Month: January 2013

Resilience and community mental health nursing in Palestine

With his permission, let me introduce you to Mohammad Marie. I know Mohammad as a PhD student in the Cardiff School of Nursing and Midwifery Studies. He is also a mental health nurse and teacher, who (when he isn’t attending to his thesis in south Wales) works at An-Najah National University in Nablus, in the Palestinian West Bank.

Mohammad is interested in resilience, both generally and in community mental health nurses in particular. Through his writing I have gained a glimpse of mental health needs and services in the occupied Palestinian territories, and of the day-to-day realities of living and providing health care in this part of the world. Quite rightly, nurses in the UK complain about lacking resources, of coping with high caseloads and of the dangers of burnout. Here, however, we can barely comprehend the enormity of the challenge facing those who do nursing in Palestine. Human rights are violated, and free movement restricted. Access to medicines is limited, and rates of trauma and mental ill-health high. Few practitioners have had opportunities to develop knowledge and skills specific to the provision of mental health care. For readers wanting to know more, the World Health Organization has made available information on health and health services in Palestine here.

A simple question drives Mohammad’s study: given their circumstances, what are the sources of resilience which help community mental health nurses continue in their caring work? As part of laying out the background to his project Mohammad has introduced me to the uniquely Palestinian concept of ‘samud’. ‘Samud’ and ‘resilience’ look, to me, to be close cousins, with the former referring to steadfastness in the face of adversity. It manifests in individual and social action, as well as in specific policy (for example, to support the development of an infrastructure for public services). From what Mohammad tells me, samud has become an important part of Palestinian culture and identity.

To get answers to his research question, Mohammad returned home last year to generate data. In ethnographic style he observed nurses and other staff going about their day-to-day tasks, basing himself in a series of government and non-governmental community mental health centres. He read local documents relating to the organisation of services. In order to explore nurses’ experiences and views in depth, Mohammad conducted detailed interviews with a sample of practitioners. The absolute number of participants in this phase was modest, but still a majority of the total population of community mental health nurses working in the West Bank.

Right now Mohammad is surrounded by transcripts and notes, doing his best to make sense of everything he has seen, read and heard. It’s for him to tell the story of his findings, but I know these will be both interesting and important. I’m looking forward.

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Research, open access and academic blogging

Martin Webber, social work academic at the University of York, is inviting discussion on why researchers should blog. Martin will be drawing on what people say at a seminar he’s giving early next month as part of a York Social Research in the Digital Age series.

So, why indeed? Here are some personal reflections, on blogging and also more generally on the process of writing in an internet-connected world. These I’m basing on my (very) preliminary experiences on this site, some thinking done over the last couple of days, and an awareness of how academic practice is changing.

Word cloud 28.01.13 First, researchers might want to blog because this is a very direct, free-to-access, way of communicating. This is especially important in disciplines in which most research papers are published in journals which sit behind paywalls. In applied areas like my own (mental health nursing, systems and services), a blog can be one way of connecting with important audiences (practitioners, policymakers, managers, service users) likely to lack the necessary subscriptions

This does not mean that academic blogging is therefore redundant in disciplines where all or most research outputs are publicly available, and for free. To say why this is so, I probably need to say something about open access. Here in the UK a big shift is taking place in favour of publishing in journals which are both peer reviewed and free to the reader. Check out, for example, the 246 titles currently offered online by BioMed Central. Plenty of longer-established publishers are now also offering open access options to authors submitting to their titles. Increasingly this means that, within single issues of journals, open access content sits side-by-side with subscription or one-off payment content.

A major driver behind these developments is the Finch Report, which appeared last year. This recommended open access as the preferred publishing model for the future, particularly in the case of papers reporting research supported by public funds. Making further progress along the open access route, however, means finding new ways of covering the costs. In the traditional model authors pay nothing to see their papers in print, the costs of publishing being recouped via institutional (or individual) subscriptions or from payments made by readers of single articles. Publishers like BioMed Central do things differently, requiring authors (unless they secure waivers) to pay an ‘article processing [or publishing] charge’ (APC) for each peer reviewed and accepted paper. APCs can be hefty. For example, the current submission checklist for the journal BMC Health Services Research indicates that it usually levies an APC of £1,290 on each accepted paper. The Times Higher Education reports that in the majority of open access papers published in the new social sciences and humanities journal Sage Open, the APC has been paid by individual authors. I’m not sure that’s either fair or sustainable. In the future, financial support for what Finch and others have called ‘gold [APC] open access’ will surely have to be provided by funders and universities (presumably using money currently being used elsewhere). Government and charitable funding bodies will require applicants to include in their bids the costs of open access publication, and universities will sign up as members of organisations such as BioMed Central with the aim of waiving or reducing the costs associated with individual article processing.

There are other ways of making available, freely and publicly, the full text of published research outputs. Publishers’ policies in this area differ, but under the terms of their copyright agreements many allow versions of accepted papers to be uploaded to institutional repositories for access, at no cost, by interested readers. The best deals allow authors to deposit post-peer review versions of papers as soon as they have been accepted for publication. Other deals allow the same, but after an elapsing of time to make sure that readers wanting immediate access have to obtain paid-for versions. The text in these author-own manuscripts is the same as that appearing in journals’ versions, but the papers lack the ‘added value’ of volume and issue details, layout and formatting as per journal house style, and so forth. This ‘green open access’ model is one I have been making use of in this blog, via links to post-peer review versions of papers saved in the Cardiff University ORCA repository. Check out my Enduring posts page, which has examples of posts and linked papers on wicked problems, work and roles in mental health systems, and research ethics and governance.

So if the gathering pace of the open access movement means that research papers will be more likely to be publicly and freely available via ‘gold’ and ‘green’ routes in the future, does this reduce the need for research blogs? Not at all, in my view. Blogs can be vehicles for making clear the connections between multiple papers and projects, giving researchers opportunities to write in-the-round overviews of cumulative bodies of work. They can also help contextualize research, and unpack the detail of full-text papers irrespective of whether these are open access or paid-for. In this way blogs can perhaps help translate ideas, promote uptake and increase the use of findings. This, I think, is part of the task researchers now face to maximise what the Research Excellence Framework (REF) refers to as ‘impact’. As an aside, I am reminded in this context of the excellent material on using social media to promote research available at the LSE’s Impact and the Social Sciences blog. If anyone working in the health and social care fields has examples of blogs, tweets and the like being successfully used to promote impact outside of academia, I’m sure I’m not the only one who would like to hear more.

Blogs are also interactive, allowing fast-moving, two-way, communication between writers and readers via the use of the ‘comments’ function. This is very different from traditional academic publishing, which can be distinctly one-way. This said, there are some journals (like the BMJ) which directly encourage readers’ online responses to published papers, and which host journal content and supplementary material (blogs included) at single sites. Further, whilst publishers will often accept study protocols in their journals they are less keen on progress reports. The immediacy of blogging offers an option here. For instance, Martin Webber on his site has some excellent examples of using his blog to keep interested parties aware of his ongoing projects.

To sum up what has turned into a lengthier-than-expected post. Martin Webber asks why researchers should blog. Based on my (admittedly brief) excursion into the genre, my response is that a more appropriate question might actually be, ‘Why are researchers not blogging as a matter of course?’ I have also taken this opportunity to think, in a more general way, about blogging in the context of changing academic practice. Blogs are a way of sharing research ideas, progress and findings, and can be used to wrap around and support full-text open access content. They have the potential to promote engagement between research producers, and research consumers. They allow connections to be made, and they encourage interaction. What’s not to like?

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Remarkable stuff, snow

As an aside, with no bearing whatsoever on my last post describing what I do using only the commonest words in the English language, here are two photographs revealing what snow is capable of.

These were taken over the weekend, deep inside Fforest Fawr. The branch of this tree has entirely split, presumably under the weight of accumulated snowflakes. Parts of the Taff Trail, and certainly the Penrhos Cutting, were littered with branches (and indeed, whole trees) brought to the ground in this way. The second photograph is of the branch, collapsed following the break.

I can’t quite recall seeing this kind of thing happening during previous snowfalls. What’s different, I’m wondering? Unusually sticky snow, perhaps?

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What I do at work, described using only the commonest 1,000 words in the English language

Via a link in a tweet from @bengoldacre I came across the Bad Science (and now Bad Pharma) author’s secondary (!) blog, and this page in particular. Here, Ben describes how randomised controlled trials work, using the English language’s commonest 1,000 words.

The idea of making complex things simple in this way comes from Randall Munroe at http://xkcd.com, who produced the wonderful graphic I’ve reproduced here (with his permission) of how the Saturn V rocket works. Called Up Goer Five, the supporting text (as you can see for yourselves) explains things ‘using only the ten hundred words people use the most often’.

So that anyone can have a go at making difficult stuff understandable in this way, a text editor has now sprung up at http://splasho.com/upgoer5/. In goes your explanation, and if you happen to use a word from outside of the list of 1,000 commonest you’ll get a message telling you that it is not permitted. Such fun. You can also tell others of your efforts through Twitter using the #upgoerfive hashtag.

Yesterday and today I’ve been using this online tool to chip away at a description of what I do at work. It turns out that an awful lot of the words I’m fondest of fall outside of the list of those permitted. Examples include ‘process’, ‘system’, ‘nurse’, ‘health’, ‘complex’ and ‘organise’.

Anyway, here’s my effort:

For over 60 years people in this part of the world have believed that those who are sick should be looked after, without having to pay for their care at the time they need it. So to make sure there are always people around to do the job of caring, and to make sure there are places to go when we’re sick, everyone who works gives some of their money to pay for doctors, hospitals and so on. The important thing is that if you’re sick you should get the help you need, no matter how much money you have (or don’t have). I think this is a great way of doing things, and so do lots of other people.

But what do we mean by being sick, and what type of care is best? Some people have problems like their hearts not working in the way they should, or other bits of their bodies going wrong. But there are also people who have problems with how they think, feel or act when they are with others. They can get very sad, scared and worried. They can get confused, and/or hear things which aren’t really there. Families and friends get concerned when these things happen, but don’t always know what best to do. As it happens, we don’t completely know what causes these kinds of problem. It may be because something is wrong in the body, and/or it might be because bad stuff happens to people which makes them sad.

Maybe one day we’ll know much more about what causes people to be sick in these ways, and be able to help them more or even stop their problems happening in the first place. But for now, and I guess always, we need people who spend their time looking after those who get very sad, or worried, or confused, or who hear things which aren’t there. This is serious and important work, and there are lots of different types of people who do it. Those who do it as a job can be found in teams both in, and out of, hospitals. In truth, how these people and the teams they work in fit together can be really confusing. Nothing ever stands still, as new ways of getting stuff done appear.

So here’s what I do. I trained to look after people who have problems with thinking, feeling and acting and now I help to train others in this field. I also study people who do this kind of caring work, the teams they work in and what it’s like to be someone getting help. I do this because it’s important to find out how the different parts (the people, the teams) fit together, and to learn how caring work can be done in different, and maybe better, ways. Working with friends with the same interests I have used a number of approaches to study these things. I have sat with people and asked them questions about the work they do. I have read what people write about the care work they have done, and have watched people doing their day-to-day jobs. I have asked about the care work that people (like family and friends) do, and for which no-one is paid. I have asked people to tell me what it is like to get help from people in different jobs, and what it is like to have care across different teams over time. I have given people pieces of paper with questions about what they think and feel, and asked them to return their answers for us to read and study.

What have I found? The work that people do is changed by where and when they do it, and by who else is around. So you and I might think we know about the work that people in caring jobs do, but it turns out that there are lots of different ways of getting stuff done. Jobs change over time, and sometimes people do not agree who should do what. In teams, people sometimes do work which has to be done because there is no-one else to do it. I happen to think this is interesting and important, for lots of reasons. One reason is that if we don’t know what types of work people will end up doing, how do we know how best to train students? I have also found that a lot of caring work is hidden, because it is done by people who are not paid and/or who are on the edges. This is especially so in the case of people living in their own homes, and who get help from care teams which are placed outside of hospitals. Everyone thinks of doctors, but who remembers the work done by the person living next door? The way the different bits (the people, the teams) fit together means that those who are in need sometimes have problems getting the right help at the right time. And, when new teams appear, I have found that these can do great work but at the same time cause new problems to pop up somewhere else. This is because everything is joined to everything else. From studies completed with friends some years ago, I have also found that doing caring work is not easy. People who do it can get to feel very worn out.

Here is some new stuff I’m doing now. With friends I’m going to look at how people plan care, and what this means for the person who needs help. I’m also about to start a new study where we will read about young people in hospital, and how those who care for them keep them safe.

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Snow, research and higher degrees

Red weather warning Today brought the predicted dollop of snow, meaning that yesterday there was no bread to be had in the shops. See this Met Office map of the UK, with its colour-coded weather warnings? See the red blob? That’s where I live, and where I am now.

This has been an interesting, and particularly research-oriented, working week. I spent part of Monday with a group of postgraduates, discussing processes for the review and approval of research and other projects. It has to be said that the opportunities for MSc students to complete small-scale data-generating studies are fewer than they once were, particularly if their plans are to generate data in the NHS. The time needed to secure R&D and research ethics approval can take a serious chunk out of the typical student’s period of candidature. Now, unless studies can be shown to be linked to larger research endeavours there’s also a fair chance that some NHS organisations will want to levy charges for processing R&D applications and for consuming their resources. As I ended up telling this particular MSc group, for NHS governance purposes there are also fine distinctions sometimes to be made between ‘research’ and other activities (like ‘service evaluation’ and ‘audit’) which, on the face of it, can look pretty ‘research-y’.

Monday also brought a meeting with second year, undergraduate, pre-registration mental health nursing students. That was nice, and we got to talk about all manner of things: the history of mental health nursing, developments in local services, experiences of practice.

Tuesday brought a project advisory group meeting chaired by Professor Billie Hunter. Billie’s study is funded by the Royal College of Midwives, and is examining midwives’ resilience. It’s interesting both methodologically and substantively, and one of the things I’m learning about is the generation of research data using social media.

Wednesday was an unusual day, involving a trip to another university to examine a doctoral thesis. People often have lots to say about preparing for vivas from the student point of view, and in every university there will be stories to be heard about students’ (good and bad) doctoral examination experiences. Less is said about the experiences of examiners. In my view the invitation to examine a doctorate is an honour, and the occasion demands careful preparation. After all, we’re talking here about the culmination of years of work, folks. On this week’s and on the few other occasions in which I have examined I have, I hope, combined rigorous enquiry with respectful courtesy. This is certainly how my examiners were on the day of my viva, I’m pleased to say.

Thursday (yesterday) began with a meeting to review a contract, connected to a funded research project I’m involved in which formally commences at the start of next month. I learnt some new stuff along the way, including the distinctions between ‘background’ and ‘foreground’ intellectual property and copyright. Michael Coffey, Aled Jones, Jennifer Egbunike and I met to make practical plans for a segment of another project, led by Alan Simpson. This study is also involving Alison Faulkner (whose website, if she has one, I do not know), Jitka Jancova and (soon) Sally Barlow. All very productive and interesting, and I was pleased to round off the day in the office with an expected conversation with the clinical psychologist, Andrew Vidgen, about his work in early intervention in psychosis, my Connections and consequences paper, and a few other things besides.

January 18th 2013 And today the snow came (check out this photo, revealing the red blob’s local snowfall), and as anticipated a large thesis chunk to read and review from my esteemed colleague, Pauline Tang, who is also a research student. Pauline is interested in the use of electronic patient records, and I am again reminded of the discipline and hard work required by part-time doctoral students who have to combine their studies with the day job. The equally esteemed Jane Davies, my longstanding friend and colleague and now a full time (pretty much) PhD student, also sent me some interesting initial reflections relating to her planned study of decision-making in adolescent cancer.

Running looks out of the question this weekend, and, for all I know, the coming week. Today’s deep snow will be tomorrow’s ice, and that stuff’s not to be run on. Long walks look a tantalising possibility, though.

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Student nurses and degrees (once again)

Writing in today’s Guardian Peter Wilby asks ‘if our long love affair with education is coming to an end’. He refers back to this earlier article reporting a UK government announcement that future accountants, lawyers, engineers and others will be able to qualify without having a degree. Noting that the children of affluent parents do best in education, Wilby argues that the raising over time of the academic bar for entry to many professions has effectively blocked poorer children from getting a foothold.

I agree that we should be concerned over post-compulsory education becoming the preserve of the privileged few, which is why I believe charging tuition fees for university study is a bad policy likely to deter many from applying. I’m also reminded of the efforts that colleagues in my workplace go to in order that people with non-traditional educational backgrounds put themselves forward for university entry, and the work that goes on to help students succeed once they have enrolled. Like Peter Wilby, I too think that education should be something which people engage in over the course of a lifetime, and not in their first two or three decades only.

What I object to is that part of Wilby’s argument where he turns to nursing specifically and says, ‘As Ilora Findlay, professor of palliative medicine at Cardiff University, has put it, “a nurse can graduate without being able…to apply the scientific basis of illness to real patients or respecting the importance of hands-on care”. This is not a scenario I recognise. Student nurses spend half of their time on placement, and whilst there have to demonstrate to the satisfaction of their mentors their ability to perform in practice. This includes providing real care, to real patients.

For more on this, here’s a link back to an earlier post on this site referencing the Willis Commission on Nursing Education.

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New year…

Cardiff University Colleges and Schools Happy new year. 2013 promises plenty. I’m committed to two externally funded research projects, collaborating with outstanding folk located both in, and out, of Cardiff University. In the fullness of time I’ll perhaps blog about these studies when there’s more to say. I’ll be supervising people working on their doctorates, and as always will be teaching and assessing across the range of academic levels. I’ll be working up grant applications (there’s one in the pot at the moment), writing papers (including the one I’ve mentioned before), and contributing to various types of ethics and scientific review processes. I also have a number of external examining roles to fulfil, at doctoral and pre-registration undergraduate level.

In the year ahead I suspect there will be some interesting organisational changes to adjust to as Cardiff University refashions itself, and as the new College and School structure (which I’ve reproduced to the left of this post, with an added oval to highlight where I work) takes shape. As it happens, the University is making headlines at the moment. Just before the Christmas and New Year break Cardiff’s collaboration with the Open University (and others) to develop ‘MOOCS’ (Massive Open Online Courses) was widely reported. As I understand it, MOOCS are free-to-access courses made available via the web to pretty much anyone with use of a computer and an internet connection. I’m not sure how, if at all, people are able to work towards achieving formal academic awards in this way but I very much like the idea of freely available knowledge. Meanwhile, in this week’s Times Higher Education there’s a report on the new Vice Chancellor’s plans to develop the University’s international presence.

REF 2014 In 2013 there’s also the small matter of the Research Excellence Framework (REF). I think the REF (like its predecessor the Research Assessment Exercise, or the RAE) is a flawed process, but it remains a (very) big deal for the UK’s universities. In this cycle, formal submissions will be made at the end of the year. Panel members will then have their work cut out in 2014, reading and assessing the quality of outputs (typically, journal papers), judging the impact of completed research beyond the realms of academia (for example, on policy and practice), and reviewing the institutional environment for research activity. Universities will be ranked on the results, and money will flow (or not). For an ambitious, research-led, Russell Group university like Cardiff this is an exercise of great import. It’s also significant for the professions of nursing and midwifery, which have spent the last decades upping their evidence base. In the last RAE, the outcomes of which were made known at the end of 2008, nursing and midwifery research fared pretty well. Let’s hope this can be sustained.

Outside of work I’ll keep running, hoping to stay injury free. As a meticulous record keeper I track my miles. So far for 2013 it’s 22-and-a-bit, and the aim is to manage 1,000 in total. This I achieved in 2012, and more besides. There’s also an increasingly good chance that this year will see Cardiff City climb out of the Football League Championship. I’m liking this, and it’s something I follow (with season tickets) with one of my boys. And, for those interested in the health and well-being angle of all this, check out the work of Alan Pringle and his colleagues on using football as a means to promote mental health, particularly amongst young men. Alan gave a fantastic talk on this at last year’s Network for Psychiatric Nursing Research conference.

That’ll do for now, I think: enough of the rambling.

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