Tag: student nurses

Multiple Mini Interviews

Over the weekend I was sorry to learn that Inspector Michael Brown’s much-respected, and award winning, MentalHealthCop blog and twitter account have been suspended. I hope he is able to get back to both in the very near future.

Meanwhile, back at base I spent pretty much all of today helping select future students of nursing using multiple mini interviews (MMIs). Not sure about MMIs? Neither was I until recently. Here’s what we’re saying about them in the School of Healthcare Sciences at Cardiff University:

The interviews at Cardiff University School of Health Care Sciences for Nursing involve the use of a Multi Mini Interview procedure which is based on the Objective Structured Clinical Examination format that is commonly used by Health Sciences programmes to evaluate clinical competence.

The interview process is an opportunity to assess interviewees in person and assess information, such as personal qualities, that is not readily forthcoming in traditional application processes. The majority of these interviews will take place the week commencing 17 February 2014. 

The MMIs are made up of a series of short, carefully timed interview stations which provide information about applicants’ ability to think on their feet, critically appraise information, communicate ideas and demonstrate that they have thought about some of the issues that are important to the nursing profession. There are six stations in total. Each mini interview lasts a maximum of 5 minutes.

The School assesses the ability to apply general knowledge to issues relevant to the culture and society in which students will be practising, should they be successful in gaining admission to (and ultimately graduating from) the School. Equally important will be an assessment of the ability to communicate and defend personal opinions.

That’s pretty much it in a nutshell. Sticking to time is clearly important, and there’s plenty of moving around for applicants as they shuttle from station to station. As a process I rather liked it. I’ll be back for another slice of the same tomorrow, but will spare a thought for my esteemed Mental Health Nurse Academics UK colleagues who will be meeting at Lincoln University.

Catching up post

Plenty going on in the last week or so. I had the chance to join pre-registration mental health nurses and occupational therapists for a second day as they made preparations for an interprofessional event scheduled for early December. Some of these students have also been giving me drafts of assessed work to comment on, but as the deadline for receipt of these is first thing next week I expect a deluge then. ’twas ever thus.

Elsewhere there has been RiSC reviewing to crack on with, assignment marking, and peer review reports to both consider and write. I’ve also put myself in the frame to act as a reviewer for another university’s proposed new MSc mental health programme, this being the kind of curriculum work I haven’t had the chance to do for a while.

I’m not normally one for formal, suit-and-boot, events, but made an exception last Wednesday (November 27th) to join a posse of colleagues from the School of Healthcare Sciences at the RCN Wales Nurse of the Year awards. These took place at Cardiff City Hall, and the overall winner was Cardiff and Vale UHB ward sister Ruth Owens. Congratulations, Ruth. Congratulations, too, to the individual category winners: including Andy Lodwick (also from Cardiff and Vale) for picking up the Mental Health and Learning Disabilities award and Dr Carolyn Middleton, doctoral graduate from what was the Cardiff School of Nursing and Midwifery Studies, for winning the Research in Nursing award.

This week also brought me to a meeting of the MHRNC Service User and Carer Partnership Research Development Group and, yesterday morning, to the Cardiff City Stadium for an open meeting to discuss NISCHR’s infrastructure and programme funding review. Both were lively events, and on the NISCHR front I see big changes ahead from 2015.

And to close this summary post: via the twitter grapevine I see that the RCN is now giving early notification of the Network for Psychiatric Nursing Research 2014 conference. This will take place at Warwick University on the 18th and 19th of September. I’ll post a link to the call for abstracts once this appears, but for now will reproduce this extract from the event website:

This year [2014] is the 20th international NPNR conference and it’s going to be a celebration.

We wish to celebrate and promote some of the outstanding mental health nursing research that shapes mental health policy and nursing practice across the world. We will also acknowledge some of the best psychiatric and mental health nursing research that helped create the strong foundation for our work today. And we will invite delegates to look ahead to map out the future for mental health nursing research, education and practice.

Standard professions?

The Times Higher Education reports this week on comments made by Vince Cable at an event hosted by the Sutton Trust. According to the THE, the Business Secretary:

[…] has criticised the “qualification inflation” that means entrants to “very standard” professions such as nursing require a degree.

In truth I find the THE‘s report a little disjointed, as elsewhere it quotes Vince Cable on a host of other matters including private schooling, support for postgraduate study and the promotion of social mobility.

But I understand enough of it to take issue with the Business Secretary’s side-swipe at graduate nurses. On what grounds might we distinguish ‘standard’ from ‘elite’ professions, or sustain the argument that only those joining the latter must of necessity possess degrees? We await an explanation. In the meantime, for a considered review of nursing education I refer readers to the report of the Willis Commission, which I wrote about on this blog last year. For a research-oriented post on the division of labour in health care (and particularly, on professions in the mental health field), try this post.

Writing an undergraduate dissertation

Here’s a link to a full-text green open access version of a paper called Preparing and writing an undergraduate dissertation. Philip Burnard and I published this in Nurse Education in Practice in 2001. Our aim was to produce something of practical use to students working on what is, typically, their single biggest piece of written work.

I appreciate that my timing here is very poor. Right now most students will be on, or planning for, their summer holidays. So I’ll draw attention to this paper again once the new academic year has started.

Jobs for new nurses

One of the things I’ve been doing recently is meeting up with final year students about to complete their degrees and register with the Nursing and Midwifery Council. These are hard-working, committed, people who have chosen to prepare for careers in mental health nursing. They’re now looking for jobs, and from what I’m hearing opportunities locally and nationally are few and far between.

Here, then, is the sharp end of NHS underfunding. There’s no question that new mental health nurses are required. In fact, we should expect demand to increase at a time of hardship. The problem is that vacancies are being frozen and services are generally retracting. As economic collapse fuels distress and increases need austerity bleeds public services of the capacity to respond.

So, good luck to everyone preparing to qualify. I hope you get the jobs you want and deserve, because you’re needed.

Nursing beleaguered?

Catching my eye earlier this week was an interview in The Guardian with Jane Cummings, Chief Nursing Officer (CNO) with a place on NHS England‘s National Commissioning Board. Under the header, ‘Nobody can say care is brilliant all the time’ the article opened with this understated quote:

‘It was very clear that nursing was getting a bit of a bad name and it felt like the profession was being quite beleaguered and criticised.’

Nursing certainly has been under siege. Responses to descriptions of poor care have included the three year Compassion in Practice strategy introduced by the CNO and her Director of Nursing counterpart at the Department of Health, Viv Bennett. It is in this document that the 6Cs are described:

It is also in this general context, but specifically following the publication of the Francis Report into Mid Staffordshire NHS Foundation Trust, that the proposal was made that student nurses should spend a year doing health care assistant (HCA) work before beginning their training. This government plan has proven mightily controversial, and when announced provoked immediate broadsides from (amongst others) June Girvin (a nurse, and Pro Vice Chancellor at Oxford Brookes University) and Jackie Kirkham (a health visitor and researcher at Edinburgh University). Now it has drawn a closely referenced rebuttal from the Council of Deans of Health. Here is what the Council says in its conclusion:

The proposals for HCA experience prior to joining a pre-registration nursing programme are underpinned by a set of assumptions about nursing education and selection of prospective students that is deeply flawed. It paints a picture of students who have never had experience of caring and little interest in patient care, picked out for their grades by a group of academics in total isolation from staff working in clinical services. The message from current practices and the NMC Standards that govern them is that this mental picture needs to change. In particular, the assumption that students are not recruited for their values and that students do not have prior care experience are incorrect.

What about the nub of the proposal: that exposure to the clinical frontline as a HCA will create better nurses? The evidence here is equivocal at best. What care experience does seem to do is give prospective students exposure to the reality of working in healthcare and so it may reduce attrition from programmes. But there is also evidence that working as a HCA can socialise prospective students into poor practice and inhibit their development as nurses. Unless the evidence is looked at carefully, these proposals could therefore embed rather than challenge poor patient care. As the pilots of the proposals are developed, care must be taken both to recognise existing practice and carefully test assumptions against the evidence.

So, nursing practice and nursing education are in the spotlight, and the profession has responded. Senior members have asserted a set of fundamental values (the 6Cs), and in resisting the year-as-an-HCA idea have reminded people of the differences between what nurses and other health care workers do.

Nurses discomforted by this heightened scrutiny might consider their position alongside that of other public services workers. Social workers draw attention to the problem they face of being ‘damned if they do and damned if they don’t’. Then there are teachers, who fear the erosion of their professional standing as former servicemen and women prepare to enter the classroom without having to study for degrees. Back in the health service, some doctors (psychiatrists, in this instance) express concern over threats to their role and identity, whilst the profession as a whole is accused of greed.

We are therefore in good company. Other workers know what it is like to be told they have collectively fallen short, and understand how it feels to have their status undermined. Status-knocking sometimes happens because professional groups engage in ongoing division of labour skirmishes, as I have drawn attention to on this site before. But nursing’s current predicament, in which we are charged with having a ‘compassion deficit’ and sacrificing a commitment to care in the pursuit of academic credentials, is different.

Perhaps nurses have finally lost enough of the untouchable, ‘angel’, image (no bad thing, in my view) to now be viewed as ‘just’ another professional group in whom trust is conditional. We control entry to our profession, expect degrees from new entrants, have university departments and lead interprofessional teams and whole services within the NHS. In turn, we must expect to face questions when things go wrong, and to justify why we do practice and education in the ways that we do. For the record, I strongly favour system explanations for what happens in the health service (including its failures), see no evidence that student nurses no longer care and much prefer practitioners to be educated than not. But I also think we must expect, and should prepare for, more ‘bashing’ in the future.

Exam time

For students up and down the country it is examination season. Whilst students of mental health nursing are busy submitting their dissertations, writing up their reflective essays and achieving their practice-based ‘competencies’ I thought it might be interesting to share the ‘Regulations for the Training and Examination of Candidates for the Certificate of Proficiency in Nursing and Attending on the Insane’. I have scanned these from my copy of the Red Handbook:

In uploading these pages I have just noticed the mention (on page 147, the last-but-one reproduced above) of ‘Attendance of the insane in private houses’. Is it stretching things too far to suggest this as an early reference to community mental health nursing?

I also notice how much these regulations refer to the assessment and maintenance of bodily health (although I have no idea whatsoever what might be meant by ‘the insane ear’, a phrase appearing on page 146). Earlier this week, writing in an editorial for the BMJ Graham Thornicroft described the excess mortality of people with mental health problems as ‘a human rights disgrace’. He’s right, and whilst I’m glad we’re out of the age of the asylum and of ‘attending on the insane’ we might yet learn something from an historic nursing syllabus which placed emphasis on the importance of physical well-being.

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.

From ‘The Red Handbook’ to ‘The Art and Science of Mental Health Nursing’

Unbidden, but very welcome nonetheless, a freshly pressed copy of the third edition of Ian Norman and Iain Ryrie’s edited The Art and Science of Mental Health Nursing: a Textbook of Principles and Practice has arrived on my desk. This is a mighty tome indeed, and this latest version promises to cement the book’s status as a ‘must have’ for pre-registration students of mental health nursing.

A rather earlier text I also have a copy of is The Handbook for Attendants on the Insane, which Peter Nolan tells us was first published in 1885. This was the first book produced in the UK for the express purpose of instructing people we now uniformly call mental health nurses, and was produced at the instigation of the Medico-Psychological Association (MPA). The MPA later became the Royal Medico-Psychological Association, and eventually the Royal College of Psychiatrists.

No sooner had the Red Handbook (as it was often referred to) appeared than questions were being asked about the wisdom of educating attendants. This is a point Henry Rollin makes in this paper marking the centenary of the Handbook’s publication. In this extract, Rollin quotes from an (unnamed) reviewer writing in the Journal of Mental Science (now the British Journal of Psychiatry) in the year the Handbook went to print:

“We are not quite sure ourselves whether it is necessary or wise to attempt to convey instructions in physiology, etc., to ordinary attendants. Will they be the better equipped for their duties for being told that the brain consists of grey and white matter and cement substance?”, writes the anonymous reviewer. He adjusts his elegant pince-nez and continues, “We hardly see what is to be gained by superficial knowledge of this kind”.

Goodness knows what this anonymous reviewer would have made of Norman and Ryrie’s 728 pages of analysis, guidance and instruction, let alone the idea that mental health nurses now have to complete an undergraduate degree in order to register and practice.