Category: Research

#NPNR2014 call for abstracts

Not much time for blog-writing lately, for various reasons, but this morning I want to point readers to the full details and call for abstracts for this September’s International NPNR Conference. The event website can be found by following this link, from where I have lifted this:

20th International Network for Psychiatric Nursing Research conference

18 September 2014 – 19 September 2014

The University of Warwick, Coventry, UK CV4 7AL

Event home

This year is the 20th international NPNR conference and it’s going to be a celebration.

We wish to celebrate and promote some of the outstanding mental health nursing research that shapes mental health policy and nursing practice across the world. We will also acknowledge some of the best psychiatric and mental health nursing research that helped create the strong foundation for our work today. And we will invite delegates to look ahead to map out the future for mental health nursing research, education and practice.

**The NPNR steering committee are proud to announce the call for abstract submissions is now open until 30 April 2014**

Conference themes

Programme themes for 2014

Contemporary practice in mental health nursing research

Involving people – where has it got us?

Reflections and reminders

Building new knowledge for effective partnerships

Methodologies, methods and magic

Innovation in teaching, learning and practice

Call for abstracts

Check out the abstract section for full details and to submit an abstract.

Keynote speakers

Understanding Pathways in Mental Health Care | Professor Swaran P Singh, Head of Division, Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK

Mental health and Wellbeing: Books on Prescription | Debbie Hicks, Director of Research, The Reading Agency

Co-production and the future role of Mental Health Nursing | Dr Julie Repper, Recovery LeadNottingham Healthcare Trust, Nottingham, UK

Managing and delivering evidence-based mental health and substance use services | Dr Kevin Ann Huckshorn, State Division Director for the Division of Substance Abuse and Mental Health, Delaware, USA

Quotes from NPNR 2013

” NPNR – Power to the people conference” A service user

“Good key speakers, relevant content and engaging presentations. Excellent concurrent sessions” A delegate

“I’ve found the conference extremely inspiring. This was my very first conference; I enjoyed presenting my research and valued the feedback given. It’s great to see frontline staff carrying out research and being supported by their organisations in doing so. I would like to do further research myself. The keynote lectures were great especially ‘spirit level.” New Researcher

Piece in the Guardian by Helene Mulholland (4 September 2013)

“Charles Walker MP: ‘Mental illness is not a weakness'”
http://www.theguardian.com/society/2013/sep/04/charles-walker-mental-illness-not-weakness

#NPNR2014

Join the pre conference discussions on www.twitter.com now…

Professor Alan Simpson, chair of NPNR steering committee
@cityalan

Dr Michael Coffey, chair of MHNAUK and chair of NPNR scientific committee
@D10Coff

Event contact

Laura Benfield
Conference Organiser
Royal College of Nursing
20 Cavendish Square
London
W1G 0RN

Tel: 020 7647 3591
Email: npnr@rcn.org.uk

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Identity and education

One of the things I discussed with Swansea University’s Approved Mental Health Professional (AMHP) students today was how the emergence of a system of community mental health care opened up important new sites for the advancement of professional jurisdictional claims. For more on this idea of jurisdiction (which comes from the sociology of work) check out these earlier posts and embedded links to full-text articles here, here, here and here. It implies that in a dynamic division of labour professions engage in a constant jostling to cement and advance their positions, against the claims of others. The appearance of the AMHP role, fulfilled not just by social workers (as was the case with the old ASW role) but also by nurses, occupational therapists and psychologists, shows how the relationships between professions and tasks can change over time.

It is additionally the case that occupational groups are not homogeneous, but are internally segmented. This means that within a single profession differentiated elements can find themselves battling it out to control work and its underpinning knowledge, or to determine what counts as a necessary preparation for new entrants. And nursing, it appears to me, has plenty of form when it comes to internal divisions and disputes of this type.

With all this in mind, two papers caught my eye before heading off to teach this morning. Both are authored by Professor Brenda Happell. In her editorial in the current issue of the International Journal of Mental Health Nursing, titled Let the buyer beware! Loss of professional identity in mental health nursing, Brenda says (amongst other things):

Most of the time, I feel eternally grateful for my decision to pursue a career in mental health nursing […] At other times, I despair and wonder about the future of our profession, and the care of people experiencing mental health challenges.

I’ll quote some more, as the full text of the editorial is behind a subscription paywall. Writing about the Australian context in particular (this being a part of the world where nurses are trained as generalists rather than, as here in the UK, for a specific field of practice), Brenda adds:

Some of my concern can be traced back to the professional identity of mental health nursing. Identity is such an important part of being professional, and how we consider and present ourselves both individually and collectively.

[…]

Mental health nursing is becoming integrated into other content, in the absence of any evidence to suggest this is an effective means of education and plenty of anecdotal evidence to suggest it isn’t. Nurses without any specialist qualifications,
and often without experience in mental health, are increasingly teaching the content, medical-surgical wards are being considered suitable places to gain clinical experience in mental health, and nurses who work in mental health for more than 5 minutes are referred to as mental health nurses, despite not having the appropriate qualifications.

That’s a dismal picture indeed. Through a ‘jurisdictions’ prism it might be thought of as a case of one segment within a highly differentiated profession claiming possession of sufficient knowledge to capture the work previously done by another, and to reframe what counts as adequate educational preparation.

Brenda and colleagues’ second paper has just appeared in early online form in Perspectives in Psychiatric Care. Majors in Mental Health Nursing: Issues of Sustainability and Commitment reports findings from an interview study involving representatives of Australian universities which had committed to (or actually implemented) mental health ‘majors’ within their comprehensive undergraduate nursing curricula, but which then discontinued them. Noting the lack of sustainability of embedded mental health nursing options within larger courses of generalist pre-registration education, Brenda and her team conclude:

[…] these experiences suggest that the current comprehensive nursing education programs are not well suited to promoting mental health nursing education as a positive future career destination. While such apparent attitudes prevail, the workforce problems in mental health nursing are likely to persist and indeed worsen.

A dismal conclusion again, linked once more in Brenda’s analysis to a shift away from a pre-qualification route to specialist mental health nursing practice.

Arguments for comprehensive, generalist, nurse education and thus for greater homogeneity in the workforce are frequently made here in the UK. When the Nursing and Midwifery Council opened a consultation on proposed new standards for pre-registration nursing in 2007 it specifically asked people to give a view on whether the branches (Mental Health, Adult, Children and Learning Disabilities) should remain. Mental Health Nurse Academics UK (drawing in part on Sarah Robinson and Peter Griffiths’ National Nursing Research Unit international comparison of approaches to specialist training at pre-registration level) submitted this in its 2008 response:

Experiences from other countries that have gone down the generalist pre-qualifying nursing education route show that this leads to a lack of skilled MHN workforce, difficulties in recruiting to post-registration MHN training and a reduction in the quality of care and service provision for those with MH problems […] In attempting to achieve some unitary, generalist view of nursing to fit with other countries, many of whom are envious of our branch specific pre-registration model, we run the very real and significant risk of simply repeating the errors of others for no gain.

We’ve had changes in formal interprofessional divisions of work (which takes me back to this morning’s AMHP students, notwithstanding that all in this class happened to be social workers). But we’ve hung on to branches (or ‘fields’, to use the current nomenclature) in UK nursing, and continue to prepare nurses to exclusively do mental health work from pre-registration level onwards. Six years on, Brenda Happell’s cautionary tales from Australia remind us of what might have been had decisions been made differently.

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More, and more educated, nurses make a difference

Whilst I was wandering around Cornwall last week (see photograph for evidence), The Lancet was busy publishing the latest paper from Professor Linda Aiken and her colleagues in the RN4CAST consortium. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study uses discharge data for 422,730 surgical patients in 300 hospitals in nine countries along with survey data from 26,516 practising nurses. That’s one big study. The abstract goes on to say:

Finding

An increase in a nurses’ workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031—1·106), and every 10% increase in bachelor’s degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886—0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor’s degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor’s degrees and nurses cared for an average of eight patients.

Interpretation

Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor’s education for nurses could reduce preventable hospital deaths.

[NB: Not sure about odds ratio? Check out the relevant Wikipedia entry here.]

On the day the article was published in early online form the Council of Deans of Health here in the UK ran with this, The Conversation ran with this and The Guardian ran with this. The Lancet supplemented its article with this podcast.

The media interest reflects the scale of the study and the importance of its findings, which make a strong case for investment in nursing. A year ago, the International Journal of Nursing Studies published this special issue on the nursing workforce and outcomes, carrying a series of open access papers from the same RN4CAST team. There are other papers published elsewhere arising from this same study, and no doubt more to come.

What the RN4CAST researchers have not done is to have generated any data in psychiatric hospitals or involving mental health nurses. This is very reasonable, as theirs has been a complex-enough study ‘focused on general acute hospitals’, to quote from its published protocol. But it would be good to know more of the relationships across Europe between mental health nurse staffing and practitioner characteristics, organisational and management features and service user outcomes. Now there’s a challenge for someone.

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Making psychiatric wards safer and more peaceful

Safewards, led by Professor Len Bowers, has been funded through a National Institute for Health Research (NIHR) Programme Grant for Applied Research and aims to make psychiatric hospitals more peaceful, safer and therapeutic.Twice in the last year I have had the opportunity to hear Len present the thinking behind the Safewards model, outline the design and methods of the Safewards randomised controlled trial and talk through its main findings.

Following the link from the Safewards logo above takes you to the project’s website. This is packed full of useful information, including the detail of the simple nursing practices which Len and his team found reduced rates of conflict and containment in the hospital wards participating in their study. For an accessible introduction to what Safewards is all about, there is also this video in which Len presents his work to an audience in Melbourne in October 2013:

As I suggested in a meeting yesterday with esteemed Cardiff and Vale University Health Board colleagues, this really is exceptionally important new knowledge for mental health nurses. Now that the main trial is complete Len and his collaborators look to be devoting much of their energies to helping inpatient mental health staff and managers make use of the Safewards interventions in their everyday practice. I wish them every success, and am encouraging people to find out more and to spread the word.

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Reviewing health and social care research in Wales (reprise)

Time this morning, before I head off for a second day of MMI-ing, to draw attention to revised restructuring proposals from (and for) the National Institute for Social Care and Health Research here in Wales. I’ve written about the NISCHR review in this earlier post, and this latest document is the version which has gone out for external peer review.

I’m pleased to see that NISCHR proposes a continuation of its support for research capacity building in nursing and the allied health professions. Here’s a snip from the new document:

Research Capacity Building Collaboration (RCBC) – RCBC was established in 2006 as a collaboration between six universities in Wales to increase research capacity in nursing/midwifery and the allied health professions in Wales. It does this through a number of funding schemes including PhD Studentships and Post-doctoral Fellowships.
v. It is proposed that a new specification is developed for an application for renewal of RCBC/ a new initiative to increase research capacity in nursing/midwifery and the allied health professions in Wales.

For those not familiar with the RCBC scheme I recommend a visit to this website.

Elsewhere, I see that NISCHR proposes pressing ahead with its plans to close the gap between its funded Registered Research Groups, Biomedical Research Centres and Biomedical Research Units. It says:

There is a need to further integrate the functions of the BRC, BRUs and RRGs into the NISCHR infrastructure and to provide clear objectives and indicators to ensure NISCHR funding makes a real difference and contributes to future outcomes. There is also a need to avoid duplication and address the perception of NISCHR’s infrastructure being unnecessarily complicated.
b. It is proposed to create new entities known as NISCHR Centres and Units. These will replace BRCs, BRUs and RRGs and become central pillars of the NISCHR infrastructure to create a more streamlined and integrated structure, improve cost-effectiveness and foster collaboration across sectors to facilitate translation.
c. It is proposed that NISCHR Centres will have responsibility for portfolio development and delivery in their areas across the translational spectrum, in collaboration with other elements of the infrastructure. In some instances they may also provide elements of infrastructure support themselves.
d. It is proposed that NISCHR Units will be smaller entities than NISCHR Centres and focus on specific points of the translational spectrum, specific activities, or represent emerging areas of research strength with aspirations to become NISCHR Centres in the future.
e. It is proposed that a competition is held for NISCHR Centres and Units; the existing BRC, BRUs and RRGs will be able to apply and be encouraged to consider how best to augment existing functions and strengths to become more integrated entities in the future. They may also incorporate the functions of other elements of the existing infrastructure. The NISCHR Centres and Units will have a Director, Operational Manager and Leads for specific specialties/areas. They will be multi-professional and multidisciplinary, including Public and Patient, NHS, HEI, Industry and Social Care representation as appropriate.

This is a significant, if not unexpected, proposal. As future arrangements begin to become clearer I’ll be looking for ways to make sure that research into mental health systems and services continues to be supported. Plenty to think about, then, as I head for the train.

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End of week catch-up

This week I learnt a whole lot more about framework analysis, having made the trip to City University London to join others in the COCAPP team for a NatCen training event. This was also my first introduction to the use of NVivo (a computer-assisted qualitative data analysis software package), my experience having previously been with Atlas.ti.

Elsewhere the RiSC project team convened, via teleconference, for an important decision-making meeting. We’re entering the closing stages of this study, and it’s interesting stuff: about which I’ll be able to say more in time.

And, as planned, this was also the week I made the short hop to Cardiff Met (at the invitation of Lynette Summers in the University’s Library and Information Services) to meet with folk there to talk about my experiences in using this blog, and other things, to bring my research and writing to a wider audience. That was fun, and I hope useful, too.

Along with some classroom teaching, marking, a committee meeting and reading a nearly-there doctoral thesis that just about sums up my recent workplace activities. Varied, as always. Looking ahead, I realise that (unusually) I’ll be missing the next meeting of Mental Health Nurse Academics UK due to take place at Lincoln University on February 18th. Other commitments have won out on this occasion.

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20th International NPNR Conference: call for abstracts

Early news of this year’s International Network for Psychiatric Nursing Research conference, and a call for abstracts, have just appeared. The event takes place at Warwick University on September 18th and 19th, and more information can be found by following this link. With support once again from both the Royal College of Nursing and Mental Health Nurse Academics UK this promises to be a special occasion, this being the 20th running of this esteemed event.

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Activity based funding and student research in the NHS

Yesterday I spent time with a group of MSc students, talking about research review processes. I’ve written on this blog in the past about my experiences of seeking approvals for my PhD, and in Monday’s session I urged people to be exceptionally cautious about planning NHS-related research in pursuit of their Master’s degrees.

Preparing for and securing NHS research ethics committee and R&D office approvals takes time. In this part of the world at least, some healthcare organisations are also likely to ask researchers to cover the costs to the NHS of supporting studies which are not portfolio adopted. Here I’m thinking of, for example, the costs arising when staff leave the workplace to participate in interviews or join focus groups, or suchlike.

The relatively new practice of directly seeking payment from research teams for the costs of studies which are not eligible for portfolio registration has appeared with the shift to activity-based funding. Here in Wales, the National Institute for Social Care and Health Research (NISCHR) has published criteria for entry to its portfolio, which are summarised here and are elaborated on here. It is from this second document that I have snipped the following:

A research study is a structured activity which is intended to provide new knowledge which is generalisable (ie of value to others in a similar situation) and intended for wider dissemination.

Studies eligible for the NISCHR portfolio should involve face to face contact with NHS patients, social care service users or people involved with their care. Studies must be led from and/or recruiting participants from Wales. All studies must already have research funding before they can be included in the Portfolio. Research Costs cannot be provided by NISCHR CRC.

The following types of study are not eligible for inclusion in the NISCHR Portfolio:

audit,

needs assessments,

quality improvement projects,

directly commissioned studies,

secondary research such as systematic reviews,

purely laboratory based studies,

routine biobanking of samples would not be eligible but a hypothesis based sample collection would be if appropriately peer reviewed and funded,

own account funded studies,

studies closed to recruitment.

MSc projects invariably do not meet these criteria, meaning that numbers of taught postgraduate students get to cut their dissertation teeth on non-NHS research studies or (where academic regulations allow) on other types of project altogether. Examples are service or quality improvements, service evaluations and systematic reviews. And, in my view, these are sufficiently testing options for students working at MSc level, with some (like local quality improvements) having the added advantage of immediately and obviously benefiting the NHS and those who use its services.

However, a problem arises in the case of postgraduate research degrees. In some disciplines, including nursing, these are often undertaken part-time and are carried out with limited or no external grant income. Opportunities for studentships are relatively rare, and where they are available may be financially unattractive to practitioners who have already built careers in the health service. As with MSc projects, ‘own account’ doctorates will struggle to get onto the portfolio. They therefore run the risk (in some circumstances) of not being supported by organisations within the NHS unless their associated costs are explicitly met. One way of achieving this may be for local NHS managers to agree to carry the costs of non-portfolio studies which it is planned will take place within their services. But securing this kind of support is not straightforward, and for would-be research students the added challenge of finding a means of paying costs is hardly an encouragement. And, where MSc students can usually opt for non-research projects this is not so for those aiming for PhDs or Professional Doctorates. These are awards made only to those who generate new knowledge using sound and defensible research methods.

So what does all this mean? It’s early days, but one likely outcome may be a reduction in small-scale research projects within the NHS, along with an increase in the preparations and negotiations which precede data generation. Another may be the proliferation of non-portfolio projects which are explicitly designed to meet ‘research’ criteria for academic award purposes, but which are constructed to be something else (typically ‘service evaluation’) within the context of NHS research governance. A reasonable, longer-term, concern is that research capacity-building in fields like nursing may falter as potential students rethink their plans. And that, in my view, would be a big step backwards.

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‘Psychiatric Ideologies and Institutions’: 50 years and counting

Happy new year. In the midst of a series of holiday period email exchanges Michael Coffey happened to mention that 2014 marks the 50th anniversary of the publication of Anselm Strauss and colleagues’ Psychiatric Ideologies and Institutions.

This is a fine book indeed, which during my time as a PhD student concerned with work and roles in mental health care was an absolute essential. In it, Strauss and his collaborators reported findings from prolonged and intensive fieldwork conducted in two North American psychiatric hospitals. Whilst today’s qualitative research reports will typically include lashings of direct data extracts, Psychiatric Ideologies and Institutions has little in the way of what Strauss et al referred to as ‘illustration and quotation’. Yet I never once recall, as a reader, doubting that Strauss and his team were truly there, participating in and recording everyday hospital life and its organisation.

It is at this descriptive level that the book initially works: as a meticulous account of the interplay between ideas, professions and practices in an area of health care which (both then, and to this day) happens to be particularly contested. One part of the dataset drawn on in the book comes from a questionnaire, designed to capture information about affiliations to particular treatment ideologies. From this nurses emerge as being ‘ideologically uncommitted’. In a later, detailed, section Strauss et al wrote of the problems faced by nurses in reconciling their managerial, administrative and therapeutic tasks and in answering the still-pertinent question:

…at the heart of her professional identity: What does therapeutic action toward patients actually involve for a psychiatric nurse?

My copy of Psychiatric Ideologies and Institutions is the edition published in 1981, for which a new introduction was added. In this, Strauss and his collaborators wrote of their original ambition to produce a book which was not only descriptive, no matter how detailed or accurate, but which was also theorised. It was the fieldwork and the findings reported most completely in this monograph that gave rise to the idea of the negotiated order. This is a sociological theory of importance which, in the decades following its introduction, went on to develop a life of its own. As Strauss et al wrote in their 1981 introduction, their original observation that theory might emerge from data represented a considerable methodological departure, more fully articulated at a later point with the introduction of grounded theory. Here, then, is a second way in which Psychiatric Ideologies and Institutions works, and remains of interest to people unconcerned with research into the world of mental health care: as an exemplar of how data and theory can dance together.

Today I’ve turned up this review of the book, which appeared in 1965 in the journal now called Psychiatric Services. In it the reviewer sums up with the recommendation that:

All in all, most professionals will find this book profitable to read, study and think about.

I concur, and commend this classic text to professionals and others alike. And as an aside, perhaps this short celebratory post can help persuade students (usually undergraduates, in my experience) that books and articles which happen to be more than five years old can still be worth reading.

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