Nursing, COVID and the End of Resilience

I’ve been wanting to add a post about this book for a while. Its finished and its recently published by Routledge.

It was nearly ten years ago that I first stumbled on two pieces of writing about resilience. One was a critical article by economist Mark Neocleous, Resisting Resilience. Published in 2013, the author describes how a turn to resilience has embedded itself across military support systems, responses to threats of terrorism, urban planning and self-help advice.
‘Resilience’ [he says] has in the last decade become one of the key political categories of our time. It falls easily from the mouths of politicians, a variety of state departments are funding research into it, urban planners are now obliged to take it into consideration, and academics are falling over themselves to conduct research on it.’

The second piece that I read that morning ten years ago was an editorial in Nursing Standard by Jean Gray, Building Resilience in the Nursing Workforce. At the time I read it as a more or less uncritical encouragement to nurses to become more resilient in the face of a range of workplace pressures but a more careful re-reading shows that Jean was well aware of the combination of ‘adversities’ that nurses face, those inherent in the work itself and those that are the effect of policy and funding decisions. But for Jean’s cautious article, there are probably a hundred that enthusiastically promote resilience training as a solution a host of entrenched workplace problems. Their message, to put it bluntly, is that systems are far too difficult to change, so nurses should change the way they think instead. Despite the claims that evaluations show that an afternoon of resilience training can reduce intention to leave among nurses, I suggest that this approach adds to many nurses’ sense that their managers are not serious, or do not have the power, regarding improving working conditions. The imperative for nurses to learn to be more resilient is often received by nurses as insulting.

Neocleous, and many others, describe system resilience initiatives and concerns alongside the way that the concept of resilience has emerged within positive psychology and self-help. Despite the optimistic twist that politicians have found attractive and useful, I find the positive psychology movement problematic. Perhaps the main reason is its disregard for material conditions and there are strong elements of this thinking in resilience research. For instance, one study of resilience among nurses working in the Philippines during COVID found that they were highly anxious about the poor provision of protective equipment and of becoming infected. The researchers recommended not that the supply of PPE be urgently improved but that managers support nurses to not feel so anxious and to develop positive coping strategies (Labrague and de Los Santos, 2020).

My book lists some of the nurses that died after contracting COVID in the UK – and of course many more died worldwide. I suggest that resilience is of no use to these nurses. In the book I also report on signs that in policy and professional communities there is now a fundamental scepticism about this individualised version of resilience and an acknowledgement that it is a totally inadequate concept if we want to understand and improve health systems.

You can find more details about the book, Nursing, COVID and the End of Resilience here:

Labrague LJ and Santos JAA (2020) COVID‐19 anxiety among front‐line nurses: Predictive role of organisational support, personal resilience and social support. Journal of Nursing Management 28(7): 1653-1661.

Researching Racism in Nursing: book launch at the RCN

Last night saw the launch of a multi-contributor book, Researching Racism in Nursing, published recently by Routledge. Here’s what the publisher’s website says about the book:

Research shows that racism affects the working lives of nurses and nurse academics, as well as healthcare service delivery and outcomes. This book looks at the impact of racism, from experiences of microaggression to discrimination and structural and institutionalised racism.

Focusing on the work of six doctoral researchers and practitioners who have chosen to address and investigate the racism they experience, witness or observe in the UK’s National Health Service and Universities, this book includes personal reflections on their findings. The substantive chapters are framed by a discussion of policy and research on racism, thoughts on research supervision within this field and a drawing together of the key themes developed through this book.

Giving voice to nurses’ and lecturers’ responses to racism in nursing education and practice, this is an important contribution for students, researchers and practitioners with an interest in health inequalities, healthcare organisations, research methods and workforce development.

Thanks to all of the contributors/speakers and to the RCN for organising and hosting this event. Thank you to Wendy Irwin for introducing the event and chairing proceedings.

Here’s the book’s Table of Contents

Foreword by Sheilabye Sobrany

1        Introduction: Researching racism in nursing Helen Allan

2        Doctoral research – the personal is academic Michael Traynor

3        On listening to Migrant Women         Ann Mitchell

4        Experiences of perinatal British mental health services: reflections on conducting research with migrant women from Sub-Saharan Africa       Gabriel Ngalomba

5        An ethnography of Islamophobia      Dave Ring

6        The Nursing and Midwifery Council’s role in Integrating Internationally Educated Nurses in the UK healthcare       Monday Ugiagbe

7        An exploration of the experience of Black and Minority Ethnic nurse educators in UK universities Donna Scholefield

8        Racism in nursing: the more things change, the more they stay the same      Petula Gordon

Evaluation of Online Simulated Scenarios for Nursing

Mike O’Driscoll,  Professor Michael Traynor

Report published: July 2021.

Introduction

In April 2020 the adult child midwifery (ACM) department at Middlesex University started using online screen-based simulation (OSBS) software sourced from Oxford Medical Simulation[1] (OMS). OMS was originally designed to be used with virtual reality hardware and delivered in the classroom setting. However, due to COVID-19 restrictions the delivery of the programme was remote and online only i.e. students participated in these simulations on their own computers, and mostly at home.

This simulation platform places students into a virtual ward or single bedded area, students are then able to control their environment and interact with the surrounding equipment as in clinical practice. There is a usually a support worker present in the room who the student can interact and communicate with. Each of the simulations features a patient presenting with a specific medical condition with certain scenarios also involving patients presenting with a variety of social or psychological issues. The student is then required to undertake a clinical assessment of that patient, using their clinical knowledge to draw conclusions and make decisions regarding patient care within a safe environment.

Evaluation

The independent evaluation of this OSBS initiative was commissioned by the ACM department in April 2020 and data collection was carried out between June and September 2020. The mixed methods evaluation was led by Mike O’Driscoll and Prof. Michael Traynor, incorporating an online survey and online focus groups with students who had participated in the OSBS initiative as well as an online focus group with staff. Relevant secondary data (such as the number of times students participated in each scenario), which was available via the OMS system, was also analysed.

Learning Objectives

Learning objectives for 3rd Year (adult and children and young people) nursing students who were to go into practice earlier than anticipated (through an opt in ‘extended placement’) because of the increased need for staff as a result of the COVID-19 pandemic: included  

  • To develop knowledge and understanding of the physical assessment of an acutely unwell patient and reflect on their practice.
  • To develop the technical and non-technical skills required when assessing and intervening with the acutely unwell patient and reflect on their practice.
  • To upskill current third year adult and children and young people nursing students to prepare them for being deployed as a result of the COVID-19 pandemic.

The OSBS initiative was also aimed at adult and children and young people third year nursing students who did not opt for the ‘extended placement’ and with adult and children and young people second year students; mental health nursing students (2nd and 3rd year); nursing associates (2nd year); third year midwifery students and PG Dip 2nd year students. For these groups there were slightly different learning objectives:

  • Enable healthcare students to develop knowledge and understanding of the physical assessment of the acutely unwell patient.
  • Enable healthcare students to develop technical and non-technical skills required when assessing and intervening with the acutely unwell patient.

Evaluation Findings

The response rate to the online survey was 25% (617 students invited, 154 wholly or partially completed questionnaires obtained). 13 students took part across two online focus groups. Seven members of staff took part in an online focus group and one took part in a one to one interview (as they had been unable to attend the focus group).

There is strong evidence of the OSBS learning objectives having been met, particularly from survey evidence regarding which skills students perceived they had gained which could be transferred into practice and learning outcomes or objectives they felt they had achieved, and this is supported by focus group evidence. A very large majority of respondents felt that they had gained skills in making clinical decisions based on their observations and prior knowledge; escalating issues to senior members of staff and using time effectively across different activities.

Respondents were very positive (mean ratings above four on a scale of 1 to 5 about the last scenario participated in, on a range of measures including realism, usefulness and overall satisfaction. Most respondents did not consider  there were serious barriers to their participation in OSBS and there were no statistically significant differences in perceived barriers to participation by scenario, age, learning style, programme or year of programme and few differences on gender. However, a considerable limitation of the evaluation is that those who took part in the evaluation had participated in the OSBS (i.e. those who experienced barriers  (or did not like OSBS for whatever  reason) were under-represented in the evaluation).

Download executive summary

Download full report

If you have any queries about this research or would like to discuss a research project please contact Mike O’Driscoll (m.odriscoll@mdx.ac.uk) or Professor Michael Traynor (m.traynor@mdx.ac.uk).


[1] See http://oxfordmedicalsimulation.com

Michael Traynor: talk on ‘Nursing, stupidity and the benefits of higher education’

Another contribution from Centre members for the ‘Scholars at Work’ lunchtime talks run by the Department of Adult and Child (nursing) and Midwifery at Middlesex University.

Brief Outline:                       Some politicians and sections of the media see nursing as the only profession where it is actually preferable for its members to be less educated. This presentation discusses the links between level of education and professional status. On the way it summarizes different views of the professions. It ends by setting out some of the benefits of university education for members of the nursing profession.

Short Biography:                   Michael Traynor was born in London. He read English Literature at Cambridge University, then completed nursing and health visiting training. He moved to Australia where he was a researcher for the South Australian Health Commission. He worked at the Royal College of Nursing in London and at the Centre for Policy in Nursing Research at the London School of Hygiene & Tropical Medicine. He is now Professor of Nursing Policy at the Centre for Critical Research in Nursing and Midwifery at Middlesex University. He is editor of the journal Health: an interdisciplinary journal for the social study of health, illness and medicine. He recently wrote Critical Resilience for Nurses, published by Routledge in March 2017 and Stories of Resilience in Nursing, 2020.

Helen Allan on Contract research in Higher Education: atheoretical or anodyne

Helen gave a talk at the ‘Scholars at Work’ series at Middlesex University.

Brief Outline:      I seem to have Two contradictory existences:

  1. Phd supervisor and researcher where I spend my time encouraging my students (and making myself explore theory to inform the social world.
  2. Contract researcher where I work on contracted work as a researcher with no seemingly obvious theoretical stance; neither is one wanted (apparently). It reminds me of earlier work I did on the massification and commercialisation of HE (in relation to students and maximising profit from numbers of students) while at Surrey. But here I am actively contributing to profit while doing nothing to develop theory which does rather seem the point of an academic?

Short Biography: Helen Allan is Professor of Nursing at Middlesex University in the Department of Nursing, Child Health & Midwifery. She has had three professional careers: as a practitioner in intensive care and women’s health; as a teacher and for the last 20 years, predominantly as a researcher. Her research is informed by sociological view of the world and she is co-founder and lead of the Centre for Critical research in Nursing and Midwifery in the Department.

Mike O’Driscoll on public attitudes to privatisation and rationing in the UK NHS

Mike gave a talk based on initial findings of his PhD work at the series ‘Scholars at Work’ at Middlesex University in January 2021. See the video here.

Title of presentation:Attitudes of public staff and other key stakeholders to privatisation in the general public

Brief Outline: I will present the initial exploratory findings from the first data collection of my Doctoral research – an online survey with a sample of the general public in England (n=220) regarding their attitudes to privatisation and rationing in the NHS (especially since the Health and Social Care Act 2012 which radically changed the structure of the NHS) .  

The fundamental problem which inspires this research is an apparent contradiction between the views of the public regarding how the National Health Service (NHS) of the U.K. should be run and the way in which the service is actually run, in terms of recent reforms and its apparent future trajectory.

The NHS has been described as the closest thing the UK has to a national religion and opinion polls suggest that it is the most valued and trusted public service (King’s Fund / MORI 2018)  and one of the UK’s greatest national achievements. Research suggests that a majority of  people are opposed to privatisation of the NHS, regardless of political affiliation or demographic profile and yet most governments from Thatcher’s onwards have, in one way or another, sought to impose market models and privatisation on the NHS and this reached unprecedented levels with the Health and Social Care Act (2012) which was described by a senior Department of Health official as ‘‘the only change management system you can actually see from space – it is that large’’(Timmins 2012).

This Act abolished Primary Care Trusts and forced GPs to take the lead for commissioning healthcare services by coming together in clinical commissioning groups (CCGs). CCGs were obliged by the Act to tender healthcare contracts externally, so that ‘any qualified provider’ (public, private or third sector) could bid and also removed the responsibility of the Secretary of State for Health to provide a universal healthcare service, granting CCGs considerable discretion to choose which services to provide and who to provide them to. This has led to an increase in private sector provision and rationing of healthcare with many CCGs choosing not to offer, or to severely limit, varicose vein removal, cataract removal, IVF and many other procedures or treatments (Heneghan 2017).

These changes have attracted relatively little media coverage and awareness of them amongst the general public (and indeed amongst health professionals) seems to be low although there does not seem to be any published research on this point (one of the gaps in the literature which I hope to fill).

Furthermore, both COVID and Brexit may lead to further NHS privatisation. The current government’s approach to managing the COVID pandemic has been heavily focussed on the private sector in terms of track and trace,  test laboratories, PPE procurement and  the use of private hospital facilities (Wrigley 2020; The Guardian 2020). The EU referendum was allegedly ‘won’ by the Leave campaign on the promise of dramatically increase NHS funding (London Economic 2017) but many fear that Brexit may in fact lead to further privatisation as part of a trade deal with the US.

Short Biography:  Mike O’Driscoll is a mixed methods researcher with a particular interest in the use of IT in social research. His first degree was in Sociology and Social Policy and has an MSc in research methods and is currently a Doctoral student at Middlesex.  Mike O’Driscoll has worked in many research environments including local government, charities and academia and has considerable experience in evaluations, particularly  in health and education settings (this link to publications gives an idea of his research interests  https://orcid.org/0000-0001-9221-6164).

CCRNM researchers evaluate new work-based healthcare apprenticeship models

The Learn and Earn career pathway (LECP) was established in 2017 following a pilot by Islington, Haringey and Camden community education provider networks (CEPNs) and is managed via Community Matters. It attempted to address some of the perceived barriers to employers’ engagement with apprenticeships by means of administrative assistance, financial incentives and the development of a bespoke ‘apprenticeship-plus’ model where additional training, particularly clinical skills, are included within the offer. Specifically, it was set up to promote the career pathway towards nursing and to explore the viability of using apprenticeships as a sustained funding source for training required to progress along the pathway.  

The central ‘offer’ on the pathway was a Healthcare Assistant (HCA) programme, adapted to accommodate both newcomers to the HCA role (e.g. admin or reception staff) as well as experienced HCAs who want to gain the level 3 Diploma in Clinical Healthcare Support, and to develop additional clinical skills. The programme was based on a traditional apprenticeship model but with  additional clinical skills classrooms that reflect the tasks typically undertaken by HCAs in General Practice. 

Evaluation commissioned
In 2019 a research team from the Centre for Critical Research in Nursing and Midwifery Education in Middlesex University led by Mike O’Driscoll was commissioned to carry out an independent evaluation of the Learn and Earn project. The evaluation aims included understanding the take up of each course on the Learn and Earn pathway (numbers of employers/learners, profile, progress, outcomes, reasons for take up and barriers to take up);comparing progress against targets; understanding what worked well and what did not work well and evaluating the impact of project activities at individual/business and project level.

Evaluation methods
The mixed methods process evaluation which was completed in early 2020, involved an online survey, focus group and telephone  interviews with all stakeholders  (learners, training providers, employers, CEPNs and the project managers). It also included a ‘business case’ analysis of the project, providing  a tool to inform and support employer decision-making regarding placing learners on the LECP. The business case tool, developed by Dr Wendy Knibb, provides a structure around which employers can develop their consideration of key aspects of the decision-making process such as benefits and potential non-monetary benefits of training; costs and potential non-monetary costs to training; perceived risks/challenges of training and comparing the apprenticeship model to other training options.
The evaluation also provided an evaluation toolkit, to facilitate future evaluations.

Key evaluation findings included:
Learner’s main reasons for taking part in courses were  career development (86%), followed by wanting a role which involves more healthcare expertise (83%) and job satisfaction (72%). 62% said that they had taken part in course/s because they wanted to improve their employability and just over half (51%) chose ‘get a better salary or working arrangements’ and 38% did the course/s because they ‘want a role with more contact with public’.

Level 2 HCA Apprentices

Overall satisfaction with courses, which may have been negatively impacted by some initial teething problems, was moderate – however the vast majority of current learners  (84% ) reported feeling very or fairly confident about taking part in their current course and satisfaction with current course was high for peer interaction and support (79% very or fairly satisfied), employer support (74% very or fairly satisfied) and timing / pattern of course (68% very or fairly satisfied).

Many learners felt that their course would have a positive effect on their career and their current employing organisations (or had already done so) and that their course had had a positive effect on the level of service provided to patients (especially in increasing capacity and the range of services which are offered in a GP practice).

Employers were, on the whole positive about their experiences of Learn and Earn courses and recognised benefits such as the ability to ‘grow their own’ primary healthcare workforce, i.e. to increase skills and capacity in their existing staff and to gain specific skills which the employer needed and which could be tailored to the needs of the employing organisation and to provide a better service for patients.

If you would like to commission an evaluation please contact Mike O’ Driscoll (m.odriscoll@mdx.ac.uk)

For more details of the evaluation findings please contact Community Matters (training@communitymatters.co.uk)

Report title:
Learn and Earn Project – Evaluation Report
O’Driscoll, M., Traynor, M. and Knibb, W. (2020). Middlesex University, Centre for Critical Research in Nursing and Midwifery.



Michael Traynor receives award

Last week I was awarded a fellowship of the Royal College of Nursing. It is extremely flattering and fun to be involved with the opening of the RCN’s 2019 Congress in Liverpool with their new president Anne Marie Rafferty.

The RCN is facing some challenges in the wake of what was widely seen as a failure to manage and communicate the government’s pay offer last year. The then General Secretary resigned and some active RCN members campaigned for the organisation’s Council also to stand down. The campaign turned out to be controversial with some suggestions of a left wing ‘infiltration’ of the RCN. So we have the appearance of a confrontation between an ‘old guard’ and ‘modernisers’.

One of the long-standing disappointments is that nursing (in England at least – the other countries of the UK may be different) rarely seems to be able to draw on its huge strength in numbers and wield political power in the field of health service policy or regarding the working conditions of nurses. I would hope for changes that move the RCN in the direction of being able to do this.