mental health, nursing, policy, services, people, research, education
Time this evening to note tomorrow’s COCAPP project advisory group meeting (to be held at City University London), to be followed by a trip to the Institute of Psychiatry to hear the delivery of this year’s Eileen Skellern Lecture by Professor Joy Duxbury and Professor Hugh McKenna’s acceptance of the JPMHN Lifetime Achievement award. Time, too, to note Thursday’s meeting of Mental Health Nurse Academics UK at London South Bank University.
So, lots to talk about and listen to.
At June 2014’s meeting of the School of Healthcare Sciences’ Research and Innovation Committee there is an agenda item on the UK higher education funding councils’ new policy for open access in the post-2014 Research Excellence Framework. This document contains important information for UK academics with aspirations for future REF return. Here’s a snip from the opening pages, addressing the new requirements for journal articles:
[…] to be eligible for submission to the post-2014 REF, authors’ final peer-reviewed manuscripts must have been deposited in an institutional or subject repository on acceptance for publication. Deposited material should be discoverable, and free to read and download, for anyone with an internet connection. […] The policy applies to research outputs accepted for publication after 1 April 2016, but we would strongly urge institutions to implement it now.
Elsewhere the policy states that publishers’ embargo periods before final versions of papers are deposited can be respected, but with limits. For articles included in submissions to REF Main Panel A (and that includes Nursing), the maximum time period before REF-eligible papers must be made freely available in either green or gold open access format will be 12 months.
There are circumstances in which future REF panels can make exceptions to these rules, but (by the looks of things) not many. In any case, plenty of publishers and individual journals already use copyright transfer agreements which allow authors to comply. It is precisely because of these agreements that I have been able to freely deposit full-text, post-peer review, green open access versions of many of my publications in Cardiff University’s Orca repository and to include links to them on this blog.
But not all journals are currently using copyright transfer agreements which adhere to these new rules. Here’s an example. Nicola Evans’ and my recent paper on critical junctures appears in Social Theory & Health, which is published by Palgrave Macmillan. The journal’s current copyright transfer arrangement (which we signed) allows authors to deposit a post-peer review version of their accepted articles to a repository, but only after an embargo period of 18 months. As things stand, this fails to meet the post-2016 requirement for articles eligible for return to Main Panel A in the next REF. As Palgrave will surely want REF-aspirant nurses (and others) to continue submitting papers to its journals this embargo period will have to be reduced by at least six months.
And then there are the journals published by Wiley Blackwell, including the Journal of Psychiatric and Mental Health Nursing. I’ve published lots in this over the years, most recently on work and roles. The relevant copyright transfer agreement can be viewed here, in which I see that authors retain the right to:
[…] self-archive the peer-reviewed (but not final) version of the Contribution on the Contributor’s personal website, in the Contributor’s company/institutional repository or archive, and in certain not for profit subject-based repositories such as PubMed Central as listed at the following website: http://olabout.wiley.com/WileyCDA/Section/id-820227.html, subject to an embargo period of 12 months for scientific, technical and medical (STM) journals and 24 months for social science and humanities (SSH) journals following publication of the final Contribution.
So peer reviewed, but not ‘final’, versions of accepted papers can be deposited? But it’s the ‘final’ versions which the funding councils specify must be made available. But might ‘final’ mean different things to different people? If Wiley uses ‘final’ to refer to the formatted, pdf, versions of papers identical in every way to the versions appearing in its journals, then authors depositing their word-for-word, post-peer review, author-accepted green open access versions will be compliant. But if ‘final’ for Wiley refers to the accepted, word-for-word (but not necessarily value-added) versions of papers then the inability of authors to make green open access deposits becomes a problem from 2016. So perhaps this all needs some clarification.
Sadly for me I couldn’t be at Geoff Brennan‘s meet-up today with Cardiff and Value UHB mental health nurses to talk about the Safewards study and its implications. But here’s a message Geoff sent, and a fine photo, to mark the occasion:
Last Wednesday (May 14th 2014 ) I had the chance to speak at the 4th National Association of Lead Nurses in ECT (NALNECT) conference. ECT (electro-convulsive therapy) has been around since the 1930s. It’s sparingly used, typically as a treatment for severe depression and only after other interventions have been tried and found wanting. The procedure involves the use of electricity to induce a seizure, and is conducted under anaesthesia. In the UK there are standards for ECT clinics, which place particular emphasis on quality and safety.
I’m no expert in ECT as a treatment, but I do know something about work and roles and it was this that I spoke about at the NALNECT event. I suggested that, rather like the physical holding of patients and other restrictive practices, ECT might be thought of as an example of the mental health system’s ‘dirty work’. It arouses strong views, and may well be an area about which there is more heat than light. A quick pre-conference search on Scopus turned up just 100 articles at the intersection of ‘ECT’ and ‘nursing’, with only 12 citations attributed to authors in the UK. Amongst these I found this paper investigating nurses’ attitudes, and this paper reporting findings from an observational study of the ECT workplace.
At Wednesday’s event I also talked about the ECT clinic’s unusually complex division of labour. Where else do mental health nurses, psychiatrists, anaesthetists, operating department practitioners and health care assistants routinely work together? The main item at the NALNECT conference was a debate on nurse-led clinics, though there seemed to be a number of different versions of what this might actually look like. Large parts of the discussion centred on the technical: who might apply which bit of the machinery, and who might press which button. I pointed out that tasks have forever moved around in the mental health system, and that a bigger question may not be the physical handling and usage of the ECT kit but nursing’s possession of sufficient knowledge to sustain claims to jurisdiction.
Work on the RiSC and COCAPP studies means that, of necessity, I’ve had to let this blog site (and pretty much everything else) take something of a back seat in recent weeks. The picture on the left is a screen shot of the RiSC study final report, which is now perilously close to completion. Once submitted to the funding body (the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme) it will be peer reviewed, and once accepted for the NIHR Journals Library progress through an editorial process before (hopefully sometime before the end of this year) appearing online.
Elsewhere, I see that the call for abstracts for this year’s NPNR conference remains open for a little while yet, as this tweet from Laura Benfield who works for the RCN Events team indicates:
I’m pleased to say that both the RiSC and COCAPP teams have already submitted abstracts. The conference will again be at Warwick University, and promises to a special affair. Here’s a snip from the event’s website:
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.
Whilst my head has been somewhere else I see that the Department of Health has now published Positive and Proactive Care: reducing the need for restrictive interventions (something which members of Mental Health Nurse Academics contributed to) and that, yesterday, it was announced that NICE is about to step into the debate on nursing numbers. Here’s how The Guardian reported this:
Nurses in hospitals should not have to look after more than eight patients each at any one time, the body that sets NHS standards will urge next week in a move that will add to pressure to end what critics claim is dangerous understaffing.
Responding to concerns about standards of patient care in the aftermath of the Mid Staffs scandal, the National Institute for Health and Care Excellence (Nice) will warn that registered nurses’ workloads should not exceed that number because patients’ safety could be put at risk.
The regulator’s intervention will intensify the pressure on hospitals, growing numbers of which are in financial difficulty, to hire more staff to tackle shortages even though many have little spare money. Campaigners on the subject believe at least 20,000 extra nurses are urgently needed at a cost of about £700m.
This looks to be a very important intervention indeed, with all sorts of potential implications. It will be interesting to see how policymakers respond. I also wonder how this debate will play out in the context of community health care, and whether we might expect some kind of consideration of caseload sizes. This is a fiendishly difficult area, and is far more complex than simply saying that (for example) ‘each community mental health nurse should have a caseload of no more than x‘.
I also see that Community Care has been continuing to highlight the extraordinary pressures facing people working in, and using, the mental health system. Austerity is very harmful, and Community Care is drawing necessary attention to the problems of lack of beds, funding cuts and retractions in community services.
Before I get my head back down into report-writing here’s a final plug, this time to a piece Michael Coffey has written over on the MHNAUK blog:
As we roll up to the end of April and summer is just around the corner the planning of our next meeting is starting to fall into some sort of shape. MHNAUK meetings usually take the form of morning presentations and afternoon group business items. After a meeting devoted to group strategy and plans in Cardiff in the Spring of 2013 we have attempted to get work done in our meetings and be much more strategic in terms of themes for presentations and outputs arising from these. This has meant that in the past year we have focused on dementia care and produced a position paper from this and in subsequent meetings we have discussed restrictive practices and physical health care in mental health which will result in further position papers.
For our coming meeting this June we are currently discussing ideas around the history of mental health nursing as one possible theme alongside plans to further our relationships with the mental health nurse consultants group. In addition we will revisit our plans for future themes so that we keep the focus firmly on supporting education and research in our field. Agendas are never truly fully complete and over the next few weeks new items will arise and suggestions will arrive that members feel we must discuss. This is as it should be and I welcome this as evidence of the vitality of the wider group, anyone fancy discussing yet another review of nurse education for instance?Michael Coffey
Chair of MHNAUK
Congratulations to RCN Mental Health Advisor Ian Hulatt for editing this new book, Mental health policy for nurses. This hits the shelves any day now, and I want to give it a plug via this post. Here is what the publisher is saying:
Policy determines much of what nurses actually do on a daily basis, which means it is essential for nurses to engage with policy if they are to understand their own practice. Mental health nursing in particular has been shaped by a variety of policy factors in the past fifty years. In this new textbook, edited by the mental health advisor to the Royal College of Nursing, a range of experts in their field introduce the essential elements of mental health policy to students and experienced practitioners. The book covers a broad range of areas, including settings for care and the historical context, policy affecting various diagnoses and service user groups, and how policy is translated into action. Clinical examples are drawn on throughout, to help students think about the real-life context of what can be a difficult subject.
It will be essential reading for pre-registration mental health nursing students, and valuable to those working in practice who want to gain an understanding of policy.
There are some nice-looking chapters here, as the contents list suggests:
The History of Mental Health Policy in the United Kingdom Peter Nolan
The European Context Neil Brimblecombe
Community Services Ben Hannigan
Psychosis Norman Young
Older People Elizabeth Collier and Catherine McQuarrie
Dementia Trevor Adams
Personality Disorder Karen M. Wright
Service User Involvement Mick McKeown and Fiona Jones
Equalities in Mental Health Nursing Ann Jackson
Child Mental Health Policy in the UK Tim McDougall
Dual Diagnosis Cheryl Kipping
Policy into Action? Cris Allen
I was pleased to have a chance to contribute, writing a chapter addressing past and present policy for mental health care in the community. I started with an account of historical developments, and worked my way towards an analysis of recent policy including changing roles for nurses and the impact of austerity.
Just what we need: another review of nurse education. Yesterday the Nursing Times carried this item reporting a joint Health Education England and Nursing and Midwifery Council plan to investigate standards. The NT says:
Health Education England and the Nursing and Midwifery Council will launch the review in May to specifically investigate the standard of education provided to around 60,000 nursing and midwifery students each year.
The Shape of Caring Review, which will be led by Lord Willis of Knaresborough, will also consider the standard of post-registration training for the NHS nurses once they have qualified. The review is due to produce a final report by early next year.
It follows concerns over the standard of nurse training raised by the Francis report into care failings at Mid Staffordshire Foundation Trust.
As part of its work, the review will examine the controversial pre-nursing experience pilots that have seen around 160 students work as healthcare assistants for a year before starting courses, and which were a key plank of the government’s initial response to the Francis report.
This is the same Lord Willis who chaired the RCN’s review of nursing education which reported in 2012, and about which I wrote a piece on this site here. As I wrote then, there was some scepticism on the timing given that universities and their partners in the NHS were in the throes of reshaping their pre-registration curricula following the publication in 2010 of new NMC standards for pre-registration education. This latest review is going to start before more than a handful of new, post-2010, nurses have registered and certainly before we know anything of the impact of these new regulatory standards on practice. This is exactly a point the NT goes on to make:
But Professor Ieuan Ellis, chair of the Council of Deans of Health, said he was concerned the review would duplicate work already underway by “multiple different projects and working groups”.
“This group needs to reflect on the reviews that have already happened, some quite recently – otherwise there will be a lot of duplication going on,” he added.
Jackie Kelly, head of nursing at the University of Hertfordshire, pointed out that the NMC had already imposed new standards for pre-registration courses in 2010, and stressed 50% of nursing students time was spent in a clinical setting away from the classroom.
She said: “We have already gone a long way and I wouldn’t want the review to move in a direction of travel before we have seen the output from the new standards agreed in 2010.”
Quite so.
Today, returning to this blog after something of a gap, I find reason to reflect on the many flavours of evidence review which now exist.
In the RiSC project we’ve been using the EPPI-Centre approach, developed by people working at the Institute of Education in London. This framework has a number of desirable features, including the combination of a phase 1 mapping with a more in-depth phase 2 involving quality appraisal. Deciding the focus of phase 2 in an EPPI-Centre review involves discussion with stakeholding collaborators. That’s all to the good, proving that in evidence syntheses, as in primary data-generating studies, it is possible for researchers to work jointly with service user, carer and practitioner colleagues.
Last week, with other members of the Wales chapter of the COCAPP team, I spoke on our meta-narrative mapping of care planning and care coordination at a Swansea University seminar. Amongst other things meta-narrative mapping traces the different research traditions found within a given field. And, today, I mock-examined a delightful doctoral thesis containing a scoping review, which lays out what’s there but does not include formal quality appraisal. Then there are realist syntheses, where reviewers look across multiple studies for evidence of the generative mechanisms underpinning change in policy, services or practice. The list goes on, encompassing thematic literature reviews and, of course, Cochrane-style systematic reviews. This latter approach has been very important in driving the evidence-based practice movement, but personally I’ve always been a little disappointed at its insistence on hierarchies with randomised trials as the gold standard.
So how might decisions be made on selecting one approach over another? Practical considerations have a bearing, but perhaps more important are commitments to certain intellectual or other principles. We chose the EPPI-Centre approach in RiSC because we valued user, carer, practitioner and manager perspectives and wanted a way of hearing these and using them to inform our project. Realist reviewers sign up to particular sets of ideas on how programmes work, and meta-narrative mappers embrace the idea, and seek out examples, of paradigmatic differerence. Perhaps the key thing is to be aware of, and articulate, these in justifying the choices which inevitably have to be made.
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 ResearcherPiece 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
#NPNR2014Join the pre conference discussions on www.twitter.com now…
Professor Alan Simpson, chair of NPNR steering committee
@cityalanDr 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 0RNTel: 020 7647 3591
Email: npnr@rcn.org.uk
Perusing, for no particular reason, my fourth edition of the Red Handbook (published, I think, just after the start of the last century) I find this early reference to mental health nursing in people’s homes. Here are the relevant pages for those interested:
Note the sections implying that attendance in private houses is for the higher classes only, along with the description of all those things which should be done to reduce risk.
Interesting, too, that attendants are reminded that drinking alcohol on duty might not be the best of ideas. Advice like that never goes out-of-date.
For other posts drawing on this first-ever textbook for mental health nurses, try From ‘The Red Handbook’ to ‘The Art and Science of Mental Health Nursing’ and Exam time.
Ben Hannigan's blog 