Australian College of Mental Health Nurses Conference: Collaboration and Partnership. 2013.
I was privileged to attend this conference on behalf of the College as Daryle (President) was unable to attend. I attended with Reena Kainamu from Maori caucus. Adrienne Lee a Registered Nurse from Invercargill also attended and it was great to be able to share this experience and the learning’s with her. I am grateful to the Southern DHB for supporting the study leave. The theme for the conference was collaboration and partnership and the key notes speakers and the paper presentations certainly explored this theme thoroughly.
Dr Frances Hughes was the opening keynote speaker. Frances is a New Zealander currently working as the Chief Nursing and Midwifery officer for Queensland Health. The title of her presentation was ‘Going for Broke’. Frances talked about the importance of taking the time to reflect on what we are doing as nurses, challenging the status quo, of speaking up and being political. A lack of interest or not speaking up is a political position in itself as the status quo is maintained. She described a continuum; the ethos of collective non responsibility (with people not taking responsibility because someone else is responsible) vs. the ethos of individual accountability (with people taking on total responsibility and not allowing others to have a voice). Frances encouraged nurses to work within an ethos of collegial generosity where no one professional group has a monopoly but work as a team to meet the needs of clients. Taking responsibility for our own actions and speaking up to challenge the status quo when this is not in the best interests of the clients we work with. Professor Dawn Freshwater was a keynote at the New Zealand College conference in Dunedin so is was lovely to catch up with Dawn again. Dawn is the Professor of Mental Health at the University of Leeds and has taken on the role of Pro Vice Chancellor. She talked about how within mental health nursing we have a shared understanding of what we do and offer as nurses; however people outside of mental health nursing do not necessarily share this understanding. The terms she used to describe the inside/outside perspectives were ecology of performance which is the shared understanding within a profession and the economy of performance which is the outsiders view. She challenged the concept of ‘collaboration’, cautioning that collaboration needs to be driven by compassion and not power. She used examples within the Second World War to illustrate her point. Dawn also encouraged us to think about our identity as mental health nurses. Does collaboration with other professions contribute to ‘’identity theft’’ with other professions clearly articulating their role while mental health nurses do what is left undone? A thought provoking challenge for mental health nurses to clearly articulate what they offer as nurses to consumer care and to the multi disciplinary team. Two non-mental health professional speakers, Lt. Col. Cate McGregor and Pastor Keith Carmody offered their unique perspectives. Catherine McGregor is a graduate of the Royal Military College Duntroon, which she entered in 1974 as a male named Malcolm McGregor. Cate is an extremely acomplied woman who has filled a number of regimental appointments as an infantry officer. She commanded a rifle platoon and the Machine Gun Platoon in the 8th/9th Battalion the Royal Australian Regiment and served as an instructor at the Jungle Training Centre Canungra. She commanded the Australian Army Training Team in East Timor and served as the political
adviser and translator for the Commander of Australian Forces in East Timor in 2006. Cate is a published author. Her works were published under her previous name. She commenced gender transition in June 2012 and since the 8th of July 2012 has been known as Catherine (Cate) McGregor. Cate told her story of this journey, in particular how she credits a mental health nurse with saving her life. The mental health nurse was knowledgeable, compassionate and well informed, these attributes led to Cate’s referral to a counselor who was able to meet her needs because of the skill set she had. Cate also talked of her life’s work learning to be me, and the understanding she has developed about her transgender journey.
Keith Carmody is one of two full-time chaplains with the Western Australia (WA) Police and has over 31 years of pastoral experience. In the 15 years of service with WA Police he has attended numerous critical incidents and tragic events requiring his experience and expertise. Keith spoke about the police/mental health nurse interface, describing the two professions as not being in conflict with each other but in the battle together. When there are tensions between the police and mental health nurses this is often a result of the workload pressures and the traumas both professions are exposed to on a day to day basis. He spoke of both of our professions wanting to provide the best of care for the most fragile in our community and to be ‘’weary in well’’ doing not ‘’weary of well doing’’. He encouraged the Police and mental health nurses to proactively develop their professional relationships to enable both professions to work effectively together and support each other in ‘’well doing’’. Professor Pat Dudgeon – Mental Health Commissioner Professor Pat Dudgeon is from the Bardi people of the Kimberley in Western Australia. She was the first Aboriginal psychologist to graduate in Australia and has made outstanding contributions to Indigenous psychology and higher education. She was the Head of the Centre for Aboriginal Studies at Curtin University, for some 19 years, leading the field in providing culturally appropriate education. As well as leadership in Indigenous higher education, she has also had significant involvement in psychology and Indigenous issues for many years. She has undertaken much work and many publications in this area and is considered one of the ‘founding’ people in Indigenous people and Australian psychology. She is actively involved with the Aboriginal community, having an ongoing commitment to social justice for Indigenous people. During her session she spoke of the increase in Mental Health Aboriginal workers and how this was helping support the Indigenous people. Professor Dudgeon talked of the importance of accepting cultural differences and working in partnership with each other. Professor Eimear Muir-Cochrane is Chair of Nursing (Mental Health) at Flinders University with adjunct professorial positions at City University London and the University of South Australia. Eimear spoke on her research interest in acute psychiatric settings, her findings indicating that these units were unsettling places with “restraint creep’’. She described the issue at times for clinicians as being “between a rock and a hard place”, about the tensions of practice and culture within practice. Her main message was that this is our responsibility as we are the culture. Eimear emphasized the importance of risk assessment as this was core to the function of acute care settings. She used an example of the zero tolerance to violence policies within organizations. Within the mental health setting that these policies reduce flexibility for people and lead to a non acceptance of expression of any anger. She asked us to consider how we would feel if told we could not leave a setting, anger maybe part of our response. Eimear
suggested we look at the wording of signs; rather than saying “zero tolerance for violence’’ a message saying “if you are feeling distressed or upset come and talk to your nurse’’ acknowledging the feelings but giving people options of what to do with these feelings. Eimear also talked of the manner in which modern society organizes its response to risk and suggested we look at the risk assessment to ensure it is actual, dynamic and uses structured clinical judgment; involving families to identify what level of risk they can accept e.g. lap belts in the elderly. She concluded by reminding us that”the standard you walk past is the standard you accept’’. In acute units we need to be ‘rush ready’’ due to the nature of acuity and acute admitting units while displaying hospitality within a homely environment, being generous with our time and conveying to people that they are welcome. PAPER PRESENTATIONS The safe wards model and cluster RCT: Len Bowers. I have heard a lot about Len Bowers over the years, specifically about his expertise, leadership and contribution of useful research so it was a real privilege to attend this session and to meet Len. He did not disappoint. He presented the randomized control trial research into the Safewards intervention which describes a model of intervention. The model depicts six domains of originating factors that have the capacity to trigger conflict and/or containment. The research involved 30 wards at fifteen hospitals and looks at the effectiveness of interventions that can make a difference. The outcomes of this study are significant for NZ as we work towards reducing restraint and seclusion within Services. The outcomes of this research are accessible on https//www.facebook.com/groups/safewards. It’s not the kids fault children’s and adolescents understanding of parental mental illness: Kim Foster and Andrea McCloughen. The evaluation of this programme which worked with children or siblings who had a family member with mental illness. The key learning’s were the need to be helping parents know how to talk to children about their illness and what good support is available. A large percentage of children in the study did not know the illness their family member had, and a significant number who thought they had caused the illness, Malnutrition risk in aged person’s mental health, Development of a nutrition screening tool. Martine Hatzi This session was about the development and implementation of a validated nutrition risk screening tool for acute inpatients with the aim of picking up issues early. This was an enlightening session and well worth considering within inpatient settings. Introducing Peer support to Freemantle Mental Health Services. A collaboration with Perth home care services: Brett Heslop, Mathew Dinsdale and Cathy Thompson. This session talked about the collaboration and lessons learnt from developing a successful peer support programme. Key to their success appeared to be the understanding of staff, clients and peer support workers about what the role was and the importance of sharing information. Metabolic Monitoring. There were several sessions looking at Metabolic Monitoring. One focused on keeping the Body in Mind and talked about ‘’don’t just screen intervene’’. As part of the programme they use peer support and have a gym on site. When clients first come into
their service health education is a strong focus from the beginning of treatment for clients starting on Olanzapine.
Building compassion in collaborative partnerships in MHNs. Tom Ryan and Evan Player. As the title indicates the paper explores the concept of compassion, suggesting that compassion is taken for granted and declining as the value of compassion is being questioned. Tom and Evan argued that compassion is an essential element of alliance and collaboration in mental health nursing. They suggest that compassion can be learned and developed however also identify a number of barriers to this learning, namely task orientation, lack of time, lack of caring, organizational rather than professional values, administrative tasks, and focusing on outcomes impacting on quality (prioritizing quantitative rather than qualitative outcomes). They described how clinical supervision can encourage, develop and/or maintain compassion in the supervisee. Using reflective strategies, examining issues in a gentle and non judgmental way, using a naïve enquirer approach and making compassion an explicit goal of supervision were all strategies suggested to assist the supervisee to develop and/or maintain their compassion. Changing supervisor and ongoing monitoring to ensure that supervision doesn’t just become another task is important if supervision is to be developmental and supportive for the supervisee.
Academic and MHN collaborations.The future of knowledge translation: Brian McKenna. Brian talked about how collaborations between services and universities are essential if best practice evidence is to be embedded into service delivery for the benefits of clients. He started by posing an interesting question about the Intellectual Disability Sector, with the move towards normalization the psychopaedic nurse has just about disappeared. He asked what does the concept of recovery mean for mental health nurses, what value do we add as nurses. Allied health articulate what recovery means and how they contribute very clearly. Brian strongly supports nursing being very clear, articulating their value through research outcomes. Defining distinct MHN practice:Help or hindrance to collaborative partnerships: Peter Santangelo (the immediate past president of the Australian College presented his progress on his PhD). Peter has completed his interviews and the initial findings indicate that mental health nurses do offer a distinct contribution to care delivery, by using who and what we are as mental health nurses in the service of others, working to the edge of our broad scope of practice, and the concept of wise reciprocity - using every opportunity as an intervention. He raised some questions as he progressed with his research about focusing on the mental health nursing contribution rather than how the MDT collaborates to provide care, the co constructing of care rather than the individual contribution. Other random thoughts arising from the presentations and discussions.
1. NZ College communication – should we be using face book and twitter for
2. During conferences using time cards to indicate to presenters their progress with
allocated time rather than verbal prompt?
3. A scope of practice statement has been added to the Australian Standard for Practice –
both in terms of content and the title. Is this something our College could consider?
4. The launch of the chronic disease and mental health learning programme. Five
interactive modules focused on educating general nurses within hospital environments regarding mental health issues. These modules cover cancer, diabetes, respiratory and cardiovascular disease and are accessible on the Australian college website.
5. Undergraduate programmes. A number of papers touched on the MH aspect of
undergraduate nursing training or more specifically the lack of MH content. A couple of important point
a. The college has released a statement about non MH nurses teaching MH content
– basically this is unacceptable to the college. National committee have this discussion with potential of releasing a position statement – this position could also talk about recency of MHN practice, post graduate qualifications required etc.
b. Student experiences – a simple way of ensuring students feel part of a team is
including their names on the staff roster.
c. Queensland is now offering a direct entry MH undergraduate nursing degree.
Again with thanks for this great opportunity Heather Casey and Adrienne Lee.
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