There remains considerable scope for development […], particularly in capacity and capability building and the support of early career researchers. The sub-panel identified that fostering a collaborative cadre of research active individuals with such expertise, equipped, and resourced to deliver international multicentre studies, was important for the future vitality and sustainability of these disciplines.In this context, the two School of Healthcare Sciences studentships which are on their way promise to make an important contribution to promoting both ‘vitality and sustainability’, and here’s to them attracting lots of interest. Follow @benhannigan
Tag: doctoral study
Here is news of two completed doctoral theses which I have helped support as a supervisor, both being within the mental health field. First is Fortune Mhlanga’s Implementing recovery-oriented practice in mental health services: a qualitative case study, which is all about how recovery ideas are used in everyday practice. The summary for Fortune’s study is this:
Although the recovery philosophy has been adopted in mental health services in various Western countries including England, its implementation in practice has been described as “slow and patchy”. Furthermore, there are suggestions in the literature that there is a lack of clarity around the implementation of recovery-oriented practice (ROP) and a dearth of research exploring the phenomenon. This study aimed to discover how recovery-oriented practice is implemented in an NHS Trust providing care for people experiencing mental health problems, in order to add to what is already known about the implementation of ROP to inform future practice.
A qualitative case study approach was employed to investigate the implementation of ROP from strategic to grassroots level in two practice settings (Community Mental Health Team and Rehabilitation ward) within one NHS Trust providing mental health services in the South of England. Semi-structured interviews were conducted with 16 participants (senior managers, practitioners, service users) investigating their perceptions and experiences of ROP. Data were analysed using thematic analysis and further interpreted by situating it in the literature.
• Whilst there was a shared common understanding of the meaning of recovery and ROP in the organisation, there was a fundamental difference between practitioners and service users’ conceptualisations with service users leaning more towards clinical recovery.
• At strategic level, strategies to facilitate implementation of ROP focused on changing the culture within the organisation through Implementing Recovery through Organisational Change (ImROC) recommended interventions such as: Recovery College, peer workers and use of the Recovery Star. At grassroots level, implementation was via the development of therapeutic relationships between service users and practitioners.
• Salient barriers to the implementation of ROP included: time taken completing paperwork resulting from performance measures used by commissioners in the community team, the shortage of resources and the tension between risk management and ROP in both settings.
This study addresses the gap in research on the implementation of ROP through an exploration of how ROP was being implemented in two practice settings in an NHS organisation providing mental health care. Methodologically, the qualitative case study approach adopted in the study allowed triangulation of data from participants ranging from grassroots level to strategic level. Furthermore, the approach taken with the sample consisting of service users, senior managers and practitioners from inpatient and community practice settings within the same organisation is not comparable with any other studies on ROP that have been conducted in England. This study therefore informs implementation efforts of similar organisations and makes recommendations for practice, commissioners and research.
Second up is Bethan Mair Edwards’ A window of opportunity: Describing and developing an evidence, theory, and practice-informed occupational therapy intervention for people living with early-stage dementia, which addresses the development of OT practice in the support of people with memory difficulties. The summary from Bethan’s thesis is this:
There is a scarcity of evidence generated in a UK context to inform the practice of occupational therapists working with people living with early-stage dementia. This Thesis’ overarching aim was to describe and develop an evidence, theory, and practice-informed occupational therapy intervention for people living with early-stage dementia.
In accordance with the MRC Framework for the Development and Evaluation of Complex Interventions, an Intervention Mapping approach was utilised to guide the development process. Thesis Objectives were developed based on Intervention Mapping Steps 1 – 3, and to meet these objectives, this Thesis consists of three studies. Study 1 (a two-stage mixed methods evidence synthesis) and Study 2 (semi-structured interviews with people affected by dementia and occupational therapy practitioners) sought to understand the intervention population and context, as well as identify existing research and practice-based interventions. Study 3 involved describing and developing an intervention programme theory and programme design.
Studies 1 and 2:
Multiple personal and environmental (social, physical, and occupational) determinants associated with the occupational performance problems that people living with earlystage dementia may experience were identified. Existing research and practice-based interventions were heterogenous in nature and no programme theories were reported; however, strategies that problem-solve occupational performance problems were identified as a primary intervention component. In practice contextual barriers were associated with resources, other professionals’ awareness and understanding of occupational therapy, and a lack of control and influence over service development and policy.
A logic model of the problem and population, matrices of change, and a simple intervention logic model were developed to articulate a proposed programme theory. A broad overview of the proposed interventions’ design, including components and context, were specified and key uncertainties outlined.
This research has developed a robust foundation for further development work at Intervention Mapping Steps 4 – 6, including developing theoretically informed implementation strategies and producing materials in preparation for a feasibility evaluation.
Two super pieces of work, with real relevance for interprofessional mental health services and practice: congratulations to both.Follow @benhannigan
Getting started in research
Currently I’m serving a term as Director of Postgraduate Research in the School of Healthcare Sciences, which means I have responsibilities for our PhD and our Doctorate in Advanced Healthcare Practice (DAHP) programmes. For aspirant researchers a doctoral degree is a necessary qualification, with the PhD culminating in the production of a thesis of some 80,000 words whilst the DAHP in Cardiff combines taught modules and a shorter thesis of no more than 50,000 words. In the School we have numbers of students in the thesis stage of their DAHP degrees, but this particular programme no longer recruits new entrants. The PhD, though, continues to attract people from the UK and around the world and information on it can be found here.
October is the first opportunity in each academic year for postgraduate student enrolment, and compared to the numbers of people commencing their undergraduate and taught postgraduate studies our newly starting students are small in number. This is to be expected, but this also takes me to the general observation that the health professions need many more people to get involved in research and knowledge creation.
Information on developing research careers in the mental health field can be found at the NIHR Incubator for Mental Health Research website. There is lots of value here, including advice on first steps, on sources of funding, and on finding support and mentorship. There are case studies, too, of people from a range of backgrounds and at different stages of their research careers (including people studying for doctorates), and a whole section aimed at nurses.
Meanwhile, the Royal College of Nursing has launched the Annie Altschul Collection, an online repository of doctoral degrees completed by mental health nurses. The repository is searchable, and is also themed, with hyperlinks to the full text of each included thesis where these are available.Follow @benhannigan
Perinatal mental health care
Continuing from this recent post celebrating the publishing of papers from doctorates I’ve had a hand in supervising, here now are links to Nicola Savory’s PhD and to a first article from this in the journal Midwifery. Nicola is a midwife, and in her thesis (funded by RCBC Wales) used quantitative and qualitative methods to investigate women’s mental health needs in the antenatal period.
Nicola’s whole-thesis summary is this:
Background: Existing research on poor perinatal mental health largely focuses on recognition and treatment of postnatal depression. Consequently, there is a need to explore antenatal mental health.
Aim: To assess poor mental health prevalence in pregnancy, its relationship to sociodemographic characteristics, self-efficacy and perceived support networks. To understand experiences and barriers preventing women with mental health problems from receiving help and explore midwives’ understanding of their role.
Method: Questionnaires were completed by women in early pregnancy. A subset identified to have mental health problems, were interviewed in late pregnancy to explore their experiences and barriers to receiving care. Midwives completed questionnaires exploring their experiences of supporting women with mental health problems and focus groups further discussed the issues raised.
Results: Amongst participants (n=302), the Edinburgh Postnatal Depression Scale (EPDS) identified 8.6%, and the Generalised Anxiety Disorder Assessment (GAD-7) 8.3%, with symptoms of depression or anxiety respectively. Low self-efficacy (p=0.01) and history of previous mental health problems (p<0.01) were most strongly associated with anxiety or depression. Thematic analysis of interviews with women (n=20) identified three themes: ‘past present and future’; ‘expectations and control’; and ‘knowledge and conversations’.
Questionnaires were completed by 145 midwives. The three themes identified from the focus groups with midwives were: ‘conversations’; ‘it’s immensely complex’; and ‘there’s another gap in their care’.
Conclusion: Prevalence rates of anxiety and depression amongst women in early pregnancy were found to be similar to those reported in the literature. Low self-efficacy and previous poor mental health were significant predictors of anxiety and depression. Continuity and more time at appointments were suggested by midwives and women to improve discussions regarding mental health. Midwives were keen to support women but lacked knowledge and confidence. Consistent reference was made to the need for training regarding the practical aspects of supporting women’s mental health.
Nicola has a series of journal papers lined up from her doctorate, with the one I’ve linked to above (‘Prevalence and predictors of poor mental health among pregnant women in Wales using a cross-sectional survey’) being just the first.Follow @benhannigan
Understanding continuous education
One of the nicest things about my job is the opportunity to supervise and support doctoral students, and to then publish with them. Belatedly (as this has been available for some time), here is a paper arising from Freda Browne’s doctorate. Freda works at University College Dublin, and in her thesis used a realist approach to understand how knowledge and skill are transferred from the education context to clinical practice.
This paper, appearing in the journal Nurse Education Today, is a fine piece of work and a good example of theory-informed evaluation. Here’s the abstract:
Background: Continuing professional education (CPE) for nurses is deemed an essential component to develop, maintain and update professional skills. However, there is little empirical evidence of its effectiveness or factors which may influence its application into practice.
Objective: This paper explores a continuing professional education programme on the safe administration of medication and how new knowledge and skills are transferred into clinical practice.
Design: Realist evaluation provided the framework for this study. Realist evaluation stresses the need to evaluate programmes within “context,” and to ask what “mechanisms” are acting to produce which “outcomes.” This realist evaluation had four distinct stages. Firstly, theories were built as conjectured CMO configurations (Stage 1 and 2), then these cCMO were tested (Stage 3) and they were then refined (Stage 4).
Methods: Data was collected through document analysis and interviews (9) to build and refine CMOs. The conjectured CMOs were tested by clinical observation, interview (7), analysis of further documents and analysis of data from reported critical incidents and nursing care metric measurements.
Results: This study has shown the significant role of the ward manager in the application of new learning from the education programme to practice. Local leadership was found to enable a patient safety culture and the adoption of a quality improvement approach. The multi-disciplinary team at both organisation and local level was also found to be a significant context for the application of the education programme into practice. Reasoning skills and receptivity to change were identified to be key mechanisms which were enabled within the described contexts.
Conclusion: The findings from this study should inform policy and practice on the factors required to ensure learning from CPE is applied in practice. The realist evaluation framework should be applied when evaluating CPE programmes as the rationale for such programmes is to maintain and improve patient care.
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.
Fees, theses and project updates
Last week brought the news that, in England, people beginning nursing degrees from the 2017-18 academic year will need to take out student loans to cover the cost of their tuition fees. The cap on student numbers will also be removed. The Council of Deans of Health broadly supports this move, having previously argued for change. One of the things it points out is that current funding for students (via the agreement of the benchmark price) does not cover the real costs of educating new nurses. The Royal College of Nursing, on the other hand, is concerned that last week’s announcement prepares to break the connection between the NHS and financial support for student nurses, and simultaneously risks making nursing a less attractive career option. This concern particularly relates to mature students and those contemplating a second degree, for some of whom the prospect of additional debt may be exceptionally unappealing. As a nurse academic in Wales I wait with interest to see what policy on fees will emerge from the Welsh Government.
In other news, I find myself engaged in a prolonged period of doctoral student activity. I’ve examined a number of theses in and out of Cardiff in recent months, and have sat with students during their vivas as either supervisor or independent chair. This term has been particularly packed. Plenty of writing has also been taking place: papers and reports are being written from COCAPP, RiSC and Plan4Recovery, and from completed theses I have helped to supervise. Data generation in COCAPP-A has almost concluded, and new research ideas are taking shape. Exciting times, if a little frenetic.
Studying for a PhD in the School of Healthcare Sciences
Here in the School of Healthcare Sciences at Cardiff University we’ve continued to think about how best to appeal to potential PhD students, and to simultaneously develop research capacity across nursing, midwifery and the allied health professions. A change which we’ve recently made is to invite applicants for postgraduate research study to make clear how their developing plans fit with the research already going on in at least one of the School’s research themes. To help in this process we’re now advertising areas for future PhD study, closely aligned to the substantive and methodological expertise already found in the School. This makes lots of sense, and will help us to grow research in programmatic fashion and ensure students are appropriately supervised.
The place to go for the current list of topics/areas is here, where under the Workforce, Innovation and Improvement theme you’ll find this:
The use of in-depth qualitative methods to examine mental health systems. Specifically, projects investigating aspects of policy; service organisation and delivery; work, roles and values and user and carer experiences.
That’s the kind of PhD I’m primarily interested in supervising. For an example of what a completed one looks like, then follow this link to the full text of Dr Mohammad Marie’s freshly minted thesis titled, Resilience of Nurses who work in Community Mental Health Workplaces in West Bank-Palestine.
Supporting doctoral students in mental health nursing
Over on the Mental Health Nurse Academics UK blog, Julia Terry from Swansea University has written a post introducing the new Mental Health Nurse Doctoral Students’ Network which she has worked so hard to convene. The group met, for the first time, as part of an NPNR conference fringe at Warwick University last month.
Here’s what Julia has to say:
Welcome to the first official blog post for the:
Mental Health Nurse Doctoral Students’ Network
At the NPNR in Warwick this year 10 Mental Health Nurse Doctoral Students came forward and agreed that a network was a good idea.
This network can work in a number of ways:
- Meeting up for occasional face to face discussions
- Using an email group to contact like-minded people
- And using this blog
You may have questions, tips to share, events and books to recommend, the possibilities are wide.
As you’re reading this we’ve now increased the network to 24 interested doctoral students already, so the interest seems to be there. Thanks for your support.
2 great books I read from start to finish and keep going back to –
Petre, M., Rugg, G. (2010) The unwritten rules of PhD research. 2nd ed. Berkshire: Open University Press
Phillips, E., Pugh, D. (2010) How to get a PhD: a handbook for students and their supervisors. Berkshire: Open University Press
I found them very easy to read, and good to dip in and out of. Tips about writing, planning your time, supervision, etc..Well worth a read.
Bw, Julia Terry
Great work, Julia: I hope people get involved.
Whilst I’m on the topic of postgraduate research, I note that the European Academy of Nursing Science (of which I am a Fellow) runs a doctoral student summer school for nurse researchers. There’s also the Academy of Nursing, Midwifery and Health Visiting Research with its mentorship scheme.
Teaching preparation and bursaries
The formal academic year for students of the health professions (and therefore for their teachers, too) tends to be on the long side. Whilst many UK university students will have ended their studies until the autumn there are plenty of nurses, midwives and others with work to do before they can knock off for the summer. In September I’ll be working with pre-registration, second year, students of mental health nursing in a module assessed through the critiquing of published research. Before then I have a short, intensive, module to lead which is part of the taught component within the School’s professional doctorate.
This doctoral level module is all about ‘complexity’ and ‘systems’ and starts next month, and today I’ve been putting the finishing touches to some of the materials I’ll be using. As befits the student group and their thesis-producing aspirations I have opted to draw heavily on colleagues’ and my research experiences as far as is possible. I’m also hoping to foster a spirit of studying and learning together, and want to avoid being didactic.
Elsewhere today, in addition to research project-related work, I have had the opportunity to be part of a panel considering applications for RCN Foundation bursaries. There were some strong candidates, and well done to all who are about to get letters confirming their success. Others will be invited to interview (which I personally am unable to take part in). My commiserations, too, to those dropping out at this stage. I know how it feels to apply for support and not to get it, but there are always other opportunities. As I once heard someone, somewhere, say: if you’re not getting funding bids rejected you’re not applying enough!