Naive holism II - Hodges' model and String theory

Where were we? Oh yes, maybe string theory can help...?

Health is complex, labyrinthine and while there is no Minotaur to slay (?) we must constantly mine* for information. If we venture forth then best to take some string for reassurance:

• Fully navigate the labyrinth (use technology if you must - audit trails count);

• Find your way out and then you can report your deeds to the wider world.

The maze entrance is revealed when the pin is 'stuck' onto the referral source map. Post or ZIP code: "use it for geographies sake." You want to get out don't you?

Then start laying the thread - REASON-4-REFERRAL

weight loss, fatigue, tremor: SCIENCES domain
low mood, anxiety, agitation: INTERPERSONAL domain
carer under stress: SOCIOLOGY domain - and so on.

Check the health policies hurriedly scrawled on the walls (you may well find the Garden of Policy Delights#, but otherwise make do with the graffiti). Are you truly client-centred or service-centred?

What do you mean you don't know?

OK, well check the string. What sort of pattern have you made?

It's a right mess... Chaotic, even! Yes - mm... well that's OK. It actually looks like you are client centred to me. Just remember to backtrack, check and fill those string-less voids if need bee.

What's that? You are worried because you're tying yourself in knots!

Look don't panic! On the contrary - rejoice! It's what makes health care the magical job it is...

You see 'cc' also stands for 'cat's cradle' as well as 'client-centred' and 'complex care'!

If you never move out of the sciences domain (highly unlikely!) then in string theory that is a closed loop. The care is prescribed - not much room for creativity there - pretty vacuous in fact. Nature abhors a vacuum though, so attend to the care needs within the closed loop with due diligence and utmost priority. Otherwise the vibrations of this critical loop may become universal and the loop resemble a noose.

Prior to evaporating a closed loop can do a lot of damage.

If on the other hand your care winds its way across the care domains, back and forth, play the lace-maker - the artisan you are.

If you become tired, struggling in poor light: keep laying the thread - help may be at hand.

Whether it is a professional or volunteer who takes the lead, apart from those critical exceptions in the SCIENCES and POLITICAL domains, the string must be open at the ends from the start.

The dialogue always begins with an explanation, a rationale.

As soon as the closed loops are cut, the way is open to fully communicate, to comprehensively explore care possibilities.

Patient and carer can then take the other end, indeed if/when able they lead the way!

(Of course, just don't let it become a tug-of-war).

At the end reel the string in and measure (count the knots too).

Whether or not you met the Minotaur - there is the evidence, the outcome of your holistic reach.


Hodges' Health Career - Care Domains - Model

- sufficient to reach and engage the whole community.


Images: Thanks to medeba.com (skipping) & (fractal)
Paul Bourke

#Ack. William Latham 1990s CD-ROM Garden of Earthly Delights.
* From the last post: There are vast and rich seams to mine here (without damaging the environment) and they run under ALL the subject disciplines....
This particular mine is also renewable.

Thanks BGS & CPNA-T: NCRS* Project secondment ends; back to clinical practice

I would like to publicly thank the British Geriatrics Society# and CPNA Trustees who have covered my travel costs to the SPT conference 2007. I could not have attended otherwise.

You may notice a lack of advertising on the website and blog. I've tried to focus on the message - but funds do matter. If an 'appropriate' organisation(s) would like to fill the vacant space here that could feature advertising to help sponsor future conference attendances please get in touch!

Come August 1st - I'm back in clinical harness (Community Mental Health Nurse Older Adults) after an almost three year secondment, which has been a great experience. The highlights? Well, that would include...

• Working with new colleagues - Barbara, Jeremy, Tracey and Heather - good luck all! - and change consultants, learning the ropes and being let loose on the service.
• Working on data quality, comms materials...
• Explaining to clinicians what's coming down their way (locally and nationally), why it's needed and the challenges we still face.
• Being able to comment on proposals for future system content, including aspects of the interface(s) which are often taken for granted, but are of course critical in so many ways: safety, usability...
• Meeting other clinicians from other areas and organisations, notably Social Services and debating what's happening in their locality (have any dots been joined for you?).
• Going on a 2nd secondment and gaining insight into information standards development and management - a real challenge and well worth the effort - I'm still tingly from that.
• Acting as mentor for Chris our (former!) Trainee Public Health Analyst. All the best for September and Med. school Chris! Thrilled to pieces when I heard !
• Although not directly related to my secondment the week long Ideas Factory in Bath last October definitely still has me tingling from the new Roman baths complex and at 0230 on the Friday trying to finish a research proposal. This was quite scary in some ways, I had nothing to lose, but for the academics you could see the stakes were very high. Another set of processes revealed, an opportunity to use and share Hodges' model.
• One of the biggest things was being part of a National programme and seeing the amazing work that is going on amid enormous challenges and hurdles. The future of health and social care really is going to be different, it has to be: we have to make sure it is also better. Clinicians on the ground must never be an after thought. And there's the question of public engagement too.

As to my future - in-between the home visits, allocation meetings and case reviews each month I'll definitely be keeping in touch with things informational. I'm really grateful to my clinical and ICT managers for being able to pursue all the above and ongoing informatics threads...

Back in Nov 2004 I really needed a change and I felt the team needed a change too. I grabbed the opportunity, in denial about the piece of elastic that would eventually haul me back. Well it has and it isn't the prospect of the clinical work that brasses me off, it's walking into a building I first entered in 1989. Its days are numbered as a base and it's true I have been 'leaving' for at least a decade, but in that time I've been drafted onto other projects, constantly learning and I hope helping others to learn too.

Clinical work: no problem! You can't beat the buzz of knocking on a person's door in order to check what's happening and help them to help themselves whenever that's a goer. When you can't do that there's still a vital role to play. It's a sobering responsibility and when you see how and what people are struggling/coping with - well....

So, if you are reading this AND a student - undecided regards a career - do check out nursing (and other career pathways) and social care: you really can make a difference.

After all the above for me it's time for a proper change. I've started another book chapter on socio-technical structures and Hodges' model - now with a philosophy of technology bias. I'd really like to focus on learning and teaching with space reserved for clinical practice - cognitive/humanistic therapy.

I've mentioned Drupal, Ruby on W2tQ; but I've have no time to pursue and test ideas. I'm sure I could use these tools, if time, time...

Better still exercise the need to pass on this keystone, this baton to students - it is their race, their care that counts now.

I'm sure h2cm isn't just an over-valued idea.

There are vast and rich seams to mine here (without damaging the environment) and they run under ALL the subject disciplines.

Before that - IF it happens at all ;-) let's see what's happening for clinicians, as I pick up the phone and knock on doors once again.

Having knocked on two already, I have a feeling I'm going to need my infra-red glasses - more to follow....

Whatever you are about - keep smiling as you join your own dots...

*NCRS: NHS Care Record Service
# Conference brief on its way...

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..?

Human Ecology: Northern England CHE Group - Sedbergh 30 June

As mentioned previously the 2nd Northern England Centre for Human Ecology group meeting was held in Sedbergh last month Saturday 30th 11-3pm.


In addition to hosting the meeting the local organiser(s) also arranges the content for the session - with outside support if necessary. This time Deyna and Criggy took up the baton.

To begin, Criggy shared her work working in rural communities. Referring to my notes many topics were discussed including: community halls as a focus of the community. Raising the profile of sustainable communities, transport in a rural vs urban context and climate change.


Although we were not a legion the diverse experience represented that afternoon showed in knowledge of organisations, e.g. the work of the Commission for Rural Communities and publications - 'What are sustainable rural communities? - 5 Thinkpieces'.

We discussed the car and private transport, the state of public transport, housing, community engagement, belongingness and parish plans. Also in our minds were the extremes of community in terms of age groups, those commuting and second home owners, 'active' and 'passive' community members.

Next: AGENDA 21 and the need to empower civil society locally and globally.

Criggy highlighted and explained the CRC's work on Rural Disadvantage, especially the overlap of:

• Access poverty
• Network poverty
• Financial poverty

The Rural Community Carbon Network and the number of communities that are driving forward with the sustainable agenda not just with words but deeds towards carbon neutrality.

Personalities in this field also featured notably Rob Hopkins. Finally, at least by my notes "Sustainable Communities Plans" were discussed.

Next, Deyna presented her work (I've copied her notes below) on Green Sedbergh covering:

PROJECTS:

Book town and the regeneration after foot-and-mouth
Green Marquee - raising awareness of environmental issues
Green Tourism initiatives - cycle map/local access leaflet / outdoor festival
Peoples Hall - green refurbishment / rebuild
Plastic bag reduction / replacement
Community cinema - social events
Local sustainability - range of shops /local produce
Farmers market
Sedburgh School - local employment
Hydro-electric scheme?
Re-opening of reservior?

ISSUES:

Low wages / High cost of housing / 2nd home syndrome
Rural location / Public transport
2 car families / middle class values
YDNPA national park
Apathy / smugness / commitment

Deyna then sought the groups ASSISTANCE regarding:

Green Parish plan - How? What? Timescale? Cost?
Alternatives to plastic bags?
Implementation incentives - socio-economic?
Balance of individual / community / business needs
Other sustainable / green possibilities

The time really whizzed by, to the extent that my tea went cold (a crime in these circles!) and we only had a break for lunch around 2pm.

The next meeting will be end of Sept-Oct time and may be near Horwich, Bolton. I'll post more details as soon as they are available. Sedbergh is a lovely book town (I bought two second hand) and I really enjoyed meeting CHE students and alumni old and new and as an outsider learning more about human ecology.

Andy also reminded me about the CHE ecopsychology course.

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.

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.

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!

Google Health Advisory Council - no nurses, what a surprise

Three days - three posts... but this is very important as highlighted already c/o Rod Ward, Peter Murray and Bob Pyke. Please find message copied below from Peter Murray with my added graphic [TM acknowledged!] ...

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As you may be aware, Google have set up a 'Google Health Advisory Council' - further details are at: http://googleblog.blogspot.com/2007/06/new-advisory-group-on-health.html

And, what a surprise, there don't seem to be any nurses on it ;-)) - as others have also pointed out, most other health professions, apart from physicians, also seem to be absent.

There has been a growing discussion on various nursing informatics email lists in recent days, where many people have expressed concern/outrage at Google's actions in not having any nurses on their new 'health advisory group'. US male medics are vastly over-represented (what a surprise!?!), and many other health professionals are also not represented; representation of patient/citizen advocacy is also poor.

Their advisory group listing has 22 names - 17 men and 5 women (23%) out of the 22, seemingly no-one from outside the USA, and 13 (59%) have MD after their name. No-one has RN after their name, and I do not recognise any nursing names there. All names appear to be from USA.

Among ideas for how to engage in activity:

1. the blog post in question (http://googleblog.blogspot.com/2007/06/new-advisory-group-on-health.html) has a link that says 'We love feedback' and inviting people to send email - the address is gblog AT google.com

OK, let's take them at their word. Perhaps everyone could send them an email saying (politely) what they think. It might also be useful to copy these to the leadership of their own nursing/informatics organisations and urge the leadership to also take up the cudgels.

2. if you have a blog, put up a post and make a link to the article - it will then appear in the 'links to this post' at the bottom of the article.

3. many people have raised the possibility of using their positions to exert pressure on their own organisations to take action - that would be great.

This is a grassroots campaign - the wider nursing community and many health professions feel they have been left out by blinkered thinking, and action is urged.

Please forward this to your colleagues and other lists and drip-feed the activity.

Thanks to Rod Ward's Informaticopia blog for alerting on this:
http://www.rodspace.co.uk/blog/blogger.html

Regards, Peter Murray
------------------------
So, (me again) please forward on and maybe Google will wake up and realise they are missing a whole world of health and social care ideas and disciplines, plus the worlds of expertise within the patient and carer communities...

Come on Google be the global player you are: don't limit yourselves to the chorus, listen and join in with the verses too!

Nursing Times and mind mapping: All my slides are packed, I'm ready to go...

This Saturday I leave for the Society for Philosophy and Technology Conference in Charleston, SC. Still awaiting news regards funding with £200 gratefully received thus far.

I'm really looking forward to this, not just being able to contribute, but listening to the other presentations. Must admit that after the weather here in the UK, warmer climes will be most welcome.

The past week's Nursing Times included a feature on mind mapping in research. I haven't checked the full paper, but in NT noticed two references to Buzan (1997 and 2003).

I'm keen to differentiate h2cm from mind mapping, even though of course there are a lot of similarities.

I wonder if Hodges' model gets a mention in the full paper? If not then of course other people realise h2cm isn't about mind mapping!

The reason why I ask (beyond the obvious) is that for many people models of nursing are old-hat. When were they really in fashion? The 80s...

When did Buzan's mind mapping arrive? I think 'Use your Head' aired on TV in the 70s, early 80s...? My Library thing includes books written by Buzan in the 80s and one or two from the 70s.

Maybe it really is time to move on?

So looking forward to the (relaunch of) semantic web Community too!

Smoke gets in your eyes, hair, socks and underwear....

July 1 2007 England: at last smoke free indoor public spaces!

I don't smoke. Hate cigarettes, but not people who smoke.

I've seen cigarettes used to control patients in the past and seen the effects on people when if the supply of cigarettes was not 'managed' then major problems ensued.

Both patients, staff and nicotine were well and truly locked in an institutionalised embrace. This relationship was strongest in the old mental health institutions on the long-stay (or 'rehab' wards).

I used to arrive home from work and ALL my clothes absolutely reeked of cigs. Into the shower. Nausea as the water ran over my hair.

As I prepare to return to work in the community: on home visits if someone goes to light up, I beg their pardon and acknowledge that I am a guest in their home - but could they please possibly hold-on a while. This isn't just a strategy to shorten visits. The first lesson of first aid is DO NOT become the next casualty. I also take the role of health promotion seriously. When people put the smokes away, I thank them on leaving highlighting the great favour granted to me. In summer and sometimes winter - their addiction helps me to help them - an excuse for us to venture outside to have a walk: ecotherapy! If people value your input, most do not mind. They also remember for next time - so social skills are employed. If needed though in the car I have a jacket just for the 'smoky visits'.

Cigarettes have been the cause of so many problems on wards resulting in aggressive behaviour.

Before I start sounding holier-than-thou - one of the worst instances was an elderly gentleman on a then 'psycho-geriatric' ward who with no smokes was livid. He wielded his zimmer walking frame at staff. We sorted the problem, calmed him down and no one was hurt; but the distress caused to this gentleman and many others over decades....

IF there is a benefit to be associated with cigarettes it's teaching the art of anticipating a person's needs and differentiating between the person and their behaviour.

An organic, naturally occurring pesticide must be bad for you and that's just one of the poisons in a cigarette (a regular chemical factory).

There is an established body of research on the links and effects between mental health, specific diagnostic groups and smoking. As for summer 2007 looking at the grey skies over the UK at present, many people WILL struggle. You have to wonder how referrals to all mental health services (primary and secondary care) will run over the next 12 months (next spring!) and how well we can monitor the effects?

Source: Nicotine molecule image (permission sought): Ron Perry and Sarah Frisken

P.S. To what extent have cigarettes affected human genetic development?