Month: April 2013

Critical junctures

How pleasing it is to report that the paper I blogged about in this earlier post has now been accepted for publication. Co-written with Nicola Evans this (re)introduces the idea of ‘critical junctures’ and will appear in Social Theory & Health. We draw on two project datasets and show how action at pivotal moments can set individual service user trajectories on directions which are hard to reverse. We also show how, in certain circumstances, small-scale critical junctures can trigger (or be used to lever) larger organisational change.

Next up will be the checking of page proofs, and advance online publication via the journal’s website. What we won’t be able to do for another 18 months is upload a PDF of the post-peer review manuscript to ORCA. This is something Palgrave’s copyright rules are very clear about. In the meantime here’s the abstract which will, of course, be freely available:

Hannigan B. and Evans N. (in press) Critical junctures in health and social care: service user experiences, work and system connections. Social Theory & Health

This article makes an original contribution through the revitalisation, refinement and exemplification of the idea of the ‘critical juncture’. In the health and illness context, a critical juncture is a temporally bounded sequence of events and interactions which alters, significantly and in a lasting way, both the experience of the person most directly affected and the caring work which is done. It is a punctuating moment initiating or embedded within a longer trajectory and is characterised by uncertainty. As contingencies come to the fore, individual actions have a higher-than-usual chance of affecting future, enduring, arrangements. These ideas we illustrate with detailed qualitative data relating to one individual’s journey through an interconnected system of mental health care. We then draw on observations made in a second study, concerned with the improvement of mental health services, to show how micro-level critical junctures can be purposefully used to introduce instability at the meso-level in the pursuit of larger organisational change. In addition to demonstrating why scholars and practitioners should pay closer attention to understanding and responding to critical junctures we are, therefore, also able to demonstrate how their emergence and impact can be examined vertically, as well as horizontally.

A nursing view of the REF

REF 2014I haven’t seen much commentary by nurses or midwives on the forthcoming Research Excellence Framework (REF), so I thought I’d make a start.

For those coming to this afresh, the REF has replaced the Research Assessment Exercise (RAE) as the mechanism through which the quality of research conducted in the UK’s universities will be weighed up. The results will provide the basis for the recurring allocation of quality-related (QR) research funding to higher education institutions for a period of years thereafter (until the whole exercise, or a version of it, is repeated). As has been the case with the RAE, the results from the REF will also be used to rank universities and the departments located within them.

Universities will make their formal submissions to REF 2014 by the end of November this year. These will be made to one of 36 ‘units of assessment’ (UoA), each of which is part of a larger main panel. Nursing had its own UoA in RAE 2008, but this time around is subsumed within a larger UoA also including the Allied Health Professions, Dentistry and Pharmacy.

Making a submission means providing information on the vitality and sustainability of the research environment. It also means giving details of individual researchers, and up to four separate research outputs for each where an ‘output’ will typically (but not necessarily) be a paper published in a journal. For the first time the wider impact of research, judged in terms of its reach and significance beyond academia, will also be assessed.

Of these three components it is outputs which will carry the most weight, accounting for 65% of the overall quality profile to be awarded to each submission. Impact is weighted at 20%, and environment at 15%. Given their weighting, it is outputs that I want to concentrate on in this post.

Each UoA expert panel will have the task of reviewing outputs using this five-point scale:

Four star Quality that is world-leading in terms of originality, significance and rigour
Three star Quality that is internationally excellent in terms of originality, significance and rigour but which falls short of the highest standards of excellence.
Two star Quality that is recognised internationally in terms of originality, significance and rigour.
One star Quality that is recognised nationally in terms of originality, significance and rigour.
Unclassified Quality that falls below the standard of nationally recognised work. Or work which does not meet the published definition of research for the purposes of this assessment.

The Allied Health Professions, Dentistry, Nursing and Pharmacy UoA has a Chair (Professor Hugh McKenna, an academic mental health nurse at the University of Ulster and Chair of the Nursing and Midwifery UoA for RAE 2008), a Deputy Chair (Professor Julius Sim) plus 33 members and three assessors (there to ‘extend the breadth and depth of expertise on the sub-panels as required to carry out the assessment’). Of these 38 individuals I count 13 with nursing and/or midwifery backgrounds. Collectively this panel will be required to assess the quality of all outputs which come before them, and to do so ‘with a level of detail sufficient to contribute to the formation of a robust sub-profile for all the outputs in that submission’ (I’ve extracted this statement from the Panel Criteria and Working Methods document).

Expert review is fine, but in the context of the REF I think there are problems with how this is going to work. In Annex E of the RAE 2008 Manager’s Report the total number of outputs received by each RAE 2008 UoA is given. In the table below I’ve brought together the figures for each of the separate UoAs which, for REF 2014, are combined within UoA A3:

RAE 2008 UoA Outputs submitted to RAE 2008
Dentistry 1664
Nursing and Midwifery 2851
Allied Health Professions and Studies 6240
Pharmacy 1843

Total

 12598

Higher education institutions have already responded to a survey inviting them to indicate their intentions to return researchers to the REF, and a summary of the findings can be found here. This suggests that, across Main Panel A (which includes UoA A3 for Allied Health Professions, Dentistry, Nursing and Pharmacy) 2% fewer people will be returned than were returned in RAE 2008. So let’s assume a uniform 2% drop in outputs across all of Main Panel A’s UoAs compared with RAE 2008, which (based on the 12,598 figure above) suggests a total return to UoA A3’s expert reviewers of some 12,346 individual outputs. That’s 12,346 journal articles, book chapters, reports to funding bodies (and so on) to be read and quality graded by a panel of 38 people. Assuming each output is considered by two panel members then each person will have around 650 items to consider, throughout the period from January to December 2014. For a cross-panel comparison, I note that this is a figure remarkably close to the 640 items the blogging physicist Peter Coles estimates will be read and reviewed by members of the Physics UoA.

That’s a whole lot of reading, reviewing and ranking. It’s also only one part of the work that REF panel members will have to do. What chance, then, that all 12,000+ individual outputs will be examined in close detail? Very little indeed. Perhaps abstracts (the 200 or so word summaries appearing at the start of published papers) will be crucial pieces of information on which assessments will be based? Or possibly papers will be sampled, with some being read in relatively greater depth than others? Who, at this stage of the process, knows? What we do know is that in undertaking their assessments of quality expert reviewers will have access to supporting information, including citation data provided via Scopus. This suggests that the number of times submitted outputs have been cited in subsequent publications is likely to have a bearing on assessments, even though the relationship between citations and research quality is a complex one. And, whilst we know from the Panel Criteria and Working Methods document that ‘No sub-panel will make use of journal impact factors, rankings or lists, or the perceived standing of the publisher, in assessing the quality of research outputs’ it may in reality be difficult for hard-pressed reviewers not to take informal account of journal titles in giving a view.

So the sheer volume of outputs presents a challenge. I also happen to think that, even with the benefit of time, achieving consistency in quality assessment is incredibly hard. Nothing in my experience tells me that different reviewers, even with similar academic backgrounds, will necessarily agree on a journal article’s status as ‘world leading’, ‘internationally excellent’, ‘internationally recognised’ or ‘nationally recognised’. These are not self-evident categories, and the distinctions to be made on the grounds of ‘originality, significance and rigour’ are fine indeed. The problem of assessment inconsistency is also magnified in the case of REF UoA A3 as this is a panel bringing together reviewers from academic fields which are remarkably diverse. Unless I have missed something important, I see no stated process for the alignment of UoA A3 reviewers to outputs based on disciplinary background. So papers by nurses reporting explorations of service user experiences using qualitative methods might (for example) be read and reviewed by pharmacists with expertise in the laboratory development of new drugs. This is odd, to say the least. So odd, in fact, that I’m now wondering whether, when panel A3 begins its work, members will do something to make sure that each output is assessed by people who really know the area within which it sits. How else can the reviews be considered ‘expert’?

That, I think, will do it for today, and thanks for reading. Perhaps I’ll say something in a later post on the ‘impact’ component of REF.

Football and mental health

A highlight of last year’s Network for Psychiatric Nursing Research conference in Oxford was Alan Pringle‘s talk on football and mental health. Alan works at Nottingham University, and here’s what his web page has to say:

Alan has worked in the area of using football as a vehicle for mental health promotion and interventions in a number of ways in recent years.

His PhD looked at the impact that actively supporting a club (in this case Mansfield Town FC) could have on the mental health of supporters. He was involved in the development of the “It’s a Goal!” programme. This programme places staff in football stadiums to work primarily with young men in mental health promotion and mental health intervention work. “It’s a Goal!” has run in 16 different professional clubs from large premiership clubs like Manchester United and Stoke City to lower division clubs like Macclesfield Town and Plymouth Argyle.

Alan was involved in developing the Positive Goals football league with Nottinghamshire Healthcare Trust. This league for service users involves teams from all over the county coming together to play matches on a monthly basis and each year comprises of between 10 and 12 teams.

Alan is a member of the Football and Mental Health Group for Time-to-Change the national anti-stigma organisation.

Alan’s NPNR talk was excellent, and his research and wider work has clearly made a real difference. If you navigate to his webpage you’ll find references to publications he’s written, too. There’s also the It’s a Goal website, which is full of information.

This leads me nicely to last Tuesday at the Cardiff City Stadium, where along with thousands of others I witnessed the moment of Cardiff City‘s promotion to the top flight of football, securing a place in the Premier League for the coming season. A big deal all round. Here’s a photo, taken just after the game’s end.

MHNAUK launches a blog

Michael Coffey, chair of Mental Health Nurse Academics UK, has today launched the group’s blog at http://mhnauk.com.

On the site’s home page Michael writes that:

This is the first entry in what we hope will be a vibrant and engaging place for members of MHNAUK to communicate the range of work we as a group do […] we want to communicate to a wider audience via this blog to show what we are doing and to engage in dialogue about our views on the future direction of education, research and ultimately the practice of mental health nursing.

Michael also points to some of MHNAUK’s current projects. These include Andy Mercer (from Bournemouth University) gathering evidence on the different ways applicants for pre-registration mental health nursing courses are selected, and Fiona Nolan (from UCL) leading an overview of mental health nursing research in the UK.

I’ve posted a comment on the site, and look forward to others doing the same. Go check it out. Right now!

Some brief thoughts on academic writing

Amongst the general array of things occupying this last working week has been some academic writing. On this occasion my hand has been forced somewhat by news of a previously submitted paper having been rejected by a journal editor, an event noted earlier on this blog here. So I’ve been putting in some early starts to pick up the threads with an eye on a submission elsewhere.

It interests me how people go about the business of crafting papers for publication. I enjoy playing with words, and am forever toying with sentences in the hope of producing an improvement. I also find it impossible to leave an error in spelling or grammar uncorrected. This means I do plenty of editing as I go along, which I know is not the way that everyone writes. But I really, honestly, cannot abide a page of text full of red underlines. Once I have a good draft I always seek the views of one or more valued colleagues, and listen carefully to what they have to say. To borrow a phrase Howard S. Becker uses in Writing for Social Scientists, I then like nothing more than to ‘get it out the door’. Papers have to be drafted, honed and tweaked but also published. That means letting them go, and submitting to the rigours of peer review.

There are plenty of places to read about people’s experiences of writing for publication, and spaces where ideas can be shared. #Acwri is the hashtag used by contributors to the Twitter academic writing discussion group hosted by Jeremy Segrott and Anna Tarrant. Pat Thompson has a good academic writing blog here. A book I particularly appreciated when I first started out is Philip Burnard’s Writing for Health Professionals.

Two out of three (revisited)

A brief note, further to yesterday’s post on the business of submitting papers for peer review and possible publication. Aled Jones (tweeting as @AledJonze) alerts me to this post on the LSE Impact of Social Sciences blog. In it Vincent Calcagno, an evolutionary biologist, writes that the ‘[p]re-publication history of articles tells us that rejection leads to higher citations’. Interesting.

Two out of three…

…ain’t bad. After a fairly intensive burst of writing over the last few months I received, on Saturday, an editor’s ‘no thanks’ email following completion of the peer review of a paper I offered for publication at the end of 2012.

Of three manuscripts under review at the turn of the year one is now available as early online and in green open access form. This is the article (written with Michael Coffey) on nurses as approved mental health professionals, which I blogged about here.

A second, which I mentioned here, has been revised and resubmitted. Fingers and toes remain crossed for a positive final outcome.

The last is now back with me for a rethink following receipt of this weekend’s editorial decision email. The anonymous reviewers and the editor, I have to say, gave this third manuscript a proper run-through. In turn I’ve thanked them for their efforts, disappointing though the outcome is. As it happens, one reviewer liked what s/he read, and a second definitely did not. The editor went with the second, and gave a reasoned account why the paper should not proceed. Thank goodness for that academic rhino hide I’ve developed. Emails rejecting papers sting, but it passes. So right now I’ll take what I’ve got and put some time into refashioning this paper for another outlet. More to follow in due course.

Learning from the study of trajectories

Trajectories paperHere’s a post about research, which draws on the paper Complex caring trajectories in community mental health: contingencies, divisions of labor and care coordination which I authored with Davina Allen.

One of the things I’m interested in is the study of ‘trajectories’. With colleagues, the US sociologist Anselm Strauss wrote about these in the book Social Organization of Medical Work. Most people will be familiar with the idea of illnesses ‘running their course’. To this everyday concept Strauss and his collaborators added a whole lot more, introducing the term ‘trajectory’ to refer:

…not only to the physiological unfolding of a patient’s disease but to the total organization of work done over that course, plus the impact on those involved with that work and its organization (Strauss et al. 1985: 8).

Trajectories are dynamic and often unpredictable, not least because they involve people. They are also vulnerable to being tilted by what Strauss et al term ‘contingencies’. Contingencies can have origins in the health and illness experience. So, a trajectory can (for example) veer off in a new direction because of an acute exacerbation of a chronic illness. But trajectories can additionally be shaped by contingencies which have organisational origins. These can relate to the biographies of workers, and to features of the system such as the availability of resources.

Trajectories can be studied. In my PhD I borrowed the design and methods used by Davina Allen, Lesley Griffiths and Patricia Lyne in their study of stroke care, and used these to understand the trajectories of people using community mental health services. In each of two contrasting parts of Wales I recruited three people currently using secondary mental health services. Each became the starting point for a detailed, small-scale, trajectory case study. Over a period of months I followed each person’s unfolding experiences, and the organisation of work surrounding. Using snowball sampling I mapped the network of (paid and unpaid) people providing care to each, and interviewed those identified in this way about their work. I observed care planning meetings, home visits, and read each service user participant’s National Health Service (NHS) records.

Community Mental Health JournalIn the publication for Community Mental Health Journal to which this post relates, Davina and I drew on these data to show how trajectories unfolding in the mental health field are shaped. We offered instances of trajectories being tilted by mental health crises, but also by key professionals leaving their posts and by a lack of resources within the larger system.

We then used data to reveal actual divisions of labour, in a way which has not (to the best of my knowledge) been done before  in the mental health context. By mapping the networks of care surrounding each user participant we were able to learn about work being done by all sorts of people, including many who (I suspect) are rarely thought of as making significant contributions at all. We wrote about the work of community pharmacists, support workers, lay carers and indeed the work of service users themselves.

Having laid all this out we closed by pointing to the importance of what Strauss et al called ‘articulation work’. This is the work associated with the management of trajectories, through mechanisms such as care coordination. Mental health workers in the UK know all about this through things like the care programme approach (CPA).

The detail of this paper you can read for yourself, with the link at the top of this post taking you to our author’s copy of the manuscript as stored on Cardiff University’s ORCA repository. This, word-for-word, is the same as the version of the article which is currently in press here.

For those interested in the paper’s back story, just to note that when it came to selecting a journal I was keen not to submit to a nursing publication. I have no problem with nursing journals per se, but this ‘trajectories’ paper was (and is) aimed at a wider readership. Community Mental Health Journal is based in the US, and publishes papers on, well, community mental health. And that fitted well with the intended audience. This said, one of the anonymous reviewers of the submitted manuscript had things to say about the language used, reminding us that the journal to which we had submitted is read by mental health practitioners and academics and not, primarily, by sociologists. Attending to the review meant some rewriting to improve accessibility. I’ll leave future readers to judge for themselves whether we succeeded.

19th International Network for Psychiatric Nursing Research Conference

Here is just-published information on this autumn’s NPNR conference, which I’ve grabbed from the RCN website:

The Personal and Political of Mental Health Nursing Research

  • 05 September 2013 – 06 September 2013
  • Warwick Arts Centre, The University of Warwick, Coventry, CV4 7AL

Event home

Calling for papers NOW

This international conference aims to examine the personal everyday experiences of living with mental health problems and delivering mental health nursing care and some of the political responses and implications of the events and forces that provide the context within which we live and work.

Mental health nurses regardless of setting are engaged in highly personal alliances with individuals with mental distress. In that light, we wish to hear about research that examines the therapeutic alliances, mental health nursing interventions and creative partnerships that form the focus of much mental health care.

But these personal and professional alliances can also be influenced by wider events that can shape and determine the culture of mental health nursing practice. National responses to global financial crises in the form of austerity measures, cutbacks in services and changes to roles within the workforce can dovetail with existing patterns of inequality, stigma and discrimination to the detriment of mental health service users and staff alike.

The personal and political can be seen to be played out too in the relationships between nurses and the people they seek to support and help through issues of involvement, partnership and collaboration – whether in practice, education or research.

This conference provides an opportunity for an informed and critical look at the therapeutic alliance and the therapeutic environment from the personal and political perspectives of service users, carers, mental health nurses and colleagues. Papers examining interactions and interventions in mental health settings and the wider community are welcomed and could include nurse/patient interactions dealing with resistance, challenge, compliance, containment, risk, sexuality and gender, employment and inequalities.

Oral and poster papers are invited that seek to measure mental health outcomes and critically examine the ways in which these findings work to advance the development of interventions better suited to the needs of individuals and society.

Papers are invited which fall into the following themes:

  • Researching alliances, interventions, partnerships

Therapeutic alliances, mental health nursing interventions, creative partnerships in mental health care: this thread will include papers that focus on the personal and professional aspects of mental health nursing care.

  • Politics, populations, equality and diversity in mental health nursing research

We welcome contributions to this new thread that focuses on research that addresses political issues, including equality and diversity, in mental health nursing or that considers mental health needs in particular populations.

  • Austerity, costs and service delivery

We are keen to focus on service developments, evaluations and research that address the realities of financial restrictions and cuts in service delivery and some of the innovations and creative solutions that are emerging as a result.

  • New roles, new ideas, new researchers

We welcome papers reporting research that explore new or developing roles emerging in mental health care alongside papers that have something new and stimulating to say – give us something to think about! This thread is also open to new researchers perhaps presenting for the first time or presenting work in progress.

  • Innovation in teaching and learning

Developing new ways of delivering teaching and learning in mental health, for both staff and service users, has never been more urgent as roles and demands change, costs are considered and new technologies invite fresh ideas. We are keen to include papers that report research and evaluation of educational initiatives in mental health.

Concurrent sessions

These are presented orally. Each presenter is allocated a total of 20 minutes per session to include time for discussion (5 minutes).

Workshops

Workshops are interactive sessions of 50 or 70 minutes where the leader works with the participants to develop their knowledge and understanding within a specific field. A workshop is presented by an expert within the field and may be pitched at a novice, intermediate or advanced level. Please indicate the level in your submission. To be considered for a workshop you must submit an abstract (1000 words limit), detailing the focus of the workshop and the nature of participation.

PhD Symposium

This will be an interactive session of 90 minutes where PhD students are invited to present one aspect of their research, which may be related to their theoretical framework, methodology, preliminary findings etc. Each presenter is allocated a total of 20 minutes per session to include time for discussion (5 minutes). PhD students are invited to submit an abstract is the usual way, but mark the theme ‘PhD Symposium’.

Posters

Poster presentations form a significant part of the conference proceedings and presenters will have an excellent opportunity to interact with delegates. Posters should present key themes or findings in a clear and stimulating way.

Ready to submit your paper?

Please prepare your abstract submission in a word document, (using Arial, regular, font size 10), including all points within these guidelines and save a copy to your device. Please forward a copy of your paper via email to Laura Benfield at npnr@rcn.org.uk. Please note only submissions received via email can be accepted. You will receive an abstract reference number for use in all future correspondence regarding the abstract.

The process for accepting abstracts is carried out through a scientific committee and the critieria can be dowloaded here.  

Key dates for your diary

– 5 April Call for papers open
– 12 April Registration opens
– 17 May Deadline for submissions
– 12 June The Skellern Lecture (Prof Alan Simpson) Sign up
– 17 June Abstract outcomes communicated
– 1 July Final programme announced
– 31 July Special rate for presenters (£220) ends
– 5-6 September Conference

Start networking now!

www.twitter.com

Use #NPNR2013 to tweet with the network as well as keeping up to date with programme developments and other conference news!

uk.linkedin.com/pub/network-psychiatric-nursing-research/50/1b8/a92/

Join over 700 contacts engaged with NPNR, find us using the above link.

More details about NPNR can be found at www.rcn.org.uk/NPNR

Two day delegate fee
Presenter rate – £220
member rate – £260
Non member rate – £330
Student/carer/service user – £100
Conference banquet – £40

Event contact

Laura Benfield
Conference and Events Organiser
Royal College of Nursing
20 Cavendish Sq
London
W1G 0RN

Tel: 020 7647 3591
Email: NPNR@rcn.org.uk

NHS changes, and the state of research in nursing

Since publishing my last post the Health and Social Care Act has come into force in England. For a frontline NHS worker’s views on what this means, check out this commentary by East London GP Dr Youssef El-Gingihy. Personally I’m glad to be living and working in Wales. I am pleased to say that here there is still government support for an NHS which is funded, planned and provided with the public good in mind.

Elsewhere, within my corner of nursing (the academic bit) an editorial by David Thompson and Philip Darbyshire which appeared in the January issue of the Journal of Advanced Nursing has provoked a series of robust, just-published, responses. These have variously been penned by Bryar et al, Gallagher, Ralph, Rolley, White and Cross and Williams. JAN also carries Thompson and Darbyshire’s rejoinder, through which the responses are responded to.

The debate has a number of elements. In their editorial Thompson and Darbyshire argued that the quality of academic nursing has declined, and that some nurses working in some universities occupy positions of seniority which their experiences and qualifications have not prepared them for. They also accused those they termed the ‘killer elite’ of running departments as managerial fiefdoms, without tolerance for critical enquiry or dissent. This month’s responses include pieces both for, and against, the Thompson and Darbyshire position. Interested readers can follow all this up for themselves through the links I’ve given above, and I won’t attempt to summarise the full range of views offered.

What I will say is that, for all sorts of historical and contextual reasons, it remains remarkably difficult to sustain a career as a nurse doing research. Funding streams for nursing and midwifery departments in UK universities are largely earmarked for teaching, and relatively few university-based nurses have had opportunities to study for research degrees. Amongst those who have completed doctorates many have found it hard to progress to become independent researchers. Large numbers appear to have returned to roles which do not include significant research components. Only a handful of departments have a critical mass of research-active nurses and midwives, leaving the majority vulnerable when key people leave or retire.

But we have to keep at it. What nurses do touches the lives of millions, every day of the year. Research has an important part to play in improving the nursing contribution: from finding out ‘what works’, to learning about the experience of people on the receiving end of nurses’ services, and onwards to establishing how care might best be organised. Taking a research idea and turning it into a proposal which stands a chance of securing funding through open competition is tough (ask a scientist or a historian: it’s just the same for them), but if we truly want a sound base for nursing practice then this is work which has to be done. And as I am currently learning all over again, actually doing research once funding has been obtained is never as straightforward as the textbooks would have us believe.