Early careers

A discussion unfolding at the Mental Health Nurse Academics UK meeting held on March 12th 2021 was how best to support colleagues making the transition from clinical practice into higher education. Given the very limited success within nursing in growing clinical academic careers, through which people might sustainably combine roles in practice with roles in education and/or research, this transition is a very real one. It is also, as Jan Hunter and Mark Hayter observe, relatively neglected.

The rhythms and demands of clinical practice are very different from those in universities. Most nursing, midwifery and allied health professional academics come to work in higher education without having had prior opportunities to hone their research skills through doctoral-level study. Many need to grow their skills and experiences in teaching, too, but it is on developing early career researchers that I wish to focus in this post. Along the way I draw on experiences of my own to illustrate some wider points.

I was helped to write two doctoral fellowship applications, the second after the first was unsuccessful. In this, I proposed using a set of design and methods crafted in an existing study of recovery from stroke to examine work and roles in the trajectories of people using mental health services in the community. With part-funding from a competitively secured fellowship and then employer support I was on my way. I therefore benefited from a very sensible, strategic, approach to research capacity-building which combined mentorship, help with funding applications, ongoing institutional support, and supervision. Very importantly, I was also encouraged to think programmatically, and to link my research to existing lines of enquiry with the aim of adding to a concentration of substantive, theoretical and methodological expertise.

Sharing my thesis findings through publishing was an absolute given, informed by the view that a study is not completed until it is shared. Beyond this, having concluded my PhD I both wanted, and was encouraged, to develop further the body of research commenced in my thesis. I moved swiftly from doctoral studies to a part-time post-doctoral fellowship, in which I again examined service user trajectories, work and roles but this time in the context of mental health crisis services. I was grateful for the support I received for this project from the Research Capacity Building Collaboration Wales. I also reflect, now, that our collective efforts to grow a doctorally qualified nursing, midwifery and allied health profession academic workforce have not been matched by equal efforts to enable holders of new PhDs to grow their research programmes into the post-doctoral period. It is deeply frustrating to see the holders of new doctorates devoured by teaching and related activities, their research expertise and aspirations risking extinction barely as soon as they have emerged. Mentorship to develop ongoing research plans, space for dissemination and grant-writing, and strategies for networking are so very important in the immediate post-doctoral period.

My view is also that institutional and external support for a PhD brings with it the obligation, in time, to become a PhD supervisor. Debra Jackson, Tamara Power and Kim Usher have recently published findings from a study of doctoral supervision within nursing, accurately pointing to the labour involved in this work and the degree to which it needs to be recognised by employers. Without supervision there can be no doctoral study, and without doctoral study no future research leaders.

Finally, my impressions are that, historically, research careers have tended to begin many years after initial registration and periods in practice. I would like to see more encouragement to newly registered nurses to consider research (and a career in academia) as an option, beginning with early registration for PhD study. Quite possibly this takes me back to where I started in this post, which is to observe that, despite many years of talking and trying, we haven’t yet managed to create coherent career pathways for clinical academics in nursing.

Advertisement

Animating research

A short post arising from the observation of the extent to which researchers are increasingly turning to animations as a way of sharing their findings both succinctly and accessibly.

On this site in the past I’ve written about the 3MDR trial for people with post-traumatic stress disorder, led by Jon Bisson, and this month I’m alerted to this fine animation produced with the help of Studio Magenta in Cardiff:

 

More observations from a small country

This new paper has been a long time in the making. Work on it began with preparations for an address given at the Australian College of Mental Health Nurses conference in 2018. Refinements and updates happened towards the end of 2019, in the context of preparing for a talk delivered at a Royal College of Nursing-sponsored event in Cardiff in 2019, with a further version presented at an online conference organised by Julia Terry, from Swansea University, during the 2020 coronavirus lockdown. Along the way the written article has benefited from a critical reading from both Michael Coffey and  Nicola Evans, and from no fewer than four anonymous peer reviewers. My thanks to all of them.

Observations from a small country: mental health policy, services and nursing in Wales can be downloaded in green open access form from the Cardiff University institutional repository, and has this as its abstract:

Wales is a small country, with an aging population, high levels of population health need and an economy with a significant reliance on public services. Its health system attracts little attention, with analyses tending to underplay the differences between the four countries of the United Kingdom (UK). This paper helps redress this via a case study of Welsh mental health policy, services and nursing practice. Distinctively, successive devolved governments in Wales have emphasised public planning and provision. Wales also has primary legislation addressing sustainability and future generations, safe nurse staffing, and rights of access to mental health services. However, in a context in which gaps always exist between national policy, local services and face-to-face care, evidence points to the existence of tension between Welsh policy aspirations and realities. Mental health nurses in Wales have produced a framework for action, which describes practice exemplars and looks forward to a secure future for the profession. With policy, however enlightened, lacking the singular potency to bring about intended change, nurses as the largest of the professional groups involved in mental health care have opportunities to make a difference in Wales through leadership, influence and collective action.

The argument I’ve developed here is that policy for health care in Wales, and for mental health care specifically, has distinctive features. As a peer reviewer I continue to have to correct manuscripts which conflate ‘England’ with the ‘UK’, and I’ve tried in this article to point out some of the things which make Wales different. I have also highlighted what seem, to me, to be gaps between well-intentioned policy aspirations and actual experiences as revealed through research. Overall, though, I intend the paper to convey a message of optimism, noting (amongst other things) the high value placed on the relational work of mental health nurses and the positive differences nurses make. Enjoy the read!

Out with the old

As this most difficult of years reaches its end here’s a big shout-out for registered and student mental health nurses everywhere, whose work and study has been tipped on its head during the pandemic. It’s not been easy, as this preprint from the Mental Health Policy Research Unit shows. The article reports pre-peer review findings from a survey examining how the coronavirus crisis has exerted an impact on the care provided by mental health nurses in the UK. Here’s the ‘what this paper adds’ section:

This paper provides a unique insight into the experiences and impact that the Covid-19 pandemic has had on mental health nurses across a range of community and inpatient settings to understand what has changed in their work and the care they can and do provide during this crisis. This includes exploring how services have changed, the move to remote working, the impact of the protective equipment crisis on nurses, and the difficult working conditions facing those in inpatient settings where there is minimal guidance provided.

The detailed findings in this paper paint a picture of members of a profession working at great pace to adjust to new ways of practising, to manage risk to self and others and to continue to provide quality care. It’s worth remembering that mental health nurses were in short supply prior to the pandemic, and possess skills, knowledge and qualities that will continue to place them in great demand in the months and years ahead.

In a second (and very specific) shout-out, here again are my thanks to the #mhTV crew comprising Dave Munday, Nicky Lambert and Vanessa Gilmartin Garrity for the very fine work they’ve been doing with #mhTV throughout the year. #mhTV has helped the mental health nursing (and wider) community to stay connected, despite the challenges of social distancing and repeated lockdowns. Dave, Nicky and Vanessa also stepped in to support the International Mental Health Nursing Research Conference 2020, and to host this year’s Skellern Lecture and Journal of Psychiatric and Mental Health Nursing Lifetime Achievement Award evening

Wishing a safe and a peaceful new year to all, and here’s to a 2021 which improves considerably on the year now departing.

The 876 Group

When I upload blog posts to this site I use tags to help group items together. Today, having looked at the tag cloud created by WordPress I see that ‘Mental Health Nurse Academics UK’ appears in larger size than any other single word or phrase. This tells me that this is my single most-used tag, and I’m not surprised.

This week, over at the Mental Health Nurse Academics UK website, we’ve announced the election of Jim Turner as the group’s Vice Chair and Chair-elect. Jim will first be working in support of Fiona Nolan, who steps into the Chair position at the beginning of the new year following the conclusion of my term of office next month.

I was at the first-ever meeting of the group now calling itself ‘Mental Health Nurse Academics UK’, which took place on April 29th 2003 hosted at City University and convened by Len Bowers, Julie Repper and Mary Watkins. I’ve attached to this post the agenda for the meeting, which reveals how the group began its life linked to organisational arrangements in England, uniquely. That changed once those present determined that the group should simultaneously become both UK-wide and independent from any other organisation or government department.

Very briefly, as I recall, we referred to ourselves as the ‘876 Group’, which was the sum of the ages of all those present at the inaugural meeting. On the naming front, ‘Mental Health Nurse Academics Forum’ was toyed with, and my copy of a draft set of our first-ever terms of reference speaks tenatively of the ‘Assembly of Mental Health Nurse Academics’.

As ‘Mental Health Nurse Academics UK’ our group has grown as time has passed. Membership now includes people from over 70 UK higher education institutions, plus colleagues from other organisations sharing our interests and concerns. We have a number of Standing Groups, principally leading work in the three fields of Education, Research, and Policy and Policy. We’ve always aimed to be proactive, producing (right from the start) independent papers and statements, as well as taking opportunites to respond to consultations. Our first position paper was on post-registration education, and on our website we now have a long list of pieces we’ve produced over the years including evidence submitted to the House of Commons, editorials and journal articles, responses to the NMC, and a whole lot more. An often-referred to piece, written by Steven Pryjmachuk, introduces mental health nursing to people considering making applications for pre-registration degree entry.

I’ll continue getting to meetings once my term as Chair ends, and know that our next meeting (and possibly more) will again be convened online. Our last two meetings, in June and October 2020, were our most-attended: something no doubt related to the fact that they happened using videoconferencing software. For the future, Fiona and Jim are going to be a super combination leading the group onwards, and I’m wishing both all my very best and my support as they press ahead with their work.

Mental health policy, services and nursing in Wales

The COVID-19 pandemic has drawn attention to the existence of devolved government in the UK. Here in Wales we’re used to hearing from Mark Drakeford, but my guess is that it’s only in recent months that most people in other parts of the UK will have become actively aware of his role as First Minister, and indeed the authority held by the Welsh Government to create policy and to legislate. For a helpful discussion on all things Wales and COVID-related, here’s a link to an episode of The Bunker podcast on the same.

In a Wales-themed episode of #mhTV held in October 2020 I joined a discussion panel alongside Hazel Powell (Nursing Officer for Mental Health and Learning Disability in the Chief Nursing Officer’s team) and Michelle Forkings (Associate Director of Nursing/Divisional Nurse for Mental Health and Learning Disability in Aneurin Bevan University Health Board) to talk about policy, power and mental health health nursing. Here’s a link:

International Mental Health Nursing Research Conference 2020

This year’s International Mental Health Nursing Research Conference (#MHNR2020) happened over two weeks in September, as planned through #mhTV and with a whole lot of help from Dave Munday, Nicky Lambert and Vanessa Gilmartin. Along with everyone else who values this annual event I’m indebted to all three for the work they’ve put in over the months to make #mhTV happen, and to do so as an entirely free offering open to anyone with use of an internet connection.

I enjoyed my chance to join Mick McKeown as a co-host of #MHNR2020’s evening panel discussions, and the format of inviting guests to pre-record and upload their presentations ahead of bringing them together in themed groups worked well. Every pre-recorded presentation and panel conflab can be viewed on the conference webpage, and will remain there as a resource for the future. As it happens, I pitched up as a panel member on the evening of September 25th, speaking about findings from the MENLOC evidence synthesis in the area of end of life care for people severe mental illness.  As a shortcut, here’s a link to my pre-recorded presentation summarising our main findings:

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.