Risk: Triangles that Trip [ack. Siegel, HSJ 20 Dec. p.23]

Happy holidays to one and all! Your interest is greatly appreciated.

In last weeks HSJ Matt Siegel's Data Briefing featured 'Missing pieces of the emergency plan', the focus was the risk relative to the population average of emergency admission, outpatient and A&E visits for specific intervention groups.

One of the figures comprised a pyramid which lists the intervention strategies that aim to reduce these service contacts:

CASE
MANAGEMENT
[Very high relative risk]
DISEASE MANAGEMENT [High risk]
SUPPORTED SELF-CARE [Moderate risk]
PREVENTION AND WELLNESS PROMOTION [Low risk]

By pursuing case management of course we can reduce the number of people needing to visit or be admitted to health services. Siegel highlights that if efforts are limited to those at very high risk then we can only influence (at best) 10% of total emergency admissions.

I've been working quite closely with a community matron recently and this 10% are a worthy target, but looking at triangles there are two essential dimensions here. One concerns the 'ascent'. Although it usually takes time (and may even entail oxygen at home) we need to entertain people at base camp for as long as possible. Why?

Because when viewed in terms of the health career every one of us is a climber.

As the supported self-care and prevention labels reveal this is recognised and is very much a part of overall strategy - but; in the low-lands though, the fog can cloud our vision.

The other dimension also lies in the very structure of triangles. The sticky-out-bits: the feet - can trip you up. Siegel points out the need to intervene elsewhere; apparently for example, the two middle risk levels which account for 20% of the total population. In the saga of joined-up health and social care the value of day care for example seems lost in the debate about who/how it should be provided? I need to check the latest literature, but I thought the size and stability of an individual's social network is a key determinant in +ve mental health? Another research question relates to how the number of required day places is derived?

In looking to make changes in the towering heights, let's not forget the nitty-gritty of care on the ground.

It isn't just having these varied intervention programmes in place. It's about managing the traffic on the passes (now there's a subtle interface!). There are many communities out there and they are far from equal. Community care: define. ...

an·a·gram: triangle = alerting, altering, integral, relating

Two UK conferences 2008

Here are two conferences - flyers with the Health Service Journal:

Patient Safety Congress 2008

and

Integrating the Primary and Secondary Care Interface

Why bother to single (double!) these out? I've been fascinated for ages by the primary-secondary care interface at the level of mental health and the health of our notions of holistic care. Safety is ever paramount across the b-(B)oard.

It's well recognised that junctions, transitions, information interchange - INTERFACES in short - between people, technology (hard/soft) and organisations are an invitation for things to go awry. They are also an opportunity to learn.

How many axes are there in Hodges' model?

On paper the answer is two: INDIVIDUAL-GROUP and HUMANISTIC-MECHANISTIC
It could be argued there are four.

They meet at the centre of the model.

I believe there are many more.

Although simplistic and static in appearance the axes are dynamic and compound in the imagination. The situations you care to throw at Hodges' model stress the framework and so stress the axes. They partially give way. Stress fractures. Across the interfaces that result meaning can be found if we care to look and listen (with all our senses).

Learning heals people and organisations too.

HTML -> XHTML & accessibility in my hands

My copy of Jeremy Keith's "DOM Scripting: Web Design with JavaScript and the Document Object Model” was published in 2005. Sat on the shelf for a year or so (don't let the library list fool you), finally reading it cover2cover.

I've developed bad habits over the past year or so, especially when updating the four links pages (no small task). Sometimes I'm using upper case HTML tags, on other occasions lower case. For HTML that's no problem, but Keith advises that if you have the future of the web in mind XHTML insists that all tags must be closed and tags plus attributes must be typed in lower case (p.149).

So, the revisions for the Drupal site and on the 'old' site will be XHTML compliant from now on; that's a lot of tags to change.

Keith's brilliant book also describes step-by-step Javascript functions, e.g., to list abbreviations and (as I mentioned recently) making use of ID and CLASS. The potential of using the DOM to create content is going to have me day dreaming (but not while I'm driving).

Keith has woke me up regards my accessibility requirement too. I knew I was missing something! Here I am wondering about what Drupal modules can do for me, but where have I been? I hadn't come across 'accesskey' before (p.171). Well no time like the present! Just what I (and future visitors!) need. My apologies to visitors in need of keyboard links, these will be provided in future.

Little boxes, little boxes ....

We are obsessed with 'boxes' - many of us especially so - at this time of year.

We cut and dice Nature into categories - boxes for things and concepts. Leaving the car and aircraft aside, being somewhere else - means thinking out of the box. Materialism? Well that is thinking out of the box taken to the extreme since materialism has us:

• filling boxes
• shipping boxes
• and the populous buying the latest and greatest of them.

(What would I like for Christmas? Well, I could really put a MacBook to good use - please!)

It used to be you shook the box - something rattled. These days silence prevails. The contents are virtual. The only rattle is from the dosette boxes. Count them out - M:T:W:T:F:S:S....

Science and medicine in particular has a thing about boxes. Of course, I have to put my hand up here as Hodges' model is not exactly quadratically challenged. It's rather ironic that in order to think out of the box, Hodges' model encourages us to think in four or five (spiritual) of them!

The business community is equally obsessed. The box clichés abound loud and clear in group, consultancy and change exercises. Of course the problem is when we only think in one box then things can come unstuck. They are often blinkered and this makes sense at times. As mentioned previously, medicine very frequently has to deal with life saving interventions that need snap decisions. I don't think it would go down very well in a crisis that someone pipes up "Now hold-on everyone we need to reflect on this, let's proceed in an holistic manner." At other times though critics point the finger, when people are treated purely in a box called 'SCIENCES' and the person becomes a mere adjunct to the box: a sticky label with a diagnosis (or two) written on it.

Nurses pride themselves and their person-centred caring approach on seeing the individual, not just the diagnosis.

Health professionals spend several years getting to know their box(es). The SCIENCES anatomy, biochemistry, physiology... Now in medical training doctors spend more time on communication skills. All health and social care professionals are prepared to 'travel', i.e. to put themselves in the patient's (carer's) shoes and see the world through their eyes. Increasingly in all human activities one discipline depends on the combined contributions of many others. Maybe that's why there's so much emphasis on words and disciplines like - integrated, transdisciplinary, socio-economics, interdisciplinary, psychosocial and geopolitical. New disciplines like neuromarketing emerge which we can expand in the respective boxes - e.g.

• INTRAPERSONAL box: behaviour, experiments, priming, freewill, ethics, personal choice, memetics
• POLITICAL box: consent, advertising, legislation, neuroeconomics, public health, governance-control, measures
• SCIENCES box: functional-MRI, bioinformatics, research programmes
• SOCIAL box: media, language, mental pollution, social nets, cultural acceptance, public perception

Using the model and 'travelling' you don't have to think of it as being 'in' or 'out' of boxes. Draw Hodges' model on A4 paper:

[Archived]:
https://web.archive.org/web/20060705190702/http://www.p-jones.demon.co.uk/index.htm

OK, now mentally fold it - one way - then another.

Suddenly disparate ideas, issues, techniques are thrown together. As physicists show (in theory only alas) as our learning grows, our previous journeys (new experiences - role plays, placements, secondments...) mean we don't have to travel the full distance. You too can warp space. In addition you are better equipped to take the patient and carer (student, whoever) with you and (try) to get their engagement.

It's true that many of these combined horizons may not work, but that's the nature of risk and creativity for you. Boxes! Do take care how you handle yours. Look out for those edges too - the leading edges change constantly....

Image source: Copyright © 2007 Apple Inc.

GP launches YouTube health films

Bob Pyke posted the following today:
--------------
I wrote about this about a year ago and they recently updated it, but it is still pretty cool.
http://www.builthsurgery.co.uk/

A GPs' surgery in mid Wales has launched a series of health education films on YouTube, better known as a website featuring home videos.

Advice about flu vaccination and cervical screening are two of the topics covered by Builth and Llanwrtyd Medical Practice in Powys.

Doctors said they wanted to help educate their 7,700 patients and a wider global audience.

Last year, the surgery launched a series of podcasts to advise patients.

YouTube allows users to upload their home videos and other clips online.

Dr Richard Walters, who helped to develop the practice's project, said surgeries normally printed leaflets to advise patients, but added that things were changing.

He told the Western Mail newspaper: "There are a lot of things that we do in a GP practice that have to be conveyed to patients, some of which are not easy to demonstrate within the surgery.

"Sometimes getting patients to watch a quick video on the computer screen is a lot easier."

He added: "We are a practice in rural mid Wales, shops in Hereford and Aberystwyth are an hour away, Cardiff an hour-and-a-half, so although broadband access is not ideal, people tend to use the internet for all sorts of things."

The practice, which covers more than 500 square miles (1,295 sq kms), hopes its advice online will avoid unnecessary travelling to a see a doctor. The videos include tips about asthma inhalers, smear testing, blood sugar testing and the winter flu vaccine, and are made by two practice nurses.

New topics are planned to be added every month. As well as being available on YouTube, the videos are posted on the practice's own website and can be downloaded onto an MP3 player. The surgery is no stranger to using modern technology to get across its health messages to patients. Last year, it launched podcasts demonstrating, among other topics, how to use an asthma inhaler properly.

Story from BBC NEWS:
http://news.bbc.co.uk/1/hi/wales/mid/6234141.stm

Drupal Themes - eeny meeny minny mo.....

I've been going through the Drupal themes again, this time with a fresh pair of eyes - having tinkered and read a little. The themes that stand out for the h2cm archive project include:

• Aurora
• Brushed Steel
• Denver
• Flexible
• Foundation
• Itheme
• Meta
• Multiflex37
• Salamander
• Stylized Beauty
• supriya
• Wall

With the admin theme fixed, I've been enabling and making the themes default in turn. Some of them stand out straight away in terms of fitting the content and the styling. Unsurprisingly, others mess up positioning the title and the menus - although I have been messing about and I'm not using the theme engines. The other two requirements I have - page printing and accessibility are also varied. As the names above suggest some are bare bones that you can adapt yourself, including Zen which is were I am up to. I'm going to need to decide soon! In Mercer's book though, he advises taking some time to check through the themes - so....

It shows you Drupal's reach as there are UN templates, yes, that 'UN'. This shows how open source projects often 'give-back' the community as a whole.

There are four of us so far for Wednesday's Drupal night. Hope there's a few more.

Bell jars and bell curves

To those who do not know Mathematics it is difficult to get across a real feeling as to the beauty,
the deepest beauty of nature. ... If you want to learn about nature, to appreciate nature,
it is necessary to understand the language that she speaks in.
Richard Feynman. 1918-1988. American physicist.

As those of us who can - work through school, college and those who are gifted (in both senses) take the university detour we identify, refine and utilise our intellectual strengths. This entails that we must also come to recognise our limitations. Looking heaven wards the day dawns that the "way of the astronaut" is a step too far, that's OK others can fly for me. ... At some point and usually much too early in academic careers specific aptitudes, intelligence and abilities crystallise into that form of diamond known as yea or nay. Statistics have it that there are many average scholars out there. Some people are average in maths AND English (languages), a smaller proportion excel in one or the other. So, how is your essay writing? Or should I ask how is your number theory?

The bell curve has its say, but having that bell jar placed over you is just the start of the story. Minds should be constantly enquiring. The result is coming across things you cannot fully comprehend and yet you have this real sense - you know - that "there is a tool here I could use - if only...."

At work we will naturally share many abilities with our peers - including befuddlement when it comes to maths. The nursing literature includes an ongoing parade of titles dedicated to explaining maths and stats to the numerically challenged.

In the mid 80s the dichotomy between the SCIENCES and HUMANITIES was illustrated for me in a working paper from the school of geography at University of Leeds. I still have it, saving it for a rainy day:
Macgill, S.M. (1984). Structural Analysis of Social Data, A Guide to Ho's Galois Lattice Approach and A Partial Re-Specification of QAnalysis, Working Paper 416, School of Geography, University of Leeds.
Abstract 1985

I came across this like a moth to a flame (thankfully I found an egg-carton to hide under). I began to work through the paper and had a puncture before even leaving the lay-by. My '84 A5 copy is rather basic in terms of print quality. Showing it to a few people at the time they thought perhaps there were some printing errors. They may well be right although may be they were also being kind. It wasn't just a 'NO ENTRY' sign, it was a brick wall I had met before. Some teachers reinforced this wall; while there were many others who did their level best to help me find a way through, or around. The truth is my cognitive wiring just ain't up to it. Referencing a paper is one thing, plumbing its depths and applying it is another.

So the obvious conclusion from this mathematical close encounter (more like a distant approach really) is that I'm challenged when it comes to maths. I've worked my may through (IBM) SPSS descriptive stats and some 'real' stats; implemented BASIC search algorithms. But away from the lecture-IT room the knowledge quickly evaporates. I'm utterly fascinated looking at the world-universe within and around me, but I'm knee deep in a river and dying of thirst. There are millions of people haunted by the spectre of their ineptitude with numbers.

This is one of the main points of Macgill's text. The paper highlights an approach of great potential to social science researchers (including health and social care?) and yet the people most in need of such methods are frequently disadvantaged being unable to fully understand, grasp and apply these tools.

So tantalising, so frustrating - the glass is very frosted for this 'average student' (lifelong learner!).

Is it just about opportunities or opportunities to break the frosted glass?

Drupal - CSS and the DOM, NHS & Paxman

I managed to sort the image in the Drupal archive (trial and error - learning!) page. Now to get to grips with CSS, DOM and Drupal themes. Human nature often wins out to the detriment of learning: you pick up just sufficient HTML, a limited amount of javascript to get your website up and running and then your learning stops.


Reading through DOM Scripting there is so much more I can do by correctly and comprehensively using CITE, 'title', 'ID' and 'class'. ... There's a name for it starting from scratch. So, the old content I have copied and pasted thus far needs a lot of tweaking stylistically. I plan on to spend some time on this, but not as long as I feared. Using CSS stylesheets a single change can be reflected across the whole site.

I've also downloaded a Drupal print module and will ask about this next Wednesday night in Manchester.

I just watched Can Gerry Robinson Fix The NHS? One Year On and must dash soon 22:30 BBC2 Newsnight with Jeremy Paxman there's a follow-up to the programme. This should be available online for 24 hours after and VERY 'interesting' too? [Hope they do re-visit this topic].

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

Health Career Model Cygnet Hospital Bierley [II]

Dear Denise

Thanks for your message, interest and ongoing support of Hodges' model. I've copied your query to Brian. It is marvellous to read of your career to date and how you have adapted the model to fit your needs.

I have some insight into PSI (psychosocial intervention) and feel that the model could certainly be used in your new post. I suppose (as ever) there are several caveats as you may have already found...

Chief among them is that your colleagues may be reluctant to follow your lead - asking for the evidence* to support safe and effective clinical use of Hodges' model?

The website and blog represent a call for research in Hodges model and similar approaches.

In support of Hodges' model in Bierley -

* 16 bed Acute Ward(male)
* 15 bed Complex Needs Ward (male)
* 15 bed PICU Ward (male)
* 15 bed Personality Disorder Service Ward (female)

- as you will be aware the model is very high-level and it does not dictate practice or philosophy. If adopted however the model can help assure (not guarantee) a holistic approach, as you have already found.

You may care to look at the current processes - care pathways - and map these using Hodges' model. Then look at the specifics of therapeutic modality and PSI (for example, specialised cognitive therapeutic/schema therapies personality disorder) on the unit and effects on the key (h2cm) elements -

INDIVIDUAL-GROUP
HUMANISTIC-MECHANISTIC

- and across the four knowledge domains.

On the blog, check the post 'labels' (on the right-hand side) for -

process,
practice,
purpose
and policy [4P's]. These posts may help also.

An often 'neglected' area is outcomes and outputs. Check what aspects of care (and outcomes) the commissioners of care are focusing upon? Public involvement, client and family engagement may be challenging aspects of care for you and your colleagues? You can also utilise the POLITICAL domain which in your work - as with the TEMSS/secure services posts is no doubt central. The focus on PSI is another crucial dimension SOCIOLOGY - POLITICAL, especially if family oriented? What areas do you want change? Should you concentrate your efforts on one care (knowledge) domain, or are there some inter-domain dependencies highlighted in the literature*?

What data do you have on your patient (referral) population (month-year?); your local (catchment area) population?

Hodges' model is a space - what can you fill it with?

What data do you already have? Sometimes this can come as a pleasant surprise, or a data-poverty shock? Who can you speak to internally - externally? Statistics, reports, intelligence? Is your organisation a learning organisation? (There are times to join in with the fashion game...) If so, does that include the clients and their families? Is anyone on a course and in need of a project? What does multidisciplinary team and integrated care (really) mean in your service? Has a staff member been away for 6-12 months, if so speak to them...

Your bed numbers:staffing ratios speak volumes to some people more than others (£...$) how does economics figure across Hodges' model? If it may help SWOT each domain?

Currently on the psychiatric nursing mail list there is a discussion on 'recovery' and employment-benefits. What does this mean for your care objectives and service overall?

If you still have any contacts at Kemple View or notes (essays) that you could possibly share please let me know. If you are interested in writing / collaborating on a paper I'd be happy to assist.

If there is a 'clinical development (governance) lead' in your new organisation it would help to get them on-board - then you are not out-on-a-limb. Your success thus far suggests you'll have this covered!

If you would like some views on your progress to date do not hesitate to tap my screen.

All the best to you and your colleagues Denise with your plans and for the holidays - 2008!

Keep in touch...

Peter J.
===========================================================
Peter,
Thanks very much for your speedy response, I have already met with my two charge nurses on the ward and we have agreed a way forward. There is of course much to do to ensure that we can introduce the model successfully, your answer will prove very useful. I would be happy to keep in touch and of course feel free to add my question to the blog if you think that this will be helpful to others.

Kind Regards
Denise Banks

Drupal tinkering - images walking into walls

I managed to wade into Drupal last night, not quite the dive I had in mind although still very useful.

Drupal is a gift for creating communities of users as the Drupal site title makes clear. So here am I wanting first to create an archive, basically duplicating three existing pages with some corrections/revision along the way:

1. Brian's lecture notes introducing Hodges' model;
2. Brian's notes on bridging theory and practice;
3. My original 1998 introduction to the website and Hodges' model, written after interviewing Brian in Manchester.

I created an Adobe pdf version of Brian's intro notes many years ago, but never had the bandwidth to publish in this way. It's not that I expect a deluge of downloads, it's just that I know how many papers I download and never quite have a chance to read in full. Now though thanks to Chris Ward's great offer of sponsorship with hosting the future looks a lot more open. There should be scope to offer several formats.

After the PC power supply problem interrupted play I fired Drupal up and quickly ran into a wall. There does seem to be some issues with image management in Drupal. Drupal's community plumbing prowess is concerned with how users can add images to their posts, not the type of static content I am concerned with at present. There's a way around this which I am looking at - using inline images. Also wondering about 'content types' and what the existing ones may offer? At last month's Drupal meeting TinyMCE and IMCE image tools were discussed. It looks like there are many options with the modules on offer. The .pdf, .doc option may be simpler for this at least?

Anyway I've an image in the 'files' directory and added the necessary html to the page, but the image wants to play hide and seek. Will tackle this later.

I'm using the Ubiquity theme (see below) at present and will need to settle on one theme soon. I think themes are up for discussion in Manchester MDDA this month. It's one thing to keep changing themes and posting pretty (or not so pretty) pictures here, but it's what's under the surface that counts. I'm going to have to dig a little bit. Mercer's beginner's Drupal book will be required (re-)reading for a long time yet! Drupal's is now on version 5.5, so I will update this week - another useful lesson just before the next Drupal meeting on the 19th. The update will also force me to back things up.


Re. Atlantis: hope they sort those engine cut-off sensors soon - there's a lot of medical and materials research to follow when the Shuttle crew finally deliver the Columbus lab to the International Space Station. I wonder what new medical wonders will arise from the materials research, in orbit and at home? Now launch is set for 2nd January. Safety first!

Socio-tech paper and snippet

Close now to completing the paper I think - 30 refs and 7,085 words, eight figures with two to draw.

About five years ago I desperately needed to write to complete a dissertation, but personal circumstances had the better of me. The difference then was walking away with a PG Dip. not an MSc.. There are two positives: 1. walking away with something and 2. I was walking.

Now I'm up and running and finding it much easier to write (really enjoying it) and the ideas are flowing, which as a mental health nurse can be a bit scary at times. Whether these thoughts, this work adds up to much is not for me to judge... Anyway here's a snippet from the draft paper (concerning socio-technical structures in nursing informatics). A student nurse - thanks Brenda - is kindly reading the text through. I'll also post it on to a few other contacts this week - feedback ever crucial (which reminds me I've some reading to do for someone):

As befits the socio-technical and media drenched world we live in, it seems that everyone is busy moving forward. Nursing as a profession must constantly aspire to make a difference and effect positive change. In the decades ahead (nursing) informatics can help leverage positive change in tackling health inequalities, and addressing the ongoing revision of the new health agenda of health promotion and education. To do so though nursing informatics must also recognise its limits; it must seek out or help create new structures through partnerships with other informatics disciplines; community, social care, urban, citizen for example. Although 2x2 matrices are ubiquitous as a structuring device for concepts, ideas and much more, they are also consequentially much maligned: a ready reckoner for gross assumptions. Upon first encounter Hodges’ model may be considered merely as a brainstorming tool. Hodges' model can act as a framework for weaving, a template for a socio-technical tapestry. The framework provides a lattice upon which vital conceptual connections can be displayed explicitly on its public face, or privately when the handicraft is viewed from the back – the infrastructure. ....

I've noticed and highlighted in the paper that h2cm can show two formulations of socio-tech that overlap across Hodges' knowledge domains and highlight the primacy of the 'individual'. I've used Word for two related figures which need to be drawn up - then I can post them here.

Bye for now - PJ

To follow: Drupal and a sore nose plus that boxing post!
8 hours 22mins and counting: Atlantis - Good luck-Great flight!

Thermo, Long Way Down, Aether and Atlantis

Here's a video on a forthcoming new Adobe development tool - 'Thermo'.

Thanks Ewan and Charley - great TV.

Another journal - Aether : The Journal of Media Geography -

Aether offers a forum that examines the geography of media, including cinema, television, the Internet, music, art, advertising, newspapers and magazines, video and animation. It is our goal to provide a space for contributions to current issues surrounding these media, beginning with constructions of space & place, cultural landscapes, society, and identity.

Atlantis takes flight tomorrow (fingers x'd). For a different media mix try NASA EDGE.

In the Northern hemisphere whether you're walking the dog or E.T. is walking you, keep your eyes open for the Shuttle and ISS. In the Southern hemisphere too with those mid-summer nights - enjoy!

Hosting sponsor offer for Hodges' model site

I've had some great news (really welcome as I try to sort my pay and future career prospects)! The offer of sponsorship with hosting - 5GB space and bandwidth to boot - c/o and thanks to Chris Ward at Human Ecology Forum and Greenhosting.

Chris and I have exchanged e-mails and blog posts already through the Northern England Human Ecology - CHE - group, which should next meet in March - details tbc.

This is a great incentive for me to push on with Drupal and content revision. It will take some time, but knowing there's a home for h2cm is a flag to aim for. Apart from the part-time flavour of this enterprise another reason not to hold your breathe is that I plan to include learning objectives with all relevant content. So with Drupal I need to check the potential of CONTENT TYPES and MODULES and forms .... without re-inventing any wheels. Exciting, but heady times...

Socio-technical ticket stubs

Psychologists are a busy bunch. The number of tests, assessment schemes and theories to help explain intrapersonal and socio-political phenomena are legion. All strive to be scientific, constantly refined and evidence based.

It was recognised a long time ago how we humans have a tendency to polarise, dichotomise - left-right, good-bad. ... We have to dice and slice the world in order to make it accessible and understandable. Life and death decisions have always depended upon this ability, which is one of the reasons why we're all here today.

This vital capacity also assures the creation of socio-technical structures. A ticket that provides entry to several problem domains, each with two, three, four, five .... viewpoints. And as safety dictates there are at least two entrances-exits.

The problem is of course that as is customary only half the ticket is actually 'used'. So many stubs end up on the floor. Such a waste.

Make sure you use and retain yours. Happy memories of a project well done!

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.

Lonely model seeks ...

 


Lonely model seeks caring companion in mind and body. Open minded and adventurous (so make that companions!). Seeking at minimum a life-long relationship. Wise head on young shoulders. Outgoing: ready to travel anywhere. Enjoy milling around hospitals guessing the illnesses of out-patients. Will consider alternate scene. VERY flexible. Minimal baggage (will help YOU to carry yours). Interests span sciences and arts, ICT, global health, human ecology, the world of ideas and ideologies, analysis and synthesis: but never before breakfast in bed. Bag-ladies and excluded others please do apply. If you are into boxes or out of them get in TOUCH asap! Reply PO Box h2cm-4 (or is that 5?)
 
Image source with thanks to Ellis Nadler.

PC restored thanks to Computers dotcom

It was the power supply. Back up and running now thanks to Computers dotcom at 116 Winter Hey Lane, Horwich, Bolton, BL6 7PJ. I'll add their link which is down at present - another new site is on the way.

I've an old Dell PC case, I'd love to put some kit together a media PC, or Linux box - one of these days... Meanwhile back to catchup and writing...

'P' also for 'complexity' and 'power supply'!

Oh dear! My PC a senior citizen at 5 years old this month is poorly. The power supply had indeed given up the ghost on Saturday and I've a (red) confession to make: the CPU runs constantly, processing data from -

SETI@Home
Rosetta
LHC
SZTAKI

Not very green I know. I do invest time switching other things off at home and work, to save some money and CO2. We could save a fortune at work...

I'm writing this on Matt's laptop, so no Skype at present. Hope to be sorted soon - funds...!

I'm still reading and thinking things through - static archive, website, Hodges-informatics, students (podcasts!). It's quite frustrating having attended the Drupal meeting last Wednesday in Manchester. Having listened to some great talk-throughs covering specific modules, you're left itchy to try stuff while the thoughts are hot. The next meeting is December 19th, just hope there are no school carol services then! In the Pro Drupal Development book there's a section on a simple XML-RPC Server. Which is why I'm thinking.... Reading this stuff I feel like a Beach Boy - Wouldn't It Be Nice!! Well, it sure would... Chris, Steve and the other established Drupalers are keen to have others up-front, sharing their experience and for beginners to show work in progress and seek help with problems. Now there's a future aim and one that may be hard to dodge (which is what I need)....

I've been given admin rights to an established, but still emerging Drupal website. Someone trusts me and for that I'm really grateful. This is another very useful way to learn. I can check how this already well populated site is configured, how the content types are used... and pick up and report errors. Plus sharing some insights from Manchester.

On Saturday I lost an update to the socio-tech paper, the notes are no longer recycling bound. As you're reading this I'll be downloading the file from an e-mail I sent to myself last Friday night. Can't afford downtime on this project there's scope for 5-7k words, I've 6k, but a lot still to do. I'm pleased to learn I can include some B&W figures.

Speaking of 'P' again - some of our visitors arrive at the website having searched for 'p'. Google picks up the 'p' in p-jones. I should have realised of course: the heart of Hodges' model - COMPLEXITY. Although many of the forms of complexity are completely over my head. We need tools to understand complexity within the humanities - social sciences: is that possible without maths? There are certainly books and journals out there.

Must go: Sam - our dog is stood up at the door with his legs crossed and a wolfish grin (of discomfort). OK let's go...

'P' is for Philippines

In addition to the USA and EU for several years now it appears that many of our website's visitors come from the Philippines. Brian and I greatly appreciate the interest of our virtual Filipino guests, so welcome one and all...

Over recent decades the global migration of nurses has become a much needed phenomenon, but one that can also quickly become a newspaper headline depending on where nurses are moving from and going to....

Given the (relatively) high profile of Hodges' model as a model of nursing on the web, I wonder if these visits reflect:

1. An assumption by potential nurse migrants that Hodges' model is de rigueur here in the UK?
2. There are tutors/lecturers teaching the model in the Philippines and directing their students to the site?
3. They use a curriculum that is suited to, or finds merit in Hodges' model?
4. With more than 180 languages and dialects perhaps Hodges' model is also helpful in this multi-cultural and ethnically rich country?
5. Perhaps the visitors are not primarily nurses?

Whether or not any of the above apply, I would love to hear from our Filipino visitors? How is Hodges' model being used in the Philippines?

I don't want to put any visitors off, but of course the website and this blog represent a call for research in global conceptual frameworks for health and social care and general education too. Wherever you are - you can make a difference...

All the best.

h2cmng AT yahoo.co.uk

(My PC's off-line at present - power supply?).
Image source:
http://en.wikipedia.org/wiki/Image:Phillanguages.jpg

To follow - another 'p'.

Socio-tech paper and Skype: hodges_model

I've been working on the socio-technical (s-t) structures in nursing informatics paper....

The guidelines insist on definitions, so in addition to socio-tech and socio-tech structures I've added s-t-political. It is possible to consider s-t in isolation, but I don't think this is a valid exercise. The politics of matters s-t are all over. Hodges' model can really bring these to the fore.

It's always a struggle to balance the content, how much background to cover. In the paper I've thrown in a horse and litter, plus the moon for good measure. Instead of sociotechnical I've opted for socio-technical; the hyphen's important which I'll need to explain.

There is a question that's cropped up about this word - 'technology'. Is 'technology' special as an -ology?

I'm trying to get in the habit of plugging the Skype phone in, there must be a way to preserve the microphone setting!

Skype: hodges_model

h2cmng AT yahoo.co.uk

Update - REFERENCE:

Jones, P. (2009) Socio-Technical Structures, the Scope of Informatics and Hodges’ model, IN, Staudinger, R., Ostermann, H., Bettina Staudinger, B. (Eds.), Handbook of Research in Nursing Informatics and Socio-Technical Structures, Idea Group Publishing, Inc. Chap. 11, pp. 160-174.

What the World Eats & The Year in Medicine

TIME magazine - Specials:

What the World Eats

The Year in Medicine - A to Z Health Guide 2007

Thanks to the XMCA list.

Health Career Model Cygnet Hospital Bierley [I]

Dear Brian,

I have always been interested in the theory behind the use of Hodges' Health Career Model. During my time as a student nurse (back in 93-96) I came across information about how the HCM could be implemented in practice. As a newly qualified nurse I took these ideas into my first development post at Kemple View in Blackburn, Lancashire and successfully introduced an adaptation of the model adding risk to the dimensions.

I understand that the model is still in use and many patients have benefited from its holistic approach to psychiatric care. I also note reference to this on your web page. I am quite pleased that a student nurse has clearly recognised the benefits as I did during training.I am now working at Cygnet Hospitals at Bierley in Yorkshire and am again looking to introduce the model as a means to provide a framework to nursing care. The favoured approach on the ward (FAIRFAX Rehab - complex care for males) is PSI, but I am of the opinion that the HCM can be used as a framework for nurses to deliver such an approach.I would be interested to know what your thoughts are on this and of course if there is any advice that you can offer.

Many Thanks

Denise Banks RMN PGCM DMS JP

In December 2003 a student nurse brought information to my attention that Kemple View Psychiatric Services, Blackburn, UK are using the Health Career Model as an aid to assessing individual needs.

Links by PJ and reply to follow ....

PJ meeting with Brian Hodges - Spring 2008

Since I approached and met with Brian on 28 May 1997 about creating the original website (1998-2015), I can count the number of times we have met on one hand. Sheffield and Bolton are not that far apart, but you know what it's like....

Brian and I have managed to meet up prior to site updates and we hope to catch up in person in the Spring or possibly sooner (February half-term).

This really helps to focus my efforts as I like to take along ideas, drafted plans and actual pages if possible. By then I should have a clearer idea of not just what I would like to do - including what goes where - but what I can do...

P.S. Other ideas and inputs are also invited!!

h2cmng AT yahoo.co.uk

Ruby, Eclipse AND Rails

Last February I mentioned here that I was going to try to learn Ruby. Regardless of the name, it really seems to be a gem of a programming language. Finding Eclipse -

Eclipse is an open source community whose projects are focused on building an open development platform comprised of extensible frameworks, tools and runtimes for building, deploying and managing software across the lifecycle. A large and vibrant ecosystem of major technology vendors, innovative start-ups, universities, research institutions and individuals extend, complement and support the Eclipse platform.

- also made me hungry again (after some 12-15 years) to tinker with code. After installing and trying Eclipse and Ruby in the spring - time got the better of me.

Then last week I read an item from October's PC PRO - 'A total Eclipse'.

I removed Ruby, who am I trying to kid!

It was time to check out Ruby AND Rails -

Rails is a full-stack framework for developing database-backed web applications according to the Model-View-Control pattern. From the Ajax in the view, to the request and response in the controller, to the domain model wrapping the database, Rails gives you a pure-Ruby development environment. To go live, all you need to add is a database and a web server.

I installed INSTANT RAILS and it's awe inspiring; so much to learn, but it really feels like the motor's running. I've had the Rails book since the spring with one reading and now the mini library (Ajax, PHP, Drupal, DOM Scripting) I managed to put together is paying dividends (I think!).

So now Aptana is plugged into Eclipse and I'm up to Part II - Building an Application (just to put things into perspective that's p. 51/719 actually!).
If you follow this blog, you may be thinking he has dropped Drupal! Far from it. I can't wait for this Wednesday night and the meeting at Manchester Digital Development Agency. Books aren't the whole story: I have to add that installing Drupal, screwing up, deleting, installing again and finding some stability at last... such that I can check out the innards of Drupal (play!) has helped me enormously in starting with Ruby, Rails and Eclipse. Hope I can maintain this momentum.

I've also noticed the ads for Ruby and Rails hosting too - wish I could find a sponsor or two...

Spreading the cognitive and temporal jam yet further - I've downloaded Inkscape's Vector Graphics editor. Still need a decent banner (and finish the socio-tech paper - must contact the editors!).

13 books to inspire action for people and planet

On his blog Osbert's ethical enterprise Osbert Lancaster -

13 books to inspire action for people and planet

- a couple of videos also feature.

Although I'm not a CHE alumni - just a prospective student - the posts and blog roll provide a rich sustainable seam.

ERCIM News #71 Technology-Enhanced Learning (TEL)

Amongst a packed issue on Technology-Enhanced Learning (TEL), the latest edition of ERCIM news mentions how computer aided learning has become TEL.

If you are researching this field, or would like a heads-up on EU activity in e-learning this is a great resource. My interest is three-fold:

1. investigating CAL in the early years;
2. recognising h2cm's potential in curriculum development
3. and of course the possibility of producing TEL resources in the future.

The next ERCIM issue for January 2008 is on The Future Web, you can subscribe online.

Must check on the equivalent sources for the Americas, Africa, Middle East, Asia, Australia - New Zealand - Oceania...?

Bye for now - back to cooking, ironing AND writing ;-)
h2cmng AT yahoo.co.uk

Reminder: Socio-Technical Structures in Nursing Informatics

Several other people and I received an e-mail yesterday - a reminder that a book chapter was a day late. (Wish that reminder had arrived a month ago - oh well.) I knew the deadline was nearing and with 4,500 drafted words I'm far from finished. The Hodges-Serres chapter will be published next year, and that was rejected in its initial form, so....

The subject of this effort - socio-technical structures - is a bit like playing Pooh sticks.

You see I'm standing on the bridge at the centre of Hodges' model on the I-G axis - and I can see the H-M concepts flow by underneath. Well, it's only a bit like Pooh sticks because sometimes the flow is tidal, and at others it is just plain weird. Walking home from Rivington in the dark, warm as much from having more writing under my belt as just having had a coffee - in my mind's eye on the bridge - I realised I was surrounded...

Tolerance and persistence were on both sides and heading my way.

Ideas are one thing, but writing something that is relevant, coherent and finds favour with editors is another, it's fun trying though...

"BonkersFest has identified normality as a mental health issue..."

Although it's a while since I ran around the school playground, mentally for the sake of my well-being, creativity and general zip-n-zest; I like to think that I'm still there (minus - knees plaster clad, nose running, sleeves flowing....).

Now, it's just that the playground is a tad bigger.

As an adult thinking about the banter and slang terms banded about back then the differences and connections between adult-childhood worlds become quite stark and makes you wonder - where does stigma begin?

When I first came across BonkersFest this year I thought "they can't call it that - can they...?"


Well they obviously did. In doing so this year and with plans for 2008 the participants, organisers and sponsors are addressing the question (issue!) of stigma around mental health and disability head-on.

BonkersFest, the ongoing attention of the BBC, the Independent newspaper campaign and efforts of others in the media are still much needed.

iPhone™, Open Handset Alliance™ - Android™

With the iPhone now available here in the UK, the mobile market is bound to change and quickly - the latest and greatest never last long.

"Unlimited data" sounds great, but the usual fair use caveats apply.

Elsewhere, Google has announced the Android Developer Challenge, supporting OHA ...

Welcome to the Open Handset Alliance™, a group of more than 30 technology and mobile companies who have come together to accelerate innovation in mobile and offer consumers a richer, less expensive, and better mobile experience. Together we have developed Android™, the first complete, open, and free mobile platform.

We are committed to commercially deploy handsets and services using the Android Platform in the second half of 2008. An early look at the Android Software Development Kit (SDK) is now available.

On the OHA site -

Participate in the Android Developer Challenge, which will give away $10 million to developers who build apps on the platform.

Better watch that market space!

Mental health problems and worklessness

Change at work tends to be viewed as just that - change within the sphere of your profession and colleagues. The changes inevitably affect your clients, but the bubble by-and-large stops there. In the 1990s community mental health resource centers were being built with kitchens to cater for day care/hospital patients. Now many of those kitchens are not needed as mental health services have stepped away from day care provision. This move is a smart one, since if you read (and contribute to) mental health news groups you note that current and former users of mental health services recognise for themselves the dependency that prolonged day hospital attendance can promote. That said there are many acutely worried people out there. Having lost day care services, they face interviews that seek to address their level of disability. Depression and anxiety need no introduction to helplessness and hopelessness.

Enter a further phase of change and one with much wider ramifications - tackling worklessness.

There is a new EU strategy for 2008-2013 which includes (with my emphasis):

The Commission report to the 2006 Spring European Council urged Member States to reduce the high number of people inactive through ill-health13. It stressed that policy in many sectors has a role in improving health for the benefit of the wider economy.

Spending on health is not just a cost, it is an investment. Health expenditure can be seen as an economic burden14, but the real cost to society are the direct and indirect costs linked to ill-health as well as a lack of sufficient investment in relevant health areas. It has been estimated that the annual economic burden of coronary heart disease can amount to 1% of GDP15, and the costs of mental disorders to 3-4% of GDP16. Healthcare spending should be accompanied by investment in prevention, protecting and improving the population's overall physical and mental health, which, according to OECD17 data currently amounts to an average of 3% of their Member States' total annual budgets for health compared to 97% spent on healthcare and treatment18. [p.5]

Does overall planning, action and evaluation in physical and mental health call for an overarching framework? When possible the drugs may be replaced or combined with information prescriptions, but care is still needed in preparation, administration and monitoring the positive and negative side-effects....

Brussels, 23.10.2007 COM(2007) 630 final
WHITE PAPER Together for Health: A Strategic Approach for the EU 2008-2013

Hobbyist programming

Another barrier to trying to learn programming on the PC as a hobbyist, is simply being able to keep up. Versions change rapidly, the proprietary package adorning the shelf quickly becomes dated. If used regularly no problem, otherwise what a waste of money...

That's no excuse now, as there is a stable collection of languages to use such as Java, C and its many variants and IMHO Ruby seems an exciting and mature prospect. Plus, open source offerings like Ruby means a free entry ticket to tinker with soft tech. Today though the need for a database, styling, web, application interfaces makes for a complex mix of programs that must work together. As Drupal and no doubt other CMSs reveal there is no single DIY technology, you really have to look under the hood.

I'm well sorted with Drupal and can't wait for 21 November and the next NW England meeting in Manchester. It appears a time though of great change in programming circles. How so? Well I think it is significant that Microsoft's Vista and Apple's Leopard are creasing themselves to look 21st century and yet they have apparently caused incoherent waves in the market place - the former more so. In order to produce the software of tomorrow the tools must evolve. Widgets rule? The latest developments suggest some great opportunities (creative ideas and time permitting!) - for example:

Adobe's AIR used to produce - Acesis Point-of Care

Watching the tech media for things to try (and fuse together) I've also wondered for ages about SVG. It's been around for many years. Is SVG about to fully realise its potential, or has it been passed by...? Given where I am at - I'll revisit this topic again...

Well back to Drupe, PHP, SVG... and a really helpful blog in terms of sorting the tech-jig-saw.

From Sinclair and [BBC] BASIC to PHP, AJAX, Javascript and Drupal?!

Starting the server and delving into Drupal I'm reading too:

Babin's - Beginning Ajax with PHP
Darie et al. - AJAX and PHP

The code in these and most books is available on-line and while this makes life easier, I've realised that the time spent in the 1980s typing code into the Sinclair ZX81 (with 16k RAM pack) and BBC microcomputer provided a great way to learn programming structures and syntax. Now, I don't have time for typing even though I'm no keyboard slouch (and yet - posture! posture!).

Another thing I've never faced up to the challenge represented by the PC in terms of programming and networks. Lots of reasons including family, day job, a static website, some publications and amongst the excuses is the arrival of OOP (object oriented programming). I found myself using C+ on my degree course (philosophy:computing) and worked through the assignments 'OK', but this was no springboard.

In the books you can feel short-changed as the code examples include repeated functions - browser checking, error handling and such like. So what to do? Well, re-use of code is a key principle of programming and so whether a case of typing or copy-paste re-use makes sense.

I've got some of the chapter exercises working including this AJAX grid, which I know is no great shakes. What I think will help push me forward is to flavour this with data related to Hodges' model. That's a problem too - having meaningful data.

Anyway, must go - to check if the three updates in the image to the left are actually in the database table. MySQL is another thing to get to grips with and I notice that the latest version of PHP can be used to write object oriented code - OOPs - no escape!

TEMSS - Therapeutically Enhanced Medium Secure Service for Women [II]

Dear Rachel (Ms Magee)

Delighted to help you and well done on picking out Hodges' model. It sounds like an exciting time for you personally being newly qualified and working on a new unit.

Apart from several occasions as a student (late 70s at Winwick Hospital) and more recent liaison through my Trust's NHS Care Record Service Project I have not worked in forensic/secure mental health services. So what follows is a very generic over view. That said Hodges' model is more than an out-liner - brainstormer tool. As your experience grows the model will grow with you and your clients if it is appropriate to share it with them. Anyway, here are some initial thoughts a real mish-mash running through the care (knowledge) domains in turn (with some repetition).

If you wish to develop and elaborate on what follows, casting a distinct TEMSS light on each care domain I'd be happy to place your prioritised version in a graphic (with you duly ack.)

intra-INTERPERSONAL
Screening on admission. Existing psychic 'injuries'.

An·a·gram: 'secure' = 'rescue' .....

Life history, experiences +ve/-ve (including hospital care), skills, strengths, beliefs, mood, expectations, RISK behaviour, personality, psychological reactions to situation (admission, secure environment, diagnosis, prognosis, treatment - psychotropics, locus of control, helplessness, motivation, family contact...), specific, individualised - person-centred care. Thought disorder? Attribution. Risk - self-harm, harm to others, self-neglect. Psychological dependence. Intelligence. Literacies: 3Rs, visual, social, information. Boredom, Mental capacity. Cognitive functioning. Religious beliefs. Personal skills, strengths, interests. Education - access to training. Response to stress - existing coping mechanisms. Sleep. Attitudes. Sexuality. Biopsychosocial influences PMT (sorry don't wish to seem sexist!)? Stress-vulnerability. Biases, prejudices. Orientation time, place, person (not just older adults).
(YOU as a nurse are also in this domain - your skills, control and restraint, anticipation of needs, observation, empathy, self-awareness, non-judgemental, bias etc....) Assessment tools. My care plan. 'personal' time. Quality - therapeutic time if used.

SOCIOLOGY
Family, pressure on existing - new relationships, spouse-boy/girlfriends, socialisation into the 'secure' environment, dependencies - children / pets. Observation. Group activities. Group therapies. Routine. Co-operation. Team work. Leadership. Status, stigma, respect. Communication. Social skills, Assertiveness. Media - papers, radio, TV. Qualitative research - client narratives. Demographic profiles - catchment areas - deprivation indices.

SCIENCES
Screening on admission. Existing injuries. Access to GP, emergency services if needed. Physical characteristics, height, weight - BP, temp, bloods, mobility. Evidence based care? NICE. Drugs, side-effects (+ substance misuse / alcohol), physical effects of addiction, physical environment - lighting (on-off [fade]), noise (acoustic) signature, colour, architecture (sharp corners vs curves), physical health problems, trauma. ADLs. Assessment toolkit - what's in yours? Nursing (care) process. Hygiene, Domestic services. Infection control. Physical space allocation. Multidisciplinary assessments - occupational therapy, physiotherapy, psychology, pharmacist. Unit viewed as a system - ecology. Complexity within TEMSS. Literature review. Site visits / conferences. Learners. Staff course study opportunities. Academic partnerships. Quantitative research. Triangulation. Statistics. Data gathering processes. Geographic profile of referrals.

POLITICAL
Human rights, policies, protocols, GP service provision, right of appeal as relevant, 'disciplinary constraints', compliance-concordance, 'offence' category. Client space - privacy / dignity. Access to therapies, rehabilitation, training opportunity, AUTONOMY, ability to exercise choice, institutional 'rules' make-up, clothing, bathing, kitchen, toilet facilities, dignity and privacy, 'unwritten' rules - bullying - vulnerable adults, abuse, financial, sexual, physical. Inspection - Commissioners - accountability. Referral process-pathway. Thresholds, waiting lists? Travel distance - regional resource. Transport links - visiting times. Cost of fares. Staff establishment. Health & safety rules. Disability. Care transitions. Learning disability. Early onset dementia. Ageism (other '-isms') RECORDS. CPA. Community Team. Qualified-unqualified staffing. Patient-relative groups. Service user representation on management. Academic links. Visiting. SAFETY - patients-staff. Serious untoward incident reporting. Translation. Advocacy - short-long term. Other agencies - Social Services, third sector voluntary partners? Philosophy of care, OUTPUTS vs OUTCOMES? 'contracts', Mental Health Act, appeals, hospital managers. Politics of care. Psychiatry in Dissent. Audit, data collection, IT systems. Access to REPORTS - INTELLIGENCE "How are we doing?" "Where are we going and is that the right way?" Your involvement - engagement - in these processes. Client - carer - public involvement. Finance budgets - (unit budget - resources), staff support / supervision. Energy use. Recycling. Client abilities with finances / debts. Homelessness. Re-housing. Existing tenancy. Opportunity for (regular) TEAM BUILDING ;-) Innovation and creativity. PDP - KSF. Targeted issues: Managed care. Personality disorder....? Professional associations, groups:
http://health.groups.yahoo.com/group/forensic-psychiatric-nursing/
No group for TEMSS for women? Over to you! .....

As you can see the model is high level. It does not DICTATE how your unit is run, what therapy is undertaken. It can help as an aide memoire prompting you and your colleagues to systematically consider all the care domains according to the context-situation and can help ASSURE an holistic assessment and evaluation.

The model can also be used to help explain problems, issues and their solution - or realistic outcomes to clients and their families. So the model doubles as an educational resource - very helpful to engage the INDIVIDUAL or a GROUP (family). You can do this EXPLICITLY using paper or flipchart for example, or implicitly with you using the model mentally as you go along...

By including a POLITICAL domain Hodges' model is ideally suited to your speciality - in fact POLITICALLY and SOCIALLY there are 'nested' issues within your 'secure care' context: gender, ethnicity, equality and equity, public attitudes, institutionalisation, citizenry, public involvement....

This blog includes many labels (on the right hand side) I will also add 'secure services'.

Rachel - I noticed on your organisation's website there are the names of the wards and address - there's a space to fill there...

Good luck, hope this helps and thanks again for your interest.

Best,
Peter

J'accuse Apollo

'I don't know what you could say
about a day in which you have seen four beautiful sunsets.'
John Glenn

I blame Apollo and Gerry Anderson too

for wanting to be an astronaut.

What must it be like

To have the right stuff?

To have the courage

To do the things that must be done

To go to the places that test

Mind, heart, soul: moments - case of stress

Potential spent - kinetic venerability

Cast adrift, burdened wait lifted: sweet release -

Flotsam, jetsam :object: back to Space

The world is suddenly lighter and older

To remind us of who we are and once were

To look after the where, when, who and see the whole

Trying to keep the stars alight at home

The world is full of astronauts

Call them Carers

Above All - they travail alone


Thanks Apollo and Gerry A. wouldn't want it any other way...

P.S. Amid Future plans - Time travel 1999

Next April the website will be 10 years old. Here's what the first version looked like.

VERSION 1999

LATEST 2005-2007

If you have any thoughts on the home page, things to remove, update or add please let me know...

h2cmng AT yahoo.co.uk

To follow - TEMSS Therapeutically Enhanced Medium Secure Service for Women [II]

Drupal + Being and Time

I'm continuing to explore Drupal amid some reading, blocks, menus, content.... Searching for content to practice 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. Aarrrgh! Must also dream and think, dream and think, dream:think ....



Have a great week!

Elderly Care: "Follow me please" along the gangway

It goes with the job, seeing people in residential care and nursing homes. The past few weeks walking through several care facilities - corridor-lounge-corridor - you pass a series of open doors, an invite to gaze that way. (People do ask to have their doors left open and visitors should not be able to walk past open doors if privacy and dignity are at risk?) Walking along - a smile, nod of the head, wave of the hand it's like a gangway.

Recently, though it was a case of 1, 2, 3 and counting: residents sat in their rooms; chair, wheel chair, special chair bound.

A gallery of still-life studies. So many heads bowed, cast as life and world-weary statues. So many aged variations of The Thinker.

The homes and their staff do the best they can, some employ people dedicated to 'activities'. Despite this, it's not easy for many new carers to appreciate the value in engaging people who are disoriented for TI:ME, PLACE and PERSON in chit-chat or a group activity when five minutes later they have forgotten all about it. People are referred to mental health services because they have a mental health 'problem' and yet in many cases their bags are packed and they are ready to take you on a journey: if you care to listen.

We seem to focus on the cognitive value of the things we do, but is this a variation of task orientation that delivers a concrete output (PROCESS vs PURPOSE again)? What about the emotional value of the things we do and the possible benefits, whether visible or intangible? ALL work and the effort it requires carries a price and despite the forgetting, the emotional engagement and safe social contact can still make a real positive difference to people. The price paid by residents in being engaged in conversation, can reduce any sense of alienation, loneliness and the aggression and agitation that can follow.

What do I mean 'safe' social contact? Many people in care are disinhibited; they say things to their fellows and staff that are very personal and upsetting. Cognitive decline is a fact of life, but even for people diagnosed with dementia, the damage done varies from person to person. For many they are profoundly impaired and yet their personality flickers through and with it sensitivity to things said by their peers. Remember those anxious moments in the play ground? Social mores are deeply ingrained in us. Maybe this is why for youngsters the current spate of e-bullying is having such a impact. Bodies may be battered and worn, but INTRA - interPERSONAL and SOCIAL exercise mediated by carers (and relatives!) can pay longer term dividends.

In between care needs that also demand quiet, rest and sleep and our need to be realistic and objective; personal and group engagement can I'm sure make a real difference. It depends on the resources + the right attitudes to make it happen. To see the person not the statue.

Even if only for a few moments
bringing statues back to life is real magic.
Walking the gangway is one thing,
but residential care should not be the gangplank
as it is so often portrayed for residents or staff.
Converse-2-conserve.

Rodin image original source: http://users.ox.ac.uk/~ball0888/oxfordopen/Rodin.htm

Northern Skies: Comet Holmes in outburst

If you've dark skies (and even if you are under urban skies) look out for Comet Holmes, which has brightened suddenly:

http://antwrp.gsfc.nasa.gov/apod/ap071026.html

See also an animated Astronomy Picture of the Day

More to follow in 2008!

TEMSS - Therapeutically Enhanced Medium Secure Service for Women [I]

Dear Peter Jones

My name is Rachel Magee. I am a registered mental health nurse working for Bolton Salford and Trafford Trust at the Prestwich site. I work in a medium secure unit called The Edenfield Centre. We have recently opened a new department called -

TEMSS (Therapeutically Enhanced Medium Secure Service) for Women.

As I am a newly qualified nurse I am looking to learn more about this model and see if it would be a useful tool to incorporate into the women's service as part of my preceptorship project.

I am writing to you, to ask if you have any information or views on this particular area, which I could possibly use to help me in my research.

I look forward to hearing from you.

Many thanks

Rachel Magee (RMN)
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Thanks for your interest Rachel this sounds an exciting time for you -
response to follow....

[used with permission of Rachel Magee]

Drupal: steep curve - still climbing ....

Just trying to get an idea of what Drupal can do. It really is powerful (in the right hands!). There's no text as yet - or what is there - is not formatted. Still not sure about the content beyond the Archive comprising Brian's course notes, my intro and (updated) reflections; the Book and the h2cm Chronology.

Weird that A, B, C ... just wish it was easier.

The book may need to wait, but is I believe a great global project - wish I were a midwife....

From a Distance: 4Ps, Nursing Process & Socio-Tech I

In the 4Ps post last year each 'P' (purpose, process, policy and practise) sat in its own domain. I made no effort to differentiate them; each 'P' was left to stand for itself - so here's a question for you...

Assuming you agree with this 4P formulation, which 'P', if any, do you think is primary?

For me the mainstay is PROCESS because chronological and pathological TIME ticks in the SCIENCES domain. Plans and actions are situated (see Hodges' model) in time and besides pathologically speaking I only have one pair of hands tied to a finite metabolism and hence limited information processing capacity.

Now, casting my vote to PROCESS within the SCIENCES domain, may seem something of a sell out to advocates of the humanities and me a mental health professional to boot... Where is the warm-touchy-feely essence of care? So, as we look to the HUMANISTIC hemisphere for quality assurance the next query is yours:

Without a sense of PURPOSE tasks x, y, and z will not be done properly, if even initiated?

Very true. PROCESS like PURPOSE has its micro-macro dimensions. PROCESS in particular is notorious in the extent to which it can be reduced to ever finer detail.

Looking at h2cm, the antipodes must not be ignored. Sometimes people believe they are on solid ground, secure (smug even) literally in the knowledge where PROCESSES abound; but the need to take in other perspectives can prove a wake-up call in the form of a sudden dousing.

Balancing POLITICAL need, encapsulated coherently in POLICY, must constantly be weighed against actual PRACTICE in the SOCIOLOGICAL domain and the constraints that operate there.

Just because you have TI:ME and individuals allotted on the Gant and PERT charts, subjective ti:me can literally slap us in the face if the mood is judged wrongly. PROCESS may be primary, but its ramifications are and must be constantly transformed-translated and enacted in personal and social form.