Mais les résultats doivent être attendus longtemps et il n'y a généralement pas de temps azithromycine prix L'autre cas, c'est que l'achat d'un ou d'un autre antibiotique dans une pharmacie classique nécessite des dépenses matérielles considérables et pas toutes les personnes ne peuvent acheter des produits pharmaceutiques aussi coûteux.
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.
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.
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
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. T
he 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
Malnutrition risk in aged person’s mental health, Development of a nutrition screening
tool. Martine Hatzi T
his 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.
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.
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
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 c
ollaborations 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
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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