Rubens Tour - themes
- provides a space devoted to the conceptual framework known as Hodges' model. Read about this tool that can help integrate HEALTH, SOCIAL CARE, INFORMATICS and EDUCATION. The model can facilitate PERSON-CENTREDNESS, CURRICULUM DEVELOPMENT, HOLISTIC CARE and REFLECTION. Follow the development of a new website using Drupal (it might happen one day!!). See our bibliography, posts since 2006 and if interested please get in touch [@h2cm OR h2cmng AT yahoo.co.uk]. Welcome.
Rubens Tour - themes
When an individual becomes a group -
I bought The Times today and on the front page is the news from University of Oxford:
Dehydration ‘common’ among patients admitted from care homes
When nursing and residential homes are struggling to manage an individual's care and look to refer to mental health services (usually) they know they need to asked the 'question'. This is about physical health: does the resident have an infection, are they eating and crucially drinking, are they in pain, constipated. ...
Although the headline augers badly and points to an ongoing (politically) 'inflammatory' problem within the sector, there is a great deal of compassion out there.
A resident's marked emotional distress and torment can upon investigation become a matter of how to also manage the staff's distress as they try to meet the individual's care needs. The latter does not help the former and amongst other things points to an educational need. This is especially so, if residents are to be able to continue to 'age' in their new 'home' with the additional complex needs that might follow.
Fluid balance used to be an element of basic nursing care.
'Privileged' is definitely the wrong word. Perhaps it is the advantage of experience and the passing of almost four decades and more....
Times have changed since arriving at Winwick Hospital on a bike as a student nurse for an early shift at 0655. I would leave my bike just down a small corridor to the right of the main entrance. I don't think I locked it. Then depending on the ward allocation I walked through the red carpeted front of the hospital to the increasingly rough and seemingly lost corridors beyond.
Hospitals have changed markedly. Winwick and other asylums have gone - thank goodness.
Cockroaches, leaking roofs, two-storey blocks where when necessary the patients would carry the meals up the stairs. A charge nurse set about ensuring that the patient's were provided with proper safety equipment if there were no lifts. The dormitories were large: 40+ bedded and more. There were lockers of some description I think, but personalised clothing was still to follow in 1977.
Despite the emphasis on community care, a project that in reality is still a work in process, the need for hospital beds remains. I have worked to keep people out of hospital, to help provide crisis support at home. When beds are needed the experience for members of the public and their families is radically different today. As taxpayers we recognise the need for efficiency in design, procurement, commissioning and managing new buildings. So it is within the NHS. Visiting new modern facilities, and this includes private nursing homes, you really appreciate the benefits good design can bring for patients-residents, staff, students and visitors.
|My space |
Private space - observations permitting/negotiated
Space to wander
Space for wheelchairs
Why is Joe staying in bed?
Why is Mary not going in the lounge?
Quiet spaces (who says?)
Value for Money
Although the number of posts using Hodges' model may suggest I'm obsessed with putting things in boxes and I am extolling you to do the same, please note; this is not the case [well not entirely ;-) ].
The model recognises the natural need we all have to make sense of things, hence our tendency to dichotomise, to categorise, to seek meaning and order. The model makes explicit 'four basic boxes', but then invites us to transcend them by testing each one, subjecting the four domains to reflection. Five domains, taking in the spiritual also.
Given a situation, a context, a patient, or carer, or student ... we can ask what are the facts, what are the issues and how are they linked? Mentally we can consider what important concepts are missing?
It is not for me to provide all these concepts. I
may|should|must also listen, observe and liaise in order to identify them. The solution is about teamwork, partnership and collaboration.
Yes, the 'boxes' really are there. The disciplinary divides do still exist. In h2cm they are integral to the structure of the model. But as we progress in applying the model we seek to blur, if not erase the boundaries. To achieve holistic and integrated care we need to collapse the boxes. It seems something more than interdisciplinary and interprofessional is needed to connect and integrate what are frequently neglected knowledge (care) domains and content.
I should be able to explain some of this in my review of Prof. Carel's book 'Illness'.
Over the UK holiday period in-between searching the literature (pre-reading list) for the next module I've been catching up with very overdue book reviews.
Havi Carel's book Illness (2013) [2nd edition] was received December 2013 and is thankfully short and very readable. The review's still to follow as I am just halfway through, but there is a point in the preface (xvi) that cascades down each side of Hodges' model as Prof. Carel identifies two approaches to how illness is approached:
|NORMATIVIST approach |
sees disease as a value-laden term.
sees disease as a value-free concept, as biological dysfunction.
stigma, communication, friends, compasssion...
matters of fact, procedure, targets...
The Difference That Makes a Difference 2015 (DTMD 2015) is the third in a series of biennial workshop on the nature of information. The theme of this event is Information and values: ethics, spirituality and religion. It forms part of a larger summit on information organised by the International Society for Information Studies, held on the 3rd-7th June at the Vienna University of Technology, Austria. DTMD 2015 is organised by The Open University, UK.
This workshop starts from the premise that information and values coexist in a relationship of tension, and that they engage in a dialectical process in certain key areas of human society. Within these areas, information and values co-construct a synthesis which includes but transcends both aspects. This synthesis is particularly expressed in the fields of ethics, spirituality and religion.
Particular inspirations for this workshop include the work by West Churchman on The Systems Approach and its Enemies, which argued for a dialectical relationship between the rationalist ‘hard’ systems approach and perspectives such as morality, politics, religion and aesthetics which are apparently opposed to it. Ethics and religion have also been long-standing interests in various areas of cybernetics, which is the starting point for this exploration of information, and were central concerns in the later work of Norbert Wiener, Heinz von Foerster and Gregory Bateson. In this sense the workshop is continuing an ongoing stream of work.
As well as leading to new insights into ethics, spirituality and religion, this work also acts as a further lens through which to explore the nature of information. The language of information is increasingly used in many different disciplines, and comparing the usage in different fields contributes to a better understanding of information in its own right. The areas of spirituality, ethics and religion are somewhat less examined in the context of information than many other disciplines, and so this workshop will continue the ongoing process of exploring multi-disciplinary aspects of information.
This workshop follows two international workshops held in Milton Keynes, UK, in 2011 and 2013, both entitled The Difference that Makes a Difference. These workshops explored the nature of information in a range of disciplines (including physics, biology, sociology, computing, systems thinking, philosophy, geography and art, among others). Proceedings of both workshops can be found at http://www.dtmd.org.uk/.
Key questions which the workshop will address include:
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In Education for work:
background to policy and curriculum
Corson (1991) considers the workplace, workers, satisfaction and the constraints that operate there. From almost a century ago Dewey is cited and resonates with nursing and Hodges' model:
The result was a redesign of workplaces to lessen the constraints and to satisfy worker's desires from achievement, recognition and interest: to offer them meaningful work. For Dewey work of this kind plays a critical role in self-fulfilment and in continuing education: it becomes a vocation or a calling:
A calling is of necessity also an organizing principle for information and ideas; for knowledge and intellectual growth. It provides an axis which runs through an immense diversity of detail; it causes different experiences, facts, items of information to fall into order with another (Dewey, 1916, p.362). p.173.
Quinn's Principles and
Practice of Nurse Education
1 Introduction: Nurse Education in the university and the clinical setting
PART ONE – THE PSYCHOLOGICAL BASIS OF TEACHING AND LEARNING
2 Adult learning theory
3 Perspectives on teaching and learning
PART TWO – LEARNING, TEACHING AND ASSESSMENT
4 Curriculum theory and practice
5 Planning for teaching
6 Teaching strategies
7 Assessment of learning
8 Student feedback / feed-forward
9 Teaching study skills
I read Nortin Hadler's Missing the Forest For the Granularity (July, 2014) on The Health Care Blog with great interest. The article draws attention yet again to the risks and preoccupation with processes and systems. This provides me with another opportunity to highlight the 4P's within Hodges' model: Process, Policy, Practice and Purpose and add some of the points that Dr Hadler addresses.
The 4Ps by themselves might have meaning but they can't do work. For that we need a context and several perspectives. As Dr Hadler points out big data intrudes on the clinical encounter determining not just what is collected, but how it is captured and structured.
There are frequently two datasets at the practitioner level: one is administrative and managerial in form and purpose; the other is clinical - patient, person centered. Effective communication already presents a challenge. On top of that then how relevant are the IT systems. The holy grail of IT systems still seems to be benefits for clinicians and patients - the public. Until then will the IT continue to push the patient-clinical relationship as if it is some wobbly toy? You bet it will!
Where exactly should the “Physician’s Dashboard” reside? Is it a case of "the ayes have it" but only on the right?
Nortin also refers to the United States postponing ICD-10. From Wigan Pier I clearly do not understand the issue, but this seems from here more like a very prolonged delay. A delay that perhaps says more; not just about the healthcare 'system(s)', but the many interfaces to be found there.
Many thanks to Dr - Prof. Hadler for his article.
|“cognitive” specialists, the care of the patient revolves around the “granularity” of the narrative. |
individual attention and focus
ability to share purposes
Using individual differences and idiosyncrasies
patients as widgets (here)?
Can you see the dashboard here?
big data, ICD-10
Electronic Medical Record -
templates and “smart sets”
Patient - BIG DATA - Doctor
empathy 'NOISE' empathy
life-course (“social”) epidemiology
Europe, health care systems, United States, health economists, hospital administrators, patients as “units of care”, physicians as “providers”, clinical demand = “throughput.”
1. A total absence of information about a given subject usually solicits no curiosity: without an awareness of its existence, we can’t possibly care about it.
7. Eventually, we have a dictionary definition.
$ £ ...
Born in Liverpool. Three children. Community Mental Health Nurse NHS, West Lancashire, Independent Scholar & Researcher Nursing & Technology Enhanced Learning
RMN, RGN, CPN(Cert.), PGCE, BA(Hons) Comp/Phil, PG(Dip)COPE.
Live and Work in Central & West Lancashire, England - working on achieving a global perspective.
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