Hodges' Model: Welcome to the QUAD

The art and science of nursing: the poetry of caring

2009-11-08T12:37:00.001Z

Another quote:

... The best translators seem to have an extra ear, indeed, have to have an extra ear, for the literary dimensions and possibilities of their own language. Translation can draw the poet out of someone who may not have realised the poet in himself. The response to poetry is in us all but it takes an extra talent to turn response to invention, to hear and speak echo in a fresh voice. ...

George Szirtes, The Times, Words with a fresh voice, 7 November 2009, p.8.

Original image source with thanks: Alikaragoz.net

Innovation and the 'middle' in NHS computing

2009-11-07T00:01:00.003Z

Let's start with a quote:

Information systems are no longer associated mainly with data processing; they are increasingly seen as a management tool and an aid to action. This means that the costs of failure are much greater, and these costs are incurred when expensive systems are not used or are inadequately used. Surveys have shown that in as many as half of systems there are large gaps between users' expectations and the system's performance.

When do you think the above was written?

Here's the reference:

Mumford Enid (1991) Need for relevance in management information systems: what the NHS can learn from industry. BMJ. June 29; 302(6792): 1587–1590

1991: quite sobering really.

Previous - part-time - work reviewing data standards proposals focuses the mind in terms of the role of standards in interoperability, service impact and other essential assessment qualities. As the NHS has sought to implement standards as with the National Programme for IT you are also aware of the clamour for creativity and innovation. Innovation is there in the title of agencies.

I have long pondered about the extent to which - like Nature and vacuums - standards abhor innovation and creativity. How much is the 'standard' about doing things by the 'book' ... page 57 : para.3 ...

My eye caught the viewpoint piece in this week's Computing -

If you approach the world positively, a downturn is a good time for innovation. The shortage of people and money can create the pressure that leads to creativity. There are three areas where action will help organisations succeed in exploiting IT to enable business innovation:

Kick out Prince2

What more is there to say about innovation and Prince2? The focus of the Prince2 project management methodology – on organisation and control, and defining what to deliver before you have begun – is death to innovation. It is a bad solution trying to solve the wrong problem. It takes the IT profession in the wrong direction if we want to contribute to business innovation. It has to go. The agile development movement provides much stronger foundations for succeeding with projects that result in business innovation.

Ashurst, Colin, Viewpoint: How to use IT to enable innovation, Computing, 5 November, 2009.

Of course there IS a world of difference between information standards and project management standards, but there is no escape from the need for (effective) management of transition and change WITH business continuity. Within that management - engagement approach (as per agile) -

+++++++ socio-technical +++++++

- perspectives, as highlighted by Mumford (and others) all those years ago must have a place.

Additional links:

Computing, Letter of the week, UK is cursed with an anti-innovation culture, 5 November

BCS Sociotechnical Specialist Group

eHealthNews NHS Bury Primary Care Trust Goes Live with iSOFT Lorenzo RC 1.9

Global reach 4 a model in search of creative, innovative (caring) minds

2009-11-06T00:01:00.001Z

"An idea is not an innovation until it r e a c h e s people." p.45
the myths of innovation, scott berkun
O'Reilly

At Drupalcon Paris in September in his keynote Dries (Buytaert) highlighted the importance of reach in that mix of:

RICHNESS + R E A C H = SUCCESS

As per the 'badge stack' lower right in a search for traffic a while back I registered with feedmil.com. They offer real-time feed search. I realised I had not replied to them following a request for extra details. Here's what I have sent through for "Words from the Author(s)":

Welcome to the QUAD is an experiment of sorts. What I hope will prove a valuable stepping stone from a static website c.1998-2005 to a new dynamic, database driven resource devoted to Hodges' model and related learning. The blog reflects this - and I hope the creative potential of Hodges' model which is an *open* conceptual framework. This explains the scope and range of the blog across nursing, health, education and informatics. I am planning to use Drupal for the new site and although comments are disabled my e-mail is available so please get in touch. Always open to hear from people using the model, and keen to learn of the features and content types users of a new site might wish to see.

One of the appeals of Feedmil for me and the growing archive of content on W2tQ is their goal to allow users -

to serendipitously discover high quality,
but less popular feeds located in the long tail of feeds.

I've been using Clustermaps for quite a while and have the visitor's map updated every month, here is the (clickable) map for W2tQ through October 2009.

1,844 hits for last month,
that's terrific:
thanks to everyone for your support!

Watch this caring space: Workshop - Robots 4 independence

2009-11-05T00:01:00.005Z

The KT-EQUAL initiative has another event scheduled for later this month, another workshop on the application of technology to improve the quality of life of older people and their carers. Please find the call copied below. The workshop I attended in September and reported on here was very enjoyable and a great source of information and inspiration.

The topic for the 24th November paradoxically sends me back to The Which Computer Shows at the NEC in Birmingham which I used to attend with my father. In the late 80s and 90s the pace of change was clear to see. The topic for the 24th November is Robots and of course they are already everywhere, but the combination of:

demographic change - ageing population(s)
hence need to focus the skills and knowledge of the care workforce
emerging and refinement of safety and quality standards
design and innovation
the rise of 'single households'
mobile comms and ubiquitous computing
the expectations of the baby-boomer generation (and those who follow!)
lessons learned through early telecare(?)
and much more besides

- means that change isn't just on the cards, it's in neural nets, speech synthesis and the programme for this event. So as they say watch this space - it will change and move! Here is a marvellous opportunity to find out what is really happening in this field ....

Robots supporting personal independence and rehabilitation

This workshop organised with the University of Hertfordshire will present and discuss the role of technology in the rehabilitation of older people and children, including some of the latest developments in the use of 'robotic' technologies. The perspectives of research scientists, clinicians and users will be explored through presentations, videos and breakout sessions.

Hosted by: University of Hertfordshire

h2cm: windows on the mind, body, society and State

2009-11-03T13:38:00.003Z

h2cm is not just a window and handle on the mind and that of patient's and carer's.

h2cm can reflect (as per its original purposes):

health and social care policy;
the aspirations of local care communities and economies;
signs, symptoms - priorities;
care plans, actions and care pathways;
research objectives;
procedures;
ethical deliberations;
recovery, relapse prevention;
information requirements;
learning objectives;
and outcomes.
...

HOW Hodges' model can achieve this...?

Now that IS the question that can really open the windows, whether you believe in four or five....

Image source: with thanks to - FineArtAmerica.com: and the artist of -
I Marry Your Mind to Lights Window, Stephen Lucas

Drugs, Policy and spent Energy

2009-11-02T12:46:00.003Z

The ongoing controversy here in the UK over drugs policy amid the sacking of Prof. David Nutt - chairman of the Advisory Council on the Misuse of Drugs and since Friday the resignation of other members highlights the tension between the SCIENCES and POLITICS.

As a father, mental health nurse (and light imbiber of real ale and wine) all I know is that the government has been lobbied for decades by concerned groups over the risks of excessive alcohol consumption. With changes in alcohol licensing opening hours and pricing/tax it seems the government has the local town centres and community legislation it deserves.

Given the current spat you might think that within Hodges' model the SCIENCES and POLITICAL domains would be diametrically opposed? But no! There they are bosom buddies on the mechanistic side of the model.

Although the clue is in the title - advisory - as to the extent to which the government is bound to follow advice, the government's policy, advisory groups and policy should be in accord as far as the media and public are concerned.

Otherwise what price for evidence-based politics?

For individuals and communities alike we need order between the SCIENCES and POLITICS otherwise chaos reigns. Order does not just fall out of the tree. The issues here include at risk youngster's for whom exposure to cannabis might precipitate a psychotic episode; the granularity of a classification of drugs for legal purposes and that for clinical and social care. The debate is complex and takes work and energy on many levels. There are many dimensions to appreciate in this situation:

While very unfortunate, this is timely as I read Ben Goldacre's Bad Science.

You do have to worry about the position of
common sense.

There are other sources of heat already on the boil with many spillages to follow. These will arise from the friction of SCIENCE, climate change and policy. Ah bliss to live in interesting times. ...

'Well-being' - a discipline unattached: enter 'informatics' the ubiquitous bed-partner

2009-10-30T19:07:00.009Z

Informatics has been around for decades in many guises, associated with established academic disciplines and emerging fields as a consequence of the application of technology across society, education, work and more besides. As a result new schools of informatics emerge all the time.

The status, role, theory and practice of informatics is much debated within existing peer groups and professional associations. Prime examples include:

medical informatics
health informatics
nursing informatics
community informatics
urban informatics
citizen informatics
gender informatics
social informatics

- there is also a list on wikipedia.

The community informatics mail list and others have deliberated on the differences and boundaries of various schools (notably for the CI fraternity - community, urban and social informatics).

I have contributed to discussions and often thought about how to get a handle (map!) on the various schools. Inevitably I draw on Hodges' model and wonder if from the center there is a spectrum of informatics schools, something akin to a pattern made up of sectors encompassing the whole model.

Imagine my interest then when I noticed (and linked to) a workshop organized within CHI 2010 on -

Wellness Informatics (WI)

This is a great turn-of-phrase with an explanation behind it provided by Beki Grinter an organizer on her blog. Wellness and well-being are on the lips of us all at the moment. Informatics as we've seen is also quite a disciplinary bed-fellow.

I hope this workshop does take place and would love to attend. As for my thoughts and Hodges' model, I wonder when the circle will be closed?

Perhaps by that time 'informatics' will not be a discipline in which humans are the 'principal investigator'?

h2cm: fixed or primary concepts the push and pull of nursing

2009-10-29T00:01:00.001Z

When commentators, students and others write of the primary or core concepts of nursing what does this mean in terms of Hodges' model [h2cm]?

For quite some time I have been describing Hodges' model as a cognitive - conceptual space. This suggests that there are fixed concepts within the care domains. Yes, they may vary according to the context and over time, but if concepts were arrows and our aim is true then h2cm would provide the ideal target. It on this care matrix that we really could take aim and nail the kernels of knowledge that make up our care activities.

Is it a mistake to venture that for people to talk of basic nursing care, essential care needs, that there must be some fixed ideal out there; an ideal that nurses, society and policy makers can hang discussion and debate upon? And let's face it there is much to debate - mental health stigma, obesity, nutritionism, heart disease, dementia, unplanned pregnancies, funding, access, poverty. ...

Medical sociology has done and continues to do society at large a great service. It forces practitioners to look over their shoulder and take in the social and cultural forces that influence health. As a question for further deliberation within medical / clinical sociology we might ask: How are the concepts in Hodges' model fixed? There are several possible answers:

1. Someone determines that concepts a, b, c, d are in care domains 1, 2, 3, 4. The question of whether Hodges' model (or any other conceptual resource) is classed as evidence based depends on how that determination is made.

2. Alternately, the structure of the model provided by the axes, could act as a skeleton. This might serve as a boot strap breathing life into the empty spaces created by this structure. The first instances of concepts might then arise like some sort of quantum event - self, other, temperature, time, height, mood. ...

3. As (medical) sociology, philosophy and psychology continue to reveal, we also need to accept of course that society, culture and language are all inextricably linked and they pre-empt that empty space, predetermining what will be written (thought and reflected) there.

4. This external influence is a must if those working in the health and social care professions are to communicate with those 'outside' (public involvement can only run so far?). It is not so much a case of common ground, as common space and the freedom and opposition that this affords. this is essential for communication amid what is variously called - multidisciplinary working and integrated care. Here there must be a degree of latitude between different disciplines' usages of terms. This must provide common understanding or some close approximation and yet still be safe.

So rather than empty space the care domains are really full of care concepts all waiting on tenterhooks, to see whether they will get to aggrandise and become 'complex care needs'. Will the assessor / care evaluator pick them - from what is initially a virtual crowd? Go on make their day: care-fully!

A pantological links palette

2009-10-26T00:01:00.000Z

The table below displays the existing link categories for all four care (knowledge) domains of Hodges' model:

INTER-intraPERSONAL : SCIENCES
          SOCIOLOGY  : POLITICAL

The categories included on the links pages are intended to be suggestive rather than definitive of Hodges' model. Advice regards broken links is much appreciated (I am aware that health promotion is listed twice).

Psychology I	Psychology II	Mental Health	Therapies	Anatomy & Physiology	Care Theory & Practice	Evidence Based Practice	Quant. Research
Philosophy	Creativity Ideas	Communication Studies	Theology / Transdisc	Coding, Classification	Health Informatics	Info Sources	Diagrams
Health Promotion	Study Skills	Education	A.I. Knowledge Man.	Visualization I	Visualization II	MarkupLangs	Ajax & XML
Human-Computer Interface	Accessibility	Creativity	Graphics	Environment	Virtual Reality	Science	Astronomy
Rest & Rec				Maths, Logic	Engineering	Programming	[Toolset]
7 Ages	Health Promotion	Patients & Carers	Practitioners	Development Poverty	Democracy Justice	Economics	Policy Studies
Computer Supported Collab Working	Sociology I	Sociology II	Qual Research	Activism	Citizenry	Employment	Human Rights
Anthropology	History	Art, Tech &CultureI	Art, Tech & Culture II	Info. Gov Assurance	Standards	Open Source	Community Informatics
				News	Software Hardware	Search	Organisations
				Commercial I - IV

Definitions: pantology

Web can help elderly surfers slow dementia: The Sunday Times

2009-10-23T11:24:00.000+01:00

From The Sunday Times
October 18, 2009
Web can help elderly surfers slow dementia

Ivy Bean

(Photo by Bob Collier)

Ivy Bean, who is 104 years old, is the UK's oldest Tweeter (IvyBean104) on the social networking site, Twitter.
Jonathan Leake, Science Editor

GOOGLING is good for grandparents. Internet use can boost the brain activity of the elderly, potentially slowing or even reversing the age-related declines that can end in dementia, researchers have found. Using brain scans, they found the internet stimulated the mind more strongly than reading, and the effects continued long after an internet session had ended.

“We found that for older people with minimal experience, performing internet searches for even a relatively short period of time can change brain activity patterns and enhance function,” said Gary Small, professor of neuroscience and human behaviour at University of California, Los Angeles (UCLA). In the research, Small and his colleagues worked with 24 men and women aged between 55 and 78. Half of them had used the internet a lot; the others had little experience.

At the start of the research, they were asked to conduct a series of internet searches while their brains were scanned using a technique known as functional magnetic resonance imaging (fMRI). This measures changes in blood flow around the brain to work out which parts are the most and least active. After the initial scan, participants went home and used the internet to carry out specified tasks for an hour a day at least seven times over the following fortnight. Then they had a second brain scan, again while searching the internet.

Small and his colleagues found the impacts began immediately, with the first scan demonstrating brain activity in regions controlling language, reading, memory and vision. By the time of the second scan, however, the activated areas had spread to include the frontal gyrus and inferior frontal gyrus, areas known to be important in working memory and decision-making. The researchers suggest internet searching stimulates brain cells and pathways, making them more active.

“Searching online may be a simple form of brain exercise that might be employed to enhance cognition in older adults,” said Teena Moody, a UCLA researcher who co-wrote the report with Small. Moody believes internet searching challenges the brain more than reading because people need to perform several tasks at once. These include holding important information in their own memory while simultaneously assessing the information on screen and extracting the parts they want from graphics and words.

The research will be presented tomorrow at the annual meeting of the Society for Neuroscience in Chicago, where the impacts of ageing on the brain are a big theme. It has long been known that as people age, their brain functions and abilities also change. In many respects these changes are beneficial — verbal and social skills tend to improve until at least late middle age, for example. In other areas there can be declines. One of the best known is mathematics, as shown by the number of mathematicians and physicists who do their best work early and then struggle to match their youthful performances.

It is only in recent years, however, that researchers have been able to use technologies such as fMRI to observe the brain in action and measure the changes that come with age. What they have found is that as people age, their brains undergo structural and functional changes, often including atrophy, reductions in cell activity and increases in deposits of insoluble protein. All of these can reduce cognitive function.

In Britain, for example, around 700,000 people suffer from dementia, a condition in which so much of the brain has died that function is severely impaired.

Small and Moody’s argument is that brains are similar to muscles, in that the more they are exercised, the healthier they become. So, activities such as internet use, reading and socialising can slow or reverse normal age-related declines. Small said: “Our most striking finding was that internet searching appears to engage a greater extent of neural circuitry that is not activated during reading.” Other neuroscientists support the idea of exercising the brain but question the benefit of spending too much time on the internet.

http://www.timesonline.co.uk/tol/life_and_style/health/article6879663.ece

My source: CI list thanks to Michael Gurstein (with additional editing and links)

Where is Hodges' model in the curriculum?

2009-10-21T11:10:00.003+01:00

While Hodges' model provides an overarching conceptual framework that can be used by all disciplines, its position within education needs to be discussed and debated. The existing notes briefly explain the theory and practical use of the model, but much more detail and justification is needed.

h2cm can undoubtedly inform specific lessons either theoretically, practically or both. Clearly, the model cannot carry a course of its own, but h2cm can certainly contribute to several concurrent courses. All disciplines engage in their respective assessment, intervention, evaluation and review activities and these can all be considered in a cross curricula manner. Reflection, creativity and innovation are additional aspects of student activities that might be informed by exposure to Hodges' model. The decades since the model's creation (in the 1980s) and statement of its original purposes, provoke new challenges that bring further opportunities. So Hodges' model can now also flex its axes in public and carer engagement and involvement, health promotion and informatics.

Traditionally several definitions and types of 'curriculum' have been identified:

The curriculum on paper	i.e. the statement of purpose, aims, content, experiences, materials etc
The curriculum in action	i.e. the way in which the curriculum in paper is put into practice
The curriculum learners experience	i.e. what learners do, how they study, what they believe they should be doing etc
The hidden curriculum	i.e. the behaviours, knowledge and performances that the learner infers to be important. [PMETB]

In highlighting h2cm's place above the model was positioned and fixed in lessons, courses and in cross curricular approaches. For all its overarching size and scope perhaps the model can also be fleet footed, informal and furtive?

I would suggest that Hodges' model also has a role to play in influencing the hidden curriculum?

Reference:
What is curriculum? PMETB

Image source: CubeMe

CfP Socio-Technical Aspects of Mashups - IEEE 1st Int. Workshop

2009-10-20T11:43:00.003+01:00

In Conjunction with IEEE AINA 2010 (Advanced Information Networking and Applications)

Call for Papers

In recent years, mashup has emerged as a rapid and light-weight development approach for creating distributed Web applications. The advent of easy-to-use, dynamic programming and scripting techniques (e.g. PHP, AJAX, etc.), increasingly open APIs, Service-Oriented Architecture (SOA), dedicated frameworks and environments (eg. Facebook API Platform, Yahoo Pipes) and the wide availability of free, syndicated content (eg RSS) has provided myriad opportunities for people to create mashup-based Web applications in ways unprecedented to traditional software development methods. Mashups can bring data and functionality together in different ways and for different purposes. Many would argue that their greatest potential is for addressing transient problems for specific groups of users in dynamically changing business, social or political contexts. Mashups can be created by people, who may or may not be skilled in programming, to test out ‘self-service’ whenever needed through integrating heterogeneous information across the boundaries of different organizations over the Web.

The implication of such an end-user development approach is far-reaching and hence deserves extensive scientific investigation. However, beyond all the hype, studies of the actual development and use of mashups for delivering business, social or political value are extraordinarily rare. While previous studies have focused on the technical side of constructing the Mashups infrastructure, little has been reported to demonstrate the real value or identify the problems, practicalities and pitfalls of their construction. Essentially, we need to understand how mashups emerge and change, succeed or fail, in settings where people, policies, systems, and data are intertwined with each other, forming a complex yet dynamic system. Among many research challenges, a list of questions that are yet to be addressed by researchers are:

Who makes mashups?
Why do mashups succeed or fail?
Are useful mashups really quick to develop?
Is it better to develop a lot of low fidelity mashups or a few well engineered ones?
How do communities of users emerge?
How is the design of mashups participatory?
What is the life cycle of a mashup?
What business or social environments are condusive to mashup creation?
What happens when bugs emerge in mashups?
What happens when there are competing mashups to do the same job?

To answer these questions, a dual-focused approach that investigates both social and technical aspects of mashups is crucial. The aim of this workshop is thus to bring together academic researchers, industry practitioners and open source community participants for reporting research findings, sharing practical experiences, and highlighting research challenges and future directions in both the social and technical aspects of mashups. Intended topics may include but are not limited to:

Paper Submission

Both academic papers and industry reports will be accepted. Original full papers should be formatted in a two-column IEEE Computer Society format, and should not exceed 6 (six) pages including figures and references. Submission of a paper should be regarded as a commitment that, if the paper is accepted, at least one of the authors will register and present at the workshop. All submitted papers will be judged based on their quality through peer reviewing, where TPC members are invited to assess the scientific contributions of papers. Accepted papers will be published by the IEEE Computer Society Press and archived in the IEEE Digital Library.

Please click here for online submission

Important Dates

Submission deadline	15 November 2009
Author Notification:	1 December 2009
Final Manuscripts Due:	15 January 2010
Registration Due:	15 January 2010
Workshop Date:	20 April 2010

Nursing and the care 'event horizon'

2009-10-19T18:50:00.000+01:00

The axes of Hodges' model as illustrated:

HUMANISTIC - MECHANISTIC
and
INDIVIDUAL - GROUP

- are quite straight forward to understand, hence the ready utility of the model.

Nursing care is often described in terms of care that is 'visible' and that which is 'invisible'.

Hodges' model then makes explicit the division between physical - task-based care (upper-right SCIENCES domain) and that which concerns mental health and emotional care (upper-left INTRA-INTERPERSONAL domain. Within Hodges' model what is considered the individual axis can be likened to the astrophysicist's 'event horizon'. An irrevocable barrier and division between two fundamental areas (quadrants) of care that we are still working to conjoin and integrate.

Boyer's model, Hodges' model, scholarship, future website and Drupal

2009-10-17T16:50:00.008+01:00

Ack: This blog post draws on a brief but informative two page text by Marta Nibert, Educational Consultant for Occupational Therapy.

Models abound of course (not only on catwalks where other career choices are displayed), but in nurse education and the sciences. The review of Curriculum Development In Nursing Education reminded me of Boyer's model of scholarship. I have maintained a link to this for many years, the book review prompted me to read more. Boyer is a gift for this scholar of Hodges' model and any others, a gift not just in that off-the-shelf sense, but in a constructive advisory sense.

The table below highlights Boyer's types of scholarship, purposes and measures of performance. The focus of Boyer's model is the quality of professorial activities, in the same way highly skilled and experiences nurses can be removed from the front-line, so to can specialist faculty be distanced from teaching.

Type of Scholarship	Purpose	Measures of Performance
Discovery	Build new knowledge through traditional research.	• Publishing in peer-reviewed forums. • Producing and/or performing creative work within established field. • Creating infrastructure for future studies.
Integration	Interpret the use of knowledge across disciplines.	• Preparing a comprehensive literature review • Writing a textbook for use in multiple disciplines. • Collaborating with colleagues to design and deliver a core course.
Application	Aid society and professions in addressing problems.	• Serving industry or government as an external consultant. • Assuming leadership roles in professional organizations. • Advising student leaders, thereby fostering their professional growth.
Teaching	Study teaching models and practices to achieve optimal learning.	• Advancing learning theory through classroom research. • Developing and testing instructional materials • Mentoring graduate students. • Designing and implementing a program level assessment system.

What I will try to do here is briefly suggest how Boyer can inform consideration of scholarship in Hodges' model and a future website. This is not just a one-way dialogue I believe Hodges' model can also inform Boyer's model. For example according to Nibert, Boyer proposes using 'creativity contracts'. The creative utility of Hodges' model is surely demonstrated in the posts and archive on W2tQ spanning nursing, education and health care? Since the publication of Boyer's paper in 1997 it could be argued there are new forms of scholarship that cast light and shadows on traditional academia and forms of research. More specifically though we can take Boyer's measures of performance and apply them in turn to h2cm. Even though the purposes differ (I am neither quality faculty nor professor) the reflection is helpful:

DISCOVERY

Publishing in peer-reviewed forums.

There is a limited bibliography listed here on W2tQ and on the main website.

Producing and/or performing creative work within established field.

The bibliography and website constitute a mixture of formal and rather ad-hoc creative works in nursing. Much more needs to be done.

Creating infrastructure for future studies.

As noted in the book review I am fascinated by this word infrastructure. I recognise the need for a 21st century home for Hodges' model; the limitations of a static website and the need to benefit from the stimulus and energy that a community of users would provide. Drupal is the future a means to provide an infrastructure out of which a community may grow and inform.

INTEGRATION

Preparing a comprehensive literature review.

Hodges' model deserves a comprehensive literature review, one that spans education, nursing, global health, informatics and cognitive science.

Writing a textbook for use in multiple disciplines.

'Book' is an established content type within Drupal and this is a worthy objective, as Hodges' model is the ideal academic Swiss Army knife.

Collaborating with colleagues to design and deliver a core course.

This is so dependent upon infrastructure and it seems my actively engaging with academics in curricula design and course planning. Drupal is being adopted in education so the scope to engage from an external position is a possibility.

APPLICATION

Serving industry or government as an external consultant.

Is professorship a pre-requisite for consultancy work? No. Do we just leave this to the professors? No.

Assuming leadership roles in professional organizations.

Being in the North West of England, a full-time nurse and with many meetings down South this is a barrier to adopting such roles. For the future should there be any opportunities these must be tried - only that way can they be tested.

Advising student leaders, thereby fostering their professional growth.

As a mentor in clinical practice with the chance to develop local educational links there is scope here; and possibly others?

TEACHING

Advancing learning theory through classroom research.

As noted above it would be marvellous to be presented with the task of producing lesson plans to encourage research into Hodges' model.

Developing and testing instructional materials.

As far as the classroom is concerned this is very much a bullet point for the future. Using Drupal however a future site can incorporate some instructional materials.

Mentoring graduate students.

Ongoing, but would like to engage more in this - and whilst h2cm is on my agenda I do understand models represent a small part of student learning.

Designing and implementing a program level assessment system.

Another point for a future departure; how do you demonstrate competency in Hodges' model? There are means of assessment, which were applied in the 1980's, case studies, essays and discussion. ...

More to follow...!

Blog Action Day: Imagine a generation taking nothing for granted from the start

2009-10-15T00:00:00.010+01:00

Blog Action Day 2009:

"Climate change" - these words spoken in so many different languages may be the first uttered by the World's infants over the next decade. It really could happen! If these words are the constant they need to be, on the lips of all parents, teachers, leaders and all who 'know'.

That would be no bad thing for the (near) future.

Just imagine:
a generation taking nothing for granted from the start.

People respond best to change they see. In particular change in their environment. We are hard-wired to react to change that represents a threat. We respond with flight or fight. On island Earth, this rock we share, the options are becoming ever more limited, limite, limit, limi. ...

In order to respond now, we must rely on several forms of vision. We must take into account not just ourselves, but as is often highlighted:

future generations, our legacy - their inheritance (SOCIOLOGY)
other individuals - our brothers and sisters - and their situation (INTERPERSONAL)
the evidence for climate change and solutions (SCIENCES)
those in power and their translation of the agenda for positive change (POLITICAL)
the effect of climate change on flora and flora (SCIENCE, SOCIOLOGY and POLITICAL)
the physical health impact (SCIENCES)
the emotional and mental health impact (INTERPERSONAL)
the changes needed in policy and political change succession (POLITICAL)
the ethical values that are shared and debated - consumerism (business at any price $1, £1, €1 .... stores), Deep Ecology (INTERPERSONAL & POLITICAL).

Things, especially human 'things' are never that straight forward. The impact of climate change is writ large in that last word - change. Perhaps in erecting the faces the lesson of Easter Island is environmental dominoes. For us of course this means that as the climate changes so does the environment. For some the change is quickly evident if you live by the ocean, tundra or mountainous glaciated regions.

Change happens on local, regional, national and international levels.

From the Earth observing satellites above, to survey vessels on the oceans, and the research stations in the Antarctic and Arctic vision is everything in hearts and minds paving the way for action in classrooms, homes and eco-prise. ...

Additional links:
How psychology can help the planet stay cool, New Scientist

Maldives government takes a dive for climate change, NatGeo

Hodges' model SCIENCES links 'Environment, Sustainability, Ecology & Eco-system Health'

Image source: Easter Island photo -
http://www.fractalenlightenment.com/2007/08/easter-island-and-us.html

Book review: Curriculum Development In Nursing Education

2009-10-11T14:17:00.002+01:00

It is high time I reviewed a book on nursing so when I came across Curriculum Development In Nursing Education by Carroll L. Iwasiw, Dolly Goldenberg and Mary-Anne Andrusyszyn, I was really pleased to receive a review copy. While I am not a full-time academic I learned a little about curriculum development on the PG Cert. Ed. course. As for all qualified nurses I take the mentoring role seriously, enjoy it immensely and of course we are all life long learners. The other benefit comes from curriculum planning being one of the original purposes for Hodges' model.

To begin the book is a very comprehensive and yet accessible introduction to this subject. The language is clear and not technical, the print is also clear (and large - for an ageing readership!) the format is modern. The book is well referenced overall, leaving me with several leads to follow-up. Although grounded in and with case studies based on hypothetical North American institutions the scenarios, questions and critque are easy to appreciate and relate to, whether you are faculty, nurse (student), or other stakeholder. Iwasiw et al. stress how curriculum development (CD) is ongoing, recursive and the limitations of a 2-D representation of the process on paper. A model is provided on pages 6-10 and in figure 1.1 with many very useful definitions.

The politics of educational settings and their activities are clear as Iwasiw and colleagues explain the 'sales pitch' for CD and the importance of interpersonal skills and foresight. CD the authors make clear is a non-trivial pursuit. It should be ongoing all the time with established curricula under review. At first I was surprised about the lack of mention of project management, specialist consultants are referred to and Gantt charts and project plans are discussed subsequently. The book starts and ends with the nursing and faculty shortage (which seems ironic from here).

In chapter 3 leadership is covered and the need for formal preparation of staff to manage CD. Faculty development for CD features in the majority of chapters. The case studies engaged me throughout. Chapter 4 leads on to the organizational context of CD, with helpful introductions to change theories and their application. So we have Kotter's 8-Stage process; the Transtheoretical Model of Behaviour Change. Talk of leadership and organizations inevitably leads to the adminstration and management of CD and types of committees. Not exactly page-turning content, but essential to planning, collaboration and ongoing success. CD is viewed as a golden opportunity for change, so decision making and critical reading is emphasized, with several methods of ideas generation outlined in a table (wither Hodges' model?). There is a 2 year Gantt chart, despite my initial reservations about 'project management'. (I am still surprised and must address my impression that academia is largely untainted by external project management and consultancy speak?). Page 80 sees an explanation for the book's cover.

There is a crucial point made in programs and courses taught and how these can act as an assett or a constraint:

Knowledge from the physical, biological and psychological sciences, as well as from the arts and humanities, contributes significantly to the nursing knowledge and well-rounded graduates p.106.

I have always been interested in this word 'infrastructure'. The complexity of education and CD is revealed as the author's explore human resources, physical resources, resources to support teaching and learning. These headings do not do justice to the content here which is dealt with economically, but effectively. Moving to external contextual factors and I can see how Hodges' model is ideally suited to helping to frame CD. The authors also cover demographics, culture, health and health care, professional standards and trends, technology and information and the environment. There is a summary of the social, political and economic conditions and their impact and influence on CD p.115-16.

The section on Approaches to data gathering for CD, seemed familar, reminding me of Management Information System books of old. Here the contrast is between data gathering for CD and data collection for research. Perhaps the distinction here is less important if we are equally open to quantitative and qualitative methods and triangulated approaches p.116-17. Tables 6.3 & 6.4 over four and a half pages run through data, data sources and data gathering methods for internal and external contextual factors. The initial definitions are supported by a further collection (p.136-7) curriculum concepts, professional abilities, curriculum possibilities, curriculum limitations, administration and curriculum nucleus. Data collection is one thing, but it is in subsequent analysis, interpretation and synthesis that value is found. In response five processes are introduced:

Examining and integrating contextual data - identifying patterns and trends
Inferring curricula conceptions and professional abilities
Proposing curriculum possibilities
Deducing curriculum limitations
Identifying administration issues

Although not stated in the text, I enjoyed reading about the over-riding, over-arching ideas that nurses should learn and apply. The fundamental ideas that shape how nurses relate to their clients, how they think and behave. How are these ideas to permeate and be promoted through the curriculum? In confirming the curriculum nucleus (and another bread and butter point for Hodges' model) has anything important been missed p.148?

Educational establishments are of course living entities. Continuity is essential and is attended to here in the Popularfield case study p.150-169. If things get heavy in the book then currculum philosophy is the focus of chapter 8, and considers the role of different audiences of curriculum outcome statements. Program models (p.201-09) leads (inevitably) to models of nursing - listing Orem, Leininger, Watson. The nitty-gritty of teaching and learning is discussed in contemporary organisational structures and course sequence patterns p.211. Table 9.1 provides an interesting matrix of core curriculum concepts. The table headings include:

health promotion : empowering interpersonal relationships : caring : social justice

Deliberating curriculum delivery requires selection of delivery application, program model, and organizational strategy and course sequencing pattern - all discussed across chapters 9-10. I've been wondering about 'process' across the humanistic-mechanistic divide and there are some lines that set me to thinking:

Process-orientated courses further integrative learning, de-emphasize specific content and reduce reliance on the lecture method p.243.

Of particular interest to me is designing individual classes with table 10.5 providing example of instructional events and teacher activities. Gagne, et al., may be a primary source, but the date of 1992 troubles me. It is undoubtedly difficult to encompass the whole range of instructional events and activities in 2-3 pages, but future editions would benefit from a revision of the 'state of technology' in the book as a whole.

Chapter 11 throws CD into a public light in planning curriculum improvement and making curriculum plans public. Discussion includes division of criteria along structural and process lines. The former - adherence and duration; the latter - quality of delivery and program of differentiation. Contractual agreements are raised between health care and community agencies, legal areas of concern and insurance. The human side of CD cannot be ignored looking at the existing work force - skills - and demands and requirements of a new curriculum. The phasing of the change to a new curriculum from an old needs to be handled sensitively is an issue well made in the text. New students must not feel they are missing out and being experimented upon, while students on existing programs feel they are missing out on what is 'new and shiny'. As noted faculty development remains a constant throughout the book.

Chapter 12 is an excursion through planning curriculum evaluation taking in outcomes, human and physical resources, learning climate and policies. Skills and means in judging curriculum quality, reporting results, and reflecting on the process are explored with further definitions supplied. Utilization-focussed evaluation is described - in which the focus is on the intended use by the intended users. Program evaluation is broken down into internal and external forms (p.281) and as if to give credence to the adage "All work and no play makes Jack (and Jill) dull people"... the benefits of CD for faculty are explored.

Typologies of Curriculum Evaluation Models are presented, a generational view 1st-4th, again with resort to a table. The 4th generation - the post-late 1970s is described as holistic and inclusive. RCAR stands out Relevance-Congruence-Adequacy-Reasonableness and other examples. I thought about learning management systems here and was surprised that there is no tie-in, or mention in the index as a reporting resource. Planning evaluation of curriculum components also touched on philosophical aspects.

Chapter 13 on Flexible Deivery of Nursing Education Curricula is central to my interest and criticism of the book if there is one. Distance education and flexible delivery are differentiated. Guidance at a distance is stressed not technology (p.315). There may be be too much reliance on 2-way communications between tutor and student, and the important thing for me to remember here is the focus is on CD (academic responsibility, obligations, affirmation), not teaching methods, multimedia and instructional technology. That said, the problem of instructional technology models and their integration into curricula appears to be a key challenge: http://it.coe.uga.edu/itforum/ Tied to this as the authors state are the politics of schools of nursing who are obliged to follow the strategic plans of their institutions. There is reference here to an online critical care nursing course p.318. Plus integrating pedagogy and technology with Blackboard Learning System, Moodle, Desire2Learn and Knowledge Hub, so this book is far from a technology-software desert. Virtual reality is in the index.

Surprisingly or highlighting how enclosed (institutionalized) CD is, 'open source' is not considered. Too risky perhaps? Nevertheless, this is a surprising omission from the index (unless I have missed it in the text?). There are some marvellous open source projects in education, and surely some of these touch on curriculum development, especially in the developing world? Drupal the content management system (and many other open source tools) is increasingly being adopted. Libraries are deploying Drupal on the 'front desk'. The closing chapter 14 draws attention once again to the nursing and nursing faculty shortages and related politics. This really is an important message with global implications for the future of local training of nurses, job readiness, the refocus of existing nurse curricula, subsequent migration and standards within the profession. In summary:

I enjoyed reading CDiNE.
Learned a great deal about this important subject.
It is accessible and readable.
I have many leads - references to follow up.
The book is a comprehensive in its treatment of CD in nursing education.
The many definitions are informative.
The tables are a great signposting and summary resource.
The book encourages further reading and study - and actual engagement
in the CD process.

If the book has a problem for me there is not enough on technology AND information - as a lever for change and source of metrics. My impression admittedly from one book is how untainted academia is by project management and an information (consultancy?) driven ethos. This is just an impression and I am biased as this blog demonstrates. I do believe that in discussing CD (p.195-99) that while the Web is clearly mentioned, more could be made of learning management systems. I would have thought that 'systems' to a organization of any sort, would be viewed across operational, tactical and operational levels. Where is the management dashboard here? If it is an issue of maturity this could be stated. I thought these may feature in a more integrated way, also being used as a data gathering resource. To the author's credit the book is nicely balanced as an introductory source.

Recent students have highlighted that they do not cite (unless the work is historical) references older than four years. The references here that relate to technology are for me quite dated and should be revisited and considered afresh. Recent literature suggests that the days of the university are numbered. Whether you take this seriously or not the position of instructional technology, the web, scholarship and future of academic publishing - the smoke under the door - should at least merit examination. Otherwise - from my external locale - this a very comprehensive, informed and accessible account of CD in nursing education that continues and must continue to build on previous editions. Meanwhile thanks to this good book - I must also re-visit Boyer's model of scholarship.

Acknowledgement: Thanks to Clare McMillan, Marketing Specialist and Jones & Bartlett International for the review copy.

Ref:
Carroll L. Iwasiw, Dolly Goldenberg abd Mary-Anne Andrusyszyn, (2009) Curriculum Development In Nursing Education (2nd edition), Jones and Bartlett Publishers.
(My) additional image:
Möbius Strip As Quotient Space

World Mental Health 'Day' - what about the night shift?

2009-10-10T00:00:00.065+01:00

For convenience sake our lives usually follow the sun's traverse. The majority of events associated with World Mental Health Day will take place during office hours and early evening.

I am looking forward to a local event in Leyland, Lancashire on Monday, which includes speed dating. This will provide that 10-15 minute opportunity to share and obtain information about other services and people involved in local mental health care. The agenda looks excellent and includes the active participation of carers and service users.

So, what of World Mental Health 'Day'?

Mental health - like all health and social care is a 24 hour affair. How often do we forget this? Of all the care (knowledge) domains I write about here, mental health remains the 'silent one'. If you have had worries, anxiety and much more besides you know full well there are actually 24 hours in a day and the silence is not because 'mental health' sleeps. So 'Day' is quite apposite in shedding light on what remains a poorly understood and stigmatised aspect of health care and our lives.

Comprising all four declared domains and uncertainty - the spiritual domain is not referred to in Hodges' model explicitly and yet in our day-to-day existence spiritual matters figure in lives just begun, journeys ongoing and lives at an end and people remembered. Whether we practice a religion, follow a belief there is no escape from news that relates to religion. Strange then: not listed in Hodges' model and yet more evident and prevalent than mental health it seems. In my career I have noticed how religion and mental health can be very uncomfortable companions for some individuals. One exacerbating or being the cause of problems in the other. By the same, or maybe a different token, religion is also a great source of comfort, solace, affirmation, peace and reconciliation for many and a crucial resource through the many people who work under the auspices of the World's religions.

I have tried to catch this 'relationship' in my categorization of links in the INTER - INTRAPERSONAL domain which includes:

Psychology, Mental Health, Therapies, with Philosophy, Ethics, Ideas, Context, Creativity, Theology and Inter-Transdisciplinary resources.

So wherever you are, I hope you find peace especially through this day and night, whether or however you illuminate your mind, heart and soul.

Image source: http://www.daily-tangents.com/ImageCat/ErthMoon/
and NHS various.

Health care and handedness

2009-10-07T20:22:00.004+01:00

The word legerdomain featured on Wordsmith's Word.A.Day as listed below:

PRONUNCIATION:
(lej-uhr-duh-MAYN)

MEANING:
noun:
1. Sleight of hand.
2. A display of skill.

ETYMOLOGY:
From French leger de main (light of hand), from leger (light) + de (of) + main (hand). Ultimately the from Indo-European root man- (hand) that's also the source of manage, maintain, maneuver, manufacture, manuscript, and command.

It is a shame and a matter debated at large that specialists - whether medical or of other disciplines - are not held in the high esteem that they once were. And yet when you come across a leader and specialist in their field the way they deploy their knowledge, insight and skills remains something to greatly admire and respect. I mean knowledge and experience that transcends sole reliance on interpersonal skills and blinding people with jargon and 'science'. Such are the outcomes of what the specialist brings to the (operating?) table, that it may even seem like a sleight of hand. Not in the sense that it is a trick, but there is an effortless transparency to not only what they achieve, but how they make people - their patients, clients feel. Not just feel, but how these people react and may find themselves.

If there is a sleight of hand it is in how while a specialist, they can and do cross boundaries. They see and can count the important numbers (evidence) in their discipline, but they know (from some no doubt hard-won lessons) that frequently some of the numbers in the very sequence they need lie outside their comfort zone.

RIGHT-handed (mechanistic)

(humanistic) LEFT-handed

- they know there is a

middle

and they cross it, without anyone noticing.

Future Conceptual Frameworks for Global Health: a quote

2009-10-07T00:00:00.009+01:00

When as an established user I compare my clinical information system to that used by my patients, their carers and those of colleagues in the interdistrict multidisciplinary team, my practise and studies reveal how far (our) health information systems have progressed. The systems (if we can still call them that) are all different. Yes different, even if the supplier is the same. It is not just the supplier, procurement process and overall appearance, but the dynamics of the interfaces with their data-information-knowledge views that now bleed semantically. Instead of the multiaxial nature of health care spearing us with its complexity, at last the domain perspectives simplify and clear vision and apprehension. The systems vary to the extent that the purposes represented could be something other than 'health', something other than the requirement. Today the purposes, our purposes are - more than ever - manifold. Whether desktop, smart-mobile, kiosk, tablet, pervasive, device bound, everyware or wearable the information systems must suit each of us individually according to our roles, clearances, purposes, use-history and info-literacy. The common features of the systems - what we do not see - are what really matter. They are becoming transparent; namely - safety, standards, fitness of purpose, usability, accessibility, but let's be ambitious, if not greedy, and add to that outcomes and reporting for all who really do need to know.

Ms. Florence Seacole Mashaba*. 3rd Year Student Nurse
Keynote address 2nd February 1000hrs
Global Conceptual Frameworks for Health & Education:
1st International Conference on Visualization in Care Models, Assessment and Evaluation.
St Francis Bay, South Africa. Monday 2nd - Thursday 5th, February, 2015.

Additional link:
RCN, Make IT SAFE, 2008
GANM - Global Alliance for Nursing and Midwifery

* Personal communication from a future fictitious individual. ;-)

Forensic Nursing: bio-psycho-social (political) steps

2009-10-01T00:00:00.005+01:00

I've been searching for a definition of forensic nursing and came across this by The International Association of Forensic Nurses (IAFN)…

“the application of nursing science to public or legal proceedings; the application of the forensic aspects of health care combined with the bio-psycho-social education of the registered nurse in the scientific investigation and treatment of trauma and/or death of victims and perpetrators of abuse, violence, criminal activity and traumatic accidents.”
IAFN 2002

While seeing bio-psycho-social in the definition comes as no surprise - the list of areas, situations and contexts that forensic nurses may work in is enlightening:

Interpersonal Violence
Forensic Mental Health
Correctional Nursing
Legal Nurse Consulting
Emergency/Trauma Services
Patient Care Facility Issues
Public Health and Safety
Death Investigation

In writing about the relevance of Hodges' model in this field there is the assumption that forensic nursing is specialized, but built - of course - upon fundamental nursing principles and values. These are carried forward in forensic nursing theory and practice - Beyond Tradition, Advancing Humanity - as the IAFN slogan ably puts it. Being reminded yesterday of mental health law (always a good thing!) in training on Mental Health Act 2007, I can see just how well Hodges' model can support the early bio-psycho-social steps of the nurse learner. Then if students go on to specialize in forensic care, the model's political care (knowledge) domain will continue to serve them well.

Hodges' model: publications

2009-09-28T23:18:00.000+01:00

The book chapter for Radcliffe Publishing is now in the hands of the editor. This is great step forward for Hodges' model (and me) in that the text considers the model within substance misuse care and services. To my knowledge the only other book chapter is that of Brian Hodges' in Hinchcliffe (1989) [please see the bibliography lower right].

The next project entails me completing my half of a paper on the application of Hodges' model in forensic nursing. My contribution introduces the model (with new text) to a forensic nursing audience and highlights why h2cm is of relevance to this very challenging specialised field of nursing. This is also a significant development being yet another clinical example and a co-authored effort. Collaboration with other people interested in and actually applying Hodges' model is definitely the way forward.

There are other topics that in championing h2cm would hit the sweet spot:

Continuing the current vein - papers on clinical applications for the model in mental health, learning disability and health visiting. These are areas in which the model was first taught and originally applied.

The four original purposes for the model also compete for attention:

supporting holistic theory and practice;
reflective practice;
bridging the theory - practice gap;
curriculum development.

On that last theme, I need to type up a review of a book on curriculum development in nursing that will be featured here shortly. In the meantime if you have an essay, case study to complete, please bear h2cm in mind (and paper). ...

Foundations, projects, corners and cornerstones

2009-09-26T13:58:00.002+01:00

Ok, so you have a new project - that's great!

Yes, we are going to build something - outstanding!

Sounds absolutely marvellous!

We are going to use up-to-the-nanosecond project management tools.

And you're going to do it by the book, charts and real-time tags.

Yes, with a dash of intuition plus - you know - gut instinct!

Well sure, pleased to hear that too.

We will take account of history, learn the lessons -
we've a researcher onboard you know?
Building a world-class team that's all fleet of foot and mind.

We'll tick all the boxes, check all the corners and leave no stone unturned.

Truly admirable, but how many boxes and corners have you got and how many cornerstones* will you need?

Eh?

Hey listen up. Corners are for losers,

naughty children

and people lost in the dark.

Nobody is going to be stuck standing in the corner on this one!

Oh - right.

Well good luck....

Image sources:
'Cornerstone office': Cornerstone Corp. Center
Dan Flavin: at Artnet.
Inspired by the word 'cornerstone' and Untitled (Corner Piece) 1969 on visit to Tate Liverpool, 25 September 2009 (not the piece illustrated above):

Flavin made a number of works intended to be shown in corners, engaging directly with the architecture of the gallery. His use of commonly available fluorescent tubes enabled him to explore light as a non-physical material, animating gallery walls. The size of the work was determined so that the units could be fastened in the centre only, without having to be anchored to the floor. The artist rejected any symbolic significance of the object, insisting that it was simply a form that made good use of a corner.

Question: How many corners are there in Hodges' model?

*Cornerstones: here referring to stakeholders, sponsors, owners, partners, investors, builders, architects, designers...?

KT-EQUAL event Ageing Research 17 September

2009-09-23T08:37:00.002+01:00

I was really pleased to be able to attend this event last Thursday (do check the site as there is an ongoing programme of workshops):

Making the most of the potential of Assistive Technology

This workshop organised in conjunction with BIAS (Brunel Institute for Ageing Studies) will provide a round-up of recent developments in AT and the underlying research aimed at enhancing independence in the home, improving safety and security, extending the use of the car, managing continence, maintaining the body and stimulating the brain.

Hosted by: Brunel Institute for Ageing Studies
Sponsored by: BIAS and KT-EQUAL

10:20 Welcome and Introduction, The world of BIB and older people, Chair for the morning, Professor Emeritus Heinz Wolff, Founding Director, Brunel Institute for Bioengineering (BIB), Brunel University
10:30 New Service Quality to Support Self-Care, Keren Down MBE, Director of FAST
10:55 Tackling Ageing Continence, Felicity Jowitt, Brunel Institute for Bioengineering
11:20 Refreshments
11:40 From chairs to stairs, Dr Ruth Mayagoitia, Applied Medical Research Group, King's College London,
12:05 "The Companion" - Independence, choice and self-sufficiency, Edward Varney, Brunel Institute for Bioengineering
12:30 Discussion
12:45 Lunch
13:45 Introduction to the afternoon, The world of BIAS and older people, Chair for the afternoon, Professor Mary Gilhooly, Professor of Gerontology, School of Health Sciences and Social Care, Brunel University
13:50 KT-EQUAL: its mission for older people, Professor Peter Lansley, Director KT-EQUAL, University of Reading
14:00 Older drivers & older IT users: designing new technology, Suzette Keith, Middlesex University
14:25 Safety and Security in Later Life, Professor Rachel McCrindle, KT-EQUAL Consortium, University of Reading
14:50 Tea
15:10 Nourishing the body and saving the soul, Dr Arlene Astell, St Andrews University
15.35 Technology for people with dementia, Eleanor van den Heuvel, Brunel Institute for Bioengineering
16:00 Discussion
16:30 End

As noted above Prof. Heinz Wolff duly and delightfully introduced proceedings and chaired the morning. As a community mental health nurse for older adults and informatics / ICT enthusiast the day certainly proved worthwhile for me. Here are some reflections on two sessions:

While clinical and information standards have and remain a preoccupation for me, Keren Downs' session raised the chicken and the egg problem of standards and quality in the development of self-care and assistive technologies. Keren's presentation highlighted the stasis in design in the older adults sector and the question of how to energise future vision and models for innovation. There was reference to Shaping the future of care together and Common Core Principals to Support Self Care 2008, Department of Health.

Funding inevitably featured - the green paper listing three options:

Partnership - government pays for between a quarter and a third of care costs ...
Insurance - government pays for between a quarter and a third of care costs ...
Comprehensive - everyone pays into a state insurance scheme, whether or not they need care, and everyone gets free care when they need it.

The next slide reminded me of the tilting, table fitted geriatric chairs of old as Keren Downes highlighted the relative stasis in design and need for change for this population group.

While form follows function - can it also stifle innovation? When you consider change in materials, people's homes, care environments, attitudes ... there must be opportunities for innovation?

I also recalled similarities between this market of assistive technology and that of benefits realization within nursing (health) informatics. Especially as barriers were considered such as:

poor design (usability)
information provision
workforce competency
procurement
(To which I would add 'value added services' - maintenance, life-cycle management.)

As the speaker and work of FASTUK made clear, older adults represent a growing and emerging market, for whom standards and design will be critical if self-care and assisted living are to be fully realised *.

The final slide listed some reports and a web link as follows:

FAST reports: www.fastuk.org

• Assistive Technology supporting self care, July 2006
• Assistive Technology –Workforce Development, June 2007
• Annual Report to Parliament on Research and Development in Assistive Technology, July 2009

Felicity Jowitt in another session:

TACT3: Tackling Ageing Continence through Tools, Theory and Technology

- provided a concise non-medicalized definition:

Urinary Incontinence 'is a condition in which involuntary urine loss
is a social or hygienic problem and is objectively demonstrable'.

International Continence Society definition of incontinence

The talk included explanations of the problems and how they arise, prevalence, management, available AT options and the anatomically - stigma driven challenges that male and female continence presents. To close new assistive devices were discussed. The creation and production of discrete, well-designed person- (in a social context) friendly aides, special pads and devices to detect the odour that signifies the need to change a continence pad before the human nose is alerted.

The sessions featured a Q&A session and amongst the many questions raised, I wondered about the ideal of continence aids that also help nurses and carers maintain high quality standards of care and professional values. ... Perhaps from the late 1970s I have antiquated notions of basic nursing care? It is shocking to hear stories of people being told to "do it anyway - you've got a pad on!". Does it not occur to these people that if the person is asking they obviously have insight and are distressed by their urgent situation. As to people who are confused and asking as a result of agitation - the mind boggles and the heart aches at the standards of care evident in such an attitude.

So, this was a really thought provoking and - despite the subjects - enjoyable event and I have only of course scratched the surface.

The majority of presentation (including those above) are available on the download page.

A related reference I am following up:

Duarte, L.R., Marquié, L., Marquié, J-C. et al. (2009) Analyzing feature distinctiveness in the processing of living and non-living concepts in Alzheimer’s disease, Brain and Cognition, Volume 71, Issue 2, November 2009, Pages 108-11.

I will do a h2cm matrix on continence in the future.

* You can almost hear the critical exclamation of a future aged '60s generation - "No way dude I'm not using that!". Perhaps by then we will have the means to ensure they retain the faculties to pass a critique.

Hodges model: indicative concepts in Substance Misuse Care

2009-09-19T13:42:00.009+01:00

Hodges' model
in substance misuse services

psychological dependence vulnerable individuals, education, risk, assessment, review, motivation to change, harm reduction, motivational interviewing, appreciative inquiry, life skills, education, advice, feedback withdrawal, aggression, hallucinations, change, drug use history, measures, care pathways, contract, rapport, empathy	substance profiles, abuse, signs physical dependence, health status, pregnancy, research methods, evidence, diagnosis, co-diagnosis, staff awareness, statistics, scientific advice, dissemination models: stepped care, training, forensic science - mental health, classification, interventions, physical access, stepped care models
dependents, family, social network social attitudes, vulnerable communities, community projects, self-help, e.g. A.A., socio-economic depreviation, systemic - family, group therapies Advertising, housing, casual drug use, work, employment, benefit incentives, re-integration, inclusion, community, neighbourhood policing, drug culture, media	supply, cost of drugs - alcohol health & social care policy, service interfaces, statistics Drugs strategy, funding, X-agency working, funding, GP contract, commissioning, "client contract-plans", National Treatment Agency, NICE, Home Office, legislation, crime, offending, re-hab. / specialist teams / treatment facilities, Government data, community prescribing, employers

Additional links:

Hodges' model: QUADS 'A4 page' with indicative generic content for the four care domains

The SOCIOLOGICAL links page includes Seven Ages, Public, Patients, & Carers...
The INTRAPERSONAL links page - Mental Health, Psychology, Therapies...
The POLITICAL links page - Economics, Policy, Citizenry...
The SCIENCES links page - Research, Drug resources, Anatomy & Physiology...

Sour grapes and 'holistic' academic publishing

2009-09-15T21:52:00.005+01:00

Having been a student on several occasions, an independent scholar and online for the past decade (I was a late arrival) something is really getting on my pips.

When I see an Editorial entitled -

Theoretical Frameworks

and Concept Development

in an established publication -

Journal of Holistic Nursing

That states -

There is a commitment within holistic nursing to explore and refine terminology and frameworks that will enhance the care of patients and provide understanding about the healing process. To accomplish this directive, manuscripts will be published that provide an in-depth analysis of existing, alternatives, or extensions of concepts, frameworks, or theories associated with holism and holistic health and nursing. Holistic nursing involves a complex view of the individual, family, and environment that is constantly being challenged by new and emerging paradigms and information that furthers the ability to understand humans as multidimensional and pandimensional beings.

I do wish someone else would recognize the
holistic value inherent in Hodges' model.

That value is not there by default it has to be found, learned and earned, but there are few frameworks that can simultaneously encompass holistic nursing, healing, touch, global health, informatics disciplines, the green agenda and human ecology. ....

So come on just a whisper - who Dares...?

Ref:

Diane Wind Wardell, Editorial, Theoretical Frameworks and Concept Development, Journal of Holistic Nursing, American Holistic Nurses Association, Volume 27, Number 3, September 2009 158.

Additional links:

How many interfaces are there?
http://hodges-model.blogspot.com/2007/04/hodges-model-how-many-interfaces-are.html

Hodges model: What is it? [2] It’s an interface...

http://hodges-model.blogspot.com/2007/01/hodges-model-what-is-it-2-its-interface.html

Lonely model seeks ...
http://hodges-model.blogspot.com/2007/12/lonely-model-seeks.html