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City University, London
UOA 11 - Nursing and Midwifery
RA5a: Research environment and esteem
The focus of this submission is healthcare research and development, with particular reference to the roles of nurses and midwives. The submitted work derives primarily from the former School of Nursing & Midwifery (SoNM). This School integrated in 2007 into City Community and Health Sciences (CC&HS), a new School created through merging SoNM and the School of Allied Health Sciences. Because of their academic affinity, counselling (Cross and Farrants) and health (Marks, Sykes and Willig) psychology researchers are included in this submission. Two radiography colleagues (Flinton and Miles) from CC&HS whose research is concerned with healthcare practice, and Fanghanel, from the Centre for Educational and Academic Practices (CEAP), who collaborates with colleagues from our Professional and Interprofessional Education research programme, have also been entered into this submission.
Current and future research strategy and achievements
Following its incorporation into City University in 1995, the SoNM embarked on a long-term strategy designed to deliver international excellence in practice-relevant nursing, midwifery and healthcare research. This approach fits with the University’s strategic goal of developing high quality research activity which influences strategy, policy and practice. City University focuses particularly on the work of business and the professions, and maintains close links with practice.
SoNM strategy since RAE-2001 has aimed:
- To build on the previously achieved rapid development of its research profile, as evidenced by progress from a 1 in RAE-1996 to a 4 in RAE-2001 with 20 category A researchers.
- To at least double the volume of research over a five year period, whilst enhancing overall quality from national to international level.
- To maximise research practice and policy relevance.
- To make a significant contribution to healthcare research capacity building by creating opportunities and support for new and mid-career researchers.
- To utilise synergies between research, learning/teaching and knowledge transfer.
This strategy has been underpinned by major investment in research infrastructure, including chairs, readerships and a dedicated research office, partly financed through externally-earned infrastructure funding. Following SoNM’s success in RAE-2001, a strategic decision was taken to invest the resulting QR income in developing research over the next five years. The scale of our research has increased substantially since 2001. Comparison on a like-for-like basis indicates that about twice as many category A researchers have been submitted for RAE-2008 as for RAE-2001. Research income has expanded significantly over the last 10 years, to around £1,500,000pa in 2006/2007. As research programmes have matured, the proportion of funding obtained from national competitive sources, including the Department of Health (DH), major charities and research councils has increased markedly. Research strategy is no longer concerned primarily with growth, but with establishing a robust infrastructure which allows projects to be firmly based in sustainable research programmes with good track records and reputations. These programmes have developed independently of departments, fostering cross-departmental linkages.
Our research has been built on two particular strengths. One is the capacity to draw together academic disciplinary and clinical expertise, as demonstrated by the achieved mix of national and local funding, and by a strong and varied publication profile. This combination enables researchers to integrate academic and professional disciplinary perspectives powerfully and creatively. The second strength is the breadth of expertise available. This breadth enables researchers to cross health service and social care organisational boundaries, identifying critical areas for quality of care. Examples include R&D concerned with the mental health of renal patients, the primary/secondary care interface, organisational issues impeding infection control and partnership working with the care home sector. Freeth and Meyer are using a mobile simulated skills environment to enable staff working in care homes for older people to minimise avoidable hospital admissions.
Over the next five years, priority will be given to developing our well-established research programmes. Integration of SoNM into the new CC&HS will enable links with other health disciplines, particularly radiography, speech and language therapy, optometry and healthcare management to be strengthened. Research capacity building will continue to be prioritised, building on the School’s leadership of the £2,600,000 Consortium for Healthcare Research and the research facilitator programme at Barts & The London NHS Trust. Further funding for health professional research fellowships and joint clinical/research appointments will be sought. We anticipate bidding with HEI and health service partners to lead the London-based NIHR Research Design Services in close collaboration with the University of Kent. We will participate in a bid to host an Academic Health Science Centre in London. The work-based professional doctorate programme will be expanded as a means of promoting clinical/academic career pathways. In keeping with current British Psychological Society requirements, counselling and health psychology students will undertake a professional doctorate (DPsych). Links between research programmes, learning/teaching and knowledge transfer will continue to be strengthened.
Research will address new modes of NHS R&D funding. Colleagues will participate in major bids for NHS research programmes, collaborating in larger research groups encompassing bigger networks of HEIs and health service partners. Currently, researchers are working on proposals for programmes concerned with mental healthcare, the outcome of pregnancy and hospital acquired infections. The Research for Patient Benefit (RfPB) programme provides a particularly good fit with our research strategy. One grant of £250,000 to evaluate a birth centre has already been obtained. RfPB proposals driven by expressed patient needs and linked to the evaluation of specific clinical initiatives will be developed, for example through the Homerton Hospital/City University Colorectal Nursing Research Unit, and in infection control.
The Organisation of Research
Research coherence is achieved through its organisation into programmes associated with staff groups, and connected by overarching research themes. This approach ensures that staff can support and substitute for each other as required, and promotes cross-linkages between research groups.
Six themes cross-cut substantive research programmes and groups. The first three themes outlined below match those discussed in RAE-2001. The others reflect emerging strengths.
Research concerned with stakeholder perspectives explores the experience of service users and providers in order to inform improvements in health and social care practice. For example, Sykes has used patient narratives to identify ways of improving coronary care. Bridges is analysing a national DH data set concerned with older users’ experiences of A&E services.
Research focusing on workforce development is concerned with ensuring that the health and social care workforce is fit for purpose. One important topic is evaluation of classroom and workplace education for professional and interprofessional practice. For instance, Copperman has investigated the educational needs of social workers practising in healthcare settings. Another concern is the use of knowledge intended to inform new roles, skill mix and service developments. For example, the MOSES (Multidisciplinary Obstetric Simulated Emergency Scenarios) project, led by Freeth, is investigating interprofessional collaboration on four labour wards. Meyer and colleagues are working closely with Help the Aged and the National Care Forum to develop evidence-based educational resources promoting quality of life in care homes.
Research concerned with healthcare best practice and policy focuses on the development of the evidence base for optimal healthcare activities, its application to the development of practice, and the implications for healthcare and wider social policies. For instance, Ball has researched the nursing contribution to the recovery of patients receiving critical care. Perry has investigated nutrition for stroke patients in different healthcare settings.
Research focusing on risk assessment and management addresses epidemiological issues related to healthcare outcomes and the complexities of risk perceptions. For example, Macfarlane has participated in the five-part European Project on Obstetric Haemorrhage Reduction, working with a multidisciplinary group of clinicians and researchers. Heyman and colleagues have published extensively on processes of risk management in forensic mental health care and learning disabilities services, and in relation to prenatal chromosomal screening.
A wide range of research methods, including randomised controlled trials, secondary data analysis, surveys, qualitative interviewing and ethnography are employed. Our research frequently involves methodological innovation required to engage hard to reach groups or encompass complex issues. Examples include: using the internet as a research tool; developing new ways of combining qualitative and quantitative data, and of researching sensitive issues; reflective inquiry into healthcare practice; and facilitating service user research participation through appreciative inquiry and service user led projects. Waddington has analysed gossip as a source of insights about healthcare organisations. Willig is an internationally recognised authority on the use of qualitative methods in psychology, and the invited joint editor of the 33 chapter Sage Handbook of Qualitative Research in Psychology (in press). Marks is joint editor of the Sage text Research Methods for Clinical and Health Psychology.
Issues concerning the health needs of a multicultural society have become an important research concern over the last five years, reflecting the increasing ethnic diversity of East London. Projects address the cultural context of health and healthcare, the provision of culturally sensitive services, the needs of people who do not speak English as a first language and the impact of service provider ethnic diversity.
Substantive research programmes are co-ordinated by senior researchers, and undertaken by research groups which include established and new researchers, research students and service and research users. Programme responsibilities include: sustaining coherent areas of work of international excellence which inform healthcare practice and policy; maintaining regional, national and international links with service providers and users; engaging with local healthcare sectors; building academic and health professional research capacity and offering a supportive environment for developing researchers and research students; contributing to the learning and teaching programme; and generating knowledge transfer activities. Detailed information is provided on the City University website.
The work of six research programmes is outlined below. Because the cross-linkages between the research programmes are so strong, evidence about policy and practice impact is presented in a single section, below.
Care for people with acute and long term conditions (Lead, Professor Gould)
This programme focuses on R&D which enhances primary and secondary care for people with acute and long term conditions, reduces rates of unplanned hospital admissions and iatrogenic illness, promotes recovery and enables people with persisting ill health and disability to live as full a life as possible.
Applied biological science research focuses on the control of healthcare-associated infections, symptom control for people with chronic diseases, and evaluating the education of health professionals in applying biological science to their practice. Gould has led a review on hand hygiene for the Cochrane Effective Practice and Organisation of Care (EPOC) group.
This group has a particular interest in conditions requiring complex care. Drey has investigated the epidemiology of chronic renal failure, and Esmond best practice for the use of home oxygen. She has been awarded £25,000 to undertake a feasibility study of setting up a national home oxygen database for the British Thoracic Society. Bryar and Esmond participated in a systematic review of effectiveness of innovations of nurse-led chronic disease management which is relevant to the new NHS Framework for COPD. Colorectal research is developed through the Homerton NHS Trust/City University Colorectal Nursing Research Unit. Its collaborative projects include a randomised controlled trial of nurse advice versus medical interventions for patients with haemorrhoids, and a quantitative and qualitative study of stoma complications risks. Another major research strand, led by Procter, is based on active research collaboration with walk-in centres. She has investigated the effectiveness of hospital discharge and prevention of hospital readmission in relation to the primary/secondary care interface.
Ball belongs to an international team researching delays in responses to acute myocardial infarctions. The work of Davis on the role of nursing in care for women with pelvic floor dysfunction has been presented at two invited international plenary conference sessions. Other projects have been concerned with improving the evidence base and services for people with cardiovascular conditions, tuberculosis, chronic obstructive respiratory disease, Parkinson’s disease, chronic renal failure, cancer and sexual dysfunction. Projects aiming to reduce iatrogenesis have been undertaken in relation to infection control, tissue viability, nutrition, reducing the side-effects of medication and occupational health risks.
Floyd and colleagues have evaluated innovative approaches to providing vocational rehabilitation services for disabled people, including a major study of supported employment for people with mental health problems, funded by the European Commission. Another strand of their work has focused on the impact of the Internet on disabled people. Funding for this work has come from the Joseph Rowntree Foundation, BT, Vodaphone and Oftel.
Procter is undertaking an SDO-funded project evaluating the nursing contribution to long term conditions with the University of Hertfordshire. Ball is lead investigator for an SDO-funded evaluation of critical care outreach services. Cox is leading a study investigating how non-English speaking women with breast cancer use information about healthcare and other services. Floyd and colleagues are writing up a pioneering study of unpaid carers which has documented lack of hospital support during the patient stay and during/after discharge. Esmond belongs to a research group who are piloting the development of the national home oxygen database. She is undertaking a mixed methods research project designed to determine the optimal use of ambulatory oxygen therapy for patients with chronic lung disease.
At local level, the future of the programme lies in practice-related research with strong links to health and social care agencies. Procter’s team will undertake international comparisons of care for people with long-term conditions, initially with colleagues in Canada and Australia. Gould has forged links with colleagues in the US, Canada and the European Union through which she will take forward her work on infection control. Williams is further developing evidence-based guidelines for the management of people with tuberculosis in under-resourced countries.
Care for older people (Lead, Professor Meyer)
This programme is concerned with improving quality of life and care for older people in a wide range of settings, including acute, primary care, and mental health NHS trusts, independent care homes and the domiciliary sector. Researchers work with and for older people, their relatives and health and social care staff to identify services in need of change, which is achieved through role redesign and developing new ways of working. Findings are fed back to multidisciplinary teams through action research in order to facilitate organisational, workforce and practice development. Health psychology research into ageing, memory and identity, along with a blend of social and psychodynamic approaches, provide a broader context for researching and developing services.
A major component, the £1,000,000 CELEC Care for Older People Action Research Project, led by Meyer, took forward the NSF for Older People through a collaborative initiative between City University, an education consortium and seven local NHS trusts. The success of this research is demonstrated by the response of the workforce development confederation, which extended the project into the independent care home and domiciliary care sectors. This ongoing work aims to improve the learning environment for staff and students. Meyer has received 11 grants worth £2,100,000 for action research projects designed to improve health and social care for older people.
Other national and international work focuses on care for older people in receipt of emergency and acute care services, loneliness and frailty in the community, and end-of-life care for those who have decided not to have renal dialysis. The group has co-hosted an ESRC seminar series, Transitions in Care Homes: Meeting the Demands of the 21st Century which explored international perspectives on quality of life in care homes.
Current work clusters around three themes, acute, continuing and end-of-life care for older people. Bridges leads the acute care strand. She is exploring older people’s experiences of A&E and undertaking a systematic review of acute care for the oldest old. The continuing care strand, led by Meyer, is focusing nationally on quality of life in care homes, and internationally on loneliness in the community. Holman is developing the end-of-life strand, currently concerned with the impact on staff of dealing with bereavement.
The three strands outlined above will be further developed. In her new additional role as Director for the My Home Life Programme, with £280,000 funding from Help the Aged, Meyer will lead on continuing care R&D initiatives. This UK-wide research is concerned with improving quality of life for those living, dying, visiting and working in care homes for older people. The research builds on Meyer’s work as Co-convenor for the National Care Homes R&D Forum. Bridges will be undertaking a review of the evidence base for acute care for older people and developing national guidance on nursing care, updating a previous project. She has recently received £110,000 from the Burdett Trust for this work.
Health and care of parents and babies (Lead, Professor Alison Macfarlane)
This programme focuses on population-based analyses of pregnancy and its outcomes, multiple pregnancies, the pregnancy experiences of women and their partners, community midwifery; inequalities in health and access to healthcare, community maternity care and the evaluation of clinical and educational maternity practice.
Particular strengths are the interpretation and secondary analysis of routinely collected data, and the use of multilingual interviews and focus groups in qualitative research. Secondary analyses have covered national and local data, focusing on socio-economic and ethnic inequalities in pregnancy outcomes. Macfarlane received £70,000 from the DH for a study analysing inequalities in pregnancy outcomes, and £120,000 from the SDO for a review of the availability of data for monitoring access to care. The group has participated in the Peristat and Euro-Peristat-II perinatal indicators projects, major European collaborations involving secondary data analysis. The secondary data work has impacted on national policy, contributing to confidential inquiries on perinatal and maternal mortality.
Qualitative research has explored the maternity needs of first and second generation women from minority ethnic groups. For example, focus groups in four languages have been used to investigate women’s views of antenatal HIV screening. Another research strand has been concerned with women’s decision-making about prenatal screening for chromosomal anomalies, investigated through Heyman’s participation in a £240,000 ESRC-funded three university project. Midwifery education projects have researched education about hospital postnatal care and joint teaching of midwifery and medical students.
Macfarlane, Drey and Hilder are collaborating in a set of linked projects relating to infant mortality, funded by Team Hackney, the local strategic partnership. They are leading three projects, including a pilot study which will inform the design of a case control investigation of very preterm birth in women of West African and Caribbean origin. Hilder and Macfarlane are involved in the pre-implementation phase of an evaluation of a birth centre in Tower Hamlets, and have recently received £250,000 from RfPB for a post-implementation evaluation. Another project has involved the development of a database of routine birth statistics for NE London from the late 1980s to the present day. Hilder has worked with the Office for National Statistics to extend birth statistics for England and Wales. Craig is writing up her study of feeding and parenting.
The database of NE London maternity data developed by the group can be used for secondary analyses focusing on preterm birth, stillbirth, multiple pregnancy and inequalities in the outcome of pregnancy. This work will draw upon the group’s successful collaboration with the Office for National Statistics in enhancing national statistics. The group seeks to extend its evaluation of the innovative Barkantine Birth Centre project through Macfarlane’s involvement in the Birthplace programme led by the National Perinatal Epidemiology Unit. In collaboration with the Multiple Births Foundation and others, the group wishes to carry out a survey of multiple births and a subsequent cohort study and is working on an application to RfPB. Another planned focus is the investigation of very preterm birth in the population of West African and Caribbean origin.
Mental Health and Learning Disabilities (Lead, Professor Len Bowers)
This programme is concerned with developing knowledge which benefits patients by contributing to the improvement of mental health services and the interface between these and other services. Innovative methods include the observation of restraint episodes in acute psychiatry, accompanying patients on their journeys from home to hospital and using video recordings as a tool in research led by forensic mental health service users. A major component is concerned with the investigation of conflict and containment in psychiatry. Bowers received £300,000 from the SDO for the City-128 project. This study has investigated patient, staff and Trust variables predictive of negative outcomes such as suicide and self-harm to patients under special observation in 136 randomly selected wards in three English regions. He also received £300,000 from the Lord Mayor’s Fund for a project designed to improve nursing practice with respect to conflict and containment. This study draws upon the methodology developed for the CELEC project, outlined above. Other research lines focus on the role of liaison psychiatry in A&E and renal dialysis services, risk management in forensic mental health and learning disabilities units, dual diagnosis, work-related stress and mental health nurse education.
Bowers is leading a project which will identify effective nurse-patient interaction strategies for very unwell psychotic patients. A Psychotic Acuity Scale has been created and piloted, and a survey of nurse attitudes will be undertaken. Another study, funded by the SDO, is examining staff, patients’ and visitor views about keeping psychiatric wards locked. Heyman leads the qualitative arm of the national DH-funded Pathways Project, based at the University of Northumbria, which is investigating care pathways for offenders with learning disabilities. Simpson has recently completed scoping research designed to inform the development of a national curriculum on supporting mental health carers. Jones is principal investigator for a multidisciplinary study involving nurses, doctors and social scientists which is investigating disruptive patient behaviours in haemodialysis units.
Health psychology research is also concerned with mental health and well-being. Marks is completing projects concerned with psychosocial interventions for carers of people who have died from strokes, and for patients with head and neck cancer who continue to smoke. Sykes is interviewing family carers of people with end stage heart failure about the precipitation and management of crisis hospital admissions and preferred place of death. Willig is using client material to explore the potential of amplifying meaning through a combination of theoretical models, including attachment theory, existential perspectives and analytical psychology.
The work on conflict and containment is shifting towards larger scale, multi-ward cluster randomised controlled trials, with interventions based on findings from current studies. Some additional work on patient/staff ethnicity and relationships with conflict and containment is also planned. The research concerned with risk management in forensic mental health services will increasingly adopt an ethnographic observational approach, and will be applied to service development.
Professional and Interprofessional Education (Lead, Professor Della Freeth)
This programme addresses international, national and local healthcare education priorities including: patient safety; improving interprofessional collaboration; developing new roles and ways of working; supporting learning and assessment in clinical settings; supporting educators; assessment of prior learning; and reducing course attrition.
Larger research grants focus mainly on educating staff to promote patient safety, for instance through high fidelity simulations of teamwork under pressure. Other grants have supported studies of educational developments and technologies, and literature reviews of interprofessional education (IPE). Some studies are concerned with rapid cycles of educational development. Others examine the longer-term impact of educational interventions. The programme team are strongly committed to research capacity building, supporting lecturers and clinical staff who wish to examine educational practices at pre- and post-registration levels. They contribute to the development and evaluation of practice-based IPE in maternity care, care for older people and medical and surgical wards. In collaboration with the interprofessional Centre for Teaching, Education and Learning (CETL) which focuses on clinical and communication skills (see www.cetl.org.uk), we help tutors to get the best from learning through simulated professional practice.
Freeth and Berridge are writing up ethnographic work concerned with teamworking and decision-making in maternity care, and with meeting the CPD needs of night staff. Spouse is supervising research into the support provided by senior professional mentors.
Educational research promoting patient safety will be extended. Freeth is principal investigator for a three year £300k HTA-funded study which will triangulate three means of assessing safety and teamwork climates in midwifery and A&E departments in four strategic health authorities. Another important focus concerns investigation of ways to better support learning which encourages interprofessional patient-centred care. For example, supported by a grant from the Higher Education Academy, colleagues recently piloted and evaluated an education programme for students from four professions which was led by the family carers of people with severe communication disabilities. This study will now be scaled up, and its impact on all stakeholders investigated.
A recently commenced full-time doctoral studentship, awarded to a lecturer from a Chinese university, seeks to examine interprofessional education and collaboration in relation to technological innovation. We also aim to strengthen collaboration with educational researchers from contrasting disciplines across the University.
Sexualities and Sexual Health (Professor Jonathan Elford)
This programme is based on the UK national Sexual Health and HIV Strategy. It prioritises research which explores the social contexts of sexual behaviours and the epidemiology of sexually transmitted infections in hidden or marginalised populations. The programme aims to: inform policy development and implementation of best practice in relation to sexually transmissible infections, particularly HIV/AIDS; contribute to the evidence-base on sexualities and sexual health; and develop innovative research methodologies designed to broaden and enhance public participation in healthcare research, for example use of the internet as a research tool.
Research topics have included: the internet as a new sexual risk environment; sexual health services for ethnic minority men who have sex with men; homosexual identity in the context of counselling; treatments for premature ejaculation for Bengali Muslims; the experience of living with HIV of Africans residing in East London; teenage pregnancy; the sexual health needs of young unaccompanied asylum seekers; men in prostitution; and behavioural surveillance involving gay men. Elford is principal investigator for two MRC grants worth £500,000 focusing on the internet as a sexual risk environment and the sexual health of ethnic minority men who have sex with men in the UK. The latter is the first major study of its kind in the UK among this hard to reach group. Elford has also received funding from Haringey PCT for a study of behavioural surveillance among gay men.
Pryce is currently undertaking projects concerned with care for gay and bisexual people in later life, risk and internet chatrooms, the management of professional boundaries in massage practice, and the impact of civil partnerships on the health and well-being of gay couples. Elford and McKeown’s study of ethnic minority men who have sex with men is investigating their perceptions of sexual risks, stigmatisation and sexual health services.
A national study of use of sexual health services by ethnic minority men who have sex with men, and an innovative study using the internet for delivering interventions to people living with HIV are planned. Proposals are currently being developed in association with Age Concern for a study of the sexual identities and practices of older people. International collaborations have been established and will be further developed with academic institutions in Australia, the United States of America and Europe. Pryce has been invited to lead a large, internet-based survey of heterosexual practices, beliefs and relationships in Germany.
Research culture and infrastructure
City University seeks to sustain a research culture through a variety of investments and initiatives co-ordinated by its research office. These include: centrally funded fellowships and studentships, light touch pump-priming funds of up to £5000, research seminars and training days, research prizes and the University Society of Research Students. The University runs a research ethics committee, and provides infrastructure support for School-based research degrees programmes. It offers direct and remote access to library materials, databases and e-journals.
School research culture is promoted through a system in which research programmes are sustained by senior researchers and supported by administrators. Research leads, all professors, develop and implement research programmes, advise Heads of Academic Departments, support individual researchers and contribute to overall research management. In order to achieve critical mass, senior researchers developing strategically important research programmes were given substantial start-up packages, including research assistants and administrators, for five years after which they were expected to become self-sustaining.
Annual research weekends aimed particularly at PhD students and new researchers, sabbaticals and awards for new researchers have been provided. Large MSc programmes in nursing, midwifery and interprofessional practice provide an infrastructure of taught modules in quantitative and qualitative research. Able students are encouraged to progress to doctoral study. Writing for publication is supported by research leads. An extensive range of seminars linked to research programmes and involving internal and external speakers is offered.
Research staff and students are given dedicated office space and networked computing facilities, with access to online bibliographical databases and the University library. The University has two specialist nursing/midwifery libraries and a main central library. Simulated ward settings, a moving and handling room, an Interprofessional Skills Centre and an Interprofessional Communication Skills Suite can be used for both research and teaching.
Support for PhD students is co-ordinated through Research Degrees Committees. Students on the thriving nursing and midwifery programme receive a handbook which sets out the support programme, clarifies supervision expectations and provides advice about thesis writing. They are allocated two supervisors who combine subject expertise and successful supervision experience. Student progress is monitored through annual reports and review meetings, and a formal MPhil/PhD upgrade which simulates a viva voce examination. The support programme provides supervisor training, methodological workshops and an annual two day conference. PhD students can draw upon learning resources developed by the four university Consortium for Healthcare Research, outlined below, which is led from City University. A professional doctorate with a large research component and a PhD by publication offer alternative study modes. Over 100 doctoral students are researching a broad range of healthcare related topics for the Professional Doctorate in Counselling Psychology, the DPsych Health Psychology and the Post-Chartered DPsych.
Arrangements for supporting the active involvement in research of service users
SoNM research governance procedures require that projects establish advisory groups which include service user and carer representatives, and that users and carers are actively engaged in discussion of draft research reports. Innovative methods of involving service users and carers in all stages of the research process have been developed. Simpson and colleagues have evaluated the use as an educational tool of a moderated web-based discussion forum involving student mental health nurses and service users. A mental health service user has been employed in an academic post in the School. Copperman is the women’s research lead for the Social Perspectives Network which disseminates research findings to mental health service users and providers. Godin and Davies undertook a DH-funded project which explored the complex issues associated with forensic mental health service user led research. Floyd’s disability and employment projects employ service users as researchers. Elford and Ridge produced a DipEx website which explored the experience of HIV-positive gay men through their own stories. Ball is an expert advisor to DipEx on critical care. Bridges is using focus groups to consult with older service users, carers and voluntary organisations about the outcomes of her emergency care research.
Practice and Policy Impact and Relations with Research Users
Research is strongly focused on issues affecting the quality of health service delivery, attracting considerable interest from practitioners and policy makers. It is responsive to government national policy initiatives concerned with developing services for the benefit of service users and carers. Research programmes are underpinned by a range of collaborations with international, national and regional research users in the public, voluntary and private sectors.
Internationally, Elford is an invited expert consultant to the US NIMH on the internet and sexual health in relation to gay men, and to the African HIV Policy Network. The research of Marks and Sykes influenced the European Commission’s Programme of Community Action on Health Promotion, Information, Education and Training. Meyer is contributing to the development of acute services for people aged over 85 through her role as co-investigator for a £200,000 project funded by the Australian NHMRC. The intervention designed by Bowers and colleagues to reduce absconding by mental health service users has been taken up by hospitals in Australia. The systematic review work of Freeth and colleagues is noted within the Health Canada Human Resource Strategy Interprofessional Education for Collaborative Patient-Centred Practice. Macfarlane’s group have evaluated policies for maternity care on a European scale in the EUPHRATES project. Drey’s research into the epidemiology of chronic renal failure has influenced international standard setting in the USA, Australia, New Zealand, China and Saudi Arabia. Sully was a consultant to the WHO on their international TEACH-VIP (Violence and Injury Prevention) programme. Esmond’s work on home oxygen provision has influenced international standard setting in the USA, Australia, New Zealand, China and Saudi Arabia. Williams has developed internationally peer-reviewed evidence-based guidelines for optimising the health and social care of people with tuberculosis and lung disease, focusing particularly on countries with limited resources.
Nationally, Meyer co-ordinates the National Care Homes Research and Development Forum, which provides a platform for practitioners and researchers to share information and ideas. She is currently developing an international arm to this forum. Her group was commissioned by the DH Standing Nursing and Midwifery Advisory Committee to develop principles, standards and indicators for best practice in the care for older people in the acute phase of illness. The resulting document, Care for Older People: a Nursing Priority, was launched simultaneously with the NSF for Older People. She has sat on DH advisory groups, including the Our Healthier Nation subgroup for older people, the Advisory Committee on Complementary and Alternative Medicine and the Advisory Group for the Nurse Advisor for Older People. The DH Nurse Advisor for Older People (Deborah Sturdy) has an honorary University appointment to Meyer’s group.
Elford belongs to the MRC College of Experts, the Health Protection Agency, UK HIV Prevention Liaison Group and the Health Development Agency evidence-based public health programme (HIV prevention) committee. Esmond is a member of the management of medicines, devices and non-pharmacological interventions group informing the development of this framework. Her work has influenced the UK NFS. She was invited by the British Thoracic Society to co-chair the development of national evidence-based home oxygen guidelines. NICE has invited Gould to provide information about healthcare-associated infections to the Citizen's Council. Copperman is an invited social care expert advisor to the DH Victims of Violence and Abuse Programme, and an advisor to the London Ambulance Service on the implementation of ‘No Secrets’. Abbott’s work on public health networks for the Health Development Agency was cited in the Wanless Report (2004). Drey’s research into the epidemiology of chronic renal failure has been widely cited, in the National Service Framework for Renal Disease, the Royal College of Physicians guidelines for the management of chronic renal failure and HTA and NICE guidelines.
The work of Freeth and colleagues is referenced within the British Medical Association Board of Medical Education information resource on interprofessional education. Their systematic review of interprofessional education for health has been used as a template by the Social Care Institute for Excellence. Macfarlane and colleagues have collaborated with the Office for National Statistics in analysing data relating to inequalities in pregnancy outcomes. Hilder is working on a birth record linkage project with the Office for National Statistics. This work has enhanced the data available nationally for research into the epidemiology of preterm births.
Implementing this linkage routinely will improve the quality of national maternity statistics. Macfarlane contributed to the influential three-yearly reports on the confidential enquiries into maternal deaths and acted as statistical adviser. An intervention designed by Bowers’ group to reduce absconding, and based on their research, has been adopted by over 20 NHS Trusts. The contribution of this work to acute inpatient care has been recognised in the Chief Nursing Officer's Review of Mental Health Nursing, and in the Eleventh Biennial Report of the Mental Health Act Commission. Presentation of research findings to the NIMHE-led Cross-Government Group on the Management of Violence stimulated recognition that manual restraint blurs into a variety of coercive strategies used by staff, for example to enforce medication. Bowers has fed research findings on physical restraint practice and the causes of patient aggression into the development of policy by the National Institute of Mental Health for England, the Prison Service, the Police Service and others, via the Cross Government Committee on the Prevention and Management of Violence and Aggression, of which he is a member. His work has informed the development of an NHS national curriculum on violence prevention. He has advised the National Patient Safety Agency via his membership of the National Mental Health Safety Initiatives Group. Bowers has contributed to two National Institute of Mental Health for England Policy Implementation Guides: Adult Acute Inpatient Care Provision (2002); and National Minimum Standards for General Adult Services in Psychiatric Intensive Care Units and Low Secure Environments (2002). Copperman is a specialist social care advisor to the DH Victims of Violence and Abuse Prevention Programme.
Gould’s work has highlighted the importance of infection control and pressure ulcer prevention as indicators of hospital and domiciliary care quality. She is working with colleagues at Barts & the London NHS Trust on a clinical trial of the sterilisation of breast pumps which will provide the basis for evidence-based guidelines. These will have international significance as none are yet available. Williams has given evidence to the House of Lords Science and Technology Subcommittee about health and social care for people with tuberculosis. The research of Elford and colleagues into the views and needs of people living with HIV in London has provided a valuable evidence base for the non-governmental health sector including the National AIDS Trust. Floyd’s research into supported employment for people with mental health problems has provided an important contribution to the evidence-base for policy and practice relating to the recent government green paper on incapacity benefit. Bryar is a member of the NICE Appraisal Committee.
Regionally, Bowers occupies a senior role at East London and the City Mental Health NHS Trust. Bryar is a non-executive director of City and Hackney Teaching PCT. A five-year research facilitator programme led by Heyman involved two researchers, Perry and Drey, working with non-medical health professionals in order to develop research capacity at Barts & the London NHS Trust. Meyer and colleagues collaborate with the Tavistock Clinic, drawing upon a common interest in psychodynamically informed approaches to research and practice development. Procter and Macfarlane have completed an evaluation of the Islington Sure Start Programme, and Procter and colleagues are developing a skill mix model for long term conditions in Tower Hamlets. Perry was the nursing and therapies representative for the Thames Stroke Local Research Network. She is a nursing representative on the Intercollegiate Working Party for Stroke, the lead professional group for stroke in the UK.
Macfarlane and colleagues are constructing a database about births among the multiethnic population of NE London for use in audit, epidemiological studies, health services research and teaching. Elford’s work on the sexual behaviour of gay men living in London influenced the development of local prevention strategies. A research project concerned with the sexual health of asylum seekers has led to more outreach work being undertaken in the borough of Hackney, in conjunction with the Terence Higgins Trust. This group are involved with the development of an integrated adolescent health centre and support services for vulnerable young asylum seekers.
The CELEC Project, mentioned above, supported seven Lead Research and Development Nurses who took forward the NSF for Older People in four acute, two PCT and one mental health trust. Bowers has adopted a similar approach in mental health through the City Nurses project, financed by the Lord Mayor’s Fund, which is concerned with reducing conflict and containment on mental health wards.
Staff are strongly committed to knowledge transfer of research findings. One important means of impacting on professional practice is through Strategic Health Authority (SHA) funded work-based projects. Gould’s project with Barts & the London NHS Trust is concerned with developing the role of the modern matron in reducing hospital infection risks. The anti-absconding intervention produced by Bowers is now marketed via a dedicated website. Meyer and her group utilise action research to develop new ways of making services for older people more user-focused, working closely with practitioners. The Terrence Higgins Trust has begun to use the internet for sexual health promotion in response to Elford’s DIPEx project.
Research governance is managed through a formal audit system which ensures that proposals are subject to appropriate review, through NHS Research Ethics Committees or the University Senate Research Ethics Committee, as appropriate. Active projects are audited through annual reports. Any which cause concern are followed up. This system is administered from the School research office.
Details of other UOAs to which related work has been submitted
Many components of City University undertake research related to the heathcare domain. Work carried out in other Schools/Departments has been submitted to UoAs 7 (health informatics/healthcare management); 12 (optometry and language and communication science); 25 (general engineering including radiography physics); 34 (health economics); 40 (food policy); and 41 (sociology of health and illness).
Interdisciplinary and collaborative research
Our research involves a wide range of professional and academic disciplinary collaborations, illustrated below. Bowers has drawn together a team of researchers with expertise in human geography, psychiatry and health economics who conduct research into special observation in acute psychiatry. The care for people with acute and long term conditions research programme draws on applied biological science in relation to its application in nursing and midwifery practice, e.g. through the work of Gould and Chudleigh on hand hygiene. Procter, with colleagues from the University of Hertfordshire, is contributing findings about the nursing contribution to outcomes for patients with long-term conditions to the Health Outcomes Data Depository at Cardiff. Meyer has been a member of the Royal Pharmaceutical Society Concordance Steering Group. Miles participates in PARSPORT, a multi-centre randomised controlled trial of a new radiotherapy technique for patients with head and neck cancer. CC&HS provides a framework for encouraging disciplinary research collaboration with allied health sciences. For example, Heyman collaborated with Law and Byng from the Department of Language and Communication Science in a study of the communication needs of people with speech disabilities.
A huge range of local, national and international individual research ties are complemented by more formal relationships. Close collaboration among four universities, Hertfordshire, London School of Hygiene and Tropical Medicine, Queen Mary and City, is achieved through the Health Foundation and Burdett Trust funded Consortium for Healthcare Research. The Consortium, which offers doctoral and postdoctoral fellowships in nursing, midwifery and the allied health professions, is committed to achieving long-term sustainability through maintaining a ‘virtual’ university infrastructure for doctoral and postdoctoral healthcare research training. Researchers associated with the programme in care for older people work closely with the Tavistock Clinic on research concerned with emotional aspects of care. Formal links with the International Institute for Qualitative Methodology have been established, with a joint international conference on Advances in Qualitative Methods held in Australia in 2006.
The extensive range of international collaboration can only be illustrated through examples. Macfarlane and co-researchers involved in the Peristat and Euro-Peristat projects aim to develop comparative perinatal indicators on a European scale. Heyman and Reynolds collaborate with the Department of Nursing at the University of KwaZulu Natal, South Africa, on a project comparing staff and patient experiences of forensic mental health services in South Africa and the UK. Meyer is currently working on an international study on loneliness in the community with colleagues in Australia, Japan, Norway and South Africa, as well as contributing to the Australian NHMRC project mentioned above. McKeown is collaborating with the University of Bern on a study of the sexual health of ethnic minority men who have sex with men. Jones is working with the University of Verona in an investigation of the impact of geographical distance and social-economic status on utilisation of mental health services.
The nature, source and sustainability of research funding
Researchers receive funding from a wide range of healthcare providers. Bowers and Simpson are fully funded by East London and the City Mental Health Trust. The Charitable Foundation of Barts & the London NHS Trust funds an annual three-year research studentship. Other research infrastructure funding has been obtained for five-year periods. The above Charitable Foundation funded half the cost of a Chair in Child Health and a research facilitator post for five years. When the external funding of strategically important posts reaches the end of its time period, new funding is sought, usually from a different source. For example, Gould and Heyman have recently been awarded £350,000 from the Burdett Trust to fund a further cohort of research fellowships to the Consortium for Healthcare Research. Early career researchers are encouraged to participate in joint bids with more experienced colleagues and supported administratively and academically with their own applications.
Major institutional restructuring, new mergers and new initiatives in the assessment period
Two key developments have been the establishment of the university level strategic alliance between Queen Mary (University of London) and City University; and the merger of the SoNM and SAHS into the new CC&HS in 2007. The strategic alliance has provided the framework for collaborative initiatives such as the Consortium for Healthcare Research. The Schools merger, currently being implemented, will enable research to be organised on a broader scale with unified research administration.
Staffing policy and practice
Staffing policies are designed to enable staff at all levels of research accomplishment and seniority to develop as researchers. Teaching staff are entitled to 25 annual study days, use of which is evaluated by heads of department through the appraisal system. The sabbatical system provides opportunities for staff to spend more extended time periods on their research. Where appropriate, staff are encouraged to apply to undertake research degrees, with fees part-funded.
Readers and professors are appraised jointly by their head of department and the associate dean for research with whom they have worked closely. Academic staff with research interests are appraised jointly by the appropriate research lead and head of department. Contract researchers report to an experienced research leader, and are attached to a department and research programme. The University expects all academic staff to be research active. The criteria for promotion to senior lecturer include research accomplishment. The University, unusually, does not have a fixed staffing establishment and allows staff to apply for the post of reader/professor when they consider that they meet the criteria for promotion.
Since 2001, two professors, Elford and Gould, have been appointed to develop strategically important research areas, sexual health and infection control respectively. Only two senior researchers have left City University since 2001. The professor of maternal health (Sandall) left and was replaced by Macfarlane. When Bryar, the Professor of Primary Healthcare, became a Head of Department, Procter was recruited to replace her. The Professor of Child Health (Roberts) who left in 2007 will not be directly replaced, but the research of children’s nursing colleagues continues to be supported within current programmes. Freeth and Pryce have become Heads of Department after promotion from senior lecturer to reader, and in Freeth’s case to professor. Procter has become Associate Dean (Preregistration). Such trajectories demonstrate the close integration between research leadership and academic management which has been achieved.
The School strongly supports joint appointments with NHS Trusts and other service providers and combined academic/clinical career pathways. Ball is a senior research fellow at City University and a consultant critical care nurse at the Royal Free Hampstead NHS Trust. Meyer is the director of the My Home Life Programme on a 40% secondment with Help the Aged. Three trainees are jointly appointed to the Doctorate in Health Psychology Programme with Camden PCT who pay their tuition fees. Research, learning, teaching and knowledge transfer are integrated as closely as possible without impeding the capacity of researchers to progress their work. Pre-registration research methods training is now offered as a coherent package led by a category A researcher (Allan).
Continuity of employment for contract researchers has been achieved by naming them in joint bids for research funding, and seeking further contracts. In 2007, all research staff who had been employed for more than three years in the former SoNM were transferred onto permanent contracts. This transfer, undertaken despite serious financial problems, provides clear evidence of the CC&HS and University commitment to healthcare research. Researchers whose funding is derived from external contracts are not required to undertake unpaid teaching duties. They are encouraged to work on writing for publication and grant-seeking with more experienced colleagues. As far as possible, externally funded research is undertaken by colleagues who have an ongoing relationship with the School and are treated as core members. In consequence, staff turnover has been low, and the staffing profile contains a relatively low proportion of research assistants.
Academic staff at all stages of their careers are encouraged to develop as researchers. For example, one new category A researcher, Sully, will retire in 2008 after developing an original and significant research focus on serious domestic violence in the last few years of her career. She has received support and mentorship from senior researchers and will continue to work with the School after her retirement. The quality and impact of her work were recognised by the University which awarded her one of the staff prizes for research in 2005. Newly appointed academic staff receive ongoing mentorship from a named senior researcher. Affiliation with research programmes allows new and aspiring researchers to develop their interests and expertise in relation to well-structured areas of activity. New researchers are encouraged to participate in joint research bids and writing for publication with more experienced colleagues. Academics new to research have been able to bid for annual £20,000 grants.
Markers of Esteem
Staff accomplishments and their recognition have been described throughout this document. This section will offer further quantitative evidence of other aspects of esteem plus additional qualitative descriptions.
Six category A researchers are journal editors, five have edited seven special issues, five are sub-editors and 13 are members of 15 editorial boards. Ball is editor in chief of Intensive and Critical Care Nursing. Meyer is an editor of Educational Action Research, Marks of The Journal of Health Psychology, Bryar of Primary Health Care Research and Development, Elford of AIDS Care, Freeth of Professional and Interprofessional Education and Perry of The Journal of Advanced Nursing, as was Gould (2002-2006). Miles and Heyman are book review editors of Radiography and Risk, Health & Society, respectively.
Fifteen colleagues have been invited to present 65 keynote/plenary conference addresses. Sykes’ book (Dealing with Dementia) was launched in the European Parliament. Bridges was invited to contribute two guest editorials to The International Journal of Nursing Studies on workforce development and the art of caring. She won the prize for the best paper by a new researcher at the 2006 International Conference of Organisational Behaviour in Health Care. Craig was awarded the British Psychological Society of Women postgraduate prize for the best women-centred research publication.
Membership of research grant awarding bodies
Nine category A researchers have sat on research grant awarding committees, and 20 have peer reviewed grant applications. Marks participated in the European Commission Alzheimer’s Research Advisory Panel, Luxembourg. Elford sits on the NIHR Research for Patient Benefit and MRC Sexual Health and HIV Strategy grant awarding committees. Bowers has been a member of the grant awarding advisory group of the National Forensic Mental Health R&D programme, and of the National Coordinating Centre for Service Delivery and Organisation Research. He has reviewed grant applications for the MRC, ESRC, Wellcome Trust, Scottish Chief Scientists Office, the DH Policy Research Programme, Health Research Board of Ireland, and Swiss National Science Foundation. Meyer was a member of the DH Advisory Committee on Complementary and Alternative Medicine programme for developing research capacity, the NHSE London Organisation and Management R&D Group and funding bodies associated with two local London NHS trusts.Procter belongs to the boards of North East London Consortia for Research and Development, the North East London Support Unit for Ethnic Minority Health Research and the Local Clinical Research Network for Diabetes. Macfarlane served on the RCOG/Wellbeing of Women Research Advisory Committee, and Heyman on a National Patient Safety Agency research commissioning board. The School has two ongoing places on the Research Advisory Board of Barts & The London Charitable Foundation, currently occupied by Bryar and Gould.
Participation in official committees and inquiries
Thirteen category A researchers participate in official committees. Freeth is a member of the US Advisory Board of the Academy for Healthcare Improvement, and co-opted onto the Professional Education and Research Committee for specific projects. Bowers has been a member of the Cross-Government Steering Group on Violence and the National Mental Health Safety Initiatives Group. Meyer has participated in the DH Standing Nursing and Midwifery Advisory Subgroup for Care of Older People in Acute Settings, and produced a confidential expert briefing report drawing on Learning the Lessons from London PALS. Macfarlane acted as statistical advisor to the House of Commons Health Committee Maternity Sub-Committee (2003) and as research advisor to the Kings Fund enquiry into the safety of maternity services in England.
Cross is Chair of the British Psychological Society Division of Counselling. Bowers and Meyer hold honorary chairs, at the Universities of South Australia, as does Heyman at the University of Northumbria. Four researchers have honorary fellowships. Meyer has been an invited visiting international scholar in Australia, Malaysia, Switzerland and United States. Cox is treasurer of the Society for Scholarship in Nursing, Midwifery and Allied Health Professions, and was previously Chair of the European Honours Society. Perry won an RCN scholarship which funded research work on stroke in Australia. Godin took up an invited residency at the Rockefeller Foundation in Bellagio, working with an international team writing about the health status of incarcerated women. Davis was awarded the Smith and Nephew Foundation Research Fellowship in 2001. Simpson received an ‘Outstanding Contribution to Clinical Research and Teaching’ award from East London & the City Mental Health NHS Trust in 2004.