Tag: nursing research

Building research capacity

Last night I enjoyed an evening event in Cardiff with other past, and present, members of the RCBC (Research Capacity Building Collaboration) Wales Community of Scholars. This is a collaborative venture supported by higher education institutions, with funds now coming from NISCHR. Since coming into being in 2006 the RCBC programme has sought to develop research capacity across nursing, midwifery and the allied health professions. I’ve written about the scheme on this blog before (see here and here), and am personally grateful for the support I received as an RCBC Post-Doctoral Fellow which enabled me to complete my study into the work and system impact of crisis resolution and home treatment teams. For more on what I found in that project, check out these green open access articles saved in Cardiff University’s ORCA repository:

Hannigan B. and Coffey M. (2011) Where the wicked problems are: the case of mental health. Health Policy 101 (3) 220-227

Hannigan B. (2014) ‘There’s a lot of tasks that can be done by any’: findings from an ethnographic study into work and organisation in UK community crisis resolution and home treatment services. Health: an Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 18 (4) 406-421

Hannigan B. and Evans N. (2013) Critical junctures in health and social care: service user experiences, work and system connections. Social Theory & Health 11 (4) 428-444

Hannigan B. (2013) Connections and consequences in complex systems: insights from a case study of the emergence and local impact of crisis resolution and home treatment services. Social Science & Medicine 93 212-219

Last night began with a talk from Tina Donnelly, Director of RCN Wales and Commanding Officer of the 203 Welsh Field Hospital. In introducing Tina, RCBC Grant Holder Professor Donna Mead (from the University of South Wales) shared the news that the RCBC scheme has received confirmation from NISCHR of continued funding. That’s good, and means we can look forward to more doctoral (and hopefully, post-doctoral) opportunities in the coming months and years.

 

Activity based funding and student research in the NHS

Yesterday I spent time with a group of MSc students, talking about research review processes. I’ve written on this blog in the past about my experiences of seeking approvals for my PhD, and in Monday’s session I urged people to be exceptionally cautious about planning NHS-related research in pursuit of their Master’s degrees.

Preparing for and securing NHS research ethics committee and R&D office approvals takes time. In this part of the world at least, some healthcare organisations are also likely to ask researchers to cover the costs to the NHS of supporting studies which are not portfolio adopted. Here I’m thinking of, for example, the costs arising when staff leave the workplace to participate in interviews or join focus groups, or suchlike.

The relatively new practice of directly seeking payment from research teams for the costs of studies which are not eligible for portfolio registration has appeared with the shift to activity-based funding. Here in Wales, the National Institute for Social Care and Health Research (NISCHR) has published criteria for entry to its portfolio, which are summarised here and are elaborated on here. It is from this second document that I have snipped the following:

A research study is a structured activity which is intended to provide new knowledge which is generalisable (ie of value to others in a similar situation) and intended for wider dissemination.

Studies eligible for the NISCHR portfolio should involve face to face contact with NHS patients, social care service users or people involved with their care. Studies must be led from and/or recruiting participants from Wales. All studies must already have research funding before they can be included in the Portfolio.  Research Costs cannot be provided by NISCHR CRC.

The following types of study are not eligible for inclusion in the NISCHR Portfolio:

  • audit,
  • needs assessments,
  • quality improvement projects,
  • directly commissioned studies,
  • secondary research such as systematic reviews,
  • purely laboratory based studies,
  • routine biobanking of samples would not be eligible but a hypothesis based sample collection would be if appropriately peer reviewed and funded,
  • own account funded studies,
  • studies closed to recruitment.

MSc projects invariably do not meet these criteria, meaning that numbers of taught postgraduate students get to cut their dissertation teeth on non-NHS research studies or (where academic regulations allow) on other types of project altogether. Examples are service or quality improvements, service evaluations and systematic reviews. And, in my view, these are sufficiently testing options for students working at MSc level, with some (like local quality improvements) having the added advantage of immediately and obviously benefiting the NHS and those who use its services.

However, a problem arises in the case of postgraduate research degrees. In some disciplines, including nursing, these are often undertaken part-time and are carried out with limited or no external grant income. Opportunities for studentships are relatively rare, and where they are available may be financially unattractive to practitioners who have already built careers in the health service. As with MSc projects, ‘own account’ doctorates will struggle to get onto the portfolio. They therefore run the risk (in some circumstances) of not being supported by organisations within the NHS unless their associated costs are explicitly met. One way of achieving this may be for local NHS managers to agree to carry the costs of non-portfolio studies which it is planned will take place within their services. But securing this kind of support is not straightforward, and for would-be research students the added challenge of finding a means of paying costs is hardly an encouragement. And, where MSc students can usually opt for non-research projects this is not so for those aiming for PhDs or Professional Doctorates. These are awards made only to those who generate new knowledge using sound and defensible research methods.

So what does all this mean? It’s early days, but one likely outcome may be a reduction in small-scale research projects within the NHS, along with an increase in the preparations and negotiations which precede data generation. Another may be the proliferation of non-portfolio projects which are explicitly designed to meet ‘research’ criteria for academic award purposes, but which are constructed to be something else (typically ‘service evaluation’) within the context of NHS research governance. A reasonable, longer-term, concern is that research capacity-building in fields like nursing may falter as potential students rethink their plans. And that, in my view, would be a big step backwards.

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:

paperchain people

 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.

Top tip:

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.

Research and mental health nursing

Over on the Mental Health Nurse Academics UK blog, the group’s chair Dr Michael Coffey writes:

The Research Excellence Framework (REF) looms large for many of us. This is part of the regular round of judging of peer-reviewed research publications on which the UK government bases its decisions on distribution of institutional research funding. Decisions within Higher Education Institutions are being made around now on who is considered returnable and then whether it is strategically advantageous to submit these researchers in the exercise. For individual research careers these decisions weigh heavy. For the profession of mental health nursing there may be wider implications. Previous research assessment exercises have seen more and more evidence of mental health nurses being returned. This has undoubtedly led to an improved profile within individual universities and recognition of the contribution of research to improving the experience of people using mental health services.  There remain significant opportunities for mental health nurse researchers to contribute and bring to bear a professional view on what needs researching and how this should be conducted. We will have to wait until 2014 for an idea of what the landscape will look like in relation to mental health nursing. One thing for sure is that we need a highly engaged mental health nurse academic workforce to continue to provide high quality education and research. By doing this we can make a meaningful contribution to the development of mental health care both here in the UK and beyond.

Nursing certainly did do well in the UK’s last Research Assessment Exercise, the precursor to the REF to which Michael refers in his post. Results for all higher education institutions submitting to Unit of Assessment (UoA) 11 (Nursing and Midwifery) in RAE 2008 can be found here. In his subject overview report for UoA11, Professor Hugh McKenna of Ulster University ended with this:

In conclusion, the sub-panel members were very impressed with most of the submissions they reviewed and with the pervasive pattern of world-leading and internationally excellent research. There are many models of good practice from which developing research groupings can learn in terms of research activities, outputs, environment and esteem. It is clear that investment by Governments, funding bodies and universities has increased research capacity and developed research leaders capable of undertaking nursing and midwifery research that is internationally excellent and world leading. These funding streams need to be sustained and enhanced if the upward trajectory and momentum are to continue and if the quality differentials between the strongest and weakest departments are to be addressed.

And, when the results from the last RAE were published in December 2008, The Guardian ran an article titled Nursing research takes its place on world stage. Here it said:

Nursing, for many years medicine’s poor relation, has come of age in the 2008 research assessment exercise (RAE). Academics in the field can justifiably claim to be world-leading in terms of research. Nursing and midwifery was among the subjects with the most highly rated research in the results published today.

Heady stuff indeed, and testimony to years of hard work, strategy, and capacity-building investment. All this does, though, seem an awful long time ago. As Michael reminds us in his MHNAUK post, attention has long since turned to preparations and prospects for REF 2014.

I have written about nursing and the Research Excellence Framework 2014 on this site before, drawing attention to the workload facing members of UoA A3 (Allied Health Professions, Dentistry, Nursing and Pharmacy) and to the challenges of demonstrating and assessing ‘impact’. So, as we hurtle towards the deadline for REF submission, in what shape does UK mental health nursing research find itself?

Readers of this blog will know that this is a question that MHNAUK is also asking, and is seeking an answer to in organised fashion. Professor Len Bowers led a discussion on this at the MHNAUK meeting held in Cardiff last March. When the group reconvened in Liverpool in June, Dr Fiona Nolan asked members for items to include in her planned survey of research activity and capacity.

Whilst we await findings from Fiona’s project in the first instance, my personal view is that there is much to celebrate in mental health nursing research but also room for development. A small number of universities are home to strong and established research groups. Leaders of these have built national and international collaborations across disciplinary and institutional boundaries. They have laboured to secure funding in open competition and to complete and publish studies with real implications for policy, services, education and practice. This is excellent progress, and I think we now need more of this type of activity across more universities. This means people (and I include myself here) extending their ambition, and perhaps being a little bolder. As an example, early next year the European Union’s Horizon 2020 research and innovation programme invites a first round of applications for funding. How excellent it would be for mental health nurses in the UK to be leading, and collaborating on, high-quality bids submitted there.

My more general reading of the field is that, in many universities, mental health nurse researchers are thinly spread. I’ll bet that in most of the sixty-plus universities represented at MHNAUK the number of people predominantly involved in teaching far outstrips the number predominantly engaged in research. Teaching is important – really important – but the lone researcher in a team of teachers is in a tough place indeed. As I cast an eye around the departments I am most familiar with I also wonder where the younger mental health nurse researchers are. How many mental health nurses in their 20s are studying for PhDs? If the answer is ‘not many’, then what should we collectively be doing to make research a viable, and attractive, career proposition for nurses at the start of their careers? How might we nurture a future generation of mental health nursing clinical academics?

Anyway: all is speculation until we have some evidence. The MHNAUK survey, I anticipate, will paint a more rounded and complete picture of the true state of research activity and capacity than will the Research Excellence Framework. The REF, being what it is, is subject to all sorts of inter- and intra-institutional politicking and will produce only a partial view of what’s really going on.

Mental Health Nurse Academics UK meets in Liverpool

Yesterday Mental Health Nurse Academics UK met at Liverpool John Moores University, for its third and final meeting of this academic year. Hosts were Lisa Woods and Grahame Smith, and the chair was Michael Coffey. In the first part of the day Grahame and Lisa gave an excellent presentation on their cross-European Innovate Dementia project. Business items included updates on plans made at the previous MHNAUK meeting held in March in Cardiff. Andy Mercer presented findings from his and Karen Wright‘s survey of the methods used by universities to select new students of mental health nursing. Fiona Nolan asked members of the group for their suggested items to be included in her forthcoming research expertise, interests and capacity mapping exercise. This will be useful indeed, and at some point soon we will have a better idea of the full range of mental health nursing research being conducted within the UK’s universities.

NHS changes, and the state of research in nursing

Since publishing my last post the Health and Social Care Act has come into force in England. For a frontline NHS worker’s views on what this means, check out this commentary by East London GP Dr Youssef El-Gingihy. Personally I’m glad to be living and working in Wales. I am pleased to say that here there is still government support for an NHS which is funded, planned and provided with the public good in mind.

Elsewhere, within my corner of nursing (the academic bit) an editorial by David Thompson and Philip Darbyshire which appeared in the January issue of the Journal of Advanced Nursing has provoked a series of robust, just-published, responses. These have variously been penned by Bryar et alGallagher, Ralph, Rolley, White and Cross and Williams. JAN also carries Thompson and Darbyshire’s rejoinder, through which the responses are responded to.

The debate has a number of elements. In their editorial Thompson and Darbyshire argued that the quality of academic nursing has declined, and that some nurses working in some universities occupy positions of seniority which their experiences and qualifications have not prepared them for. They also accused those they termed the ‘killer elite’ of running departments as managerial fiefdoms, without tolerance for critical enquiry or dissent. This month’s responses include pieces both for, and against, the Thompson and Darbyshire position. Interested readers can follow all this up for themselves through the links I’ve given above, and I won’t attempt to summarise the full range of views offered.

What I will say is that, for all sorts of historical and contextual reasons, it remains remarkably difficult to sustain a career as a nurse doing research. Funding streams for nursing and midwifery departments in UK universities are largely earmarked for teaching, and relatively few university-based nurses have had opportunities to study for research degrees. Amongst those who have completed doctorates many have found it hard to progress to become independent researchers. Large numbers appear to have returned to roles which do not include significant research components. Only a handful of departments have a critical mass of research-active nurses and midwives, leaving the majority vulnerable when key people leave or retire.

But we have to keep at it. What nurses do touches the lives of millions, every day of the year. Research has an important part to play in improving the nursing contribution: from finding out ‘what works’, to learning about the experience of people on the receiving end of nurses’ services, and onwards to establishing how care might best be organised. Taking a research idea and turning it into a proposal which stands a chance of securing funding through open competition is tough (ask a scientist or a historian: it’s just the same for them), but if we truly want a sound base for nursing practice then this is work which has to be done. And as I am currently learning all over again, actually doing research once funding has been obtained is never as straightforward as the textbooks would have us believe.