Conference Papers and Posters

Next month it’s the annual health care computing bash in Harrogate - HC2007. My first visit was back in 1986 when the venue was Manchester. I’ve been fortunate on a couple of occasions to attend the whole event, that is the conference and exhibition. If you can get there for one day and take in the free exhibition it’s well worth the effort. I try to kill two birds with one stone and visit on the day when the British Computer Society Nursing Specialist Group also has its AGM.

For many people the ‘reminder’ often comes rather late in terms of contributing a paper. As an alternative a poster is a great way to take part and of course h2cm is ideally suited to this type of presentation. Posters are a useful way to highlight projects still in their early stages. Looking at this year's HC2007 theme there's a lost opportunity in publicising Hodges' model and Challenging Boundaries.



Unfortunately I can't get there this year, but if you can - be that Harrogate or another conference - ENJOY and safe travels. (If it runs again do keep an eye open for the HC bursary in 2008 - well worth entering!)

Apple Store: enter with Charles - leave with Charlie

Home from London 0030hrs. After posting that last message standing in the Apple Store I’d noticed someone standing next to me was looking at a Drupal site. We’d exchanged a few Q&As, like how to open the web browser and using the built-in camera on the iMac monitor. Me being me - I asked her about Drupal and how the h2cm site needs an update using a content or learning management system. It works out she was on the way to a Drupal meeting at the BTR internet café near Goodge St tube station. OK...!

Please believe me I don’t usually leave stores with women other than my wife (and daughter) I explained this to Charlie, whose work is on cause-based medicine; exchanging interests, names, jobs and activities we found the cafe.

I introduced myself to the organiser Robert, plus Ian, Peter and others as people arrived. Groups like this really help, just listening to what people were doing, the problems they were wrestling with and their successes proved a real inspiration. Some good advice too - what is the h2cm site about, what's it for?

Listening to Robert explain about CSS in Drupal and the Firebug plug-in for Firefox I noticed two other guys had arrived. Crikey, one was Roger who I met in October in Bath at the Ideas Factory. Four of us have kept in touch, and now Roger and I hope to meet up soon while I am working over at Leeds. In Bath there was a research proposal around bereaved relatives that needs more work, Roger as a Drupal developer is creating a site. Wish I could have stayed longer, but the last train was 2046. I've come away with some links to check up on and will definitely have a look at Drupal.

The final twist is that I only ended up in the Apple Store having gone along with Charles a colleague from the meeting. Plus my son Daniel has been talking about Apple kit. Thanks Charles, Charlie, Robert and the London Drupalers: the interconnectedness of all things…

Greetings from London

In London today - a SNOMED meeting - and with a while until the train takes me North I'm writing this in the big Apple store. Plan to visit a few other places. It's hard work writing standing up, ergonomics says it's time to move on...

Holistic Care No. 1

If you’ve checked the main website and some of the references you’ll have noticed the recurring theme of ‘holism’ and the assumed lack of progress in achieving “holistic care”. It has been talked about for decades, but how would we know even if holistic care was delivered into our midst? We need to know where to look and how to recognise holistic care. In which direction do we look – primary care, secondary care, or social care, or maybe all of these? The word 'achieved' also suggests measurement of some sort. So three points then:

1. Definition – to recognise
2. Criteria – to define and measure
3. Location – to seek

Over several posts we’ll explore these points and see where we end up....

Hodges' model and the art of seeing

On paper and as presented to date Hodges' model suggests that the paths to holistic and integrated care merely requires consideration and recording of care concepts ordinarily 'out of scope'. Oh, if life were that simple! Looking at h2cm you can see why this assumption follows.

Two interests which I have not pursued for many years are astronomy and oil painting. The first time you look through a telescope at the moon or Jupiter, what do you see? We tend to think that what is there in the field of view is what we see, but even after a brief time at the eyepiece you learn to see. The last time I picked up a brush it felt good, but the buzz was missing. It helps to paint regularly, if time permitted joining an art club would definitely re-light the fuse. You have to be in the right frame of mind, ideally with a space permanently set-up with your table/easel and paints.

Hodges model can provide a space and using that space can help bring about *a change in the way of seeing that means a change in what is seen.

*Bortoft, H. (1996) The Wholeness of Nature: Goethe's Way of Science (Paperback), Floris Books.


This book could feature on the h2cm reading list!

"Ruby don't take your code to town"

When the home microcomputer boom took off I learnt BASIC programming on a Sinclair ZX81 and then moved on to BBC BASIC in 1982-3. Since then I've never managed to program on a PC. I kept the day-job, but those hobbyist coding days (and nights) were really enjoyable.

Several computer programs were produced that sold in nurse education:

• Nursing Process
• Computer Assisted Nursing Assessment
• Blood Groups
• Shades of Grey (nuclear weapons simulation)

In the 90's I looked at C++ and Smalltalk, but nothing happened. The first pit-a-pat of tiny feet in 1985 was the key factor. Now in 2007 the h2cm website needs revising. I'm undecided on how to tackle this; a content management system is a possibility? While doing some reading/browsing though, I've discovered a computer language with an enticing shine.

I've decided to try to learn Ruby. Whether this will lead anywhere remains to be seen, but it's fun and challenging just to enthuse a little. There's a tutorial that is encouraging, intriguing and additional tools that support Web 2.0 and Ajax look well worth the effort. Now with Ruby installed, I've run the ubiquitous "hello.rb" program using the Eclipse development environment - that's a start.

Maybe in future posts we can compare programming and nursing? That said, there doesn't appear to be any direct connections in this book. That's one birthday present sorted!

Signatures: Patient* and professional get engaged

These days signatures are a prime time issue.

For personal, professional, business, political and electronic accountability the dotted line in one shape or form still rules. In health and social care there's another signature that contributes to security and certainty: the relapse signature. Whether you see this as stark pessimism or realism there's no doubting its ... erm ... significance.

Relapse is an unfortunate prospect across the care spectrum, but especially for people with severe and enduring mental health problems and those with long-term medical conditions [LTMC]. For these people and their families the risk of relapse is a fact of life. As new health and employment policy encourages people to return to work, employers are affected too.

Health economists and commissioners of care recognise how in the UK of about 17 million people living with LTMC, just 2% of them account for 30% of unplanned hospital admissions. [Carlisle, D. (2006) Predicting the Future, HSJ, 2 Nov. p.24-26] Add to a LTMC a mental health problem (very likely!) and you have a mega care 'transaction' with multiple signatories involved.

If you listen carefully you'll hear the arrows whiz by towards the financial targets that follow.

Hodges' model can help target those arrows and assist with in-flight corrections across the care spectrum, especially when staying-well needs to be emphasised and enhanced. This does not mean you pull a flip chart or laptop from your pocket and commence a presentation on the model. If engagement at this point is rather like paddling up-river, then h2cm can help you navigate and locate the best channel for communication. If family and carers are also on-board that is great. Together, you can map the physical, emotional, social and service aspects of a previous crisis. Alternately, you can anticipate future difficulties in each of the care domains, identify and agree courses of actions and solutions were possible.

Nurses have a penchant for injections and - increasingly - prescribing. There is also the matter of how best to deliver and reinforce social and information prescriptions? So inject some realism by having the participants use their imagination. Given events last year are x and y really likely at 02:30 AM? There are several benefits in using Hodges' model:

• Using the model can help both internalise and externalise problems and solutions -

patient: "This is my fault!"
carer: "I can cope with this myself."

• Formal arrangements, documents and agreements can follow this global yet gentle introduction.
• The model can capture physical signs and symptoms, side-effects, interpersonal and behavioural changes.
• Strengths & Weaknesses: Pros & Cons, Warning Signs.
  
• Outline plans, actions for X,Y,Z ...
• Share expectations.
• Service coverage 24 hours?, alternatives. Respite provision.
  
• This is not about you the professional (or volunteer!) displaying your knowledge, the patient and family are the experts.
• Even though you set boundaries on the session (time, objectives, 'taboo topics - for another time & place' ...), you may be surprised by what the four+ care domains help reveal for future reference and benefit. (This also extends to palliative care, where relatives and carers needs are further emphasised.)
  
• If the patient and family struggle to understand h2cm, don't forget you can still use the model as a guide, an aide mémoire.
• And OK flip chart paper would help! ...
  

Now, if you can please sign here ............................... confirming this message received:
it's over to you - and make that care count!

*And carers too of course.

Think Tank Invitation [2]: Environment, Citizenry, Ecosystem & Health

My response? No major surprises...

In order to integrate - we first need to dis-integrate. Within these four 'issues of the Century' - Environment, Citizenry, Ecosystem & Health there is IMHO a distinct 1 x 4 hierarchy with which to grapple. As ever everything depends on the foundations.

So, a first step is to separate out and protect the flora and fauna. That is, differentiate all that is wild from the spaces that humankind inhabits. The extent of our influence makes this distinction a case of trying to put the genie back in the bottle. We pose an ongoing threat to the wild, ecologically pristine places, such is the invasive nature of human habitation across the planet. For example, lead pollution from Roman times and the more recent industrial age covered the planet as captured within Arctic and Antarctic ice cores. So the FIRST starting point is the natural environment or general biosphere.

This is followed by the artificial environments created as we peopled the world over some 160,000 years. Our modern concrete footprints alter the climate and conditions that would normally prevail. Our cities, farming and use of the soil, sky, oceans and seas all have a wider impact. In 2006 a key phrase was 'climate canary', so of course this natural-artificial distinction already exists. The state of the natural environment speaks volumes, as per one of the first warnings Silent Spring and more recent concerns regards increasing hormone and chemical levels in the oceans. We use light to show the way and lights certainly chart our accelerated progress in the past century.

The THIRD level must - in order to effect change - be not about place but agency. Commentators have highlighted that from now on it is the day-to-day decisions that citizens make that will ultimately make a difference.

So to recap: we have the wilderness as a FIRST level, then SECONDLY our constructed 'biospheres' - cities, towns, networks of various sorts - transport, power - what is often described as infrastructure and finally waste. (I suppose definition of biosphere must entail sustainability. Clearly, this is not yet an appropriate descriptor for our cities.) And THIRDLY citizens; the agency that once politically activated can (must) help bring about change.

Health (and social care) is the FOURTH and key point, crucial in that health links citizens, our environment and the environment with quality of life.

Contemporary (Western) health and social care systems focus on the health of individuals and groups, the latter also at the family and population level. Now we realise the health of the planet has a direct bearing on our health. How hot and dry will it be next summer? How wet and windy will it be next winter? Why is the sun not as bright? When is the next solar maximum?

We tie ourselves in knots, the individual before us. Save some of those sutures (and staples), another casualty demands our attention and needs our care. It is also time to remember our roots, feel the sand beneath our feet and witness once more the stars in the night sky.

Health - Quality of Life
Citizenry - Individual & Group Politic
Artificial or Human 'Biosphere' Footprint [eco-City?]
Global Biosphere - 'Natural' Fauna & Flora Environment

And yes, Hodges' model can help map and represent these four essential ingredients for lively debate.

Think Tank Invitation: Environment, Citizenry, Ecosystem & Health [1]

Dear Welcome to the Quad blog visitor,

Thank you for your ongoing interest and accepting this think-tank invitation.

In the session you and your fellow delegates are asked to debate and order the following:

• citizenry
• ecosystem
• environment
• health promotion

Various bodies from national governments, lobby groups, media and UN constantly stress the need to address each of these factors. They are, however, often considered in isolation from each other at a time when integration is vital.

Your task then is to solve this four-piece jig-saw puzzle. Success, however, is not only measured by a completed puzzle. You must collectively debate and agree on how to cut the jig. Which - if any - factor should have priority? Where exactly do citizens figure in this picture?

Obviously a four-piece puzzle is child's play. The adult (citizen!) challenge comes from your decision: Is this puzzle arranged 2 x 2 or 1 x 4? More to follow... RSVP indeed...