A realist evaluation of an enhanced court-based liaison and diversion service for defendants with neurodevelopmental disorders.

BACKGROUND: In England, court-based mental health liaison and diversion (L&D) services work across courts and police stations to support those with severe mental illness and other vulnerabilities. However, the evidence around how such services support those with neurodevelopmental disorders (NDs) is limited. AIMS: This study aimed to evaluate, through the lens of court and clinical staff, the introduction of a L&D service for defendants with NDs, designed to complement the existing L&D service. METHODS: A realist evaluation was undertaken involving multiple agencies based within an inner-city Magistrates' Court in London, England. We developed a logic model based on the initial programme theory focusing on component parts of the new enhanced service, specifically training, screening, signposting and interventions. We conducted semi-structured interviews with the court staff, judiciary and clinicians from the L&D service. RESULTS: The L&D service for defendants with NDs was successful in identifying and supporting the needs of those defendants. Benefits of this service included knowledge sharing, awareness raising and promoting good practice such as making reasonable adjustments. However, there were challenges for the court practitioners and clinicians in finding and accessing local specialist community services. CONCLUSION: A L&D service developed for defendants with NDs is feasible and beneficial to staff and clinicians who worked in the court setting leading to good practice being in place for the defendants. Going forward, a local care pathway would need to be agreed between commissioners and stakeholders including the judiciary to ensure timely and equitable access to local services by both defendants and practitioners working across diversion services for individuals with NDs.

Severe mental illness, common mental disorders, and neurodevelopmental conditions amongst 9088 lower court attendees in London, UK.

BACKGROUND: Court Mental Health Liaison and Diversion Services (CMHLDS) have developed in some countries as a response to the over-representation of mental illness and other vulnerabilities amongst defendants presenting to criminal justice (or correctional) systems. This study examined the characteristics and rates of mental disorder of 9088 defendants referred to CMHLDS. METHOD: The study analysed service level data, obtained from the National Health Service's mental health data set, to examine characteristics relating to gender, ethnicity and comorbidity of common mental and neurodevelopmental disorders at five CMHLDS across London between September 2015 and April 2017. RESULTS: The sample included 7186 males (79.1%) and 1719 females (18.9%), the gender of 183 (2%) were not recorded. Of those referred, 6616 (72.8%) presented with an identifiable mental disorder and 503 (5.5%) with a neurodevelopmental disorder (NDD). Significantly higher rates of schizophrenia were reported amongst Black defendants (n = 681; 37.2%) and Asian defendants (n = 315; 29%), while higher rates of depression were found amongst White defendants (n = 1007; 22.1%). Substance misuse was reported amongst 2813 defendants (31%), and alcohol misuse amongst 2111 (23.2%), with significantly high rates of substance and alcohol misuse amongst defendants presenting with schizophrenia or personality disorder. CONCLUSIONS: This is one of the largest studies to examine mental health needs and vulnerabilities amongst defendants presenting to CMHLDS. It will enable an improved understanding of the required service designs and resources required to manage the healthcare pathways for people attending CMHLDS.

A thematic analysis of system wide learning from first wave Covid-19 in the East of England.

BACKGROUND: The Covid-19 pandemic has created an unprecedented challenge for health and social care systems globally. There is an urgent need for research on experiences of COVID-19 at different levels of health systems, including lessons from professional, organisational and local system responses, that can be used to inform managerial and policy responses. METHODS: This paper presents the findings from a thematic analysis of front-line staff experiences working across the Norfolk and Waveney integrated care system (ICS) in the East of England during April and October 2020 to address the question "What are the experiences and perceptions of partner organisations and practitioners at multiple levels of the health system in responding to COVID-19 during the first wave of the pandemic?" This question was posed to learn from how practitioners, interdependent partner organisations and the system experienced the pandemic and responded. 176 interview transcripts derived from one to one and focus group interviews, meeting notes and feedback from a "We Care Together" Instagram campaign were submitted for qualitative thematic analysis to an external research team at a regional University commissioned to undertake an independent evaluation. Three phases of qualitative analysis were systematically undertaken to derive the findings. FINDINGS: Thirty-one themes were distilled highlighting lessons learned from things that went well compared with those that did not; challenges compared with the celebrations and outcomes; learning and insights gained; impact on role; and system headlines. The analysis supported the ICS to inform and capitalise on system wide learning for integration, improvement and innovations in patient and care home resident safety, and staff wellbeing to deal with successive waves of the pandemic as well as prioritising workforce development priorities as part of its People Plan. CONCLUSIONS: The findings contribute to a growing body of knowledge about what impact the pandemic has had on health and social care systems and front-line practitioners globally. It is important to understand the impact at all three levels of the system (micro, meso and macro) as it is the meso and macro system levels that ultimately impact front line staff experiences and the ability to deliver person centered safe and effective care in any context. The paper presents implications for future workforce and health services policy, practice innovation and research.

Examining arts-based practice in midwifery education: An integrative review.

AIMS: The aim of this integrative review is to synthesise the literature on creative teaching methods in midwifery education. The review question seeks to investigate the experiences of student midwives and midwifery educators of using creative methods as a learning approach. BACKGROUND: The benefits of creative teaching methods are widely acknowledged but the ways in which this may impact midwifery students' learning processes, or how this relates to their developing professional development, is not well understood. Research focused specifically on student midwives is yet to be synthesised. DESIGN: An integrative review was undertaken using data comparison with reflexive thematic analysis to identify common themes. METHODS: Eight electronic databases were searched with key terms in June 2022. English language studies from qualitative, quantitative, mixed-methods and wider literature were included. RESULTS: Twenty-two texts were included in the synthesis. Four themes were generated from the data; 1) What is the offering - More than a lecture; exploring the educator and student exchange and environment for learning; 2) Working in parallel - examining the change in teaching dynamic and collaborative partnerships; 3) Journeying towards holism - focused on student's integration of learning processes; and 4) Stepping into the professional - engaging with how using creativity can aid students' growing sense of themselves as professionals. This highlights improvements in levels of confidence, professional development and emotional intelligence in midwifery students. CONCLUSION: Creative teaching and learning methods enable student midwives to make meaningful connections between theoretical and practice learning environments, assisting knowledge and skills acquisition.

Cultural Influences on Mental Health Provision in the Caribbean: How Do Contemporary Perceptions and Beliefs About Persons With Mental Illness Inform Workforce Transformation?

INTRODUCTION: Mental illness is a global phenomenon in society, including trained health professionals, often responding to people with mental illness based on perceptions and beliefs. The research examined "contemporary perceptions and beliefs about mental illness held by stakeholders" attending a mental health symposium in Trinidad. METHODS: Data were collected using a 43-item questionnaire and analyzed using SPSS Version 22. Overall, 84 attendees working directly or experienced in mental health completed the survey. RESULTS: Respondents believed mental illness should be treated within local community settings. Participants who were more comfortable sharing their mental health diagnosis with friends were more likely to share with others, including their employers. There was a relationship between perception of the superstitious causes of mental illness and its effects on healing. DISCUSSION: Qualifications and experience in mental health do not reduce stigma associated with mental illness which has implications for addressing mental health literacy among health professionals.

The INFORM project: a service user-led research endeavor.

Effective engagement with people who experience mental health care services, as research participants and as research leads, is presented. A group of volunteer mental health survivors, called INFORM, worked for 6 years to develop and complete a research project, exploring service user experience of a home treatment and crisis resolution service. Within the article, discussion is given to the significance of service continuity, alongside personal accounts of the impact and consequences of health care staff's interpersonal interactions. Two contrasting messages arise from this study: first, the articulation of what services users want from services, and how that relates to what they actually receive, continues to be a necessary debate and issue for consideration at a time of considerable health care reform. The second message is that such articulation, although necessary, is not sufficient in itself to ensure that services are responsive to service user needs and preferences. Findings from the evaluation are consistent with other service user-led research. However, what is also evident is that more work is required in enabling health care consumers to provide feedback that can then be used to inform practice and service delivery improvement.

Embedding research (ER) led by nurses, midwives and allied health professionals (NMAHPs): the NMAHP-ER model.

BACKGROUND: Previous embedded researcher models have focused predominantly on an individual being a temporary team member and embedded for a project-limited short-term placement. AIM: To develop an innovative research capacity building model to address the challenges of developing, embedding and sustaining, research led by Nurses, Midwives, and Allied Health Professionals (NMAHPs) in complex clinical environments. This healthcare and academic research partnership model offers an opportunity to support the 'how' of enabling NMAHP research capacity building from within the researchers' clinical area of expertise. METHOD: Collaboration between three healthcare and academic organisations and the iterative process of cocreation, development and refinement took place over 6 months during 2021. The collaboration relied on virtual meetings, emails, telephone calls and document review. RESULTS: A codesigned NMAHP embedded research (ER) model is ready for trialling with the individual being an existing clinician working collaboratively within the healthcare setting and with academia to develop the skills to become the ER. CONCLUSION: This model supports NMAHP-led research activity in clinical organisations in a visible and manageable way. As a shared, long-term vision, the model will contribute to research capacity and capability of the wider healthcare workforce. It will lead, facilitate and support research in and across clinical organisations in collaboration with higher education institutions.

Evaluation of a liaison and diversion Court Mental Health Service for defendants with neurodevelopmental disorders.

AIM: Neurodevelopmental disorders (NDD) may present as neuropsychiatric problems as well as impairments of motor, cognitive, social and communication functioning. This study describes the introduction of a specialist service with expertise in NDD into an existing court mental health liaison and diversion service to determine if the service would impact on the health needs or disposal outcomes of defendants. METHODS: We examined referrals of defendants with NDD disorders over 30-months at a London Magistrates' Court. The pre-existing Court Mental Health (CMH) service was enhanced to provide additional expertise and hereafter referred to as the CMH + NDD Service. Baseline data including gender, ethnicity, remands and the rates of mental disorders was collected from the CMH Service using the existing minimum mental health service dataset. This was compared with data collected from the CMH + NDD Service. RESULTS: We found the following rates of NDD 9.5 % (n = 43) for the CMH service, and 9.5 % (n = 79) for the CMH + NDD service. Although overall the rates were the same the number of defendants with a single NDD diagnosis was increased in the CMH + NDD service with ADHD 10 %, ASD and ID 4% higher, the rates of comorbid NDD decreased in the CMH + NDD service compared to baseline. Specific disorders such as depression were recorded at higher rates for NDD defendants in both phases, however, this did not reach significance. In contrast, schizophrenia and delusional disorders, alcohol and substance use were observed at much higher in the non-NDD defendants during both phases of the study. The rates of diagnosis of schizophrenia and delusional disorders increased for the NDD group within the CMH + NDD service. Following the first court appearance, there was a 10 % reduction in custodial remands for defendants with NDD who were seen by the CMH + NDD service (34.2 %, n = 25 in the CMH + NDD service vs 43.8 %, n = 14 in the CMH service). CONCLUSION: The study found it is possible to successfully integrate practitioners with expertise of NDD into existing liaison and diversion services. This service enhancement demonstrated modest evidence of service effectiveness, including an increase in the detection of comorbid mental illness and a reduction in custodial remands for defendants with NDD. Further work needs to be completed to examine how this model can be rolled out across multiple courts and in particular, a cost-benefit analysis is required to understand whether an approach involving a cluster of Courts, as opposed to a single site is the most effective approach for this group of defendants.

An exploration of intent for narrative methods of inquiry.

This article discusses the purpose, process and usefulness of narrative-based research. Drawing on elements of naturalistic and constructivist approaches, the authors explore the processes and consequences of engaging in narrative-based inquiry. They propose a reconsideration of the intention, purpose and usefulness of gathering and using narratives, and suggest that narratives can provide healthcare practitioners with the opportunity to engage in inclusive research that can have a transformational effect on all research informants, including the researchers.

Re-defining nursing expertise in the United kingdom.

There is now international recognition of the importance of practice expertise in modern and effective health services. The Expertise in Practice Project in the United Kingdom began in May 1998 and continued to 2004. It included nurses working in all four countries of the United Kingdom, and it covered clinical specialists from pediatrics to palliative care. The project added to the current understanding of what nursing practice expertise is, through the identification and verification of attributes and factors which enable expert practice. The proposed framework offers a language for sharing what constitutes practice expertise and offers insight into what occurs between the expert practitioner and the people that experience their care. The Expertise in Practice Project demonstrates that nurses affect change and facilitate performance and organizational development.

Supporting student mental health nurses in clinical placement through virtual in-practice support (VIPS): Innovation uptake and the 'VIPS' project.

OBJECTIVE: The integration of technology in nurse education has become an essential element of academic practice. Yet innovation uptake between academic institutions across the four countries of the UK and their clinical practice partners has proved problematic, leading to a slow introduction of digitally enhanced teaching and learning innovations, particularly in the area of clinical decision making and leadership. PARTICIPANTS: The Virtual in Practice Support (VIPS) project involved two academic institutions working with the same mental health care service partner aiming to maximise student clinical placement learning. Student nurses in their final year of training were invited to take part in testing the viability of distance e-tutoring (via computer access to academic nurse lecturers) for facilitated critical reflection. DESIGN: An evaluation of the use of video linked conference sessions, set up for students to undertake a group based online (i.e. virtual) group tutorial is presented. METHODS: All participants completed an evaluation data sheet using a five point Likert scale and free text evaluation feedback form completed at the end of each online tutorial session. Students were also invited to a focus group and all tutors were interviewed at the completion of the project. RESULTS: The VIPS project findings highlight; i) the importance of a clear project vision for innovation uptake ii) consequences of working with innovation champions and iii) how technology can be used to maximise student learning across geographical distance through online facilitated group critical discussion. CONCLUSION: VIPS' participants were able to articulate positive outcomes as a result of engaging in a multi-institutional project that capitalised on the richness of nursing clinical practice learning experience for both the students and the academics involved as innovation champions.

Reflections on how to write and organise a research thesis.

Writing up research projects and presenting a thesis are among the most challenging and time-consuming elements of the research process. The authors provide a structured guideline to help students, particularly those undertaking Master's degrees while still practising in clinical areas, to overcome the challenges of writing their thesis and produce a cogent, logical and reflective piece of work.

Educating advanced level practice within complex health care workplace environments through transformational practice development.

Over the past 20 years health care reform has influenced the development of advanced level practitioner roles and expectations. How advanced level practitioners work to survive the highly stimulating, yet sometimes overwhelming aspects of balancing high quality provision with political reform agendas, amidst economic constraint is considered. Transformational approaches (encompassing education and practice led service development) can provide, promote and 'provoke' a harnessing of complex issues workplace environment to produce creative solutions. Transformational Practice Development provides a structured, rigorous, systematic approach that practitioners, teams and health care consumers alike can utilise to achieve skills and attributes needed for successful innovation. The authors present case study materials from action orientated locally delivered Practice Development, as a complex strategic intervention approach to influence and promote advanced level practice expertise. Initiated through facilitation of transformational leadership, and resultant team based improvements, we present how strategic collaborative processes can harness work chaos and complexity to provide sustainable and productive workplace cultures of effectiveness.

Mental and physical health comordibity: political imperatives and practice implications.

Insufficient priority is being given to meet the physical health-care needs of people with mental illness. Mental health nurses, as the largest professional group working in mental health care, have a pivotal role in improving the physical health and well-being of people with mental illness. Through health-promotion strategies, alongside recovery-focused support aimed at avoiding deteriorating physical health, mental health nurses can significantly contribute to improving the current rate of premature death experienced by people with enduring mental illness. Drawing from contemporary policy, alongside practical examples taken from the published literature, this paper considers what constitutes recommended best practice in dealing with the physical health-care needs of people with mental illness. The role that UK-based health-care policy plays in shaping care delivery that meets the needs of people with mental illness is explored and placed within the context of global health concerns. Recommendations are made on how mental health nursing can work to provide evidence for a reassertion that nurses are well placed to work across organizational and professional boundaries to deliver person-centred care and a holistic approach to population health and well-being.

Patient narratives in the investigation and development of nursing practice expertise: a potential for transformation.

This paper is a review of the experiences gained whilst working with the 'expertise in practice project'. The project was concerned with understanding the complex phenomenon of practitioners investigating and evaluating their own practice. The research intention was focused on making a difference to how those nurses practised, through introducing systematic practice-based inquiry processes that could enable nurses to think more critically about their work and how their practice affects others. Particular attention is paid to the process of engaging people who use healthcare services, as research participants in the evaluation of nursing practice expertise. We outline how the project incorporated practitioners' concerns about asking people who use health care services opinions on nursing practice expertise and how a process of discovery emerged that enabled transformation of practice and consideration of the patient-participants' role as a sophisticated evaluator of health-care. As a result, we present a case for transformational qualitative research. Such research is values-driven and uses inclusive, collaborative and facilitative processes. It contributes to human flourishing, not only through its 'ends' (i.e. research products) but also, intentionally, through its 'means' (e.g. research processes and stakeholder involvement). Thus, transformational research is complex and requires that researchers engage in reflexivity (deep self-reflection) to examine and critique their personal values.

Developing a qualitative approach to 360-degree feedback to aid understanding and development of clinical expertise.

AIM: This paper presents one aspect of a 5-year multicentre action research study to develop an accreditation process for clinical nursing expertise. Part of the process consisted of the exploration, critique and refinement of qualitative 360-degree feedback as a tool for peer review. BACKGROUND: Three hundred and sixty-degree feedback is widely used as a personal and professional development strategy. This part of the overall study challenged assumptions about the necessity for anonymity and structured questionnaires to collect data. The study involved 32 experienced clinical nurses drawn from a range of clinical settings supported by 'critical companions' (colleagues from clinical practice, education, management and research, recruited to provide supervision and support). METHOD(S): Study participants, facilitated by the project team (the authors), engaged in critiquing and refining 360-degree feedback as a process to help them examine and develop their practice. CONCLUSION(S): On the basis of our findings this approach to gathering 360-degree feedback facilitates the collection of evidence that aids professional development. There are indications that it may also contribute to improved working relationships.

Exploring nursing expertise: nurses talk nursing.

It has become increasingly important for practitioners to articulate their expertise in modern healthcare settings that demand high levels of accountability and evidence-based practice. The material presented within this article has been interpreted drawing from discourse analysis1 to help explore the discourses that shape and influence understandings of nursing practice. What we present are extracts from four of the 35 participant nurses who applied to take part in the Royal College of Nursing Institute's Expertise in Practice (pilot) Project (EPP). The material presented is used to provide a starting point for exploring how nurses talk about and construct expertise in nursing practice. The four nurse participants' clinical practice areas cover palliative care, mental health, intensive care and fertility care. The material reveals high levels of intensity in the nurse-patient relationship, 'maverick' nursing practices and ongoing reflexivity. All of these aspects appear to capitalize on expertise as a 'catalyst' that alters treatment pathways and maximizes patient-centred outcomes. Exploring a discourse of nursing expertise exposes the tacit situated nature of professional practice that is heterogeneous and most difficult to articulate and explain. It is proposed that expertise tends to be understood from traditional and dominant discourses of medicine, management and technology. Explaining expertise in practice exposes non-conventional practice that in itself can be isolating and challenging to the status quo of contemporary health-care.