Stakeholder identified research priorities for early intervention in psychosis.

BACKGROUND: Public resources to answer pertinent research questions about the impact of illness and treatment on people with mental health problems are limited. To target funds effectively and efficiently and maximize the health benefits to populations, prioritizing research areas is needed. Research agendas are generally driven by researcher and funder priorities, however, there is growing recognition of the need to include user-defined research priorities to make research more relevant, needs-based and efficient. OBJECTIVE: To gain consensus on top priorities for research into early intervention in psychosis through a robust, democratic process for prioritization enlisting the views of key stakeholders including users, carers and healthcare professionals. We also sought to determine which user-prioritized questions were supported by scientific evidence. DESIGN AND METHODS: We used a modified nominal group technique to gain consensus on unanswered questions that were obtained by survey and ranked at successive stages by a steering group comprising users, carer representatives and clinicians from relevant disciplines and stakeholder bodies. We checked each question posed in the survey was unanswered in research by reviewing evidence in five databases (Medline, Cinahl, PsychInfo, EMBASE and Cochrane Database). RESULTS: Two hundred and eighty-three questions were submitted by 207 people. After checking for relevance, reframing and examining for duplicates, 258 questions remained. We gained consensus on 10 priority questions; these largely represented themes around access and engagement, information needs before and after treatment acceptance, and the influence of service-user (SU) priorities and beliefs on treatment choices and effectiveness. A recovery SUtheme identified specific self-management questions and more globally, a need to fully identify factors that impact recovery. DISCUSSION AND CONCLUSIONS: Published research findings indicated that the priorities of service users, carers and healthcare professionals were aligned with researchers' and funders' priorities in some areas and misaligned in others providing vital opportunities to develop research agendas that more closely reflect users' needs. PATIENT AND PUBLIC CONTRIBUTION: Initial results were presented at stakeholder workshops which included service-users, carers, health professionals and researchers during a consensus workshop to prioritize research questions and allow the opportunity for feedback. Patient and public representatives formed part of the steering group and were consulted regularly during the research process.

Transitioning to university as a nursing student: Thematic analysis of written reflections.

BACKGROUND: The international literature has largely conceptualised transition to university as a process of adjustment to both the social and the academic demands of university life. Several factors influence this process including: student, parent and university staff expectations; student preparedness; and student belongingness. Moreover, some student groups (groups well-represented in nursing) appear to have particular difficulty in successfully transitioning to university life. STUDY AIMS: To explore first year nursing students' experiences of the transition to university; to compare nursing students' experiences with those of other disciplines and identify ways of easing the transition for nursing students. METHODOLOGY: As part of their coursework, first year nursing students at an English University submitted a 500-word, formative reflection on the transition to university. Anonymised reflections from 161 students were available to the researchers for thematic content analysis; 50 reflections, however, proved sufficient for 'information power'. RESULTS: Two main themes emerged from the data: (i) 'managing expectations', an overarching theme that permeated most of the reflections; and (ii) 'practical tools and support aids', the practical, concrete actions that either the university took, or the students developed themselves, to ease the transition. Both themes embraced inter-related academic, social and personal domains. CONCLUSIONS: Nursing students' transition experiences are similar to those of other university students. However, the particular demographics of nursing student cohorts amplifies certain aspects of the transition experience: more students who are likely to struggle with transition but also more students who embrace the developmental aspects of going to university. Transition requires joint enterprise between students and university staff, especially in terms of expectations and the support required to become independent learners. Transitions can be eased by tapping into student resourcefulness and seeing transition as a gradual process that cuts across academic, social and personal dimensions rather than as a short, one-off event.

Qualitative systematic review of barriers and facilitators to patient-involved antipsychotic prescribing.

BACKGROUND: Despite policy and practice mandates for patient involvement, people with serious mental illness often feel marginalised in decisions about antipsychotic medication. Aims To examine stakeholder perspectives of barriers and facilitators to involving people with serious mental illness in antipsychotic prescribing decisions. METHOD: Systematic thematic synthesis. RESULTS: Synthesis of 29 studies identified the following key influences on involvement: patient's capability, desire and expectation for involvement, organisational context, and the consultation setting and processes. CONCLUSIONS: Optimal patient involvement in antipsychotic decisions demands that individual and contextual barriers are addressed. There was divergence in perceived barriers to involvement identified by patients and prescribers. For example, patients felt that lack of time in consultations was a barrier to involvement, something seldom raised by prescribers, who identified organisational barriers. Patients must understand their rights to involvement and the value of their expertise. Organisational initiatives should mandate prescriber responsibility to overcome barriers to involvement. Declaration of interest None.