Tag: Cardiff University

Education for community mental health work

This week brought a COCAPP meet-up in Bristol, where we had the chance to plan our work for the immediate period ahead. The RiSC team also met, albeit in teleconference rather than face-to-face fashion. I’ve had pre-registration student nurses’ assignment work to begin marking, and this afternoon will be taking part in a joint Cardiff University/Local Health Board discussion on the future provision of post-qualification modules for community mental health practitioners.

This afternoon’s meeting has given me pause for thought, and a chance to reflect a little on my long involvement in post-registration mental health education. It was explicitly to lead a full-time, one-year, programme for actual or intending community mental health nurses (CMHNs) that I was recruited into what was then the University of Wales College of Medicine in 1997. Education, and my role, have changed considerably in the period following. In Wales there is no longer a fully funded, full-time, course of this type. Like pretty much everywhere else, here education for health care workers beyond registration has increasingly become part-time, and modularised.

I once wrote about the CMHN course we ran in Cardiff in the journal Nurse Education Today. The article was titled ‘Specialist practice in community mental health nursing‘, and had an abstract which went like this:

Community mental health nurses (CMHNs) work in an increasingly complex health and social care environment. Over recent years, the evolving direction of general health service and specific mental health policy has directed CMHNs towards: the provision of clinically-effective interventions; a closer attention to meeting the needs of people experiencing severe and long-term mental health problems; the simultaneous provision of services to meet the needs of people experiencing a wide range of mental health problems presenting in primary care settings; greater collaboration with workers representing other disciplines and agencies; and the development of active partnerships with mental health service users. This paper explores the context within which CMHNs practise, and within which education programmes preparing specialist practitioners in community mental health nursing have been developed. One recently-validated specialist practice course for CMHNs is described in detail, with the intention of stimulating discussion and debate surrounding the practice of, and the educational preparation for, community mental health nursing.

I can’t claim that this paper did actually trigger any particular debate, but at least I tried.

I also had the chance, during the time that I ran Cardiff’s full-time CMHN course, to survey the leaders of other programmes of this type offered elsewhere in the UK. A paper called, ‘Specialist practice for UK community mental health nurses: the 1998-99 survey of course leaders‘ appeared in the International Journal of Nursing Studies. This was co-written with Philip Burnard, Debs Edwards (who, I am delighted to say, is now project manager for the RiSC study already mentioned in this post) and Jackie Turnbull. In the paper’s abstract we said:

Surveys of the leaders of the UK’s post-qualifying education courses for community mental health nurses have taken place, on an annual basis, for over 10 years. In this paper, findings from the survey undertaken in the 1998–99 academic year are reported. These findings include: that most course leaders do not personally engage in clinical practice; that interprofessional education takes place at a minority of course centres, and that course philosophies and aims are characterised by an emphasis on both outcomes (in terms of, for example, skills acquisition, knowledge development and the ability to engage in reflective practice), and process (adult learning).

And then there was a paper called, ‘Education for community mental health nurses: a summary of the key debates‘ which Steve Trenchard, Philip Burnard, Michael Coffey and I wrote for Nurse Education Today. Here we said:

A wide range of post-qualifying education courses exist for community mental health nurses (CMHNs) working in the UK. ‘Specialist practitioner’ courses emphasize shared learning between CMHNs and members of other community nursing branches. These programmes typically include course content drawing on the social and behavioural sciences, as well as on material more tailored to the clinical needs of practitioners. Such courses and their predecessors have been subject to criticism, however. Courses have been described as anachronistic, and failing to take account of recent advances in treatment modalities. In addition concerns about the generic focus of some programmes have also been raised. Educational alternatives, such as programmes preparing nurses and other mental health workers to provide ‘psycho-social interventions’ have, correspondingly, become increasingly popular. In this paper we explore some of the debates surrounding the education of CMHNs, and explore the context in which CMHNs work and in which educational programmes are devised. We consider the multidisciplinary environment in which CMHNs practise, the differing client groups with which CMHNs work, the developing policy framework in which mental health care is provided, demands for more user-responsive education, and the relationship between higher educational institutions and health care providers. We conclude the paper with a series of questions for CMHN educators and education commissioners.

And there are other papers and book chapters, too, which I won’t refer to now. But I am reminded that I once spent large parts of my working life running programmes for community mental health workers, and managed to research and write a fair bit about the same. Perhaps today’s meeting will lead to a modest rekindling.

Mental health R&D 2013

Yesterday I made it to the SWALEC Stadium for the annual Cardiff and Vale UHB Mental Health R&D meeting. I was pleased to again be invited, and appreciated the opportunity to talk about mental health research activity across the new School of Healthcare Sciences.

I was also reminded of the work of the National Centre for Mental Health (NCMH). Funded as Wales’ only Biomedical Research Centre by the National Institute for Social Care and Health Research (NISCHR), and led by Professor Nick Craddock, the NCMH supports mental health research, undertakes mental health research and communicates and engages. Newly housed in Cardiff University’s Hadyn Ellis Building, members of the NCMH do all three elements extremely well. The Centre’s website has recently been revamped, and is well worth a visit. Here, too, is an NCMH call for volunteers video:

Doughnut meetings

My esteemed colleague Professor Jane Hopkinson facilitates a Wednesday lunchtime research drop-in, to which people in the School of Healthcare Sciences at Cardiff University are invited. Affectionately known as doughnut meetings (see photo of today’s goodies attached), these provide a loosely-structured, supportive, space for the sharing of ideas and experiences. The gatherings are really very good: informal, but always informed. I make a point of getting along when I can.

Typically those who meet up get to propose themes for future meetings. This afternoon’s topic was ‘research and evaluation’, and more particularly the distinctions between the two. People involved in health services research (or indeed, health services evaluation) will know how important this differentiation is for NHS governance and approval purposes. Projects classified as ‘research’ require independent NHS research ethics committee (REC) approval. Projects classified as ‘evaluation’ do not. The NHS Health Research Authority provides guidance to help people work out what type of project it is that they are proposing, but in my experience making these determinations remains a wholly inexact science.

I have also learned that a project can be ‘evaluation’ in one context (e.g., for NHS research governance and ethics review) and ‘research’ in another (e.g., for academic progression and award purposes). My own PhD was designed, part-funded through open competition, completed and examined as ‘research’: what else could it possibly have been, as a research degree? But it was also categorised as something else when I offered it up for NHS REC approval, as I’ve written about here and (at length) in this paper.

So there we have it. Potentially all rather confusing, and certainly enough to make me want to eat a doughnut.

New school

A quick post. Today I returned to work from a fortnight away in the knowledge that, at the start of next month, the Cardiff School of Nursing and Midwifery Studies will be joining with the School of Healthcare Studies to become the new School of Health Care Sciences (but not the Cardiff School of Health Care Sciences, unless I’ve missed something?). This change will bring academic nurses, midwives, occupational therapists, physiotherapists, radiographers, operating department practitioners and medical photographers (and all our students) together in a single department. I hope I’ve not missed anyone out in this list: apologies if so.

I’m sure there will be some headaches and hiccups along the way as people and processes adjust, but I understand the idea behind this move and broadly welcome it. Hopefully both research and education will benefit, and it will be good to work more directly with people who have similar interests (in the mental health field, for example) but who happen not to be nurses.

Anyway, more immediately today was the small matter of picking up some important research threads. This included preparing for tomorrow’s service user researcher meeting, in which we’ll be discussing (and using) interview schedules in preparation for fieldwork. I also had the chance to correct proofs for a new article, which I’ll blog about in time. But now it’s late, so I’m off.

Thoughts on the occasion of having written 100 posts

My first post was written and uploaded to this site on November 24th last year. I wrote about my interest in exploring the mental health system’s ‘wicked problems’, and drew attention to an article Michael Coffey and I had recently published in this area. In this, my 100th post, I want to think a little about what I have learned using a blog as a medium of communication.

As a mental health nurse academic my job involves researching and writing. I have wanted this site to be a vehicle for bringing some of this work to a wider audience. The main way I have gone about doing this has been to write posts to surround published articles, and where copyright makes this possible to add links to full-text green open access versions of papers stored on Cardiff University’s ORCA digital repository. The link above to Michael’s and my paper on wicked problems is an example. I’d like to think that this strategy has had some effect. As I wrote in this post last month, copies of papers I have deposited and then blogged about have been downloaded. By whom I cannot know. Nor can I be sure what use, if any, people have made of what they’ve read. If anyone wants to let me know, then that would be all to the good.

Over the last eight to nine months I have also learned that a blog needs looking after. So in addition to writing about research I have taken the opportunity to write generally about other things I do at work or am interested in, or about stuff which has simply caught my eye. My approach has been to write little, but to write often. I reflect that adding small pieces here and there has helped me in my teaching, as I noted earlier here. I also realise that in blogging beyond research I have blurred my boundaries somewhat, having added notes along the way about (for example) the simple pleasures of running. As an aside, I’ve been plagued by minor, but annoying, running-related injuries over the last few months and am missing my forest jaunts very much.

Just as a peer reviewed, published, article can be given a leg-up by a post on a blog, so too can a new blog be supported by a tweet. I have taken to using Twitter to draw attention to newly published posts, and indeed have started using this (sporadically, it has to be said) as another, independent, way of exchanging ideas.

That’ll do, for now. But I conclude that I’ll maintain this site in its small niche for a while longer yet.

Stress and community mental health nurses

A particular aim of mine in starting this blog was to bring research I have been involved in to a wider audience. So with this in mind, here is a post introducing readers to a series of studies I worked on, with Cardiff colleagues, from the late 1990s to around 2006.

The All Wales Community Mental Health Nursing Stress Study was our first project, led by Professor Philip Burnard. Included in the team were Deborah Edwards, Dave Coyle, Anne Fothergill and myself. Our funding was from the GNC for England and Wales Trust, and we aimed to find out about the causes, moderators and outcomes of stress in community mental health nurses (CMHNs) working in Wales. Our data were generated using a demographic questionnaire and these previously created measures:

  • Maslach Burnout Inventory
  • General Health Questionnaire (GHQ-12)
  • Rosenberg Self-Attitude Questionnaire
  • Community Psychiatric Nursing Stress Questionnaire (Revised)
  • Psychnurse Methods of Coping Questionnaire

Our first published paper was this literature review, which Scopus tells me has thus far been cited in 66 subsequent publications. We went on to publish a series of data-based articles from the study, in some of the journals whose names I have added to the word cloud above. The references for these papers are listed here, along with a brief summary of our headline findings.

The team’s next study was a systematic review of stress management in the mental health professions. This was funded by the Wales Office of R&D for Health and Social Care, which was the predecessor body to NISCHR. We found far more papers describing how stressed people are than we found papers suggesting solutions to this problem. Follow this link for a reference list and project summary.

Finally in this series of projects was a study ‘to identify the factors that may influence the effectiveness of clinical supervision and to establish the degree to which clinical supervision might influence levels of reported burnout in community mental health nurses in Wales, UK‘. An expanded team this time included Linda Cooper, John Adams and Tara Jugessur. This study involved the distribution of two questionnaires, again to community mental health nurses in Wales:

  • Maslach Burnout Inventory (MBI)
  • Manchester Clinical Supervision Scale

This project, too, has a webpage giving details of our main findings and of our published papers.

In the years since this last project concluded I have had conversations with people on what the next line of inquiry might be. The questions we first asked some 15 years ago seem to me to be as relevant today as they were then. I imagine there remain large numbers of very stressed and burned-out mental health practitioners out there. I also suspect there is still work to do to protect the well-being of staff, and to promote their resilience.

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.

The COCAPP crew, and MHNAUK comes to Cardiff

Yesterday’s COCAPP meeting in Cardiff was both productive and fun. It was lovely to welcome those members of the London contingent able to make the trip, and I extend my apologies (again, and for the last time!) to those I conspired to keep waiting in a darkened corridor before turning up with a room key.

COCAPPers 07.13.13COCAPP is an exciting research project to be involved in, and pretty soon it will have its own blog. I’ll then add links from here for those who are interested. Briefly summarised, this is an England and Wales cross-national investigation into mental health care planning and coordination, and into the relationships between these processes and recovery and personalisation. It’s funded by the NIHR Health Services and Delivery Research Programme, and has lots of distinct elements: about which more will follow, I guess, once the dedicated project blog is up. For now, here’s a photo of yesterday’s assembled COCAPPers (where from left to right there’s Aled, Jitka, Alan (COCAPP’s chief investigator), Sally, me and Michael. We very much missed Alison and Jennifer and their wise contributions, and when we’re all in one place I imagine we’ll take another, and more complete, photo.

Yesterday evening was the traditional social involving food and drink with fellow members of Mental Health Nurse Academics UK, ahead of today’s meeting proper. As Cardiff hosted we got to select the venues, and I hope everyone who was able to make it enjoyed the selection of fine ales and wines, and indeed the general ambience, at The Rummer Tavern. Likewise the food at The Mango House.

MHNAUK’s first meeting of 2013 was a good ‘un. Jen French talked about mental health strategy in Wales, and Ian Hulatt updated us on the Willis Commission. Eschewing the usual format of host universities presenting their research and teaching activities in the morning, Michael Coffey (in the photo above, and MHNAUK chair) and Joy Duxbury (newly elected vice chair) invited reflections and discussion on the aims and purpose of the group, and on the character of research in mental health nursing and what can be done to nurture it. There was some lively discussion in the two groups (facilitated by Linda Cooper and Len Bowers respectively) which convened to talk to these areas. It occurred to me unhelpfully after the event that we might have taken a MHNAUK photo, including the 35 or so members participating today: not least as MHNAUK, like COCAPP, is collectively thinking of increasing its presence via a blog.

Work aside, running has taken a big back seat this week, what with one thing and another. Must get out soon!