Hodges' Model: Welcome to the QUAD: March 2009

- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Sunday, March 29, 2009

Independence and Quality of Later Life: A decade of research to support older people 14th May

The next KT-EQUAL event for all-comers is on 14th May in Bath.

It will showcase the outcomes of a decade of research to support older people and disabled people, especially:

- improving accessibility to the world outside of the home:
streets, neighbourhoods, parks, transport systems
the very spaces and places that many older people look forward to visiting.

- the better design of everyday products and packaging:
products which are not stigmatised as being for older or disabled people but are mainstream products, which are enjoyed by everyone.

- using new technology to support individuals in the self-management of chronic conditions such as diabetes, heart conditions, and the effects of stroke:
Can these technologies be easy to use and unobtrusive? Do they really they boost health, activity, confidence and well-being?

As well as presenting some of latest findings and developments, the workshop will also be looking to the future, especially at how researchers are coming together to make certain that older people benefit from the best of British Science by getting their findings into policy and practice.

The event is free and is open to anyone with an interest in improving the quality of later life - professionals from all sectors, policy makers, representatives of charities and voluntary bodies, older people and their carers, as well as researchers. It is being held in the centre of Bath so is easy to reach from the railway station. Bath in May can be idyllic!

Full details can *could* be found on the SPARC website.

Best wishes

Peter Lansley

Professor Peter Lansley, BSc, MSc, PhD, MCIOB, FCOT
Director, KT-EQUAL – Knowledge Transfer for Extending Quality Life
School of Construction Management and Engineering, URS Building,
University of Reading, Whiteknights, PO Box 219, Reading, RG6 6AW, UK
My source SPARC mailing list

Tuesday, March 24, 2009

Intellect UK - Women in IT Scorecard: Ada Lovelace Day II

A definitive up-to-date evidence base for data and commentary on women in IT employment and education

Women in IT Scorecard (PDF 1MB) Published: March 2009
Type: Scorecard
Area: Transformational Business


Technology is central to the success of the UK economy and is becoming even more important the current economic situation. It is important to understand the trends in employment, education and any issues that could impact the future of the industry especially in such turbulent times.

British Computer Society (BCS), e-skills UK and Intellect., with support from Department for Business Enterprise and Regulatory Reform (BERR), have worked in partnership to produce a ‘Women in IT scorecard’ to understand and demonstrate the trends in our industry by gender from secondary education through into the IT workforce. The purpose of this document is to provide a robust evidence base for the facts behind the trends, to demonstrate differences in the participation rates between the genders and to present an analysis of these trends and the current situation to inform policy debate and future action by the partners and their communities.

The concern
While females represent 45% of the UK working population, they only make up 21% of the IT Industry workforce. For a profession that a few years ago was beginning to edge towards a ‘critical mass’ of 30% women - reaching 23% - we now find an alarming situation. In 2008 the make-up of the profession has changed:

* Males outnumber females in the IT industry by nearly 4:1.
* In the IT workforce, the number of males has fallen by 23,000 while the number of females has fallen by 63,000 since 2001.
* In IT occupations the number of males has increased by 77,000 while the number of females has fallen by 28,000 since 2001.
* Females account for around one in every five IT professionals.
* In Higher Education females account for 25% of all lecturers and 12% of professors in Computer Science / IT related subjects.
* In 2008 there were 17,455 male and just 1,581 female chartered IT professionals – 8% female.

See also - Ada Lovelace Day: Enid Mumford - Socio-technical perfume down the mine

Ada Lovelace Day: Enid Mumford - Socio-technical perfume down the mine

I had to enter a pledge and join the call today to post in response to Ada Lovelace Day - an international day of blogging to draw attention to women excelling in technology.

Women’s contributions often go unacknowledged, their innovations seldom mentioned, their faces rarely recognised. We want you to tell the world about these unsung heroines. Entrepreneurs, innovators, sysadmins, programmers, designers, games developers, hardware experts, tech journalists, tech consultants. The list of tech-related careers is endless.

Recent research by psychologist Penelope Lockwood discovered that women need to see female role models more than men need to see male ones. That’s a relatively simple problem to begin to address. If women need female role models, let’s come together to highlight the women in technology that we look up to. Let’s create new role models and make sure that whenever the question “Who are the leading women in tech?” is asked, that we all have a list of candidates on the tips of our tongues.

It was soon after this blog first appeared that I learned of the news of Enid Mumford's death. I never had the pleasure of meeting Prof. Mumford, but came across her work whilst doing my own studies and a degree at Bolton. We have something in common in being raised in Merseyside. In the NW of England there is also a tradition of mining...

Studying geology at school we went on a field trip down the pit at Golborne Colliery. Strange to be told after an underground train ride we where under the East Lancashire A580. Enid Mumford's early work took her underground, but her impact extended far beyond her perfume bottle:

'A woman down the mines?" Enid Mumford's classic sociological research for the National Coal Board had a strong impact on unbelieving miners. Later, as an active advocate for women's rights, Enid, who has died aged 82, enjoyed recounting her early experiences: "They were terribly nice to me whenever I turned up, but they were awfully embarrassed at what I might catch them doing." Enid would "drench herself with perfume", so that the ventilation system would give the miners a chance to prepare themselves for her arrival at the coalface. In such ways, Enid began her contributions to social theory, with its challenges to action researchers like herself.
The Guardian obituary
As posted previously this year sees a chapter published on Hodges' model and socio-technical structures in nursing informatics (See bibliography in the blog's side bar). I really latched on to Enid Mumford's approach and needless to say Professor Mumford's invaluable work figures in my overview:

Background: Existing socio-technical structures and methods

This section scratches the pages of the socio-technical literature by introducing two seminal contributions and briefly references other sources. The two authors discussed are Mumford (1983) in the socio-technical sense and Giddens (1984) who is more generic socially and organisational oriented. Enid Mumford created ETHICS, a systems design methodology: Effective Technical and Human Implementation of Computer-based Systems. The need for ETHICS is to help manage change with three objectives.

First, ETHICS stresses that the future users of computer systems, whether directly or indirectly involved should play a major part in designing these systems. User involvement is closely related to subsequent job satisfaction and efficiency gains and hence the realization of benefits. The users of systems are credited as experts; if this knowledge and experience is recognized and utilized then job satisfaction gains are likely as the users are active agents in the change process and not passive. There is an interesting correspondence here with the continuing emphasis on patients and carers being acknowledged as experts in their care assessment, management and evaluation.

The second objective focuses on the human – behavioural response to change. It is important that specific job satisfaction objectives are factored into the design from the outset and not left to chance, lost amid technical specifications and objectives. In this way potential negative change impacting the quality of work life can be anticipated and avoided or at least ameliorated. Technology has frequently been associated with de-skilling and of course the loss of traditional jobs. The prospect of technical, management led change can cause consternation in the user community. If alienated employees may be absent, seek alternate employment, and overall be less productive.

ETHICS is not restricted to the computer system; the third objective highlights the need for a new computer system to be ‘surrounded by a compatible, well functioning organizational system’ (Mumford, 1983). Design must be viewed globally as a whole. The technical design is just one part of a very complex design process that must also incorporate the details of human-machine interaction; what would be called gap analysis, the differences in existing processes and proposed new processes and procedures. In addition, as per objectives one and two, individual jobs and workgroup activities must be reviewed; how are existing roles and relationships altered and newly defined? What new management arrangements are needed, since (middle) management is rarely untouched?


I wish I could spend more time on Hodges' model, socio-technical thought and its application. Women in ICT? This is not a new call.

Women must have role in IT - not just to ensure the social in SOCIO-technical.

Not just to ensure that the 'c' in ICT happens.

Whether in programming, instructional technology, internet infrastructure, semantic web, the games industry and a whole host of other areas - Ada Lovelace, Enid Mumford - and of course others past and present must not be lone pioneers. ...

Additional links:

BCS Women

Daphne Jackson Trust

Girl Geeks

The Register (2008) Women IT EU Job Shortage

WITI - Women in Technology International

For BR

Friday, March 20, 2009

Study the hoops, but care about the thresholds

When you are on a course you really have - quite rightly - to do things by-the-book. That is the way - they say - you learn which corners of the pages you can turnover. Students learn early on that you have to jump through various hoops in order to complete the course and earn the stripes. The art and science of caring presents its own hoops, but in addition it is thresholds that present a barrier, thresholds that need to be negotiated in order to meet need.

Suddenly this is not about one person (you) it is about a partnership. A partnership of professionals allied and directly collaborating with a 'patient' and their carers.

One of the hoops is the paper or electronic referral form. Are you still sure this referral of yours is necessary? Are those two assessments really necessary?

There are a host of thresholds that may (or may not?) shift like a tide around the local and increasingly extended health and social care community, or 'economy' if you prefer, for example:

The threshold at which a nursing home will contact a GP surgery; or mental health services?
Just exactly what is residential care's capacity to cope internally and manage with a given range of health and social care challenges? What exactly should that capacity be? Should the public have access to referral data from care homes - to accident and emergency, mental health services, primary care? What proportion of 'referral problems' are dealt with at the nursing - social work level? What is the mental health service's threshold in terms of responding to a referral? What is the threshold for relatives believing that sufficient is being done for their loved one?

As lifelong learners of course we are all perennial hoop jumpers, learning the art of scaling and re-framing the thresholds that cross our way.

Image sources:

Seed-and-threshold segmentation

hula hoop (no longer available)

Tuesday, March 17, 2009

Why health care is complex: data + process + information models...

The cover of David Benyon's (1990 & 1996) Information and Data Modelling book features the diagram below. The combination of data model and process models gives rise to a data processing model which can be termed an information model.

The processes giving context to data and thereby rendering it more meaningful hence 'information'.

Appreciating this computer science example, we can get a grasp of why health and social care is so complex.

Not all things are purely accumulative, but perhaps by extending this we can also see why creating, representing and implementing a model of care (social, nursing, ...) is so difficult.

Not only that, but we also need to consider the arrival of ICT in the care arena. This means mixing the information and care models to deliver a working 'bells and whistles' information system solution.

Since Hodges' model is composed from assumptions about nursing - health and social care - the model can also be used here through decomposition. The model's domains suggest at least four core models:

SCIENCES: the usual sense of data model in this sense physical data;INTRAPERSONAL: a mental health - emotional care - or personal data model;SOCIOLOGY: a social data model frequently characterised temporally as a social history;POLITICAL: governance model, covering security, access, sharing, consent.

So it is a big order. To the informatics take on the book cover above we can add

+ physical 'care' data model
personal data model
social data model
+ governance data model

And just to think - all this needs to be done in a socio-technical harmony with the info-tech players paying heed to the four P's (PROCESS, POLICY, PURPOSE and PRACTICE) plus whatever modelling, project management, service improvement methods may be employed.

The biggest potentially confounding factor though
and the biggest 'P' of all is of course
but no problem that is why we care.

Additional links:

David Benyon

Sunday, March 15, 2009

Clickstream Data Yields High-Resolution Maps of Science - PLoS ONE

Johan Bollen, Herbert Van de Sompel, Aric Hagberg, Luis Bettencourt, Ryan Chute, Marko A. Rodriguez, Lyudmila Balakireva

Abstract: Background

Intricate maps of science have been created from citation data to visualize the structure of scientific activity. However, most scientific publications are now accessed online. Scholarly web portals record detailed log data at a scale that exceeds the number of all existing citations combined. Such log data is recorded immediately upon publication and keeps track of the sequences of user requests (clickstreams) that are issued by a variety of users across many different domains. Given these advantages of log datasets over citation data, we investigate whether they can produce high-resolution, more current maps of science.


Citation: Bollen J, Van de Sompel H, Hagberg A, Bettencourt L, Chute R, et al. (2009) Clickstream Data Yields High-Resolution Maps of Science. PLoS ONE 4(3): e4803. doi:10.1371/journal.pone.0004803

Editor: Alan Ruttenberg, Science Commons, United States of America

Received: June 25, 2008; Accepted: February 6, 2009; Published: March 11, 2009

Additional link:

Arthur M. Sackler Colloquium on "Mapping Knowledge Domains"

My source: Humanist list

Friday, March 13, 2009

HC2009 Shaping the Future - April, Harrogate: Group Discounts

28-30 April, Harrogate, UK

We have put together an exciting conference programme that includes thought-provoking and highly informative presentations and debates on current hot topics. Keynote speakers and industry ‘personalities’ include Christine Connelly (Chief Information Officer for Health) and Martin Bellamy (NHS Connecting for Health, Director of Programme and System Delivery).

New for 2009! Group discounts!

Now available to delegates, as follows:
  • 5 - 9 places block booked …. 15% discount
  • 10 - 19 places block booked …. 25% discount
  • 20+ places block booked …. 30% discount
For information on how to obtain these group discounts, please contact:

Judy Hayes on ...

My source: BCS informatics specialist group mailing lists

Thursday, March 12, 2009

Update on h2cm, books, Drupal, Ruby and that website....

I have not posted anything on where things are up to here for a long time. Largely because as you've guessed not much IS happening. There are a few things afoot though ....

Scotland on Rails
Later this month I'll be travelling up to Edinburgh again. A once a year event plus some reading / tinkering in-between is not the best way to learn, but I'm a nurse (still)....

This time I'm there for the full duration and the first day is dedicated to beginners:

Charity tutorial news
Friday, March 06, 2009
A big thanks goes to Ron Jeffries for donating $500 (USD) towards the charity tutorial room hire; this is huge help.
We have now booked the main conference hall for the tutorial on Thursday March 26, and now have space for around 20 more people. This is a great chance to learn Ruby from two of the top names in the community – Rails-core alumnus and Pragmatic Studio instructor Marcel Molina Jnr, and Pragmatic studio Rails and Ruby instructor Chad Fowler. In return we suggest a £75 (minimum) donation to the Children’s Hospice Association Scotland here.

All things being equal I hope to attend Drupalcon in Paris this September. There are a few people from Manchester planning to travel over. Drupalcon 2008 Szeged was great and I'm still convinced that the learning there will pay dividends in time. I do still wonder "WHAT AM I DOING THIS FOR", but I'm still also convinced that Hodges' model as a conceptual framework for global health and informatics is worthy of the effort.

Drupal and books
As mentioned quite awhile ago (and Packt the publishers have been in touch) I am reading Drupal for Education and E-Learning by Bill Fitzgerald. I have been looking forward to this for three reasons:
  1. My early programming efforts were based on programs for nursing education using the BBC micro;
  2. I am intrigued as to the content and 'educational' scope of this book and what it might suggest about where Drupal sits in relation to Moodle.
  3. In creating a new website I need to focus on a specific audience or user community - at least in the first instance - this book might help with some early decisions.
Up to page 144 I'll have this finished for the month end [or mid-April ;-) ], before then though I will have tinkered with Views and a few other key Drupal bits-and-pieces. I must say the chapter on Views makes me appreciate why established Drupallers have it in their 'must have' module lists.

The Website Redesign
I'm not so much sleeping on the question of content types for Hodges' model as in a state suspended animation. Whatever the spell is, whatever the cause - my physical / mental state, Drupal's complexity or the 'problem domain' which in this case comprises:

Hodges model AND.....

holistic care, integrated care, collaborative care, care perspectives, care precepts, user community, accessibility, Web 2.0 - 3.0 - all chasing educational, informatics, health and social care policy....

Well, when I wake up the beta site will appear and the prospective ingredients will be a sweet after taste, that hopefully gets sweeter with further revision and development!

Once again as noted previously it would be helpful to field a poll, survey here to help decide on the future content - especially what the priorities are for different users? Thinking back to Szeged though the best source is to get a site up and running...

I've decided on NetBeans as my editor and I am impressed (with the editor). To get to grips with it I'm looking afresh at the links pages to revise them so that the row categories can be expanded and collapsed using jQuery.

Hodges model application
There are some developments regarding Hodges model and its use within forensic mental health services. I hope to report on this in the near future.

Next book chapter

As noted last month there is another exciting project with a paper on Hodges' model, Substance Misuse and Mental Health in preparation (outline still c.1000 words).

The paper on h2cm and conceptual spaces drawing on Gardenfors is not forgotten - an update on that maybe in the summer...?

Pre-Publication Discount: Nursing and Clinical Informatics - Socio-Technical Approaches

Take Advantage of the Pre-Publication Discount by Ordering this Book Today!

Nursing and Clinical Informatics: Socio-Technical Approaches

Edited By: Bettina Staudinger, University for Health Sciences, Medical Informatics and Technology, Austria; Victoria Höß, University for Health Sciences, Medical Informatics and Technology, Austria; Herwig Ostermann, University for Health Sciences, Medical Informatics and Technology, Austria

The field of nursing informatics is one of the fastest growing areas of medical informatics. As the industry grows, so does the need for obtaining the most recent, up-to-date research in this significant field of study.

Nursing and Clinical Informatics: Socio-Technical Approaches gives a general overview of the current state of nursing informatics paying particular attention to its social, socio-technical, and political aspects to further research and development projects. A unique international comparative work, this book covers the core areas of nursing informatics with a technical and functional respect and portrays them in their proper context.

Table of Contents:
Chapter I: A Treatise on Rural Public Health Nursing
    Wanda Sneed, Tarleton State University, USA The objective of this chapter is to promote public health nursing and community health nursing’s role in the new care delivery patterns, with predictive and preventative care models for populations. This entry will broaden the range of information available for informaticists, as their role expands in the new healthcare arena. Articulation with nursing informatics and the “quality chasm” crossings in U. S. healthcare will assist the informaticists with search and retrieval activities. All players in the healthcare arena will continue to be involved, but probably with a more rational policy-making role.
Chapter II: Assessment in a Computer-Based Nursing Documentation
    Elfriede Fitz, University for Health Sciences, Austria
    Daniela Deufert, University for Health Sciences, Austria
    Johannes, Hilbe, University for Health Sciences, Austria
    Christa Them, University for Health Sciences, Austria
    Experience in nursing practice shows that there are still problems with assessment in computer-based nursing documentation. In addition to nursing documentation, an assessment instrument that captures the needs for care must also be integrated. This chapter describes different Nursing Assessment Instruments and the advantages of Computer-Based Nursing Process Documentation by using quality criteria for assessment instruments such as validity, sensitivity, specificity, reliability, practicability, and the appropriateness of the instrument. Quality criteria for computer-based systems are basically software ergonomic aspects and therefore not part of this study. Each country should choose for itself those specific assessment instruments that capture the needs for care of their clients. The data presented make it possible that facilities are compared (also in regard of reliable cost estimates).
Chapter III: Clinical Decision Support Systems in Nursing
    Dawn Dowding, University of York, UK
    Rebecca Randell, City University, UK
    Natasha Mitchell, University of York, UK
    Rebecca Foster, School of Health Sciences at the University of Southampton, UK
    Valerie Lattimer, School of Health Sciences at the University of Southampton, UK
    Carl Thompson, University of York, UK
    Increasingly, new and extended roles and responsibilities for nurses are being supported through the introduction of clinical decision support systems (CDSS). This chapter provides an overview of research on nurses’ use of CDSS, considers the impact of CDSS on nurse decision making and patient outcomes, and explores the socio-technical factors that impact the use of CDSS. The chapter presents the results of a multi-site case study that explored how CDSS are used by nurses in practice in a range of contexts. The study reveals that how a system is used and may vary considerably from the original intentions of the system designer.
Chapter IV: Culturally Sensitive Healthcare for Newcomer Immigrants
    Jerono Rotich, North Carolina Agricultural & Technical State University, USA This chapter will give an overview of the healthcare-related challenges that most newcomer immigrants and refugees encounter as they acculturate into their new environments in Western countries. It will highlight practical tips that can: a) enhance the caregiver and patient relationships across cultures and across continents; b) enhance culturally sensitive healthcare services; and c) help to create culturally inviting healthcare environments. It is also evident that, although these newcomers enrich their new nations with their diverse backgrounds, language, and cultural differences, each continues to pose formidable obstacles to their health, healthcare providers, and the health system in general. While the patients and providers realize the effects of immigration on the quality and access to healthcare, they seem to be overwhelmed by the barriers.
Chapter V: Mobile Technology in a Developing Context: Impacts and Directions for Nursing
    Pammla Petrucka, University of Saskatchewan, Canada
    Sandra Bassendowski, University of Saskatchewan, Canada
    Thomas F. James, Apogia Networks, Ltd. , Canada
    Hazel Roberts, Government of St. Kitts-Nevis, Ministry of Health, Canada
    June Anonson, University of Saskatchewan, Canada
    This chapter presents the imperatives of mobile technologies in the healthcare. It presents the contextual overview in development of the diffusion, penetration, and uptake of health-related mobile technologies. A consideration of the roles and responsibilities of the diaspora in the embracing of information and communication technologies is emphasized. Key examples of mobile technologies in development to increase understanding and demonstrate promising practices in this emergent field are given.
Chapter VI: Nursing Documentation in a Mature EHR System
    Kenric W. Hammond, VA Puget Sound Health Care System, USA
    Charlene R. Weir, University of Utah, USA
    Efthimis Efthimiadis, University of Washington Information School, USA
    Computerized patient care documentation (CPD) is a vital part of a Patient Care Information System (PCIS). Studying CPD in a well-established PCIS is useful because problems of system adoption and start-up do not interfere with observations. Factors interfering with optimal nursing use of CPD are particularly challenging and of great concern, given today’s shortage of nursing manpower. The chapter describes problems and advantages of CPD usage identified by nurses in a series of research interviews. It is shown that explicit consideration of nursing workflow constraints and communication processes is necessary for development of effective nursing documentation systems. Some findings point to a PCIS reconfiguration strategy that is feasible in the short term. Other findings suggest the value of considering mobile and team-oriented technologies in future versions of the PCIS.
Chapter VII: Nurses and Telehealth: Current Practice and Future Trends
    Sisira Edirippulige, University of Queensland, Australia
    Anthony C. Smith, University of Queensland, Australia
    Mark Bensink, University of Queensland, Australia
    Nigel Armfield, University of Queensland, Australia
    Richard Wootton, University of Queensland, Australia
    Home telehealth, the use of information and communication technologies to deliver and support healthcare directly to the home, is emerging as an important application for nurses. This chapter provides an overview of home telehealth and how it may be applied to the practical challenges nurses face everyday. We provide a summary of the evidence available to support its use in specific areas and a guide for those thinking of implementing telehealth in their own practice. The future of home telehealth lies in carefully considered and designed research, ongoing education, and training and a multidisciplinary approach.
Chapter VIII: Successful Online Teaching and Learning Strategies
    Mary D. Oriol, Loyola University New Orleans, USA
    Gail Tumulty, Loyola University New Orleans, USA
    This chapter presents a theoretical framework and research base for the successful transition of an established Master of Science in Nursing program from that of traditional classroom delivery to one that is Web-based with no geographic limitations to students. The application of socio-technical systems theory to facilitate creation of a positive learning environment for future nurse leaders is described. Use of social processes and application of technology to optimize learning is explained and the latest research on content presentation and student engagement in an e-learning environment are presented. The chapter gives an understanding of the competencies necessary for students and faculty to be successful in online education.
Chapter IX: Shaping Funding Policy for Nursing Services
    Virginia Plummer, Monash University, Australia Concerning nursing resource allocation health service executives have different views about whether systems based on ratios or those based on patient dependency are more accurate. This chapter reports on a statistical analysis of almost 2 million hours of nursing data provided by 22 acute care public and private hospitals in Australia, New Zealand and Thailand. To evaluate both ways an informatics system was used which has the capacity to simultaneously measure nurse patient ratios and nursing workloads by a dependency method of nursing hours per patient day. The results showed that it predicts actual direct nursing care requirements with greater accuracy than ratios for all hospital and patient types, facilitating better allocation of nursing resources and demonstrating that the cost of nursing care would be less for hospitals using that system than for ratios.
Chapter X: Simulations to Assess Medication Administration Systems
    Elizabeth M. Borycki, University of Victoria, Canada
    Andre W. Kushniruk, University of Victoria, Canada
    Shigeki Kuwata, Tottori University Hospital, Japan
    Hiromi Watanabe, Tottori University Hospital, Japan
    A range of new technologies/information systems are being implemented in clinical settings in order to reduce errors associated with the medication administration process. Simulation methods can be used to assess the impact of integrating new technology/information systems into the nurses’ work environment prior to full-scale implementation of a health technology/information system. Simulations as an evaluative tool emerged from a direct need to assess unintended and intended consequences of health information systems upon nurses’ work before systems are fully implemented. Nurse information use of simulations to assess and test health technologies/information systems will allow nurses to determine the impact of a new software and/or hardware upon aspects of nurses’ work before its implementation to allow for appropriate system modifications.
Chapter XI: Socio-Technical Structures, 4Ps and Hodges' model
    Peter Jones, NHS Community Mental Health Nursing Older Adults, UK This chapter explores the potential of a conceptual framework – Hodges’ model – both as a socio-technical structure and means to explore such structures of relevance to nursing informatics theory and practice. The model can be applied universally by virtue of its structure and the content which it can encompass. In apprehending this chapter, readers will be able to draw, describe, and explain the scope of Hodges’ model within contemporary healthcare contexts and the wider global issues presented by the 21st century that influence and shape nursing informatics. Critically, the reader will also gain insight into how socio-technical structures can facilitate cross fertilization of clinical and informatics theory and practice; drawing attention to information as a concept that provides a bridge between socio-technical, clinical, and informatics disciplines. The paper will review the socio-technical literature and venture definitions of socio-technical structures related to Hodges’ model and advocate the need for sociopolitical-technical structures. This chapter also proposes the 4Ps as a tool to facilitate reflection upon and the construction of socio-technical structures. The adoption and significance of the hyphenated form as per “socio-technical” will also be explained.
Chapter XII: Strategies for Creating Virtual Learning Communities
    Beth Perry Mahler, Athabasca University, Canada
    Margaret Edwards, Athabasca University, Canada
    Teaching nursing online requires teachers to purposefully use strategies that facilitate the development of virtual learning communities. This chapter proposes answers to the question, “How can educators effectively teach the very social discipline of nursing in virtual classrooms?” Specific online teaching strategies including Photovoice, Virtual Reflective Centers, and Conceptual Quilting are explored. The social and socio-technical implications of teaching nursing online are considered. A final section in the chapter describes how these developments in online nursing education are changing the social and pedagogical perspectives of distance learning. Research questions that arise from this exploration are presented.
Chapter XIII: The Impact of Technology in Organizational Communication
    Roberta Cuel, University of Trento, Italy
    Roberta Ferrario, Laboratory for Applied Ontology (ISTC-CNR), Italy
    In this chapter a case study is presented, in which the ethnomethodological approach is used to analyze the impact of the implementation of an information system, called Sispes, on organizational communication processes in the residence for elderly Giovanelli (Italy). Sispes is a Web-based platform which sustains communication processes and knowledge management according to a customized workflow management system. Adopting structuration theories in the analysis of the case study, and taking inspiration from the philosophical tradition, especially in epistemology and in the analytic philosophy of law, an innovative perspective is adopted, which specifically acknowledges the role played by the communication processes in shaping both the attitudes of the involved actors and the social reality in which they are immersed. According to this perspective, three types of communication processes are presented, namely the normative, descriptive and constructive approach. These latter are then applied to a concrete case study.
Chapter XIV: The Roles of a Nurse in Telemedical Consultations
    Boris A. Kobrinsky, Moscow Research Institute for Paediatrics and Children’s Surgery, Russia
    Nikolay V. Matveev, Moscow Research Institute for Paediatrics and Children’s Surgery, Russia
    Telemedicine, or distant medical consultations using communication via electronic networks, is gradually becoming a standard of medical care delivery in distant areas worldwide, including both the most developed and the developing countries. For instance, in 2007 telemedical centres existed in 55% of the Russian regions (on average, about 4 centres in each region). In most of the cases, nurses are actively involved into organization of various types of distant consultation. Main types of telemedical services include: (1) emergency consultations of patients by telephone (2) telemedical consultations using videoconferences or store-and-forward systems and (3) home telecare systems. Possible roles of nurses in different types of telemedical consultations are discussed.
Chapter XV: The Role of EBM and Nursing Informatics in Rural Australia
    Daniel Carbone, University of Melbourne, Australia The purpose of this chapter is to discuss broadly the need for enhanced evidence-based medicine (EBM) by nurses in the context of rural Australia and the role that nursing informatics and an informed strategy could facilitate in making such need a feasible reality. First, the introduction highlights current time gaps between health discoveries and eventual practice and the potential for information technology to positively affect this gap. Then, the need for nurses to take an active role in evidence-based medicine in rural settings is argued. The link between information literacy and evidence medicine is consequently presented and gaps in knowledge regarding nursing informatics training are highlighted. Concluding with the argument that to achieve evidence-based research and eventual use, there needs to be a purposeful health informatics learning strategy that recognises the role of computer and information literacy.
Chapter XVI: Use of Handheld Computers in Nursing Education
    Maureen Farrell, University of Ballarat, and RMIT University, Australia The use of mobile technologies in nursing education is rapidly increasing. Handheld computers are the most frequently used of these technologies as they can provide students with information for point of care clinical reference, such as diagnostics, medical terminology, and drug references. Integrating the management and processing of information into clinical practice is an effective learning approach for students and reflects a changing paradigm in nursing education. Traditionally, nursing programs have the tendency to separate the acquisition of academic knowledge from clinical practice, and the process of integrating academic information into the decision-making processes in the clinical area has been difficult for student nurses. This chapter will provide an overview of the use of handheld computers in nursing and medical education, including a brief synopsis of current use in clinical practice. It will discuss the advantages and disadvantages of their use, barriers to implementation and future directions.
Chapter XVII: Using Information Technology in Nursing Education
    Elizabeth Rogerson,University of Dundee, UK
    Linda Martindale, University of Maryland School of Nursing, USA
    Carolyn Waltz, University of Maryland School of Nursing, USA
    This chapter addresses issues relating to nursing informatics as used and applied in nursing education. This includes the use of information technology (IT) in delivering nursing education, as well as the teaching of IT and informatics skills to prepare nurses for practice. Drivers associated with the development and use of IT in nursing education are discussed, as well as current use of IT in nursing education and practice, including both mainstream and emerging technologies. Lastly some key issues for the future are identified. Internationalism is regarded as a consistent theme in IT development and occurs as a recurring thread throughout this chapter.

Friday, March 06, 2009

The moon, Saturn V, policy and holistic care

The last time human kind ventured to the moon it took a three-stage rocket to get us there.

Unlike the space race and Kennedy's breathtaking commitment, there never has been a political objective akin to - "We choose to achieve holistic care in this decade, and do the other things like multidisciplinary, integrated, electronically supported collaborative care. ..."

Perhaps the UK's series of National Service Frameworks goes some way towards this, with the Next Stage Review over the next decade set to make the holistic difference?

So, it appears that the objective of holistic care isn't easy, like going to the moon it is hard and in this problem domain - care engineering - we have had more than a decade to get there.

There has been a space race in nursing. A race to fill curricula, wards and the heads of many with models and theories of nursing.

Like Apollo this race has petered out.
Like Apollo this programme is safety critical.
Like Apollo ambition can be re-kindled.

We need a new imperative. Something to charge policy landscape of our time. There is still a need to deliver on this and the other things....

Hodges' model is a marvellous delivery system.

Unlike the Saturn V it boasts four stages.
Like the Saturn V it incorporates the means to take us to some place and make the journey back: quantity - quality and the universe between.

The stages of h2cm are interchangeable their use dictated by the situation and context. There is even recourse to a virtual fifth stage as required, since as the astronauts found:

you can find bliss up there : looking down here

Image source: ABC News

Ack: John F. Kennedy Moon Speech - Rice Stadium

Wednesday, March 04, 2009

RCN Nursing Older People Conference 1 April 2009, Salford, UK

Registration 09.00, Conference 09.50 - 17.00, Wednesday 1 April 2009
Mary Seacole Building, University of Salford, Manchester, M6 6PU

This exciting one-day programme, compiled by the RCN Nurses Working with Older People forum, will address the key topics most relevant to you in your workplace. With a varied programme presented by key invited speakers and fellow nursing colleagues, this conference is essential for all health care professionals working with older people.

This conference will include session on:

• Human Rights Act and Mental Capacity Act
• Adult protection
• Dignity
• Involvement and decision-making
• Use of technology
• Inter-generational issues

registration, conference fees, contacts: RCN Nursing Older People Conference

Sunday, March 01, 2009

Squaring circles: Compressed patient care pathways = rich(er) patient experiences?

The use of Lean and Six-Sigma, their combination and other service improvement approaches has resulted in much more effective patient care pathways. A shining example is that of diagnostic medicine and subsequent out-patient appointments, apparently patients can attend for diagnostic services such as imaging and on the same day also attend for their first out-patient appointment. This saves time for all, with expensive imaging technology also proving its worth and RoI by working from 0700-2200.

Trust Boards are well pleased with such progress, but there is no such thing as a free lunch. Managers and execs know the lunch (diagnostics and imaging) isn't free, but quantitative aspects aside what does does this mean in terms of quality and assurance? Quality in the sense of:

  • patient (and carer) experience;
  • staff capacity to find and take advantage of patient learning (self-care, patient health career management) opportunities;
  • assessment and evaluation of patient (carer) comprehension;
There is a circle to be closed by relating quality to quantitative aspects; such as, re-referral rates, re-admission, medication / treatment concordance, plus the infusion of intelligence from local and national patient related outcome measures [PROMS] to new patient journeys.

In information science there is the concept of information compression, taking out the redundancy - repetitive data in an image or text to save on processing, transmission, and storage. As Lean Six Sigma assists teams to remove tasks, processes that do not 'add value' then the result is a richer experience. The patient journey has in this sense been compressed. The patient has fewer hospital and clinic visits with fewer bus, taxi journeys, or they pay less in car park fees. Health personnel and specialists are primed to help and deliver services that really count.

What does this compressed - 'denser' experience - mean though? Does it mean that:

  • patient's are exposed to more information (2-3 significant interviews / leaflets / instructions)?
  • there is less time available for education, health promotion, info Px giving?
- or alternately:
  • does this 'value packed' patient journey help by providing rapidly successive hooks - experiential threads to integrate patient (carer and staff!) learning?
It will be interesting to see answers to these questions and how extensive the scope of benefits are of these patient experiences across different care contexts.

Is there an optimal number for 'clinical encounters' before things start to go awry?

PROMS are quite specific (as they need to be initially), but amid richer and varied patient journeys there will be a need for other (national and local) measures.
What about the extent and level of 'care complexity' and 'holistic care'?

Image source: http://www.navyenterprise.navy.mil