A blog from Bodø, Norway. The regional capital of Nordland… a town of about 52,000 people… just north of the arctic circle… the land of the midnight sun. I am here to speak at a European Mental Health Conference… it is a regional town… out of the way, hard-ish to get to…
I was talking with a nursing colleague yesterday. She was stunned to find that an Australian had travelled all the way to attend the conference – about 37 hours of travel…
She asked… Was I lost? Why was I here? As a university academic surely I was in the wrong place?
I said… No, I am in just the right place…
You see, I am a rural and regional person, from birth to present day. My career has been dotted around regional and rural communities across Eastern Australia and regional Denmark, so far… I understand rural and regional communities – from the inside out. I love them. I am most at home in them. I know what makes them ‘tick’. I know what ails them. I know when they are in pain, and distressed. I care about the people, and their health and well-being opportunities, most particularly.
At the beginning of my career, I set about attempting to make things better for rural and regional people… starting out small, learning my craft – working with individuals and small groups… providing rural and regional nursing care to people – often stretching my scope of knowledge and practice to the edge of capability, and sometimes, by necessity beyond… Rural nurses eventually acquire specialist generalist skills – because we look after every problem that presents for the human condition… and we learn to cope! It gives us a unique skill set and expertise… not easily achieved in urban settings with more discreet silos of expertise…
Later, I was able to study more, and learnt to scale my nursing skills and expertise to contribute towards making things better for communities in national and international settings. Somehow… in a convoluted way… it has become what I do! My agricultural worker father (retired) still can’t get his head around it all and has been known to suggest that life might have been easier if I have stayed working in country town retail instead! (He is proud of me… but wonders what it is that I actually do! To him, a nurse is at the bedside… Teaching and creating the evidence on which nurses today base their practice is less of a job to his mind! But, as he receives nursing care, he is especially proud to be nursed by some of the nurses that I have taught… and I am glad that he is the recipient of ‘my nurses’ care too!) So, my rural and regional roots continue to infiltrate what I do, and how I see the world… it frames my contributions to health disciplines, and to nursing specifically.
I contribute to rural and regional health…
I do this through playing my part in educating nursing and other health professionals to care for others… 1000’s of nurses now have passed through my classrooms.
I do this through scientific investigation. Researching the triggers of distress in people’s lives and contributing evidence to help build solutions for improving the health care of rural and regional people – in hard to reach places… all over the world. Hundreds of others have cited my publications… journals, textbooks, articles, presentations….
I do this through teaching others to conduct scientific investigation…
I do this through using my accumulated scientific and clinical knowledge to advocate for the health and well-being needs of others.
I do this in many other ways too… but for the sake of brevity… I stop the list here!
So, naturally, it is a priority…when I communicate the findings of my research, I take it back to the regions... I remain curious and connected with the regions, and to rural people generally. It is where I fit in… and where my science and practice fit in…
Major capital cities and big urban conferences – they all have a place, and, I have learnt to speak up in these forums too, in advocacy for rural and regional communities. But, when it comes to being in the right place, and communicating with the right people… for me, they are often located in the hardest to reach, most inconvenient places on the globe. That is the right place for me, and this is where I consider that I can make the most impactful and meaningful contributions to society, although be it small, it is significant. It is not the same as urban-based academic impact and meaning… but it is, most often, the most relevant audience for my work. Notably, in stark contrast to the usual connotations of impact and meaning in the academic world… driven by big conferences, with big followings, big consortiums and big funders…big impact factors… huge H indexes… But, me… My influence is more particular… it might be less prominent on the world stage perhaps… (all a matter of perspective and biased privileged metrics really). My work is aligned with relevance to the people and places where it makes the most sense. It fits just right!
It is not the dream for everyone… I get that (actually kinda don’t get that!). It is not likely that I will never be the most popular mental health researcher… in demand for keynotes across the capital cities of the world… I won’t achieve the biggest impact in my nursing discipline, I won’t win the biggest grants – with the ‘in-crowd’ collaborators, I won’t have the biggest most eminent teams…they are not my goals… My rural and regional sentimentality is not always welcomed by the high-flyers based in powerful and ivory research consortiums… sometimes it is even shunned. But, I am confident beyond and I do play my part in furthering mental health knowledge. There was a time when I thought that being a rural and regional nurse was a ‘less than’ value to that of a urban counterpart nurse…Now I see it as a highly prized badge of achievement, as a unique honour that does not come easily won. I am in a minority subset, and inclusion at the main table is often hard fought, and tokenistic… You probably won’t find me at the world’s most prestigious hospitals and universities… But, you will find me at the smaller, less well resourced institutions… out of the way, and off the main strip… But, I know who I am am and what I am doing! I am a rural and regional insider… a health researcher. Advocating for rural and regional fair share of health budgets and resources… for service access and delivery… and contributing scientific evidence to support my advocacy… there are others like me… but we are relatively few! All doing our bit… the world needs us.
Rural and regional people make up about 45% of the world population – by 2050… according to the United Nations 68% of people will live in urban populations. In Australia, currently about 1/3 of the population live in rural and regional areas… There are implications for access to services… including health services. Rural and regional people make significant contributions to society… we grow food, and provide services and commodities to world markets… the health and well being of rural populations is a critical aspect of country health and sustained economic viability… and then there are human rights to consider too. Yet, the health and well-being of rural and regional people is generally poorer than urban counterparts. This all matters…
So, why am I tucked away in a regional town, so far from home… ? …discussing the mental health needs of hard to reach populations? Because global rural and regional health matters… and, it is what I have spent a great deal of time and dedication learning about, and this meeting in Bodø, in out-of-the-way, Norway is a particular opportunity to meet with other experts and to discuss and share news about how to help regional people with mental health needs best.
Is it worthwhile… ? Yes! Am I am in the wrong place? No, absolutely not!
I am right where I should be, in the regions, representing regions as an authentic insider… participating in the development of mental health knowledge for the benefit of enhancing health services for hard to reach populations.
So – to my well meaning nursing colleague who asked if I am lost? No, I’m not lost! I do, however, recognise that I am incredibly privileged to see and visit the exquisite regions of the world… outside of the major cities… working towards making things better for rural and regional peoples… just how I like it, and just where I fit in the scheme of things.
A bit like Maslow… but a bit different! What are your needs to survive, thrive and be healthy in the in the Real World? Everyone is a Digital citizen… but have you thought about it this way before?
Whether you are a consumer/user/patient, carer or family member, clinician, or a researcher… if you have some experience with mental health… you probably have some information that you have learned along the way about improving mental health opportunities for others in the future. And information from all of these sources contributes to the pot of all known knowledge about mental health. Sharing the gems of knowledge we have can be challenging (and a bit scary sometimes too!) But, sharing makes a useful contribution. This blog is about one way to contribute to the convincing tried and tested evidence end of the knowledge spectrum…
These days in mental health conferences in particular we are seeing more people with lived experience speaking, and being included in conference discussions and agendas – respect is growing, the environment is becoming more inclusive. Clinicians are also increasingly being included, and asked to share their practice…
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…in excess of 7.7 billion mobile technology subscriptions worldwide – and growing…
…mobile networks cover around 95% of the world’s population (note: not the same as landmass)…
…In 2018 the global mHealth market is expected to be valued at USD 28 billion, more than tripling its value since 2015. By 2020, the market value is anticipated to reach USD 46 billion…
…more than 318,000 available health apps…
…worldwide and counting, with more than 200 new health apps made available daily…
…currently more than 860 clinical trials on Digital tools and mHealth apps worldwide…
(Lange Nielsen 2018)
Key factors to consider to assess suitability of a health app:
Privacy / Data protection’
Credible sources / Evidence-based information’
Usability / user experience’
‘Security / authentication’
‘Effectiveness / Impact’
(Lange Nielsen 2018)
Click here to read a review that lists a range of health app’s that have undergone assessment according to the above suitability criteria (Lange Nielsen 2018). Tip: scroll to the appendix to see the apps!
The Mobile App Rating Scale is also a useful resource to assist in assessing the suitability of a health app – click here to find out more:
This is what is happening in the EU at the moment…. (Byambasuren, Sanders et al. 2018)
Quality, safety and your best clinical judgement:
But we (Søgaard Nielsen and Wilson 2018) think there are some other factors that you need to take into account when using your clinical judgment in regard to selecting quality and safe digital interventions for therapeutic use in the clinical setting: Combining e- mental health intervention development with human computer interaction (HCI) design to enhance technology-facilitated recovery for people with depression and/or anxiety conditions: An integrative literature review Click here
And for nurses specifically… this quick-to-read free-to-read guide about the safe administration of digital interventions is useful: The right way for nurses to prescribe, administer and critique digital therapies (Wilson R. L. 2018)
…and more on the topic here too: Preparing nurses to be prescribers of digital therapeutics (Ferguson, Hickman et al. 2018)
Last word… If you are a registered health practitioner and you are providing advice about the suitability of health apps to assist people with a health problem… you have a responsibility to ensure that you have the right skills, and the right evidence to underpin your practice. There are so many apps to choose from, and there are a lot of charlatans to avoid… but if you do clinical due digital diligence, you should be able to find a vast array of suitable digital therapeutics for the prevention, management and treatment of physical and mental health problems for many people in most places in the world.
Byambasuren, O., et al. (2018). “Prescribable mHealth apps identified from an overview of systematic reviews.” Digital Medicine 1: 1-12.
Ferguson, C., et al. (2018). “Preparing nurses to be prescribers of digital therapeutics.” Contemporary Nurse 51(1): 1-4.
Lange Nielsen, S. (2018). Report On International Practice On Digital Apps. S. Rimpiläinen. A project supported by the European Union’s INTERREG VA Programme, managed by the Special EU Programmes Body (SEUPB), The Digital Health & Care Institute: 1-97.
Søgaard Nielsen, A. and R. L. Wilson (2018). “Combining e-mental health intervention development with human computer interaction (HCI) design to enhance technology-facilitated recovery for people with depression and/or anxiety conditions: An integrative literature review.” International Journal of Mental Health Nursing.
Wilson R. L. (2018). “The right way for nurses to prescribe, administer and critique digital therapies.” Contemporary Nurse 0: 1-3.
Preparing for going out on Clinical Placement or Practicum (Prac) takes personal courage… every Registered Nurse has been there… Personally, I think I loved all my pracs. I was able to choose a major theme for mine… no surprises… I chose mental health. Acute care and community… and loved every second. I am still in contact (and even have enduring treasured personal friendships) with some of my student-days lecturers and clinical facilitators/ mentors… some very special nurses! I remember I felt challenged with each new practicum…
IN real life…. a story for my student practicum days: I recall one experience on prac on an orthopaedic ward, where we had admitted a patient as ‘overflow’ from another ward… he had no orthopaedic problems… but he did have a tracheotomy tube in place (a consequence of smoking that he was quick to point out and recommend that smoking was a bad health choice to others)… he was a lovely fellow, and I was asked to look after him (under the supervision of a Registered Nurse). He was to be my patient load for the day… and I was determined that he would get the best nursing care known to humankind!
There was one problem though… there were no emergency dilators on the ward, should his tracheotomy tube dislodge. I was quick to note that these should be at the bedside in case of an emergency… staff around me were not too concerned about the missing equipment, after all, they wouldn’t have sent a high risk patient to the ortho ward! And… the Clinical Nurse Specialist was booked to do a round to see him each day… it should be fine!
I wasn’t satisfied with the responses I had from my ward nursing team… so I decided to discuss it further with my Clinical Facilitator when she came around to check on me later in the morning…. See, we had practised the care of a patient with tracheotomy in the simulation labs back at university the week before – something just wasn’t right. My Clinical Facilitator and I went and checked the hospital policies and procedures together… it was a book in those days, (but you would check the intranet now)! We discovered the policy concurred with my hunch that dilators should be present at the bedside at all times… so with my Clinical Facilitator, we tracked down a pair of the dilators required at the Central Sterilising department… and took them back to tape to the the bed unit wall… I reported in the handover that the safety equipment was now located at the bed unit (the Nursing Unit Manager thanked me for my diligence) I went home from that shift feeling very happy that even if they were not ever required (and it was not clinically likely in this case), I had made sure that my patient was safe!
The next morning… off my patient went for his shower… and while he was in the shower I made up his bed beautifully, refreshed his water jug, and tided-up his bed unit. I checked that the oxygen tubing was intact and the suction was working…. and the dilators were still safely taped to the wall. I was very eager to be a fine nurse… All was sparkling clean, fresh and ready for his return. As he sat on the edge of his bed… he coughed – and enormous cough…. his tracheotomy tube dislodged… fell out completely…. I could not believe my eyes… we were located in an alcove at the end of the ward… I buzzed three times for others to come and take over … (my plan in the event of an emergency was to assume a notetaker role… and being so eager to learn all I could… I would take very good notes!). Nurses came from everywhere… arriving in the room and know one knew what to do… so, I found myself applying the dilators to the patients tracheotomy to maintain his airway, while a code was called. The Junior Medical Officer appeared… and had never inserted a tracheotomy tube before…. so there I was, after practising the procedure over and over again in the simulation lab at university… guiding a bunch of senior health professionals in the procedure! My flashbulb memory persists years later… The NUM wrote a lovely commendation, and offered me a graduate position for the following year (you could do that then!). (I didn’t take her up on that offer… as it turned out… the cardiac intensive care unit offered me a spot and I took that instead). But, that was my first lesson in speaking up respectfully, being brave, being prepared and being safe.… with real life and death consequences in the balance. So… some tips from my prac to yours…
- Be brave! Yes, you will see and do things you never imagined – even on student prac! Each day will make you stronger.
- Be prepared… be ready to try new things… have a go (under appropriate supervision).
- Say yes! And, respect no!
- Mind your manners! Be quick to introduce yourself, don’t stand back and wait for introductions. Hello – my name is… I am from… I am here to help you with… Thank your patients and nursing teachers for guiding you and supporting you as you learn.
- Talk it thorough… what you’re doing, why you’re doing, how you’re doing, where you have been, and where you’re going, and … who you are doing with, and to… talk about your feelings, your thoughts and your actions as they relate to your developing practice with a trusted and confidential nursing mentor.
- Be kind to your student peers, mentors, teachers and of course – patients and their families.
- Be safe… do safety checks where and when ever you can – check the safety of equipment, processes, bed unit and environment. Every time you do a safety check you reinforce your learning and you train yourself to deliver quality care while keeping your patients and colleagues safe.
- Read all the policies and procedures you can… knowing the organizational structure helps you to navigate your way through the health care maze… and helps you to guide others towards the assistance they need too.
- Ask questions… don’t be put off by the unofficial-student-code-of-conduct that says ‘don’t ask questions so we can get out of here quicker’! Rather engage, immerse, ask, read, and listen.
- Turn-up, show-up, put-in… make yourself useful. Be ready to play an active role in the health care team, be prepared to help-out and chip-in. Onlookers need not apply.
To prepare for you own nursing practicum… you can learn more if you read Chapter One (by me and some of my past nursing students) The Australian healthcare context, Clinical Nursing Skills: An Australian Perspective. Cambridge University Press, Pages 11-19… here’s the link:
Or – ask your nursing school library for a copy.
If this has been useful to you – remember to share it with others too!