Nursing (Health) Art or Science...?

Is nursing an art or science?
It is simply and complexly both ...

"Warp. Weft. Woof! are terms from weaving: the threads or yarns that run lengthwise on the loom are called the warp; the crosswise threads or yarns are called the woof or weft. The web is the name given the completed woven fabric, and it also has wide figurative use: What a tangled web* of circumstance you've woven.
All these are Standard."
(http://warpweftwoof.com/)

*Also known as the care plan!

Original image source:
http://www.wovenwire.co.uk/plainweave.htm

Additional links:
http://www.africancrafts.com/

h2cm: Original purposes and 21st century additions

Listed below are the four reasons that prompted Brian Hodges to create Hodges' model in the early-mid 1980s, these being to support:

1. reflective practice (Moon, 2004; Jasper, 2006) ;
2. holistic care (Brooker and Waugh, 2007);
3. curriculum development;
4. bridging the theory – practice gap. (Doherty, 2009)

Although nursing, health care and society have changed to a revolutionary extent these original purposes are still outstanding some 25 years later as the authors above and many others testify.

Perhaps in the next few years it would be timely for researchers to revisit the original stimuli and consider afresh the role of Hodges' model within nursing theory and practice and beyond. I believe the relevance of the model grows not because of the constant need for the big picture, but the need to represent and consider new dichotomies and challenges. To the original four then we might add:

• To inform the socio-technical application of information and communications technologies in health and social care;
• To conceptually ground (domain relate) and integrate the 4Ps of PROCESS, PURPOSE, PRACTICE, POLICY in theory and practice;
• To provide a universal conceptual framework to conjoin all multidisciplinary teams across the 4Cs of COMMUNICATION, COLLABORATION, CO-ORDINATION, CONTINUITY and COMPLEXITY*;
• To inform research in what may be termed ‘cogeographics’ the fusion of conceptual spaces and visualization in the humanities - social sciences.

The 4Ps and 4Cs provide a further aide memoir for students and practitioners to accurately locate situated care. Finally, nursing and health, social care as a profession is bound to a code of practice, accountability and has an educational – public (mental) health duty to the aims and objectives of the global health community. Cogeographic (or cogneographic) may be a neologism, but seeks to conjoin the cognitive (cognition) involved in defining, representing and using concepts in conceptual spaces; AND the finding that knowledge is invariably situated - that is knowledge has a geography.

References:

Brooker, C., Waugh, A. (2007) Foundations of Nursing Practice: Fundamentals of holistic care, Mosby.
Doherty, C. (2009) A qualitative study of health service reform on nurses’ working lives: Learning from the UK National Health Service (NHS), International Journal of Nursing Studies,46,8,1134-1142.
Jasper, M. (2006) Reflection, Decision-making and Professional Development (Vital Notes for Nurses), Blackwell.
Moon, J.A. (2004) A Handbook of Reflective and Experiential Learning: Theory and Practice, Routledge.

*I can count really ;-)

Workshop - Delivering High Quality Health Care for All: Bringing the social and technical together...

My SOURCE: SOCIOTECH at JISCMAIL.AC.UK

Dear Colleague,

Please find details attached of a Think Tank focused on developing socio-technical approaches to the provision of healthcare (in the context of the National Programme for IT in the NHS).
Please note that attendance is restricted to around 30 people and that anyone wishing to contribute will need to apply (as specified in the attachment) - which follows below PJ.

Thanks and best wishes

Chris
P.S. please feel free to circulate these details to colleagues who you think may be interested. Thank you.

Professor Chris W Clegg
Centre for Socio-Technical Systems Design
Leeds University Business School
University of Leeds
Leeds
LS2 9JT
c.w.clegg at leeds.ac.uk

Delivering High Quality Health Care for All:
Bringing the social and technical together for a joined-up approach to deliver supporting systems and technologies
10th/11th December 2009

Call for contributions to an event organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group

Core idea
This 2-day Think-Tank event has been set up to discuss and report on how Health and Social Care employers and other key stakeholders in the Informatics field might bring about a joined-up approach to the implementation of electronic health records, one that brings together changes both in technology and in the social practices around it.

Rationale
The National Audit Office’s report on “Delivering successful IT-enabled business change” see: www.nao.org.uk/publications/nao_reports/06-07/060733es.pdf and the University College London Evaluation report on the Early Adopters of the Summary Care Records project (see: https://discovery.ucl.ac.uk/id/eprint/6602/1/6602.pdf) both highlight the challenges of implementing technology-based projects within a fixed time line and how this can reduce the opportunities to get a more “user-centred” approach to change.

In many sectors of the UK economy the drive to get the technology ‘on desk, on time, and on budget’ can mitigate against developing a full understanding and consideration of how the changes may be of real practical value to users and customers.

It is increasingly recognised that ‘technology-push’ will not be enough in its own right to achieve the full benefits and efficiencies that are being sought in service delivery. Rather, we need to bring about innovations both in the technical systems, and in the working practices, work roles and processes that surround them. Put bluntly we need a more joined-up approach to change. This has been variously called ‘user-centred’ or ‘socio-technical’ or ‘holistic’.

Objectives
The objectives of this event are to discuss and subsequently report on –
• What does such a joined-up approach mean in practice?
• What examples exist from across the UK Health and Social care sector where such approaches have been used?
• Who has to do what, to make it happen consistently across the NHS and Social Care services?
• How will we know if it is succeeding?

Organisers
The event has been organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group.

The event will be chaired jointly by Professor Chris Clegg, Chair of the British Computer Society’s Socio-Technical Group the and Doctor Beverley Ellis, Joint Vice-Chair of the UK Faculty of Health Informatics.

Getting involved as a contributor or delegate at the event
If you wish to attend the Think Tank, please submit an Expression of Interest (EOI) to Bruce Elliott, Co-ordinator of the UK Faculty of Health Informatics at bruceelliott@nhs.net by 28th September 2009.

Your EOI should include brief summary (of up to 200 words) of your role, experience and expertise in this context.

Please note we are seeking people from a range of stakeholder groups including:

• Acute Hospitals
• Suppliers
• Health and Care Commissioning organisations
• Primary and Community Care Providers
• End users of nationally-led systems, e.g., CMS, SCR, ECR
• Connecting for Health, Informing Healthcare and the Scottish Government’s E-Health Programme
• Academics
• Patient Leads

In the event that we are over-subscribed, we will select people so as to provide an appropriate balance of experience and expertise, to ensure the Think Tank can meet its objectives.

Please make it clear in your EOI if you would also like to present a short paper at the event. In such a case please also add a brief abstract of your proposed paper (of up to 200 words).

If you have been allocated a place you will receive written confirmation along with a copy of the final programme by 16th October 2009.

Associated papers
In November 2009, a Position paper capturing some of the Key Challenges in adopting Socio-Technical approaches will be shared with the participants to identify some of the key issues that will be addressed at the event.

Following the event, up to 5 contributors to the event will be commissioned to write papers on the topics and issues emerging, with the aim of informing key stakeholders in how Socio-Technical approaches can be utilised effectively across the NHS and Social Care. These papers will be completed by the end of January 2010, for inclusion in an overall Briefing report. We will also be actively exploring avenues for wider publication in order that the good ideas can be spread and acted on.

Location
Weetwood Hotel and Conference Centre, Leeds

NHS data breaches: the 'cogeography' of who and where?

Computing this past week featured an item (extract below with link) -

Five more NHS trusts involved in serious data breaches
Written by Tom Young
Computing, 17 Jul 2009

Privacy watchdog the Information Commissioner's Office (ICO) has found five more NHS organisations in breach of the Data Protection Act.
The Royal Free Hampstead NHS Trust reported the loss of an unencrypted CD initially thought to contain medical treatment details of 20,000 patients from the hospital’s cardiology department.
Chelsea and Westminster Hospital Foundation Trust reported the theft of an unencrypted memory stick containing 143 patient details including sensitive medical information.
And Epsom and St Helier University Hospital NHS Foundation Trust has been storing hospital records insecurely for nearly two years following data being transferred between hospitals. ...

Straight away reading this I thought of my previous post about cogeography and commented accordingly (which registered twice - oops!). In light of the previous post here's that comment with some additions....
Such events merely (without trivializing) highlight the human capacity to ERR big(gish) time. Is it not possible for tech to help? If info systems through to mobile devices had a sense of where they are and their status as carrying sensitive data recognised through digital IDs - plus additional meta-dynamic data, then 'cogeographic awareness' might result?

I blogged about this with ref to conceptual spaces.

This would be an artificial example and would make it possible for data previously designated as confidential, sensitive, - HOT data if you will - to self-destruct, 'e-vaporate' if it found itself beyond a given combined virtual or physical environment be that hospital, Trust boundary, SHA, or National border...? This capability already exists no doubt in the security services (although sometimes you wonder) or as suggested in the realms of 'MI' and '007'.

Cogeographic or (cogneographic) may be a neologism and seeks to conjoin the cognitive (cognition) involved in defining, representing and using concepts in conceptual spaces; AND the finding that knowledge is invariably situated - that is knowledge has a geography.

Copies of NHS and social care
data could - should - MUST
have a geography too...?

Another comment rightly questioned the ability to put personal data on
CDs and other media in the first place. Amid the emergence
of renewed debate about the future of e-health
records, clinicians may have a professional
duty to demand cogeographic
properties no
less ...?

Image source: http://www.tapintoquality.com/facts/glossary-d.html

Happy Anniversary 20th July!

Holistic care and 'where' it means....

Delivering holistic care does not mean being -

here	here
here	- or here

Holistic care is not even
about being in all these
places at the same time.

It means you have already
been to these places and you
will be going back again.

Holistic care also means
none of the participants travel alone ...

Well-being, Teddy Bears and the NYC Fresh Air Half-Marathon

These days 'well-being' crops up everywhere it seems. Literally in the crops and technology used to grow our food, in response to the rise of obesity and its personal and social impact. Diabetes, bullying, the need for exercise, personal space and quality time the well-being list and its associations is as long as the number of journals and magazine issues and covers it features in.

For Hodges' model though where can well-being be found?

I believe there is a risk that 'well-being', whilst it undoubtedly has a role to play in health and social care, education, media, policy (oh and lifestyle), runs the risk of diluting the critical health messages. Not in the sense of not dealing with critical health problems but not as bad as putting your health at risk. If you do not do X, or Y and put your well-being at risk this is not as bad as putting your health at risk...? Do people really make the right connection? One response to my initial question is as follows:

Emotional Well-being	Physical Well-being
Social Well-being	Political Well-being

Since well-being is a rather nebulous concept the risk is that -

'Well-being' may become* a sort of Teddy Bear comforter.

Well-being is very helpful in opening doors to walk-in centres, well man and women clinics and in damaging the stigma that surrounds mental health. For me though well-being is not to be found in the h2cm matrix, Well-being is the totality. It is how well we are in all the care domains. How well are they integrated? Well-being brings a whole new meaning to global health. Collectively this also includes that spiritual yearning found within humanity. Miss one domain out and like a pack of cards... ...

So next time you drag Teddy up the stairs easy
as you go....

Speaking of well-being: running while you can - is a great mantra because the ability to run is a great gift for those of us who can; whether 100s of meters or marathons. Here is news of what looks a truly great event across the Pond:



Hi again Peter

I sent you an email last week and didn't hear back so I thought I would try again. The Fresh Air Fund is still looking for runners and sponsors to join our Fresh Air Fund-Racers team for the NYC Half-Marathon on August 16th. It would be a huge help if you could post a mention of this exciting news on Hodges Model: Welcome to the QUAD. This is a great way to participate in NYC's premier summer road race while helping Fresh Air Fund children. Please feel free to use anything from our site...

Last summer's NYC Half-Marathon was a huge success and the Fresh Air Fund-Racers raised more than $125,000. We are also still in need of Friendly Town hosts for next month. Host families open their hearts and home to a NYC child who would not otherwise have the opportunity to escape the hot, crowded city streets. Please let me know if you are able to post or have any questions, and if you could send me the link that would be fantastic.

Thank you so much, (A pleasure Sara - all the best for next month!)

Sara
-----
Sara Wilson,
The Fresh Air Fund
sara AT freshair.org
www.freshair.org

Additional link:

Runners Web: Run for Charity

* may already be...?

Distorted care

Some musical performances are so polished, clear and (p)honed that we readily attribute them to the classical genre. There are experimental pieces that 'buck this quality trend' but the musicianship, melody and composition stand the test of time grabbing audiences by the ear, throat and heart. On the popular music front some bands - The Eagles spring to mind - are not universally appreciated for their sound, (sales), shine and harmonies.

Whatever the music though if you ramp up the volume enough - distortion happens. This disturbs and disrupts the artist's, composer's and producer's original intent.

The worry is that care can be similarly distorted, not only by those who can shout the loudest creating noise, but the political clamour that creates its own form of cultural background radiation. It becomes hard for everyone to listen and reflect on the track we've heard so many times since our teen years:
you know the one - 'Quality Care' by 'Informed Debate, Health & Social Lookyafters'.

Image my source: Sodahead.com

Additional link - BBC: Compulsory social care bill plan

Workshop: Making the most of the Potential of Assistive Technology

Dear KT-EQUAL/SPARC supporters

I am pleased to confirm that the next KT-EQUAL workshop, in this case organised jointly with and hosted by the Brunel Institute for Ageing Studies (BIAS), will take place on 17th September at Brunel University, Uxbridge. It is now possible to register for this workshop by going to the SPARC website (www.sparc.ac.uk). There is no charge for attendance just an enthusiasm and interest in extending the quality of life of older people through informed user-focused research and its application.

Making the most of the Potential of Assistive Technology will provide a round-up of recent developments in AT and the underlying research aimed at enhancing independence in the home, improving safety and security, extending the use of the car, managing continence, maintaining the body and stimulating the brain. It will also look at new models for the delivery of care through employing AT and how current research is supporting industry and government in the design, development and adoption of new technologies.

Several speakers have confirmed their participation:

Ms Keren Down MBE, Director of FAST, New Service Quality to Support Self-Care
Professor Rachel McCrindle, University of Reading, Safety and Security in Later Life
Mrs Eleanor van den Heuvel and Ms Felicity Jowitt, Brunel Institute for Bioengineering, Tackling Ageing Continence - and several other speakers are in the process of confirming/reorganising other commitments so that hopefully they will be able to take part:

Professor Heinz Wolff or colleague, Brunel Institute for Bioengineering, "The Companion" - Independence, choice and self-sufficiency for the housebound.
Dr Arlene Astell, St Andrews University, Nourishing the body and saving the soul
Dr Ruth Mayagoitia-Hill, Applied Medical Research Group, King's College London, From chairs to stairs
tbc, Middlesex University, Older drivers and technology
tbc, Centre for Information Systems Research, Brunel University, Supporting industry and Government in the design, development and adoption of medical devices.
The programme is being constructed and more details will be available in late July. We expect to start at 10.30am with registration opening at 10.00am and to finish before 4.30pm, with several presentations as well as lunch and refreshment breaks in between!

The workshop will be of interest to a wide range of practitioners and policy makers, health and social care practitioners, industry, charitable and government bodies concerned with the needs of older people, as well as researchers and academics from engineering, biological, social science, medical and health care disciplines.

Older people are especially welcome.

Please make certain to register sooner rather than later, especially if you are about to go on holiday as you might forget to register when you return!!!

We are delighted to be running this event with BIAS, a new and exciting grouping of researchers drawn from within and outside Brunel University.

Kind regards and best wishes for a relaxing summer

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
p.r.lansley at reading.ac.uk www.sparc.ac.uk
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

My source: The KT-EQUAL/SPARC list
(I have registered and hope to attend this workshop)

Call for Papers: Special Issue of Nonlinear Dynamics, Psychology, and Life Sciences on Medical Applications of Nonlinear Dynamics

NDPLS is actively searching for manuscripts for a special issue to be entitled, “Medical Applications of Nonlinear Dynamics.” Potential papers could range from the level of individual patients to that of the health care system, and could include such topics as:

• Nonlinear patterns in illness
• Treatment effects and nonlinearity
• Practice change via nonlinear intervention
• Neural networks in clinical decision-making
• Catastrophes in health care utilization
• Nonlinear advice for health care reform
• Modeling ambulatory practice
• Dynamical effects of illness upon the family
• Nonlinear dynamics within the doctor-patient relationship

Contributions may be theoretical or empirical. Theoretical papers should be firmly grounded in the extant literature and culminate in new principles involving nonlinear dynamics that can be tested; manuscripts heavy on conjecture with little reference to evidence are not encouraged. Reviews of the relevant literature on applications of nonlinear dynamics are also welcome, if they synthesize and interpret this material in novel ways. Empirical papers may include experimental observations, simulations, or analyses of real-world data. Articles will be reviewed by two or more experts in the relevant field.

The purview of the journal is critical to the inclusion of articles: Nonlinear Dynamics, Psychology, and Life Sciences publishes papers that augment the fundamental ways we understand, describe, model, and predict nonlinear phenomena in psychology and the life and social sciences. One or more of the following nonlinear concepts must be an explicit part of the exposition: attractors, bifurcations, chaos, fractals, solitons, catastrophes, self-organizing processes, cellular automata, genetic algorithms and related evolutionary processes, neural networks, agent-based models.

The broad mixture of the disciplines represented here indicates that many bodies of knowledge share common principles. By juxtaposing developments in different fields within the life and social sciences, the scientific communities may obtain fresh perspectives on those common principles and their implications. Because the journal is multidisciplinary in scope, each article should make an original contribution to at least one substantive area and, to the extent possible, illuminate issues beyond that area's boundaries.

NDPLS is a refereed journal and is published quarterly by the Society for Chaos Theory in Psychology & Life Sciences. Additional information for the preparation of articles for submission can be found on the journal’s web site: www.societyforchaostheory.org/ndpls/ .

The project is planned on the following schedule (please see link above for full details):

• Abstracts are requested prior to submission in order to assist with the organization of the issue contents, and they are welcome any time before the paper submissions deadline.
• Full-text papers need to arrive by December 31, 2009.
• Manuscripts should be prepared in APA style. Key style points and small variations that are specific to the journal can be found in the Instructions for Authors on the journal web site. Reviews completed by February 28, or sooner to the extent possible. Revisions and final edits should be received by April 1, 2010.
• Publication in October, 2010.

We look forward to receiving your abstracts and papers. If you have any questions about the project, please do not hesitate to ask one of the editors below.

Sincerely,
Stephen J. Guastello, Ph.D.
Stephen.guastello at marquette.edu
Editor in Chief

David Katerndahl, M.D.
katerndahl at uthscsa.edu
Special Issue Editor

My source:COMPLEXITY-PRIMARY-CARE at JISCMAIL.AC.UK

'cogeographic' or 'cogneographic' - concepts situated and abstract

The term 'cogeographic' materialised while writing a short article for the nursing press on Hodges' model.

Searching SCIENCE DIRECT and similar academic resources I thought I had found the word relating to geography, borders, ethnic groups and geopolitics, but now it seems to have disappeared....?

So I am not 100% sure whether cogeographic is a neologism. In some ways cogneographic better suits my purpose. That Matrix associated addition is a rather bizarre coincidence given the word's status and so with that I should explain how my lexical arrival here came about. ...

I was focusing on two fundamental claims in Hodges' model. Namely:

• The model is situated;
• The model assumes that concepts can be located within its knowledge domains.

For me, cogeographic (cogneographic) conjoins the cognitive (cognition) involved in defining, representing and using concepts in conceptual spaces; AND the finding that knowledge is invariably situated - that is knowledge has a geography.

Philo and Pickstone (2009) highlight the work of Haraway:

No knowledge, however ‘scientific’ or prestigious, can ever truly come from nowhere; it can not but originate somewhere, being thoroughly situated, in Donna Haraway’s (1991) valuable terminology; and it commonly bears marks of that origin - situation wherever it might then travel. p.651.

This combination of physical and mental (abstract) location then supports the use of a metric or measure. I suppose what I am thinking about is GIS for concepts - which in turn is the semantic web?

Should I locate any sources I will update this post, or if you can direct me to any please let me know: h2cmng at yahoo.co.uk

Reference:

Philo, C., Pickstone, J. (2009). Unpromising configurations: Towards local historical geographies of psychiatry, Health & Place, 15, 3, 649-656.

The domain once removed ...

When we reflect or physically interact with the world it is easiest to effect those things nearest to us. From an early age - stationary - we learn to look and reach.

Sometimes however it is those things that are remote, inaccessible that may be significant and deserving of our attention.

Imagine yourself placed in any of Hodges' knowledge domains as if in a prison cell.

The knocks on two walls clearly come to our attention. There - is another domain that remains off-limits.

This domain is the cognitive blind-spot: which will be yours today?

Image source: Fallingpixel.com

The Conceptual Age needs tools to catch, match and patch ...

I have finally read some of Dan Pink's book A Whole New Mind: Moving from the Information Age to the Conceptual Age.

The graphic copied here from the book is interesting for this blog and its readers by both what is included - the conceptual age and what is omitted.

Pink's graphic supports and reinforces what I have felt for many years. Namely, that in Hodges' model we have a conceptual framework fit for our time and purposes. Looking at the figure developmentally then of course we think conceptually from a very early age in order to make sense of self, other, world and future.

Pink's graphic is interesting in that as depicted here we have not reached the knowledge age as yet. While these ages are discrete when conducting health and social care and other activities the boundaries are of course unclear and fuzzy.

Being in the conceptual age we need tools that can catch our care and related concepts. A stage that makes them accessible for reflection and association.

Moving further towards the knowledge age we then need tools that can recognise patterns in our concepts and begin to match them.

For safety's sake we then need to recognise the important concepts missed in our assessments, problem solving, project management and service improvement processes ... These tools will be able to suggest and patch the gaps in our framework and hence our understanding.

Image original source: http://elearningtech.pbworks.com/f/daniel-pink-conceptual-age.png

Additional links:

Dan Pink - A Whole New Mind

'conceptual spaces' on W2tQ

'concepts' on W2tQ

Reflecting on this it is a shame that there is no Innocent Age any longer or what there is often cut short.
The least we can do is to try to preserve it for as long as possible ...

Relationships matter: Society Guardian & The WSJ

Re. Charles Leadbeater's State of Loneliness, The Guardian, Society, 01.07.09

The cover of this weeks Society Guardian immediately caught my eye with its picture (I wonder which corner of which care domain this lady is sat in?):

The text initially passed me by; then yesterday I caught up, it seems the business model quest in one sector is having a domino effect with new models needed elsewhere including health and social care.

Leadbeater's piece reminded me of Lean thinking the improvement process with its drive to identify value, reduce waste and repetition. ... His text points out that:

More efficient services quickly move in and out of people's lives, but they don't really change how people live. That is one reason why we have not made deep inroads into the most deprived communities, the most troubled families, the most intractable social problems. Services manage and process people and problems, but only rarely allow people to change their lives. Service solutions are ill-suited to the emerging challenges of the rise of long-term health conditions, diseases linked to lifestyle and diet, ageing or climate change. You cannot deliver a solution to an epidemic of diabetes the way that DHL delivers a parcel.

So any model, method that is primarily process centered may find itself compromised - providing just one cylinder's worth of power in a four cylinder engine. In Hodges' model I have identified the 4Ps. PROCESS, PURPOSE, POLICY, and PURPOSE (to which we must now add PROBITY). It will be interesting to see how value is defined across service forms of engagement, intervention (including signposting) and the new set of outcome measures to follow whether local, national, service-reported or patient reported outcome measures. Leadbeater continues:

The key will be to redesign services to enable more mutual self-help, so that people can create and sustain their own solutions. The best way to do more with less is to enable people to do more for themselves and not need an expensive, professionalised public service. Enabling people to come together to find their own, local solutions should become one of the main goals of public services. Services do a better job when they leave behind stronger, supportive relationships for people to draw on and so not need a service.

So Jo(e) Public needs to reflect, compare, evaluate, learn, collaborate and make informed decisions in order to stay well amongst many other things. They need to be engaged holistically.

Where is the model for this...?

I believe I know.

The Wall Street Journal has something to add here The Doctor Will Text You Now and relating to my earlier posts on 'Beware Reflex Moves'. Relationships matter, but if nurses are out there assessing, assessing, assessing who is doing the education, dividend added therapy outcome focused?

If e-health is going to make a real contribution in augmenting and freeing high value care resources then this in turn depends on the value invested in relationships.

Louis Petrillo, 57, a psychologist in Westfield, N.J., says he regularly turns to his family’s doctor, Robert Eidus, for online advice about his frail 90-year-old mother, who finds office visits difficult. His son who is away at college also used an online visit when he had sinus problems. “I can get into his virtual office anytime,” says Dr. Petrillo. He feels the online care works well largely because Dr. Eidus knows his family members’ regular health complaints.

If older adults move home and need new primary care services, what are most probably(?) well established patient - doctor (patient - primary care team!) relationships are not just undermined they are undone! A person's sense of community is fractured. ...

Yes that image speaks volumes.

Image source: Guardian

Mathews, A.W., The Doctor Will Text You Now, JULY 1, 2009, The Wall Street Journal Interactive Edition

Relative poverty (3) - sciences

[The introduction is repeated across these posts: intrapersonal, political, sociology]

There are many paradoxes in life and many of these are concentrated in the realm of health and medicine (a major sub-division of life and death).

For decades the link between poverty and standards and quality of health has been recognised and politicised in the media and policy. Just this past week was news of a Bill to make the eradication of child poverty a legal obligation not something that can be the political objective at the start of a Government and then cast aside.

Many things are relative and poverty is often described in this way applying to individuals, social classes, communities, regions and whole nations. Using the domains of Hodges' model what reflections does this prompt? Let us see:

SCIENCES: We tend to think of economics and the definition of poverty in materialistic and monetary terms. In this domain things become things. Processes and much more besides - people are objectified and commodified: prostitution, child labour, child soldiers, people trafficking - individuals as numbers at a certain time, certain place. The person reduced to a process - service.

On the sciences front in an explicit way our poverty of knowledge ('education, education, education') becomes apparent as we try to place value on the environment and not only our personal use, but national use of the green and blue. A new economics is indeed called for.

In the current 2009 Reith Lectures (closing lecture this week) Professor Michael Sandel presents A New Citizenship. Within these lectures Prof Sandel explains how fees change services, values and expectations with examples of child care and blood supply in health care. Organisations have to be aware of their assets with laptops, PCs and umpteen other pieces of equipment and resource possessed of their own unique ID.

Yes, according to my interpretation of Hodges' model the points raised here belong in the political domain, and yet we are so befuddled, intoxicated and to a certain extent deluded with the sciences, technology and material things (de-vices?) that in contemplating poverty we must extend the political realm. ...

From now on the public's attitude to science as individuals and families, communities and nations is going to be critical to change our understanding and more importantly our experience of poverty - material, relative or otherwise.

Image source: BBC

Additional links:

The Simonyi Professorship: hair for the Public Understanding of Science at Oxford University

'Poverty' on W2tQ

Sciences care (knowledge) domain links resource

Political care (knowledge) domain links resource