Month: June 2013

Jobs for new nurses

One of the things I’ve been doing recently is meeting up with final year students about to complete their degrees and register with the Nursing and Midwifery Council. These are hard-working, committed, people who have chosen to prepare for careers in mental health nursing. They’re now looking for jobs, and from what I’m hearing opportunities locally and nationally are few and far between.

Here, then, is the sharp end of NHS underfunding. There’s no question that new mental health nurses are required. In fact, we should expect demand to increase at a time of hardship. The problem is that vacancies are being frozen and services are generally retracting. As economic collapse fuels distress and increases need austerity bleeds public services of the capacity to respond.

So, good luck to everyone preparing to qualify. I hope you get the jobs you want and deserve, because you’re needed.

Welcome meeting for the RiSC project

Yesterday brought a there-and-back trip to Southampton, with esteemed colleagues Nicola Evans and Deborah Edwards, for an NIHR Health Services and Delivery Research Programme welcome meeting for our RiSC project. This was an opportunity to meet with other funded researchers (and very interesting they were, too) and to learn more about how the HS&DR Programme works with investigators over the lifetime of projects and beyond. We also had the chance to present our study, and to field questions from the floor.

On its website the HS&DR Programme says that it:

aims to produce rigorous and relevant evidence on the quality, access and organisation of health services, including costs and outcomes. The programme will enhance the strategic focus on research that matters to the NHS including research on implementation and a range of knowledge mobilisation initiatives. It will be keen to support ambitious evaluative research to improve health services.

And that it:

aims to support a range of types of research including evidence synthesis and primary research. This includes large scale studies of national importance. This means primary research projects which:

  • Address an issue of major strategic importance to the NHS, with the cost in line with the significance of the problem to be investigated
  • Are likely to lead to changes in practice that will have a significant impact on a large number of patients across the UK
  • Aim to fill a clear ‘evidence gap’, and are likely to generate new knowledge of direct relevance to the NHS
  • Have the potential for findings to be applied to other conditions or situations outside the immediate area of research
  • Bring together a team with strong expertise and track record across the full range of relevant disciplines
  • Will be carried out across more than one research site.

A search through the programme’s portfolio of projects turns up a raft of studies of national and international significance, including work (ongoing and completed) led by or involving nurses. Well worth a look, in my view…

Stress and community mental health nurses

A particular aim of mine in starting this blog was to bring research I have been involved in to a wider audience. So with this in mind, here is a post introducing readers to a series of studies I worked on, with Cardiff colleagues, from the late 1990s to around 2006.

The All Wales Community Mental Health Nursing Stress Study was our first project, led by Professor Philip Burnard. Included in the team were Deborah Edwards, Dave Coyle, Anne Fothergill and myself. Our funding was from the GNC for England and Wales Trust, and we aimed to find out about the causes, moderators and outcomes of stress in community mental health nurses (CMHNs) working in Wales. Our data were generated using a demographic questionnaire and these previously created measures:

  • Maslach Burnout Inventory
  • General Health Questionnaire (GHQ-12)
  • Rosenberg Self-Attitude Questionnaire
  • Community Psychiatric Nursing Stress Questionnaire (Revised)
  • Psychnurse Methods of Coping Questionnaire

Our first published paper was this literature review, which Scopus tells me has thus far been cited in 66 subsequent publications. We went on to publish a series of data-based articles from the study, in some of the journals whose names I have added to the word cloud above. The references for these papers are listed here, along with a brief summary of our headline findings.

The team’s next study was a systematic review of stress management in the mental health professions. This was funded by the Wales Office of R&D for Health and Social Care, which was the predecessor body to NISCHR. We found far more papers describing how stressed people are than we found papers suggesting solutions to this problem. Follow this link for a reference list and project summary.

Finally in this series of projects was a study ‘to identify the factors that may influence the effectiveness of clinical supervision and to establish the degree to which clinical supervision might influence levels of reported burnout in community mental health nurses in Wales, UK‘. An expanded team this time included Linda Cooper, John Adams and Tara Jugessur. This study involved the distribution of two questionnaires, again to community mental health nurses in Wales:

  • Maslach Burnout Inventory (MBI)
  • Manchester Clinical Supervision Scale

This project, too, has a webpage giving details of our main findings and of our published papers.

In the years since this last project concluded I have had conversations with people on what the next line of inquiry might be. The questions we first asked some 15 years ago seem to me to be as relevant today as they were then. I imagine there remain large numbers of very stressed and burned-out mental health practitioners out there. I also suspect there is still work to do to protect the well-being of staff, and to promote their resilience.

Mental Health Nurse Academics UK meets in Liverpool

Yesterday Mental Health Nurse Academics UK met at Liverpool John Moores University, for its third and final meeting of this academic year. Hosts were Lisa Woods and Grahame Smith, and the chair was Michael Coffey. In the first part of the day Grahame and Lisa gave an excellent presentation on their cross-European Innovate Dementia project. Business items included updates on plans made at the previous MHNAUK meeting held in March in Cardiff. Andy Mercer presented findings from his and Karen Wright‘s survey of the methods used by universities to select new students of mental health nursing. Fiona Nolan asked members of the group for their suggested items to be included in her forthcoming research expertise, interests and capacity mapping exercise. This will be useful indeed, and at some point soon we will have a better idea of the full range of mental health nursing research being conducted within the UK’s universities.

Mental health nursing’s dirty work

Yesterday the national mental health charity Mind released information on the use of face-down restraint in mental health services. It says:

Mind is today calling for the government and NHS England to put an end to life-threatening face down restraint of people with mental health problems in healthcare settings. Data secured by Mind under the Freedom of Information Act reveals that at least 3,439 patients in England were restrained in a face down position in 2011-12, despite the increased risk of death from this kind of restraint.

Restraining people is part of mental health nursing’s ‘dirty work’. This is a phrase which originally comes from the American sociologist Everett Hughes. Robert Emerson and Melvin Pollner picked it up in a paper titled, Dirty work designations: their features and consequences in a psychiatric setting, and more recently Paul Godin wrote about A dirty business: caring for people who are a nuisance or a danger. There are plenty of other ‘dirty work’ articles out there, too, for those interested in finding them.

‘Dirty work’ involves doings things which are in some way tainted or shameful, but which might still have to be done. A professional group’s dirty work is not the first thing its members typically like to talk about when asked to describe what they do. When mental health nurses present themselves to others it is the helping relationships they build, the listening they do and the recovery they promote that are more likely to feature. My guess is that experiences of holding, secluding and forcibly medicating people are not things that nurses immediately volunteer.

Because dirty work can sometimes feel degrading and morally suspect it can feel easier not to talk about it at all. The good news in mental health nursing is that there are plenty of people interested in describing, researching and questioning the more coercive and controlling aspects of what we collectively do. Len Bowers and Joy Duxbury are examples. In addition to calling for a ban on face-down restraint, in its news release yesterday Mind pressed for the implementation of national standards and accredited training in this area. Nurses have a big part to play in the debates which are to follow and in developing new practices, and I’ll be watching with interest.

Teaching preparation and bursaries

The formal academic year for students of the health professions (and therefore for their teachers, too) tends to be on the long side. Whilst many UK university students will have ended their studies until the autumn there are plenty of nurses, midwives and others with work to do before they can knock off for the summer. In September I’ll be working with pre-registration, second year, students of mental health nursing in a module assessed through the critiquing of published research. Before then I have a short, intensive, module to lead which is part of the taught component within the School’s professional doctorate.

This doctoral level module is all about ‘complexity’ and ‘systems’ and starts next month, and today I’ve been putting the finishing touches to some of the materials I’ll be using. As befits the student group and their thesis-producing aspirations I have opted to draw heavily on colleagues’ and my research experiences as far as is possible. I’m also hoping to foster a spirit of studying and learning together, and want to avoid being didactic.

Elsewhere today, in addition to research project-related work, I have had the opportunity to be part of a panel considering applications for RCN Foundation bursaries. There were some strong candidates, and well done to all who are about to get letters confirming their success. Others will be invited to interview (which I personally am unable to take part in). My commiserations, too, to those dropping out at this stage. I know how it feels to apply for support and not to get it, but there are always other opportunities. As I once heard someone, somewhere, say: if you’re not getting funding bids rejected you’re not applying enough!

Theses, vivas and research students

I’ll be examining another doctoral thesis soon, which today I’ve started reading. I won’t say anything about it specifically, but the occasion does give me a starting point for this post.

My own PhD thesis ran to about 450 pages, references and appendices included. It was years in the making, not least as I was a part-time student with plenty of other things to keep me busy. My supervisors, who I’ve mentioned on this blog before, were Davina Allen and Philip Burnard. As an internal candidate it was necessary for me to have two external examiners, and these were Ian Norman from King’s College London and Lesley Griffiths from Swansea University. Here’s the summary from my study:

My viva went well, proceeding in a spirit of collegial inquiry. This is how it ideally should be, and even where a thesis is judged to have major weaknesses I firmly believe that the examination should be conducted fairly and with courtesy. Cardiff University vivas are independently chaired, which I think helps the process, though I know this is not standard practice everywhere.

As it happens the Cardiff School of Nursing and Midwifery Studies has significantly grown its postgraduate research in recent years, and we now have a healthy number of UK and international PhD and Professional Doctorate students. Together they run a lively multi-author blog under the title PhDays. Check it out.

First reflections on two days away

A series of train journeys home gives me space to mull over two days spent in London. Yesterday opened with a meeting of the COCAPP Lived Experience Advisory Group (LEAG), expertly chaired by the wonderful Alison Faulkner. Significantly, key parts of COCAPP are changing in response to LEAG recommendations. Our semi-structured interview schedules, for example, directly reflect the LEAG’s input. This is all good, and I am personally learning huge amounts from the opportunity to be involved.

Yesterday evening saw Alan Simpson give his Skellern Lecture followed by Malcolm Rae receiving his Journal of Psychiatric and Mental Health Nursing Lifetime Achievement Award.

As entirely anticipated Alan gave an informed, engaging and challenging talk, which took in his personal journey into mental health nursing and conveyed key messages from his research. Alan gave us plenty to think about. Might peer support workers be attractive to managers with squeezed budgets? Might they begin to replace members of more established groups, nurses included? Or, as Alan hoped, can peer support workers, nurses and others work side-by-side in harmonious fashion for the benefit of people using services?

Malcolm Rea I do not personally know, though based on the talk on leadership in mental health nursing he gave yesterday this has been my loss. I shall remember his contrasting of ‘drains’ and ‘radiators’ (and try personally to be more of the latter than the former).

Yesterday ended with a convivial social in a London pub, and today was more COCAPP: this time a team meeting followed by a Project Advisory Group (PAG) skillfully chaired by John Larsen from Rethink. Some of our discussion centred on the finer aspects of COCAPP’s design and methods, and for that the study will benefit.

So there we are then: only the shortest summary of some pretty involved discussions, but it will do for now. Home calls.