Goodbye to David McKendrick an 'old' friend and personal reflections

The past three years have been quite challenging both personally and professionally.

Professionally as an IT secondment came to an end in 2007 and brought with it positive and negative changes. The positive of moving back to clinical practice, the negative the vagaries of clinical banding and the Knowledge and Skills Framework which many health sector organisations are still attempting to fully implement. On a personal level, I am now also divorced. Working on the community for so many years - just over the border of my clinical patch - was a gift of convenience in terms of the children's schooling and playing taxi driver.

While there was a very objective interview panel I feel I owe having my current job to my friend David McKendrick. This fact now scares me witless that this was back in 1985 when my eldest son was born. I was so wrapped up in this life-changing event that the secretary phoned to ask if I did want the job. The organisation I still work for has changed its title and status umpteenth times it seems and I have had several roles over the years, including research and service development projects. The truth is though that when it comes to work, this journey began at Chorley with David and that is essentially where I am still at.

I was really shocked then when Sue, David's wife phoned with the news that David had died earlier this month. I'd kept in touch with David through the years. Due to my new domestic circumstances I moved back to Ashton-in-Makerfield - living not far from David and Sue - in July last year. David was so helpful, patient and supportive as I have progressed through the divorce.

We both worked at Winwick Hospital, Warrington, UK and I am pleased I went along this summer to a reunion and saw David in his element with friends, Sue and a pint. I also managed to take quite a few photos which will now be extra memorable for so many of us. Although I didn't work with David at Winwick, as already suggested he was my boss on the community mental health team at Chorley, Lancashire from October 1985 through to his early retirement due to illness.

We shared a love of IT and coding as enthusiasts. In the early 80s David called to my parents home when I'd bought a BBC micro, an upgrade from a Sinclair ZX81. David contributed so much to health IT, through his work with Open Software Library, computer aided learning and his pioneering bulletin board. David was also a co-organiser of a computer based training conference at Keele University 1987-88. Open Software Library distributed several computer programs I wrote on the BBC micro. One thing that makes me smile is the way in the late 80s early 90s I got my underpants into a bit of a twist over the copyright. Now reflecting back, David was a real Gent in how he handled that, my concerns to which he listened, accepted and explained. There was a lesson there also in terms of Hodges' model and Brian Hodges' worries over the same. Where might the model be now, we often pondered, if it had been driven hard from the outset!

When David retired it wasn't the same. Of course you know the job changes constantly, but there was a real loss of impetus: from warp to impulse drive. David was much liked and respected as a boss and colleague. If you were professional in your approach put the clients, carers and families first then he left you to get on with the job. That said his recognition for accountability and governance was communicated and shared by the team. He used an Amstrad micro to produce statistics on the number of home visits, injections and many other details. David was ahead of the informatics game in recognising the value of information for service planning, development and improvement. When David was off a while I kept this effort going for a short while until duties dragged me elsewhere. David's early IT work was published in the Community Psychiatric Nursing Association journal, an association (now the MHNA) which he helped established initially.

I can see us all walking from the team office at Eaves Lane hospital (long gone now), up through the tunnel to the main hospital for the regular team meeting. That was a golden age of sorts, when all the community nurses came together. David was always keen on that. You were a member of a team and everyone was valued and had a role to play.

David recognised my interest (and yes skill -- thanks David!) in computing and sent me on a health care computing conference held in Manchester 1986. I wrote a report and have attended and presented at the HC-XXXX series on several occasions since. We often shared books, papers and plans around technology developments and when to build or buy that next PC.

I really, really can't believe David has gone. He was (very) widely read and we loved knocking ideas around always wondering about what sort of clinical / nursing application might have a future. I only learned since his passing of his excellence as a student nurse. When he qualified as a Registered Mental Nurse (RMN) he was awarded the Gold Medal. He was always keen to read my writing efforts and discuss the same. I remain really impressed with his website on Winwick Hospital - Winwick Remembered. While there is much in the old institutions to say good riddance to and never again this IS social history and as BBC R4's In the Mind featured there is much to record and document. In 2006 David got in touch with a query regarding relatives of patients from Winwick trying to trace details of their family members. I posted his inquiry on the psychiatric nursing list.

Over the past year or so, we met a few times at Tom & Gerry's the local pub with David riding there on his bike: magic!! Sitting at that usual table (near the plug) sad, but lots of smiles too.

I arrived late to politics and I much admire his involvement in community work, the Three Sisters Recreation area project in Ashton. While I enthused over 'community informatics' David was practicing it, engaging with others. I'm sure I don't appreciate the extent of his efforts, the youth club - helping make IT available to youngsters, environmental projects, and the community forum.

I am truly thankful for having met David, for his friendship, support and guidance over the past 18 months and the years before. If I've three regrets:

1. I never did take my guitar around; as I realise now how good David was - McKendrick's Moonshiners no less - I clearly missed a lick there!
2. Also never did find and show David the old photos from Winwick hospital - the show we put on as students.
3. Being able to explore Ashton Heath, the types of heather and the bees there.

Regular readers here know of the hyperbole over the new website, well now if I ever do create the new website - maybe we'll know why...

David - I'll miss you pal and miss you already!
As the new decade begins bless you, Sue and your family and friends...

Peter

===================================
From: Richard Lakeman, richard.lakeman at dcu.ie
To: Peter Jones h2cmng at yahoo.co.uk
Sent: Mon, 14 December, 2009 14:40:27
RE: [PSYCHIATRIC-NURSING] David McKendrick - CPN - CPN Manager, Winwick & Chorley, UK

I’m sorry to hear about David, Peter. Thanks for letting us know. I never met David, but he marketed some software I wrote for some years and He was a pleasure to deal with.

Regards
Richard

Call for papers: IFLA Health and Biosciences Libraries Section open session

Colleagues from around the world are invited to submit an abstract for consideration for the HBS Open Session:

Health and Biosciences Libraries Section

Aim and Scope of the Session

It is hoped that papers will cover a wide range of areas - for example:

• Partnerships and collaborations that support free access to health information.
• Health libraries/health information professionals role in promoting open and / or equitable access.
• How health information is disseminated to the general public?
• How useful is free health information? Is it evidence based?
• How evidence based information is incorporated into freely available health information?
• Is there a decline in the use of health information that is not freely available e.g. library subscriptions?
• How do consumers prefer to access health information e.g. mobile devices, magazines, newspapers?
• What role health information literacy may have in health information?

It is anticipated that presentations be 15 minutes with time for questions at the end of the session.

Important dates: ...


Submissions are to be submitted before February 1st 2010 by email to:

Paivi Pekkarinen
National Library of Health Sciences
Haartmaninkatu 4
FI-00290 Helsinki, Finland



My source:

HIPNet Listserv

New education bodies created to promote innovation in the NHS

Health Innovation and Education Clusters (HIECs)

New bodies that combine the expertise of industry, health and education have been formed to promote innovation in the NHS, Health Minister Ann Keen announced today.

Health Innovation and Education Clusters (HIECs) are cross sector partnerships between NHS organisations, the Higher Education sector and blue chip companies such as BMW, GlaxoSmithKline and BT.

Through joint working HIECs will provide professional education and training and promote innovation in healthcare by speeding up the adoption of research. They will also provide professional education and training.

Over £11 million will be given to the 17 successful applicants that were chosen by an Independent Award Panel Chaired by Sir Alan Langlands, Chief Executive of the Higher Education Funding Council for England.

Health Minister Ann Keen said:

“HIECs are special partnerships that draw on the wealth of skills and experience of their members to improve the development of high quality care and services by quickly bringing the benefits of research and innovation directly to patients.

“These projects will attract and encourage the best talent who can recognise and rapidly adopt new and innovative healthcare and treatment.”

Independent Award Channel Chairman, Sir Alan Langlands, said:

“The standard of applications has been really high and we have been impressed by the high profile names that want to be involved in improving NHS care.

”HIECs will drive up quality standards in education and training and ensure fast adoption of innovation for the benefit of local people.

“The flexibility of the HIEC model means that the vision of each one is appropriate and specific to its local area.”

The HIEC concept was originally developed by a group of leaders from the NHS and university sector during the NHS Next Stage Review as one of the ways to deliver high quality healthcare.

Ends


My source: NHS-HE-FORUM at JISCMAIL.AC.UK

Free Introduction to Sociology Textbook (for adoption)

Dear Colleagues,

- and with Merry Christmas to all!

This is a great time of year for changing textbooks and adopting our free Introduction to Sociology Text.

Over the last fifteen years the cost of textbooks has outpaced inflation at a phenomenal rate. USA Today reports that over the past 25 years the average cost of tuition and fees has risen (35%) faster than personal income, consumer prices and even health insurance (Block, 2007).This increases the financial burden on college students who are trying to afford a bachelors degree.

In an effort to combat the exorbitant costs of college textbooks, we wrote a free 20 chapter brief Introduction to Sociology Textbook. It was funded by a one-time grant and is now available to any college student or faculty member anywhere in the world--FREE!

You may access it at this Internet address:
http://freebooks.uvu.edu (copy and paste in URL)

This textbook reflects 20 years of teaching in the field. This book is current, concise, and visually aesthetic. It has an equivalent market value of about $40-$60.00 compared to most brief texts on the market. It also has a brief how to succeed in college section with success strategies built in for students.

No passwords are needed and no costs whatsoever to faculty or students. The book is licensed under the Creative Commons Attribution (BY) which means you may use any portion of it as long as you reference the original authors.

We have created a test bank of over 5,300 questions (1,261 Multiple Choice, 2,250 True/False, 1090 Fill in the Blank, 793 Matching) covering each chapter of this text. These are formatted to easily load into blackboard or any other LMS you may be using.

If you chose to adopt it, simply fill out the form (located under the Faculty Tab) and we'll send you the secure testbank.

If you know of a colleague who might be interested please forward this e-mail.

Knowledge must be affordable to all who seek it

Sincerely,

Ron Hammond, Ph.D Sociology at UVU
Paul Cheney, Ph.D. Multi Media-Web Design at UVU

Ron J. Hammond, Ph.D.
Assistant Department Chair
Behavioral Science Department
Mail Stop 115 at
Utah Valley University
800 West University Parkway
Orem, Utah 84058
RonH at uvu.edu


My source: TEACHSOC: list teachsoc at googlegroups.com

Related post: Book review: Gary Hall's "Digitize This Book!" (DTB)

Open access on W2tQ

Care is a 4 perspective business ...

Health care as practised in whichever sector prides itself on being business-like and professional. As we are often reminded health care costs. Health care is a business and like finance a very serious one.

On the computer graphics card notice the four display ports? This card - the NVIDIA® Quadro® NVS 450 is apparently capable of driving up to four 30" displays and is designed to meet the needs of today’s most demanding business user.

I wonder if there is another application that could also utilise
four perspectives? What about the business of care?

Call for Papers for Special issue on Linking the Local with the Global within Community Informatics

Please forward as appropriate. Thanks!

Dear all, a special issue of the Journal of Community Informatics (http://ci-journal.net/index.php/ciej) will be devoted to ´Linking the Local with the Global within Community informatics`, guest-edited by Liisa Horelli and Doug Schuler.

The Journal of Community Informatics is a focal point for the communication of research of interest to a global network of academics, community informatics practitioners and national and multi-lateral policy makers. The field of community informatics seeks to explore the potentials of ICTs and their applications for economic, ecological and socio-cultural development efforts at the community level. It seeks to ensure that individuals and communities can take advantage of the opportunities that these technologies can provide.

For this special issue of the Journal, we are inviting submission of original, unpublished articles. We welcome research articles from different disciplines, case studies and notes from the field. All research articles will be double blind peer-reviewed. Insights and analytical perspectives from practitioners and policy makers in the form of notes from the field or case studies are also encouraged. These will not be peer-reviewed.

You can find the full Call for Papers below. Looking forward to hearing from you.
Warm wishes, Liisa and Doug

------------------------------------------

Journal of Community Informatics:

Call for Papers for Special issue on Linking the Local with the Global within Community Informatics

Guest editors: Liisa Horelli and Douglas Schuler

The Journal of Community Informatics is a focal point for the communication of research of interest to a global network of academics, Community Informatics practitioners and national and multi-lateral policy makers.
We invite submissions of original, unpublished articles for a forthcoming special edition of the Journal that will focus on Linking the Local with the Global within Community Informatics. We welcome research articles from different disciplines, case studies and notes from the field. All research articles will be double blind peer-reviewed. Insights and analytical perspectives from practitioners and policy makers in the form of notes from the field or case studies are also encouraged. These will not be peer-reviewed.

What is Community Informatics?

Community informatics

...links economic and social development efforts at the community level with emerging opportunities in such areas as electronic commerce, community and civic networks and telecentres, electronic democracy and online-participation, self-help and virtual health communities, advocacy, cultural enhancement, and e-planning among others....is concerned with carving out a sphere and developing strategies for precisely those who are being excluded from this ongoing rush, and enabling these individuals and communities to take advantage of some of the opportunities which the technology is providing. It is also concerned with enhancing civil society and strengthening local communities for self-management and for environmental and economically sustainable development, ensuring that many who might otherwise be excluded are able to take advantage of the enormous opportunities the new technologies are presenting.

- Michael Gurstein in Community Informatics:
Enabling Communities with Information and Communications

Why a special issue on Linking Local with the Global within Community Informatics?

Community informatics (CI) is the study and practice of information and communication systems (especially involving networked digital systems) in the community. Regardless of the agreement on the broad definition, there are inherent tensions within the CI community and with the CI perspective itself. The "simple" idea of community is the source of one tension since there are a multiplicity of definitions and usages of the word "community", many of which are semantically loaded or ambiguous. Is, for example, a "virtual community" a real community?

Another source of tension is between the local and the global, the focus of this special issue. What's local and what's global? What is their significance in terms of our focus on "community"? How do we define the two terms so that they are meaningful and useful to our work? Perhaps these terms distract us from conceptualizing our enterprise in ways that are more useful? What characterizes phenomena or artifacts as belonging to one or the other (and how do they influence each other)? Interestingly, the community of community informatics researchers, practitioners, and activists itself is part of a new hybridity that blurs local and global.

The term glocalization has been coined to focus on the intermixing of local and global influences which are present and active everywhere. Although the phenomenon is not new, it has intensified in recent years due to the Internet, mass communications, mobile telephones, air travel, war, migration, economic interdependence, environmental impacts, and other aspects of 21st century mobilities. But identifying and naming a phenomenon is only the beginning. We must not mistake our use of a new term for understanding. For example, how would glocalization help us understand a network of local communities?

The availability of urban and community ICT could allow people to understand the larger impacts of their everyday decisions. It could also enable people to understand and promote not only the particularities of the local but also commonalities of the global, and to engage with the broader global “sphere”. Consequently, people could become actors who are engaged in the glocal networks of mobile people, goods and information.

However, glocal influence or interaction could be directed from the top-down, laterally, or from the bottom-up. CI implicitly embraces the tension between the local and the global. On some level, global and local pit two types of forces against each other. How does CI consider this clash or intermingling of forces? Does it advocate larger barriers, shelters, or hiding places, from these forces or does it inspire or promote the type of collective intelligence that goes beyond "using ICT?" The recent debate on the CI-research list brought up the idea that CI could be used, in addition to the benefit of communities, to the benefit of global communities. This debate raised arguments that both supported and questioned the claim. On the one hand, there is the risk that glocalisation can dilute (and downgrade) the "community" to some larger (and less individually significant) whole. In that case, it may be important to preserve the 'local' as it maintains the community's domains of control and power over the circumstances that impacts it. It can be reasoned that greater globality essentially removes self-control and self-governance.

On the other hand, glocalisation provides new strategic options for movements who seek resources and support far beyond national boundaries, such as the Chiapas, in Mexico. The global opportunities even begin to play part in the way local activists frame the issues they raise locally. Thus, the "outside world" affects communities, but communities exert forces outwards as well. Local communities can also share experiences and strategies, thus mutually strengthening each other. We need to figure out, how we are going to make the glocal or translocal connections work most effectively. This special issue is intended to help surface the opportunities, challenges, and risks around this theme.

These issues give rise to a large number of research questions. Some of these are listed below but there are many yet to be identified and researched. What processes underlie the forces of globalization? Which are forces of localization? How are people affected by each? How do these forces originate, diffuse, and make their effects felt? Do these forces affect all communities equally or are gender, ethnicity, or other features significant factors? And what should CI researchers / practitioners do in relation to those forces? Is the issue trying to help communities use ICT more effectively, or is it working in a general way to develop communication systems that will help local communities intelligently address the problems that they (and the rest of the world) face? In some situations, for example, this means helping to develop collective problem-solving tools so people can more effectively resist oppression or fight the status quo. Or should their inhabitants be full citizens of the world with the rights and responsibilities that accompany that status? How can we characterize the new diversity of global / local relationships? What patterns exist? In what ways might (hyper?) localism breed parochialism and isolationism? Can we embrace CI without unnecessarily valorizing the local community? What are the opportunities (and what should the limits be) to our research and activism on behalf of and with the local community?

Because CI is a brand new field of research and practice we have the rare opportunity to define our field. Is it useful — or even possible — to conceptualize a social enterprise that is relevant today without explicitly acknowledging climate change, environmental degradation, oppression, poverty, human rights, war and militarism, and other "global" problems that face us all, however indirectly. How should these manifest "global" concerns be factored into our enterprise? And how does the role of information and communication, the foundations of our enterprise, change — if at all — the way we answer these questions? This positioning of our enquiry at such a point should enable a new set of opportunities. CI integrates research and engagement. So its view of localism and globalism needs to be informed through those perspectives.

We invite authors to submit in English both full articles for peer-review, as well as short pieces on specific experiences and/or policy and regulatory issues, to be reviewed by the guest editors.

Please note the deadlines:
Deadline for abstracts: 28 February 2010
Deadline for submissions: 30 May 2010
Publication date is forthcoming

For information about submission requirements, including author guidelines, please visit:
http://www.ci-journal.net/index.php/ciej/about/submissions#onlineSubmissions

For further information, clarifications, comments or suggestions, and to send abstracts of papers for consideration, please contact:

Dr. Liisa Horelli Helsinki University of Technology Centre for Urban and Regional Studies liisa.horelli AT tkk.fi
Douglas Schuler The Public Sphere Project and The Evergreen State College douglas AT publicsphereproject.org

Global health: Organ failure and systemic sustainability

... or
Blue Planet :: Blue People

Original image sources:
Northern Europe - http://commons.wikimedia.org/wiki/File:Northern_Europe_10.17239E_63.58242N_center.png

Nursing human rights - dementia care II: fao Sir Gerry Robinson

The 2nd and final edition of BBC Two's TV programs Can Gerry Robinson Fix Dementia Care Homes? was on last night and made for uneasy viewing.

The saving grace for the public's confidence (if there is one) was repetition of the excellent care at one home.

For all the negatives presented on TV, before mapping the key content of this program using Hodges' model it must be acknowledged that the staff and both managers involved are to be congratulated in allowing and facilitating the production of this program. Sir Gerry and the program's producer(s) obviously travelled an especially difficult course in this episode.

Unless qualified or having undergone some training, many staff will behave and eventually modify their norms and expectations according to what they are exposed to within a short period of starting to work in residential care. Perhaps, this explains in part the adage 'start as you mean to go on'? It was apparent that many staff knew they were failing, they recognised the lack of leadership, their inability to sustain the effort for positive change.

This is why (in 1977 at least) the school of nursing I attended was a little more than churlish about students initially working as a nursing assistant. If you were not working on a ward that also trained student nurses then you may adopt the wrong attitudes and with it what we might call 'non-skills'. This includes 'learning' means of avoiding contact and interaction with patients; and possibly interpreting behaviour in a purely negative and non-therapeutic way. This may extend to the point of becoming personally involved - taking things personally - whether the behaviour exhibited is aggression or sexual dis-inhibition, for example.

Here then are some of the points I noted, many are repeated from the first program with some very unfortunate and troubling additions (which I may further review as per the above text):

PURPOSE, CARE PHILOSOPHY (none?), person-centered care, attitude, memory loss, vulnerable individuals, training, risk, assessment, motivation to change, interpersonal skills, motivation, listening, life skills, knowledge and skills, feedback, aggression, agitation, measures, rapport, empathy, +ve care, boredom, personal choice & autonomy, access to personal belongings, dolls, personal focus, anxiety, psychological stress and trauma of physical relocation

physical environment, colour, decor, noise, outside access - physical security, physical restraint - use of furniture, position of furniture, day-to-day items, tasks, PROCESS, measures 'dementia care mapping', routine tasks, time with residents, assessment, care files (paper!), bed occupancy, activities - painting, gardening, sheds, staffing cover : resident ratios, models of care (none?), objective measures

PRACTICE (common minimum standards), the residents, team work, day staff:night staff, collective faith and trust, collaborative objectives, care, shared enthusiasm, social attitudes, dignity and respect, relationships, social values, personal-social history, engaged activities, involvement, 'social' norms, inclusion, community - institution, being valued by others, impact on families and local community of home closure

POLICY (the lines in the sand?), management spot checks, '24 hour care', disciplinary procedures, professionalism in management relationships, duty of care, ratings: tokenistic inspection regime, home closure, consultancy, audit, legislation, sickness, pay, business ethos, staff morale, recruitment and retention, confidentiality, sanctions, management style, qualifications, standards, institutionalised care, re-location, lessons learned (business involved, local authority)?

There are also Open University learning resources associated with the program.

My closing thought: in closing the asylums over the past 40+ years I hope we have not and are not creating a series of micro-institutionalised replacements.

This is an issue for everyone.

The Communication Initiative Network and holistic bandwidth

In 2004 I attended a day at a community informatics conference in Brighton, UK (see the side bar for details). My interest in that event stems from recognising the different schools of informatics and the multidisciplinary potential for Hodges' model that extends beyond health and social care. The model provides a cognitive gymnasium for us to test and exercise our holistic bandwidth.

The notion of 'holistic bandwidth' really comes into its own within global development and communication. In 2004, or soon after I discovered The Communication Initiative Network. They kindly posted the Brighton position paper on their site and were very encouraging regards the model. Now they are developing a new Communication Initiative Social Networking Platform - http://groups.comminit.com/

There are many groups including:

• The Future of ICTs and Development
• Communication and Climate Change Adaptation

In the above group I learned of the following initiative :

There is an interesting initiative in Africa called AfricaAdapt. It is a network that works to facilitate the flow of climate change adaptation knowledge for sustainable livelihoods between researchers, policy makers, civil society organisations, and communities who are vulnerable to climate variability and change across Africa. There is a whole section on their website that allows for communities to upload their own information on how they are adapting to climate change. The initiative also offers an award for best community project which helps elicit contributions.

Africa: never far from the news. Lets hope this next week there is some +ve news from COP15 Copenhagen.

• Students - Communication for Development
• HIV/AIDS Strategy: Future Directions
• Polio Communication Consultation Group

There are diseases lost to the developed nations and with diseases like polio and leprosy communication and education are central to those who are ill and their families. Even as a nurse there is a stark reminder in the need for an International Leprosy Day.

• Gender, Education, and HIV/AIDS

On the teaching psychology list someone asked this past week about alternatives to structure a student's lifespan assignment. I suggested Hodges' model an approach that can also be adapted to educate people about disease ....

SCIENCES: aetiology, prevention, transmission, hygiene, diagnosis, prognosis, evidence, research, physical resources, drugs, nutrition, age, weight...
INTRAPERSONAL: attitudes, beliefs, education, literacy, personal responsibility, mood...
SOCIOLOGY: social networks, cultural beliefs, gender expectations, community, family, friends, trust...
POLITICAL: policy, leadership, funding, activism, infrastructure: housing heating..., access to services, media, employment, governance...

• Ethics in Communication for Development
• Gathering Theories and Models

This group only has 5 members and is of obvious interest to me. I can't recall whether I signed up: must check! Planning and development in this context covers topics and issues I know nothing of and yet I am sure that dressed in its socio-technical guise Hodges' model can contribute to the theoretical development here. It could be that there are other perspectives, models and conceptual frameworks to be found that can inform the global health agenda?

• DRAFT: Technical Update on Social Change Communication and HIV/AIDS
• Human Rights and Technology
• Web Site Directors

So, do visit the Communication Initiative both the new groups above and the general website.

NHS clinical informatics best practice marketplace 25th March 2010 Waterside, Watershed, Bristol

An opportunity to share innovations and experiences in the field of clinical informatics that can make a real difference to patient care.

25th March 2010 - Waterside, Watershed, Bristol

A collaboration between:

UK Faculty of Health Informatics and Bristol Royal Children’s Hospital -

Dear Colleague,

We would like to invite you to participate in an innovative new meeting which aims to bring together clinicians and social care staff from various backgrounds, who are involved with real world informatics solutions.

Many of the themes that we will be covering at our first market place are focusing on sharing informatics solutions that have already made and can make huge differences to patient safety and the overall quality of care.

The 6 main areas that we plan to cover on 25th March we hope are of huge interest, potential and at times frustration for NHS and Social Care staff, patients and carers. These are:

1. E-prescribing with decision support in secondary care

2. Clinical incident reporting systems and clinical audit tools

3. The development and use of community based information systems spanning across mental health, long term conditions and social care

4. Telecare and the use of teleconferencing in patient care

5. Clinical portals, patient portals and the use of clinical dashboards

6. Medical simulation and its use in clinical learning and development

The features of the proposed market place are very distinct from existing conferences and trade exhibitions in that it will be:

• Clinically focused – the issues that we are trying to find solutions to and share lessons learned from are led from a clinical viewpoint rather than a technical or sales perspective. There will be suppliers present but they will all have been invited along by Health or Social Care service provider.
• Focused on real experience of what already works – too often NHS staff have felt frustrated by suppliers promoting technical developments that haven’t actually yet been deployed in UK health and care settings. This market place is designed to share what has already been tried and tested in different parts of the NHS and Social Care from across the UK from a clinical/service perspective.
• Free of charge – the event is funded by the UK Faculty of Health Informatics and has been organised in partnership with Clinicians from Bristol Royal Children’s Hospital and academics from the University of the West of England. The personal details used when registering will not be shared with any other suppliers i.e. no follow-up sales calls or invitations to demonstrations
• Provide access to established Communities of Practice – if you want to progress ideas or issues more you will be able to sign up for free membership of an on-line community based on the Department of Health’s Informatics Directorate’s eSpace platform as well as other groups in order to keep in touch with other people that you have met on the day.

Format and structure:

Although the market place will be open all day from 9.30am until 5pm, unless you are a presenter or exhibitor you only need to attend when you wish to or are free to.

Short presentations on each of the 6 main themes will take place throughout the day from 10am until 4pm in a separate auditorium adjacent to the market place. You can attend as many of these interactive presentations as you wish.

We will have a limited number (around 16) stands for participants and their associated suppliers to demonstrate their solutions

The event is designed for staff working in Medical, Nursing, Pharmacy, AHP, Social Care, Informatics, Senior Management, Communications or Education and Training roles.

Support for back-fill and travel costs will be available to NHS and Social Care staff who exhibit a solution and/or share their experiences at one of the plenary sessions.

Organisation and next steps:

The event has been organised by 5 members of the UK Faculty of Health Informatics, including:

Bruce Elliott – Co-ordinator of the UK Faculty of HI/ Programme Manager – DH Informatics Policy & Planning, ... bruceelliott at nhs.net

If you would like to share your experiences at the event please contact leon.rushworth at nhs.net by Friday 29th January 2010.

You can book your place at the event by registering at ...

We hope that it is of real interest to you.

Kind regards

Bruce Elliott

The UK Faculty of Health Informatics purpose is:
To stimulate the uptake and application of Informatics research and development within UK Health and Social Care services in order to improve the quality of care for all.
This is done through providing opportunities for anyone with a passion for applying their Informatics knowledge and experience in practice to participate in:

• an engaging on-line discussion forum
• vibrant face to face events and meetings
• writing relevant and stimulating reports and papers
• sharing their own research findings

Online Deliberation: Design, Research, and Practice

This is the website for the book Online Deliberation: Design, Research, and Practice, edited by Todd Davies and Seeta Peña Gangadharan (CSLI Publications, November 2009).

All content on ODBook.Stanford.Edu is licensed under a Creative Commons Attribution-Share Alike 3.0 Unported License.

My source: Community Informatics list.

(many) Care Transitions and The Little '-' That Could

Some people looking at Hodges' model may believe that the model perpetuates the dichotomies of old:

Human --- Machine
Individual --- Group
Sick --- Healthy
Supply --- Demand
Home --- Hospital
Self care --- Nursing care

In the 1990s as a community mental health nurse I was involved with a group of general nurses looking at ways of improving:

• discharge planning
• continuity of care

These issues remain and with the dichotomies of care above we can see how Hodges' model can assist our thinking and planning about transition. Not just one transition, but several.

This past week I was fortunate to attend one of a series of workshops -
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, Leeds, UK

Organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group

The event was very good, stimulating and challenging. In the closing debate the appeal of 'socio-technical' and how to market a much needed joined-up approach in health IT came down at one point to the difference between:

'socio-technical' and 'sociotechnical'

In trying to find an alternative title, the hyphen was lost, and whilst it is not a crucial issue - for me that hyphen represents the axes of Hodges' model. Hodges' model acts as a high level aide-mémoire and that little hyphen can perform the same trick. The hyphen reminds us of the differences. The dichotomies that need to be navigated and negotiated in our dialogues about care AND caring. These are most evident in transfers and transitions (after all - "getting out of bed is a risk").

There are mini and macro transitions. Care pathways are not yellow-bricked unbroken splines from cottage to cottage hospital. They should be tortured if they do reflect person-centered experiences and needs.

Some transitions are process laden and repetitive, such as drug administration and must be protected - free from interruption. Although grounded in a social exchange of (correct) identities: a registered nurse, the right patient, right drug, right dose, right duration and right time these can be framed within the SCIENCE domain. That is where (for me) the conventional 'drug round' can be found. Counselling is another transition (if effective it also moves people on). 'Counselling' can be found in the INTRAPERSONAL domain - close to the border with SOCIOLOGY.

Other transitions and transfers are more involved:

• person's home to attend day care (for the first time!)
• person's home to residential home
• hospital ward to home
• home encounter with the crisis team
• telecare consultation
• ...

Care is constantly passed hence the need to write and record. Passed from -

person-to-person
team-to-team
team-to-carer
time-to-time
discipline-to-discipline
self-care

This is the outcome that is sought. Ultimately passing responsibility back to the individual and when applicable their family. Having formal integrated care pathways is one thing, but they are never truly continuous, clear and true. And as they say crossing bridges you may have to break step and surely different disciplines march to different tunes? Today though the most audible tune must be socio-technical. ...

Additional link: The Little Engine That Could
Image source:
Drug round tabard http://internet-workwear.co.uk/acatalog/Drug_Round_Tabard.html

IMIA monthly news bulletin; no. 8, 08 December 2009

My source: Rita Arafa, BCS Health Northern Specialist Group, Membership Secretary.
Original source - IMIA: International Medical Informatics Assoc. see below.

For more frequent news updates, and subscription options by email, RSS feeds, etc., see the IMIA
...

Items:

1. MedInfo2010
a] Early bird registration deadline
b] Submissions feedback dates
2. Forthcoming events
a] IMIA Working Group activities
b] Regional events
c] National/international events
3. Boards (deleted for brevity)
4. Publications
5. Corresponding members - new SOP (deleted for brevity)
6. January 2010 bulletin

1. MedInfo2010

MEDINFO 2010 - 13th World Congress on Medical and Health Informatics;

12 to 15 September 2010 in Cape Town , South Africa.

a] Early bird registration deadline

Early bird registration closes 18 December 2009 - book early to save money. The site for conference registration and accommodation booking payment is open - via the main MedInfo 2010 website.

(NB BCS Health will be offering funding for those participating in Medinfo 2010 – details to be announced soon).
b] Submissions feedback dates

The SPC and reviewers are currently working hard on the paper submissions and other scientific submissions. Notification on acceptance of papers should be by 28 February, 2010.

2. Forthcoming events

Due to the increasing number of events, we will only here mention those in 2009-10. Notices of events in 2011 and beyond will be added to the IMIA website and IMIA news website when they are announced or when there is significant new information.

a] IMIA Working Group and Special Interest Group activities

The IMIA Health Information Systems Working Group (IMIA HIS WG) will be organising a two day workshop on Health Information Systems – 30 Years of Evolution, that will take place on September 10-12, 2010 in Stellenbosch, South Africa, just before the Medinfo 2010 Conference in Cape Town, South Africa. Further details will be advised in due course.

A number of WG/SIG chairs and vice chairs have changed as of the 2009 GA. This information will be updated on the IMIA website in the next few days. ... If WG/SIGs have activities planned, please send in the information so that we can help promote them.

b] Regional events

The 2010 Special Topic Conference (STC) of the European Federation for Medical Informatics (EFMI) will take place in Reykjavík, Iceland on June 2-4, 2010. The event has the theme ‘Seamless care – safe care. The challenges of interoperability and patient safety in health care’. 

c] National/international events

HIMSS10 - March 1-4, 2010. Atlanta, Georgia, USA. http://www.himssconference.org/

eHealth2010 - May 6-7, 2010. Vienna, Austria. ...

e-health 2010 - May 30 - June 2, 2010. Vancouver BC, Canada. http://www.e-healthconference.com

HINZ2010 - 2-4 November, 2010. Wellington, New Zealand. http://www.hinz.org.nz

AMIA2010 - 13-17 November, 2010. Washington DC, USA. http://www.amia.org

4. Publications

Applied Clinical Informatics (ACI) is a new official eJournal of the International Medical Informatics Association (IMIA) and the Association of Medical Directors of Information Systems (AMDIS), and will be published by Schattauer. This is Schattauer's first online journal. Full information about this new development, including instructions for authors, can found at the journal website –

http://www.aci-journal.org

The proceedings of the Post-Congress Workshop of the 10th International Nursing Informatics Congress (NI2009), which was held at Vanajanlinna, Finland on July 1-4, 2009, are titled “Personal Health Information Management – Tools and Strategies for Citizens’ Engagement”. The 215 page book has been edited by Kaija Saranto, Patricia Flatley Brennan and Anne Casey.

6. January 2010 bulletin

The January 2010 bulletin will be published on 04 January. We welcome all feedback (to imia@imia-services.org) and any news items, conferences, etc for the websites.

END OF IMIA News Bulletin, December 2009
- - - - - - - - - - - - - - -
Dr Peter J. Murray
Executive Director
IMIA, International Medical Informatics Association

Nursing human rights and Int. Human Rights Day: fao Sir Gerry Robinson

On last nights BBC Two TV program: Can Gerry Robinson Fix Dementia Care Homes?

- amongst the angst his visits and engagement with several care homes provoked Sir Gerry highlighted the need for a moral compass and compassion. The themes I expected to find were there: the need for person-centered care, knowledge of the clients and their backgrounds, being occupied and having access to a secure environment when the weather permits, staff morale and the level of staff training and competence. Although not necessarily 'enjoyable' viewing the program was very good in raising awareness and included either directly or indirectly:

person-centered care, attitude, memory loss, vulnerable individuals, training, risk, assessment, review, motivation to change, interpersonal skills, motivation, listening, life skills, knowledge and skills, feedback, aggression, agitation, change, measures, rapport, empathy, +ve care, boredom, diurnal variation of mood, personal choice & autonomy	physical environment, colour, decor, noise, outside access, physical security, nutrition, tasks, processes, measures 'dementia care mapping', routine, meal times, time, physical risk - falls, mobility, assessment, care files (paper!), bed occupancy, staffing : resident ratios, models of care
the residents, visitors, family, love, social attitudes, dignity and respect, relationships, social values, personal-social history, engaged activities, involvement, 'social' norms, inclusion, community - institution, being valued by others, distraction	records, freedom, care funding costs / weekly charges, funding, inspection, consultancy, audit, legislation, rules (meals), pay, investment, business, staff morale, recruitment and retention, financial risk, confidentiality, plans and initiatives, management style, qualifications, standards

Today 10 December 2009 is also International Human Rights Day. To many people elderly care issues in a Western democracy may seem a world away from 'human rights' as per:

• false imprisonment
• denial of justice, law and order
• political repression
• freedom of expression
• education and health for all
• discrimination
• ....

- and yet the situations that arise within nursing, health, social care are never far from ethical and human rights concerns:

• Mental capacity
• Consent
• Physical restraint
• Mental health law
• Environmental health law
• Conscientious objection
• Medicine and nursing in the armed forces
• Equity and equality
• Accessibility
• ....

Moral dilemmas can and do arise in any and all of the care domains of Hodges' model and all combined (the spiritual). In addition to a moral compass, it seems we need a compass in nursing in order to be compass-ionate.

Hodges' model can provide a compass.

A compass to help navigate open waters, new coastlines and the uncharted corners and recesses of human nature.


Additional links: Amnesty International

POLITICAL care domain resources


Compass image: http://clipart-for-free.blogspot.com/2008/07/compass-rose-clipart.html

Dementia BBC TV & Radio

This evening on TV BBC Two 2100 hours UT:

Can Gerry Robinson Fix Dementia Care Homes?

Businessman Sir Gerry Robinson returns in a new series in which he tries to turn around three struggling care homes.

In the next twenty years over a million Britons will have dementia, and sufferers are likely to end up in one of the country's privately run care homes. It's a huge business worth six billion pounds, largely paid for by taxation, yet a great deal of the care is woefully inadequate. Can Gerry, whose father had the disease when he died, change a culture of stagnant lounges, a lack of specialist training among staff, and a focus on keeping people alive rather than helping them to live a happy life?

It is very difficult to keep up with the various 'World Days' there are so many. The BBC's Archers has also dealt with dementia through the character Jack Woolley and the impact of the illness not just on the fictional families concerned, but the small fictional village community. The writers have done an admirable job in raising awareness about dementia.

Now over three years later, the past week has brought us to Peggy's final realisation of the extent of Jack's care needs with his arrival at a care home.

This care transition has provided an opportunity for wider debate and discussion:

Additional links:

Active Minds

memo FROM: Classroom health TO: Global health - PSHE education and model standards

Health care and educational professionals learn and adopt the key tools of the trade whilst training. Although for several decades experiential learning has also gained recognition and weight, it is the learning of theory and relation to practice in basic training that shapes the future career. We can describe this as formative professional education. We then trust that this learning and the tools in use are updated according to research, evidence and best practice. There is much navel gazing at present as to how to measure, nurture, instill and strengthen the character trait of compassion. This applies not only to children, but within nursing.

This issue highlights of course what students bring with them to the lecture theatre, clinical arena and what they take from there to carry them through their professional career. My ideal would be that students have already learned and used Hodges' model as 14-16 year old's, as they negotiate their personal, social, health and economic (PSHE) education.

While Hodges' model is a world away from a de jure standard
- that is, defined and enforced by the ISO -
it might just :) become a de facto standard,
because of its widespread adoption in and beyond the classroom.

There is a great opportunity here for Hodges' model in the UK as PSHE education becomes compulsory in 2011. Perhaps you can help in or beyond the UK?

Reference:
Mooney, H. (2009). Can you measure compassion?, Nursing Times, 21 April 2009.

Blog post inspired by adamatronics groups.drupal.org Drupal in Education: Joint effort on a D6 SCORM API

tags: 'preventive medicine' + 'preventive medical sociology'?

KT-EQUAL workshop: Who is the (research) User?

Dear Colleagues

Just a reminder that the next KT-EQUAL workshop will be on the subject of "Who is the User"

This will be held on 26th January at Loughborough University. As with all KT-EQUAL events there is no charge for attendance.

The workshop will be of interest to a wide range of professionals and policy makers, health and social care practitioners, employers, charitable and government bodies concerned with the needs of older and disabled people, all those involved in the provision of services and, of course, researchers and academics from engineering, biological, social science, medical and health care disciplines. Older people, who have the biggest stake in ageing research, are especially welcome.

To register please go to ... and follow the links.

Specific enquiries should be made to:

Heather Williams
Project Officer (KT-EQUAL)
School for Health, University of Bath

Kind regards
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

NIGH message for GANM network - We Need Your Help with the UN General Assembly

Please assist if you can....

Dear GANM Colleagues,

The Nightingale Initiative for Global Health (NIGH) (www.nightingaledeclaration.net) team invites you to join with us to ask the 2009 UN General Assembly to consider the UN Resolution proposal (see below) as they will be voting until the end of December 2009.
Currently the NIGH team is working in and around the United Nations in New York City — to propose a UN Resolution (below) recognizing the work of global nursing.

Please write to your country's UN Ambassador in New York City.

To find your country's UN Ambassador:

1.) ...

2.) to find the mailing address and a link to your country's web page (where you can find their email address) for your country's representative - go to:
https://www.un.org/en/sections/resources-different-audiences/delegates/

Address the following message to your UN Ambassador. Finding the email address may take a little more effort, but it is quicker. We hope you will take the extra effort to let your representative know how important this issue is.

If you want to add a personal note to this example message please feel free:

≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈
re: Resolution to Acknowledge Campaign for 2010 to Support UN MDGs

(Enter the name of your UN Ambassador and country)

Permanent Mission to the United Nations

EXCELLENCY,

We ask you please to consider, now, initiating or supporting a Resolution for this 2009 General Assembly:

1/. The General Assembly, in recognition of the devotion and dedication of the world’s nurses and midwives and their care and concern for the health and well-being of the “peoples of the United Nations,” hereby acknowledges, with gratitude, their celebration of the “2010 International Year of the Nurse,” the Centennial of Florence Nightingale, through their campaign to raise global public awareness and support for the eight Millennium Development Goals (MDGs).

2/. The Assembly recognizes, in particular, their vital contribution to reducing child mortality and improving maternal health — as specified in MDGs 4 and 5 — and expresses appreciation for their overall commitment to the achievement of these United Nations’ objectives.

Sincerely yours,

Phalakshi Manjrekar, MScN, RN, India
Barbara Dossey, PhD, RN, AHN-BC, FAAN, USA
Dionne Sinclair, MSN, RN, Jamaica
Cynda H. Rushton, PhD, RN, FAAN, USA
Deva-Marie Beck, PhD, RN, Canada

Co-Directors, Nightingale Initiative for Global Health (NIGH) on behalf of 20,000 nurses from 110 nations who have signed the ”Nightingale Declaration for a Healthy World.” See: http://www.NightingaleDeclaration.net

≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈ end of message~~~~~~~~~

”Global Public Health“ has been a key focus of the United Nations, until December 31, 2009, and then the UN focus moves to “Gender Equality” for 2010. We believe that it is, therefore, urgent that we get this Resolution into the UN General Assembly agenda for adoption before the end of 2009.

We have contacted Ambassadors from all 192 Member States, asking them to support this proposal. As well, we have sent them the attached press release, which we will also be forwarding on to all 200+ media representatives and media agencies accredited at the UN.

The NIGH team thank you for your consideration of our request. Please circulate this request to other colleagues.

Additional links: 2010 International Year of the Nurse (IYNurse)

GANM (Global Alliance for Nursing and Midwifery)
 

Sheltered housing, care domains, ADLs, telecare and wardens

Shelter is a basic human need, one rendered acute when people are forced to flee their homeland. On a rather different level in the UK there is currently quite a debate about sheltered housing and the withdrawal of live-in wardens. This 'debate' has even progressed to judicial review.

I've visited many clients when the warden has appeared at the window or door to check that things are aok? Such has been the time keeping and client's faith in their clock that on occasion it could have been Kant walking by. It is often helpful to invest some time and get to know the warden, too see what they know not just about 'care of older adults', but about their residents many of whom become friends. We need to remember what a difference an individual can make in these situations. The clue is in the title 'sheltered housing' which in Hodges' model spans the interpersonal and sociology care domains. I've illustrated this below:

Suddenly, the advent of telecare, video and mobile comms and resulting benefits raise the possibility of service 'duplication' at a time when cost savings are sought in social care. Alternately, we might ask if some overlaps in service provision are good insurance? For the people in sheltered housing and their relatives what did sheltered mean to them when they first viewed the facility, what does it mean now? As is the case with day care centre managers, the more dynamic wardens really do make a difference to these communities of individuals. As Peter Sellers showed us sometimes for a gardener - or a warden - just Being There is reassurance enough.

Hodges' model can be used as a reflective device for this real-world bricks and mortar example of a clash between the humanistic and mechanistic care domains.

Additional link: International Human Rights Day 2009

Original dwelling image from: http://www.cherokeemedicineman.com/dwelling.html

Film image source IMDb

comment: Activities of Daily Living ADLs and Hodges' model [1]

Guy Dewsbury got in touch through LinkedIn in response to the ADL post [1]:

On 12/01/09 6:49 AM, Guy Dewsbury wrote:
--------------------
Hi Peter
Really like your post on ADLs, but it seems that ADLs whenever they are used omit the need of the person in preference to the risk associated with them. I am sure you would agree, that is why I tend to pay a passing nod to ADLs but instead concentrate on what the person actually wants and aspires to and see how this can be achieved.

I wonder what your take on this is. I would have thought that aspiration and need are critical in mental health as well, in fact I would posit that by concentrating on ADLs it is easier to omit looking beyond them to the real needs of the person.
Over to you..
Guy

On 12/01/09, Peter Jones wrote:
--------------------
Hi Guy
Thanks for your comments and feedback. I quite agree - in a way that's what the blog post is saying. If you look at the basic ADLs they are 'placed' or associated with the sciences - processes - physical tasks. That's why I highlighted some of the psychological aspects in the intra-interpersonal domain.

For example, in future posts I may add the way that there are a lot of people with quite chronic respiratory problems, but they carry on as their behaviour has modified such that they know they can no longer run for the bus. Although an assessment of respiration may reveal their (medical) problem their needs are elsewhere.

Perhaps - if you don't mind - I could post your reply and my note above on the blog as a follow-up - since the comments are disabled.

Cheers Guy appreciate your getting in touch.
Peter J.

--------------------
Guy Dewsbury has sent you a message.
Date: 12/02/2009
Hi Peter
Happy for you to post anything you want.
Great reply too
Guy

Image source: Running for the bus - Jess and James

h2cm - Being at the center of things [I]

The center of Hodges' model can represent many things:

an epistemological nexus for the transdisciplinary dependencies of our times
multidisciplinary coffee shop
self-care engagement stage
the chaos of all things
holistic harmony
integrated idyll*

More down to Earth and acknowledging this cruciform '+' structure as a mythic device, in addition to searching for the mysteries of the universe at the center we can also place the 'well' person there.

As the previous post on ADLs suggests the 'well' person can function on a basic level and has negotiated the four axes and the four and five fold knowledge domains. They can therefore be considered (sufficiently) wholly integrated. We are all travellers, constantly traversing these domains of experience consciously, unconsciously, expertly or with the awkwardness that denotes the novice.

Conversely and reflecting the model's utility: it is also possible to locate the unwell individual in the center too. In this instance the placement suggests impoverishment of experience, ongoing personal and social stasis and in the case of substance misuse the presence of specific disruptive focus and preoccupations. The person becomes lost to their potential, stuck in a 4:5-fold minima. They continue to travel chronologically, but the journey is spiral, self-iterative and diminishing by return.

However: what you can see you can change, or come to terms with.

*from Greek eidyllion, little picture (h2cm as a snapshot).

Original image source: http://www1.lsbu.ac.uk/water/protein2.html

Activities of Daily Living ADLs and Hodges' model [1]

The Hodges' model matrix below lists some basic Activities of Daily Living. The intention is to read the table as per the numbers. In 1. - the sciences domain - is a list of basic ADLs, this represents my classification of 'where' these ADLs live within Hodges' model. This is followed by a qualification in the intra-interpersonal domain 2.:

2. While basic ADLs are typically designated as 'functional', that is related to physical abilities they are of course also very dependent upon mental health status. Including: mood, motivation, memory, orientation, confusion. Many ADLs are closely associated with disease and illness, which affects people's independence.	1. personal hygiene dressing - undressing eating and drinking toilet: (urinary and faecal) elimination (often taken for granted) transfers: e.g. bed to chair and back degree of mobility (sitting - standing balance)
4. We can appreciate the impact of the carer's burden by arriving here finally. The sciences, interpersonal and political domains weigh heaviest here, as the carer assumes responsbility for the care of another, themselves and often other dependents.	3. Assessment of ADLs covers aspects of safety and risk to SELF, OTHERS and risk of SELF-NEGLECT. Increasingly, however the emphasis is on self-care, independent living and strengths in the above ADL skills.

In further blog posts I will present a similar treatment of other ADLs with references.

Link:
"Activities of Daily Living Evaluation." Encyclopedia of Nursing & Allied Health. Ed. Kristine Krapp. Gale Cengage, 2002. eNotes.com. 2006. 30 Nov, 2009 http://www.enotes.com/nursing-encyclopedia/activities-daily-living-evaluation