Nursing

May 28, 2014

Expectations

When I arrived for my first agency nurse contract on Badu island in the Torres Strait I wasn’t aware of having any expectations. My main thought was that I was having an adventure. After a day or two I realized I was waiting for “something” to happen. Maybe shouting in the street, or some other type of sudden violence. The Cape York community I’d worked in for two years experienced a high level of violent outbursts. Raised voices in the streets were often the background noise to every other day. I had been initially shocked at that, but by the time I left I had grown accustomed to it.

The Cape York community was my first experience in working as a remote area nurse. I learnt my emergency skills there and began to have some understanding of the health and social difficulties of Indigenous people living in traditional lands. I didn’t know, though, that I expected every group of Indigenous people to be similar. Leaving the place I knew and arriving to work on a small island, my first lesson was about my own expectations. The fact that I had them, and that they were wrong.Since then I have worked almost two years in various Torres islands and can count on one hand the number of times I’ve heard shouting in a street. Becoming aware of my expectations and letting them go is a lifetime’s work. I learnt after those first few days to be more open to what I actually saw and heard instead of living from my assumptions. And I’ve been constantly and wonderfully surprised at the differences within Australian Indigenous cultures and individual people.

May 15, 2014

Singing Days

The French author Marcel Proust once wrote “There are hilly, difficult days that one takes an infinite amount of time to climb, and there are downward-sloping days that one can race down singing.”

I knew I was going to have many singing days when I stared out of the window of the small plane flying low over the Torres Straits, just off the top of north Queensland. The water below was a collage of blue greens and tiny uninhabited islands. I was on my way to work my first nursing agency contract on Badu island. I had grown used to island life in Samoa, where my partner came from. The long, lazy fishing days, the close knit family and community life that comforted me with the feeling of never being alone, and the endless beauty of the surrounding sea.

From the moment the plane touched down on the Badu airstrip and I saw coconut palms fringing the fence line, I couldn’t stop smiling. The two years I’d been in Aurukun on the western side of Cape York, had been mostly “hilly difficult days”, coping with being a long way from family and friends in a harsh environment. I was looking forward to living and working in a quieter environment. There is nothing as restful as being able to look at the sea and what I enjoyed as I walked in through the door of the Badu clinic, was being able to see straight down the corridor to sparkling water.

Singing days can be created or caused by any number of reasons. My Badu six weeks were filled with songs from the sea.

April 26, 2014

New Chapters

When I left Aurukun and began working for a nursing agency it was certainly a new chapter in my life. I’d worked for Queensland Health for around 20 years. I enjoyed the certainty and security of permanent work and, while I listened in awe to the stories of agency nurses I’d worked with, I was too afraid to follow them into the wide world of choices and possibilities.
In late 2010 I began work on my first agency contract on Badu island in the Torres Straits off the top of North Queensland. Prior to arriving I knew hardly anything about the islands, but the flight from Cairns to Horn island and then on a smaller plane to Badu whet my curiosity. I had never imagined any kind of life off the tip of Cape York. There had been a time in my adult life were I’d never been further north than Bundaberg, and even that felt like I was about to drive off the edge of Australia.
Flying over the Torres I stared down through a smudged plane window at a blend of ocean blues and greens and tiny uninhabited islands and knew I wanted to stay awhile to get to know this place.
So much has been written and said about new beginnings, basically the fact that the past needs to be let go of to embrace the new. I let go of the need for certainty and security and whole-heartedly embraced a sense of adventure which opened a fascinating chapter of island life and culture.

April 6, 2014

Breaks

Oddly, where I finished my last blog in my remote area nurse story, there was a natural pause, or break in events. I went from being permanently employed by Queensland Health to choosing uncertainty as an agency nurse. My first contract was on Badu island in the Torres Straits. I’d experienced life on a tropical island in Samoa and in many ways I found a similar culture on Badu.

I haven’t written anything here for five weeks. I’ve just returned home after spending time in Tasmania, another island, and at the opposite end of Australia to the Torres islands. Another island culture, but with few similarities to the tropical north. They share being surrounded by the sea and having a relaxed feel, but then landscape, weather and history diverge.

Breaks are essential to the narrative of our lives and their meanings many. We take a rest from everyday busyness, we end one thing and begin another, we voluntarily plan them or they’re forced on us. They’re usually a waiting time, a marking time until life resumes where we left off or we begin an entirely new thing. Either way, we’re never quite the same person. I went to Tasmania to witness a friends wedding, for her it was a wonderful beginning to something new, for me it was the experience of a place of beauty I’ve never seen before and to which I want to return. And which has given me another view of island life, new possibilities. I will return to my remote nursing story this week and write about life on tropical islands but my thoughts for now are very much still on the break I just took on a more southerly, cooler and greener island.

February 21, 2014

Beauty as Therapy?

I’ve just read an article entitled “Beauty Myths” by Dr Mary Grogan in a magazine called “Mindfood. She writes about how people are attracted to others with symmetrical facial features and how often beautiful looking people have a smoother path in life. But to balance that she mentions a book called “The How of Happiness” (Prof Sonja Lyubomirsky, Penguin 2007) which states that attractive people are no happier than plain-featured folk. Her ideas were interesting but what stopped and made me think was the following: “Interestingly, appreciation of beauty is one of two character strengths that have been shown to be associated with life satisfaction following recovery from a psychological disorder (the other is love of learning).

She continues “In a web-based study of 2087 adults published in The Journal of Positive Psychology 2007 Christopher Peterson and colleagues found that people who had a high appreciation of beauty were more likely to recover from depression and anxiety disorders with greater levels of life satisfaction. Thus, interventions that include how to develop appreciation of beauty may be useful not just as a general life skill, but in enhancing life when experiencing psychological distress and afterwards. So how do we find beauty in our world and appreciate it?”

When I worked in Aurukun, a remote Indigenous community in far north Queensland, for two years my sanity saver was to walk down to what was locally known as the landing on the Archer river after work and watch birds, sunset, sparkling water or misty mangroves depending on the weather and to photograph what was memorable. I’ve found in the years since I left and worked in various remote locations, finding beauty spots in nature and just sitting and watching and maybe photographing (which makes me notice more) has calmed my mind repeatedly. I can’t recommend appreciation of beauty, highly enough as a therapy for stress and a life enhancer. Remote area nurses are lucky to have access to some of the most amazing places in Australia if we take the time to find and notice them.

This photo was taken recently in the Northern Territory across the Gulf of Carpentaria from Aurukun.

February 19, 2014

A Creative Life

I can’t drag myself away from the topic of creativity it seems to me to hold much that is hopeful and playful and worthwhile. I’ll share another quote from Eric Maisel’s “The Creativity Book” in which he invites the reader to think about creativity in a broader life sense than merely a narrow “artistic” view.

“Creativity is linked in our minds with poets, artists, inventors, and people of that sort. We think of the Edisons, Einsteins, Picassos and Beethovens of the world as creative. But any job can be done more creatively and life can be lived more creatively. What’s required are certain changes: that you begin to think of yourself as creative, that you use your imagination and your mind more, that you become freer but also more disciplined, that you approach the world with greater passion and curiosity.”

Even the dullest job, the most tedious task and the most unpromising day can hold possibilities if we approach them with curiosity and imagination. I found nursing like that…curiosity as to what was coming next, what my patients would be like, what could they teach me, what stories could I hear? and so on. Curiosity keeps us alive and growing.

Pictured here is an Indigenous weaver from the central Desert visiting Aurukun Art Centre to share her techniques with her Queensland sisters.

January 31, 2014

Trauma

How many times do we hear the news of a traumatic death in the media? We might stop for a moment and think how shocking it is or we might not even do that, we might be too busy to ponder anything except the task at hand. I remember when I worked in hospital I often thought, after I’d nursed someone with a broken leg, that never again would I say “oh, that’s good they just got a broken leg” after hearing about an accident. Until you see injury and death up close you don’t realize just how physical it is, how weighty and wearing on all involved.

A year into my remote area nursing I was called to a stabbing where a short while later the victim died. I couldn’t sleep properly for weeks. The sheer physicality of the event had lodged in my imagination, I couldn’t get free of the movie that kept replaying in my mind.

I saw a visiting psychiatrist who told me that the murder had ticked every box indicating it was indeed traumatic, but as I spoke to him throughout the week he was visiting the community, he told me in his opinion, I’d been more traumatised by a sequence of events involving bullying by two nurse colleagues in a hospital prior to me working as a RAN.

What traumatises us is as unique to each of us, as is what contribute to our recovery, and the time and the journey our healing takes.

For me, I’ve always needed to get out into nature on my own and just be. It somehow seems to put emotional upsets into a larger, calmer context. Pictured here was my favourite getting out into nature spot in Aurukun, the landing, where I often walked to after work and sat until sunset or the mosquitoes came out.

January 29, 2014

Mental Health

I just finished reading a book called “Madness: a memoir” by Melbourne doctor, Kate Richards. It’s an honest and poignant account of her experience with mental illness. She ends the book by saying…”I’m grateful to be living in a country where medication and therapy are mostly available and affordable. However even in Australia, we are still not caring for the most vulnerable members of our communities. Those who, through no fault of their own, are not as lucky as I have been to respond to medication or to be able to find the right kind of therapy. These people are of all ages and backgrounds, and we ignore their suffering because most of us don’t understand their ways of seeing the world or we are afraid of their difference or embarrassed by their appearance and because we don’t see their injuries. No-one ever wakes up one morning and thinks, today I’d like to go mad, lose my job and friends, and end up odd-looking and living on the streets, anymore than they think, today I’d like to get cancer.”

Aurukun has the highest number of mental health clients in Cape York and is serviced well by visiting mental health teams. The RFDS built a Wellbeing Centre (pictured here) in the grounds of the clinic a few years ago which offers support, counselling and education. But providing services is just one way to support “vulnerable members of our communities”, having, and showing, kindness and compassion, firstly on ourselves in our demanding work as remote area nurses and then to others is the key to our continuing mental health and our patients healing.

January 25, 2014

The Royal Flying Doctors

100_8090Every Australian knows what the RFDS is and what work they do. Every remote area nurse will at some stage in their lives have looked longingly at the sky to see the first glint of silver approaching or strained to hear a faint engine rumble along with hopes that their patient would stay stable during the wait.
During the two years I worked in Aurukun and later in other far away places it was the knowledge that the RFDS was only a phone call and a flight away that enabled me to work without overwhelming fear. I still marvel at it’s history and the initial concept of a “mantle of safety” covering outback Australia. What a man of vision John Flynn must have been. Barely a day went by when I worked in Aurukun that I didn’t enjoy working in partnership with the RFDS staff based in Cairns. I think as Australia Day comes around again the RFDS can be numbered among our local heroes.

December 10, 2013

Sleep Deprivation

When I applied to work in a remote clinic I assumed that being on call after hours would be like doing night shift. It wasn’t. With night duty you know what hours you are rostered to work, with remote area after hour call outs, nothing is certain. You quickly learn that you could be woken up several times a night, rarely for real emergencies.Nurses are often told to educate the community on what an emergency is, but at 3am arguing with someone who’s woken you with a toothache,simply guarantees that you lose more sleep than if you just get out of bed and go and see them.

The US National Sleep Foundation recommends that adults need between seven and nine hours sleep a night. Continued lack of uninterrupted sleep results in sleep deprivation with potentially fatal effects.Remote area nurses usually have fatigue leave (if they don’t work in a single nurse post) which is supposed to make up for lost sleep. While we all value it, it is rarely a substitute for sleep. If staffing is short or clinic demands many, a nurse repeatedly on call can be functioning at a much reduced level of competence. When important decisions have to be made for patients health one has to wonder if the added responsibility put upon them to “educate” the community about what an emergency is, is a wise thing?

Among the many results of lack of sleep are an increased risk of accidents and injury, impaired attention, alertness, concentration, reasoning, memory and problem solving. It can lead to health problems such as heart disease, stroke, diabetes and depression. Judgement can be impaired, especially in regard to being able to assess what lack of sleep is doing to oneself. Also hurting their ability to make sound judgments because of a reduced ability to assess situations accurately and act on them wisely.

Before deciding to work in remote areas nurses do well to assess how well they function without sleep.