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University of East Anglia

UOA 11 - Nursing and Midwifery

RA5a: Research environment and esteem

Context

This submission is based on the research of the Nursing and Midwifery Research Unit (NAMRU) within the School of Nursing and Midwifery (NAM) at UEA. Established since RAE 2001 as a compact interdisciplinary research unit within NAM, with its own Research Director at professorial level (Salter), NAMRU has:
• achieved a strong flow of Research Council funding and other research income (value of new awards since 2001 = £850K),
• created a vibrant community of research students,
• formed productive research relationships with the NHS.

All category A staff in this submission are qualified nurses. The strong nursing research element is additionally supported by a broad range of health service research skills and methods located in other parts of the Faculty of Health (FoH) at UEA.

NAM is one of three Schools in the Faculty, the others being the School of Medicine, Health Policy and Practice and the School of Allied Health Professions. Since 2004, all research-active members of staff within FoH have been aligned to at least one of six research themes, which run across and within Schools. Strategic direction and integration is provided by a Faculty Research Committee, comprising an Associate Dean for Research, co-ordinators for each research theme and the University's Pro-Vice-Chancellor for Research. This structure has had the benefit of cross-pollinating research skills and networks across the Faculty and ensures convergence between Faculty and University research strategy, implementation and assessment.

The Faculty is part of a highly research-intensive campus University, sitting on the Norwich Research Park, which includes the 1000 bed Norfolk and Norwich University Hospital. All member organisations are located within one square mile, which facilitates collaboration. A key feature influencing the Faculty’s research culture is its strong relationship with the NHS, reflected through partnership boards involving senior staff, close contact with the local NHS R&D Consortium and good links with clinicians and service users.


Across the Faculty a continuing culture of research success is supported by:
• appointment of thirteen new Chairs since 2001,
• extensive investment in research facilities, including a recently opened £3.5M Clinical Research and Trials Unit for health services research (including nursing-focused randomised trials) in 2007. Since 2006 NAM has occupied new-build accommodation on the University campus, having previously been off-site or in temporary accommodation,
• recruitment of high numbers of research students (312 recruited in total across the Faculty for the assessment period 2001 to 2007). In the competitive 2007 round of UEA - funded PhD studentships, two have been awarded to the nursing group (supervised by Pfeil and Lindsay),
• cross-Faculty access to methodological expertise, especially in statistics and health economics,
• an integrated programme of research mentoring from lead FoH researchers,
• a Faculty Research Office (linked to the NHS Consortium Research Office) which supports research bidding,
• a Faculty-wide seminar programme,
• excellent accommodation (dedicated desk-space and computer facilities) for research students and post-doctoral researchers.

Within the Faculty NAM has developed, since 2001, a body of research activity with international, national and local impact. A focused strategy has enabled NAM to create a strong community of post-graduate research students, and to develop research expertise within its staff. NAM’s research output - published in highly-regarded journals as well as working papers and policy documents - is known internationally and has had a major influence on several areas of health care policy. Salter’s work on adoption of new technologies has been a leading example of this.

 

Staff strategy, infrastructure and development

The School has recognised the need to focus research resources efficiently and has developed a supporting HR strategy to identify and support staff’s research abilities. Active researchers (including those within this submission) provide mentorship and support to those on Teaching and Scholarship contracts with the potential to develop their research skills. Selected staff members are assisted to formulate Personal Research Plans (PRPs) – setting feasible performance targets and timelines – which feed into the School’s distribution of research time and support. Those who successfully become research active are eligible for transfer to Teaching and Research contracts. Lindsay, Pfeil and Hardy have all transferred to such contracts via this route.

The School’s research infrastructure includes the following:
• research mentoring to provide support, particularly with regard to constructing and implementing PRPs,
• research investment in people and networking capacity. As well as the core funded staff of NAMRU, a Post-Doctoral Research Fellow (Cooper – now Category B) has been funded, along with enhanced administrative support for research activities. There is also a ‘pump-priming’ fund for networking / developmental research activities and a conference fund,
• research seminars via monthly sessions with internal and external speakers,
• Working Paper Series serving to raise the School’s research profile and encourage collaboration. The School has produced 25 Working Papers since 2001.

 

Research students

The success of the School in creating a critical mass of active researchers and a supportive research environment is evident in the ability to attract research students. Between 2001 and 2007, the total number of research students who registered in the School rose from 1 to 37. Twenty-nine of these students are supervised by submitted academics. In addition, 3 students registered in other Schools of the UEA are co-supervised by NAM academics. This total of 40 students includes:
• 3 completed PhDs (2.6 returned in RA3a),
• 6 completed MSc by Research (5 returned in RA3a),
• 4 international PhD students (2 registering prior to 2001 and 2 registering post 2001 with 0.35 returned in RA3b) with 4 more registering in October 2007,
• 3.75 UEA-funded full-time PhD studentships (with 2 more registering in October 2007).

One reason for PGR growth has been the establishment and energetic marketing of a part-time MSc by Research funded by the Strategic Health Authority. This has drawn highly effectively on local networks of nurses and other health professionals. Students are recruited predominantly from nursing and address topics spanning clinical, educational, and organisational settings. NAM aims to encourage suitable candidates to pursue opportunities (e.g. NIHR/Finch Report) for personal PhD and post - doctoral fellowship funding.  All postgraduate research students are supported by Transitions, UEA's generic skills development programme which complements subject specific training provided within the Faculty.

 

NAMRU

The Nursing and Midwifery Research Unit (NAMRU) was established in 2001. Under the leadership of Salter, the School’s Director of Research until September 2007, it has pursued a strategy of harnessing the internal resource of staff and seed-corn funds to lever the maximum flow of research income and postgraduate research students. This strategy has produced high quality research relevant to policy and practice, coupled with a continually developing research culture in the School.

Salter  (category B) has led NAMRU highly successfully and its current research reflects his vision and drive. His departure (with Cooper – category B) to a Chair in Social Science at Kings College London is evidence of the strong research reputation he developed whilst at UEA, his notable success with the ESRC and the robust and supportive research environment provided by NAMRU. His move provides an opportunity to re-focus the Unit’s research direction more explicitly on developing the evidence base for nursing practice, as guided by national and international policy interest. His successor, Dr Richard J Gray recruited 23 November 2007 from the Institute of Psychiatry, will start early in 2008 as Unit Director and will build on opportunities in nursing practice evaluation provided by FoH expertise in the areas of randomised trials, health economics, research synthesis and statistics.

 

Research income

Since January 2001, NAMRU has won 13 projects with a total value of £850,000. The upward bidding trajectory is evidenced by the fact that, since January 2001, NAMRU staff have been involved in the submission of 40 project applications worth over £6 million. Most recently Gega has successfully applied to the Wellcome Trust for a grant of £307,000 as a co-investigator.

The targeting of the ESRC has been a notably successful component in NAMRU’s strategy to build a dynamic research environment, establish the Unit’s reputation as a mature contributor to UK health and social research and provide access to important national and international networks. Since 2001, NAMRU has been successful in securing ESRC grants totalling over £570,000 (i.e. four project grants, one travelling fellowship and one post-doctoral fellowship [Harvey, not submitted]).

The other main sources of research income have to date been government departments (including the Department of Health (DoH) and NHS R&D), regional health and social service funders and the Royal College of Nursing (RCN). It is envisaged that the new Unit Director is likely to access an expanded range of prestigious funders, including NHS R&D, MRC and Wellcome, building on the Unit’s considerable success with ESRC.

 

Research focus

The research achievements of the staff submitted link to four of the Faculty’s six research themes - Evidence Based Practice, Education and Learning, Mental Health and Policy and Decision Making.

Evidence based practice theme
Lindsay has developed work in this theme through his contributions to:

• the Cochrane Collaboration Epilepsy Review Group. He has co-authored two systematic reviews - the first to be published on specialist epilepsy services - influencing the development of epilepsy care guidelines within health services in Scotland, the USA and Italy. He is currently undertaking two more, one earning a Department of Health Innovation Award.
• the Cochrane Collaboration Child Health Field, from which he has advised additional Cochrane Review Groups on developing child health related systematic reviews.
• the debate about methodologies for the study of socially-complex health care interventions. His paper on the use of randomised trials in evaluating these (2004) has been widely cited in nursing, pharmacy and epidemiology literature.

Hardy’s research in this theme has involved:
• a RCN joint commission on the ‘Expertise in Practice Project’ (2001-03), followed by the RCN - funded evaluation of the ‘Practitioner Development Project’ (2003-04), which have impacted on the development of Nurse Consultants and on the Nursing and Midwifery Council (NMC)’s higher level practice policy.
• work with the RCN on its DoH- funded project ‘Improving services to critical care patients’ which influenced the DoH’s revision of intensive care delivery.
• a current two-year secondment to the Royal Children’s Hospital, Melbourne to research and evaluate the introduction of a nursing practice development strategy which affects care delivery models for the Australian health care system (contracted to return in October 2008).

Pfeil  has co-authored, with NHS colleagues, a study of early discharge following appendicectomy (2006). The results were used to initiate a formal change in clinical policy to incorporate early discharge and to expand this work into the care of boys following hypospadias repair.

Halliday co-authored a study on diversity in the organisation of the Macmillan nursing service (2002) which influenced the clarification of its role and support functions.

Education and Learning theme
Hardy’s research on expert nursing practice included the development of a formal accreditation of practice process, linked to the NMC Higher Level Practice award. Her educational development expertise was sought in a project to develop the research culture in the Norfolk Mental Health Care Trust (2002). She is currently an Honorary Professor at Monash University in Australia.

Lindsay’s educational research has included:
• a historical study ‘Educating Nurses to Meet the Emotional and Psychological Needs of Children 1920-1952’ (2003) supported by a Wellcome Trust Travel Grant.
• applied research into web-based interactive software for the education and assessment of health professionals. Following this project, Lindsay applied the results in the ‘Skills for Caring in Health Interactive Project’ (2005).

His work has been supported by two research-orientated Teaching Fellowships from UEA:
• the first (2003) resulted in the creation of an Reusable Learning Object on research methods, now used within NAM and freely available to the international Higher Education community online.
• the second, ‘An international online ‘community of practice’ for the development of skills and understanding in student health professionals’ (2005) was undertaken jointly with researchers in Australia and Norway. His e-learning work has also led to the development of collaborations with commercial partners.

Halliday  has co-authored (2005) the only national empirical study relating to nurse cadet projects.

Mental Health theme
Gega  (who is an Early Career Researcher, recruited in January 2007 from the Institute of Psychiatry) has led, or been a member of, four projects dealing with computer aided techniques in the treatment of mental illness and psychological aspects of physical health, a body of work which has had a significant impact on policy and practice, e.g.:
• she was co-investigator on a two-year project, ending in 2002, which established the first ever self-help clinic to deliver computer-aided treatments for anxiety and depression (West London Mental Health Trust, Hillingdon Primary Care Trust and Imperial College London). This informed NICE Guidelines on computerised cognitive behaviour therapy (CCBT) in 2002, reviewed in 2006, with the outcome that, in 2007, the DoH issued guidelines for the implementation of CCBT for anxiety and depression across all PCTs in England and Wales.
• her further analysis of data identified the most effective referral route. As a result, responsibility for provision of computerised CBT (CCBT) was allocated to Primary Care Trusts rather than Mental Health Trusts.
• she has developed a tool to help practitioners screen suitable patients for the use of CCBT, published in 2005, and continues to respond to enquiries from PCTs nationwide on its implementation.
• she has further developed her research interests in collaboration with psychologists in other parts of the Faculty and is about to embark on a 3-year Wellcome Trust £307K funded project (wef 2008) on alleviating anxiety through Cognitive Bias Modification, led by Mackintosh (Panel 44).

Hardy’s research
• has influenced policy development at DoH level through the Mental Health Nurse Academics UK.
• has led to an invitation to work in consultation with the DoH on mental health nursing competency framework development.
• has assisted the development of service user led initiatives in mental health care in Norfolk, completing the first user led research project with the Norfolk & Waveney Mental Health Care Trust (2002).

Policy and decision making theme
Salter (category B) was joint leader for the Faculty’s Policy and Decision Making theme. Salter’s six ESRC-funded projects since 2001 (totalling £574,000) have addressed key international policy issues in the field of genetics and new health technologies, e.g. the governance of human genetics and the development of the stem cell bioeconomy. His book The new politics of medicine (Palgrave 2004) is an important analysis of the governance of the medical profession.

Lindsay has been involved in policy evaluation with the evaluation of the Norfolk Care Co-ordination Initiative (2004). Lindsay and Pfeil collaborated on a study of non-medical prescribing which highlighted the conflicts and practice issues resulting from this initiative. They were invited to contribute a paper on this work to the influential Harvard Health Policy Review.

Pfeil  has addressed issues of policy evaluation in his ‘Evaluation of the City Reach Project’ (2003) in terms of health policy impact on deprived sectors of the population and the methodology of evaluation itself. This work directly influenced the decision to make this a permanent service within Norfolk.

Cooper (now Category B) added a sociological and philosophical dimension to Salter’s work that is explicated in her forthcoming book Surplus Life. Biotechnics and the transformations of capital.

 

Building networks and collaborations

Supported by the Faculty’s infrastructure and NAM’s networking and conference funds (see above), the staff submitted have steadily developed their external research networks and collaborations at international, national and local levels.

International and National Networks
International and national networks are strong. They have included:

• UK National Stem Cell Network (Salter)
• Panel for the Mid-Term Review of the ESRC’s Genomic Centres and Network (2005-6) (Salter)
• Steering Committee of the Medical Research Council’s China-UK Research Ethics Project (Salter)
• Ethical Review Panels for the European Union’s Framework Programme Six (Salter)
• Cochrane Collaboration, in particular the Epilepsy Group and the Child Health Field (Lindsay)
• the international Society for the History of Children and Youth (Lindsay)
• UK Centre for the History of Nursing and Midwifery (Lindsay)
• Nursing History Colloquium (Lindsay)
• Child Health Researchers UK (Lindsay and Pfeil)
• International Practice Development Colloquium (Hardy)
• governmental advisory body Mental Health Nurse Academics (Hardy)
• Collaborative Action Research Network (CARN) (Hardy)
• International Society for Research on Internet Interventions (Gega)
• British and European Associations for Behavioural and Cognitive Psychotherapies (Gega)
• International Society for the Psychological Treatments of the Schizophrenias and other Psychoses (Gega).

Local Networks
At local level, there is a strong collaborative relationship with clinicians, service managers and service users. This relationship ensures that research findings can be effectively shared with the local community and that the design of locally-based research projects is informed by that community’s expertise and knowledge. Through informal discussions and through Halliday’s role in liaising with NHS- based researchers as Co-ordinator of the Research and Development Support Unit (RDSU) for Norfolk and Suffolk, the academics within this submission also help to promote research skills and activity within the local professional and lay communities. NAM researchers are able in designing their research projects to draw on the resources of PPIRES (Patient and Public Involvement in Research) a local initiative to enable and encourage volunteer members of the public to participate actively in delivering successful research studies. All NHS based research is submitted for Research Ethics and Governance approval.

All of the submitted academics hold Honorary Contracts with local NHS Trusts. In addition, individuals hold the following positions:
• East Norfolk & Waveney NHS Research Governance Committee (Halliday, Pfeil)
• Eastern Region Nursing Research Network (Lindsay, Pfeil, Halliday). This network was established by Hardy
• membership of the Research Committee of NNUH Trust’s Children’s Services Directorate (Lindsay, Pfeil and Halliday)
• membership of the Practice Development Round Table (a collaboration based in Victoria, Australia) (Hardy).

Research Collaborations
International and national collaborations are an increasing feature of NAMRU’s nursing research. They include international collaborations with universities in Norway, Australia and the Netherlands. Recent collaborative work includes Lindsay’s e-learning research undertaken with the Universities of Stavanger and Sydney.

 

Future strategy

NAMRU’s future research direction will be shaped in detail by the recent Faculty decision to assign research active staff to three discrete Research Institutes during 2008. NAMRU will become a Unit within the Institute for Health and Social Research. This reconfiguration will build on current research themes and enhance cross -School collaboration, mentorship and bidding for research funding, drawing on the most experienced researchers and optimum mix of expertise.

The Chair position, which also carries the role of Director of NAMRU, has been accepted by Dr Richard J Gray (Institute of Psychiatry) to start early in 2008.  He will lead randomised trials in nursing practice and a key responsibility will be to continue to target research council income (both ESRC and MRC) and other nationally and internationally competitive sources, including NHS R&D and Wellcome.

The Chair will be involved in the early appointment of at least one additional academic post at either Lecturer or Senior Lecturer level and will be allocated at least one PhD studentship.

The strategy of NAMRU will entail:
• further bidding for project and programme grants in selected areas, critically depending on the interests of the new Chair.
• identifying and supporting promising new researchers - within the University, among recent graduates and among staff of NHS partners - in bidding for personal awards at masters, doctoral and post - doctoral level, responding to the opportunities of NIHR and the Finch Report.
• using Faculty funds and University strategic investment to make at least one further senior appointment (SL or Chair) during the next three years, (likely to be in the area of Health / Social Psychology, in order to support research focused on achieving behaviour change among professionals and patients).

 

Indicators of Esteem

Salter:
• social science representative on Steering Committee of the UK National Stem Cell Network (2006 - )
• Chair of ESRC-funded international symposium ‘Stem Cells: From Tissue Engineering and Regenerative Medicine to Policy’ (April 2005 - attended by over 250 scientists and social scientists).

Lindsay:
• invited plenary speaker at the Anglo-Spanish Colloquium on Rural Health (2004, University of Valencia)
• Chair of the Nursing History Colloquium Conference 2004
• Executive Committee member of the UK Centre for the History of Nursing (2001-04)
• member of judging committee for inaugural Essay Prize of the international Society for the History of Children and Youth (2005)
• commissioned by Reflect Press to author a textbook for health and social care students and professionals, Understanding Research and Evidence Based Practice (published October 2007)
• jointly awarded (with Dr Peter Bradley) a 2007 DoH Innovation Award for a systematic review of epilepsy services for adults; co-presenter of paper on this review at 2007 Cochrane Colloquium in Sao Paulo, Brazil
• Conference Committee member for 2008 International Conference on E-Learning to be held in Cape Town.

Hardy:
• Associate Fellow of RCN Institute (2005-present)
• invited speaker at National Psychiatric Nursing Practice Conference (2004, Oxford) and Intensive Care Nursing Conference (2002, London).

Pfeil:
• awarded 2006 Grant Memorial Prize of British Association of Paediatric Surgeons for work on early discharge post-appendicectomy
• awarded ASEM DUO Fellowship by Royal Thai Government (2007)
• member of the International Scientific Advisory Panel (ISAP) for the 2008 RCN International Nursing Research conference. 

Gega:
• invited to co-author a Maudsley Monograph reviewing all English-language literature on computer-aided psychotherapy (published 2007)
• invited to co-lead plenary sessions at conferences organised by Royal Society of Medicine and by World Psychiatric Association European Regional Meeting/Royal College of Psychiatrists (London, 2001).