Category: Research

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.

Cardiff hosting, and NPNR news

This is the week that both Mental Health Nurse Academics and the COCAPP team come to Cardiff. MHNAUK’s meeting on Friday will take place in the Council Chamber in the Main Building, which is really rather grand. Visiting COCAPPers can look forward to a more everyday venue for our Thursday meet-up. This will be in Eastgate House (which is where I’m based).

Other news of note in the world of mental health nursing education and research is the impending move of this autumn’s Network for Psychiatric Nursing Research conference from Oxford to Warwick. The annual NPNR bash has taken place in Oxford pretty much since it was launched in the 1990s. I gather from my Twitter-using pals who sit on the scientific and organising committees that we can expect a relocation for an event scheduled, this year, for September 5th and 6th. It occurs to me that Warwick University is well-placed for delegates travelling from all parts of the UK, and indeed from around the world.

Acronyms and initialisms abounding

Now we’ve completed our IRAS form and been to REC, its onwards to NIHR CSP and NISCHR PCU. Hopefully the SSI we give to R&D will be OK, and once we’ve been adopted by the CRN and CRC we’ll get help from a CSO or two.

So that’s all clear then, right? Apart from ‘OK’, which I presume needs no introduction, these are acronyms and initialisms associated with the process of applying for approval to conduct research in the NHS, and getting help to recruit participants and generate data once permission has been secured. I could add that, in the case of COCAPP, we’re making these applications because we’re interested in the CPA and CTPs, and that we should probably make links with a CLAHRC, an AHSP and keep in with the RRG. And did I mention the MNM we’ve already started? You don’t know about MNM? Then read the papers coming out of RAMESES.

Of course, in writing all this I am wilfully and rather mischievously seeking to confuse. The point, though, is that words matter. Shortcuts and abbreviations can save the time of people who are already in the know, but can present an impenetrable thicket to the outsider. Perhaps the process of navigating NHS research approvals should be described using only the commonest 1,000 words in the English language.

TTFN.

Nursing and the approved mental health professional role

AMHPFurther to my mentioning of a new paper on the development of the approved mental health professional (AMHP) role, and what this might mean for nurses, here now is a link to a full text open access version downloadable from ORCA.

In this article, my friend Michael Coffey and I discuss the implications of the changes made in 2007 to England and Wales’ Mental Health Act for the role of the mental health nurse. We were helped on our way by Jackie Neale, Michael’s colleague and Co-Director of the AMHP programme at Swansea University and by Dr Martin Webber, Reader in Social Work at the University of York, both of whom read and commented on an initial draft of our paper. Writing for this blog, Michael says:

Nurses for the first time can make applications for detention in hospital based upon their independent judgement and with regard to the opinions of their medical colleagues, based upon a social perspective and the principle of least restriction. This is as far as we know unprecedented in UK mental health law. In many ways this changes the provision of mental health nursing in ways that have as yet to be measured. These changes reflect similar moves internationally in mental health law.  There are huge challenges here though. Nurses are creeping into the territory of other professions who are not exactly welcoming them with open arms. Specific occupational knowledge and values are claimed by social workers who have traditionally fulfilled the approved role. These may be seen as jurisdictional claims and nurses have to show that they too can ‘pass’ as workers with a social perspective who are able to be independent of doctors. This is easier said than done and nurses have a chequered history in relation to occupational biomedical dominance. Added to this nursing is chiefly a biomedical task nowadays despite all the claims to being ‘holistic’ and being as focused on the social aspects of people as on anything else. Claims by nurses to be ‘psycho-social’ oriented or even ‘bio-psycho-social’ should be treated with some scepticism as many of these nurses subscribe to ideas of genetic determinism and are overly chemotherapy-focused. So can nurses actually juggle both a primarily biomedical focus and a social one to come to independent decisions in cases where the person might lose their liberty?

The backstory to this publication includes the fact that, with Jackie Neale, Michael runs Wales’ only AMHP programme. You can find out more about this post-qualification, postgraduate, course here. Our new article also comes out of Michael’s and my shared interest in mental health work and roles, and in thinking about (and researching) what nurses and others do. Another piece of behind-the-scenes detail is that Michael and I were once part of a team which came pretty close to getting a large grant to investigate AMHPs, and the experiences of people on the receiving end of their services.

Abstract-sifting, a new publication, and music to work by

Not much time for blogging lately, what with one thing and another. I’ve turned into a kind of abstract-sifting machine, poring over the details of papers for possible inclusion in two unrelated evidence syntheses/literature reviews. Amongst other things I’ve also been making some final preparations for a day away (as an examiner) later this week, catching up with colleagues over various bits and pieces, and arranging to meet up with undergraduate students.

Some good news over the weekend was confirmation of a new paper being accepted for publication, in the International Journal of Nursing Studies. My friend Michael Coffey is lead author, and we’ve written about the emergence of the role of approved mental health professional and what this means for nursing. A quick look at the SHERPA/RoMEO website suggests we’ll be able to add post-peer review versions to our respective institutional repositories. I’ll then add a link, and perhaps a bit of a commentary, on this blog.

As an aside, I am reminded of the majesty of Miles Davis’ Kind of Blue. It’s more than a decade since I was first introduced to this, and it now occupies a special place in my (eclectic) music collection. I mention this as Kind of Blue is an album I often turn to when I’m fretting over tasks requiring concentration: like writing, or indeed sifting abstracts. I listened to it today, in its entirety. Then I listened to it again.

Gold and green

Further to my earlier open access blogs, here and here, having finally worked my way through the unexpectedly heavy traffic around the University Hospital of Wales I spent the first part of today in an open access workshop, facilitated by colleagues from Cardiff University’s library and information services. I was struck by the speed with which things are changing. I learned that Cardiff researchers now have a good chance of securing University funding to support the open access publication of papers arising from RCUK-funded studies. Whether this applies to all papers submitted to all journals with all varieties of open access (‘gold’, ‘green’ or ‘hybrid’) I’m not sure about. I hope it does, because I’d hate to think that researchers end up making decisions on where to publish based solely on their need for financial support to cover their APCs.

I also learned that, as things stand, there is no University financial support for the open access publication of papers from projects completed with funding from the NIHR or NISCHR. This is because neither is a Research Council, even though both run highly competitive funding schemes of particular interest to health and social care researchers. Bids to both bodies can include requests for funds to cover APCs, but this is a cost which can quickly add up. If everyone adds APC fees to their grant proposals then fewer studies will be funded, as the money to support paid-for ‘gold’ open access publication has to come from somewhere. The cost-free ‘green’ open access model, using institutional repositories, is an option here: but generally I am, again, driven to the conclusion that APC tariffs urgently need to come down.

Getting back to it

IMG_1414A quick post following a half-term break. Cornwall proved to be a fine place to spend last week. It is, truly, a most beautiful part of the country. Here’s a photo of the beach at St Ives to prove it.

Now it’s back to it. This week I’m working on two projects, and in the case of one will hope, by Friday, to be clearer on local arrangements for making payments to service user researchers. There’s some work to be done on preparing NHS R&D applications, too. Over the next week or so I also need to put some time aside to respond to Cardiff University’s consultation on the reorganisation of schools within the College of Biomedical and Life Sciences. The idea has been formally proposed that the School of Nursing and Midwifery Studies (where I work) and the School of Healthcare Studies (home to the academic occupational therapists, physiotherapists, radiographers and operating department practitioners) might merge. A move of this type has been on the cards for some time, so no surprises there.

Research, open access and academic blogging [2]

In last month’s Research, open access and academic blogging post I neglected to ask the obvious question: why are the article processing charges (APCs) levied by some open access journals so high? In that post I gave the example of BMC Health Services Research, which (unless a waiver is applied for and granted) demands the sum of £1,290 before each accepted paper progresses to online publication. What, exactly, is all that money for? It’s certainly not to pay peer reviewers for their time or expertise, because if it was I would have received some additional earnings from BMC by now. Does it really cost so much to iron out the typos, format to house style and upload an article to the journal’s servers?

I pointed out in my original piece that it is neither reasonable nor sustainable to systematically expect individual academics to pay APCs. This being the case, universities and grant awarding bodies are going to have to stump up. But via this post on the Sussex (and former Cardiff) physicist Peter Coles’s In the Dark blog I was alerted to this cautionary note from the Royal Historical Society on the unintended consequences of this arrangement. For the interested reader there’s also this RHS President’s letter on the same. The argument goes like this: if universities are going to be paying the APCs associated with individual open access articles then academic freedom will be eroded, as the final decisions on which publications are to be financially supported and which are not will be made by budget-holding managers.

The problem, then, is not with open access per se but with the extortionate costs currently associated with some versions of it. These need to come down, and quickly.

Giving a fig about roles

Hannigan and Allen 2011In a paper published in the Journal of Psychiatric and Mental Health Nursing at the start of 2011, Davina Allen and I drew on detailed, qualitative, research data to examine the relationships between policy, local organisational context and the work of community mental health practitioners. A version of the article, which carries the short title Giving a fig about roles, can be downloaded from the ORCA repository here.

Our paper drew on many of the social scientific ideas previously introduced on this blog in my Sphygmomanometers, remedial gymnasts and mental health work post, and which are rehearsed more fully in this earlier Complexity and change paper. Davina and I observed how recent mental health policy had triggered disruption in the system of work, with occupational groups advancing new, public, jurisdictional claims in response to perceived threats to their positions in a dynamic division of labour. One of the examples we gave was the response by sections within the profession of psychiatry to the policy of new ways of working, and its emphasis on ‘distributed interprofessional responsibility’ in particular.

The larger part of our paper reported new research findings. In the project from which it was drawn I had the opportunity to compare and contrast the organisation of community mental health services in two parts of Wales. With a view to understanding each site’s contextual features I read local policy documents, interviewed senior managers and practitioners and observed people at work. I was also interested in gaining a detailed, micro-level, view of the actual delivery and receipt of care. To this end I had permission from three service users in each site to follow their journeys through the mental health system, each over a period of four to five months. I interviewed all six about their experiences, and using snowball sampling mapped out the range of people providing them with care, whether paid or unpaid. The nurses, social workers, psychiatrists, psychologists, occupational therapists, general medical practitioners, pharmacists, health and social care assistants, family members and neighbours identified in this way were invited to take part in interviews focusing on work and roles. I also observed interprofessional care planning meetings and home visits, and read the written notes about each of the six service user participants made by practitioners.

As the full text of the paper reveals, in the analysis developed here we were particularly interested to explore the relationships between workplace characteristics and what practitioners actually did. Not unexpectedly, nurses carried out medication tasks, social workers (as the sole group able to do this at the time data were generated) fulfilled the ‘approved’ role during the operation of the Mental Health Act, doctors diagnosed and prescribed, and the sole participating psychologist provided structured therapy.

Word cloud 02.02.13Beyond this we also found that the work of professionals was ‘patterned’ (to use the phrase coined in this context by Anselm Strauss) by immediate organisational forces. In one of the two sites nurses and social workers had enlarged ‘bundles of tasks’ (this being Everett Hughes’ term). This shaping of what people did could be understood with reference to a variety of contextual features. Key informants in this site described a particularly long and positive history of health and social care staff working together. This manifested during fieldwork in an approach to care provision which emphasised shared tasks and downplayed rigid demarcations. Single community mental health workers, rather than multiple representatives of different groups, tended to be attached to the care of individual service users. Health and social care organisations in this site were also small, lacking pools of staff from which people might be drawn to cover gaps left by departed colleagues. In this constellation of circumstances nurses and other members of staff fulfilled roles which were more ‘generalist’ than was the case in the other of the two sites.

Davina and I were interested to set our findings in the new and emerging context for mental health care. We pointed to larger policy trends favouring unpredictability in working practices, and to the idea that competency (rather than professional background) should determine practitioners’ eligibility to fulfil roles. We observed that ‘flexible, boundary-blurring, professionals competent to carry out multiple tasks may find favour with managers concerned with meeting local needs in local ways’. We reflected on the implications of this for continuity of care, capability and the preparation of new professionals. The paper ended with our thoughts on the challenges all this poses to professions and their jurisdictional claims.

In a later post I’ll return to this study, and in particular to what I learned about the experiences of the people whose unfolding care I followed as each moved through the different parts of his or her local, interconnected, system of mental health care. But that’s for another day.

Resilience and community mental health nursing in Palestine

With his permission, let me introduce you to Mohammad Marie. I know Mohammad as a PhD student in the Cardiff School of Nursing and Midwifery Studies. He is also a mental health nurse and teacher, who (when he isn’t attending to his thesis in south Wales) works at An-Najah National University in Nablus, in the Palestinian West Bank.

Mohammad is interested in resilience, both generally and in community mental health nurses in particular. Through his writing I have gained a glimpse of mental health needs and services in the occupied Palestinian territories, and of the day-to-day realities of living and providing health care in this part of the world. Quite rightly, nurses in the UK complain about lacking resources, of coping with high caseloads and of the dangers of burnout. Here, however, we can barely comprehend the enormity of the challenge facing those who do nursing in Palestine. Human rights are violated, and free movement restricted. Access to medicines is limited, and rates of trauma and mental ill-health high. Few practitioners have had opportunities to develop knowledge and skills specific to the provision of mental health care. For readers wanting to know more, the World Health Organization has made available information on health and health services in Palestine here.

A simple question drives Mohammad’s study: given their circumstances, what are the sources of resilience which help community mental health nurses continue in their caring work? As part of laying out the background to his project Mohammad has introduced me to the uniquely Palestinian concept of ‘samud’. ‘Samud’ and ‘resilience’ look, to me, to be close cousins, with the former referring to steadfastness in the face of adversity. It manifests in individual and social action, as well as in specific policy (for example, to support the development of an infrastructure for public services). From what Mohammad tells me, samud has become an important part of Palestinian culture and identity.

To get answers to his research question, Mohammad returned home last year to generate data. In ethnographic style he observed nurses and other staff going about their day-to-day tasks, basing himself in a series of government and non-governmental community mental health centres. He read local documents relating to the organisation of services. In order to explore nurses’ experiences and views in depth, Mohammad conducted detailed interviews with a sample of practitioners. The absolute number of participants in this phase was modest, but still a majority of the total population of community mental health nurses working in the West Bank.

Right now Mohammad is surrounded by transcripts and notes, doing his best to make sense of everything he has seen, read and heard. It’s for him to tell the story of his findings, but I know these will be both interesting and important. I’m looking forward.