Where the heck am I (and where are you on Hodges' model)?

A combination of nursing experience and informatics knowledge and skills have meant that for a long time I have been able to sit on the fence and listen appreciatively to two sides of an ongoing saga. I am sure the ending will be a happy one, if not for the reason that there is no such thing as a 'finished' (nursing) information system. There is however a need for targets, deadlines, plans for a series of software releases and all the activities that accompany 'IT' projects. In short - project management. There is then a constant need for people to sit on the fence.

While the ability to sit on the fence may be something of an advantageous position, there are times when it becomes a source of anxiety and dissonance. Off the fence as a nurse without an informatics role (without i-portfolio), you feel left out of things. Literally chomping at the bit to contribute to the developments taking place - elsewhere.

Also off the fence, but alternately wearing the informatics shoes you have a sense that those soft, fuzzy caring, psychobabble skills are slowly yet inexorably melting away. How credible can you be if you have not 'nursed', that is - seen a client, managed your case load for 1, 2 or 3 years? Whatever your field, you can lose your touch.

Reading Michel Serres and his use of Harlequin as a trope really caught my imagination and breath (as lots of things do). Here's some background to Harlequin (and Hermes):

Two figures, then, inform Serres's oeuvre: Hermes and the Harlequin. Hermes the traveller and the medium allows for the movement in and between diverse regions of social life. The Harlequin is a multicolored clown standing in the place of the chaos of life. Two regions of particular interest to the voyager in knowledge are those of the natural sciences and the humanities. Should science really be opened up to poetry and art, or is this simply an idiosyncrasy on Serres's part? Is this his gimmick? The answer is that Serres firmly believes that the very viability and vitality of science depends on the degree to which it is open to its poetical other. Science only moves on if it receives an infusion of something out of the blue, something unpredictable and miraculous. The poetic impulse is the life-blood of natural science, not its nemesis. Poetry is the way of the voyager open to the unexpected and always prepared to make unexpected links between places and things. The form that these links take is of course influenced by technological developments; information technology transforms the senses, for example. Source: Dr.Vicente Forés López

This short quote hopefully illustrates the attraction of Serres to me as I study Hodges' model and informatics. Discovering Serres really creased me up. I say creased because that is where I am, trapped between two worlds. Stuck in that line between HUMANISTIC and MECHANISTIC realms. If I run the gauntlet there, the only other avenue open to me is that afforded by the INDIVIDUAL and GROUP axis.

Now I'm clearly not the only one able to sit on the fence and take in the views and perspectives of two frequently disparate worlds. On informatics secondment and at events such as HC2008 (HC2009) as a nurse - informatician you have to see lost opportunities looking at the speaker line-up and number of nurses present and able to take the messages home.

As a fact of life change will happen.

How much better though is change borne of
dialogue and engagement?

Like Harlequin those of us with clinical AND informatics insights must mix things up. There is a need to constantly enquire, challenge, influence and direct at times. A need also to pass the baton and let others experience the dual perspectives from the fence (and the splinters too).
Image sources: http://commons.wikimedia.org/wiki/User:Malene
and http://www.qosmiq.com/cdiadrone/ghis/pfolio/characters/index.htm

Hodges' model and care domain dependencies

Analysis and Synthesis: pretty powerful tools.

Looking at Hodges' model the other day I've thought of the model as a foundation upon which learners and experts alike can build. Looking at the model afresh I've realised that (whatever we all may or may not believe) outside of the model there is the 5th spiritual domain. After this and for some people because of this 5th domain time, energy, matter and love came into being.

So now to Hodges' model itself: we could not have health, social AND pastoral care systems if it were not for the SOCIAL and POLITICAL domains. These two group domains underpin and support the individual domains. There has always been talk of the golden age. These two domains provide the scaffolding for our lives and we would do well to remember this in these burnt umber times.


Reading Michel Serres and other authors you realise that the SCIENCE and intra-INTERPERSONAL care domains depend on the continued support and sustenance of the SOCIAL contract and the POLITICAL contract. I have not written 'social AND political contracts' purposefully as this suggests far greater similarity than I can argue for.

As we look and consider the relationships at work, what else can you see?

Well, we can see the distance between our collective understanding of science AND the distance between many individuals and the political process. Depicted in this way the fragility of things so often taken for granted - research, health care, individual choice, technologically enhanced and aspirational life styles becomes starkly apparent. The things that are granted do rely on contracts. Now though these two contracts themselves depend on the formulation and enactment of a natural contract between the Earth and its inhabitants (Serres, 1990).

Serres, M. The Natural Contract, trans. Elizabeth MacArthur and William Paulson, University of Michigan Press; 1995.

Original image source: http://www.leader-lift.com/sca.html

Fundamental-ism lost to nursing

Nursing, health and social care are full of fundamentals:

- of care, aims, objectives, arguments, issues, targets, values ...

- and much more besides. Fundamentals fuel and provide the oxygen that sustains the research literature and media. Fundamentals are the constant heat for education, practice and policy. Amongst the definitions of -

fun·da·men·tal (fŭn'də-mĕn'tl) there is

Basic, base, foundation, central, core, essential, necessary, key, primary, significant ...

Language is amazing in how far a short detour can take us.

Fundamentalism has always been associated with religion and of course no less today; when the literal reading and interpretation of religious texts means that fundamentalism is tainted by beliefs and actions that extend from intolerance, through to extremist tendencies and terrorism. Fundamentalism in this extremist religious guise is not the focus here.

Looking at nursing text book titles fundamental still sells. At times seeking out high standards of nursing care makes you wonder whether a fundamentalist reading of nursing (and human rights) is needed?: and as you get older the need gets ever more acute.

In our informationally overloaded world maybe the message of high quality (fundamental) basic nursing care is lost in the noise. The problem I believe lies in the other meanings of fundamental -

Physics.
a) Of or relating to the component of lowest frequency of a periodic wave or quantity.
b) Of or relating to the lowest possible frequency of a vibrating element or system.

This means that even though those low frequency, infrasound messages can travel an awful long way and strike an occasional significant ethical chord: the population at large is hard of hearing.

Book: Social Information Technology: Connecting Society and Cultural Issues

Social Information Technology:
Connecting Society and Cultural Issues

Edited By:
Terry Kidd, Univ. of Texas Health Science Center, USA;
Irene Chen , Univ. of Houston Downtown, USA

Table of Contents

Description:
An interdisciplinary field, technology and culture, or social informatics, is part of a larger body of socio-economic, socio-psychological, and cultural research that examines the ways in which technology and groups within society are shaped by social forces within organizations, politics, economics, and culture. Given the popularity and increased usage of technology, it is imperative that educators, trainers, consultants, administrators, researchers, and professors monitor the current trends and issues relating to social side of technology in order to meet the needs and challenges of tomorrow.

Social Information Technology: Connecting Society and Cultural Issues provides educators, trainers, consultants, administrators, researchers, and professors with a fundamental research source for definitions, antecedents, and consequences of social informatics and the cultural aspect of technology. This groundbreaking research work also addresses the major cultural/societal issues in social informatics technology and society such as the Digital Divide, the government and technology law, information security and privacy, cyber ethics, technology ethics, and the future of social informatics and technology, as well as concepts from technology in developing countries.

-<>-

I have not read this new book, but understand that chapter 7 is not a bad effort. ;-)

Serres-Hodges model chapter proof & Oamos

I've received the proof for the book chapter to appear in:

Social Information Technology: Connecting Society and Cultural Issues
edited by Dr. Kidd and Dr. Chen
IGI Global

Exploring Serres’ Atlas, Hodges’ Knowledge Domains
and the Fusion of Informatics and Cultural Horizons

Abstract

This chapter explores the extent to which selected writings of French philosopher Michel Serres and a health care model created by Brian Hodges in the UK can augment and inform the development of social informatics. The volume of Serres’ output contrasts markedly with work devoted to Hodges’ Health Career - Care Domains - Model. Since the concept of health is universal culturally, and informatics disciplines are emerging fields of practice characterised by indistinct boundaries in terms of theory, policy, and practice, various ethnographic and cultural associations will be made. Placing Hodges’ model and Serres' work together is not intended to suggest direct equivalence, other than the common themes this author intends to bring to the attention of the social informatics community. Central to this is the notion of holistic bandwidth, utilising Hodges’ model as a tool to develop and disseminate sociotechnical perspectives.

-<>-

This has been a long road, but it is smashing to see your text nearly there as 'chapter 7'.

To close here is a new media search engine:

http://www.oamos.com/

Holistic Bandwidth [I] - Where's the brush?

Apart from those intervals and instances (times!) when emergency intervention is needed, holistic care is seen as a primary goal in health and social care theory, practice and policy.

IF care is not holistic THEN it could be argued that there is care dissonance.

The high quality non-critical, general efforts in the PHYSICAL [SCIENCES] care domain -

fluids, diet, warmth, pressure sore care, comfort, security, infection control ....

can be compromised by lack of attention to the EMOTIONAL [Intra-INTERPERSONAL] care domain -

respect, empathy, unconditional +ve regard, non-judgemental attitude, time, space, attention ....

- what the patient (carers and others*) expect to follow does not occur.

Rather like cognitive dissonance acute discomfort results when care of the required high quality (holistic, timely, person-centred...) is not applied across the board (h2cm).

(In being human) everyone recognises the BASICs of CARE (discuss?):

It is the remembering that is the problem.

Remembering demands an assured space in the organisational memory - such that staff in those other spaces - wards, clinics, patient's homes, residential homes are able to fulfil the holistic spectrum of care needs.

Dissonance encourages game playing with beliefs [1-n players].

It is very easy and a fairly well understood human trait for us to become pre-occupied with what we do. (As you will have noticed I have a problem with brackets and italics...) When at work (i.e. not day-dreaming) "It is what we do that counts."; but care variances bound to professional disciplines and particular clinical settings should not be wielded as a foil.

So, perhaps this dissonance can be represented as distance:

• patients and carers may not articulate their discomfort - at the time

(and hence is perceived of less consequence to the service - at the time);

• as the distance between concepts and their meanings.

Could this distance provide a measure of holistic bandwidth? No doubt, it already has somewhere in the literature? The first holistic bandwidth metric suggested above is acknowledged in policies around the response to complaints, which stress the need to deal with the complaint there and then if possible. Is this enough and what about the distances between concepts and meanings?

more to follow....

I Googled 'organisational dementia' and found the following reference:
‘Sustaining New Industrial Relations in the Public Sector: The politics of trust and co-operation in the context of organisational dementia and disarticulation’ (with M. Martinez Lucio), in P. Dibben, P. James, I. Roper, and G. Wood (eds.) Modernising Work in Public Services London: Macmillan. 2007.

*Of course there is a major cost on staff morale here also.

The symbol '+'

Apart from a multitude of symbolic meanings the figure below also provides the structural foundation for Hodges' model and as symbols.com notes:

The cross with arms of equal length is an extremely old ideogram used in most cultures. It is also one of the basic gestalts in Western ideography (as opposed to the basic elements, which are derived entities). The cross is found in every part of the world, in prehistoric caves and engraved on rocks.

In my interview with Brian Hodges' over 10 years ago in May 1997, Brian provided an account for how he arrived at this structure (summarised below). As mentioned elsewhere on this blog, the website, symbols.com and other sources - the cross, or 2x2 matrix is a common device to explain and structure. The four elements, the four humours (or humors) yellow bile, black bile, phlegm and blood, the seasons; there are so many things that can be characterised in this way.

With '+' as a starting point for me to reflect on Hodges' model I see each line as an individual. This agent or subject could include patient (person) and health care worker; lecturer and student and many other examples.

The act of cros-sing, the intersection of the axes represents two human beings being in a situation.

Space and time brings people together:

and also forces us apart - physically and temporally.

Adding an arrow to one end of these axes creates the dynamic of communication.

The angular distance in the alignment of those arrows offers hope -

• in our common humanity we are never in 180 degree opposition;

and yet acknowledges:

• the isolation of the individual -
  
• and the challenge.

The work that must done. Hence the primacy of communication skills and values; in order to bridge individual being, ti:me and space.

Perspective is helpful here as an extension:

While we may get close to another person, through relationships that entwine the lines - be they spun by professional obligations, friendship, family ties, or intimate sexual relationships - the two lines are always distinct: part of an elaborated knot.

Is it just the special ties that must forever seek to be one+

---

The best way to explain h2cm is to review the questions Brian Hodges originally posed.

To begin, who are the recipients of care? Well, first and foremost individuals of all ages, races and creed, but also groups of people, families, communities and populations. Then Hodges asked: what types of activities - tasks, duties, and treatments - do nurses carry out? They must always act professionally, but frequently according to strict rules and policies, their actions often dictated by specific treatments including drugs, investigations, and minor surgery. Nurses do many things by routine according to precise procedures, rather like the stereotypical matron with machine-like efficiency? If these actions are classed as mechanistic, they contrast with times when healthcare workers give of themselves to reassure, comfort, develop rapport and engage therapeutically.

This is opposite to mechanistic tasks and is described as humanistic; what the public usually think of as the caring nurse. In use this framework prompts the user to consider four major subject headings or care domains of knowledge. Namely, what knowledge is needed to care for individuals - groups and undertake humanistic - mechanistic activities? Through these questions Hodges’ derived the model axial structure.

To all 'average scholars'...

Michel Serres:

"Intelligence is not about knowing axiomatically how to reason... The French 16th Century philosopher Montaigne already had dismissed the concept of a 'well-stuffed head'. The advent of the printing press made the memorization of Ulysses' travels and of folk tales - the support of knowledge at that time - redundant. Montaigne saw no longer use in memorizing a library that was potentially infinite. But does not the Internet ask for a 'well-endowed head'? Won't the best surfer be a 'Jack of all trades'? The fastest surfer is not going to be your typical Ivy-league super-titled philosopher: That guy's head will be simply too loaded to sort it out on the Net. So, there will be fresh opportunities for those who were viewed by society as laggards. It is a clean start with equal opportunities for all."

Source:
Join-Lambert, L., Klein, P., & Serres, M. (1997). Interview. Superhighways for All: Knowledge’s Redemption. Revue Quart Monde. http://www.nettime.org/Lists-Archives/nettime-l-9810/msg00137.html

Sociotechnical paper and a new S-T journal

Well I have 7,100 words for the socio-tech structures paper, need to chase some references, prune the deadwood and complete three figures. Then leave it alone for a few days. While enjoying this morning's coffee at the Barn I had written that some of the vitality seems to have gone out of socio-tech. ... Big mistake: this afternoon a new quarterly journal was announced for January 2009:

International Journal of Sociotechnology and Knowledge Development

There's another revision then. ... I should have known better, as there is an active British Computer Society S-T specialist group that meets in London and the NE. I'll post more about the journal with a link that is apparently to follow soon.

Not unrelated the Society for Philosophy and Technology also have a journal TECHNE. The Charleston trip is still a highlight of the year (sure do miss the sun):

http://hodges-model.blogspot.com/2007/07/soc-philosophy-technology-conf.html

http://hodges-model.blogspot.com/2007/07/spt-2007-infovis-infoaesthetics-history.html

Ellis Nadler whose hearts image I used in the previous post spotted a typo on the SCIENCES links page (I can't spell 'domain'). Sorted now thanks Ellis! If you find any others please let me know - h2cmuk at yahoo.co.uk

To follow: the noble art of boxing plus a snip from the paper. This week I must also bury myself in Drupal and sort how to add images.

Drupal + Being and Time

I'm continuing to explore Drupal amid some reading, blocks, menus, content.... Searching for content to practise upon, I checked one of the old (1997-8) introductory pages - Brian's course notes - and found my closing sentences were utter drivel! [Well it was a surprise to me.]

Although the prospect of a winter through spring clean is daunting, it will also prove an exciting completely about-time refresh.

Drupal is forcing me to do things I should have done ages ago:

• Separate the content from styling;
• Separate the static (historic) content from dynamic;
• Review the graphics;
• Thinking about audience(s);
• - and related content and solutions (archive, computer aided learning, prototyping).
  

Don't panic about the colour scheme in the screen shot below, this one allows authorised users to alter the colour, font size and width (see the very top line). Accessibility is a must this time, plus printer friendly content. The flexibility is quite amazing. There are errors on the page illustrated, the theme is not compatible with the latest Drupal version; but it works. I've gone through my own introductory page and stripped out the FONTS, TABLES and other superfluous HTML tags. What is a real conundrum is the front page.... The A,B,C I mentioned before may come to the rescue as 'this site' will just feature static content at first. So all I need is a menu in the sidebar. Users won't need to register, which may require a multi site config to develop the open source collaborative book.

It's cool to find there is a version of jQuery in Drupal. With a bit of PHP code I can fade text onto the screen - like many other sites and one of many effects to learn (and use sensibly!). Keith's DOM scripting will also finally come in handy through the dark months. I can't wait for the next NW England Drupal meet, it seems ages since the Cornerhouse get together. I'd put the modules and themes in the default directory, oops - that's sorted now. Need to explore content creation, the theme files and templates (CSS!) and the CCK (content construction kit) and views modules. Aaaarrrrghhh! Must also dream and think, dream and think, dream:think ....


If you are into Being & Time, you may like to listen to Hubert Dreyfus' current lectures. This week will see his talks on Care I & II being added to this excellent resource:

http://webcast.berkeley.edu/course_details.php?seriesid=1906978475

Have a great week!

Ruby and Expressions of Care

What is in a health-clinical-social-nursing information system?

REQUIREMENTS SPECIFICATIONS PROCESSES CODE LOGIC FUNCTIONS RULES ARRAYS DATA STRUCTURES INFORMATION KNOWLEDGE MENUS FIELDS ... ... ...

Caring professionals like to reflect.

When they look into the screen what do they see?

How expressive can a programming language be?

Ruby - could you help to teach a philosophy of care?

SPT 2007 InfoVis / Infoaesthetics & history

I missed out the initial plenary at the conference the other day on The Moral Significance of Technical Artifacts. Reading Michel Serres introduced me to Latour, and the speaker Peter Kroes linked Latour and Verbeek - "What Things Do". There's lots of reading as discussed on design and technology blogs.

Peter Kroes' plenary included a slide with a PHYSICAL domain and an INTENTIONAL domain. Once I swapped these around (INTERPERSONAL - SCIENCES) something (at least) made sense to me. Like the other plenaries this was totally engaging.

This session on Tuesday 10 July 9:00-11:00
Session J: Aesthetic Computing (Laurens Room)
Michael Kelly (UNC Charlotte)
Robert Kosara (UNC Charlotte)

- resulted in 6+ pages of notes. Michael Kelly presented the paper and then Robert Kosara displayed and discussed examples of information visualization - which included:

• Sick leave in Germany (striking approach)
  
• Titanic visualization
• Map of the Market
• Parallel Sets (could see Public mental Health here)
• Dumpster
• Bus times - Sweden (Art or Data)
  

I found a web resource produced by Robert Kosara which displays the above. The discussion covered criteria for visualization, recognition and the readability of forms. (The use of basic colour within data tables can work wonders: see Tidwell, Designing Interfaces, chap. 6). Kosara has other examples of glyphs for data display in intensive care units.

In addition I found two blogs, the first I believe related to Lev Manovich - Language of New Media mentioned by the speakers:

information aesthetics

and

Data Mining: Text Mining, Visualization and Social Media

I'm no mathematician as will be revealed in future posts, but for some reason (!?) visualization and Hodges' model have me in their grip.

This interest started in the late 1980s, which was good timing since the 1990s saw a major UK initiative on visualization in the social sciences. To be clear I wasn't involved beyond managing to attend some really fascinating events:

1996 'Thinking with Diagrams' Colloquium, IEE, Savoy Place, London. 18 Jan BCS-SGES et al. Professional Group C4: Digest No: 96/010

9-11 Sept 1998, Visualization and Virtual Reality in the Social Sciences Workshop: Weetwood Hall, Leeds, UK, Advisory Group on Computer Graphics [Archive: website no longer maintained since 1999] Attended by Brian Hodges and PJ. Poster 'Show & Tell' session on Hodges' model. Event reported in Information Technology in Nursing (1999) 11,1,14-15

So after the presentation I had to ask about the possible need to review existing visualization techniques, to do a stock-take - a lessons learned if you will. The session was excellent especially the mix of philosophy and visuals.

Sometimes maybe there's a risk that if a picture paints a thousand words - "well let's go home then and read Harry Potter...."

The old Advisory Group on Computer Graphics produced some excellent work and reports:

Review of Visualization in the Social Sciences: A State of the Art Survey and Report
Scott Orford, Daniel Dorling, Richard Harris
School of Geographical Sciences
University of Bristol

From my limited perspective I still have a sense that the real revolution is yet to happen - for health and the social sciences. The fact that Michael Kelly and Robert Kosara are not only displaying the slides, but with the Society for Philosophy and Technology and others they are asking the tough philosophical questions could be a sign; a resurgence of interest in the transdisciplinary connection of art TO computing (TO social sciences) - with a dusting of philosophy across all.

We talk about a web year, the vis year may turn slower but is an up-to-date review pending, perhaps it's under way somewhere...?

One for your diary: Workshop on Philosophy & Engineering

Soc. Philosophy & Technology Conf: Charleston, S.C. 8-11 July 2007

Home - safe and sound and really pleased I travelled despite the air-miles.

Charleston is beautiful and the heat was actually refreshing given June in the UK. I passed by New York in the day going, and at night coming home - it was an amazing sight.

The Society conference is biennial and alternates between the USA and Europe.

So, if jet-lag has not fogged my recall the 2009 conference will be at the University of Twente and I certainly plan to attend, even if I don't present.

The organisers, session chairs and assistants did a great job. I really do hope to meet again the fellow delegates I managed to speak to and share ideas - China, Netherlands, South Korea, UK, USA, Portugal...

I did not get to meet everyone and while I wish more people attended my presentation that's par for the course. I was prepared for that. You learn patience if not anything else riding the h2cm quad bike. Those who did attend appreciated the content and more people are aware of Hodges' model. I'm really grateful to Hugh the session Chair and the assistant for their help.

What did I learn?

Well, it was the 1980s when I first studied philosophy, so the conf-vocab was a good reminder and prompt (get the books out).

While a lot of effort had obviously been put into all the presentations, the plenary sessions stood out for me as a learning experience:

1. Friedman's The World Is Flat: The Globalized World in the Twenty-first Century (noticed new updated copy at Newark airport).
2. Repo-Tech - Reproductive Technologies and Risks of Commodification in the Global Context

The morning session on Aesthetic Computing - infovis was also of particular interest. I've many notes to reflect upon and follow up from the whole event. It was gratifying that I was able to ensure that some issues for older adults and memory loss were represented. I'll post more over the next weeks-months...

The Society members were all very friendly and supportive. This certainly isn't surprising, but as acknowledged at the conference close there was a real collegiate atmosphere.

Deliberations at the conference close included whether to publish Techné: Research in Philosophy and Technology - the Society journal as a paper journal as well as electronic. You can find the conference programme at the SPT site.

As an independent scholar I gather you can currently join the Society for $15. Yet another sub, but it's high time I rationalised. I'm at a crossroads and looking at and pursuing other avenues. And who knows - might meet you in 2009!

P.S. Coming home and reading of the U-turn regards the UK supercasino struck a cord with good vibrations - thanks Prime Minister!