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).
A pleasant surprise for a mental health nurse at an infection control conference: @CollignonPeter talking re emotional intelligence #ACIPC16
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.
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”.
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.
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: 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.
Can everything about self compassion be reduced to a 2 minute TikTok video?
Of course not.
Perhaps the key questions of what, why, how and who can be introduced though.
Let’s give that a try.
The “what” is the definition of self compassion, described here as “being empathetic and understanding towards oneself, as you might to a close friend in times of suffering”
That seems sensible. Let’s do that.
Why?
Because health professionals are more at risk of anxiety, depression and suicide than people in other jobs.
This chart is of Australian suicide data for the first 11 years of this century.
Male doctors suicide at the same rate as males in other occupations.
Female doctors suicide at twice the rate as females in other occupations.
Nurses and Midwives who are male have a suicide rate that is 50% higher than it is for males in other occupations.
Female nurses and midwives suicide at three times the rate of females in other occupations.
I’m not sure why these numbers are the way they are. Some of it would because of the nature of our work. I think some of it may be because of our collective psychopathology.
Do people who care for others prioritise their self compassion enough?
How do care for ourselves while we’re caring for others?
Here’s one idea: make every time you wash your hands a mindful moment for yourself too.
Use that 30 seconds or so as an opportunity to intentionally slow your breathing, calm your thoughts, to wash away some of the tension and stress, and to rub-in some good vibes.
Last, but not least, who can nurses and midwives reach-out to if they need a hand?
Hopefully you have, family, friends and workmates who can support you, but it’s good to know that you also have a 24/7 avenue to support on hand.
Nurse & Midwife Support is for all Australian nurses and midwives, including students and AINs. Check out the website and save the number in your phone in case you or a colleagues needs it one day.
That’s it.
Thanks for watching this ridiculously short intro to self compassion.
There is elaboration, links to data and resources, and a longer version of this video available via the QR code and meta4RN.com/grow website.
(in case the TikTok version at the top of the page doesn’t work, here it is on ye olde YouTube)
Here’s a link to the Prezi used to make the visuals. Video recorded at home in the bathroom, then edited and uploaded from an iPad (in the loungeroom).
End
Is there anything sadder than a middle aged man on TikTok?
No. There is not.
Paul McNamara, 19 July 2022
Short URL meta4RN.com/TikTokTry – TikTok try-hard, more like it 🙂
If you haven’t seen these three things happen yet, you probably will soon now that you’re on watch for them: – diagnostic overshadowing – documentation resulting in a cascade of bias – empathy failure
Together with Rebecca Callahan, I’ve written about diagnostic overshadowing before [here]. Diagnostic overshadowing is where current physical problems, symptoms or pathology gets overlooked, dismissed or downplayed because of the distraction of a documented history of a previous problem, eg: drug and/or alcohol use, mental health problems, or intellectual disability.
I was reminded of this when reading this excerpt from a recent article by Searby, Burr, James & Maude (2022):
I have a client who comes and sees me who has cirrhosis. I requested him to go and see a doctor at the local ED Department. ED don’t see him because they view him as just that junkie, just that drunk. This gentleman then has an acute exacerbation of his physical health, but it’s not seen as important…
Sound familiar? It’s not just in ED, it’s in other parts of the health system too.
Today I stumbled across a phrase I haven’t heard/read before: “a cascade of bias” (Martin, Bickle & Lok, 2022). The phrase “a cascade of bias” is in a report on a quantitative, observational study that compared the behaviour of nurses when they were exposed to either neutral or biased patient documentation. It’s embarrassing to me (a nurse) that the study found that biased language in documentation influenced how (un)helpful nurses were, and affected other aspects of clinical judgement and decision-making.
That’s a grim finding, isn’t it? It’s not just the unconscious cognitive bias of diagnostic overshadowing we have to watch out for. We have to watch out for letting that unconscious bias infiltrate our language in handover/documentation, so that we don’t inadvertently adversely affect the work of our colleagues too.
It’s easy to imagine diagnostic overshadowing (as per the excerpt above) leading to biased documentation, leading to a cascade of bias, resulting in empathy failure and poor outcomes for the patient.
That’s what my version of the distracted boyfriend meme is about.
It’s easy to be distracted from current problems, symptoms or pathology by biased documentation or past history.
Easy, but not cool.
Don’t be that guy.
References
Martin, K., Bickle, K. & Lok, J. (2022), Investigating the impact of cognitive bias in nursing documentation on decision-making and judgement. International Journal of Mental Health Nursing. doi.org/10.1111/inm.12997
Searby, A., Burr, D., James, R. & Maude, P. (2022), Service integration: The perspective of Australian alcohol and other drug (AOD) nurses. International Journal of Mental Health Nursing. doi.org/10.1111/inm.12998
End
That’s it. As always, please feel free to leave feedback via the comments section below.
Self Compassion is defined as “…being empathetic and understanding towards oneself, as you might to a close friend in times of suffering” (Aggar et al, 2022).
I’m using self compassion as a nuanced but important update to previous presentations and blog posts on the theme of self care. Why? Because self-compassion is a better fit for nurses, I reckon. As Mills, Wand & Fraser (2015) say, “…it could be argued that nursing care is synonymous with compassion.” That’s most-often compassion for others, not always each-other or our selves.
The way I see it, self care is about the tasks and strategies we use to avoid burnout. Self compassion is more of an attitude or mindset that goes beyond burnout prevention, and shifts towards making sure that we are as kind and nurturing to ourselves as we’re expected to be to our patients.
In this iteration of an annually updated presentation aimed mostly, but not exclusively, at new Graduate Registered Nurses I want to put emphasis on self compassion as a valid and sensible priority. We don’t want new grads to just survive their first year, we want them to learn, enjoy their work, and grow.
Part 2: Prezi
It’s handy to have a way where you can quickly and easily find and share presentations. PowerPoint presentations are so last century. The face-to-face presentation uses this Prezi: prezi.com/view/wsTTDmVzAJOSRpqDXs2I/
This must be the 6th or 7th iteration of a theme I’ve been banging-on about for over a decade, so I’m recycling and repurposing a lot of old ideas here. Because of that iterative process the list below is ridiculously and embarrassingly self-referential. Please don’t think of it as self-plagiarism. Think of it as a fresh new remix of a favourite old song. 🙂
Aggar, C., Samios, C., Penman, O., Whiteing, N., Massey, D., Rafferty, R., Bowen, K. & Stephens, A. (2022), The impact of COVID-19 pandemic-related stress experienced by Australian nurses. International Journal of Mental Health Nursing, 31(1). https://doi.org/10.1111/inm.12938
Australian College of Mental Health Nurses [www.acmhn.org], Australian College of Nursing [www.acn.edu.au], and Australian College of Midwives [www.midwives.org.au] (2019) Joint Position Statement: Clinical Supervision for Nurses + Midwives. Released online April 2019, PDF available via each organisation’s website, and here: ClinicalSupervisionJointPositionStatement
Chen, R., Sun, C., Chen, J.‐J., Jen, H.‐J., Kang, X.L., Kao, C.‐C. & Chou, K.‐R. (2020), A Large‐Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID‐19 Pandemic. International Journal of Mental Health Nursing. doi.org/10.1111/inm.12796
Doctors Health in Queensland for doctors and medical students dhq.org.au
DRS4DRS provides support for any doctor or medical student across Australia www.drs4drs.com.au
Eales, Sandra. (2018). A focus on psychological safety helps teams thrive. InScope, No. 08., Summer 2018 edition, published by Queensland Nurses and Midwives Union on 13/12/18, pages 58-59. Eales2018
Emotional Aftershocks (the story of Fire Extinguisher Guy & Nursing Ring Theory) meta4RN.com/aftershocks
Lalochezia (getting sweary doesn’t necessarily mean getting abusive) meta4RN.com/lalochezia
Miller, Ian. (circa 2013) Nursing ring theory: Care goes in. Crap goes out. impactEDnurse [blog]. Archived blog post accessed via Wayback Machine: web.archive.org/www.impactednurse.com/?p=5755
Mills, J., Wand, T. & Fraser, J. (2015) On self-compassion and self-care in nursing: selfish or essential for compassionate care? International Journal of Nursing Studies. 52(4). doi: 10.1016/j.ijnurstu.2014.10.009.
Nurse & Midwife Support nmsupport.org.au phone 1800 667 877 targeted 24/7 confidential support available for nurse, midwives, AINs and students
Nurses, Midwives, Medical Practitioners, Suicide and Stigma (re the alarming toll of those who undertake emotional labour) meta4RN.com/stigma
Nurturing the Nurturers (the Pit Head Baths and clinical supervision stories) meta4RN.com/nurturers
Queensland Health. (2009). Clinical Supervision Guidelines for Mental Health Services. PDF
Self Compassion and Post Traumatic Growth amongst Nurses in the Pandemic (Hooray for Grey Hairs!) meta4RN.com/grey
Spector, P., Zhiqing, Z. & Che, X. (2014) Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies. Vol 50(1), pp 72-84. www.sciencedirect.com/science/article/pii/S0020748913000357
Surfing the Omicron Wave (Cairns Hospital COVID-19 admission data, 14th December 2021 – 20th February 2022) meta4RN.com/surfing
At time of writing it looks like we are going to have another uptick in COVID-19 presentations (see above). Bugger. I won’t pretend to know how that will affect our local hospital and/or face-to-face and group learning. It will be handy to have a YouTube version of the otherwise interactive face-to-face presentation on hand just in case we revert to crisis-response mode like we did in January/February 2022 [more info about that here and here].
Part 5: End Notes
Thanks for visiting.
As always, feedback is welcomed via the comments section below.
I really like my iPhone. I’ve owned three smartphones – they’ve all been iPhones. I know the iPhone operating system so well that I can work that elegant little machine one-handed in my sleep. Give me any other phone operating system and I will turn into a slow and clumsy boofhead: nothing falls to hand, nothing is intuitive, nothing looks the same.
If I use my iPhone I’m proficient and confident. If I’m handed anything that’s not an iPhone I’m plodding and anxious.
It’s been like that at work this week.
Obligatory PPE Selfie
Queensland is one of the rare places in the world that pretty-much eliminated the COVID-19 pandemic for nearly 2 years. That gave time for every adult Queenslander to receive at least two doses of the vaccine, if they wanted to, before the borders opened and the virus arrived. Baseline data here: meta4RN.com/baseline
As a reminder, Queensland border restrictions have been reduced in steps starting Monday 13 December 2021. Less than a month ago.
What an amazing three-and-a-bit weeks it’s been! As at 13 December 2021 Queensland had accumulated 2176 COVID-19 cases in the 22 months since the start of the pandemic. In less than 4 weeks that number has grown to more than 66,000 [source]. Exponential af. 😳
We all knew a significant rise in cases was coming, but most of us are shocked by how quick and large the explosion has been.
Yes, there was lots of preparation in the lead-up, but it’s been like switching phones/operating systems. Suddenly we’re doing stuff we’re not familiar with yet: nothing falls to hand, nothing is intuitive, nothing looks the same.
We will adapt, of course, but it is understandable that it might take us a little more time. We are comforted to know that we’re not the only service that is struggling. That confirms that we’re not finding things difficult and stressy because we’re a bunch of boofheads. We’re finding things difficult and stressy because we’re in the guts of a crisis.
Put simply, psychological first aid is a humane, supportive response to a fellow human who needs a hand. Psychological first aid doesn’t require expertise or qualifications, it requires the motivation and capacity to pitch-in to promote calmness, safety, efficacy, connectedness and hope.
That kind and helpful approach, together with revisiting some ideas we had at the beginning of the pandemic, will do for now while we’re adapting. And – for me anyway – it’s probably easier to do that stuff than switching phones/operating systems. 🙂
Psychological First Aid
If you’re interested in learning more about psychological first aid see my prezi [click here] and/or this PDF from Australian Red Cross:
If you hear yourself saying, “Yeah, but…” you’re sabotaging yourself. Stop it. You deserve better.
If you hear yourself saying “Yeah, duh…” you’re on my side. I’ve doing the washing, and NOT doing any ironing, this way for all my adult life. You and I are allies. It amazes me that there are others who don’t know.
If you hear yourself saying, “Yeah, isn’t it great that a middle-aged white man is telling everyone what to do…” you’re right. It’s a bad habit us middle-aged white men have. In my defence, I’d just like to point out that as a nurse I’ve been educated, trained, mentored and inspired by smart women. I’m not assuming superiority here, I’m just sharing a life hack from the trenches.
Never iron again. Slow spin speed, thick hangers, and straight from the washing machine to the hanger will do the trick.
That’s it. At first blush it may seem that this blog post is WAY off track for a nursing blog, but I reckon it belongs here. Why? Because nurses using and passing-on self care tips is in keeping with the rest of the blog. Also, mental health week is coming-up – what better way to walk the mental health talk than stop being a slave to ironing?
As always, your feedback is welcome via the comments section below.
Naturally, if you know someone who irons it is you solemn duty to pass-on this info. 🙂
Ask a nurse how they are and they’ll probably give a positive answer: “good thanks”, “ticketyboo” and “living the dream” are favourite reflex answers in the hospital where I work.
Scratch beneath the surface though, and the overwhelming answer to the question “Are you OK?” amongst health professionals – especially nurses – in September 2021 would be: “No. Not really.”
Nurses know we’ve been lucky to have secure employment at a time when many others have not. However – as a profession – we are tired and anxious. This is evidenced by articles in the mainstream press, posts on social media, and research published in academic, peer-reviewed, journals.
There is some stuff to manage stress that we can do by ourselves. Simple things like mindfully washing our hands, for instance. I first read about this idea via Ian Miller (aka @impactednurse and @thenursepath) in 2013. When Ian withdrew from the online space, I reprised the idea in a 2016 blog post:
Sharrock, J. (2021). Professional self-care. In Foster, K., Marks, P., O’Brien, A. & Raeburn, T. (Eds.). Mental health in nursing: Theory and practice for clinical settings (5th ed.). (pp. 93). Elsevier Australia. pic.twitter.com/2S2zFe17Hi
Being published in a text book makes an idea legit, right? 🙂
Anyway – if you haven’t already – try building-in something like mindful handwashing into everyday practice. Something that you can do for yourself, by yourself, while you’re at work.
On behalf of your boss, I can assure you that she/he/they does not want you to burnout – nurses have never been more valued than they are in September 2021. She/he/they needs you. If taking a couple of extra seconds to wash your hands helps you take care of yourself, your boss will be happy that you’re using that time productively.
There is some stuff that we need to do with others.
Nursing is a team sport. So is self-care.
Those familiar with meta4RN would know already that I’m likely to bang-on about clinical supervision. So as not to disappoint, here you go:
And the other thing that I want to remind readers about is Nurse & Midwife Support – a 24/7 national support service for Australian nurses and midwives providing access to confidential advice and referral.
I was chatting with one of the NMSupport staff members recently, and her only suggestion was to encourage colleagues to NOT leave it until they’re feeling overwhelmed before phoning. It seems as if many of us have the bad habit of not asking for support until we’re in crisis. Now that I think about it, phoning a week or two BEFORE the crisis is probably a better idea. 🙂
Please RT! Our latest newsletter has just been released! This newsletter is about SUPPORT! We discuss what support means to #nurses and #midwives — why the service is so important, how to access #support and how to recognise when you may need support. https://t.co/9Ey3syrEJKpic.twitter.com/MOwloq9aH3
One last thing (an overt plug for a friend’s book chapter).
In case you missed the subtle plug above, please let me be more explicit about promoting the chapter by a Consultation Liaison Nurse peer and friend, Julie Sharrock. The chapter title and book title say it all:
Sharrock, J. (2021). Professional self-care. In Foster, K., Marks, P., O’Brien, A. & Raeburn, T. (Eds.). Mental health in nursing: Theory and practice for clinical settings (5th ed.). (pp. 86-105). Elsevier Australia.www.elsevierhealth.com.au/mental-health-in-nursing-9780729
I really like that this chapter in a text book by nurses for nurses acknowledges that we need to care for ourselves to care for others. Although it flies in the face of that ridiculous hero narrative, it is legitimate for nurses to seek a long-lasting, satisfying and meaningful career. Julie’s chapter speaks to that, and provides explicit information on strategies for nurses to use.
I recommend that you have a read of the evidence-based ideas for sustaining yourself and your career that the chapter contains. Perhaps your local hospital/university already has a copy of the book.
End.
That’s it. I just wanted to make a point that not all of us are OK. Unlike the caravaner below, not all of us can “Just deal with it Trish.” Well, not ALL the time, anyway.
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.
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
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What have I missed from this description of CLovid communication? Please add your on-the-job experiences and lessons in the comments section below.
Thank you for being my local member to the Queensland parliament. I am not in the habit of writing to politicians, but feel compelled to do so on the matter of voluntary assisted dying.
It is important to acknowledge the Premier’s advice that the matter be debated respectfully, it is a matter above politics, and that all members of the Queensland parliament will have a conscience vote.
If you have already made a firm decision on how you will vote regarding Queenslanders having a choice to access voluntary assisted dying I do not expect to change your mind.
If you have not made a firm decision I am hoping to leverage my experience and credibility as a Registered Nurse to influence you to vote in favour of the voluntary assisted dying laws.
My Context
I do not talk about death every day at work, but I can’t remember the last time a week at work passed without it being part of my conversation with patients and colleagues. Death is a part of life. Not the best part, but an inevitable part. Despite the social conventions to the contrary, it’s good to talk about death.
Most of the patients I speak with have multiple comorbidities. The conversations I have with these people nearly always focus on quality of life, not quantity. The things they dread most tend to be loss of dignity, pain, and loss of control.
When these people say they would rather be dead than suffer unnecessarily I tell them that I understand and, if Queensland laws allowed, would be happy to support them in their choices.
This stance is in keeping with the position statement of Australia’s largest trade union: the Australian Nursing & Midwifery Federation.
I understand that there is some opposition to Queensland introducing voluntary assisted dying laws similar to those passed in Victoria, Tasmania, South Australia, Western Australia, the Netherlands, Belgium, Switzerland, Canada, New Zealand, Luxembourg, Colombia and some states in the USA. I would like to address some of these concerns below.
The Catholic Context
I see from your parliament profile that you identify as Catholic. I used to too.
I’m guessing, like me, it was a religion you were born in to. That’s the way religions work. There is not a high percentage of Lutherans in India. There is not a high percentage of Hindus in Germany. In the last couple of hundred years there have been lots of white Catholics who have arrived or been born in Australia. That’s an outcome of colonialism, not faith or truth.
It’s an accident that you and I were born into Australian Catholic families. It’s a choice on whether, as adults, you and I continue to subscribe to Catholic doctrines.
As the Archbishop of Brisbane, Mark Coleridge, said in February 2019, “I think we have to accept that our [the Catholic Church’s] moral authority and general credibility has been massively damaged.” I concur with the Archbishop.
Just as the Catholic church backed the wrong horse when they covered-up priests raping children, they’re backing the wrong horse when they say that competent adults who are within weeks or months of inevitable death can not decide to leave life in a way and a manner of their own choosing. The Catholic Church has form: in my lifetome they backed the wrong horse when it came to access to birth control, access to termination of pregnancy, and access to same sex marriage. You’d think a church with a congregation that has a reputation for gambling would be better at backing the right horse, wouldn’t you?
The AMA Context
The Autralian Medical Association is often the loudest doctor voice in Australia. Like the Victorian branch before it, the Queensland branch opposes voluntary assisted dying, but if the law is passed they want to be in charge of it. No, really, read the third paragraph here for yourself – it’s hilarious:
“The AMA’s position is that doctors should not be involved in interventions that are intended to end a person’s life but, if the government decides to legalise Voluntary Assisted Dying, the medical profession must be involved in developing legislation, regulations and guidelines which protect doctors, vulnerable patients and the health system as a whole.”
The Queensland AMA surveyed more than 1250 members. An overwhelming majority supported voluntary assisted dying, but the AMA Queensland President Professor Chris Perry said the survey was not a referendum on VAD.
I see from a recent speech of yours that you have a mate who is a surgeon. It would be worthwhile checking-in with your mate to see what they would think about operating on a patient who is terminally ill. My guess is that they’ll think it’s only a good idea if it improves quality of life.
Nearly every doctor I work with would support a competent adult to make their own informed treatment decisions, whether they agreed with the decision or not. That is the ptofessional, pragmatic and compassionate thing to do. That existing framework can accomodate patients who wish to discuss or access voluntary assisted dying.
The Nurse Context
Nurses are often excluded from public conversations about health matters, despite being the majority of the health workforce (344,941 of 625,228 using 2019 data, ie: nurses and midwives compromise over 55% of the clinical workforce).
This exclusion from the public conversation is even more surprising when we consider who the public trust. Australians have rated Nurses highest for ethics and honesty for 24 consecutive surveys (1994 to 2021). Higher than doctors. Higher than ministers of religion. Higher than members of parliament.
Data Source: Roy Morgan Image of Professions Survey 2021. Finding No. 8691. Country: Australia. Available via http://www.roymorgan.com
So, what do nurses think about voluntary assisted dying?
“We support legislative reform so that competent adults who have an incurable physical illness that creates unbearable suffering shall have the right to choose to die at a time and in a manner acceptable to them and shall not be compelled to suffer beyond their wishes.” Australian Nursing Midwifery Federation (ANMF) (November 2019) Voluntary assisted dying position statement, page 2, no. 14 [PDF].
Naturally, as is the case with termination of pregnancy, the proposed framework entitles nurses and other clinicians who oppose voluntary assisted dying to decline participation. See 14.96 in Queensland Law Reform Commission (May 2021) A legal framework for voluntary assisted dying [PDF].
Nevertheless, this provision has not stopped some nurses speaking out stridently, eg: “Voluntary Assisted Dying is simply a euphemism for assisted suicide, or what Adolf Hitler called mercy killing.” Margaret Gilbert, Treasurer, Nurses’ Professional Association of Queensland (NPAQ), The Courier-Mail, March 23, 2021. Open access version here. This comment should be read in conjunction with Godwin’s Law. As with the Catholic church, it should be noted in NPAQ has form: in 2019 they advocated for paramilitary forces to be installed in hospitals instead of security guards, and in 2018 were aligned with the opinions of Cory Bernadi and Peta Credlin when they misinterpreted cultural safety with an obligation for white nurses to apologise to each of their Aboriginal and Torres Strait Islanders. The NPAQ does not represent the majority of nurses in Queensland, the Queensland Nurses and Midwives Union (QNMU) does.
In February 2021 the QNMU (the Queensland branch of the ANMF) asked members if they support in principal the legalisation of voluntary assisted dying in Queensland. Approximately 87% of respondents said ‘yes’. QNMU (10 June 2021) News.
Nurses have the unique role of caring for the person in life and in the first few hours of death. Nurses are at the bedside 24 hours a day, 7 days a week. Other professionals flit in and out, but nurses are the ones on the floor. We see life and death up-close and personal.
As Joseph Heller said in his classic 1961 novel Catch-22: “People knew a lot more about dying inside the hospital, and made a much neater, more orderly job of it. They couldn’t dominate Death inside the hospital, but they certainly made her behave. They had taught her manners. They couldn’t keep death out, but while she was in she had to act like a lady.”
Heller was only half right. When we can, nurses make death act like a lady, but there are times when death is beyond the control of nurses and the rest of the clinical team. Sometimes death acts like the cruelest sadist you can imagine. Many nurses, like me, would have heard patients with a terminal illness say words to the effect of, “Please help me die. You wouldn’t let a dog suffer like this.”
There is no empathy in denying the patient relief in those circumstances.
It is only an outdated law that prevents us helping these patients.
It is only our parliamentarians who can change the legislation to be more humane. That’s where you come in Mr Healy.
End Notes
Sorry for publishing my letter online. Doing so is a bit shouty. However, the opponents of voluntary assisted dying (eg: the Catholic Church, the AMA, and NPAQ) have argued their case online. In 2021 online = the village square. This is too important an issue to ceed the village square to those who seek to control the life choices of others.
I do not seek to impose my beliefs on others, I only wish that people with a terminal illness have a choice. Whether people access voluntary assisted dying or not is none of my business. I would like to support them no matter their decision.
You can probably tell by the tacky website that I am not representing any organisation, and these opinions are my own. For elaboration on this division between employee and professional, please see number 13 on my 2012 introduction to this website: meta4RN.com/about.
Do you want to send your local Queensland MP an email on this topic? This link via Dying with Dignity Queensland will help you find the right person/email address, and – if required – give some tips
You are welcome to leave feedback via the comments section below.
Paul McNamara, 2 July 2021
Short URL meta4RN.com/VAD
Addit 3 July 2021
A postscript: Michael Healy gave a very thoughtful and encouraging response to this open letter on his Facebook page. It’s worth reading: www.facebook.com/healycairns Thank you Michael.
meta4RN 
