- Anthropologists on the Psych Ward: The Gift Economy
- Anthropologists on the Psych Ward (2): Tea Ceremonies
- Anthropologists on the Psych Ward (3): Care Plan Talismans
- Anthropologists on the Psych Ward (4): Timed Checks
- Anthropologists on the Psych Ward (5): Quantum Distortions in Time
- Nursing Research: Is it a load of old wibble?
On our recent threads about careers in psychology versus careers in mental health nursing, it’s been suggested that nursing research is a pile of clinically-irrelevant wibble. In order to consider this hypothesis, we now bring back our resident academic, Professor Humphrey G Escobar, chair of anthropology at Miskatonic University, occultist, bon viveur, author of our occasional series Anthropologists on the Psych Ward and of the religious pamphlet, How I Learned to Stop Worrying And Love Cthulhu.
Professor Escobar provides the following research paper in response.
Nursing Research – A Load of Old Wibble? A Qualitative Analysis by H G Escobar PhD (Misk.), MSc (R’lyeh), B.Demonology (Arkham)
ABSTRACT: Nursing research has at times been dismissed as “wibble”. This paper examines a sample issue of the Journal of Psychiatric and Mental Health Nursing and measures the wibble content on a series of assessment scales.
Literature Review
E said nursing research is a load of wibble. Beakie said it isn’t. Mr Ian said he didn’t care and was off to the beach to sip on a nice cold pint of Milo. Oldschoolbaby said we should all eat more organic veg and stop worrying about political correctness. Then E blew a raspberry at Beakie, and Beakie mooned his arse back at him. Azulinebloo yelled at them both to shut the fuck up and stop shouting while she’s trying to revise.
Methodology
The September 2008 edition of the Journal of Psychiatric and Mental Health Nursing was perused, and the 10 research papers within were measured on three rating scales for evidence of wibble. On each of these scales, marks are given out of 10, where 10 is maximum wibble and 0 is no wibble. The three rating scales are:
The John Heron Stating the Bleeding Obvious Scale
Does the paper tell us something new, or simply tell us something we all knew already, thus producing unanimous cries of “No shit, sherlock!” from the readership?
The Chanelle from Big Brother Utter Irrelevance Index
Is it about an important clinical issue that vexes us, or is it about something nobody gives a toss about, and has clearly been banged out purely so some careerist halfwit can stick a research publication on their CV?
The Phil Barker Kookiness Quotient
Looks for evidence of post-structuralism, post-modernism, social constructivism, epistomological relativism or just downright weirdness.
This leads to a maximum score of 30 per paper, or a total score of 300, whereby 0 would be a hard-hitting, clinically useful research journal, and 300 would have been guest-edited by John Heron.
Reliability and Validity
The scoring is based purely on my own observations and prejudices. I’ve only read the abstracts as I don’t have access to the full text, and I’m doing this with a stinking hangover from last night’s human sacrifice and BDSM orgy. So, not very reliable or valid at all.
Results
Developing more positive attitudes towards mental health nursing in undergraduate students: part 2-the impact of theory and clinical experience (p 527-536)
The John Heron Stating the Bleeding Obvious Scale – 7
“The findings suggest that an increased component of theoretical and clinical experience in psychiatric/mental health nursing is likely to produce more positive attitudes towards people with mental illness and psychiatric/mental health nursing.” Student nurses are more likely to be interested in mental health if they actually get to do some? Well, duh.
The Chanelle from Big Brother Utter Irrelevance Index – 2
In all fairness, this from Australia, where people are shrieking about how student nurses aren’t getting enough experience of mental health since the training went generic, so this is a topical issue. The NMC, who want to import the Australian model to Britain, may wish to take note.
The Phil Barker Kookiness Quotient – 0
It all appears to be statistical analysis, so no weirdness.
Total score – 9
People with learning disabilities admitted to an assessment and treatment unit: impact on challenging behaviours and mental health problems
The John Heron Stating the Bleeding Obvious Scale – 5
It basically says the unit is doing a good job, which is nice, though admittedly not very exciting. Still, it’s good to have confirmation that the approach is working.
The Chanelle from Big Brother Utter Irrelevance Index – 1
Pretty relevant, I’d say
The Phil Barker Kookiness Quotient – 0
None noted
Total score – 6
Kalevala or Keats: poetic traditions as a model for multidisciplinary miscommunication and team splitting
The John Heron Stating the Bleeding Obvious Scale – 7
“Attention is drawn to the oral tradition in poetry and some ways in which it differs from written, literary poetry. Some of these differences mirror differences between the oral communication typical of a psychiatric ward nursing handover and the writing-based communication styles of psychiatrists. In particular, the oral tradition tends to involve an interactive and participatory style, stewardship (rather than authorship) of the message, a less linear approach to time and valuing the use of familiar formulae.” Eh? So, in other words, people are interacting more when they’re talking to each other than when they’re writing to each other? No kidding.
The Chanelle from Big Brother Utter Irrelevance Index – 9
“The use of an analogy from poetry is intended to make the differences more explicit, and thus generate awareness, discussion and problem solving.” Wa….? Anyone who care about this clearly doesn’t have any real work to do.
The Phil Barker Kookiness Quotient – 10
Totally bonkers
Total score – 28
Relapse prevention in serious and enduring mental illness: a pilot study
The John Heron Stating the Bleeding Obvious Scale – 3
A relapse prevention programme was found not to prevent relapses. A slightly counter-intuitive result, so scores low.
The Chanelle from Big Brother Utter Irrelevance Index – 0
If an intervention isn’t working, then that’s definitely relevant information.
The Phil Barker Kookiness Quotient – 0
All hard stats, no po-mo to be seen. After the previous paper, thank God, quite frankly.
Total score – 3
Mental health policy and integrated care: global perspectives
The John Heron Stating the Bleeding Obvious Scale – 8
Nurses collaborating internationally is A Good Thing. Glad to hear it.
The Chanelle from Big Brother Utter Irrelevance Index – 2
It may be slightly obvious, but I wouldn’t call it irrelevant.
The Phil Barker Kookiness Quotient – 4
“Effective approaches must consider existing healthcare delivery networks, nurses as care providers, as well as social, cultural, political and historical contexts.” Starting to wibble, but it doesn’t quite go the whole way.
Total score – 14
Developing and testing an intervention to prevent homelessness among individuals discharged from psychiatric wards to shelters and ‘No Fixed Address’
The John Heron Stating the Bleeding Obvious Scale – 3
Making sure an intervention works – and it does
The Chanelle from Big Brother Utter Irrelevance Index – 0
“All the individuals in the intervention group maintained housing after 3 and 6 months. All but one individual in the control group remained homeless after 3 and 6 months. The exception joined the sex trade to avoid homelessness. The results of this pilot were so dramatic that randomizing to the control group was discontinued.” Definitely a useful set of data if you’re making pitches for funding.
The Phil Barker Kookiness Quotient – 0
A controlled trial, so no kookiness.
Total score – 3
Attitudes to animal-assisted therapy with farm animals among health staff and farmers
The John Heron Stating the Bleeding Obvious Scale – 5
Mental health staff are keen on therapeutic use of animals. Admittedly they could have just asked Oldschoolbaby, who I believe is quite into this sort of thing.
The Chanelle from Big Brother Utter Irrelevance Index – 4
Not as urgent as preventing homelessness, but I wouldn’t call it irrelevant.
The Phil Barker Kookiness Quotient – 5
“Green care is a concept that involves the use of farm animals, plants, gardens or the landscape in cooperation with health institutions for different target groups of clients.” One can just smell the mocassins and organic tofu. Still, it’s not over-the-top kooky.
Total score – 14
Exploring the role and perspectives of mental health nurse practitioners following psychosocial interventions training
The John Heron Stating the Bleeding Obvious Scale – 6
Some nurse practitioners did some psychosocial interventions training, and they felt they benefited from it. Not exactly earth-shattering news.
The Chanelle from Big Brother Utter Irrelevance Index – 5
Not a total irrelevance, but I can’t imagine major policy changes as a result of this either.
The Phil Barker Kookiness Quotient – 6
“PSI practitioners developed positive attitudes towards their client following PSI training and this attitudinal change enabled clients to develop more confidence and autonomy in managing the symptoms of their illness in a more empowered way.” Feel those sociology buzzwords!
Total score – 17
Health professionals’ attitudes towards suicide prevention initiatives
The John Heron Stating the Bleeding Obvious Scale – 7
Another study suggesting that if you train a clinician in something, they’re going to be more keen on it.
The Chanelle from Big Brother Utter Irrelevance Index – 3
I wouldn’t call suicide prevention irrelevant.
The Phil Barker Kookiness Quotient – 0
None noted
Total score – 10
The development of a nurse-led liaison mental health service for older people in Chesterfield, Derbyshire, UK
The John Heron Stating the Bleeding Obvious Scale – 2
Examines a liaison service, and discusses implications for practice.
The Chanelle from Big Brother Utter Irrelevance Index – 2
Pretty relevant stuff.
The Phil Barker Kookiness Quotient – 0
I didn’t see any kookiness here.
Total score – 4
Total Score for the issue as a whole: 108 out of 300.
Discussion
108 out of 300 suggests a journal that has some wibble but also a fair amount of useful studies as well. However, it was interesting to note the wide variation in scores for individual papers. The wibbliest paper scored 28, whereas the two least-wibbly both scored 3. Therefore it is clear that some nursing research is more wibbly than others.
Declared interests: As a dedicated servant of the Great Old Ones, I have a personal and religious interest in spreading madness, confusion and discord throughout all sectors of society. Sociology wibble, psychobabble and management twaddle are vital weapons in our ongoing efforts to drive you all to gibbering insanity. You may wish to note our deep and extensive penetration of the NMC, the GMC, the Royal College of Nursing, the British Medical Association, the National Institute for Clinical Excellence, the Department of Health and the Labour Party. Ia Dagon! Cthulhu fhtagn!
A homeless loony writes: It all begins to make sense now, I must be part of the control group of a University of Poshshire Double Blind Clinical Trial…
Oooh, how I love posts like this. Perverse, interesting and a teeny bit of something useful.
The good professor’s declaration of interests aside, is his the keen mind you’d wish to heed? When his counsel has included notions to ponder utterings such as, “Shub-Niggurath! The Goat with a Thousand Young!”
Quite. Well, it was in Boston
There is something vaguely unnerving when I read “Ia Dagon! Cthulhu fhtagn!” and think, “Cthulhu waits dreaming.” But also think, Father Dagon and Chtulhu, why’s Mother Hydra been missed out of the trio of Great Old Ones worshipped as gods by Deep Ones.
Too much lore. San rolls all round, methinks.
You know, Shrink, when you make comments like that I always find myself thinking that there’s something rather disturbing about a consultant psychiatrist who clearly has an extensive and in-depth knowledge of the Cthulhu Mythos.
Caused by an absence of Hob Nobs no doubt.
An excellent meta-analysis of primary bollox. Aside the homeless one – I’m going to look that one up. But in a journal of 10 articles – one seems useful. This is my whole point of the irrelevance of research in – err.. I forget which post/rant.
Also, why is the September issue available first week in August? Is this like Easter Eggs being on the shelves ready for Christmas?
*Only* the one on homelessness?
Not the one pointing out that relapse prevention programmes don’t work?
Or the one discussing the implications for practice of a liaison service?
Or the one scrutinising the impact on challenging behaviours of a learning disabilities asssessment unit?
I’d say those all are directly clinically-relevant research topics, and not wibble at all.
The one on attitudes of student nurses in Australia to mental health seems to be a *very* important topic to research, given all the ructions over their generic programme and how it’s not training nurses for psychiatry. And if you want policymakers to change the training, then you’ll need to have done the research to present to them and say, “See? This isn’t working.”
There’s also a few that are more focused on the staff attitudes rather than on patients (animal-assisted therapy, psychosocial interventions, suicide prevention initiatives). I’d class these as “a bit wibble” rather than total and utter wibble, It’s not as hard-hitting as the one on homelessness programmes, but it might still be relevant to somebody.
The one on global perspectives in nursing seems to be more of a policy discussion rather than actual research, so I’d put that in the “a bit wibble” category too.
The only one I’d categorically label as “total, unmitigated, of-no-use-to-anybody wibble” is the one on poetic traditions.
“. . . a consultant psychiatrist who clearly has an extensive and in-depth knowledge of the Cthulhu Mythos.
What do you think we’re trained in, over all those years?
“Attitudes to animal-assisted therapy with farm animals among health staff and farmers”
You know that really did conjure some very unnerving images.I don’t think I would apppreciate being looked after by a farm animal !!
On the plus side SS, the farm animal probably doesn’t give a fuck about the quality of training offered at their ex-poly or high falootin uni, but just wants to get on with “caring”.
*Only* the one on homelessness?
Yes. It was the only one that gave positive change as a direct result (“The results of this pilot were so dramatic that randomizing to the control group was discontinued”)
Not the one pointing out that relapse prevention programmes don’t work?
No. The idiots don’t know how to make a useful relapse prevention plan or are, once again and like de-institutionalisation, imposing off-the-shelf blanket care to a group of patients as if they’re all cut from the same cloth. A R~ plan requires education and planning with the patient on what to do in problem times – not simply planning around the patient in paternalistic fashion (I haven’t read the article – tell me if I’m wrong). Common sense tells me RPs can provide at least a phone number to call for further help; recognition of symptoms or understanding the nature of the condition. RP is merely a documentation of how to cope with relapse – right up to and inclusive of re-admission if so necessary. Then the RP gets amended to mitigate the reasons the last RP failed. RP failure is as common as Care Plan failure. If an RP fails in as much as this study suggests then not enough work went into it or they didn’t assess the suitablility of an RP approach to the client’s capacity appropriately. Not that RPs don’t work in chronic/enduring mental health.
Or the one discussing the implications for practice of a liaison service?
No use to me here. But even – in Journal of Psychiatric and Mental Health Nursing – is it any surprise they say nurses do a good job at it? I wonder if it discusses the MDT perception and or just how well the nurses did?
Or the one scrutinising the impact on challenging behaviour of a learning disabilities assessment unit?
Actually this might be of use where I am – as they don’t have a learning disability service at all (No, I’m not joking). However, anyone who needs to have an idiots’ guide that LD patients require a sympathetically sensitive service or expect an increase in challenging behaviour – is in the wrong business. My mechanic could have told me that.
I’d say those all are directly clinically-relevant research topics, and not wibble at all.
Relevant, yes; wibble, no; of any use? What does it tell us that we couldn’t work out?
Or am I just being arrogant and cynical?
What does it tell us that we couldn’t work out?
Sometimes it purely is to spell out what we already know – but not to spell it out to ourselves, to spell it out to people who hold the purse strings.
If a unit is arguing for staffing, money and resources, then they’re a lot more likely to get it if they say, “Here’s a list of research papers that show that what we want to do is an effective intervention.”
And at other times, it turns out that what we thought we knew was actually wrong – such as, e.g. if a unit discovers that their relapse prevention programme isn’t working.
I accept those arguments – but I disagree with the presumption that the quality of most nursing research is of any value. Most research ends with “more research is indicated” yet there is very rarely any comparable study done.
When was the last/first time you witnessed change to your practice or organisational model of service delivery based on nursing research?
Research depends on the propositions underpinning the questions you ask.
Take research on ritalin [for example] – how valid is any research on this drug if it is ever proven that there no such neurobiological entity as ADHD.
Equally, models of psychotherapy are not sciences, although some are increasingly borrowing from scientific methodologies to support assertions for their efficacy.
Even the very bedrock of medical psychiatric treatment , antipychotics has been questioned.
Ranking symptoms that had improved with anti-psychotics, hallucinations and delusions came out a poor 5th & 6th, after:
‘combativeness’, ‘hyperactivity’. ‘tension’ and ‘hostility’
[Breggin, Toxic Psychiatry, p75].
Other psychiatrists such as Paul Keck have claimed that the use of benzodiazepines and opiates demonstrated similar efficacy [in the treatment of schizophrenia] to that of anti-psychotics – notwithstanding the unwanted complications that invariably arise with these x2 groups [benzo's/opiates].
As to nursing research I think we could jettison just about everything on nursing models, and reflective practice – while KSF [is it research based ?] is a monumental waste of time and money.
Perhaps RMNs could brush up on a few more practical skills, like wound management ?
I’m sure inpatients would much prefer to have their wounds sutured by a trusted RMN [or closed by other methods] – it’s not that difficult to exclude a nerve or tendon injury, or infection, and it would be far better than sitting around in A&E for hours on end.
wound management?! But that’s what ordinary nurses are for :-O
*faints at the thought*
Reflective practice is something I regard as being more useful as a teaching model than as a research tool. Handy for encouraging students to think about their actions, but I wouldn’t use it as a research method.
I wouldn’t really call KSF particularly research based, as far as I can tell. I’ve read my KSF competencies that I’m supposed to “achieve”. Quite frankly, if I wasn’t achieving them on my final placement as a student, I wouldn’t have been allowed to qualify as a nurse in the first place.
I’m going to regret asking this but, what is KSF?
Have I already read it but not retained it?
Aha! Knowledge and Skills Framework.
You shouldn’t be using abbreviations Z.
ahem.