Category: People

Ten good reasons to come to this year’s NPNR conference

This year’s International Network for Psychiatric Nursing Research Conference takes place on the 5th and 6th of September at Warwick University. Here are ten reasons to come along and participate:

  1. to learn from Professor Kate Pickett (co-author of The Spirit Level) talking about global inequalities in mental health;
  2. to hear Professor Len Bowers presenting new findings from his Safewards trial;
  3. to listen to Charles Walker MP, who has talked publicly about his personal experience of mental health difficulties, speaking on the topic of making the personal political;
  4. to hear Dr Simon Duffy from the Centre for Welfare Reform talking about personal responsibility and social justice;
  5. to listen to Dr Fiona Nolan from UCL/Camden and Islington NHS Foundation Trust discussing protected engagement time in acute mental health inpatient wards;
  6. in a packed programme of concurrent sessions, to learn from delegates (from the UK and beyond) talking about their research studies large and small;
  7. to renew existing friendships within the mental health nursing research field, and to make new ones;
  8. because I defy you to tell me you have anything more interesting to be doing over the two days the conference is taking place;
  9. because if (like me) you’re a regular at this conference, being there is the only way to find out how the NPNR at Warwick compares with the NPNR at Oxford;
  10. because you will, undoubtedly, enjoy yourself.

Critical junctures (reprise)

This morning Nicola Evans’ and my paper on Critical junctures has appeared in advance online publication form on the Social Theory & Health website. This is very pleasing, though as I noted in my original post the terms of Palgrave’s copyright agreement mean that we have to wait for a period of 18 months from now before depositing a green open access version of the full text to accompany the article’s ORCA entry.

In the meantime, here again is the article’s abstract, which I hope at least whets readers’ appetites:

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.

Writing an undergraduate dissertation

Here’s a link to a full-text green open access version of a paper called Preparing and writing an undergraduate dissertation. Philip Burnard and I published this in Nurse Education in Practice in 2001. Our aim was to produce something of practical use to students working on what is, typically, their single biggest piece of written work.

I appreciate that my timing here is very poor. Right now most students will be on, or planning for, their summer holidays. So I’ll draw attention to this paper again once the new academic year has started.

Research and mental health nursing

Over on the Mental Health Nurse Academics UK blog, the group’s chair Dr Michael Coffey writes:

The Research Excellence Framework (REF) looms large for many of us. This is part of the regular round of judging of peer-reviewed research publications on which the UK government bases its decisions on distribution of institutional research funding. Decisions within Higher Education Institutions are being made around now on who is considered returnable and then whether it is strategically advantageous to submit these researchers in the exercise. For individual research careers these decisions weigh heavy. For the profession of mental health nursing there may be wider implications. Previous research assessment exercises have seen more and more evidence of mental health nurses being returned. This has undoubtedly led to an improved profile within individual universities and recognition of the contribution of research to improving the experience of people using mental health services.  There remain significant opportunities for mental health nurse researchers to contribute and bring to bear a professional view on what needs researching and how this should be conducted. We will have to wait until 2014 for an idea of what the landscape will look like in relation to mental health nursing. One thing for sure is that we need a highly engaged mental health nurse academic workforce to continue to provide high quality education and research. By doing this we can make a meaningful contribution to the development of mental health care both here in the UK and beyond.

Nursing certainly did do well in the UK’s last Research Assessment Exercise, the precursor to the REF to which Michael refers in his post. Results for all higher education institutions submitting to Unit of Assessment (UoA) 11 (Nursing and Midwifery) in RAE 2008 can be found here. In his subject overview report for UoA11, Professor Hugh McKenna of Ulster University ended with this:

In conclusion, the sub-panel members were very impressed with most of the submissions they reviewed and with the pervasive pattern of world-leading and internationally excellent research. There are many models of good practice from which developing research groupings can learn in terms of research activities, outputs, environment and esteem. It is clear that investment by Governments, funding bodies and universities has increased research capacity and developed research leaders capable of undertaking nursing and midwifery research that is internationally excellent and world leading. These funding streams need to be sustained and enhanced if the upward trajectory and momentum are to continue and if the quality differentials between the strongest and weakest departments are to be addressed.

And, when the results from the last RAE were published in December 2008, The Guardian ran an article titled Nursing research takes its place on world stage. Here it said:

Nursing, for many years medicine’s poor relation, has come of age in the 2008 research assessment exercise (RAE). Academics in the field can justifiably claim to be world-leading in terms of research. Nursing and midwifery was among the subjects with the most highly rated research in the results published today.

Heady stuff indeed, and testimony to years of hard work, strategy, and capacity-building investment. All this does, though, seem an awful long time ago. As Michael reminds us in his MHNAUK post, attention has long since turned to preparations and prospects for REF 2014.

I have written about nursing and the Research Excellence Framework 2014 on this site before, drawing attention to the workload facing members of UoA A3 (Allied Health Professions, Dentistry, Nursing and Pharmacy) and to the challenges of demonstrating and assessing ‘impact’. So, as we hurtle towards the deadline for REF submission, in what shape does UK mental health nursing research find itself?

Readers of this blog will know that this is a question that MHNAUK is also asking, and is seeking an answer to in organised fashion. Professor Len Bowers led a discussion on this at the MHNAUK meeting held in Cardiff last March. When the group reconvened in Liverpool in June, Dr Fiona Nolan asked members for items to include in her planned survey of research activity and capacity.

Whilst we await findings from Fiona’s project in the first instance, my personal view is that there is much to celebrate in mental health nursing research but also room for development. A small number of universities are home to strong and established research groups. Leaders of these have built national and international collaborations across disciplinary and institutional boundaries. They have laboured to secure funding in open competition and to complete and publish studies with real implications for policy, services, education and practice. This is excellent progress, and I think we now need more of this type of activity across more universities. This means people (and I include myself here) extending their ambition, and perhaps being a little bolder. As an example, early next year the European Union’s Horizon 2020 research and innovation programme invites a first round of applications for funding. How excellent it would be for mental health nurses in the UK to be leading, and collaborating on, high-quality bids submitted there.

My more general reading of the field is that, in many universities, mental health nurse researchers are thinly spread. I’ll bet that in most of the sixty-plus universities represented at MHNAUK the number of people predominantly involved in teaching far outstrips the number predominantly engaged in research. Teaching is important – really important – but the lone researcher in a team of teachers is in a tough place indeed. As I cast an eye around the departments I am most familiar with I also wonder where the younger mental health nurse researchers are. How many mental health nurses in their 20s are studying for PhDs? If the answer is ‘not many’, then what should we collectively be doing to make research a viable, and attractive, career proposition for nurses at the start of their careers? How might we nurture a future generation of mental health nursing clinical academics?

Anyway: all is speculation until we have some evidence. The MHNAUK survey, I anticipate, will paint a more rounded and complete picture of the true state of research activity and capacity than will the Research Excellence Framework. The REF, being what it is, is subject to all sorts of inter- and intra-institutional politicking and will produce only a partial view of what’s really going on.

Academic networking

There are plenty of places where academics can tell the world about their interests and expertise, and generally show off their publication records, ‘h’ indices and all the rest. Blogs, like this one, are an example. Then there are services like ResearcherID, ResearchGate, Academia.edu and so on. These often have a networking function to allow people to get in touch and develop collaborations. Some also have space to store open access papers, in much the same way that university-based digital repositories (like Cardiff University’s ORCA) do.

Yesterday I published my Google Scholar profile. This may be just another way of promoting and networking, but I’ve also spotted a button titled, ‘My updates’. Here it is, pointed to with a big red arrow:

And, here’s a description from the Google Scholar blog of what this new(ish) function does:

We analyze your articles (as identified in your Scholar profile), scan the entire web looking for new articles relevant to your research, and then show you the most relevant articles when you visit Scholar. We determine relevance using a statistical model that incorporates what your work is about, the citation graph between articles, the fact that interests can change over time, and the authors you work with and cite. You don’t need to configure updates or enter any queries. We’ll notify you about new updates by displaying a preview on the homepage and highlighting a bell icon on search results pages.

This service looks very useful, not least because it appears to actually work. When I’m logged into Scholar and click on the ‘My updates’ link today I get interesting references to crisis resolution and home treatment research, continuity of mental health care and interprofessional community mental health work (amongst others). All very much up my street.

The accidental grounded theorists

On Friday I had reason to ponder the relationships between theory and data, and the boundaries between different types of qualitative research. This was day two of my Working and Leading in Complex Systems professional doctorate module. What I discovered is that I may, in fact, have become an accidental grounded theorist. Or possibly not…I’ll let the reader decide.

During a talk about critical junctures I said how, in our recent paper, Nicola Evans and I had elected to lay out our theoretical contribution (i.e., our idea of ‘critical junctures’ as pivotal, punctuating, moments initiating or taking place within longer individual trajectories of care) ahead of displaying our data. We had done this even though our ‘theory’ had in fact been fieldwork-driven, as we then demonstrated in our article with extended, illustrative, extracts. Quite reasonably, in the classroom I was asked if we had therefore used a grounded theory approach.

This question got me thinking. My immediate response was that Nicola and I had developed a concept from empirical data but had absolutely not claimed to be ‘doing grounded theory’. In fact, the thought had never occurred to us (or to me, at any rate).

And there’s the nub of it. What does it actually mean to ‘do grounded theory’? Follow a stepwise recipe from a methodological cookbook? Or range freely over one or more sets of data in the search for new insights? Without wanting to suggest that ‘anything goes’ in terms of methods, I wonder if we can sometimes get too hung up on techniques and ‘rules’ when it’s the principles which really matter? In our critical junctures paper these included a commitment to the inductive ‘drawing out’ of conceptual insights from an analysis of talk and action. They also included the idea of staying close to our data, and of offering fieldwork extracts in support of the theory. I personally have no wish to agonise over what flavour of ‘doing qualitative research’ we have done here, and I’m also not sure that all of the finer distinctions and sub-divisions necessarily matter or even make sense.

But perhaps I’m missing something.

Vivas, research projects and the Welsh Government on the Francis Report

There’s plenty going on in the continuing baking sun this week. I was pleased to spend yesterday at Sheffield University (where I was once a student) examining, and recommending awarding, a doctorate addressing the use of problem based learning in mental health nursing education.

Meanwhile COCAPP is now generating data, and the RiSC project has reached a critical point as a search strategy is devised for its second phase. And tomorrow and on Friday I’ll be in the classroom with a group of professional doctorate students, talking and learning about systems and complexity.

Elsewhere, via the twitter account of the Minister for Health and Social Services, Mark Drakeford I’ve spotted the Welsh Government’s response to the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. I see there will be an annual Quality Statement for the NHS in Wales from next year, and a future NHS Wales Quality Bill.

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.