Steven Pryjmachuk

Nurse education: factors associated with attrition

AIM This paper is a report of a study to identify the factors having an impact on student completion rates in a preregistration programme. BACKGROUND Nursing student attrition is an international issue causing concern in many parts of the developed world including Australia, the United States and Europe. In the United Kingdom, nursing student attrition has become a major issue, despite having one of the lowest general university dropout rates in the developed world. METHOD A retrospective cohort study was conducted in 2007 using routinely-collected demographic and completion data on four cohorts of nursing students (1259 in total) studying at a large English university. FINDINGS Students who were older on entry were more likely to complete the programme than younger students, and those who had only the minimum educational qualifications on entry were less likely to complete than those with higher-level qualifications. There was some evidence of increased risk of resigning from the course in students taking the child branch, and increased risk of discontinuation (involuntary removal) from the course in both male and black/minority ethnic students. There was also some evidence that the healthcare organization responsible for a students placement could influence completion rates. CONCLUSION To improve attrition rates on preregistration nursing programmes, higher education institutions should actively target recruitment at mature candidates; increase the level of qualification required to gain entry; examine course structures for flexibility and provide multi-level student support.

The effectiveness of self-care support interventions for children and young people with long-term conditions: A systematic review

Childrens health policy has highlighted the need to develop self-care programmes. However, there is a lack of evidence on which to base the development of such programmes. This paper reviews the published research on the effectiveness of self-care support interventions for children and young people with asthma, cystic fibrosis and diabetes. A systematic search was conducted of a range of electronic databases, supplemented by searching the reference lists of retrieved papers and published reviews. Retrieved studies were assessed against quality and eligibility criteria by two independent reviewers. The results were narratively synthesized to examine the effectiveness of self-care support interventions on health status, psycho-social well-being, condition-related knowledge, health service use and participant satisfaction. The search strategy identified 4261 papers which were screened against the review inclusion criteria. A total of 194 papers were assessed as being potentially eligible for inclusion with 15 papers being judged as adequate to include in the review. There is strong evidence of the effectiveness of interventions that target children/young people; use e-health or group-based methods; that are delivered in community settings. There is no evidence that interventions that focus on parents alone or are delivered only in hospital settings are effective. While there is some evidence to inform the development of self-care support programmes, there is a need for well-designed trials of interventions that are feasible to transfer into real-life settings and which involve parents and children in their development.

Defining Quality of Life in the Children of Parents with Severe Mental Illness: A Preliminary Stakeholder-Led Model

Severe parental mental illness poses a challenge to quality of life (QoL) in a substantial number of children and adolescents, and improving the lives of these children is of urgent political and public health concern. This study used a bottom-up qualitative approach to develop a new stakeholder-led model of quality of life relevant to this population. Qualitative data were collected from 19 individuals participating in focus groups or individual interviews. Participants comprised 8 clinical academics, health and social care professionals or voluntary agency representatives; 5 parents and 6 young people (aged 13–18 yrs) with lived experience of severe parental mental illness. Data underwent inductive thematic analysis for the purposes of informing a population-specific quality of life model. Fifty nine individual themes were identified and grouped into 11 key ‘meta-themes’. Mapping each meta-theme against existing child-centred quality of life concepts revealed a multi-dimensional model that endorsed, to a greater or lesser degree, the core domains of generic quality of life models. Three new population-specific priorities were also observed: i) the alleviation of parental mental health symptoms, ii) improved problem-based coping skills and iii) increased mental health literacy. The identification of these priorities raises questions regarding the validity of generic quality of life measures to monitor the effectiveness of services for families and children affected by severe mental illness. New, age-appropriate instruments that better reflect the life priorities and unique challenges faced by the children of parents with severe mental illness may need to be developed. Challenges then remain in augmenting and adapting service design and delivery mechanisms better to meet these needs. Future child and adult mental health services need to work seamlessly alongside statutory education and social care services and a growing number of relevant third sector providers to address fully the quality of life priorities of these vulnerable families.

How a moderated online discussion forum facilitates support for young people with eating disorders

Young people with eating disorders are at risk of harm to their social, emotional and physical development and life chances. Although they can be reluctant to seek help, they may access social media for information, advice or support. The relationship between social media and youth well‐being is an emotive subject, but not clearly understood. This qualitative study aimed to explore how young people used a youth‐orientated, moderated, online, eating disorders discussion forum, run by an eating disorders charity.

Look before you leap and don't put all your eggs in one basket The need for caution and prudence in quantitative data analysis

This paper’s aim is to draw attention to the pitfalls that novice and, sometimes, experienced researchers fall into when undertaking quantitative data analysis in the health and social sciences, and to offer some guidance as to how such pitfalls might be avoided. Many health and social science students are routinely instructed that the procedure for undertaking data analysis in quantitative research is as follows: specify hypotheses; collect data and enter it into a computerised statistical package; run various statistical procedures; examine the computer outputs for p-values that are statistically significant. If significant differences are found, jubilation often exists because statistically significant results are deemed to be a clear indicator that something worthwhile (and publishable) has been discovered. This paper argues that this approach has two major oversights: a failure to explore the raw data prior to analysis and an overdependence on p-values. Both of these oversights are routinely present in much health and social-science research, and both create problems for scientific rigour. Researchers need to exercise caution (‘look before you leap’) and prudence (‘don’t put all your eggs in one basket’) when undertaking quantitative data analyses. Caution demands that, prior to full data analysis, researchers employ procedures such as data cleaning, data screening and exploratory data analysis. Prudence demands that researchers see p-values for their true worth, which exists only within the context of statistical theory, confidence intervals, effect sizes and the absolute meaning of statistical significance.

Helping Young People Who Self-Harm: Perspectives From England

TOPIC Interventions for young people who self-harm. PURPOSE To inform the international community of concerns that have arisen in England in relation to self-harm in young people, the therapies available to young people, and the evidence base for these therapies. SOURCE(S) USED: Published literature on the topic, together with the clinical and academic expertise of the papers authors. CONCLUSIONS A variety of treatment modalities (categorized according to whether they were individual, family, group, or psychopharmacological therapies) used in England with young people who self-harm are discussed. The overall picture regarding these interventions is unclear: a few have no research evidence; some, however, do show promise though limitations in study design, and a lack of replication means no definitive conclusions can be drawn. There needs to be further research and development in this area, especially evaluative research of interventions. Nurses should play a lead role here as they are often in the most unique position to help young people who self-harm.

What do we know about the risks for young people moving into, through and out of inpatient mental health care? Findings from an evidence synthesis

AbstractBackgroundYoung people with complex or severe mental health needs sometimes require care and treatment in inpatient settings. There are risks for young people in this care context, and this study addressed the question: ‘What is known about the identification, assessment and management of risk in young people (aged 11–18) with complex mental health needs entering, using and exiting inpatient child and adolescent mental health services in the UK?’MethodsIn phase 1 a scoping search of two electronic databases (MEDLINE and PsychINFO) was undertaken. Items included were themed and presented to members of a stakeholder advisory group, who were asked to help prioritise the focus for phase 2. In phase 2, 17 electronic databases (EconLit; ASSIA; BNI; Cochrane Library; CINAHL; ERIC; EMBASE; HMIC; MEDLINE; PsycINFO; Scopus; Social Care Online; Social Services Abstracts; Sociological Abstracts; OpenGrey; TRiP; and Web of Science) were searched. Websites were explored and a call for evidence was circulated to locate items related to the risks to young people in mental health hospitals relating to ‘dislocation’ and ‘contagion’. All types of evidence including research, policies and service and practice responses relating to outcomes, views and experiences, costs and cost-effectiveness were considered. Materials identified were narratively synthesised.ResultsIn phase 1, 4539 citations were found and 124 items included. Most were concerned with clinical risks. In phase 2, 15,662 citations were found, and 40 addressing the risks of ‘dislocation’ and ‘contagion’ were included supplemented by 20 policy and guidance documents. The quality of studies varied. Materials were synthesised using the categories: Dislocation: Normal Life; Dislocation: Identity; Dislocation: Friends; Dislocation: Stigma; Dislocation: Education; Dislocation: Families; and Contagion. No studies included an economic analysis. Although we found evidence of consideration of risk to young people in these areas we found little evidence to improve practice and services.ConclusionsThe importance to stakeholders of the risks of ‘dislocation’ and ‘contagion’ contrasted with the limited quantity and quality of evidence to inform policy, services and practice. The risks of dislocation and contagion are important, but new research is needed to inform how staff might identify, assess and manage them.

Will safe staffing in Mental Health Nursing become a reality

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Using the nominal group technique to involve young people in an evidence synthesis which explored ‘risk’ in inpatient mental healthcare

Plain language summaryWe conducted a review of research on the topic of ‘risk’ in hospital based mental health care for young people aged 11-18. We wanted to include a contribution from young people alongside other stakeholders with expertise to guide the research team in decisions made setting parameters for the review. To achieve this, we held a stakeholder group meeting. We used the nominal group technique, a method designed to create a structure and a process for getting feedback from a group of people in a way that allows everyone to have an equal say. In this study, we show how our use of this approach enabled our stakeholder group to shape the focus of our study towards an area of more importance and relevance to them.AbstractBackgroundIn this paper we demonstrate how our application of the nominal group technique was used as a method of involving young people with previous experience of using inpatient mental health services in an evidence synthesis.MethodsNominal group technique is an approach to group decision-making that places weight on all participants having an equal opportunity to express a view, and to influence decisions which are made. It is an effective way to enable people who might otherwise be excluded from decision-making to contribute.ResultsIn this study, the focus of the evidence synthesis was significantly shaped following using the nominal group technique in our stakeholder advisory group meeting. The young people present in the group invited the research group to think differently about which ‘risks’ were important, to consider how young people conceptualised risk differently, focussing on risks with long term impact and quality of life implications, rather than immediate clinical risks.ConclusionsUsing the nominal group technique with young people did offer a method of promoting the equality of decision making within a stakeholder advisory group to an evidence synthesis project, but care needs to be taken to invite sufficient young people to attend so they can be proportionally represented.

Prioritising young people's emotional health support needs through participatory research.

Accessible summary What is known on this subject?Young peoples mental health is a concern to people around the world. Good emotional health promotes mental health and protects against mental illness, but we need to know more about how to help young people look after their emotional health.We are learning that research is better if the public are involved in it, including children and young people. Therefore, we need to listen carefully to what young people have to say.In this paper, we describe some research that involved young people from start to finish. We were asking what kind of emotional health support would be useful to them. &NA; What this paper adds to existing knowledge?We developed a useful way to involve young people in research so their voice can be heard.Young people like to use the Internet to find emotional health support and information, but need to know which web sites they can trust. &NA; What are the implications for practice?Our method of bringing young people together to tell us their views was successful.It is important to explore ways to help young people judge the quality of emotional health web sites. Introduction: Youth mental health is a global concern. Emotional health promotes mental health and protects against mental illness. Youth value self‐care for emotional health, but we need better understanding of how to help them look after their emotional health. Participatory research is relevant, since meaningful engagement with youth via participatory research enhances the validity and relevance of research findings and supports young peoples rights to involvement in decisions that concern them. Aim: We aimed to develop a participatory approach for involving youth in research about their emotional health support preferences. Method: Our team included a young expert‐by‐experience. We developed a qualitative, participatory research design. Eleven youth (16–18 years) participated in focus groups, followed immediately by a nominal group exercise in which they analysed the data, thus enhancing methodological rigour. Results: This process highlighted youth perspectives on self‐care strategies for emotional health. Discussion and implications for practice: Our simple participatory research approach generated trustworthy and credible findings, which accurately reflect youth perspectives and are consistent with the literature, endorsing our method. Young people said that they want reassurances of quality and safety when accessing digital mental health resources. These findings can inform future development of youth‐oriented digital mental health resources.