Category: Nursing

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!

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 alGallagher, 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.

A brief correcting post on the education of nurses

Yesterday the Health Secretary, Jeremy Hunt, declared that would-be nurses should spend a year doing hands-on care, working directly with health care assistants, in order to be eligible for funded nursing degrees. Today it occurs to me that large sections of the population may be labouring under the misapprehension that student nurses currently spend their whole three years sitting in classrooms. So let me join the queue of people who have already pointed out that, absolutely, they do not. In order to register, students are required to spend half of their time working directly in practice. This point, plus others, was very well-made by the University of Southampton student (whose name I cannot remember, unfortunately) who was interviewed on this matter on yesterday’s BBC News. Bearing in mind that nursing degrees are lengthy affairs (the terms are much longer than those followed by students of most other disciplines), the amount of time learners spend doing care work is already significant.

Selecting students of nursing

During my recent visit to the Netherlands I learned that universities there are obliged to offer places to applicants provided that the formal entry requirements are met. So, for applicants to nursing courses, there are no selection events: no interviews, no assessments of aptitude or attitude, no tests in numeracy or literacy. Here in the UK, the NMC (our regulatory body) requires that offers of places on nursing degrees are only extended after face-to-face selections have taken place. The NMC asks that interviews include assessments of motivation, and of reasons for choice of intended field of practice (adult, mental health, children or learning disability). Would-be students are also invited to demonstrate their understanding of the work of nurses. An interesting difference in approaches, I thought.

Visiting the Netherlands

HAN 4
Bisschop Hamerhuis in Nijmegen, home to Dr Bauke Koekkoek and the Social Psychiatry and Mental Health Nursing research group

Michael Coffey and I have just returned from a four day trip to the Netherlands, an event supported with funding from the Mental Health Research Network Cymru. We were there to share and develop research ideas with the impressive Dr Bauke Koekkoek and colleagues, and to learn about the Dutch mental health system. Bauke, a mental health nurse, is Associate Professor of Social Psychiatry and Mental Health in the Hogeschool van Arnhem en Nijmegen (HAN) University of Applied Sciences, and is interested (amongst other things) in matching the needs of people with mental health difficulties with services. You can read more about Bauke’s work in his inaugural lecture.

RGF130319-1065
Bauke, in mid-flow

Bauke did a great job organising a full schedule of activities for our three working days away. Well done, Dutch train and bus companies, for delivering Michael and me to our various destinations in timely fashion. We were, though, reminded during our trip that it is the bicycle which remains the vehicle of choice for many Netherlanders.

We had the chance to meet with academics, practitioners and service users during our travels across Utrecht, Arnhem and Nijmegen. Our thanks to everyone who gave their time and who shared their expertise so generously: Dr Arjan Braam; Mark van Veen; the Kompas team at Pro Persona‘s Wolfheze site; Dr Ad Kaasenbrood and his colleagues in the Arnhem Functional Assertive Outreach Team (and particularly Vincent and Riska, who Michael and I spent Tuesday morning with); the Arnhem FACT Team service users who welcomed us into their homes; the HAN Social Psychiatry and Mental Health Nursing research group; and Hein, Rob and Leon who teach at HAN and have interests in developing international links.

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Michael, holding forth

The Social Psychiatry and Mental Health Nursing research group, who we met on Tuesday afternoon, are a capable and accomplished team. Their MATCH Project is supported by a significant grant, and Bauke and his collaborators have done exceptionally well in using this as a springboard for further, associated, studies. Examples include PhDs investigating the effectiveness of therapies, and a planned ethnographic examination focusing on discharge (and non-discharge) of people from community care.

It was good to hear people present and discuss their ideas, and in a spirit of collegiality Michael and I had the chance to share our interests and plans. I took the chance to talk about my research in a general sense, using as a prop this set of slides embedded below:

RGF130319-1126
Attentive listeners!

Interesting to learn during our time away was the system of preparing mental health nurses in the Netherlands. Yesterday, for example, we met Rob Keukens who runs HAN’s part-time, 18 month, post-qualification social psychiatric nursing programme. This is the nearest thing to what here, in the UK, we would describe as a post-registration course for community mental health nurses (CMHNs). For those interested, Bauke has described and analysed the Dutch CMHN profession in this paper.

RGF130319-1069
Me enjoying a joke. Or something like that.

The principal purpose of our trip was to further our research connections, and for Bauke, Michael and me to spend time putting our heads together to develop new research ideas. We know we’ll need to involve others, and target funding streams sympathetic to international research proposals which set out to create new knowledge to improve mental health and well-being and the organisation of mental health services.

More on all this to follow in due course, I am sure.

The COCAPP crew, and MHNAUK comes to Cardiff

Yesterday’s COCAPP meeting in Cardiff was both productive and fun. It was lovely to welcome those members of the London contingent able to make the trip, and I extend my apologies (again, and for the last time!) to those I conspired to keep waiting in a darkened corridor before turning up with a room key.

COCAPPers 07.13.13COCAPP is an exciting research project to be involved in, and pretty soon it will have its own blog. I’ll then add links from here for those who are interested. Briefly summarised, this is an England and Wales cross-national investigation into mental health care planning and coordination, and into the relationships between these processes and recovery and personalisation. It’s funded by the NIHR Health Services and Delivery Research Programme, and has lots of distinct elements: about which more will follow, I guess, once the dedicated project blog is up. For now, here’s a photo of yesterday’s assembled COCAPPers (where from left to right there’s Aled, Jitka, Alan (COCAPP’s chief investigator), Sally, me and Michael. We very much missed Alison and Jennifer and their wise contributions, and when we’re all in one place I imagine we’ll take another, and more complete, photo.

Yesterday evening was the traditional social involving food and drink with fellow members of Mental Health Nurse Academics UK, ahead of today’s meeting proper. As Cardiff hosted we got to select the venues, and I hope everyone who was able to make it enjoyed the selection of fine ales and wines, and indeed the general ambience, at The Rummer Tavern. Likewise the food at The Mango House.

MHNAUK’s first meeting of 2013 was a good ‘un. Jen French talked about mental health strategy in Wales, and Ian Hulatt updated us on the Willis Commission. Eschewing the usual format of host universities presenting their research and teaching activities in the morning, Michael Coffey (in the photo above, and MHNAUK chair) and Joy Duxbury (newly elected vice chair) invited reflections and discussion on the aims and purpose of the group, and on the character of research in mental health nursing and what can be done to nurture it. There was some lively discussion in the two groups (facilitated by Linda Cooper and Len Bowers respectively) which convened to talk to these areas. It occurred to me unhelpfully after the event that we might have taken a MHNAUK photo, including the 35 or so members participating today: not least as MHNAUK, like COCAPP, is collectively thinking of increasing its presence via a blog.

Work aside, running has taken a big back seat this week, what with one thing and another. Must get out soon!

End of the working day train blog

Here’s a quick post from the train heading home. At least there are plenty of seats to be had at this time of the evening, but missing a train can mean a fair wait until the next arrives. Anyway: this morning’s teleconference with the evidence synthesis team confirmed how much we’ve achieved so far in this project. This is a review in the area of ‘risk’ for young people using inpatient mental health services. I’m very much appreciating the design we’re using, which revolves around two reviewing stages. Following an initial scoping, representatives from the wider stakeholder field have the chance to shape the priorities for our second, in-depth, review phase.

Today has also brought some MSc-related work, and a chance to meet with pre-registration postgraduate students to talk about dissertations and research approvals. Tomorrow’s COCAPP team meeting is all planned for, and then it’s onwards to Mental Health Nurse Academics with a meal in the evening and the big meet-up of the clans on Friday. Goodness me, it’s all happening.