Tagged: nurses

Open access journal papers about health & social media

Thanks for the Collegian, a nursing journal, who are taking the lead with a discussion about social media and health with open access on recent journal papers by my colleagues and I – here they are for your easy click and free download:

Nurses and Twitter


Australian health profession students use of social media

Let us know what you think! 

Registered Nurse from South Sudan call for peace

Registered Nurse from South Sudan call for peace

A message from my friend RN Chol Deng: “I need to get the message out there… My home town back home (South Sudan) is in “state of emergency” innocent civilians have been hiding in the bush since Monday due to violence that broke out on Sunday with no water or food”.
As a mental health nurse – my heart goes out to those who are hiding in the bush in fear of their life and without access to basic goods and services. Lets spread the word – people need to choose peace – it won’t just happen…. peace needs to be pursued and practiced. Chol is right – it is a behaviour and an action that needs to be lived out in the lives of us all…. and especially in South Sudan. Let’s help Chol get the ‘word out’. Standing with him in choosing peace and shunning war. Share, like, tweet …etc! Please!


Shiny new text book – Mental health. A person-centred approach.

Shiny new text book - Mental health. A person-centred approach.

Received an advance copy of my new book today – smells new, looks shiny….. so pleased with the result and very chuffed to have worked with other mental health experts on this book – Nicholas Proctor, Helen Hamer, Denise McGarry, (Me), and Terry Froggatt. Available to the Public from January 2014. Link for more details direct from publishers – Cambridge University Press.

Chocolate survival in the presence of health professionals- a threatened commodity!

Chocolate survival in the presence of health professionals- a threatened commodity!

Proof at last….. Nurses love chocolate gifts….and they prefer Roses over Quality Street! This is important information for anyone who knows a nurse, because now you know what to give that person for Christmas!!!!!

Scientific evidence allows you to be assured that within about 5 minutes the nurse recipient will have ripped open the box and within 1 1/2 hours he or she will have consumed about a third of a boxful of chocolates…. then they slow down the pace of consumption a little but this should be seen as a lack of gratitude but rather – the data seems to indicate that by about a third of a box of consumption… nurses (and other health professionals)simply tend to continue their consumption at a slightly reduced rate! The researchers only used a 350 gram box… it is unknown if the size of the box really matters – so you might be best advised to try a range of sizes….. perhaps bigger is better (a future study perhaps!)

Surely some replication in Australian settings would contribute further important disciplinary information! Thanks to Kim Usher for the share of this scholarly journal article. 

Merry Christmas! Hope the survivor-ship of your Christmas chocolates is all that you would want it to be  -and your ‘decay’ curve is mitigated! 

Shades of Brown “Out West”

Out West for the weekend….. about 4 hours west of where I live in Northern NSW, Australia.

I have just completed some research in the same region about the emergent mental health problems of young rural people… I was looking forward to the drive, as an opportunity to reflect on the full cycle of the research project. I have been bunkered down in my office writing up the research report, so an opportunity to reconnect with the breath of the study region was especially appealing. But, what I saw, made me think more….. about how much mental health prevention, promotion and recovery supports are needed in drought affected rural communities.

It occurred to me that the colour of depression is brown…shades of brown. And the insidious slow slide from green to brown is exactly what happens to the collective mood as well. A heaviness sets in that is hard to shake off… perhaps the ‘black dog’ in the bush is actually a ‘brown cattle dog’…

In good times – things look good, and feel good and then slowly, very slowly the shades of brown start to set in, and the creep of the dry brown continues on the land, and in the mind.

Watching the stock trying to find a blade of grass, wandering in search of something to eat  is a sad creeping feeling…. and that same creep surges into the small towns and villages on the farming fringes. The shades of brown; the moods of brown seep into the main streets, and downturns in the retail and hospitality sector appear obvious… the $2 shops thrive with mountains of plastic crates for sale,and the boutique stores fade away, some to empty shops and dilapidated signs. The bubbling social hubs of clubs and pubs where ‘everyone’ gathers starts to lose some pizzazz…. and the towns start to look sad…. it is hard, very hard.

I couldn’t help but notice in one town that the only thriving sector seemed to be the great big and polished-looking police station, with lots of police… and that made me think too…

I saw a proliferation of smashed windows, boarded up  buildings, wire mesh over windows and doors, more prominent then before…. the broken window phenomenon escalating…. community hope and well-being in downward spiral… I suspect.

Drought has set in, a few rain showers here and there are just not enough….the landscape was looking dry, the only green was found in the prolific thorn bush… not good for anything. We spotted a paddock full of nothing but thistle…. the Plains were sparse; some of the stock thin, and plenty of road-kill kangaroo along the way.

A few reflections that put my research back in to perspective for me… the need to advocate for sufficient mental health care for rural people is crucial….

When the stock needs to be grazed in the ‘long paddock‘ and drovers watch and live with their stock on the roadsides to take advantage of the remnants of vegetation on the road side verges….it is a sign that times are tough. The difficulties seep through all layers of rural society. And when it does, that is when local communities need their local nurses…. to take the time to listen, to pay attention to the burdens of the shades of brown, to care… to monitor mental health of the local people, to intervene in time to make a difference

I am cheering on the rural nurses from Out West… they are important social capital in rural communities…. they have a big job ahead I suspect…

some photos…

cattle onthe roadgatelucerne slashedsheep grazing along roadside

Plain packaging for fast food? The global obesity crisis

Plain packets for fast food

What if we decided that fast food should be plain packaged with graphic health warnings like cigarette package now is  in Australia? A Fast Food Plain Packaging Act?

Some of the reasons we now force the plain packaging of cigarettes:

  • to make them less attractive to  adults and children
  • to ensure that advertising is not misleading and that there is no confusion about the health implications for consumers
  • to provide health warning on the packaging
  • to amplify the health warnings

Exactly the same messages could be echoed for fast food. I am thinking of especially the large companies who mass produce fast foods…. you know who they are…. they are dominated by bright attractive colours in their ‘restaurants’, and on their packaging…they include ‘nutritional facts’ on their labels (that you need a magnifying glass to read). They have cheap options to lure the cash poor….and they have meal deals and family meal deals which include fizzy sugary drinks to the mostly fried mix!

It is not rocket science   – this stuff…hard to refer to it as food! This stuff is really, really bad for people to consume. It directly causes BAD health.  There is a clear and obvious cause and effect….. if you eat a lot of fast food + sugary drinks you will get fat, have cardiac disease, diabetes, diminished mental health… the list goes on…. other blog posts of mine have discussed food security and the excess of poor quality food…

Fast food is addictive – our brains crave the saturated and transfats, and the more we have…the more we crave. It is fact.

Can we provide conditions that change the environment, help our brains and the brains of our children and young people to be less attracted to fast food? Would plain packaging and plain signage restrictions make a difference? I.m not sure that the evidence is out there to say it would help…. but in terms of health, I can’t see that it would do any harm to try!

Here is some more food for thought … a compilation of conversations that made me think more about this issue over the last few days…

fat map…

Could this map explain in part world obesity….The global obesity crisis. A few big companies that produce of lot of processed foods high in fats and sugars? What would happen if we stopped buying this stuff? Would it matter to health? and how would that shape society? What items should/could be plain packaged? Are there incentives that could be in place to promote fun and enticing packaging of low processed foods?


I watched  ABC TV show  Four Corners  Supersizing India’s kids  the other night…. As a health professional, I found it profoundly disturbing on so many levels…. watch for yourself! Kid’s obese… vulnerable…. surgery (and the health industry) exploiting them with expensive and invasive interventions (gastric bands and worse), without using other less invasive interventions first. Kid’s undergoing major gastric surgery… that can only end badly. Where are the nurses??? Why are they not taking some leadership in promoting health, reducing poor health….. ????  Why are they not advocating for safe health promotion and interventions for these kids…. ??? (AND – a big thumbs down to the surgeon who slapped the abdomen of a child while he was under anesthetic…. BIG thumbs down. Where was the nurse then????)

closer to home…

Kind of in my back yard…. a few blocks from where I live, an 18 year old young woman died from obesity in the last year. Devastating… so sad. So preventable… but help was needed. A few blocks from were I live major fast food ‘restaurants’ thrive… cars cue to ‘drive through’… so sad. The smell of the oils bubbling away saturate the air to those who walk by… enticing  the brains of young people with their neurochemical lures… Here in rural Australia, where we grow fresh food, produce it for the nation and the world, where idyllically healthy living can be had in bucket loads…. we have our own fast food crisis. Where are the nurses? …advocating for health?

it all makes me think….

What can be done… to reduce the fast food led health demise in my town, in my country… in my world?

Perhaps every little bit might help and is worth trying…. why not plain packaging for fast food ? I am a nurse – it is in my professional DNA to advocate for health, especially for vulnerable people  such as kids and young people, who sometimes can’t yet do that for themselves. I live in rural Australia…. it sharpens my mind to the needs of rural young people…. and to also advocate for their health.

We need fitter bodies and sharper minds in rural communities – we need less enticement to consume fast food which reduces physical and mental health. I say –  Keep the packaging plain. Add health warnings to the packages, and include photos of horrendous consequences of prolonged consumption. Just like we do for cigarettes – see what happens…

Too controversial? or, on the money? Debate welcome!


Want to get creative? Sleep on it!

Today I am sharing a TED Talks video with you. It is stuff every health professional, shift worker, parent needs to know!
Here is why:
You want to be creative – you will need a good nights sleep because sleep strengthens your creative neural pathways (yes – creativeness is not just imagination…it is a physiological structure in your brain…to feed it…SLEEP! Easy peesy!

Russell – the clever chap in this video, clearly gets his full 8 hours! But most of us are only getting 5 hours (do a personal audit…. how many really?????)
Bad news is 5 hours sleep is not enough!!!! And less than about 8 hours each night is likely to make you sick…. there is a 50% likelihood for people in the 5 hours or less category that they will be obese…. because not getting enough sleep triggers the hunger hormones…. makes people crave carbs…. and lots of refined sugars….. not pretty!

But it not just obesity on the radar…. it is STRESS too. Tired people are stressed people, they become fat, and sick (lower immunity), they get diabetes, heart disease….. do you want me to keep going……..?

It is bad news…. sleep is needed – About 8 hours worth at least. The big societal problem is that most people only get 5 hours.
(btw – Teenagers need about 9 hours…. and they are wired (literally) to stay up late and rise late… and they need a big long sleep in every once and a while. Their brains NEED the recovery and restoration time….)
But my guess is that most people who read this blog are likely to be adults…(and some will be parents of teenagers I suppose!) So – If you are trying to operate on 5 hours (or so) of sleep (like many people do), then you will probably battle with poor memory, poor judgement, poor creative and increased impulsivity (nasty mix!).

In addition your brain will crave stimulants…. like caffeine or cigarettes…. and to help you sleep, you might be inclined to drink alcohol. But – alcohol robs your brain of proper sleep…because it sedates the neurological functions of your busily sleeping brain. So you get even less value from the sleep you do get…. and then you wake up, eat carbs, drink coffee, make bad decisions, forget things…. grab a beer, and start all over!!!

Make yourself a promise…… get some sleep…the full 8 hours every night. To achieve that make sure your bedroom is a great place to sleep: Dark, make your bed every day (so it is wonderful to jump into at night), ambient temperate slightly cool, turn off your smart phone, don’t watch TV (or anything on a laptop) in bed, try not to drink caffeine late in the day or at night, and go to the loo before retiring for the night.

Get your full 8 hours – be a nicer person to live with, work with…. and let your creativity shine!

Oh and here is a thought…. we encourage patients’ to ask nurses (and other health workers) ‘have you washed your hands?’…. maybe we should also ask ‘how many hours sleep did you get last night?’ – to controversial?

Thanks Russell Foster for these handy reminders! And thanks to my Exercise Physiologist friend Bonnie Furzer for sharing the video with me….. I in turn, share it with you!

Social media in the health professions – & why we should use it more & better!

The time has come – health professionals should embrace social media and use it to promote health, well-being and recovery to the multitudes! 

There are a great many opportunities to enhance the health of people and communities which can gain a foothold in the social media environment. And – I think nurses in particular should be a the forefront, leading the charge to a healthier future… I think that so much, I gathered up several other colleagues over the last year, and together we reviewed the literature to figure out just how this could be achieved…. and now we have published our first paper on the topic….. Here is the link:

Wilson, R. L., Ranse, J., Cashin, A., & McNamara, P. (2013). Nurses and Twitter. The good, the bad and the reluctant. Collegian, in press, xxx-xxx. doi: 10.1016/j.colegn.2013.09.003

You can read the abstract at the above link, and the journal article itself is available through health and academic library subscriptions….. 

Here are a few facts from our paper:

  • Global expansion in internet and smart phone availability has led to rapid expansion of social media

  • 2.7 billion subscribers (39% of world population) to the internet with 77% of these coming from developed countries

  • 750 million of households globally are now connected to the internet which represents approximately 41% of households across the globe

  •  75% of the developed world population now have a  smart phone

  • Facebook has 11.5 million Australian users and half of them check facebook at least daily

  • LinkedIn has 2.7 million users

  • youtube has 11 million Australian users

  • Skype is used by about 280 million users around the world with and average of 7 minutes use per user per day.

  • Australia has 12.2 million internet service provider subscriptions -1/2 are wireless and 3/4 are households.

  • There are 17.4 million smart phone subscription in Australia – and rapidly rising.
  • Four out o five professionals use some form of social media.
  • Young people have a high uptake, and proficiency, of social media.
  • Increasingly health care will need to communicate and offer services and health promotion utilizing social media, because that is fast becoming the standard mechanism for convenient communication with people. 
  • Social media represents the beginnings of a new era of communication and offers a platform from which health interventions and health communication can develop in the future 
  • There are new potentials for e-health practice 


…and if the isn’t convincing enough – this is what nurses have been up to using Twitter at conferences:

At the Congress of Nurses Conference in Melbourne, Australia May 2013. Delegates and non-delegates participated in a dynamic, unplanned and spontaneous Twitter conversation prior to, during, and after the live face-to-face conference of about 4000 delegates. A total of 221 individual tweeters engaged in a lively conversation about nursing issues during 19 May – 25 May 2013, using #ICNAust2013 (www.symplur.com/healthcare-hashtags/ICNAust2013/analytics). Conference organizers did not organise or encourage the Twitter conversation, however it developed without any organized effort with tweeters self-initiating and participating in conversations. ……. Most of the posts consisted of an exchange of ideas about paper presentations. Other conversations developed where colleagues arranged to meet face to face using Twitter as a communication tool. A total of 3000 tweets using #ICNAust2013 occurred during this period, half of the tweets and mentions amongst the top ten influencers identified in their usernames a connection with one university in Australia (www.symplur.com/healthcare-hashtags/ICNAust2013/analytics). …. The top ten influencers (made up of nine nurses and one health journalist) for the #ICNAust2103 were users with larger cohorts of followers and these users developed a cumulative impression footprint which numbered 1 million connections, while the total cumulative impression for #ICNAust2013 was 1.4 million. Thus the conversation of the wider conference of just 4000 face to face delegates had a wider SoMe impression that extended to 1.4 million Twitter users (www.symplur.com/healthcare-hashtags/ICNAust2013/analytics). The actual impact and the impression footprint are quite different; however the potential for influence should be noted.


And more recently… at the 39th International Conference of Australian Mental Health Nurses in Perth, October 2013, Nurses were again out in force on Twitter! About 400 face to face delegates were present but there were over 140 individual Tweeters producing in excess of 1000 tweets and with a digital impression of about 600,00 using #ACMHN2013

There is much good that can come out of nurses and other health professionals embracing social media, developing proficient skills in using social media, and becoming advocates for fair, equitable and healthy changes for people and communities. 

Challenge – Let’s see how much good we can achieve!


What ideas do you have to contribute to get the ball rolling…..? 


Co-location of Mental Health Clinicians in Police Stations. The Canberra, ACT Australia example!

Police and mental health clinicians co-located

This is such a good idea. Following my recent research about the emergent mental health problems of young rural people, and based on my  finding too – I agree that this is an important way forward for rural communities.

Mental health nurses should be co located in police stations to improve the care of young rural people with acute mental health problems, and who as a result, become involved with the police. 

Nurses are great at listening, caring and finding ways forward to improve the well-being of others – co-location with police who come into contact with young people with mental health problems is a far better way forward.

Congratulations to ACT police for piloting there  program. Wishing them great success for the long haul!

Sending the challenge out to rural and regional police commands in all rural and regional centres to find a way to replicate the concept in their centres and stations!

This link takes you to a brief media review of the Canberra police program – watch it for inspiration!


Here are some facts about mental health and policing/justice….. (extracted from my almost completed  PhD thesis…)

  • The NSW Law Reform Commission undertook a general review of criminal law and procedures that are applied to people with cognitive and mental health impairment in NSW, and they reported that in NSW of all the young people (less than 18 years of age) detained in custody in NSW, 87% have at least one mental health problem and 73% have two or more mental health diagnoses (New South Wales Law Reform Commission., 2012).
  • Young people with mental illness are over-represented in the criminal justice system compared with the wider population, where 22% of the general population have a diagnosable mental health problem and with the total prisoner population in NSW experiencing mental health problems at a rate triple that of the general population (New South Wales Law Reform Commission., 2012).

….The stated goals of policing and justice are diversionary wherever it is possible, however that requires sophisticated referral mechanisms between justice, social and health services, and these services are not always available or accessible, especially in rural regions, and so young people are not always able to engage with diversion options, and therefore are detained in custody, either because no other option is available to them, or because they have a history of offending (New South Wales Law Reform Commission., 2012).

  • The average age for a young person with a mental health problem to be remanded in custody for the first time is 18 years of age and on average they will have had 15 police events recorded by that time, with a first police event occurring at an age of between 12-14 years likely; coincidentally an age where onset of mental illness is also noted (Kessler, et al., 2005; New South Wales Health., 2012; New South Wales Law Reform Commission., 2012).

It is difficult for non-mental health professionals to identify emerging mental health problems, and this is especially challenging in the context of the criminal justice system, however a mental health assessment service is available to some offenders who are fortunate enough to be dealt with by Statewide Community and Court Liaison Court Locations (CCCLS), however only 20 of these locations exist in NSW, with the service not available to the remaining 128 local court locations (New South Wales Law Reform Commission., 2012). The disparity of this service provision has been recognised by the Law Reform Commission and it has recommended an expansion of this program to all 148 local court locations (New South Wales Law Reform Commission., 2012).

  • Police have powers to detain a person who they believe to be mentally ill or mentally disturbed, under the Mental Health Act 2007 (NSW), and police can formally request that the person be admitted to a involuntary mental health facility. This mode of request for admission makes up 23% of all police requests for admissions to mental health facilities, however 26% of police requests do not meet medical criteria for involuntary admission to a mental health unit (New South Wales Law Reform Commission., 2012).
  • This leaves a substantial number of people who may have a mental health problem, but do not meet extreme criteria for involuntary treatment in a compromised position of not being able to access mental health help when it is needed, and at risk of reoffending and further complicating their offending track record (New South Wales Law Reform Commission., 2012).


  • Collaboration between State governed Police, Health & Ambulance services in regard to supporting people with a mental health problem to access appropriate care is ideal and fits neatly with the ideals of ‘no wrong door’ to seek mental health help which are aspired to by State & National Mental Health Commissions.
  • There are significant limitations within clinical decision making capabilities which need to be considered. In particular, no clinical risk assessment tools exist with adequate specificity, sensitivity and accuracy to predict harm to self or others (for example violence) by people affected by mental health disorder or illness (Ryan, Nielssen, Paton, & Large, 2010). It is not possible to accurately conclude that current clinical assessment of risk investigations will be sensitive enough to predict which clients will need higher levels of resource-heavy interventions and restrictive care, which people will require fewer and less expensive clinical resources and less restrictive care to achieve safety outcomes (Ryan, et al., 2010).
  • Ryan et al (2010) reviewed the efficacy of the most commonly used risk assessment instrument, that is, the Macarthur Violence Risk Assessment, which is regarded widely as a valid for use in the prediction of violence amongst people who are acutely mentally ill (Monahan, Steadman, & Robbins, 2005). Ryan et al (2010) re-examined the data in the original study and found that the level of sensitively for accurate prediction was ambiguous and that it had very poor sensitivity in regard to accurately detecting risk related to future violence. In fact, the sensitivity of the instrument produced 9% incidence of false-negative cases, where people were categorised as being low-risk and went on to commit violent acts to themselves or others in the 20 weeks immediately following the assessment (Ryan, et al., 2010). Thus, 9% mentally ill people considered to be ‘low-risk for harm to self or others and in fact ‘high-risk’, and these people will slip through gaps in service streams of all types despite having been provided with a clinical mental health risk assessment, because to current instruments available are not sufficiently accurate to detect risk, yet they are in common use despite this paradox (Ryan, et al., 2010).
  • Health services are adverse to risk events and wish to be seen to be doing everything popularly possible to reduce risk of harm to people. However Ryan et al (2010) have been able to demonstrate that based on the fidelity of the most common risk assessment tool, and the incidence of annual homicide rates by people with schizophrenia of 1 in 10,000, and if the risk assessment was conducted on every person with schizophrenia that annually 4117 people would be detained for up to a year in mental health bed-based facilities because they would achieve a ‘high-risk’ category, in order to prevent one person committing a homicide (Ryan, et al., 2010).
  • However, of those people assessed as low-risk, 1 in every 22,421 people would in fact go on to commit homicide (Ryan, et al., 2010). The health resources and cost absorbed by keeping false-negative cases in hospital detract from the finance and recourse available to provide care to the low-risk cases, and some of the low-risk cases require high levels of care (Ryan, et al., 2010).
  • The dispersal of health resources could be better allocated across a broader mental health agenda, and support the mental health of more people if the use of clinical risk assessment was abandoned as having any role in the clinical decision making process (Ryan, et al., 2010).

Given the frequency with which young people with mental illness are involved in justice and policing matters, and with a lack of accuracy and sensitivity in detecting risk related to acute mental ill-health, it is evident that the challenges in regard to helping young people with mental health problems and who are violent, and who do not wish to participate in mental health care, have little support available to them, and this circumstance perpetuates the problem of high number of young people with mental health problems in custody in Australia.

More research is needed to better understand how young people with emerging mental health problems can be helped earlier so that fewer young people are subject to custody arrangements related to their mental health state.