Tag Archives: COVID-19

On RATs and Nice

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A few months ago a half-formed idea about idea about continuing to take pandemic precautions, being kind to each other, and dumb luck began to take shape. The idea was in the context of my favourite human (@StellaGRN) testing positive to COVID-19, and me not.

Same precautions. Same knowledge-base/education. Same vaccination status. Same workplace. Same bedroom, bathroom, kitchen and sofa. Different results.

Follow the science. Hope for luck.

Follow the science. Hope for luck. (don’t do it the other way round)

I – a mental health nurse – didn’t get around to progressing that half-formed line of thought into something coherent. Then in early July I stumbled across a twitter thread by Trent Yarwood – an infection diseases physician. Trent articulated my half-formed ideas about following the science and hoping for luck (not the other way round) better than I could have.

With Trent’s permission, that Twitter thread has been copied and pasted below:

There’s plenty to be upset about in the pandemic.

It’s ruined our social lives, stuffed up our travel plans. More importantly, it’s killed millions of people, disabled some, forced people out of work and had a myriad of other effects.

You can make a pretty solid argument that the public health communication has been woeful. Frequently changing, late, technically complex, not always helpful.

You could equally talk about the incredible difficulty in communicating uncertainty about a rapidly changing situation, balancing the needs of “you told us this at 5pm Friday” vs “why did you wait the whole weekend to tell us this”.

You can (and people have) done entire careers’ worth of research on techniques for best practice in doing this sort of communication.

But the CHOs (and the talking heads) haven’t all done PhDs in risk comms, so they didn’t always get it right. Just like the advice which turned out to be not-entirely correct with the advancement of knowledge and time was – unless you are tin-foil-hatter – the best it could be at the time it was delivered.

But here’s a few questions to ponder.

Imagine you’re late for work. Is it because:
a) you didn’t leave early enough to have some slack
b) that dickhead in the volvo was in the right lane?

You’ve had a minor surgical procedure and the wound has gotten infected. Is it because:
a) Sometimes, Staph happens.
b) The surgeon must have done something wrong

Your washing machine has just broken and ruined your favourite 80s band t-shirt. Is it because:
a) it’s 10 years old and it’s had a good life
b) your landlord is a tightarse and bought dodgy-brand

What is your locus of control?

Is someone else (God, fate, other stupid dickheads) responsible for everything that happens in your life? Or do you make the best of what you have and sometimes, chance fucks you over?

If you’ve been through relationship counselling, you’ll know that they tell you that you can’t hope to change the other person, you can only change yourself. So is being angry at the dickheads “who gave you COVID” going to change the way they behave? Or is it just going to make you angry?

And finally, don’t forget it’s baked into the name. Pandemic: pan-demos – all of the people.

Railing against inevitability is a pretty sure way to make yourself miserable.

Of course this doesn’t mean we shouldn’t be doing what we can to reduce transmission. But take control of the things you can.

Get your third (or fourth) dose. Encourage your friends to do the same.

Physically distance. Stay home if you have symptoms.

Mask.

Wash your hands

And finally, be nice to each other.

Isn’t the world shitty enough already?

ID EQ BC and AD

Trent’s articulation of emotional intelligence (EQ) isn’t unique for someone with an Infectious Diseases (ID) and/or public health background. This is evidenced below by two tweets from BC (Before Covid) and one from AD (After Disaster).

🙂

End Notes

Sincere thanks to Trent Yarwood for permission to reproduce his Twitter thread. The original thread can be accessed here and is collated here. To find out more about Trent follow him on Twitter (@trentyarwood) and/or check-out his profile and articles on The Conversation.

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

Paul McNamara, 20 September 2022

Short URL meta4RN.com/RATs

freedumb

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Once upon a time – a long, long time ago (2021, I think it was) – I put a lot of effort into promoting COVID-19 vaccination.

I have stopped doing that.

As of April 2022 it looks like nearly 5% of adult Australians will choose to never be vaccinated against COVID-19 [source]. It’s been over a year since vaccines arrived in Australia. In the first couple of months it was tricky to access the vaccines, but since mid-2021 it’s been pretty easy. The unvaccinated are unvaccinated by intent, not by lack of information or opportunity.

By comparison, about 11.6% of adult Australians smoke tobacco daily [source]. Smokers ignore the health warnings intentionally – it’s certainly not through lack of information: over 75% of packaging space on tobacco products consists of graphic and text information about the harmful effects of smoking [source].

Smoking is not illegal. Vaccines are not mandatory. Adults do what they want and accept the consequences of their choices. 

Despite what people have been shouting at their ‘freedom rallies’ and in courtrooms, vaccines are not mandatory. Never have been. On 07/04/22 it was reported that Simon Ower QC said his client did not get vaccinated because she believed the mandate direction left her with no choice and it was being forced on her [source]. There was a choice then, wasn’t there? It’s not mandatory/forced on you if, as per this example, you get to say “no thanks”.

Vaccines are a condition of employment for many jobs and remain condition of entry for some venues, but they’re not mandatory. Never have been. Nobody will hold you down and inject you with a vaccine. You get to choose. As articulated in a recent eloquent editorial in the International Journal of Mental Health Nursing, “The heavy hand of coercive care is still reserved for those hearing voices and seeing things, rather than someone at risk of spreading a deadly pathogen to an unvaccinated community.” (Keep, 2021).

Let’s not muck-around here. The people who have chosen not to be vaccinated have grabbed more than their share of media space, and some people (eg: Clive Palmer and Craig Kelly) are prosecuting a peculiar political message to tap-in to that disaffection.

Let’s not buy into their frogshit. It’s more sensible to mock people like Clive Palmer and Craig Kelly (fragile manipulative narcissists hate mockery), and stick with the data.

The data shows that Australia’s COVID-19 strategy has been pretty successful [source]:

Cumulative COVID-19 deaths 29 February 2020 – 6 April 2022 (comparison of selected countries)

Out of interest, Australia’s anti-smoking strategy has also been pretty successful [source]:

Annual smoking death rate 1990 – 2019 (comparison of selected countries)

With the exception of people under the coercive/mandatory treatment conditions of the Mental Health Act, people get to choose what – if any – health advice they follow and what health interventions they receive. .

Smoking is not outlawed. Although smoking and death rates have fallen markedly in that last 20 years, more than 11% of Australian adults choose to smoke daily.

Vaccines are not mandatory. Although more than 95% of Australia adults have had two or more COVID-19 vaccines, over 4% of Australian adults have decided not to have the COVID-19 vaccine.

Some people make good health decisions. Some people make not-so-good health decisions.

Clinicians are very accustomed to providing health care to those who make not-so-good health decisions and/or are pre-contemplative to change. My concern is that if people are taking health advice from Clive Palmer and Craig Kelly are they exercising freedom or freedumb?

Reference

Keep, J.R. (2021), Enter the plague. International Journal of Mental Health Nursing, 30:5, pp. 1037-1039. doi.org/10.1111/inm.12924

End

That’s it for this angrier-than-usual blog post. The blatant distortions of truth by some incredibly well-funded politicians has made me a tad cranky.

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

Paul McNamara, 8 April 2022

Short URL: meta4RN.com/free

Surfing the Omicron Wave

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There isn’t much in the way of surf in Cairns because the Great Barrier Reef is – ahem – a great barrier. Nevertheless, this year heaps of people who live and work in Cairns showed how skilled they are at big-wave-surfing.  

The Queensland borders did not open until Monday 13 December 2021. This allowed every adult who wanted to get vaccinated the opportunity to do so. Comparing what happened locally to what’s happened elsewhere around the world, it’s clear that having more than 90% of the adult population with some vaccination coverage before opening the borders made a huge difference to how high and long the Cairns omicron wave has been.  

In Cairns our COVID-19 omicron wave started slowly. There was just a trickle of COVID-19 positive people who required hospitalisation either side of Christmas 2021. From early in the New Year the omicron wave behaved more like a tsunami. The wave came in much faster and was much larger than most of us had anticipated. It was pretty scary. Two thirds of the way through January some of us were worried about drowning. At that stage we had three wards 100% dedicated to caring for COVID positive patients, plus a smattering of positive people in other wards and in ICU.

Much to our relief the wave crested and crashed nearly as quickly as it arrived. At the end of the first week of February we still had three COVID-dedicated wards, but they weren’t quite as full or as intense as the week before. A week later we were down to one ward 100% dedicated to COVID. A week after that we had zero wards 100% dedicated to COVID; positive patients were being nursed in negative-pressure rooms as per pre-pandemic practice. Amazing.

In Queensland, especially in Cairns, we know we’ve been very fortunate compared to many people and places in the world, but that doesn’t diminish the admiration I have for all the big-wave-surfers at work. Don’t forget, as argued previously [here] , they are NOT heroes – they are health professionals. Heroes tend to be blokes who are big, boofy and fictional. People in the hospital working with COVID patients are mostly women who are not-big, not-boofy and they are real lanyard-and-PPE-wearing nurses, ward clerks, cleaners, wardies, physios, doctors, specchies, OTs, security and catering peeps.

Despite the lack of practice we have with waves in Cairns there are heaps of really good big-wave-surfers here. This is evidenced by how gracefully and expertly they surfed the omicron wave. 🏄‍♀️

Not All Good News

It would be disrespectful not to acknowledge that it’s not an entirely good news story. The wave has diminished in size and strength, but has not disappeared yet. Also, some of the people who were hospitalised with COVID during this period have a very slow, difficult pathway towards recovery. Poignantly, twenty seven local people did not survive COVID during this period. Their families and friends are in our thoughts.  

End Notes

Data Sources: The hospital/ICU numbers were released every few days via internal “Team Brief” emails and/or via social media – these were the sources of the data used to create the chart above.

Thanks for reading. If you know someone who has surfed that omicron wave I’d be grateful if you make sure they get to see their portrait above. 🙂 🏄‍♀️

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

Paul McNamara, 22 February 2022

Short URL: meta4RN.com/surfing

Vax Facts for Nurses by Nurses

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Let’s start with a quote from this ANMF zoom page:

The fast moving pace of COVID-19 science both from disease progression and treatments has been hard to keep up with. As nurses and midwives, we are well-positioned to advocate for science and safety. In this webinar, Dr Jessica Stokes-Parish (RN, PhD) and IPN Romy Blacklaw will present the safety processes, research, surveillance of adverse events (including data on safety so far) and difference between COVID-19 vaccines.

The “Vaccine Science in the Context of COVID-19” webinar was on Thursday 26 August.

ICYMI (like I did), a recording of the webinar is available for free to Australian Nursing Midwifery Federation members, including the QNMU and NSWNMA branches, until 10 September 2021.

Have a sneak peek of the content here:

Want to see more? If so, login to the ANMF continuing professional education portal 👉 catalogue.anmf.cliniciansmatrix.com 👈  by 10 September and search on the word “vaccine”. Despite missing the live event, you’ll still get a certificate in recognition of continuing profession education on completion (see example below).

What’s with the blog post? 

I have three reasons for promoting the webinar.

  1. I think the content of the webinar is worthwhile sharing. I really enjoyed learning about the COVID-19 vaccines in more depth than the info I had picked-up from work, online and in the mainstream media.
  2. Free, quality and easily accessible CPD/CPE for nurses and midwives deserves a shout-out, right? 🙂
  3. I reckon there’s a future for nurses delivering short, sharp and evidence-based information via video online. Not convinced? Have a look at the less-than-two-minute-long video clip above and see if you find it interesting/useful. I do.

Acknowledgement

Sincere thanks to the webinar presenters Jess Stokes-Parish and Romy Blacklaw, and the webinar host Australian Nursing and Midwifery Federation, for permission to use the video excerpt above, and for providing engaging and interesting CPE.

I was distracted for 15 seconds when a Harley loudly blurted past my house, and another 30 seconds by the dog chewing my thongs, so when claiming CPD hours for AHPRA will detract 0.0125 hours from the total. #fulldisclosure

End

That’s it.

You have less than 10 days to:

  1. hit this 👉 catalogue.anmf.cliniciansmatrix.com 👈 website
  2. login using your ANMF/QNMU/NSWNM membership info
  3. search the word “vaccine”
  4. and complete the free “Vaccine Science in the Context of COVID-19” CPD

Quick sticks! Don’t dilly-dally! Get a wriggle-on! 🙂

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

Paul McNamara, 1 September 2021

Short URL: meta4RN.com/VaxFacts 

Addit (to encourage Kiwis and Aussies)

CLovid Communication

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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

Vaccination Celebration

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2020 was ‘Year of the Nurse’, but it wasn’t until 2021 – when we had access to COVID-19 vaccinations – that we celebrated.

If you had told me in March 2020 that I would be vaccinated against COVID-19 before the end of March 2021, I would have told you you were crazy. And yet, here we are. I had my second injection this morning. Yay!


Dose 2 of 2 ✅ #COVID19 #COVIDvaccine

In keeping with the TGA guidelines (read them if you’re a health professional: www.tga.gov.au/advertising-covid-19-vaccines-australian-public), I shall not use “the tradename and/or active ingredient of the specific vaccine” I was given. That little formality out of the way, I’d like to thank the following:

Science and Scientists who, in less than a year, have developed eleven vaccines. Not all of them have completed clinical trial or the WHO approval process yet (more info here), but still… Amazing.

Australia’s federal government for shutting the borders on 20 March 2020, and securing the purchase and manufacture of safe, effective, free COVID-19 vaccinations.

Queensland’s state government for being humble, smart and brave enough to seek and follow the health advice. As I’ve blogged previously (here, here and here). those of us living and working in the health sector in Queensland have a lot to be grateful for. Queensland has a lower incidence of COVID-19 than any other state or territory (source), and despite having a larger population than New Zealand has had fewer COVID19 cases and deaths (source and source). This all holds true today (30 March 2021) despite a current Brisbane lockdown and state-wide mandate to wear masks indoors because of recent community transmission.

My employer for including my small but dynamic team in the 1A rollout. My clinical role takes me to pretty-much every ward in the hospital, so I’ve be carrying the anxiety of being a potential super-spreader for the 12 months. A weight has been lifted. Thank you @CairnsHHS.

Finally, thanks to Frankie and Laura for giving both of my injections so painlessly and professionally. Thanks for the lollypops too :-).

I am very, very grateful to be be amongst the thousands of Australian nurses having a vaccination celebration.

Wait. There’s More.

Check-out more stories about Australian Nurses also having a vaccination celebration via this online curation: wakelet.com/@metaRN (recommended – it’s uplifting to scroll through all the news stories featuring heaps of nurses getting and giving COVID-19 jabs).

End

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

Curious about the vaccine or when you’re likely to be invited to have it? Check out this website: health.gov.au/covid19-vaccines

Paul McNamara, 30 March 2021

Short URL: meta4RN.com/vax 

Addit @ 2 November 2021

I’m a little conflicted between celebrating my good fortune and flaunting my privilege, but I am very pleased to have received a third vaccination today. This is prophylaxis/risk reduction in preparation for the borders opening next month, and the inevitability of the virus circulating in my community/hospital.