Category: Research

Specialist practice in the community

For many years I led a Nursing and Midwifery Council (NMC)-approved post-qualification degree course for mental health nurses working in, or wanting to work in, the community. I wrote about the curriculum we developed in Cardiff, and was involved in two surveys of course leaders of programmes of this type which went on to be published here and here. Our Cardiff course, like others of its type, was recognised by the NMC (and by the NMC’s predecessor, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting) as preparing qualified nurses for ‘specialist practice’. Linked to a set of UK-wide standards, specialist practice was designated as practice beyond that expected at initial registration.

Most programmes of this type have long since disappeared, ours in Cardiff included, but the regulatory standards against which they were validated remain. The specialist practice qualification (SPQ) was first introduced in the 1990s, with the standards for SPQ in community nursing (including community mental health nursing) not being updated since the early 2000s. In 2019 the NMC commissioned an independent review into SPQ, with the final report from this exercise making clear how poorly understood these long-outdated standards had become and how much a root-and-branch review was needed.

A debate can be had on the extent to which standards for practice beyond those linked to professional registration should be prescribed by a regulatory body such as the NMC. For the professions of nursing and midwifery, however, no UK-wide bodies able to definitively set standards of this type exist other than the NMC; this is partly because we have no equivalents to the royal colleges, which exist to set and maintain standards for doctors preparing for post-registration practice in the various fields of medicine.

The NMC’s ongoing programme of work developing its standards has so far included the publication of an education framework, the Future Nurse standards of proficiency for registered nurses and new standards for student supervision and assessment. Now, following receipt of its independent evaluation of SPQ the NMC is embarking on a post-registration review. In August, through my membership of the All Wales Senior Nurse Advisory Group for Mental Health I took part in an NMC webinar and discussion on specialist practice in the community, convened as part of this wider post-registration programme of work. With work already happening in parts of the UK to more closely specify ‘advanced’ practice, such as through Health Education England’s Advanced Practice Mental Health Curriculum and Capabilities Framework, the NMC is stepping into an already-crowded space. It is in this context that consistency and joined-up policy and standards will surely be needed: which is something members of Mental Health Nurse Academics UK (me included) will continue to say as this programme of activity continues to progress.

The MENLOC study (again)

In July 2020, with colleagues I received peer review feedback on our draft MENLOC study final report, about which I’ve written before.

Final reports from studies funded by the National Institute for Health Research are sizeable affairs, typically running to 40,000 words or so and detailing the minutiae of what’s been done, and what’s been found. Once peer and editorial review has been satisfied draft reports progress to pre-publication, involving the careful copyediting of the text. Finally, once everything is typeset each report appears in a single issue of the open access journal bearing the name of the funding programme through which the research award was originally made. The screenshot I’ve included in this post is from the NIHR’s comprehensive information for authors, which takes grantholders through the process.

In the case of MENLOC the journal in which our final report will be published is Health Services and Delivery Research, and we’re expecting publication to be sometime in the spring of 2021. In the meantime, this current version of our plain English summary captures what we’ve done and what we’ve found:

We brought together evidence from research, policies, guidance and case studies in the area of end of life care for people with severe mental illness. End of life care refers to the help given to people with life-threatening conditions in their expected last 12 months. Severe mental illness refers to a range of issues for which care is usually provided by specialist mental health services.

An advisory group, including people with experience of mental health and end of life care, helped us throughout our project. We searched research databases, journals and online sources. We assessed research articles for their quality, and summarised their content. In one review we combined content from research with content from policy and guidance. In another review we combined the content of the case studies. We wrote synthesis statements summarising the research evidence, and assessed how confident decision-makers should be in these.

We included 104 documents overall. We synthesised research, policy and guidance under themes reflecting their content: the structure of mental health and end of life care services; professional practice; providing and receiving care; and living with severe mental illness. We synthesised case studies under themes relating to: delays in diagnosis; making decisions; treatment futility; supporting people; and the experience of care.

Our project has implications for care. Partnerships should be built between mental health and end of life care staff, and people should be supported to die where they choose. Care staff need education, support and supervision. A team approach is needed, including support for advocacy. Physical health care for people with severe mental illness needs improving so that life-threatening conditions can be recognised sooner.

Future research should involve people with severe mental illness at the end of life and their carers. Research is also needed evaluating new ways of providing and organising care.

MENLOC is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme (project number 17/100/15).

The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care

In addition to responding to these detailed reviewers’ and editors’ comments, as our MENLOC report continues on its way we’ll also be preparing papers for publication, and thinking about next steps in this programme of research. We’ve discovered that very little is known about how best to provide care at the end of life to people with severe mental health problems, making this a wide-open area for researchers and people concerned with service improvements.

Papers update

Papers July 2020Back in summer 2019 (which seems, for pandemic-related reasons, to be much longer than a year ago) I wrote a short post introducing the 3MDR study. Here, now, is the main findings paper in early view in the journal Acta Psychiatrica Scandinavica. Working on a clinical trial has been an interesting, learning, experience for me and this feels like an important project to have made a contribution to.

I realise, too, that I’ve neglected to draw attention on this site to two papers co-written with Ray Samuriwo, both drawing on systems perspectives, wounds and mental health: see here and here. Ray is an original thinker, and makes interesting connections across different fields: check out, too, Values in health and social care for which Ray was lead author.

#MHNR2020 joins #mhTV

Back in pre-pandemic January 2020, the idea that a couple of hundred curious mental health nurses and their friends might gather together to share their research, practice development, educational and related projects seemed quite unremarkable. At that time, with the aim of enouraging a gathering of this sort, I published a short post on this site promoting the call for abstracts for the 2020 edition of the International Mental Health Nursing Research Conference.

#mhTVHow much has changed since then. As an organising committee we made a relatively early decision to call off the face-to-face conference originally scheduled for June 11th at Middlesex University. Now, in May 2020, #MHNR2020 is being brought into a new initiative called #mhTV.

#mhTV owes its existence in no small degree to the energy of Dave Munday from Unite/MHNA and Nicky Lambert from Middlesex University and the first episode launched on May 21st 2020 as a collaboration between Unite/MHNA, the WeMHNurses Community, Mental Health Nurse Academics UK and the Centre for Coproduction in Mental Health and Social Care:

 

The #MHNR2020 scientific committee will be reviewing all abstracts submitted for the intended June 11th conference, and once this work is done we’ll be in touch with invitations for authors to consider turning their presentations into a format suitable for #mhTV. We’ll identify episodes selected in this way as part of #MHNR2020 and publish details on the MHNAUK website. In the meantime, more on #mhTV and on how to submit new ideas can be found here.

Catch-up post 3: research under lockdown

One of the consequences of NHS resources being mobilised so decisively towards meeting the threat of the novel coronavirus has been the cessation of much face-to-face nursing and health services research other than that connected with COVID-19. A response in March 2020 from the NIHR included the instruction to delay the setting-up of new non-COVID projects, and to pause ongoing studies, in order that the infrastructure supporting NHS research be brought to bear almost exclusively on efforts to tackle the pandemic.

In this context, I have also observed how the online survey has become the method of choice for researchers wanting to immediately understand the effects of the COVID crisis on wellbeing and work. In April 2020, a team led by Chris Bundy from the School of Healthcare Sciences in Cardiff University launched a coping during coronavirus survey, whilst a team including Healthcare Sciences’ Danny Kelly invited nurses to take part in the first of three planned surveys reporting experiences during the crisis. The Mental Health Policy Research Unit, meanwhile, has opened its programme of COVID-related research with a survey for people working in mental health services.

WCEBCMeanwhile, one type of research relatively unaffected by the coronavirus outbreak is the evidence synthesis. In Cardiff we have the Wales Centre for Evidence Based Care and, in the early months of 2020, I joined a team led by Nicola Evans and Wales Centre colleagues to start work on a synthesis of the evidence in the areas of service organisation, effectiveness and experiences for children and young people in mental health crisis. Our plans include database searching plus online searching for grey literature, policies and guidance. More to follow as the project unfolds, which in April saw us deep in title and abstract screening.

Catch-up post 2: Mental health matters in the pandemic

MHNAUK covidHere’s a belated catch-up post (the second of three), produced largely with the aim of revitalising this blogsite and summarising recent happenings. This one I’ve dated to March 2020, and the period in which UK was first locking down in response to the COVID-19 pandemic.

Towards the end of the month, Mental Health Nurse Academics UK (which I chair) published this statement on mental health nursing in the coronoavirus crisis. It addressed a number of areas: learning from people with early experience of caring for people with mental health problems and coronavirus infection; looking self and others; service responses and guidance for practitioners; the work of mental health nurses; supporting students; and research. I reflect how, in March 2020, relatively little was being said about mental health in the context of the pandemic. That’s changed, more recently, which I’ll perhaps return to in a later short post.

Catch-up post 1: End of life care for people with severe mental illness

menloc logo 5In the first of a short series of catch-up blogposts on this site, this non-pandemic related one refers back to February 2020 and the submission of the draft final report for the MENLOC study.

MENLOC has been an evidence synthesis into end of life care for people with severe mental illness,  funded by the National Institute for Health Research Health Services and Delivery Research Programme. I’ve introduced the project on this site before, and the bulk of our work is now done. At some future point we’ll receive peer review comments back on the (very large) document we’ve submitted, and once our responses have been written, returned and accepted the report will progress towards publication in the National Institute for Health Research Journals Library. Next up will be shorter publications in journals, about which I can post more as we progress.

#MHNR2020 call for abstracts

NPNR 1The first Network for Psychiatric Nursing Research (NPNR) Conference took place in 1996, and the picture at the left is the front cover of the delegate’s handbook. My first visit to the NPNR conference, as a non-presenting delegate,  was not until a few year’s later and I’m grateful to Russell Ashmore (the conference’s unofficial historian) for sharing this scanned document. The first presentation I gave at the event was during its seventh running, in 2001 (there having been one year previously in which two events took place); this went with the title Tales from the field: using ethnographic methods to investigate the provision of community mental health care. A glance at my records suggests that, to date, I’ve been involved in 27 papers delivered at the event over the years, as presenter, co-presenter and/or co-author. It’s the single conference I always aim to be at.

The NPNR became the International Mental Health Nursing Research (MHNR) Conference for 2017, and this year’s 26th running takes place over one day, June 11th 2020, at Middlesex University. A call for abstracts has been published on the Mental Health Nurse Academics UK website, and is reproduced here:

MHNR2020

Celebrating Mental Health Nursing

Past, Present and Future

26th International Mental Health Nursing Research Conference

11th June 2020

Middlesex University

The Burroughs, London NW4 4BT

Call for Abstracts

Follow us on Twitter: @MHNRconf and join in using the hashtag: #MHNR2020

This event represents a collaboration between Mental Health Nurse Academics UK (MHNAUK) and Middlesex University School of Health and Education.

Diversity of presenters, participants and topics will be a priority therefore all presenters will be offered one free place in addition to their own paid attendance which should be used to invite a student, service user researcher, carer, newly qualified nurse or a colleague who hasn’t previously attended a conference.

Abstracts are invited for work based in clinical practice, teaching, activism or research.  Those looking at mental health more generally are also welcome, and options for presenting will be in the form of concurrent papers, symposia, workshops or posters under the following topics:

  1. Advanced practice: To include examples of expanded roles, skills and responsibilities for nurses in healthcare services.
  2. Celebrating mental health: To include any activities addressing the history of mental health work or professional identity.
  3. Building communities: To include examples of work to promote community resilience, mental health and diversity and to reduce stigma and discrimination
  4. Creative approaches: To include any examples of creative approaches to promoting wellbeing and mental health.
  5. Activism and social justice: To include examples of rights-based approaches such as addressing restrictive practices, upholding human rights and achieving equality of access and resource allocation for mental and physical health services.
  6. Working across professions and disciplines: To include examples of inter-professional and cross-organisational projects or services
  7. General mental health: Those which do not fall into any of the above can be grouped here

Key dates and registration information

  • Call for abstracts opens: 28th January 2020
  • Deadline for receipt of abstracts: 28th February 2020
  • Confirmation of acceptance: 20th March 2020
  • Programme announced: 6th April 2020
  • Registration fees: £130 (for attenders, where this fee includes a place for an attender’s guest)/£70 for students and mental health service users
  • Please register early as places are limited

Guidance for preparing abstracts

  • Title: Should be clear, with appropriate use of capital letters that is, at the start of the title and when using abbreviations (RCN not Rcn).
  • Theme: Abstracts will be considered for one theme only, so please select the one most suitable for your submission (see above).
  • Word limit: Please adhere to the word limit given below.
  • Abstracts for concurrent sessions and posters should be no more than 350 words.
  • Concurrent sessions will be 15 minutes in length, with a further 5 minutes for questions.
  • Posters should be visually stimulating. Presenters will be expected to make themselves available to speak with delegates during identified poster viewing times.
  • Abstracts for concurrent and poster presentations MUST adhere to the following criteria:
  • Abstracts reporting on the results of quantitative research studies must be structured: background, aim(s), method(s), results, discussion and conclusions.
  • Statistics including sample size and sampling method used must be supplied.
  • Relevant contextual information must be given (e.g. research setting).
  • For qualitative studies the abstract must be structured: background, aim(s), sampling method, method(s), specific analytical approach or approaches, main findings, discussion and conclusions.
  • Theoretical/methodological abstracts and practice and/or education developments must be structured: background, aim(s) of the paper, discussion and conclusions.
  • For all abstracts authors must specify how the paper contributes to mental health nursing research, education, policy or practice.
  • All abstracts must be written in English. NB All accepted abstracts will be published ‘as submitted’. It is therefore incumbent upon the author to ensure that the spelling, grammar and syntax are of an academic publishing standard.
  • Workshop (350 words) will be 70 minutes in length. The abstract should include the aim(s) and proposed outcome(s), content, rationale for delivering the session in this format, how it relates to the conference themes, and description of any activities in which delegates will be invited to participate.
  • Recommended reading lists: Provide up to five references relevant to your abstract. These should be cited in full using the Harvard referencing system, that: Author, I. (year) ‘ Article title’. Journal name in full, vol #, no #, pp 101-107.
  • Biography: Maximum of 100 words, written in the third person.
  • Presenter details and authorship: Please include author details as you would like them to appear in a conference abstract book: forename, surname, qualifications, job title, and place of work. Please put an asterisk (*) next to the presenting author(s).

All abstracts should be submitted using this form:

https://forms.office.com/Pages/ResponsePage.aspx?id=iHvjOKGjz0ifBWU3Qn_tJCry0moWADJGn573rM2pLp5UM1JPQzNHQkg5QkJITTI3RzNLT1FCQkNTWi4u

With this being the Year of the Nurse and Midwife #MHNR2020 is aiming to be the place for mental health nurses to share what they do, and to say why it’s important. I’ll be there, as always, and am looking forward.

October review

Over on the website of Mental Health Nurse Academics UK (MHNAUK) I’ve written this brief review of MHNAUK’s last meeting, which took place at Unite the Union’s offices in Glasgow on October 11th 2019. This was a good meeting, with two guest speakers: Lawrie Elliott, Editor of the Journal of Psychiatric and Mental Health Nursing and David Thomson, Chair of the Mental Health Nursing Forum Scotland. I learned lots from both, and amongst other things ended up thinking how organised mental health nurses in Scotland look to be.

As it happens, MHNAUK is also about to embark on something new: next week we’re inviting nominations for people to lead our Education, Research, and Policy and Practice Standing Groups. Standing Groups are the engines of MHNAUK, and have been led thus far by Anne Felton, Mary Chambers and Neil Brimblecombe (and previously, John Baker) respectively. Big thanks to them for their work: the more that members become involved, the better.

Back in Cardiff, with esteemed co-investigators I’ve again (as I mentioned last month) been pressing on with the NIHR HS&DR-funded MENLOC evidence synthesis into end of life care for people with severe mental illnesses. This is proving to be a big piece of work, but we’re on track to submit our report in spring next year. As a team we’re also thinking carefully about future lines of enquiry, as there is lots still to do in this field.

A final thing to note in this catch-up: I’ve been thinking about what to say at next month’s Making a difference in Wales conference, which is all about taking the Framework for Mental Health Nursing forward. I think there is lots which is distinct about health policy and services in this part of the world, but also recognise the existence of gaps between policy and strategy aspirations, and workplace realities. One to mull over.