Category: Nursing

Seminar feast

My, what a treat awaits today: no less than two seminars and discussions in one afternoon. First up (and speaking as part of the School of Health Care Sciences’ 2013-14 seminar series) is Mary Dixon-Woods, who will be talking  on ‘Soft intelligence and hard data: how can we know if care is safe?’. In a later South Wales Mental Health Nursing Journal Club and Seminar group meeting, Gerwyn Jones will be speaking on ‘Mental health pre-registration nurses’ satisfaction with problem based learning’.

Seminars, ay? Like proverbial London buses these have a tendency to arrive in multiples. I’ll be dashing from room to room with scarcely time to pause for breath. Best make sure I put the right questions to the right speakers, lest Gerwyn finds himself facing a query about quality and safety and Mary finds herself fielding something on lecturer facilitation of PBL groups.

Nursing stress (2)

Further to my last post on nurses and stress: an email to the RCN has produced this link to the full Beyond breaking point report.

For those interested, here’s what the conclusion from the Executive Summary says:

The 2012 survey findings highlight the high levels of stress among the nursing workforce. Stress can be a causal factor for health problems, physical injuries, psychological effects and burnout. In addition to the high personal toll, stress is a major cause of both sickness absence and presenteeism and affects the ability of workers to be effective.
The survey reveals that the main causes of stress are high workloads, long hours, unrealistic expectations, lack of job control, conflicting roles, bullying and violence, poor working relationships and a lack of engagement in workplace change. Addressing these problems is an obvious way to improve nurses’ working experience, and in turn improve the safety and quality of care for patients.

Issues of workload, stress and working life are, however, often symptomatic of systemic organisational problems. Poor work environments and working relationships damage the ability of nursing staff to provide safe care and there is a direct correlation between job satisfaction and patient satisfaction.

Nursing stress

Today The Guardian reports on a Royal College of Nursing survey into levels of stress amongst 2,000 NHS and private sector nurses. Some of the nurses participating give dire accounts of their working lives when it comes to sickness and time off due to ill-health. Here is a snip from today’s paper:

The RCN said many of the nurses questioned reported that sickness absence policies at their place of work were so punitive that they had no alternative but to attend work despite feeling unwell.

One of the nurses told the RCN: “I’ve been told that if I don’t meet the 100% attendance at work I will be up for a capability hearing. I had three admissions into hospital due to a cardiac problem, so if I get chest pain I have to ignore it because I have to go to work.”

Another said: “I am currently off work following breast cancer. A senior manager called three weeks after my surgery and asked if I was coming back as people with cancer often don’t return and they wanted to fill my post.”

As someone who has investigated stress and burnout in nurses in the past I am interested to know more of this survey (or ‘poll’, as it is described). I can’t find anything in the Guardian‘s news report on the type of study which has been conducted, and I’m turning up a blank when I navigate to the RCN website for a full report. Perhaps I’m missing something?

A day at an exhibition

As an aside, this week I had the chance to visit the British Museum’s Life and death in Pompeii and Herculaneum. A there-and-back trip from South Wales to London in one day is never to be taken lightly, but on this occasion the time and effort was well-spent.

As is well-known, these two cities were catastrophically engulfed in the year 79 by a volcanic eruption of Mount Vesuvius. Excavations from the middle of the 18th century have revealed much about the day-to-day conditions of the people who lived (and died) there. Hundreds of objects from both sites have been brought to London for this exhibition, and the whole is both beautifully presented and utterly fascinating. I say ‘is’ in the knowledge that this coming Sunday is the exhibition’s last day.

What psychological traumas the survivors of this disaster will have suffered. And what, I now find myself idly wondering, was the state of mental health of the Ancient Romans more generally? I have no idea, but a brief search online turns up a book by an academic who definitely does. Seeing this I am reminded that there are so many interesting things to know, and yet so little time to learn them.

Back in the world of work it’s been a week of grant proposals, marking, meetings with students and postgraduate research student progress reviewing. All good, and the term now feels well and truly under way.

Evidence syntheses and the RiSC study

I’ve been working on a document associated with the RiSC study today. RiSC is an evidence synthesis of ‘risk’ for young people moving into, through and out of inpatient mental health services. To guide our review we’re using a framework developed by members of the the EPPI-Centre, about which more can be found by clicking on the logo below:EPPI Centre

Distinct about the EPPI-Centre approach is the emphasis placed on engaging with representatives of groups and communities with interests in the area under review. In their Methods for Conducting Systematic Reviews document the EPPI-Centre people write:

Approaches to reviewing
Involving representatives of all those who might have a vested interest in a particular systematic review helps to ensure that it is a relevant and useful piece of research.
User involvement
Everyone has a vested interest in public policy issues such as health, education, work and welfare. Consequently everyone, whether they wish to be actively engaged or not, has a vested interest in what research is undertaken in these fields and how research findings are shared and put to use.
Reviews are driven by the questions that they are seeking to answer. Different users may have different views about why a particular topic is important and interpret the issues within different ideological and theoretical perspectives.
Involving a range of users in a review is important as it enables reviewers to recognise and consider different users’ implicit viewpoints and thus to make a considered decision about the question that the review is attempting to answer. The aim is to be transparent about why a review has the focus that it does, rather than assuming it is, or is attempting to be, everything to everyone.

In our review (as you’ll see if you download our protocol from the link given at the top of this post above) we’re combining a broad descriptive mapping of the territory with a more selective, in-depth, review guided by the priorities of stakeholder representatives. These are people with experience of using, working in or managing child and adolescent mental health services.

I like this approach to conducting evidence reviews, appreciating the commitment it demands to the agreement of topic areas and to being open in decision-making. All going well I’ll be continuing with some RiSC work tomorrow.

NPNR 2013 conference review

Health and health services are political. I therefore applaud those who selected the ‘personal and the political’ as the theme for this year’s Network for Psychiatric Nursing Research conference.

A word on the keynotes:

Kate Pickett‘s Thursday morning opener pressed home how disastrous inequalities are, for all of us. For those not there to hear Kate speak there’s plenty of compelling evidence available via The Equality Trust website, and indeed in The Spirit Level (which I now realise I must read).

Simon Duffy, in his keynote yesterday, challenged mental health nurses to act collectively and assertively to improve welfare. I believe he was correct in pointing out that public services are often experienced as fragmented, bureaucratic and impersonal. Check out the Centre for Welfare Reform website for more in this area.

Charles Walker, Conservative MP for Broxbourne, has spoken openly about his personal experiences of obsessive compulsive disorder and until recently was Chair of the All Party Parliamentary Group for Mental Health. His Thursday afternoon conversation with the NPNR audience was stylishly done, and whilst I can’t bring myself to vote for his party (not now, not ever) I do appreciate what he has done to challenge discrimination.

Len Bowers used his Thursday keynote to share, for the first time anywhere, results from his Safewards trial. Len is a genuinely world leading researcher, and Safewards is a big and important study with seriously major implications for policy, services, education and practice. Take note, inpatient mental health nurses: the findings from this one are coming your way.

Rounding off the whole event yesterday afternoon was Fiona Nolan, sharing results from her pilot study of the use of protected engagement time (PET) by inpatient mental health nurses. Fiona’s was another great presentation, and her and her colleagues’ findings are important because (despite the push from policymakers) they suggest PET offers no additional benefits to service users.

Other items of news: warm congratulations to Joy Duxbury, who will be delivering the Eileen Skellern Lecture for 2014, and to Hugh McKenna, who will be receiving the Journal of Psychiatric and Mental Health Nursing Lifetime Achievement Award. Two fine people, and worthy winners both.

The concurrent sessions I had the chance to participate in were of uniformly high-quality, and there was plenty of discussion and debate to be had. I’d also like to think that this year’s event maintained the NPNR’s reputation for combining quality with informality and collegiality. For the record, my view is that nothing of great consequence was lost in moving the conference, for the first time ever, away from Oxford. Warwick worked well, and as others have said via their post-event tweets, it’s the people not the place which matter.

See you next year.

Reflections on a pre-conference week

Funding for Welsh students and Welsh universities is in tonight’s news, I see, and I’m beginning to wonder how long the Welsh Government’s current policy in this area will survive. More immediately, it’s been a varied enough week for me personally: and that’s without my two days at the NPNR conference in Warwick which begin with a frighteningly early start tomorrow morning. But at least I’ll have Gerwyn Jones and Mohammad Marie in the car for company, so all will be well.

Highlights so far include a meeting of (most of) the excellent RiSC team (which includes the newly-professored Steven Pryjmachuk), to make further progress on our evidence review of ‘risk’ for young people moving into, through and out of inpatient mental health services. This is a two-phase project, and we’re now in the second segment. This is involving searches for research and other materials across a number of databases, and putting out calls for evidence to local services and other organisations.

Data has continued to be generated in COCAPP, and this week a date has been set for a first planning meeting for an exciting new project I am involved in led by Michael Coffey. More to follow on this in the fullness of time, I expect. And yesterday took me to a second meeting of the Mental Health Research Network Cymru Service User and Carer Partnership Research Development Group, an event convened at Hafal‘s premises located in the grounds of the magnificent St Fagans: National History Museum. A good place, St Fagans: well worth a visit.

Elsewhere there have been comments to make on students’ draft assignments, research ethics committee work, undergraduate teaching to prepare (on roles in health and social care teams) and writing plans to be laid. I’ve also been reading a PhD ahead of a viva scheduled in the next few weeks. So this short post will do for tonight: time to knock off, iron some shirts, pack a bag and have an early night.

A final plug for this year’s NPNR conference

Having navigated to the website for this year’s NPNR conference I see a full (final?) schedule of presentations and discussions. The two day event takes place at Warwick University at the end of this very week, no less. It should be a good one, and if I can I’ll tweet some choice messages throughout. For those not in the know, here’s how the gathering is described by the organisers:

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 were welcomed and may include nurse/patient interactions dealing with resistance, challenge, compliance, containment, risk, sexuality and gender, employment and inequalities.

Successful papers will 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.

Improving physical health

A common refrain amongst mental health nurses is that our knowledge, skills and contributions are poorly understood and undervalued by our physical healthcare nurse colleagues. As a nurse trained in both mental and physical health care fields I have sympathy with this position. But I also wonder if our concern with meeting mental health need has caused us to lose sight of the importance of physical health? I am again reminded of Professor Graham Thornicroft’s recent editorial in the BMJ on the scandal of early death in people with mental illness. Mental health nurses have a real part to play in promoting physical wellbeing and facilitating access to services, in their capacity as direct providers and as coordinators of care. Locally, I see evidence that some are taking this part of their work seriously. I know of mental health nurses who, as part-time MSc students, are motivated to develop smoking cessation programmes in hospitals and to introduce wellbeing screening clinics in the community.

With all this in mind it was interesting to see the most recent issue of the International Journal of Mental Health Nursing carrying a series of papers on this topic. There are contributions on: the work of mental health nurses in primary care; promoting access; attitudes, knowledge and training needs; and the physical activity levels of people with mental ill-health. Worth a read, I think.

Unrelatedly, here in England and Wales we are midway through an extended (bank holiday) weekend. This is all pretty meaningless to those nurses for whom shiftwork goes on as usual. Occupying the privileged position that I do, this afternoon brings not a trip to the office but, instead, the first visit of the new season to the Cardiff City Stadium. There, the newly promoted Bluebirds play their inaugural home game in football’s Premier League. Against Manchester City, it’s going to be tough. But whatever the outcome I know we’ll enjoy the occasion.

New school

A quick post. Today I returned to work from a fortnight away in the knowledge that, at the start of next month, the Cardiff School of Nursing and Midwifery Studies will be joining with the School of Healthcare Studies to become the new School of Health Care Sciences (but not the Cardiff School of Health Care Sciences, unless I’ve missed something?). This change will bring academic nurses, midwives, occupational therapists, physiotherapists, radiographers, operating department practitioners and medical photographers (and all our students) together in a single department. I hope I’ve not missed anyone out in this list: apologies if so.

I’m sure there will be some headaches and hiccups along the way as people and processes adjust, but I understand the idea behind this move and broadly welcome it. Hopefully both research and education will benefit, and it will be good to work more directly with people who have similar interests (in the mental health field, for example) but who happen not to be nurses.

Anyway, more immediately today was the small matter of picking up some important research threads. This included preparing for tomorrow’s service user researcher meeting, in which we’ll be discussing (and using) interview schedules in preparation for fieldwork. I also had the chance to correct proofs for a new article, which I’ll blog about in time. But now it’s late, so I’m off.