Davidson, P. & Jackson, D. (2018) Preparing nurses to be prescribers of digital therapeutics, Contemporary Nurse, 54(4-5): 345-349.
doi: 10.1080/10376178.2018.1486943

Hunter Institute of Mental Health and the Centre for Eating and Dieting Disorders (2016). Navigating Your Way to Health: A brief guide to approaching the challenges, treatments and pathways to recovery from an eating disorder. NSW Ministry of Health.
via cedd.org.au/begin-recovery 

Neumayr, C, Voderholzer, U, Tregarthen, J, Schlegl, S. (2019) Improving aftercare with technology for anorexia nervosa after intensive inpatient treatment: A pilot randomized controlled trial with a therapist‐guided smartphone app. International Journal of Eating Disorders, 52: 1191– 1201
doi: 10.1002/eat.23152

Søgaard Neilsen, A. & Wilson, R.L. (2019) Combining e‐mental health intervention development with human computer interaction (HCI) design to enhance technology‐facilitated recovery for people with depression and/or anxiety conditions: An integrative literature review. International Journal of Mental Health Nursing, 28(1): 22-39.
doi: 10.1111/inm.12527

Wilson, R.L. (2018) The right way for nurses to prescribe, administer and critique digital therapies, Contemporary Nurse, 54(4-5): 543-545.
doi: 10.1080/10376178.2018.1507679

End

That’s it. Thanks for reading down this far 🙂

As always, you’re welcome to leave feedback in the comments section below.

Paul McNamara, 9 August 2020

Short URL meta4RN.com/app

 

Liaison in the Time of #COVID19

.

This page is an accompaniment to a brief presentation at the Inaugural ACMHN Consultation Liaison Special Interest Group online webinar via zoom – it is just a place to plonk things that I’ll talk about in case anyone wants to clarify anything for themselves.

So, here goes:

As noted on a previous blog post, Queensland’s population is much bigger than Australia’s smaller states/territories, but falls a long way short of Australia’s two largest states. 

 

Queensland’s population size compares better to New Zealand, Ireland, Norway and Singapore than other Australian states and territories.

 

All the data below is true as of 1 August 2020 (as you probably know, 1st of August = the Horses Birthday in Australia).

 

It is interesting to compare the number of Covid-19 cases across similar-sized populations. Obviously there are many differences between the populations too – not the least of which is land area – so I’m doubtful that a proper epidemiologist or public health professional would put much stock in this comparison. That disclaimer aside, it is noted that Queensland has a larger population than New Zealand – which is held-up as a shining-light of Covid-19 control – but, to date, has a lower incidence of Covid-19 positive people.

 

I’m not sharing the data about number of Covid-19 deaths 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. That said, isn’t it interesting how low Singapore’s death rate is compared to that of Ireland and, to a lesser extent, Norway? Both New Zealand and Queensland have been very fortunate to date in limiting the number of deaths.

 

Comparing the number of new cases of Covid-19 in the last 24 hours (as at 01/08/20) is also interesting.

 

Links to Data Sources
New Zealand
Ireland
Queensland
Norway
Singapore 

 

In the session there will be mention of the “Clean Hands. Clear Head.” strategy to embed anxiety-management into everyday clinical practice. More info about his via the blog post and video of the same name: meta4RN.com/head

 

Also in the session there will mention of “Positive Practice Environment (the other PPE)” Again, there is more info about this via a blog of the same name: meta4RN.com/PPE

 

Finally, here is a link to the Prezi that was used to make the video. My understanding is that all these pretty Prezis will stop working at the end of 2020 when everyone stops using flash (just letting you know in case you’re looking at this page in 2021).

 

In Support of our Victorian Colleagues

Like an idiot, a couple of days ago I was awake in the middle of the night responding to a Trump tweet. Doing so was undeniably stupid, but I hope the data is encouraging to people in Victoria.#COVID19Vic ↘️ https://t.co/O0e6V0P5jV

— Paul McNamara (@meta4RN) August 4, 2020

 

End

That’s it. I hope some of this info is of interest. As always, you’re welcome to leave feedback via the comments section below.

Paul McNamara, 3 August 2020

Short URL: meta4RN.com/zoom

Ye Olde Yahoo CL Nurse eMail Network

Once upon a time (February 2002) there were a bunch of mental health consultation liaison nurses in Australia, New Zealand, and other places far, far away. They were separated geographically, but became connected via the magic of email.

Keep in mind it was 2002 – Google, Facebook, Twitter etc hadn’t made their mark back then, so starting a Yahoo email list was about as clever as we could get at the time.

In 2012-2013 our Ye Olde CL Nurse Yahoo eMail network [link] stopped being used, and we transitioned to the email platform hosted via the Australian College of Mental Health Nurses instead [link].  Anyway, today I stumbled across an old powerpoint presentation and poster re Ye Olde CL Nurse Yanoo eMail Network, and thought it would be nice to plonk them both online for nostalgic/historical purposes.

Here’s the powerpoint:

Australian & New Zealand Consultation Liaison Nurses eMail Network (2002 to 2008) from Paul McNamara

 

And here’s the text from the poster and a pic + PDF of the poster itself:

Consultation Liaison Nurses
Isolated Geographically. Connected Electronically.

The Mental Health Consultation Liaison Nurse Network aims to link peers for an exchange of information and ideas. Given the nature of this mental health sub-speciality, Nurses working in this field are usually pretty independent practitioners and often don’t have regular contact with peers who share CL Nurse experiences and interests

The email network originally spluttered to life in February 2002 and has gained momentum over subsequent years. The email network’s formation and development coincided with the formation and development of the Australian College of Mental Health Nurses (ACMHN) Consultation Liaison Special Interest Group (CLSIG). The email network is also promoted by the NSW/ACT Mental Health Consultation Liaison Nurses Association. The email network is maintained by the CLSIG, but the ACMHN and the CLSIG do not take responsibility for nor endorse opinions expressed through this network.

The email network is not moderated (ie: user’s comments are uncensored), but nuisance posts (abusive, racist, sexist, advertising etc) will not be tolerated. We take pride that the tone of the email network has been always casual, generous & supportive, and that it has attracted over 320 subscribers from at least nine countries.

No matter where you live & work, if you’re a Mental Health/Psychiatric Consultation Liaison Nurse you are very welcome to join our email network…

Here’s the PDF: 1008

One Last Thing

Just a reminder, this info is being released online in September 2019 purely for nostalgic and/or historical purposes. If you’re interested in an email network for consultation liaison nurses there is one, it’s just not the Ye Olde Yahoo one described here anymore. Instead, join the email network that is being hosted by the Australian College of Mental Health Nurses Consultation Liaison (CL) Special Interest Group (SIG): www.acmhn.org/home-clsig

End

Thanks for reading.

Paul McNamara, 27 September 2019

Short URL: meta4RN.com/email

Scale Fail

Please do yourself a favour, and watch Old People’s Home For 4 Year Olds on ABC iView. Over five beautifully-filmed episodes, the program follows a social experiment that brings together elderly people in a retirement village with a group of lively 4-year-olds. It’s one of the most enchanting, life-affirming TV programs I’ve seen.

Words that make me cry. “Excuse me, he’s my grown up” Four year old Aidan declares when speaking about Eric. #OldPeoplesHomeAU

— Stephanie Borys (@StephieBorys) September 24, 2019

The kids and the grown-ups were equally adorable – each dyad (one older person and one 4 year old) seemed to bring-out the best in each other. It was delightful to watch. Fiona the kindergarten teacher/facilitator was incredible. She has amazing interpersonal skills. [BTW: does anyone know Fiona’s surname? – she deserves to be credited properly]

I only have one problem with the program: the way the 15-item Geriatric Depression Scale (GDS-15) was used/portrayed. It was a very good idea that there was some pre- and post-intervention testing, and it’s terrifically handy to be able to quantify the degree that people self-rate their mood. However, all the scales I’ve ever seen, including the GDS-15,  come with the disclaimer that they’re screening tools, not diagnostic tools. However, that’s not the way the GDS-15 was portrayed on this TV program.

Screenshot from approx. 47 minutes into Episode 5 showing the false dichotomy that 5 or below on GDS-15 = “not depressed” and 6 or above = “depressed”. Pfft! As if.

In the TV program the geriatricians referred to scores above 5 on the GDS as “depressed”. That’s not quite the way it works. The GDS-15 does not diagnose.

Four reasons why the GDS-15 is not a diagnostic tool:

1. The GDS-15 asks for a “snapshot” of how the person has been feeling for the past week. As per the diagnostic frameworks used worldwide (DSM-5 and ICD-10) symptoms must be present for at least two weeks for depression to be diagnosed.
2. The GDS-15 is a dumb screening tool. It won’t (and can’t) take social circumstances into account. Many of the symptoms of depression are also symptoms of grief/bereavement/significant recent stress. GDS-15 questions include:
   • “Have you dropped many of your activities and interests over the last week ?”
   • “Over the last week have you been in good spirits most of the time?”
   • “In the last week have you been feeling happy most of the time?”
   • “In the last week, have you preferred to stay at home, rather than going out and doing things?”
   • “In the last week have you been thinking that it is wonderful to be alive?”
     If your spouse died 10 days ago, not only would these questions be terribly insensitive, but your answers probably wouldn’t be very positive. That doesn’t mean you’re depressed. That means you loved your spouse. The GDS-15 screens for symptoms, not context.
3. There’s more than one way to interpret the GDS-15 score. Which is the correct way? It depends who you ask:
   • As per the Royal Australian College of General Practitioners, “Although differing sensitivities and specificities have been obtained across studies, for clinical purposes a score >5 points is suggestive of depression and should warrant a follow up interview. Scores >10 are almost always depression.” [source]
   • As per an online version of the GDS-15 endorsed by the GDS-15 lead authors [source], the meaning of the scores are thus:
     0 – 4 = normal, depending on age, education, complaints
     5 – 8 = mild
     9 – 11 = moderate
     12 – 15 = severe
   •  As per the screenshot above, the geriatricians in Old People’s Home For 4 Year Olds set a cut-off line between “not depressed” and “depressed” at 5.5,
4. The model of a dichotomy of “depressed” or “not depressed” does not reflect reality. You don’t suddenly get labelled “depressed” because you scored 6 on the GDS-15, and you aren’t suddenly deemed “not-depressed” because you scored 5 the next time you’re screened. In reality, clinically significant changes in mood tend to happen over weeks or months. Minor day-to-day fluctuations are just part of the human experience – not something to be pathologised.
   When it comes to mood, you don’t cross a line between “depressed” and “not depressed”. There is a line, but it’s a continuum. It’s a continuum that we all slide up and down. It’s just that people who experience depression travel further along the continuum than they would like.

https://meta4RN.com/fineline

Closing Remarks

Please don’t let my critique of the use of the Geriatric Depression Scale deter you from watching Old People’s Home For 4 Year Olds. It’s a terrific program based on a wonderful idea, which is articulated further on the Ageless Play website [here].

Something I do in my paid job and as part of my [unpaid] social media portfolio, is to challenge the myths and misunderstandings that happen around mental health matters. As I’ve argued previously [here], all I’m doing in this blog post is articulating my argument why we should resist the temptation to interpret screening tools as diagnostic tools.

End

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

Paul McNamara, 26 September 2019

Short URL: meta4RN.com/scale

ieMR Liaison Psych Templates

A Quick Explanation

In the hospital that I work in we use ieMR. I’m a fan of ieMR, even though it has made the bad art of gingerbread women/men, genograms and other diagrams obsolete (more about that here: meta4RN.com/picture).

Car vs Bike Wounds: even an illustration that completely lacks artistic merit can convey a lot of information more effectively than a page full of text.

One of the reasons I like ieMR is that it accommodates auto-text/templates, which – in turn – assists clinicians to document with better consistency and more structure than they might have otherwise. When we have students on placement I used to send them MS Word versions of my ieMR templates, and assist them to get get them set-up on their ieMR account. That’s become a bit tricky to do since my hospital has shifted to Office365, so I am liberating the templates onto this blog page simply to circumnavigate that problem.

I’ve made it clear from the very beginning that this website does not represent the opinions of anyone else or any organisation (see number 13 here: meta4RN.com/about). So, just as a reminder, I’m putting the templates here because emailing them to students as word documents doesn’t work anymore. It’s not a recommendation for you. It’s not my employer’s idea. It’s fine if you don’t like the templates. It’s fine if you never use them yourself. I’m doing this simply for the convenience of me and the students I work with, that’s all.

Making ieMR auto-text/templates

To set-up ieMR auto-text/templates It’s easiest to get someone who knows how to sit with you for 2 minutes to show you. Really, about 2 minutes is all it takes.

In the absence of a helpful human there’s videos (eg: here) and PDFs (eg: here) to guide you. Or just google your question – some hospitals have their help info behind their firewall, but many do not.

That’s all the explanation I want to give. The prime purpose of this blog post is to share the content for easy copy and paste, so let’s get on with it…

Initial/Comprehensive Psychiatric Assessment

Review

Cognitive Screening results

End of Episode/Transfer of Care

End

That’s it. I’ve only just realised now that the formatting doesn’t carry across to ieMR. Bugger.

Please let me know via the comments section below if you know how to overcome that problem easily. BTW: as you can probably tell by this very basic-looking website, i’m not a coder or computer whiz. If there’s a fix it’ll need to be pretty straight forward for me to get it right :-).

Paul McNamara, 20 June 2019

Short URL: meta4RN.com/ieMR

This work is licensed under a Creative Commons Attribution-ShareAlike 2.5 Australia License.