Category: Nursing

In praise of…student nurses

Student nurses (and their teachers) have come in for some criticism lately, as I’ve observed on this blog before. I won’t say anything about nursing academics in this briefest of posts, but I will say something about students. Which is this: the vast majority of them are really rather good. In my view this simple truth is not stated sufficiently often. Again and again I come across hard-working, inquisitive, students who are (and here’s the thing) motivated to care. They put the shifts in, come home, and read about how to do it better. They arrive in class ready and willing to learn, share their experiences and improve. They don’t get paid much, and as their careers progress they probably never will. So, students, take the applause: you deserve it.

Mental Health Nurse Academics UK: hot off the press

For the last couple of weeks I’ve been acting as a returning officer of sorts, as members of Mental Health Nurse Academics UK (MHNAUK) have been voting for a new Vice Chair. This is a position held for two years, after which the incumbent becomes Chair for a further two years.

This morning I’ve emailed members of MHNAUK with news of the outcome. Well done to Professor Joy Duxbury, from UCLan, who is duly elected. Joy knows lots about risk, safety, aggression and coercion in mental health services (see, for example, this paper and this paper). She takes up her position in the new year, picking up from Dr Michael Coffey (Swansea University) who now becomes Chair. That’s a great combination of people, let it be said: MHNAUK remains in very capable hands. By the way, I’m not sure if Joy tweets, but for the Twitter-users out there Michael does as @D10Coff.

Taking a well-earned breather having done an excellent job chairing MHNAUK for the last two years is Professor Alan Simpson from City University, or @cityalan as he’s known in Twitter-land. Good work, Alan. Now go and prepare that talk you have to give as Skellern Lecturer for 2013!

New nurses

This afternoon I’ll be joining colleagues to interview potential students of mental health nursing. I imagine I’ll meet a variety of candidates: young people who are still at (or have just left) school, others who are looking for a second (or third) career, and others again who have considerable experience in caring work gained through employment as health care assistants or similar. The range of educational backgrounds people have is likely to be varied. Some may have A levels, or undergraduate degrees (often in the humanities or social sciences). Others may have (or be studying for) Access qualifications via their enrolment at colleges of further education.

From my accumulated experiences of interviewing in this context I expect that most, if not all, of the candidates I meet today will have thought very carefully about their applications. I expect them to be enthused about the prospect of learning and practising, and informed about what this involves. I expect people to demonstrate an interest in others, to be inquisitive and engaged, and to be motivated by a desire to help.

I also imagine that candidates will be aware of today’s proceedings taking place in a context of heightened scrutiny: of nurses, their roles, and their preparation. Cynon Valley MP Ann Clwyd, for example, has had strong things to say about nurses and nursing following the death of her husband at the University Hospital of Wales in Cardiff. To repeat what I’ve said before on this blog: the fact that nurses now qualify with undergraduate degrees does not make them any less compassionate than those without. To me, the idea that there might be some kind of automatic, inverse, relationship between education and capacity to care makes no sense whatsoever. For those interested, here’s a very thoughtful piece touching on some of this on the notsobigsociety blog.

Learning together, and more on peer review

Along with spending time with students rehearsing research ethics, this week I have also had the chance to be part of a small interprofessional education initiative. This involved pre-registration mental health nurses and pre-registration occupational therapists. Two linked sessions, the last of which was a few days ago, were facilitated by a teaching team led by my excellent colleague Gerwyn Jones, and Ruth Squire (who I hadn’t met before, but was pleased to meet in this context). Also taking part was the fine Teena Clouston, an occupational therapy academic who I have enjoyed working with, on and off, over a period of many years. As an aside, meeting up again with Teena gave me the opportunity to congratulate her on her freshly minted doctorate. That was nice.

Interprofessional education in health and social care is hardly a new idea. It’s also good to do. In the workplace nurses, occupational therapists, doctors, social workers, physiotherapists and all the rest have to rub along together. So why not create opportunities for students from across these fields to learn together first, in the classroom as well as in practice placements?

It’s worth reflecting on the extent to which we still recruit and teach students in uniprofessional isolation. There’s work involved in making connections across different university departments, in creating materials and in planning what will take place. Timetables need to be aligned, and facilities booked. Only then does cross-disciplinary, university-based, learning occur. Having brokered interprofessional education initiatives of this type in the past I appreciate the time and organisation required. But I think we have to collectively put this effort in, and more.

On this occasion, this mental health-focused two days of joint learning culminated in students participating in a role played care planning meeting. I have to say that I was impressed – very impressed – by the way students managed the process. Interactions between professionals, the service user, his carer and an advocate were respectful and productive. I’ve seen a whole lot worse in real life. I left feeling optimistic.

Unrelatedly: yesterday a journal I haven’t reviewed for before got in touch and asked if I would comment on a paper submitted for publication. Last weekend I blogged about peer review, and wrote about having graciously declined an invitation. Yesterday afternoon’s request was different: I know the area being written about, and was happy to give a view.

Changing the subject again, South Wales once more is spectacularly beautiful this morning. Frosty, and dry: perfect for my run.

On not lying-in

I’m not very good at lying-in. Once I’m awake (which, on most mornings, is earlier rather than later) I’m up. It’s then a matter of creeping downstairs to do some soundless chores, before making my mandatory mug of strong coffee and grabbing breakfast. Whilst in the kitchen I’ll have the radio on, tuned (at low volume) to BBC R4, for company. Invariably I’ll then make my way to the computer: the very one I’m sitting in front of now.

This blog is about a week old, and a number of my posts have started life in this pre-dawn window of opportunity. Papers I’ve written for publication have often been chipped away at at a similar time. So far the relationship between my writing-for-this-blog and my writing-for-journal-submission has been one-way, in that I’ve used this space to share ideas rehearsed at greater length in already-published academic articles. Indeed, this was one of my purposes in setting this site up: I wanted to experiment with blogging as a way of promoting work, and as a means of engaging beyond the production of lengthy outputs for paid-for journals.

It now occurs to me that this blog might also become a working space for the development of new ideas, and that the relationship between writing-for-journals and writing-for-the-blog might sometimes run in the opposite direction. This forum will never be a substitute for my academic journal-writing, and I’m not proposing to dump heaps of unmanaged data here (even if I had it!) for some kind of public write-in. But I might bring fledging ideas which I’m in the process of working through in my head.

Which brings me to…

At this year’s Network for Psychiatric Nursing Research conference I gave a talk titled, ‘Past, present and possible future in the system of community mental health care’. I intended this to be a kind of reflective run-through, taking in a decade-and-a-half of research and writing in the field. I wanted to touch lightly over a string of studies and papers I’ve had the good fortune to be involved in, and to knit together something cumulative around the themes of system interrelatedness, complexity and change. I’m not sure I pulled this ambition off in that forum, and in the longer term I’d like to work this all up into a full-blown paper. This space might become a repository of some sort for this type of work-in-progress. We’ll have to see, though, and I’ll need to think through how this might happen.

Unrelatedly: I’ll be opening the Mental Health Nurse Academics UK Vice Chair elections on Monday. My congratulations, too, to Louise Poley (Consultant Nurse in Substance Misuse, Cardiff and Vale UHB) for becoming RCN Wales Nurse of the Year. Lou has done outstanding work improving the health of people who are homeless, collaborating with partners across the statutory and non-statutory sectors.

Now I’m off out for run. Thanks, again, for reading.

Sphygmomanometers, remedial gymnasts and mental health work

For an example of how health care tasks can become attached to different groups of people over time, then look no further than the measurement of blood pressure. One of the stories my grandmother told me when she was alive was how, whilst working as a nurse in the 1920s, whenever a new-fangled sphygmomanometer was to be used a doctor would come to the ward to operate it. The recording of blood pressure then became a task that nurses and midwives routinely did, and indeed support workers. Now it is something that anyone can do, using electronic gadgets purchased from the high street.

Tasks move around in mental health systems, too. Think, for instance, of the provision of formal therapies. Cognitive-behavioural family work used to be something which only a sprinkling of nurses did. Not any more. In this part of the UK, some of the tasks which only social workers used to fulfil as ASWs (approved social workers) during the operation of the Mental Health Act are now equally fulfilled by others working as AMHPs (approved mental health professionals).

Just as tasks appear and move between groups, so too do whole groups emerge, change and sometimes merge or even disappear. Remedial gymnasts appeared in the years after the second world war, before being subsumed within the profession of physiotherapy. Peter Nolan has told the story of mental health nursing growing from the keepers and attendants found within the asylum system. Community mental health nursing, as a particular sub-division, did not exist until the early 1950s. Now within the mental health system there are peer support workers, carrying out tasks which professionals and health care assistants might once have done.

Complexity and changeDavina Allen and I wrote about processes of this type in a paper called Complexity and change in the United Kingdom’s system of mental health care. This appeared in the journal Social Theory & Health in 2006, though a post-peer-review version of the article can also be downloaded from here. Davina is a nurse and sociologist (and was one of my PhD supervisors; the other was Philip Burnard), and in this article we drew on sociological theories to explore the changing division of mental health work in the post-war years. We used the ‘ecological’ ideas of Everett Hughes and Andrew Abbott to frame our analysis, about which you can read more here. These emphasise the division of labour as a complex and dynamic social system, which is responsive to all sorts of internal and external forces. Technology is one driver for change (for example, no-one could measure blood pressure until a device to do so had been invented. Mass production brought this work to the masses). Hughes had lots of interesting things to say about ‘mandate’ (the kinds of things groups say they ought to be doing) and ‘licence’ (what they actually do), and the ‘bundles of tasks’ which become attached to occupations at particular times and places. Abbott writes about the things that professions do to secure and advance what he calls their ‘jurisdiction’, in the face of claims made by competitors. ‘Jurisdiction’ refers to a group’s control over work.

In our Complexity and change paper Davina and I wrote about the historic success of the profession of psychiatry in drawing on biomedical knowledge to underpin and maintain a position of power in the mental health system. But as I’ve already suggested, interrelated systems of work are in motion, and in our paper we were also interested to explore sources of change. So we wrote, for example, about the challenges to biomedicine raised by dissident anti-psychiatrists in the 1960s and 1970s. We also wrote about the claims of mental health nursing to the possession of profession-specific knowledge underpinning the maintenance of helpful therapeutic relationships, and the appeals of social workers to having profession-specific ‘social model’ insights.

We also made quite a thing about the significance of community care for work and roles, and reflected on the expansion of state intervention in the mental health system (via a proliferation of policies) in the early years of this century. Now I think about it, there’s a link here between the wicked problems paper I wrote with Michael Coffey, and blogged about in both this and this earlier post. Policymakers’ recent formulation of ‘the problem’ as being one of unhelpful professional demarcations and restrictive practices has been a source of considerable disturbance in the mental health system of work. I’m thinking here, again, about the opening up of the Mental Health Act ‘approved’ role to nurses, psychologists and occupational therapists as well as to social workers, and what the longer-term implications of this might be. I’m also thinking about the division of labour consequences of peer support workers, and mental health nurses who prescribe medications, and graduates without ‘professional’ qualifications providing psychological therapies in primary care. Whatever the merits or otherwise of developments of this type, I think we should look carefully at their wider impact. Sometimes change can manifest in unpredictable ways.

And that brings me to another matter altogether: the intended and unintended consequences of action in interconnected systems. But that’s for another day, and for another post, entirely. Thanks for reading.

The Willis Commission

Nursing education sometimes gets a bad press. Students following degree-level pre-registration courses have been variously described as ‘too posh to wash’, or ‘too clever to care’. I’ve never got the argument that it’s an either/or thing. Why can’t nurses be both well-educated and caring? So I was interested to come across the final report of the Willis Commission on nursing education.

This was sponsored by the Royal College of Nursing, and set out to answer the question, ‘What essential features of preregistration nursing education in the UK, and what types of support for newly registered practitioners, are needed to create and maintain a workforce of competent, compassionate nurses fit to deliver future health and social care services?’ I confess I was doubly interested in all this as RCN Mental Health Advisor Ian Hulatt, who I used to share an office with when he worked in Cardiff before taking up his current position, played a big part in getting the Commission off the ground.

There was some scepticism about the timing of the Commission when it was first set up, particularly as nursing programmes throughout the UK were then in the process of being rewritten in response to new regulatory standards. But the final report isn’t about the strengths or shortcomings of particular curricula. What it is concerned with is the preparation and place of nurses in the contemporary health care context. I think the key messages are balanced ones, beginning with a clear emphasis on ‘patient-centred care [as] the golden thread’. There’s also an endorsement of universities’ involvement in nursing education, and of the importance of well-educated, research-minded, practitioners able to fulfil roles in increasingly complex healthcare workplaces.

Mental Health Nurse Academics UK (MHNAUK)

Over a period of almost a decade Mental Health Nurse Academics UK (MHNAUK) has grown in size and stature. The group has been chaired by a series of fine people: Patrick Callaghan, John Playle, Linda Cooper (who I work with in Cardiff) and Alan Simpson. Incoming chair to serve for two years from the start of 2013 is Michael Coffey.

I’m managing the process through which the group’s next vice chair will be identified, and pretty soon we’ll be moving to an election. Whoever takes up the position will spend two years working with Michael, before spending the two years following as chair. More news on all this at a later point.