Authors

  1. Kub, Joan PhD, MA, PHCNS-BC, FAAN

Article Content

Anna Treloar is a mental health nurse in Australia who has a PhD in storytelling. With this unique background and an understanding of how important stories are in the recovery process, Anna provided the support for patients to develop their own newsletter producing their own stories related to their recovery. I had the privilege of interviewing Anna this month to learn more about these efforts, her nursing career in Australia, and her thoughts about future directions in this specialty. It was truly an honor and privilege to learn about Anna Treloar's own story as a dedicated mental health nurse in Australia.

 

Q: Can You Tell Me A Little About How You Got Interested In Caring For Patients With Substance Abuse Problems?

A: I'm really a mental health nurse, but you can't be a mental health nurse without also being involved in drug and alcohol nursing. When I started my training, there were whole wards full of people with Korsakoff's psychosis. Then, they started to put thiamine in bread. And I can remember that a man who was confined to the Admissions Ward under the old Inebriates' Act and who had worked for the local council in their parks and gardens told me that portulacas are a good easy thing to plant! That was very early on in my nursing. Those "alcoholics" as we called them then were always very chatty, helpful, and friendly once they had detoxed.

 

I liked detoxing people in the Medical Ward-it was something about helping them get through a bad time and seeing them better at the end of it. Then, a colleague recruited me to the methadone clinic as he needed a reliever. I enjoyed the work and saw the possibilities in AOD nursing (that's what we call it in Australia-or drug and alcohol nursing). Later, I worked as a nurse in the prison system, first in the local police cells when people often underwent an unplanned withdrawal so they needed nurses there to monitor that, then later in primary health in a large new rural gaol, and finally as mental health nurse in the same gaol where we often saw the results of long-term substance misuse in the patients we managed.

 

I try never to do a job which I don't enjoy, so I suppose I must enjoy mental health nursing, AOD nursing, and teaching. That's why I stay anyway. I enjoy it. Both mental health nursing and AOD nursing are interesting, challenging, always changing, and rewarding.

 

Q: I Understand That You Have Been Working As A Clinical Nurse Specialist In Your Area Of Armidale. Can You Tell Me More About That?

A: Freeman House is Armidale's AOD rehab and outreach service. Last year, they set up a detox service as well, and I helped get that going. It means that local people no longer have to travel hundreds of kilometers for a managed withdrawal. They can stay in their area, do their detox, and then move straight to rehab or outreach.

 

I also work as mental health nurse in the emergency department at our local hospital. That means, I see any patient triaged as having a mental health problem, make the initial assessment, and then ring the on-call psychiatrist to discuss the presentation and make a plan. We also provide the same service to Moree ED using telehealth. The telehealth system we use is called the MH-COW or Mental Health Computer on Wheels. We often have to say to each other, "Oh that cow isn't working again!"

 

Q: Please Tell Me About Your Philosophy And Role In Recovery Programs In Australia.

A:The Recovery Model is important in mental health nursing. But I have always factored hope for my patients' future into my nursing practice. If we convey a sense of hopelessness in our patients' future and if we appear jaded and "burnt out" in our attitude, our patients won't do well. There are lots of rehabs in Australia, with different philosophies. Some are very 12 Step; some are very Christian in outlook. Some are evidence based; some are run by people in recovery.

 

I used to tell patients at the doctors' surgery where I worked that I was "a talent spotter." I said that it was my job to find out what they were good at, what they wanted to do next, and help them get there. I would say I approach the detox patients the same way. In the prison, I would ask mental health patients, "What are you good at?" The usual response was "Nuffin, miss." But then, there would be a pause, and I would prompt, "Everybody is good at something." And the answers would then come and were often surprising. That's why I encourage patients to write or contribute their ideas at least. Because not everybody has high literacy but everybody can imagine. And dream.

 

Q: I Understand That You Have A PhD In Storytelling. Can You Talk About This Interest And How It Has Shaped Your Work With Your Patients In Promoting This Writing?

A: I do have an interest in writing. That led to my PhD study on storytelling in mental health nursing and also to a paper I developed with members of a support group I ran as part of my work at a local doctors' surgery. I was employed there as an MHNIP nurse (the Mental Health Nurse Incentive Program is a Commonwealth scheme that puts mental health nurses into general practices to increase access to mental health services especially in rural areas). The members of the group reviewed drafts of the paper and added their comments. So they were writing bits of it. Even though they couldn't be credited because of confidentiality, they knew which bits were about them. And their GPs approved of the project. The article is called "the Therapeutic Use of Postcards." I continued that idea when I got some of the rehab residents to contribute to the in-house newsletter and also to help develop the storyline for the scenario which starts the textbook chapter on AOD nursing that a colleague and I revised. I do think that writing can empower people, especially people who never saw themselves as writers or even as having anything interesting to say. And some don't even believe they have anything to say at all.

 

Eventually, the rehab patients I was working with took over ownership of "Rehab Review" and turned it into "The Freeman Bugle." The motto they used on the banner was "Free to Dream. Always." And I do believe as nurses we must never take away people's dreams. This new title came from the author of the story and poem which you can read at the end of this interview. A fictitious name is used to protect his identity.

 

Q: This Is Very Exciting. I Am Thankful We Are Able To Share Some Of Those-At The End Of This Article.

 

As You Think About Nursing Focused On Alcohol And Drug Use As Well As Mental Health Nursing, What Are Some Of The Trends Or Emerging Issues In AOD Nursing In Australia?

A: Ice of course is getting a lot of media attention, and there are now lots of training courses offered in the management of people who use ice too. But really, I would have to think about that question[horizontal ellipsis]. It's a pity that addictions nursing is not a popular choice among new graduates, so we are not getting nurses into the field. There are often long waits to get a detox bed or get into rehab. And sometimes, people really can't wait! Plain packaging for cigarettes and the banning of smoking from public places is making a difference. Aussies still love their beers though. It's very much part of "being an Aussie."

 

Q: What Advice Would You Give Others, Especially New Nurses, About Your Career Choice?

A: I am always trying to encourage new nurses to take an interest in AOD nursing. I teach the undergraduate drug and alcohol course for the University of Newcastle in collaboration with the Sociology Department. We try to give the students a new perspective on why people begin to use substances and show them how rewarding it is to help them change. I tell the students that nurses love to see people get better, and in this specialty (and I emphasize that it is a specialty, because undergraduate nurses usually want to specialize in something, preferably something exciting and dramatic!), we do see people's health status improve, often dramatically.

 

The other thing I would say is that all nurses need to be lifelong learners. I guess I would say, "Do a MOOC and find out more." I recently completed an excellent MOOC called "Managing Addiction" from the University of Adelaide through EdX. It only lasted 5 weeks, but it gave me an update, an overview, and a look at current research.

 

BATTLE

 

By Jay

 

Blood

 

Anticipate -

 

Terrible

 

Torment

 

Left

 

Everywhere.

 

D.T. RAT

 

(recollection from 1995)

 

By Jay

 

 

I was living in Brisbane, drinking myself silly, realizing trouble. Eventually, I got around to seeing a D&A counsellor, which subsequently led me to the detox. I was nervous but optimistic that this 7-day treatment would fix me up. Should have known better, after the look on my counsellor's face when I mentioned this scenario.

 

The detox was part of the hospital and thus horribly white and sterile. Most of the staff and clients seemed OK, though a couple of nutters added variety and entertainment. There was one nice young boy who seemed to have the dreaded Korsakoff's (an affliction to the brain due to excessive alcohol consumption and lack of thiamine). He had quite some trouble finding the name for his shoe!

 

There was a stunning young blonde who got my attention and who I used to enjoy playing pool with. I remember the guy coming off heroin and the terrible pain he was suffering. Remember too the metho drinker-record for number of detoxes in Brissy, ninety something and still counting. Skin white as a waxy ghost and ashen gray. Hands all bandaged up, as he'd knocked over the metho and dropped a cigarette into the bargain.

 

The medical staff were in constant motion with stethoscopes dangling, machines to push about, and the constant buzz of "Attendance required!" A long day became bedtime. Not much hope of sleep so I just tried to rest.

 

Sometime during the night, I had a terrible fright. A huge evil rat, real as can be, was suddenly before me inches from my face. Its enormous gleaming white teeth were mesmerizing, as were its beady coal-black eyes. It was drooling disgustingly, and its tarnished claws were set for attack. I awoke from my semiconsciousness sweating and shaking. The image of rattus rattus lingered on until I was able to get a grip.

 

A restless fearful night was punctuated by the distant sound of soothing music, which I tried to track down. As I searched the corridors for its source, a nurse, who obviously had hearing problems, advised me to go back to bed.

 

In the tired yawning morning, I related the night's events to blonde. "Better not tell them about that," she advised. At breakfast, I poked about in my cereal for any possible rat droppings, which was ridiculous, as they would have been huge and very easy to spot.