Andrew McVicar

Service user involvement in postgraduate mental health education. Does it benefit practice

Background and Aims: Few universities involve service users in the presentation of postgraduate mental health education. This retrospective study evaluates their influence on Masters students within a course that has done so for several years. Method: Questionnaires were sent to all students who had completed Masters-level modules that had substantial user involvement. All students were experienced practitioners, and currently employed. The modules, and courses of which they are a component, were designed in 1993/94 by educationalists and senior representatives of user groups, and continue to be managed and monitored by personnel who include senior user representatives. Twenty-six out of 41 questionnaires were returned and 10 of these respondents were also later interviewed by telephone. Results: Most respondents (79%) were very enthused by the user contributions; none considered their involvement was poor. A majority (87%) felt that they had benefited personally and professionally from the involvement of service users in the programme. Most significantly, from the perspective of postgraduate study outcomes and practice development, many had implemented user-focused initiatives in their practice as a consequence of undertaking their studies. Conclusions: The findings suggest that a contribution by service users to postgraduate programmes can motivate practitioners to implement changes to their practice in innovative ways. Declaration of Interest: None.

Exploring the development of action research in nursing and social care in the UK: A comparative bibliometric review of action research designs in social work (2000–2010)

Action research is promoted in the UK as a vehicle for practice development in health and social care, but its application has not been evaluated. This study reviews research designs in published social work studies, 2000–2010. Applying the analytic strategy of Munn-Giddings et al. (2008) also enabled comparison to be made with nursing action research. Action research has a strong presence in social work. Studies were highly collaborative, mainly qualitative and largely focused on practice or educational development, though user-focused change had a presence. Participant groups generally were ‘active’ in the research process, but participation by academics was low. In contrast, authorship was dominated by academics. External funding suggested an attractiveness of action research to funders. Action research in social work shared similarities with nursing. Main differences were involvement of the voluntary sector, the favouring of interactive group working, and a greater likelihood of service users being co-researchers. Of most concern is the lack of authorship (and by implication, ownership) by practitioners or service users. This is contrary to the underpinning inclusive philosophy, and researchers should be more proactive in acknowledging the contribution of individuals, groups or organizations, as appropriate, and so evidence their growth in research capability and capacity.

Workplace stress interventions using participatory action research designs

Purpose – Complex collaborative interventions are increasingly applied for stress management but outcomes are inconsistent. “Collaboration” is most highly developed in participatory action research (PAR). Future research might be guided by understanding features integral to successful PAR designs. The purpose of this paper is to present a review of PAR studies which had predominantly positive outcomes, in order to identify features of their designs.Design/methodology/approach – In total, 48 collaborative intervention studies (1982‐2010) were identified, and filtered according to positive outcomes (improved working environment, job performance, absenteeism, and stress levels), and PAR criteria for stakeholder engagement: 11 studies from six countries were selected for scoping review.Findings – Organization size and sector was not important for PAR, but the extent of uptake of an intervention/change is and a “unit” of up to 100 employees was engaged in most of the studies reviewed. Study aims should not be ...

Cough strength, secretions and extubation outcome in burn patients who have passed a spontaneous breathing trial.

The aim of this study was to develop a clinical prediction model to inform decisions about the timing of extubation in burn patients who have passed a spontaneous breathing trial (SBT). Rapid shallow breathing index, voluntary cough peak flow (CPF) and endotracheal secretions were measured after each patient had passed a SBT and just prior to extubation. We used multiple logistic regression analysis to identify variables that predict extubation outcome. Seventeen patients failed their first trials of extubation (14%). CPF and endotracheal secretions are strongly associated with extubation outcome (p<0.0001). Patients with CPF ≤60 L/min are 9 times as likely to fail extubation as those with CPF >60 L/min (risk ratio=9.1). Patients with abundant endotracheal secretions are 8 times as likely to fail extubation compared to those with no, mild and moderate endotracheal secretions (risk ratio=8). Our clinical prediction model combining CPF and endotracheal secretions has strong predictive capacity for extubation outcome (area under receiver operating characteristic curve=0.96, 95% confidence interval 0.91-0.99) and therefore may be useful to predict which patients will succeed or fail extubation after passing a SBT.

Research capability in doctoral training Evidence for increased diversity of skills in nursing research

Rationale:Doctoral training should provide insight into the evolution of research capability in nursing. Methods:Research designs were evaluated from abstracts of 204 theses extracted from the ASLIB database, 1983–2002. Most were from PhD/DPhil degrees, but a few were Professional Doctorates. Findings:‘Educational’ and ‘organisational’ settings dominated, indicating their sustained popularity. A total of 11 methodological frameworks were noted, with ‘Ethnography’, ‘Social history’, ‘Work environment’ and ‘Grounded theory’ being the most popular. ‘Interviews’ with individuals and ‘Questionnaire survey’ were easily the most popular of 28 different research tools/techniques. Comparing abstracts from 1997–2002 with those from 1983–1996 identified significant changes in methodologies and methods used. The frequency of ‘Phenomenology’, ‘Work environment’ and ‘Grounded theory’ methodologies increased. The ‘Patient led’ framework appeared for the first time, albeit in just a few theses. The incidence of ‘Ethnography’ declined. Some methods only appeared for the first time during the 1990s, e.g. ‘Focus groups’. Of the methods, ‘Interviews’ increased substantially but ‘Questionnaires’ decreased slightly. In terms of developing clinical research, we noted an increased frequency of ‘All experimental’ methods. Multiple methods, used in 71% of theses overall, increased in incidence during the late 1990s, a change that was significantly associated with ‘post-1992’ universities. Over time, there was a significant increase in the number of methodologies and methods used, per thesis. Conclusions:This study documents the breadth of research designs used by students researching nursing. It provides evidence for an evolution of designs with an increasing diversity that indicates a growing maturity of nursing research culture.

The incidence and outcome of extubation failure in burn intensive care patients.

To identify the incidence and outcome of extubation failure in patients with burn. Retrospective cohort study in a tertiary burn intensive care unit. A review of the casenotes of 132 consecutive adult patients with burn admitted between 2001 and 2005, and requiring mechanical ventilation for >24 hours, was undertaken. Sixty-seven patients underwent extubation and entered data analyses. Extubation failure was defined as reintubation within 48 hours. The outcomes of interest were incidence and cause of extubation failure, duration of mechanical ventilation (DMV), length of stay (LOS), and mortality. The patients who succeeded and failed extubation were similar in terms of age, sex, burn size (P = .3), and incidence of inhalation injury (P = .1). Of 67 planned extubations, 20 (30%) failed. DMV (22.5 vs. 4 days; P < .001), intensive care LOS (1.20 vs. 0.41 days/% burn; P < .001), and hospital LOS (1.90 vs. 1.18 days/ % burn; P < .003) were significantly longer in reintubated patients when compared with those who extubated successfully. Extubation outcome, burn size, and age provided the best predictive model for patient outcome (P = .02), but extubation outcome was the only predictor that operated individually (P = .05). The aetiology of extubation failure in 15 (75%) patients was poor pulmonary toilet. The incidence of extubation failure in this homogenous population of patients with burn is higher than general intensive care patients (30% vs. 4–23%). The DMV, lengths of intensive care, and hospital stay are significantly longer in patients who failed extubation. In addition to burn size and age, extubation outcome is an important predictor of intensive care mortality. The indication for reintubation in most patients is poor airway clearance.

The Management Standards Indicator Tool and evaluation of burnout.

BACKGROUND Psychosocial hazards in the workplace can impact upon employee health. The UK Health and Safety Executives (HSE) Management Standards Indicator Tool (MSIT) appears to have utility in relation to health impacts but we were unable to find studies relating it to burnout. AIMS To explore the utility of the MSIT in evaluating risk of burnout assessed by the Maslach Burnout Inventory-General Survey (MBI-GS). METHODS This was a cross-sectional survey of 128 borough council employees. MSIT data were analysed according to MSIT and MBI-GS threshold scores and by using multivariate linear regression with MBI-GS factors as dependent variables. RESULTS MSIT factor scores were gradated according to categories of risk of burnout according to published MBI-GS thresholds, and identified priority workplace concerns as demands, relationships, role and change. These factors also featured as significant independent variables, with control, in outcomes of the regression analysis. Exhaustion was associated with demands and control (adjusted R (2) = 0.331); cynicism was associated with change, role and demands (adjusted R (2) =0.429); and professional efficacy was associated with managerial support, role, control and demands (adjusted R (2) = 0.413). CONCLUSIONS MSIT analysis generally has congruence with MBI-GS assessment of burnout. The identification of control within regression models but not as a priority concern in the MSIT analysis could suggest an issue of the setting of the MSIT thresholds for this factor, but verification requires a much larger study. Incorporation of relationship, role and change into the MSIT, missing from other conventional tools, appeared to add to its validity.

Biology of Stress Revisited: Intracellular Mechanisms and the Conceptualization of Stress

Application of allostatic theory to stress during the 1990s refocused attention on internal responses to a perceived hazard, and the last 20 years has seen considerable developments in the biological contexts of stress. Evidence from neuroscience now suggests that secretion of the hormone cortisol is not only stimulated by the outcomes of cognitive transaction but it also feeds back and contributes positively to the cognitive adaptation that is a feature of stress resilience. More recently, the operative intracellular mechanisms are beginning to be understood and provide an insight into the regulation and maintenance of intracellular homeostasis that underpins adaptive change and vulnerability. The maintenance or appropriate modulation of intracellular homeostasis usually provides a buffering of potential adverse interactions. However, the capacity to do so is diminished during chronic stress leading to intracellular and subsequently systemic, homeostatic failure and hence maladaptation. This area of research seems far removed from cognitive theory, but placing intracellular homeostasis at the core of cognitive and biological responses supports the concept of stress as a genuinely psycho-biological phenomenon.

A shared experience: an interdisciplinary professional doctorate in health and social care

This paper describes the development of an innovative interprofessional doctorate in health and social care, within an academic framework designed explicitly to ensure that candidates must demonstrate qualities of cognitive application commensurate with doctoral study, yet must also meet the practice‐focused outcomes of a professional doctorate. The degree requires students to attend highly interactive workshops in Stage 1 that encourage academic debate and ‘doctoral’ development, in contrast to the ‘taught’ modular elements of many other professional doctorates. Papers submitted during Stage 1 assume increasing levels of complex doctoral skills in developing a research proposal that undergoes the same rigorous evaluation required of PhD students in securing University Approval. The degree is awarded at the end of Stage 2 only after defence of a thesis in a viva voce examination that involves procedures and processes defined by the University for the award of PhD.

Older people as researchers - why not? An overview of a partnership project to train older people to be researchers

Malcolm Ramsays article looked at the empowerment of older people through good advice and information. Continuing this theme in our next article, Carol Munn‐Giddings et al describe a unique project that has equipped older people with the necessary research skills to go after the information themselves and is giving them the confidence to directly shape local services. Providers and commissioners ‐ beware!