16th international NPNR conference, 22 - 23 September 2010

Collaborative research and partnership working

It’s not without reason that Oxford is known as the city of dreaming spires, a term coined by poet Matthew Arnold in reference to the harmonious architecture of Oxford's university buildings, the oldest university in the English-speaking world. Despite its age and the fact that Arnold’s epithet was coined a long time ago Oxford remains a beautiful place, apart that is from a few more modern university buildings that Arnold might have considered inappropriate or unworthy of being permitted to nestle against their older and more dignified forebears. It is a place that oozes scholarly activity and research where one can’t help but feel that the opportunity to study in such an inspirational and historic seat of learning is guaranteed to lead to success in academia, politics, the arts or any other domain one cares to mention. Even the grey-gowned squirrels frolicking in the university parks in the early morning mist in autumn appear to be secreting, or excavating, their food stores with the rigour associated with a randomised controlled trial.

The Network for Psychiatric Nursing Research (NPNR) is extremely fond of Oxford and delegates for its annual conference have been making the journey to Oxford every September for sixteen years. That’s approximately two thousand people involved with psychiatric and mental health nursing - and people who have used services - who have attended the NPNR conference to present their research, seek help with their work in progress or learn from the endeavours of others – forgive some double counting for all those who are serial attendees who come every year, of which there are many.

As Professor Len Bowers, who has attended every NPNR conference to date, points out, ‘it’s the best conference, the only research conference in the world focused on mental health nursing’.

For the sixteenth NPNR conference - now organised collaboratively with the Royal College of Nursing and Mental Health Nurse Academics (UK) - held on September 22nd and 23rd 2010 there was a break with tradition. The event was held, not in its usual, and popular, home of Saint Catherine’s – a mere stripling college founded in 1962 – but in the extremely handsome and venerable Wadham College, which this year celebrated its 400th birthday and boasts amongst its early members Robert Blake – who was Cromwell’s admiral - C. B. Fry and Sir Thomas Beecham in the 1890’s, the latter more briefly, before he forsook Wadham to pursue his musical career. Cecil Day-Lewis went up to Oxford in 1923, Michael Foot in 1931 and Alan Coren, Rowan Williams and Melvyn Bragg were, comparatively, more recent members of the college. Many of the NPNR delegates were clearly stunned by the beauty of the buildings and in awe of the history-laden environment of Wadham College.

On the first day of the conference delegates and speakers from the UK, Ireland, Australia, South Africa, Japan, Thailand, Denmark and Finland assembled in the college’s Holywell Music Room, which opened in 1748 and where Haydn and Handel both performed. This provided a very different backdrop for a nursing conference’s plenary sessions, and one which nurses will seldom have the experience of enjoying, with its u-shaped, raked, seating and an organ, a harpsichord and a piano on the raised platform.

Russell Ashmore, Senior Lecturer at Sheffield Hallam University and another stalwart of every NPNR event and conference steering group member, welcomed delegates and pointed out that the conference was as well supported as ever despite financial uncertainties affecting health providing organisations and universities. He suggested that the annual pilgrimage to Oxford symbolically mirrored the increasing academic prowess of nurses. He drew attention to the friendliness of the conference and how it has supported new researchers, always reflected the agendas of mental health nursing and helped to shape its future and never shied away from discussing and addressing controversial issues. He commented that NPNR has always been about partnerships in research, friendships and collaborations, sentiments that were captured in the event’s title.

The first keynote address was given by David Richards, Professor of mental health services research in the School of Psychology’s mood disorder’s centre at the University of Exeter.

Professor Richards runs a multi-centre research team, the results of which have been fundamental to the organisational, educational and low-intensity clinical methods at the heart of the Department of Health’s Improving Access to Psychological Therapies programme - more widely referred to as IAPT and which has been funded to the tune of £300m. This programme is designed to address the under-provision of evidence-based psychological therapies by training 3,600 new therapists – 33% of whom are nurses - in England between 2008 and 2011 and with the aim of enabling 900,000 more people to access treatment, with half of those engaging in treatment and moving to recovery resulting in 25,000 fewer on sick pay and benefits by 2010/11.

Professor Richards acknowledged some of the controversies that have surrounded this programme through his political, moral and scientific commentary on what has been achieved to date. He spoke about issues of equity of access to the programme, the stepped-care model used and the high-volume, evidence and competency based treatments being deployed for all severities of anxiety and depression and the use of routine outcome measures. He described it as an outrage that prior to 2007 only 5% of people requiring access to psychological therapies were able to obtain them. He offered some interesting remarks about how people need information and support to assist them to actually access therapies and treatment – choice is irrelevant without information which is accurate. He reminded delegates of George Bernard Shaw’s remark from 1911 that ‘all professions are conspiracies against the laity’ and suggested that professionals are often a barrier to people getting help. He pointed out that whilst we know that psychological therapies are helpful few people access them and that only 38% of the referred population actually receive a treatment from start to finish.

His research reveals that IAPT, a national programme, is not delivering a national pattern and that IAPT services are full of variation in terms of clinical outcomes. Whilst it is known, he said, that psychological therapies are helpful we are hopeless at implementing them and have difficulty transferring findings from bench to bedside.

Another keynote speaker, Vanessa Pinfold, Deputy Director of Knowledge at Rethink, picked up this theme of implementation. She spoke about translating collaborative mental health research, the difficulties of getting research into practice and the value that the third sector can add to research. Too often, she said, there were transitional gaps, quality chasms and pipeline malfunctions, which conspired to prevent implementation. She, with the research team at Rethink, has sought to collaborate with many institutions and other research teams to conduct studies to progress practical solutions to challenges faced by mental health service users and carers. These include a physical health check tool, an on-line learning resource to improve best practice in information sharing between practitioners and carers and a series of reports detailing ‘recovery insights’ from a team of service user researchers and the production of a publication titled 100 ways to support recovery. Recovery research has to show that it works, she said, otherwise we won’t move forward with it and that it was important to unlock research information and turn it into learning programmes and other resources and being persistent about implementation.

Keynote speakers do much to enhance good conferences. They can inspire, set the policy context, bring insights in to their substantial research activities, arouse an audience with their perceptions, display their values and reveal the lens through which they view things. However, what makes NNPR so successful is the rich and eclectic mix of concurrent sessions and poster presentations that are provided by delegate presenters, who are positioned anywhere on the continuum from novice inquirer to expert researcher. This year was no exception and sixty-nine concurrent sessions and three workshops were available for delegates to attend and twelve posters for them to peruse, which collectively addressed all manner of research, education, practice and innovation issues, with many of them demonstrating success in bringing things from bench to bedside. Some of these were focused on acute inpatient mental health wards, which all too often only have a conference limelight beamed upon them when yet another piece of research purports to find that all mental health wards are worse than Hades and all the staff who work in them are burnt out, cynical, uncaring mental health nurses who should be suspended by their feet from an Oxford spire forthwith. So here are two examples of NPNR concurrent sessions that contribute to the exploding of such myths.

Fiona Nolan and Charlotte Kirton are mental health nurse researchers from the Camden and Islington NHS Foundation Trust who are leading a study that has received funding of £250,000 from the Research for Patient Benefit funding stream. They described in their concurrent session how their mixed methods study will evaluate Protected Engagement Time (PET) for patients in acute mental health inpatient wards in England.

As they pointed out there is considerable literature highlighting a lack of contact between ward staff and patients, a lack of ward-based therapeutic focus and accounts of patients feeling unsafe. However, PET places the relationship between staff and patients at the centre of all ward activity and recognises that interaction time is needed. It should take place at regular times, weekly or daily, and is conducted by closing the ward to visitors and relieving staff from the burden of administrative activities.

Examples of services introducing PET can be quite widely found but interest has stemmed, suggested Fiona and Charlotte, from anecdote rather than research. This is what their study seeks to address through a national survey investigating how widespread PET is in England and how it has been implemented, by evaluating the effects of PET on patients and by conducting in-depth case studies on three wards, based on a hypothesis that PET improves patient satisfaction, provides a calmer ward environment and reduces staff burnout.

Fiona and Charlotte will doubtless, like many other presenters before them, return to NPNR to share their progress and findings – and importantly how they will be implemented - to an appreciative, supportive and appropriately challenging audience in the future.

Professor of Collaborative Mental Health Nursing, Alan Simpson, from City University, London and Marion Janner, Director of Bright UK presented a concurrent session on the results and ramifications of the, engagingly titled, ‘stupidly big Star Wards survey 2009’.

Star Wards works collaboratively with the full range of mental health wards from acute admission to high secure environments to improve the experiences and outcomes of patients through the use of seventy-five practical, low cost and easy to implement ideas. It also has a role as a catalyst for change through inspiring, collecting and disseminating great practice in inpatient care.

Alan and Marion informed delegates about the survey of five hundred wards that participate in the Star Wards initiative. This revealed an increase in patient-focussed activity, reports of many ward improvements, accounts of the freeing up of time for staff to engage with patients, increases in patient satisfaction, team working and improvements in wards’ environments and their atmosphere and a decrease in aggression.

Marion said that the Star Wards initiative was born out of her own experiences where she found wards lacked therapies and things to do and that Star Wards attempts to change the reputation of inpatient wards and that the good wards are seldom commented on. Every member of staff that turns up for a shift on a ward is a hero, she said, and that using the positive core of an organisation was a foundation for future growth. Alan stated that some Star Wards initiatives were light-hearted but were underpinned by intellectual thought and what has been proven to work.

Conferences are hard work and NPNR is no exception to this. Hence an opportunity to relax, dine together and network at an evening reception and dinner is a popular fixture of this conference. On this occasion it was held in yet another beautiful environment within Wadham College, the ante-chapel and the hall. The hall, one of the largest in Oxford, has a wonderful hammer-beam roof and a Jacobean woodwork entrance screen with portraits of the founders and of distinguished members of the college. One portrait is of Lord Lovelace, who held Oxford for William of Orange during the Revolution of 1688 with an inscription that records his role in freeing England 'from popery and slavery'! Perhaps one day portraits of the lodestones of NPNR Ann Jackson and Julia Jones, and their stalwart supporters - such as Shirley Smoyak who travels from America to attend and share her considerable wisdom, experience and good humour - will look down from a college wall on a future generation of NPNR delegates.

As has become the custom at the NPNR dinner the recipients of the annual Eileen Skellern Award and the Journal of Psychiatric and Mental Health Nursing Lifetime Achievement Award were announced. The cheers of delegates echoed from the hammer-beam roof when Professor Patrick Callaghan and Professor Peter Nolan were declared, respectively, the winners of these prestigious awards, which will be conferred at an event in London in December.

NPNR has long given a platform for researchers to present their journeys towards their PhD. This year Dr Sarah Munro, Head of Nursing and Patient Safety at Cumbria Partnership NHS Foundation Trust described her PhD and told her tale.

Sarah’s initial idea for her research won her a scholarship to undertake a PhD. She explored attitudes amongst mental health nurses and service users in ten NHS trusts using qualitative and quantitative methods during the two stages of her work. Stage one was a regional survey of attitudes and predictors of attitudes of nursing staff on acute mental health wards with 487 questionnaires returned. Stage two was a qualitative study involving interviews with nursing staff and service users to explore in more detail factors that impacted on attitudes and how attitudes impacted on nursing practice, behaviour and service users’ experiences of acute mental health care.

The study found that attitudes of nursing staff do vary and directly impact on nursing practice and the care that nurses provide. It also identified a number of factors that influence the attitudes of staff during their day to day practice. Service users were easily able to identify staff who they believed had negative attitudes.

Sarah described some of the challenges that she had experienced in gaining ethical approval – ‘a traumatic process that was personally distressing – and quite a crushing experience’, which will, arguably, resonate with others. Overall she felt she had been privileged to undertake a PhD and that the skills it provided her with have been far more transferable than she thought they would be, for example, knowing how to apply evidence when developing trust policy and practice. An example of bench to boardroom perhaps.

A surprise prefaced the plenary session given by Professor John Creswell from the University of Nebraska-Lincoln, USA. He had gained access to the piano in the Holywell Music Room and was playing it delightfully as delegates arrived for his interesting address on mixed methods research.

To set the scene John had helpfully conducted an analysis of the research methods used by all the presenters at the conference and said that this had revealed that there were:

He advocated the wider use of mixed methods by NPNR delegates and set out the advantages of doing so, for example, the multiple angle argument, the more evidence the better argument, the community of practice argument – where mixed methods may be the preferred approach in a scholarly community. He also strongly encouraged researchers using mixed methods to show them in diagrammatic form and visual displays to ensure clarity about how they support each other in the research process. Mixed methods are increasingly being used in mental health research, he said, and investigators should be encouraged to use them.

It would have been nice if he had closed his session by demonstrating his mixed method musical skills and played himself out on the magnificent Holywell Music Room organ.

Initial feedback from delegates suggests that this was another highly successful NPNR conference and the steering group would like to thank all those who attended and shared their work and their ideas, all the delegates who chaired concurrent sessions, the RCN conference and events staff and Wadham College for its hospitality and facilities.

The steering group also hope that people will return next year, bringing other aspirant and accomplished mental health nursing researchers with them, to enjoy both the 17th NPNR conference and Oxford.

Cris Allen
Independent mental health nursing adviser, and NPNR conference Steering Group member, email: cris.allen@o2.co.uk