Meeting new students

This morning began in class with a group of 25 or so (very) new students of mental health nursing. The session revolved around a series of open-ended questions, in family therapy style, put to John Hyde and to me by Nicola Evans. Nic invited us to share something of our personal experiences in mental health nursing: as students, practitioners, educators and researchers. In a decidedly non-random way, one of Nic’s questions invoked the idea of ‘critical junctures’, echoing our paper in this area but referring, in this context, to pivotal moments within our individual careers thus far.

From a learning point of view the premise was to introduce new students to the rich and varied world of mental health nursing, via a listening in to a reflective conversation conducted on the same. I found it an interesting experience, and hope the students did too. In my early morning mental preparation before participating it became necessary to conjure up people, places and events dating back to at least the late 1980s. So today I remembered my first student placement working (in East London) with a community mental health nurse, my first job as a qualified practitioner, and my eventual move to Cardiff. Fascinating

Using research

I very much hope that UK readers of this blog have enjoyed this year’s summer (which, at least, coincided with the early May bank holiday weekend). Right now we’ve been plunged back into autumn, or so it feels here in South Wales. Wind and rain are everywhere.

Here’s a wordcloud used during Friday morning’s teaching with students of mental health nursing, during which I shared something about COCAPP and other (past and present) research projects involving people working in the Cardiff School of Nursing and Midwifery Studies. One of the things I did was to draw students’ attention to my paper on complex trajectories in community mental health, as previously blogged about here. Unrelatedly, towards the end of Friday I also caught sight of some newly delivered reviewers’ feedback on a grant proposal on which I am a co-applicant. One of the points the reviewers made was to encourage us, as a research team, to plan to do more to get future findings into services and practice.

The first of these otherwise unconnected events was a modest attempt to close the gap between research and education. The second was a reminder of the importance of closing the gap between research and the world of health and social care. So with both experiences in mind this post is about getting research out of the hands of academics and into the hands of others who might use it: practitioners and students, service managers, policymakers, users, carers. Coming not long after my recent post on the assessment of outputs in the Research Excellence Framework, this post might also be thought of as an excursion into ‘impact’.

Within single university departments it ought to be reasonably straightforward to bring research and teaching closer together. This said, I can still clearly remember co-presenting with Cardiff colleagues at a nursing research conference in London in the late 1990s only to be told, by a student who had travelled from our own school, that she had had no previous idea who we were or that the research projects we had discussed were ongoing. That was a salutary moment, and since then I have taken opportunities to directly bring research (mine, my colleagues’, other people’s) into the modules I have led and contributed to. And of course, I am hardly alone in doing this kind of thing. But across the whole higher education sector demarcations are growing between ‘teachers’ and ‘researchers’, with universities routinely differentiating between staff on the basis of their expected roles. If researchers become less involved in teaching then the risk is run that naturally occurring opportunities for projects to be brought into the classroom, by those who are running them, will dwindle.

But if integrating research and teaching can be challenging then getting research findings out of universities’ doors for the benefit of all is harder still. In the health and social care fields the publication of findings in peer reviewed journals comes with no guarantee that these will be read, or used to inform anything which happens outside of academia. In nursing (and I imagine in many other practitioner disciplines too) this has often been seen as part of the ‘theory/practice gap’ problem. Nurses have spent a long time agonising over this, and typing some suitable search terms into Google Scholar produces some 200,000 documents (that’s the slightly obscured number circled in red in this screenshot) evidently devoted to its examination:

Nurses are not alone in having concerns of this type. The Cooksey review of UK health research funding talked about tackling the ‘translation gap’ through getting ‘ideas from basic and clinical research into the development of new products and approaches to treatment of disease and illness‘, and at the same time ‘implementing those new products and approaches into clinical practice‘. Universities are increasingly urged to do better with their ‘knowledge exchange’ activities. And, as we know, the Research Excellence Framework 2014 has introduced the idea of assessing ‘impact’.

‘Impact’ in the REF2014 Assessment framework and guidance on submissions document is defined ‘as an effect on, change or benefit to the economy, society, culture, public policy or services, health, the environment or quality of life, beyond academia‘. It’s about research being ‘felt’ beyond universities, and assessing this. The assessed bit is important in the formal REF exercise because impact (presented using case studies, and counting for 20% of the overall quality profile to be awarded to each individual submission) will be graded using this scale:

Four star Outstanding impacts in terms of their reach and significance.
Three star Very considerable impacts in terms of their reach and significance
Two star Considerable impacts in terms of their reach and significance
One star Recognised but modest impacts in terms of their reach and significance
Unclassified The impact is of little or no reach and significance; or the impact was not eligible; or the impact was not underpinned by excellent research produced by the submitted unit.

As in the case of the assessment of outputs I am struck by the fine judgements that will be required by the REF’s experts. I suggest that one person’s time-pressed ‘very considerable’ may well turn out to be another’s ‘considerable’, or even ‘modest’.

Issues of reliability aside, the inclusion of ‘impact’ in REF2014 has got people to think, again, about how to close some of the gaps I have referred to above. For researchers in health and social care there has been new work to do to demonstrate how findings have been felt in policymaking, in services and in the provision of care and treatment. Who would object to the idea that research for nursing practice should have benefits beyond academia? But as many of the documents I identified when searching for papers on the theory/practice gap (along with newer materials on ‘knowledge exchange’) will no doubt confirm, demonstrably getting research into policy, organisations and practice can be fiendishly hard.

There are many reasons why this is so. Not all research findings have immediate and direct applications to everyday health and social care. Even when findings do have clear and obvious application, university-based researchers may not be best-placed to do the necessary ‘mobilisation’ (to use the currently fashionable phrase), including in relation to knowledge which they themselves have created. And by the time peer reviewed findings have reached the public domain, policy and services in fickle, fast-moving, environments may have moved on. In cases where we think research has made a difference there is also the small matter, in the context of the REF, of marshalling the evidence necessary to demonstrate this to the satisfaction of an expert panel. In any event research is often incremental, with knowledge growing cumulatively as new insights are added over time. Given this we should, perhaps, have rather modest expectations of the likely influence of single papers or projects.

Beyond this it is always good to hear of new ways in which wider attention might be drawn to research and its benefits, and a rich resource for people with interests in this area is the multi-author blog and associated materials on the impact of the social sciences run by the LSE. This is a suitably interdisciplinary initiative, which can be followed on Twitter at @LSEImpactBlog. I recommend it (and not just to social scientists), and as a starting point its Maximising the impacts of your research document. This sets out to provide ‘a large menu of sound and evidence-based advice and guidance on how to ensure that your work achieves its maximum visibility and influence with both academic and external audiences‘, and as such has lots of useful observations and suggestions.

Teaching research

I’ve been laid a little low this week having managed to pick up a mischievous virus somewhere on my recent travels. On Wednesday, in particular,  my throat felt as though it had been lightly sandpapered. My thanks to the inventors of both paracetamol and ibuprofen.

Following a half-morning of teaching, and before making an early getaway, yesterday I joined the rest of the Welsh chapter of the larger COCAPP team to plan the next instalment of our metanarrative mapping and comparative policy analysis. Tomorrow morning I’ll be talking research with a group of pre-registration student mental health nurses. What I really ought to do (even though, strictly speaking, this is not the purpose of the session) is to alert people to COCAPP and to the other research taking place in the Cardiff School of Nursing and Midwifery Studies. I think there is more which could be done to close the gap between teaching and research, and I’ll take the opportunity tomorrow to alert students to what’s happening on their very doorstep.

From ‘The Red Handbook’ to ‘The Art and Science of Mental Health Nursing’

Unbidden, but very welcome nonetheless, a freshly pressed copy of the third edition of Ian Norman and Iain Ryrie’s edited The Art and Science of Mental Health Nursing: a Textbook of Principles and Practice has arrived on my desk. This is a mighty tome indeed, and this latest version promises to cement the book’s status as a ‘must have’ for pre-registration students of mental health nursing.

A rather earlier text I also have a copy of is The Handbook for Attendants on the Insane, which Peter Nolan tells us was first published in 1885. This was the first book produced in the UK for the express purpose of instructing people we now uniformly call mental health nurses, and was produced at the instigation of the Medico-Psychological Association (MPA). The MPA later became the Royal Medico-Psychological Association, and eventually the Royal College of Psychiatrists.

No sooner had the Red Handbook (as it was often referred to) appeared than questions were being asked about the wisdom of educating attendants. This is a point Henry Rollin makes in this paper marking the centenary of the Handbook’s publication. In this extract, Rollin quotes from an (unnamed) reviewer writing in the Journal of Mental Science (now the British Journal of Psychiatry) in the year the Handbook went to print:

“We are not quite sure ourselves whether it is necessary or wise to attempt to convey instructions in physiology, etc., to ordinary attendants. Will they be the better equipped for their duties for being told that the brain consists of grey and white matter and cement substance?”, writes the anonymous reviewer. He adjusts his elegant pince-nez and continues, “We hardly see what is to be gained by superficial knowledge of this kind”.

Goodness knows what this anonymous reviewer would have made of Norman and Ryrie’s 728 pages of analysis, guidance and instruction, let alone the idea that mental health nurses now have to complete an undergraduate degree in order to register and practice.

Bank holiday time off

Nice to have had a few days off, and to have properly escaped the tyranny of a computer with a permanent internet connection. Apart from the odd work-ish tweet this really has been a long weekend away from the routine. There’s been plenty of cheering for a team of teenage footballers, and a squeezed-in walk along a south coast (of England) sea front. I’ve also rediscovered the joys of holidaying in close proximity to thousands of others, and the pleasures of school-style food. Such fun, but always good to be home.

Blogging for teaching

With apologies in advance for making an exceptionally obvious observation, but it has properly dawned on me this week that writing a blog might have significant advantages for teaching. A couple of days ago I was in class with a group of MSc students, talking about what we can learn from the study of service user trajectories. The sensible thing to do was to navigate to this site, and show people where they can download this recent paper. So that’s exactly what I did.

Unrelatedly, Mark Howard (who works at London South Bank University and who I used to work with in East London in the days when I was a community mental health nurse) has also been kind enough to comment on a post, and to mention that he sometimes points his students here. Hello again Mark, and hello to your students too – and thanks for your collective interest.

And today I’ve been planning a new Professional Doctorate module, and have been deliberately embedding links to this blog in my teaching materials. So what all of this is making me realise is that a blog (mostly) oriented towards research and academic stuff might, over time, become a useful educational resource. I actually can’t think of any other way in which a personal repository of papers, commentaries, onwards links and so on might be brought together.

Critical junctures

How pleasing it is to report that the paper I blogged about in this earlier post has now been accepted for publication. Co-written with Nicola Evans this (re)introduces the idea of ‘critical junctures’ and will appear in Social Theory & Health. We draw on two project datasets and show how action at pivotal moments can set individual service user trajectories on directions which are hard to reverse. We also show how, in certain circumstances, small-scale critical junctures can trigger (or be used to lever) larger organisational change.

Next up will be the checking of page proofs, and advance online publication via the journal’s website. What we won’t be able to do for another 18 months is upload a PDF of the post-peer review manuscript to ORCA. This is something Palgrave’s copyright rules are very clear about. In the meantime here’s the abstract which will, of course, be freely available:

Hannigan B. and Evans N. (in press) Critical junctures in health and social care: service user experiences, work and system connections. Social Theory & Health

This article makes an original contribution through the revitalisation, refinement and exemplification of the idea of the ‘critical juncture’. In the health and illness context, a critical juncture is a temporally bounded sequence of events and interactions which alters, significantly and in a lasting way, both the experience of the person most directly affected and the caring work which is done. It is a punctuating moment initiating or embedded within a longer trajectory and is characterised by uncertainty. As contingencies come to the fore, individual actions have a higher-than-usual chance of affecting future, enduring, arrangements. These ideas we illustrate with detailed qualitative data relating to one individual’s journey through an interconnected system of mental health care. We then draw on observations made in a second study, concerned with the improvement of mental health services, to show how micro-level critical junctures can be purposefully used to introduce instability at the meso-level in the pursuit of larger organisational change. In addition to demonstrating why scholars and practitioners should pay closer attention to understanding and responding to critical junctures we are, therefore, also able to demonstrate how their emergence and impact can be examined vertically, as well as horizontally.

A nursing view of the REF

REF 2014I haven’t seen much commentary by nurses or midwives on the forthcoming Research Excellence Framework (REF), so I thought I’d make a start.

For those coming to this afresh, the REF has replaced the Research Assessment Exercise (RAE) as the mechanism through which the quality of research conducted in the UK’s universities will be weighed up. The results will provide the basis for the recurring allocation of quality-related (QR) research funding to higher education institutions for a period of years thereafter (until the whole exercise, or a version of it, is repeated). As has been the case with the RAE, the results from the REF will also be used to rank universities and the departments located within them.

Universities will make their formal submissions to REF 2014 by the end of November this year. These will be made to one of 36 ‘units of assessment’ (UoA), each of which is part of a larger main panel. Nursing had its own UoA in RAE 2008, but this time around is subsumed within a larger UoA also including the Allied Health Professions, Dentistry and Pharmacy.

Making a submission means providing information on the vitality and sustainability of the research environment. It also means giving details of individual researchers, and up to four separate research outputs for each where an ‘output’ will typically (but not necessarily) be a paper published in a journal. For the first time the wider impact of research, judged in terms of its reach and significance beyond academia, will also be assessed.

Of these three components it is outputs which will carry the most weight, accounting for 65% of the overall quality profile to be awarded to each submission. Impact is weighted at 20%, and environment at 15%. Given their weighting, it is outputs that I want to concentrate on in this post.

Each UoA expert panel will have the task of reviewing outputs using this five-point scale:

Four star Quality that is world-leading in terms of originality, significance and rigour
Three star Quality that is internationally excellent in terms of originality, significance and rigour but which falls short of the highest standards of excellence.
Two star Quality that is recognised internationally in terms of originality, significance and rigour.
One star Quality that is recognised nationally in terms of originality, significance and rigour.
Unclassified Quality that falls below the standard of nationally recognised work. Or work which does not meet the published definition of research for the purposes of this assessment.

The Allied Health Professions, Dentistry, Nursing and Pharmacy UoA has a Chair (Professor Hugh McKenna, an academic mental health nurse at the University of Ulster and Chair of the Nursing and Midwifery UoA for RAE 2008), a Deputy Chair (Professor Julius Sim) plus 33 members and three assessors (there to ‘extend the breadth and depth of expertise on the sub-panels as required to carry out the assessment’). Of these 38 individuals I count 13 with nursing and/or midwifery backgrounds. Collectively this panel will be required to assess the quality of all outputs which come before them, and to do so ‘with a level of detail sufficient to contribute to the formation of a robust sub-profile for all the outputs in that submission’ (I’ve extracted this statement from the Panel Criteria and Working Methods document).

Expert review is fine, but in the context of the REF I think there are problems with how this is going to work. In Annex E of the RAE 2008 Manager’s Report the total number of outputs received by each RAE 2008 UoA is given. In the table below I’ve brought together the figures for each of the separate UoAs which, for REF 2014, are combined within UoA A3:

RAE 2008 UoA Outputs submitted to RAE 2008
Dentistry 1664
Nursing and Midwifery 2851
Allied Health Professions and Studies 6240
Pharmacy 1843

Total

 12598

Higher education institutions have already responded to a survey inviting them to indicate their intentions to return researchers to the REF, and a summary of the findings can be found here. This suggests that, across Main Panel A (which includes UoA A3 for Allied Health Professions, Dentistry, Nursing and Pharmacy) 2% fewer people will be returned than were returned in RAE 2008. So let’s assume a uniform 2% drop in outputs across all of Main Panel A’s UoAs compared with RAE 2008, which (based on the 12,598 figure above) suggests a total return to UoA A3’s expert reviewers of some 12,346 individual outputs. That’s 12,346 journal articles, book chapters, reports to funding bodies (and so on) to be read and quality graded by a panel of 38 people. Assuming each output is considered by two panel members then each person will have around 650 items to consider, throughout the period from January to December 2014. For a cross-panel comparison, I note that this is a figure remarkably close to the 640 items the blogging physicist Peter Coles estimates will be read and reviewed by members of the Physics UoA.

That’s a whole lot of reading, reviewing and ranking. It’s also only one part of the work that REF panel members will have to do. What chance, then, that all 12,000+ individual outputs will be examined in close detail? Very little indeed. Perhaps abstracts (the 200 or so word summaries appearing at the start of published papers) will be crucial pieces of information on which assessments will be based? Or possibly papers will be sampled, with some being read in relatively greater depth than others? Who, at this stage of the process, knows? What we do know is that in undertaking their assessments of quality expert reviewers will have access to supporting information, including citation data provided via Scopus. This suggests that the number of times submitted outputs have been cited in subsequent publications is likely to have a bearing on assessments, even though the relationship between citations and research quality is a complex one. And, whilst we know from the Panel Criteria and Working Methods document that ‘No sub-panel will make use of journal impact factors, rankings or lists, or the perceived standing of the publisher, in assessing the quality of research outputs’ it may in reality be difficult for hard-pressed reviewers not to take informal account of journal titles in giving a view.

So the sheer volume of outputs presents a challenge. I also happen to think that, even with the benefit of time, achieving consistency in quality assessment is incredibly hard. Nothing in my experience tells me that different reviewers, even with similar academic backgrounds, will necessarily agree on a journal article’s status as ‘world leading’, ‘internationally excellent’, ‘internationally recognised’ or ‘nationally recognised’. These are not self-evident categories, and the distinctions to be made on the grounds of ‘originality, significance and rigour’ are fine indeed. The problem of assessment inconsistency is also magnified in the case of REF UoA A3 as this is a panel bringing together reviewers from academic fields which are remarkably diverse. Unless I have missed something important, I see no stated process for the alignment of UoA A3 reviewers to outputs based on disciplinary background. So papers by nurses reporting explorations of service user experiences using qualitative methods might (for example) be read and reviewed by pharmacists with expertise in the laboratory development of new drugs. This is odd, to say the least. So odd, in fact, that I’m now wondering whether, when panel A3 begins its work, members will do something to make sure that each output is assessed by people who really know the area within which it sits. How else can the reviews be considered ‘expert’?

That, I think, will do it for today, and thanks for reading. Perhaps I’ll say something in a later post on the ‘impact’ component of REF.

Football and mental health

A highlight of last year’s Network for Psychiatric Nursing Research conference in Oxford was Alan Pringle‘s talk on football and mental health. Alan works at Nottingham University, and here’s what his web page has to say:

Alan has worked in the area of using football as a vehicle for mental health promotion and interventions in a number of ways in recent years.

His PhD looked at the impact that actively supporting a club (in this case Mansfield Town FC) could have on the mental health of supporters. He was involved in the development of the “It’s a Goal!” programme. This programme places staff in football stadiums to work primarily with young men in mental health promotion and mental health intervention work. “It’s a Goal!” has run in 16 different professional clubs from large premiership clubs like Manchester United and Stoke City to lower division clubs like Macclesfield Town and Plymouth Argyle.

Alan was involved in developing the Positive Goals football league with Nottinghamshire Healthcare Trust. This league for service users involves teams from all over the county coming together to play matches on a monthly basis and each year comprises of between 10 and 12 teams.

Alan is a member of the Football and Mental Health Group for Time-to-Change the national anti-stigma organisation.

Alan’s NPNR talk was excellent, and his research and wider work has clearly made a real difference. If you navigate to his webpage you’ll find references to publications he’s written, too. There’s also the It’s a Goal website, which is full of information.

This leads me nicely to last Tuesday at the Cardiff City Stadium, where along with thousands of others I witnessed the moment of Cardiff City‘s promotion to the top flight of football, securing a place in the Premier League for the coming season. A big deal all round. Here’s a photo, taken just after the game’s end.

MHNAUK launches a blog

Michael Coffey, chair of Mental Health Nurse Academics UK, has today launched the group’s blog at http://mhnauk.com.

On the site’s home page Michael writes that:

This is the first entry in what we hope will be a vibrant and engaging place for members of MHNAUK to communicate the range of work we as a group do […] we want to communicate to a wider audience via this blog to show what we are doing and to engage in dialogue about our views on the future direction of education, research and ultimately the practice of mental health nursing.

Michael also points to some of MHNAUK’s current projects. These include Andy Mercer (from Bournemouth University) gathering evidence on the different ways applicants for pre-registration mental health nursing courses are selected, and Fiona Nolan (from UCL) leading an overview of mental health nursing research in the UK.

I’ve posted a comment on the site, and look forward to others doing the same. Go check it out. Right now!