Tag: resilience

New year

Happy new year. In December 2017, I was pleased to see Values in Health and Social Care: an Introductory Workbook published, co-written with Ray Samuriwo, Stephen Pattison and Andrew Todd. It is a product of the Cardiff Values group, which began life over 15 years ago, and is the third book of its type that I’ve been involved in. The first was Values in Professional Practice: Lessons for Health, Social Care and other Professionals and the second was Emerging Values in Health Care: the Challenge for Professionals. This latest outing is very hands-on, and is packed with exercises for students and their teachers. I hope people find it stimulating and useful.

SamudIn previous posts (see here and here) I’ve written about Mohammad Marie’s PhD, which investigated resilience in Palestinian community mental health nurses. A fourth paper derived from this study has just been assigned to the January 2018 issue of the journal Health. This is a review of literature, and addresses (amongst other things) the connections between resilience and the idea of ‘Samud’. By following this link a gold open access version of the paper can be downloaded for free.

Elsewhere, I realise I have neglected to add any recent updates on this site about the work of Mental Health Nurse Academics UK. Last year was an active one. In addition to our usual three meetings we exercised our responsibilities as a Research Excellence Framework nominating body, and responded to a variety of consultations and calls for evidence: a nursing workforce inquiry initiated by the House of Commons Health Select Committee; the Nursing and Midwifery Council‘s proposed standards for education; both NHS Improvement and Centre for Mental Health reports on the mental health workforce; and more besides. Our meetings for this year are all scheduled, and it will be good to catch up in Birmingham in February, Greenwich in June and Essex in October.



Resilience of community mental health nurses in Palestine

Earlier this week a new article lead authored by Mohammad Marie, and co-authored by Aled Jones and me, was published in the International Journal of Mental Health Nursing. The title of the article is Resilience of nurses who work in community mental
health workplaces in Palestine
, and is the second paper arising from Mohammad’s completed PhD. As the article appears in gold open access form copies can be directly downloaded from the journal’s website for free: or indeed, by clicking either the hyperlinked title or image above.

The larger part of Mohammad’s qualitative dataset is interviews conducted with CMHNs working in the West Bank. Fifteen practitioners took part, from a total population of 17. For the record, that’s 17 community mental health nurses for a population of some three million people. That’s an astonishingly low number by UK standards; for more on mental health needs and services in Palestine, the place to go is Mohammad’s first paper (Mental health needs and services in the West Bank, Palestine) about which I previously blogged here.

Here is the abstract from this latest paper:

People in Palestine live and work in a significantly challenging environment. As a result of these challenges they have developed resilient responses which are embedded in their cultural context. ‘Sumud’, in particular, is a socio-political concept which refers to ways of surviving in the context of occupation, chronic adversity, lack of resources and limited infrastructure. Nurses’ work in Palestine is an under-researched subject and very little is known about how nurses adjust to such challenging environments. To address this gap in the literature this study aimed to explore the resilience of community mental health nurses (CMHNs) who work in Palestine. An interpretive qualitative design was chosen. Fifteen face-to-face interviews were completed with participants. Thirty-two hours of observations of the day-to-day working environment and workplace routines were conducted in two communities’ mental health centres. Written documents relating to practical job-related policies were also collected from various workplaces. Thematic analysis was used across all data sources resulting in four main themes, which describe the sources of resilience among CMHNs. These sources are ‘Sumud and Islamic cultures’, ‘Supportive relationships’, ‘Making use of the available resources’, and ‘Personal capacity’. The study concludes with a better understanding of resilience in nursing, which draws on wider cultural contexts and social ecological responses. The outcomes from this study will be used to develop the resilience of CMHNs in Palestine.

The idea of ‘Samud’ which is referred to above is an important one in Mohammad’s work, and (as I have learned) for Palestinian people. Drawing on the work of Toine Van Teeffelen, here is what Mohammad says about it in his thesis:

[Samud] is the art of living to survive and thrive on their homeland in spite of hardship and under occupation practices. These skills of how to live are used in different aspects of life such as economic, political and social. They can also be used at many levels: individual, family and within the Palestinian community. Moreover, Sumud has been divided into two types: tangible resources such as the infrastructure supporting basic needs (for example, schools and hospitals) which enable the existence of the Palestinians on their land and help them to be more resilient. In addition intangible sources of Sumud also exist, which include: belief systems, religion and social and family support which help the Palestinians to cope with their chronic daily collective suffering.

For Mohammad, Samud is closely related to the more familiar (to me, at any rate) idea of resilience. Or, more properly put, Samud connects to social ecological variants of resilience which place as much emphasis on the social and cultural as they do on the individual.

I’ll stop here and leave people to download and read this new paper for themselves. For those interested, Mohammad, Aled and I are working on further publications from this doctorate: so more will follow in due course.

Bus blogging

Time, just about, to use a bus journey across Cardiff en route to the University Hospital of Wales site (for the purposes of teaching) to post an update on recent activities.

There’s lots to say. Projects I’ve blogged about on this site (COCAPP, COCAPP-A, Plan4Recovery) are now being written up. Our main findings paper from COCAPP appears imminently in BMC Psychiatry. Alan Simpson, as lead author, completed checking the proofs of this in the last few days so we know it’s on its way. Michael Coffey has lead authored a COCAPP paper addressing risk; earlier this week this was accepted for publication in Health Expectations. Further papers will follow, as they will in the future from COCAPP-A. I’ll make a point of posting about each as they appear. Plan4Recovery has been about shared decision-making and social approaches to care, and here, too, work on a first publication is well underway. 

Meanwhile, Therapeutic skills for mental health nurses edited by Nicola Evans and me has just been published by Open University Press. This is a fine text indeed (though I say so myself), which we hope proves particular useful to students.

A big highlight of the last few weeks has been the award of a doctorate to my colleague and (now former) student Pauline Tang. Pauline used qualitative methods to investigate the use of electronic patient records in a medical assessment unit, and you can read her thesis here. And talking of doctorates: Mohammad Marie, writing with Aled Jones and me, has a second paper from his study of resilience in Palestinian community mental health nurses about to appear: this one in the International Journal of Mental Health Nursing

Right! I’m off the bus and walking to a classroom. Time to fly, and to remind myself that it is perhaps better to post more frequently than to cram so much into a single, short, piece like this. 

Mental health needs and services in Palestine

Mohammad Marie, Aled Jones and I have co-authored a paper arising from Mohammad’s PhD. This appears in the gold open access International Journal of Mental Health Systems, and a copy can be downloaded by following this link.

The article is titled Mental health needs and services in the West Bank, Palestine and has this for an abstract:

Background: Palestine is a low income country with scarce resources, which is seeking independence. This paper discusses the high levels of mental health need found amongst Palestinian people, and examines services, education and research in this area with particular attention paid to the West Bank.
Methods: CINAHL, PubMed, and Science Direct were used to search for materials.
Results and conclusion: Evidence from this review is that there is a necessity to increase the availability and quality of mental health care. Mental health policy and services in Palestine need development in order to better meet the needs of service users and professionals. It is essential to raise awareness of mental health and increase the integration of mental health services with other areas of health care. Civilians need their basic human needs met, including having freedom of movement and seeing an end to the occupation. There is a need to enhance the resilience and
capacity of community mental health teams. There is a need to increase resources and offer more support, up-to-date training and supervision to mental health teams.

Further papers from Mohammad’s study will follow, and I’ll aim to post updates as work progresses.

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.

Resilience and community mental health nursing in Palestine

With his permission, let me introduce you to Mohammad Marie. I know Mohammad as a PhD student in the Cardiff School of Nursing and Midwifery Studies. He is also a mental health nurse and teacher, who (when he isn’t attending to his thesis in south Wales) works at An-Najah National University in Nablus, in the Palestinian West Bank.

Mohammad is interested in resilience, both generally and in community mental health nurses in particular. Through his writing I have gained a glimpse of mental health needs and services in the occupied Palestinian territories, and of the day-to-day realities of living and providing health care in this part of the world. Quite rightly, nurses in the UK complain about lacking resources, of coping with high caseloads and of the dangers of burnout. Here, however, we can barely comprehend the enormity of the challenge facing those who do nursing in Palestine. Human rights are violated, and free movement restricted. Access to medicines is limited, and rates of trauma and mental ill-health high. Few practitioners have had opportunities to develop knowledge and skills specific to the provision of mental health care. For readers wanting to know more, the World Health Organization has made available information on health and health services in Palestine here.

A simple question drives Mohammad’s study: given their circumstances, what are the sources of resilience which help community mental health nurses continue in their caring work? As part of laying out the background to his project Mohammad has introduced me to the uniquely Palestinian concept of ‘samud’. ‘Samud’ and ‘resilience’ look, to me, to be close cousins, with the former referring to steadfastness in the face of adversity. It manifests in individual and social action, as well as in specific policy (for example, to support the development of an infrastructure for public services). From what Mohammad tells me, samud has become an important part of Palestinian culture and identity.

To get answers to his research question, Mohammad returned home last year to generate data. In ethnographic style he observed nurses and other staff going about their day-to-day tasks, basing himself in a series of government and non-governmental community mental health centres. He read local documents relating to the organisation of services. In order to explore nurses’ experiences and views in depth, Mohammad conducted detailed interviews with a sample of practitioners. The absolute number of participants in this phase was modest, but still a majority of the total population of community mental health nurses working in the West Bank.

Right now Mohammad is surrounded by transcripts and notes, doing his best to make sense of everything he has seen, read and heard. It’s for him to tell the story of his findings, but I know these will be both interesting and important. I’m looking forward.

Snow, research and higher degrees

Red weather warningToday brought the predicted dollop of snow, meaning that yesterday there was no bread to be had in the shops. See this Met Office map of the UK, with its colour-coded weather warnings? See the red blob? That’s where I live, and where I am now.

This has been an interesting, and particularly research-oriented, working week. I spent part of Monday with a group of postgraduates, discussing processes for the review and approval of research and other projects. It has to be said that the opportunities for MSc students to complete small-scale data-generating studies are fewer than they once were, particularly if their plans are to generate data in the NHS. The time needed to secure R&D and research ethics approval can take a serious chunk out of the typical student’s period of candidature. Now, unless studies can be shown to be linked to larger research endeavours there’s also a fair chance that some NHS organisations will want to levy charges for processing R&D applications and for consuming their resources. As I ended up telling this particular MSc group, for NHS governance purposes there are also fine distinctions sometimes to be made between ‘research’ and other activities (like ‘service evaluation’ and ‘audit’) which, on the face of it, can look pretty ‘research-y’.

Monday also brought a meeting with second year, undergraduate, pre-registration mental health nursing students. That was nice, and we got to talk about all manner of things: the history of mental health nursing, developments in local services, experiences of practice.

Tuesday brought a project advisory group meeting chaired by Professor Billie Hunter. Billie’s study is funded by the Royal College of Midwives, and is examining midwives’ resilience. It’s interesting both methodologically and substantively, and one of the things I’m learning about is the generation of research data using social media.

Wednesday was an unusual day, involving a trip to another university to examine a doctoral thesis. People often have lots to say about preparing for vivas from the student point of view, and in every university there will be stories to be heard about students’ (good and bad) doctoral examination experiences. Less is said about the experiences of examiners. In my view the invitation to examine a doctorate is an honour, and the occasion demands careful preparation. After all, we’re talking here about the culmination of years of work, folks. On this week’s and on the few other occasions in which I have examined I have, I hope, combined rigorous enquiry with respectful courtesy. This is certainly how my examiners were on the day of my viva, I’m pleased to say.

Thursday (yesterday) began with a meeting to review a contract, connected to a funded research project I’m involved in which formally commences at the start of next month. I learnt some new stuff along the way, including the distinctions between ‘background’ and ‘foreground’ intellectual property and copyright. Michael Coffey, Aled Jones, Jennifer Egbunike and I met to make practical plans for a segment of another project, led by Alan Simpson. This study is also involving Alison Faulkner (whose website, if she has one, I do not know), Jitka Jancova and (soon) Sally Barlow. All very productive and interesting, and I was pleased to round off the day in the office with an expected conversation with the clinical psychologist, Andrew Vidgen, about his work in early intervention in psychosis, my Connections and consequences paper, and a few other things besides.

January 18th 2013And today the snow came (check out this photo, revealing the red blob’s local snowfall), and as anticipated a large thesis chunk to read and review from my esteemed colleague, Pauline Tang, who is also a research student. Pauline is interested in the use of electronic patient records, and I am again reminded of the discipline and hard work required by part-time doctoral students who have to combine their studies with the day job. The equally esteemed Jane Davies, my longstanding friend and colleague and now a full time (pretty much) PhD student, also sent me some interesting initial reflections relating to her planned study of decision-making in adolescent cancer.

Running looks out of the question this weekend, and, for all I know, the coming week. Today’s deep snow will be tomorrow’s ice, and that stuff’s not to be run on. Long walks look a tantalising possibility, though.