Research News

Hands, face, space … and a programme of rapid response Covid-19 evaluation

An outgoing reflection of the past year working within the NSFT research department by Sarah St Ledger.

I am just leaving my current position within the NSFT research department to embark on a Doctorate in Clinical Psychology (gulp). So I figured that now was a great opportunity to write about, and reflect upon, the last year within the research team and some of the work that I have been involved in.  

I was employed around a year ago to help the research team design and develop research relating to Covid-19. The Covid work has been fast-paced, diverse and hugely interesting both from a professional and a personal perspective; knowledge is power and at a time when the whole world was grappling with the impacts of Covid it was nice to feel like I was directly involved in the learning.  

One of the first pieces of work I became involved in when I started in the team was the Covid-19 Ethnic Minority Staff Wellbeing Survey whereby almost half of respondents reported poorer mental health since the start of COVID-19, a finding similar to that of the rest of the UK at the time. From this piece of work a dedicated wellbeing officer for ethnic minority staff members was appointed, pandemic wellbeing sessions were arranged by the Black and Ethnic Minority Staff Network, and we are now following up the survey to see if anything has changed over the last 12 months.  

Another memorable piece of work was the Staff COVID-19 Vaccine Intention survey which we completed in December 2020. We knew from the literature that healthcare staff typically have lower vaccine uptake compared to the general population, but our study was able to provide valuable insights into why and what characteristics determined vaccine acceptance, hesitancy or rejection.  Our study demonstrated that vaccine promotion needs to provide healthcare staff with timely and accurate information relating to consent, safety and efficacy through targeted communication strategies to support them with their personal vaccine decisions. The information gained from this study became the catalyst for an increase in targeted communication strategies within the organisation and led to an overall staff vaccine uptake of 94%, a figure much greater than first predicted.  

One of the best things about the last year and the work I’ve been involved in was the ability to rapidly respond to the needs of our staff and service users and I feel proud to have played a small part in the development of knowledge and in seeing that knowledge embedded into clinical decision-making, directly informing the organisational response to the Covid-19 pandemic.  

One thing that has struck me about the last year has been how much I have enjoyed being in a non-clinical, research-based role! I thought working in research would be a bit dry and, dare I say it,  stuffy but it has been the opposite! The department is one of the most dynamic, skilled (brains for days!), forward thinking and compassionate teams I have had the pleasure of working with and whilst I am leaving, I am lucky in that I am not going far and will be able to maintain my connection with them as I continue in my studies. It's been an awesome year to work in research.  

 

Read Hands, face, space … and a programme of rapid response Covid-19 evaluation…

iACT4CARERS: Online Acceptance and Commitment Therapy for Family Carers of People with Dementia

carer and elderly person doing the dishes together

What we did and why we did it

Caring for someone with dementia can be hard, and family carers are much more likely to be depressed or anxious than other carers or non-carers. Unfortunately, family carers are currently under-provided for by NHS psychological services. This is because some carers are unable to travel, others do not have access to skilled therapists and, for others, finding somebody else to look after the person with dementia while they attend psychological services is an issue. Online treatments have the potential to overcome these challenges and improve equity of care. We conducted a preliminary study, funded by the NIHR, exploring whether it is possible to deliver Acceptance and Commitment Therapy (ACT) for family carers of people with dementia online within NHS services and whether this new intervention is acceptable among family carers presenting anxiety or depression.

What we found

The study was successful with more than 100 potential participants being referred to the study in just six months. Thirty-three eligible participants received online ACT, more than we had originally planned.

More than 70% of participants completed seven or all eight online sessions. There was preliminary evidence of improvements in scores of anxiety and depression following the intervention, perhaps more so for anxiety.

Individual interviews with participants highlighted that participants liked the ACT techniques, the user-friendliness of the online system and feedback received from their dedicated online therapist.

Participants also expressed that the intervention led to some improvements in their life such as making them feel it is okay to ask for help and make some time for themselves. The findings revealed that participants also noticed increased activities such as more exercises to take care of themselves due to the intervention.

Take away points

1. Acceptance and Commitment Therapy for family carers of people with dementia can be delivered online within NHS services.

2. The intervention may help cope with carer anxiety and depression, perhaps more so for anxiety.

3. The intervention may lead to some improvements in life such as making family carers feel it is okay to ask for help and make some time for themselves.

What’s Next?

A large-scale trial is now required to evaluate the effectiveness of online ACT and find out whether online ACT should be widely implemented.

The research team will use the findings from this pilot work and apply for a large grant to conduct a large-scale trial

Download the research recap iACT4CARERS.pdf 

Read iACT4CARERS: Online Acceptance and Commitment Therapy for Family Carers of People with Dementia…

“Doing research into Long Covid made me feel validated.”

Picture of Charge Nurse, Dawn Holden

Dawn Holden caught Covid in April 2020 and several months on was still struggling with long term symptoms plus trying to continue to work at NSFT. At the time she was not aware of anyone else who was experiencing long term symptoms where she worked. Dawn was feeling quite alone with what she was experiencing both physically, psychologically and the repercussions of working whilst managing the process of sickness meetings etc.

 

Dawn explains, “I thought that there must be other people within the trust who were experiencing similar difficulties. I think I must have seen something in an email or Trust communications about the research team and thought that I would contact them to ask if they had thought about doing any research based on this.”

 

Dawn had a reply from the Research Team, and she was put in touch with senior research nurse Louise McCarthy.

 

“I found Louise to be wonderful and so friendly,” Dawn explains. “We met up via Teams and discussed what I was experiencing and my thoughts about what should be asked within the research proposal.  Following this a survey was initiated which was sent out to NSFT employees.”

 

The survey looked at the prevalence of post-covid symptoms across the NSFT workforce – the details of the study were recently published in Nursing Research Matters Nursing Research Matters - Learning from COVID-19 (mmp-mmp-email.s3.eu-west-2.amazonaws.com) on page 116 and 117. 

 

“What was lovely,” explains Dawn, “Is that I was included in all of the steps, the questions that were chosen to be asked in the study and the findings. Which was so kind of the research team as I had only done a very small part of this work (asked the questions) and when I was asked if I would like my name included in the research document it was a surprise and very validating for me.”

 

Dawn has found it has given her the confidence to contribute to further research projects that have taken place, answering questionnaires and an interview undertaken by a university.  

 

“I am more aware of the benefit of research and how it is integral to development within NSFT. Participating in this research has also broadened my perspective on possible future careers paths,” explains Dawn.  

 

Dawn would advise other people to get in touch with research particularly if they have an area of interest that they feel passionate about or that they feel needs developing.

 

“Louise was so encouraging and interested in my views and I felt that what I had to say really mattered. Any email I receive now regarding research I pass on to all my immediate team in the hope that this will encourage other NSFT employees to become involved in research,” explains Dawn.

 

If you are interested in sharing an idea for research with the NSFT research team then please email  researchinfo@nsft.nhs.uk  or we have a new section on our website Become Involved | Norfolk and Suffolk NHS (nsft.nhs.uk) under speedy surveys   What would you like to see us research?  where you can suggest your research idea.

Read “Doing research into Long Covid made me feel validated.”…

Trialling a new way to help teenagers with Post Traumatic Stress Disorder

teenager looking at computer

The research team, which has received funding from the Medical Research Council, is seeking to recruit people aged between 12 and 17 who are affected by PTSD. The treatment programme delivers the same therapy and support that has proven effective in face-to-face sessions with children and adolescents affected by PTSD.

Anne Smith at Norfolk and Suffolk Foundation Trust has recently joined the trial team, she is an experienced clinician and trial therapist, she says, “The online version of cognitive therapy for PTSD means that treatment can be accessed via smartphone, tablet or computer. With online treatment there is no need to go and see a therapist every week, this will allow more young people to have the treatment.”

The online therapy involves working through online modules at the young person’s own pace. This can happen at home, guided by a therapist who will speak to them on the phone at least once a week. This will involve reading information, watching videos and inputting some information. There will be follow up reviews after treatment is completed.

The criteria for the young people is:

  • Aged 12-17.
  • Experiencing PTSD symptoms to a single event trauma.
  • Able to speak English to a level where they can engage in therapy without an interpreter.
  • Access to a smartphone and/or computer.
  • Not previously received trauma focused Cognative Behavioural Therapy for the same trauma.

Anne explains, “This particular intervention is targeting young people who have had a single traumatic event anything from car accidents, sexual assault or witnessing other traumatic events which are causing symptoms of PTSD – such as flashbacks or feeling on-edge.”

They have recruited 19 young people to the trial so far and some have given their feedback:

  • “I felt really supported. My therapist was brilliant and the modules, tasks, analogies and metaphors were really good”
  • “Seeing other people’s stories that were similar to mine really clicked with me and made me feel valid”

Clinicians at the South London and Maudsley NHS Foundation Trust and researchers at King’s College London have worked with partners from Oxford University, Cambridge University and the University of East Anglia to develop the app and website that provide personalised therapy and support to young people recovering from PTSD for this study.

If you can think of someone who might benefit from this trial for clinicians to refer Research Referral Form - Clinician/Organisation (office.com) or want to self-refer then please refer yourself via our centralised referral system  Research Referral Form - Service User / Carer / Parent (office.com) or email: researchinfo@nsft.nhs.uk  for further information. This study is called OPTYC and this is the website OPTYC.

 

Read Trialling a new way to help teenagers with Post Traumatic Stress Disorder…

Understanding how families support a person with dementia - the iCARE study

Elderly couple looking towards the camera

What we did and why we did it

Family carers are essential in supporting people with dementia living in their own homes or in care homes. Different challenges in providing care often lead to family carers having a poor quality of life (QoL). We wanted to understand how to best support carers to maintain their QoL while providing support to their family member living with dementia. Carers completed self-reported and interview-based questionnaires to explore the impact of some of the likely things that carers find stressful, for example, low mood, anxiety, hours devoted to caregiving, physical health conditions, sleep quality, psychological flexibility and care recipient’s neuropsychiatric symptoms.

Take away points

1. This project explored potential causes that could worsen the quality of life (QoL) of family carers of people with dementia.

2. 91 family carers with an average age of 69.5 took part in the study.

3. Carers’ anxiety, sleep quality and psychological flexibility seem to have a great impact on carer QoL

What we found

A total of 91 family carers from Norfolk & Suffolk, aged 18 or over, who were currently supporting a person with dementia volunteered to take part in the study. Carers’ average age was 69.5 years old, and they were primarily female family members looking after a person with severe Alzheimer's disease. Carers’ anxiety, sleep quality and psychological flexibility - the ability to do what's most important to you despite the presence of unpleasant thoughts and feelings - were the most important factors that have an influence on QoL.

What’s Next?

We hope the findings from this study will inform the development of new interventions that could help carers maintain their wellbeing across the entire journey of dementia care. Treating anxiety, improving sleep quality and promoting psychological flexibility seem to be critical to support the wellbeing of family carers of people with dementia.

Download the pdf here 177KB

Read Understanding how families support a person with dementia - the iCARE study…

Research: 'Aspirational' new family project.

Brioney and Isabela on the podcast

This week in Mental Health and You we hear about a new research project called ASPIRE.

The aim of ASPIRE is to develop a support package to build resilience in young people who have experienced adverse childhood experiences.

Brioney Gee and Isabela Tavares Junqueira from the research team, explain:

  • what the project involves,
  • the huge role co-production has
  • and how the project is going.

The new support package will empower a child’s caregiver – be it their Mum, Dad or someone else who is looking after them – to use techniques to build their child’s resilience, rather than a professional working with the young person. The National Institute for Health Research (NIHR) fund ASPIRE.

We hear from two members of the stakeholder team who have relevant lived experience. Rachel a parent of three and Seb who is a young person giving input on various parts of the project.

The aim of the support package is to support children who have experienced adverse childhood experiences (ACEs) before the age of 18. Experiences such as:

  • abuse,
  • neglect,
  • family break-up,
  • being bullied,
  • or experiencing a serious illness.

These ACEs have been linked to increased risk of a wide range of negative health outcomes across a person’s life. We also know there is a strong link between the number of ACEs a person is exposed to and their odds of experiencing mental health problems.

However, not all children who experience ACEs develop mental health difficulties. Some young people have social support and personal strengths that allow them to remain healthy despite difficult experiences. Something known as ‘resilience’.

The amount of resilience someone has is not fixed. If we can increase a young person’s resilience, we can decrease their risk of poor mental health.

The co-lead for this project is Cathy Creswell who is based at Oxford University, we also have partners who are based in the US Tim Lomaz and Cleo Berry is based at the University of Sussex. We are also working with co-applicants - two clinicians from NSFT Dr Jon Wilson and Dr Tim Clarke. We also have researcher as someone with lived experience in a parent/carer lead role Tina Walker.

If you want to get involved with ASPIRE then please email

Aspire@nsft.nhs.uk

 

 

Read Research: 'Aspirational' new family project.…

Practice-informed Guidance for Undertaking Remote-delivery Mental Health Research

Woman looking at computer

What we did and why we did it

In order to continue to provide services during a time of physical distancing the COVID-19 pandemic resulted in a need to rapidly implement and increase the use of remote healthcare delivery within mental health practice. It is expected that this accelerated implementation of digital care platforms will be maintained and expanded in routine post-pandemic health services. We recognised there was a lack of clear and practical guidance for mental health research staff when undertaking remote research visits.

Key areas to consider Research practice needs to be adapted for online appointments to allow for continuation of ethical practice and informed choice, while maintaining safety of participants throughout the study.

What we developed

We developed guidance outlining the key issues to consider when assessing appropriateness of a remote-delivery research appointments on a caseby-case basis and methods to support the development of a supportive research relationship. We produced a practical checklist to be used and adapted by research nurses undertaking remotedelivery appointments The guidance and checklist are based on the evidence to date and the teams’ own experiences and reflections of conducting remote-delivered research appointments across multiple research studies.

What’s Next?

The guidance and checklist are used routinely in our research department. We plan to undertake an evaluation of their use and acceptability. Poster presentation at the RCN International Nursing Research conference, 7th September 202

Read Practice-informed Guidance for Undertaking Remote-delivery Mental Health Research…

C-MAB: Collaborative Medication Adherence in Bipolar disorder

heads 2D layered on top of each other

What we did and why we did it

Around half of the people with mental illness do not take their medication as prescribed leading to relapse, hospitalisation and increased risk of suicide. This study aimed to understand what helps and hinders people from taking their medication as prescribed. We conducted focus group discussion and individual interviews with patients with bipolar disorder and their family and friends (n=33). We asked them about their views on what helped or hindered their medication taking. Their responses were transcribed and analysed to identify common themes.

Take away points

1. Mental health medication non-adherence is a significant clinical issue with huge economic impact.

2. Reasons for non-adherence are multifaceted, complex and unique to individual patients.

3. Clinicians should work together to explore those unique determinants and provide individualised adherence support.

What we found

We identified four key themes of medication adherence determinants:

1) The medications itself: efficacy and side effects of medication, pill burden, beliefs and knowledge about the medications, and emotion evoked by medications.

2) The practicalities - forgetfulness, access to prescriptions and medications, incompatible daily routine, practical support from friends and family to take medication or lack thereof.

3) How one sees themselves - not accepting the diagnosis or need for treatment, preference to alternative treatment, fear of stigma, worries of getting unwell and being sectioned.

4) Working with patients – being involved in treatment decision, being listened to, feeling supported by healthcare team and/or family and friends.

What’s Next?

Based on this research we have developed a questionnaire to identify non-adherence and individual determinants of non-adherence. We will be testing this questionnaire with around 500 people taking lithium for bipolar disorder. In the future, we plan to map each of the questions to evidence-based adherence intervention. So, based on patient’s response to the questionnaire, clinician can work with the patient to explore the best adherence support for individual patient.

Download recap as.pdf 431KB

Read C-MAB: Collaborative Medication Adherence in Bipolar disorder…

Research recap: Co-designing Continuing Professional Development (CPD) workshops

old person and nurse

What we did and why we did it

Independent Nurse Prescribers in memory services have a specialist role in an area of rising service demand, due to the increasing prevalence of dementia. We recognise that diagnosing dementia within a prescribing context is complex, nurse prescribers are experienced practitioners who have a valuable leadership and mentoring role within dementia services. Yet, they do not have consistent CPD opportunities for developing their own (or mentoring others) independent prescribing skills. We led a literature review and developmental evaluation as a way of supporting a group of NSFT nurse prescribers to strengthen their collective leadership skills in memory services by co-designing their own CPD workshops.

Take away points

1. Defining the role of nurse prescribers (for example, in reducing waiting times for treatment) generally seems to be difficult, even in one NHS Trust, due to varying memory service characteristics.

2. Nurse prescribers co-designing and leading their own CPD workshops are a sustainable way forward for achieving peer-led CPD relevant to their immediate needs. 3. Peer-led workshops support confidence in transitioning from newly qualified to independent prescriber; building skills in nursing leadership for evidence-based practice in person-centred dementia care and; supporting learning towards applying for Advanced Practitioner level study.

What we found

The final number of included articles in the literature review was 44, all from the UK. Literature addressing CPD issues for nurse prescribers in memory services was non-existent. Studies from different clinical areas suggest a problem with availability of CPD opportunities for nurse prescribers more generally. The link to the paper can be accessed here. We surveyed and/or interviewed NSFT memory service nurse prescribers and other key staff groups, people with experience of using NSFT memory services and their family supporters, to help us refine CPD topic areas. Based on our findings, we co-designed, held and evaluated two CPD workshops with the nurse prescribers over the course of the year-long funded project. We designed the stages needed to further develop a competency-based, confidence self-assessment tool to meet the groups specific CPD needs.

What’s Next?

We hope our findings, which emphasise the importance of developing tailored CPD opportunities based on the direct input, experiences and preferences of the nurse prescribers in memory services who will access them, will lead to effective CPD. This project focused specifically on a small group of nurse prescribers employed in one UK NHS Trust and working within memory services, however theoretically, findings could be adapted to benefit other groups of nurse prescribers. We thank the Burdett Trust for Nursing for funding this project.

Download recap as pdf  425KB

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Research recap: Evaluating Dementia Care Mapping™ training

Old people holding hands

What we did and why we did it

Dementia Care Mapping™ (DCM) enables staff to observe and critically assess the quality of care they provide within their teams from a unique perspective, that of the person living with dementia. DCM is a Quality Improvement tool underpinned by the concept of person centred care, a best practice benchmark referenced throughout the NICE clinical guideline for dementia. Since 2002, NSFT has supported CPD for a number of staff in using DCM with varying levels of expertise (i.e., Basic ‘mapper’, Advanced or Approved Trainer). However, currently, it was unclear whether NSFT staff benefit from DCM training in terms of their sense of confidence and competence in dementia care, and whether the knowledge and skills gained from the training leads to DCM being used in their daily practice. This mixed methods service evaluation aimed to explore these factors and see whether staff felt confident and competent in completing their first ‘map’.

Take away points

1. As a recommendation for DCM practice, a theme identified from attendees’ reflective diaries was challenges in finding the best time and place to provide mapping feedback to their colleagues during busy shifts. This is further evidence that managerial and organisational support is crucial to DCM’s success.

2. Overall, evidence from this evaluation suggests the 4-day DCM training was well received by care staff and was beneficial to the majority of staff’s personal development (sense of confidence and competence) in dementia care practice.

What we found

Twelve staff participants completed the course, and selfreported confidence and competence in dementia care practice were measured at baseline (before the training), post-intervention (immediately after) and follow-up (6 months later). Overall, results indicated that the DCM training was somewhat effective in promoting the attendees’ personal development in dementia care practice. Specifically, for the majority of attendees, their sense of confidence and competence in person-centred dementia care increased following the training and these gains were maintained six months after the training. Three attendees reported no reliable change in their personal development and competence in dementia care practice at baseline to post intervention, and 1 attendee showed a reliable decrease in their sense of confidence following the training (reasons for this remains unclear). At 6 months, 4 attendees provided follow-up data and all successfully completed DCM team practice development ‘cycles’ within six months of the training.

What’s Next?

We thank the Hammerton Court staff who kindly participated in this evaluation project. We hope our findings will help to plan effective training and learning opportunities for staff in person centred dementia care. Future evaluations could consider including qualitative interviews with attendees who report a reliable decrease or no reliable change in their personal development so that factors contributing to this could be understood. Further work could also explore the impact using DCM on outcomes for people with dementia staying on our wards, such as the frequency of adverse events.

Download recap as [pdf] 487KB

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