Oonagh Meade

Bringing meaning to user involvement in mental health care planning: a qualitative exploration of service user perspectives

BACKGROUND Service users wish to be involved in care planning but typically feel marginalized in this process. Qualitative explorations of the barriers and enablers of user involvement in mental health care planning are limited. QUESTION How is user involvement in care planning conceptualized by service users and how can meaningful involvement be instilled in the care planning process? METHODS In 2013, we conducted five focus groups (n = 27) and 23 individual interviews with current or recent adult users of secondary care mental health services (n = 27) in England. Eight users participated in both. Data were analysed using Framework Analysis. Results Ten themes emerged from the data: these themes encompassed procedural elements (connection; contribution; currency; care consolidation; and consequence), service user characteristics (capacity and confidence) and professional enablers (consultation; choice; and clarity of expression). Procedural elements were discussed most frequently in service user discourse. DISCUSSION The process of care planning, centred on the user-clinician relationship, is key to user involvement. IMPLICATIONS FOR PRACTICE Users describe a common model of meaningful involvement in care planning. Their requests, summarized through a 10C framework of care planning involvement, provide clear direction for improving service users satisfaction with care planning and enhancing the culture of services.

A cluster randomised controlled trial and process evaluation of a training programme for mental health professionals to enhance user involvement in care planning in service users with severe mental health issues (EQUIP): study protocol for a randomised controlled trial

BackgroundInvolving service users in planning their care is at the centre of policy initiatives to improve mental health care quality in England. Whilst users value care planning and want to be more involved in their own care, there is substantial empirical evidence that the majority of users are not fully involved in the care planning process. Our aim is to evaluate the effectiveness and cost-effectiveness of training for mental health professionals in improving user involvement with the care planning processes.Methods/DesignThis is a cluster randomised controlled trial of community mental health teams in NHS Trusts in England allocated either to a training intervention to improve user and carer involvement in care planning or control (no training and care planning as usual).We will evaluate the effectiveness of the training intervention using a mixed design, including a ‘cluster cohort’ sample, a ‘cluster cross-sectional’ sample and process evaluation. Service users will be recruited from the caseloads of care co-ordinators.The primary outcome will be change in self-reported involvement in care planning as measured by the validated Health Care Climate Questionnaire. Secondary outcomes include involvement in care planning, satisfaction with services, medication side-effects, recovery and hope, mental health symptoms, alliance/engagement, well-being and quality of life. Cost- effectiveness will also be measured. A process evaluation informed by implementation theory will be undertaken to assess the extent to which the training was implemented and to gauge sustainability beyond the time-frame of the trial.DiscussionIt is hoped that the trial will generate data to inform mental health care policy and practice on care planning.Trial Registration NumberISRCTN16488358 (14 May 2014)

An exploration of student experiences of using biology podcasts in nursing training.

BackgroundStudents regard biological science as one of the most difficult components of the nursing curriculum. However, a good understanding of this area is essential for effective nursing practice. The aim of this study was to explore nursing students’ perceptions of the usefulness of supplementary biology podcasts for their learning.MethodsBiological science podcasts (n = 9) were made available to first-year nursing students (n = 189) as supplementary learning tools. On completion of their first year, students were asked to complete a survey which investigated the frequency of their podcast use, reasons for use and their perception of the usefulness of podcasts as a learning tool. 153 of these students participated in the survey study (80.9%). Two focus groups were conducted with students (n = 6) to gain a detailed understanding of student experiences of the usefulness of the podcasts for their learning.ResultsSurvey data demonstrated that most students (71%) accessed at least one podcast. The majority of students who reported accessing podcasts agreed that they were useful as learning tools (83%), revision aids (83%) and that they helped promote understanding of course materials (72%). Focus group participants discussed how they found podcasts especially useful in terms of revision. Students valued being able to repeatedly access the lecture materials, and appreciated having access to podcasts from a range of lecturers. Focus group members discussed the benefits of live recordings, in terms of valuing the information gleaned from questions asked during the lecture sessions, although there were concerns about the level of background noise in live recordings. Lack of awareness of the availability of podcasts was an issue raised by participants in both the survey component and the focus groups and this negatively impacted on podcast use.ConclusionsNursing students found the availability of biology podcasts helpful for their learning. Successful implementation of these tools to support learning requires teaching staff to understand and promote the importance of these tools.

From the rhetoric to the real : A critical review of how the concepts of recovery and social inclusion may inform mental health nurse advanced level curricula – the eMenthe project

OBJECTIVES This critical review addresses the question of how the concepts of recovery and social inclusion may inform mental health nurse education curricula at Masters level in order to bring about significant and positive change to practice. DESIGN This is a literature-based critical review incorporating a rapid review. It has been said that if done well, this approach can be highly relevant to health care studies and social interventions, and has substantial claims to be as rigorous and enlightening as other, more conventional approaches to literature (Rolfe, 2008). DATA SOURCES In this review, we have accessed contemporary literature directly related to the concepts of recovery and social inclusion in mental health. REVIEW METHODS We have firstly surveyed the international literature directly related to the concepts of recovery and social inclusion in mental health and used the concept of emotional intelligence to help consider educational outcomes in terms of the required knowledge, skills and attitudes needed to promote these values-based approaches in practice. RESULTS A number of themes have been identified that lend themselves to educational application. International frameworks exist that provide some basis for the developments of recovery and social inclusion approaches in mental health practice, however the review identifies specific areas for future development. CONCLUSIONS This is the first article that attempts to scope the knowledge, attitudes and skills required to deliver education for Masters level mental health nurses based upon the principles of recovery and social inclusion. Emotional intelligence theory may help to identify desired outcomes especially in terms of attitudinal development to promote the philosophy of recovery and social inclusive approaches in advanced practice. Whilst recovery is becoming enshrined in policy, there is a need in higher education to ensure that mental health nurse leaders are able to discern the difference between the rhetoric and the reality.

Using Audience Response Technology to provide formative feedback on pharmacology performance for non-medical prescribing students - a preliminary evaluation

BackgroundThe use of anonymous audience response technology (ART) to actively engage students in classroom learning has been evaluated positively across multiple settings. To date, however, there has been no empirical evaluation of the use of individualised ART handsets and formative feedback of ART scores. The present study investigates student perceptions of such a system and the relationship between formative feedback results and exam performance.MethodsFour successive cohorts of Non-Medical Prescribing students (n=107) had access to the individualised ART system and three of these groups (n=72) completed a questionnaire about their perceptions of using ART. Semi-structured interviews were carried out with a purposive sample of seven students who achieved a range of scores on the formative feedback. Using data from all four cohorts of students, the relationship between mean ART scores and summative pharmacology exam score was examined using a non-parametric correlation.ResultsQuestionnaire and interview data suggested that the use of ART enhanced the classroom environment, motivated students and promoted learning. Questionnaire data demonstrated that students found the formative feedback helpful for identifying their learning needs (95.6%), guiding their independent study (86.8%), and as a revision tool (88.3%). Interviewees particularly valued the objectivity of the individualised feedback which helped them to self-manage their learning. Interviewees’ initial anxiety about revealing their level of pharmacology knowledge to the lecturer and to themselves reduced over time as students focused on the learning benefits associated with the feedback.A significant positive correlation was found between students’ formative feedback scores and their summative pharmacology exam scores (Spearman’s rho = 0.71, N=107, p<.01).ConclusionsDespite initial anxiety about the use of individualised ART units, students rated the helpfulness of the individualised handsets and personalised formative feedback highly. The significant correlation between ART response scores and student exam scores suggests that formative feedback can provide students with a useful reference point in terms of their level of exam-readiness.

EQUIP training the trainers: an evaluation of a training programme for service users and carers involved in training mental health professionals in user‐involved care planning

Accessible summary What is known on the subject?UK NHS policy highlights the importance of user and carer involvement in health professional training.We know little about service user and carer motivations and experiences of accessing training courses for delivering training to health professionals and how well such courses prepare them for delivering training to healthcare professionals.‘Involvement’ in training has often been tokenistic and too narrowly focused on preregistration courses.There is limited data on how best to prepare and support potential service user and carer trainers. &NA; What does this paper add to existing knowledge?This study adds to the international literature by highlighting service user and carer motivations for accessing a training course for delivering training to health professionals.Service users and carers wanted to gain new skills and confidence in presentation/facilitation as well as to make a difference to healthcare practice. We also learned that service users desired different levels of involvement in training facilitation – some wanted to take a more active role than others.A one‐size‐fits‐all approach is not always appropriate. Encountering resistance from staff in training was a previously unidentified challenge to service user and carers’ experience of delivering training in practice and is a key challenge for trainers to address in future.Professional training involvement can be enhanced via specialist training such as the EQUIP training the trainers programme evaluated here. &NA; What are the implications for practice?When training service users and carers to deliver training to mental health professionals, it is important that service users are equipped to deal with resistance from staff.It is important that service user and carer roles are negotiated and agreed prior to delivering training to healthcare professionals to accommodate individual preferences and allay anxieties.Training for service users and carers must be offered alongside ongoing support and supervision.Mental health nurses (and other health professionals) will be better able to involve service users and carers in care planning.Service users and carers may feel more involved in care planning in future. Introduction: Limited evidence exists on service user and carer perceptions of undertaking a training course for delivering care planning training to qualified mental health professionals. We know little about trainee motivations for engaging with such train the trainers courses, experiences of attending courses and trainees’ subsequent experiences of codelivering training to health professionals, hence the current study. Aim: To obtain participants’ views on the suitability and acceptability of a training programme that aimed to prepare service users and carers to codeliver training to health professionals. Method: Semi‐structured interviews with nine service users and carers attending the training programme. Transcripts were analysed using inductive thematic analysis. Results: Participants’ reasons for attending training included skill development and making a difference to mental health practice. Course content was generally rated highly but may benefit from review and/or extension to allow the range of topics and resulting professional training programme to be covered in more depth. Trainees who delivered the care planning training reported a mix of expectations, support experiences, preparedness and personal impacts. Implications for Practice: Mental health nurses are increasingly coproducing and delivering training with service users and carers. This study identifies possibilities and pitfalls in this endeavour, highlighting areas where user and carer involvement and support structures might be improved in order to fully realize the potential for involvement in training.

Evaluation of a co-delivered training package for community mental health professionals on service user- and carer-involved care planning

Accessible summary What is known on the subject?There is consistent evidence that service users and carers feel marginalized in the process of mental health care planning.Mental health professionals have identified ongoing training needs in relation to involving service users and carers in care planning.There is limited research on the acceptability of training packages for mental health professionals which involve service users and carers as co‐facilitators. &NA; What does this paper add to existing knowledge?A co‐produced and co‐delivered training package on service user‐ and carer‐involved care planning was acceptable to mental health professionals.Aspects of the training that were particularly valued were the co‐production model, small group discussion and the opportunity for reflective practice.The organizational context of care planning may need more consideration in future training models. &NA; What are the implications for practice?Mental health nurses using co‐production models of delivering training to other mental health professionals can be confident that such initiatives will be warmly welcomed, acceptable and engaging.On the basis of the results reported here, we encourage mental health nurses to use co‐production approaches more often.Further research will show how clinically effective this training is in improving outcomes for service users and carers. Background: There is limited evidence for the acceptability of training for mental health professionals on service user‐ and carer‐involved care planning. Aim: To investigate the acceptability of a co‐delivered, two‐day training intervention on service user‐ and carer‐involved care planning. Methods: Community mental health professionals were invited to complete the Training Acceptability Rating Scale post‐training. Responses to the quantitative items were summarized using descriptive statistics (Miles, 2013), and qualitative responses were coded using content analysis (Weber, 1990). Results: Of 350 trainees, 310 completed the questionnaire. The trainees rated the training favourably (median overall TARS scores = 56/63; median ‘acceptability’ score = 34/36; median ‘perceived impact’ score = 22/27). There were six qualitative themes: the value of the co‐production model; time to reflect on practice; delivery preferences; comprehensiveness of content; need to consider organizational context; and emotional response. Discussion: The training was found to be acceptable and comprehensive with participants valuing the co‐production model. Individual differences were apparent in terms of delivery preferences and emotional reactions. There may be a need to further address the organizational context of care planning in future training. Implications for practice: Mental health nurses should use co‐production models of continuing professional development training that involve service users and carers as co‐facilitators.

The impact of advertising patient and public involvement on trial recruitment: embedded cluster randomised recruitment trial

BackgroundPatient and public involvement in research (PPIR) may improve trial recruitment rates, but it is unclear how. Where trials use PPIR to improve design and conduct, many do not communicate this clearly to potential participants. Better communication of PPIR might encourage patient enrolment, as trials may be perceived as more socially valid, relevant and trustworthy. We aimed to evaluate the impact on recruitment of directly advertising PPIR to potential trial participants.MethodsThis is a cluster trial, embedded within a host trial (‘EQUIP’) recruiting service users diagnosed with severe mental illness. The intervention was informed by a systematic review, a qualitative study, social comparison theory and a stakeholder workshop including service users and carers. Adopting Participatory Design approaches, we co-designed the recruitment intervention with PPIR partners using a leaflet to advertise the PPIR in EQUIP and sent potential participants invitations with the leaflet (intervention group) or not (control group). Primary outcome was the proportion of patients enrolled in EQUIP. Secondary outcomes included the proportions of patients who positively responded to the trial invitation.ResultsThirty-four community mental health teams were randomised and 8182 service users invited. For the primary outcome, 4% of patients in the PPIR group were enrolled versus 5.3% of the control group. The intervention was not effective for improving recruitment rates (adjusted OR = 0.75, 95% CI = 0.53 to 1.07, p = 0.113). For the secondary outcome of positive response, the intervention was not effective, with 7.3% of potential participants in the intervention group responding positively versus 7.9% of the control group (adjusted OR = 0.74, 95% CI = 0.53 to 1.04, p = 0.082). We did not find a positive impact of directly advertising PPIR on any other outcomes.ConclusionTo our knowledge, this is the largest ever embedded trial to evaluate a recruitment or PPIR intervention. Advertising PPIR did not improve enrolment rates or any other outcome. It is possible that rather than advertising PPIR being the means to improve recruitment, PPIR may have an alternative impact on trials by making them more attractive, acceptable and patient-centred. We discuss potential reasons for our findings and implications for recruitment practice and research.Trial registration numbersISRCTN, ISRCTN16488358. Registered on 14 May 2014.Study Within A Trial, SWAT-26. Registered on 21 January 2016.

Use and evaluation of a mentoring scheme to promote integration of non-medical prescribing in a clinical context

BackgroundGrowing numbers of non-medical health professionals are attaining prescribing rights through post-registration non-medical prescribing (NMP) courses in the UK. However, not all implement prescribing post-qualification. This study evaluated the uptake and perceived usefulness of a mentoring scheme for two cohorts of NMP students at the University of Nottingham. The scheme paired students with qualified mentors with whom they had an opportunity to discuss the integration of prescribing theory into practice.MethodsMentors were allocated on days 2–5 of the course. Surveys were distributed to students who completed the NMP course [n = 63] and their mentors. Likert-scale and open-ended questions addressed: use, perceived usefulness, and positive and negative aspects of the mentoring scheme. Semi-structured interviews were conducted with both students (n = 6) and mentors (n = 3) to explore their experience of the mentoring scheme in more detail. Students were purposively selected for interview depending on their level of use of the mentoring system. Interviews were analysed using thematic analysis.ResultsThe response rates were 65.1% (n = 41) and 56.3% (n = 36) for students and mentors respectively. Just over half of students (57.1%) accessed their mentor. Having a sufficient support network was the key reason for not using the scheme. Students found mentors helpful for: moral support (68.2%); contextualising prescribing (71.4%); and helping them to think about implementing prescribing in practice (72.7%). Fewer mentors felt they helped in relation to contextualising (57.9%) or implementing prescribing (31.6%). Less than half the students and mentors surveyed agreed that they received/provided assistance related to the integration of prescribing theory into practice (38.1% and 42.2% respectively) and assistance with assignments (36.3% and 45.5% respectively).Interviews suggested that students found it difficult to focus on implementing prescribing because of the academic demands of their course, which impacted on uptake and use of the mentoring scheme. Students emphasised the importance of being paired with a prescriber who was successfully prescribing. Mentors benefited from sharing and refreshing their academic knowledge.ConclusionsStudents and mentors derived benefits from participation in this scheme. This intervention may be better as a post-qualification support resource when students are ready to consider their future prescribing practice.

Workplace complementary and alternative therapies for hospital‐site staff

Purpose – Workplace wellness schemes are emerging in NHS settings, including complementary and alternative therapy services aimed at improving employee wellbeing. The aim of this study is to explore the impact of one such therapy service on service users based at a large UK teaching hospital.Design/methodology/approach – In‐depth semi‐structured interviews were undertaken with seven staff members who participated in at least one workplace complementary or alternative therapy. An Interpretative Phenomenological Analysis approach was taken in the design of interviews and the analysis of interview data.Findings – The following themes were elucidated: having positive but tentative expectations of therapies; enhancing health and wellbeing through therapy; appreciation for the “Q‐active” therapy service as part of a workplace wellness programme; and work influencing therapy use and vice versa.Originality/value – The study adds to the limited research literature evaluating workplace health interventions by using...