RNAO Region 7 Mental Health Workshop

On Monday, March 21, I attended the last event for the academic school year hosted by the RNAO: The Region 7 Mental Health Workshop. The aim of this workshop was to educate Ryerson’s nursing students about the importance of Mental Health in health care and the application of medicine. There was also an emphasis about actions nurses in the field can take to prioritize and maximize optimal outcomes for the mental health of the patient population. The evening consisted of a dynamic panel of speakers – all of whom are professionals in the field of mental health – that provided a unique and comprehensive perspective on the role of nurses play in mental health. Some of the speakers who spoke out on the issue of mental health include: Alumni of Ryerson’s Nursing degree program, representatives from the Toronto Police Mobile Crisis Intervention Team (MCIT), and a new graduate registered nurse working in Psychiatric Emergency.

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Each speaker shared their personal experience in dealing with mental health throughout their clinical practice. The first speaker of the night – a Ryerson Nursing alumni who now worked at Ryerson to guide current nursing students as they navigate through this program – spoke about her experience with mental illness and working with nursing students. She spoke about nursing students being one of the most notorious group of students who experience the highest level of stress. This is all credited to a demanding, highly difficult, and competitive program; having to balance academic work with clinical placements; balancing extracurricular activities; balancing personal life; etc. All of these aspects can create quite a toll on the student’s mental health, as they begin to feel overwhelmed and over-stressed. Without a strong social support network, and without adequate coping mechanisms, the nursing student’s mental health may be compromised. They may feel isolated and depressed, their grades may suffer, their personal life and self-care may be neglected, etc. This speaker spoke about the importance for nursing students to seek help for whatever they may need; whether that’s academic or otherwise. She emphasized the importance of building a strong social support network, whomever that may include, and to take advantage of on-campus resources at Ryerson. Attendees were attentive and receptive to this speaker’s insights, as often times, nursing students neglect to take care of their self as they are too focused on taking care of others. Personally, I found it refreshing to be reminded that my own mental health is important as well, and that while the mental health of my patients is an important prioritization, it is important to take care of my own mental health. Providing care for others begins there.

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The next speakers for the evening were representatives from Toronto Police’s MCIT program. One of the representatives included a Toronto Police Officer who is specially trained to handle cases with individuals suffering from mental illnesses. The other representative from Toronto Police’s MCIT program was a mental health nurse, who is specially trained by Toronto Police to respond to cases with individuals who are compromising their conduct in society, due to their mental illness. This was a significant topic for the night, as the involvement of nurses in the industry of forensics is a relatively novel concept. Nurses typically work in the traditional health care environment – acute or community – whereas police officers work in their separate jurisdiction. Although there has been significant co-operation between both industries in several cases, the concept of merging both industries to address issues of mental health has only just been introduced. The speakers spoke about their individual experience with mental health as a police officer and as a mental health nurse. The police officer drew on different strategies he would employ to de-escalade situations where individuals who suffered from mental health were at jeopardy of experiencing trouble with the law. For example, as a police officer, he would often exert force and assertive actions in order to de-escalade situations and calm the individual down. If the situation escalated any further, he would be forced to apprehend the individual and take them to hospital to treat their mental illness. The mental health nurse described her role as the individual who would be typically more successful in de-escalating the situation and calming the individual down. She noted that most individuals tend to avoid police officers when in this state, for fear of repercussion, so they would prefer to talk to someone else. In this scenario, the mental health nurse is particularly useful in communicating with the individual, negotiating with them, and working with them to ensure they receive the most adequate care for their mental health illness. With both roles working together in the community, they prove to be a very successful service for the municipality of Toronto. They promote health and safety within communities in Toronto but addressing mental health crises experienced all over the city.

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The final speaker of the evening was a new graduate RN, working as a psychiatric emergency nurse at St. Joseph Healthcare Hamilton. This final speaker was especially significant as not only was she working in the mental health field, she also experienced mental illness herself early on in her life. This was a highlight of the evening as not only did we get to hear the insights and perspective of someone working in mental health, but she was also able to enlighten us with her experience as a mental health patient. She spoke about the struggles she faced making sense of her illness as a young child, how it progressed when she entered university, how difficult it was for her to find the help that she needed, and what resources she used when she was finally able to find the help that she needed. She talked about ending the stigma related to mental illness, and emphasizing how important it is to understand that mental illness is a biological and chemical imbalance in your physiology, not an “attitude you just need to fix.” She spoke about not being ashamed about having to take medication for your illness, and how taking medication can be life-saving measures to take. It was refreshing to hear a perspective that was beyond nursing and professionals. Hearing this perspective from someone having experienced both sides of the spectrum – both the patient and the health care provider – renewed my personal way of thinking, and my own clinical practice. She talked about how her personal experience has catapulted her career and how she uses it to affect positive change in the mental health of her own patients today, and how her personal experience today not only shaped her as an individual, but has shaped her personal clinical practice.

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Needless to say, this workshop provided quite a dynamic and varied range of perspectives and insights on mental health. Nurses are often used to hearing quite similar and repetitive talks about mental health issues and what we can do to address such issues with the patient population. During this night, new perspectives and thoughts word brought to the table. It gave eager nursing students something to really think about in terms of new ways to tackle mental health issues. It opened eyes and doors to different opportunities that will enable you to affect positive change in mental health on a larger scale. At the end of the night, attendees were able to leave with a renewed understanding of what mental health means to them, their patients, and to their clinical practice.

A Word About Mental Health

In honour of today being #BellLetsTalk day, a national campaign to end the stigma surrounding Mental Health and Illness, I have a word or two to say about mental health.

It’s not always obvious.

As a student nurse who has seen different forms of illnesses and diseases in front of her face, I can tell you that a fracture or wheezing in the lungs tends to be one of our easier cases. There are routine assessments for that sort of thing that have been used and developed by medical professionals and clinical specialists for many years. There are actual diagnoses that these medical professionals and clinical specialists can validate and the rest of the medical team can get behind by. There are treatments and medications for these diseases/illnesses, like insulin or morphine, which have been commonly used and prescribed for these illnesses. So when someone comes in for having an unusually high blood pressure or for spraining a joint, the medical team is prepped and ready to treat it. It’s taken with a high degree of seriousness.

When someone comes up to another person and says they’re feeling depressed, the most common responses are:

“What for? You have a great life – you have nothing to be depressed about!”

“Just try smiling and going out with your friends more!”

“You’ll be fine, just make more of an effort.”

They are quite rarely treated seriously. It is only when very serious things occur due to depression when people begin to realize the magnitude of their words or actions. Why do we have to get to that point?

It is important to be conscious about the effects our words and actions have to other people. It is vital to be understanding, empathetic, and a source of comfort for other people, and not a place of judgement. I believe this to be an “everyday rule” but this significantly applies to mental health. Your mental health is incredibly important. It’s the source of your ability for self-care, the source for your ability to function productively on a day-to-day basis, the source for your ability to interact with others, etc. It’s important to ensure that that part of you is well taken care of.

Mental illness is therefore a physiological, clinical illness that affects that part of the person. Mental illness is a product of neurological and psychological defects. Social construct refuses to see it in that way. Society would have us to believe that mental illness “isn’t real” and that it is just a way for people to “be lazy” and “complain.” I cannot stress this enough but that ideology is 100%, completely and utterly false.

If we buy in to this way of thinking, if we adopt this ideology about mental illness that society would like us to believe, we are facilitating the stigma that surrounds this issue. We are silencing voices that need to be heard. We are condemning the people who have these illnesses to fight a difficult battle alone and to suffer this silently. We are not allowing people the right to access safe, efficient health care that can possibly save their life.

What’s funny is that we wait for when someone takes their own life due to depression to be sorry for our actions.

Mental illness is still so heavily stigmatized. People still don’t take it seriously. People are ignorant about how debilitating it is emotionally and physiologically. You can provide someone with as much clinical proof as possible – that depression, anxiety, bipolar disease, schizophrenia, etc. are all physiological illnesses – and they’ll still tell you to just “get over it.” Get real. Your mental health is equally as important as i.e your cardiovascular health. Be educated. Be kind and understanding. Think before you speak. Reach out. You can be saving a life just by being an open-minded and kind person.12651241_10156543597845457_5977017614954725656_n

National Nursing Student Week 2015

National Nursing Students Week is an annual event, hosted by the Canadian Nursing Students Association [CNSA], that occurs in November intended to celebrate nursing students nation-wide in their hard work and accomplishments. It is an opportunity that allows the achievement so of nursing students throughout Canada to be showcased to the community. This year, National Nursing Student Week was from November 15th – November 21st. Each year, there is a significant theme chosen for National Nursing Student Week that reflects the nursing student population and nursing in general. This year’s theme is “Nursing the Mind,” with an emphasis on the importance of self-care amongst all nursing students.

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It is no secret that nursing as a post-secondary program of study is competitive, rigorous, and extremely demanding, to say the least. Not only do nursing students face upwards of 20-25+ hours of school hours a week, on top of a heavy course load, they must also complete anywhere from 6-24+ clinical placement hours a week as well. Overall, it is quite a difficult program, making it quite easy for nursing students to overlook their own self-care and well-being. Nursing students are easily overwhelmed with their work and with school, solely focused on the care of others, making it ironic for them to neglect their own health. This week’s theme helps to emphasize the importance for nursing students to consider their own health and wellness as a top priority as well.

While it is important to work hard and be dedicated in school, it is also equally as important to take care of yourself and make time to ensure that your needs are met. That is the focus for this year’s National Nursing Student Week. The goal for this past week was to take some time out of a nursing student’s day to relax, de-stress, and do something they genuinely enjoy. Some suggestions include, but are not limited to, taking a walk for a few minutes, sitting down and catching up with some friends, reading a book, etc. This advice can even extend towards all students because it is evident that a lack of self-care is an issue that is consistent amongst a student population.

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Ryerson has celebrated National Nursing Students Week on an annual basis as Ryerson has its own chapter of CNSA. Ryerson’s chapter of CNSA conducted a variety of events in the past week to celebrate National Nursing Students Week. Some of the events included offering free snacks for nursing students on campus, information on mental health and self-care, opportunities to relax and enjoy other nursing students’ company in the nursing lounge, etc. With the focus being self-care, the events were centred on ways in which nursing students could find the time throughout their day to relax and rest; give themselves the opportunity to re-charge and clear their busy heads.
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Being a nursing student at Ryerson in my third year, I am all too familiar with the chaos and intensity that accompanies my program. I have experienced the large number of demands that being a nursing student calls for and more often than I’d like to admit, I have overlooked my own needs in order to meet my academic and career needs. For a long time, I found it very difficult to find the time to allow my mind and body to rest and simply enjoy myself. This past National Nursing Students week has allowed me to reflect on what I can do to enhance my self-care practices in the future. It has taught me that relaxation and rest is very necessary in every individual’s life and that no matter how busy your day may be, there is always time for you to pause and rest. I have learned that while my academic and career goals are a priority and something I need to be working very diligently to accomplish, my own health and wellness is also a priority. I am more than just a nursing student, I am also a young person who enjoys life and wants to experience everything that life offers. I want to stop overlooking the joyous things in life and allow myself to take a break once in awhile. National Nursing Student Week 2015 has taught me that no matter how demanding and how stressful life may seem, there is always time in the day – whether that be 5 minutes or an hour – to take care of yourself, and your own health and wellness. As a nursing student, I have the responsibility to care for others – as well as myself.

Self Administered Treatment for Anxiety Disorder [Part II: CBT Exercises]

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It’s important to be aware of mental health issues and how to treat them. Sometimes we aren’t even aware of how we can actively be involved in our own recovery and in the maintenance of our own mental health. My last post focused on anxiety disorder, how it impacts one’s mental state and how one can address it using relaxation exercises. This weeks’ post will be focused on more cognitive behavioural approaches towards treating and minimizing anxiety on one’s own.

One cognitive behavioural technique you can do on your own is filing out a thought record. Here is a step by step description of how you can fill out a through record:

1. State the situation that triggered the anxiety by answering the 5 W’s (Who? What? Where? When? Why?).

2. Describe your mood during the situation and rate that feeling from 0-100.

3. Describe the automatic thoughts that occurred just before your feelings of anxiety began. Think about how the situation reflects who you are and your future? Write down what your fear is and why? Think about any images or memories that might come to mind.

4. State the concrete, factual evidence for the most extreme and anxiety provoking thought from step 3.

5. State the evidence against the extreme thought.

6. Are there any alternative thoughts? Rate how much you believe each thought from 1-100.

7. State what mood you are now feeling after completing the exercise. Rate that mood(s) from 0-100.

The point of this exercise is to interpret your anxiety and how you are feeling, why you are feeling it, whether your thoughts have evidence and to think of an alternative thought. After breaking down the scenario and considering how accurate your thoughts are and why they may not be as accurate as you think you will hopefully be feeling less anxious. When we get anxious, we tend to think more irrationally as our mind begins to race and we think of the worst case scenarios. Through this exercise, we are able to identify our triggers and our unrealistic thought while also thinking of more alternative, rational thoughts. It takes time to master a thought record but it is a good way to reflect on oneself and identify why you are anxious. A helpful suggestion as mentioned in the last post is to show the thought record to a friend, family member or loved one so that when an anxious episode begins, they can remind you to do your exercise and can even coach you through completing it.

If you don’t have time for complete a thought record or don’t have a template available, another helpful way to diminish anxiety on your own is by jotting down the unrealistic thought that is causing anxiety (this can be on paper, in your phone, whatever is easily available and works for you) and then coming up with a more realistic and balanced thought.

An example from http://www.anxietybc.com/self-help-cognitive-behavioural-therapy-cbt :

Unhelpful and unrealistic thought:

I always screw things up. I’m such a loser. What’s wrong with me?”

More realistic and balanced thought:

“Everyone makes mistakes, including me – I’m only human. All I can do now is try my best to fix the situation and learn from this experience”

Don’t make these exercises difficult on yourself. Jot down simple thoughts that you can work with. They can be specific thoughts to a particular situation or more general thoughts on how you view yourself. Regardless, it’s good to work through these thoughts in order to calm the mind.

I hope these relaxation techniques and CBT exercises can be helpful to those of you facing anxiety disorder. It’s a tough battle to fight, so do your best to be actively involved in your own support and treatment. Take the time to focus on yourself and work through your anxious episode through breathing, muscle tensing, thought records or realistic thinking. We are the answer to our own recovery.

Sources:

Thought record http://www.docstoc.com/docs/102511728/CBT-Thought-Record http://www.anxietybc.com/self-help-cognitive-behavioural-therapy-cbt

Images:

Cognitive Hypnotherapy for Anxiety – Article in the Guardian Newspaper

Self Administered Treatment for Anxiety Disorder [Part I: Relaxation Techniques]

It’s that feeling you get when you feel like you can’t breathe. When your heart is beating so fast you fear it might explode or simply stop altogether. When your palms become so sweaty you can no longer grip anything. When you’re too stunned to speak. When you’re too overwhelmed by thoughts and this feeling of impending doom that you just don’t know what to do. When your emotions become so out of control you no longer know how to verbalize how you are feeling. When the only actions you can manage to perform are manic and fidgety, like picking your fingers or rubbing your palms down the side of your thighs. This is the reality of many… the undesired aspects of anxiety disorder which may, in extreme cases, lead to pure and undeniable panic.thCABAZNVA

This form of mental illness is very common and can be linked to other disorders such as depression, panic disorder, obsessive compulsive disorder and other specific forms of anxiety disorders such a social phobia, separation anxiety or post-traumatic stress disorder. With that being said, how does one cope with anxiety disorder and how does one conquer these worries or fears? While psychotherapy is certainly an option using methods such a talk therapy or cognitive behavioural therapy, there are also steps one can take on their own to assist in eradicating or at least diminishing these provoking thoughts that result in feelings of anxiety.

One can learn relaxation techniques such as box breathing or progressive muscle relaxation. Box breathing is when you inhale and exhale in counts of 4 while visualizing a box (i.e. inhale 4 counts (up), hold for 4 counts (to the side), exhale 4 counts (down) hold for 4 counts (to the side) until you have completed the box). This will help stabilize your breathing when your breathing become rushed.

Box Breathing Technique

Box Breathing Technique

Progressive muscle relaxation is when you tense different muscles in your body and hold the tension for a few seconds before relaxing it. You can start head to toe or vice versa. (for example: tense face – hold – release, tense upper arms – hold – release, tense hands – hold – release etc.). I know it can be difficult to remember these exercises during an anxious episode or it can be difficult to perform these exercises on your own so I suggest teaching a friend, family member or loved one how to perform these exercises so they can remind you to do them and can coach you through it.

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Progressive Muscle Relaxation Technique

I find one of the hardest aspects of experiencing a severe anxious episode is remembering that you are not alone. It’s so easy to have your thoughts race and to begin thinking that you are the only person who goes through this and for that you are ‘odd’ or ‘not normal’. It’s important to remember how prevalent anxiety disorder is and to not focus on how ‘not normal’ we might feel, but to try and remember self-administered steps we can take to help relax our minds and bodies in order to feel a sense of equilibrium.

Next week I will be posting a continuation of this blog post on anxiety disorder treatment and will be focusing on more cognitive behavioural approaches to treating anxiety through thought records and other approaches. Don’t forget to check back next week!

Sources:

Box breathing http://www.livestrong.com/article/74944-box-breathing-technique/

Progressive muscle relaxation http://www.guidetopsychology.com/pmr.htm

Images:

http://jdy-ramble-on.blogspot.ca/2013/01/living-with-someone-with-depression-and.html

http://simplemedicine.co/2013/02/10/a-quiet-mind/

http://www.pinterest.com/pin/246994360786023886/