- provides a space devoted to the conceptual framework known as Hodges' model. Read about this tool that can help integrate HEALTH, SOCIAL CARE, INFORMATICS and EDUCATION. The model can facilitate PERSON-CENTREDNESS, CURRICULUM DEVELOPMENT, HOLISTIC CARE and REFLECTION. Follow the development of a new website using Drupal (it might happen one day!!). See our bibliography, posts since 2006 and if interested please get in touch [@h2cm OR h2cmng AT yahoo.co.uk]. Welcome.

Thursday, May 27, 2010

Wageningen MultiMedia Research Centre

I am away for a week and will be e-free. Amongst reading materials I'm packing Learning Drupal 6 Module Development. Last evening I came across Wageningen MultiMedia Research Centre (WMMRC) a treat to explore for when I return. Rather than a more complete educational Drupal distribution there are some specific modules that might work as a plug-in:

  • ClosedQuestion
  • Proteus
  • LinearCase
The publications are extensive and of relevance too.

(Bye for now ... There's a post scheduled for 1st June on Proteus)

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Wednesday, May 26, 2010

Call for Proposals to Phase 3 Lifelong Health and Wellbeing (LLHW)

Last month I posted the advanced notice about this call for proposals, which is now fully released and has been publicised on the SPARC / KT-EQUAL network:

Dear All (but especially researchers who are desperate to secure research funding)

The Call for Proposals to Phase 3 of the cross-research council multi-health agency Lifelong Health and Wellbeing (LLHW) initiative was released today.

Details can be found at:


This is a very significant opportunity, well worth close scrutiny and consideration and, hopefully, subsequent action.

If you have any uncertainties about the programme or its requirements then I am sure that the representatives of the research councils will be very pleased for you to make contact with them.

Importantly this is a call for multidisciplinary research, a requirement which must be wholeheartedly embraced for any proposal to stand a chance of being eligible for consideration.

It's time for action!!

Best wishes

Peter Lansley
Professor Peter Lansley, BSc, MSc, PhD, MCIOB, FCOT
Director, KT-EQUAL – Knowledge Transfer for Extending Quality Life
School of Construction Management and Engineering, URS Building,
University of Reading, Whiteknights, PO Box 219, Reading, RG6 6AW, UK
p.r.lansley at reading.ac.uk

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What's good for art students ....

Never take the stylus or brush
in your hand if you have not first
constituted in your mind all that you have to do.

Leon Battista Alberti, On Painting, 1435-36

My source: 16 May 2010, Visit to The British Museum, Italian Renaissance drawings.

Is this my excuse for taking so long with a new website?

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Tuesday, May 25, 2010

Curriculum design and the value of whitespace

The best websites are often variously described as clean, slick, easy to navigate and access. They are considered 'best' often as a consequence of appreciating the need for whitespace. This means of course that they are also minimalist, uncluttered, easier to style consistently and they often have plenty of free space. The Google site and resulting interface is a prime example, to the extent it has become a recognised brand characteristic.

The pressures on curricula almost preempts the phenomena of student cramming. Without careful planning and discipline curricula can be jammed so full that there is no slack, no whitespace.

As a result there is also no space to reflect (Clouder, 2009).

Lynn Clouder (2009) Promotion of Reflective Learning, Teaching and Assessment through Curriculum Design, Occasional Paper 10, Connecting Reflective Learning, Teaching and Assessment, Edited by Helen Bulpitt and Mary Deane, Higher Education Academy. p.11.

Additional links:
Whitespace programming language

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Monday, May 24, 2010

Drawing - the stage of conceptual design

The health career model
- drawing -
for health and social care professionals, et al.. ...

"The Italian word for drawing, disegno,
also encapsulates the stage of conceptual design.
The ability to imagine a design
and then develop it on paper was an increasingly valuable skill."

The Purpose of Drawing: The British Museum, May 2010.

Additional link:
Disegno: Italian Fine Art Drawing

My source: 16 May 2010, Visit to The British Museum, Italian Renaissance drawings.

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Sunday, May 23, 2010

63rd World Health Assembly unanimously adopts the WHO global Code of practice on the international recruitment of health personnel

Dear HIFA2015 colleagues,

Please find below a press release from the Global Health Workforce Alliance. In the words of Dr Mubashar Sheikh, GHWA Executive Director: "The world is now a significant step closer to ensuring health workers are available and accessible to all".

WHO/Jess HoffmanPRESS RELEASE: 'Sixty-third World Health Assembly unanimously adopts the WHO global Code of practice on the international recruitment of health personnel. Alliance members and partners applaud Member States. The Alliance 21/05/2010.

[Photo: WHO/Jess Hoffman. Dr Pierre François Unger, State Councillor of the Canton of Geneva, addresses delegates at the opening of the Sixty-third World Health Assembly.]

'Geneva, 21 May 2010 - In a historic move today, the Sixty-third World Health Assembly unanimously passed a resolution to adopt the voluntary WHO global Code of practice on the international recruitment of health personnel. With this step, the world's nations acknowledge the global dimension and complexities of the health workforce crisis and the interconnected nature of both the problems and the solutions.

'With this resolution, Member States commit themselves to the voluntary principles and practices for the ethical international recruitment of health personnel taking into account the responsibilities and rights of source and destination countries, other stakeholders, and those of the migrant health personnel themselves. The Code provides ethical principles applicable to the international recruitment of health personnel in a manner that strengthen the health systems of developing countries.

'A drafting committee was established on the first day of the Assembly and after three days of negotiations, stayed up till 4:30 am on Thursday, 20 May 2010 to seek consensus on a draft resolution that retained the principles and spirit of the Code while also representing a way forward for all countries.

'The draft was unanimously accepted at the tenth session of Committee A late evening on 20 May 2010 and brought long awaited joy and celebration to the many organizations and individuals, campaigners and professionals, institutions and Member States who had been working tirelessly since the last three years to see a meaningful and equitable resolution on the Code be adopted at the World Health Assembly.

'"The process was not always easy, but there was commitment from all Member States to see a resolution adopted. This helped to keep the process moving and the results are there to see" says Alliance Board member, Bjarne Garden, Assistant Director, Global Health and AIDS Department, NORAD, a member of the Norwegian delegation.

'"This brings to fruition the pioneering work seeded by the Alliance three years ago with the creation of the Health Worker Migration Initiative bringing together the Health Worker Migration Global Policy Advisory Council and WHO led team of technical experts. It is the result of the work of multiple stakeholders who have effectively rallied around together. The world is now a significant step closer to ensuring health workers are available and accessible to all", says Dr Mubashar Sheikh, Executive Director, Global Health Workforce Alliance.

'World Health Organization (WHO) has played a key role in coordinating the process. "The Code sets out a roadmap for implementation. Within 2 years WHO will provide guidance to countries on monitoring implementation of the Code, and then report to the Assembly on the progress against implementation. The Code is voluntary, but progress on implementation will be monitored and reviewed" explained Dr Manuel Dayrit, Director, WHO department of Human Resources for Health.

'Health personnel migration has been a clearly identified priority for the Alliance since its inception. During the First Global Forum on Human Resources for Health in March 2008, the Alliance endorsed the Kampala Declaration and Agenda for Global Action, which sparked broad interest in the creation of the Code.

'Progress on the code has been achieved as a result of consultations and discussions, particularly at all six WHO Regional Committees and national consultations, involving participation by a wide range of stakeholder groups. The UN ECOSOC meeting and the G8 Summit in July 2009, and the UN General Assembly in December 2009 had strongly supported and encouraged WHO to move forward in finalizing the draft code of practice. The 126th Session of the WHO Executive Board, January 2010, had discussed a revised draft of the Code and recommended that it be submitted to the 63rd World Health Assembly.

'At this momentous milestone, the Alliance and WHO call upon Member States and all its partners to reinforce its spirit of working together as they now gear up to implementing the code. The Alliance remains committed to facilitating the process and supporting sharing of information among Member States and all stakeholders.'

The Draft Resolution, dated 20 May 2010, is available here:

Key elements of the draft code (as described in The Lancet, 15 May) are:

  • Establishment of voluntary global standards for ethical international recruitment of health personnel, balancing rights and obligations of source states, destination states, and health personnel.
  • Promotion of coordination of national policies and international cooperation among states and their partners in health professions and civil society.
  • Recommendation that states strive to meet their domestic needs for health services with their own human resources through planning, education, and training for health workforce.
  • Recommendation that states ensure that international migration should have net positive effect on developing countries through technical assistance, support for health personnel training and retention, twinning of health facilities, and specialised technology and skills transfers.
  • Recommendation that states establish voluntary financial mechanisms to support efforts of developing countries to strengthen health systems.
  • Recommendation that states protect rights of migrant health workers through fair labour practices. In all terms of employment and conditions of work, migrant health personnel should enjoy same legal rights and responsibilities as domestically trained health workforce, without discrimination.
  • Recognition that health personnel have ethical responsibilities to cooperate with local authorities in interests of patients, health systems, and society.
  • Recommendation for national data collection and information exchange on health personnel migration, including establishment of national centre for information exchange, expansion and coordination of national research, and periodic reporting to WHO.
  • Promotion of compliance through periodic state reporting to WHA of measures taken to implement the code; and recommendation that WHA periodically reviews the code's implementation with input from non-governmental sources.
Allyn L Taylor & Lawrence O Gostin. International recruitment of health personnel. The Lancet, 375(9727)1673-1675, 15 May 2010
(free access after free registration)

My source: HIFA2015 with photo addition

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Ensuring You Have Nursing Skills Through 2030 ...

In Computing 20 May 2010 Andrew Charlesworth (p.24-26) writes about a report from Gartner the IT industry advisory group warning of a gap in mainframe skills due to the imminent retirement of experienced IT staff. The report notes:

"Increased focus needs to be to be on the preservation of detailed and specialised expertise that goes well beyond basic knowledge."
Nursing faces its own challenges in terms of skill gaps and loss of skills due to retirement. In contrast to the mainframe IT market the skills needed is in the orchestration of basic nursing care.

This is an ironic state of affairs as there are many forces acting to deprofessionalise nursing. Demographic trends is one. This is happening amid decades of specialisation and the production of - profession establishing - models and theories of nursing (care). Some of these are, however, quite complex and removed from the rudiments and tenets of basic nursing care.

The real irony here though? Well, as the demographic wave washes over many nurses themselves, the care they may subsequently need and receive will - just like mainframe skills - be the harvest from seeds they have also cast, or are sowing right now.

Ensuring You Have Mainframe Skills Through 2020, Gartner, Mike Chuba, Research VP.

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Saturday, May 22, 2010

Prognosis for NPfIT remains uncertain - 21 May 2010 - Computing

While the coalition government’s Programme for Government reiterates previous commitments around technology and civil liberties, IT procurement and broadband rollout, it is noticeably silent on the future of the NHS National Programme for IT (NPfIT), with no mention of Conservative promises prior to the election to dismantle the "NHS supercomputer" or the Liberal Democrats' pledge to scrap large parts of the NPfIT.

Prognosis for NPfIT remains uncertain - 21 May 2010 - Computing

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The health career model, reflection, curriculum development

There are many new insights and remembrances available in the content of -

Occasional Paper No 10 (PDF access)
Connecting Reflective Learning, Teaching and Assessment
October 2009 by Helen Bulpitt and Mary Deane

We tend to speak of reflection as if it is merely a case of being in the right place at the right time:
in front of a mirror or other reflective surface.

Among the issues raised in OP #10 (which I will expand and explore further) are:

  • the need to embed reflection in learning, teaching and assessment at the curriculum design level;
  • the existence of an optimal curriculum design that can foster effective critical reflection (Clouder, 2009);
  • reflection to meet specific learning outcomes can be said to be 'reflection to order' (Dalley, Chap 2, 2009);
As this short list shows reflection is a complex and serious component and activity of learning. A central problem is in the assessment and marking of reflective writing (Deane, Chap 5, 2009; Dalley, Chap 6, 2009). Marking a piece of reflective writing what would we look for:

  • Observation
  • Structure
  • Reasoning
  • Critical review
  • Argument
  • Personal disclosure
  • Writing?
There really is the basis for a paper here on the health career model, reflection and there on the horizon - curriculum development.

Image source:

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Tuesday, May 18, 2010

HEA Mental Health SIG, h2cm & reflection

The HEA mental health SIG presentation yesterday on Hodges' model was very well received. The other sessions were also very interesting and of direct relevance to my role in the care of older adults and mental health. The other sessions were on national dementia strategy and a study of competencies, plus the use of a book club in student learning. I hope other opportunities will arise to spread word of the health career model at other events. The trip (British Museum and an hour in the National Portrait Gallery inc.), networking and dialogue that ensued was very enjoyable. The next meeting will be later in the year and may be in Glasgow, so check their site and I will see if I can post future details on W2tQ.

In addition to the potential of the model being recognised, I also had to defend some points and assumptions that I have carried for a long time:

  • The Care Programme Approach and flexibility of community mental health nurses to employ the model;
  • associating 'audiences' to specific care domains (as per the - dated - introductions to the model - click on the images);
  • the level of the model - the fact it is 'high level'.
I say defend in the sense that I continue to hide behind the slogan: the website and this blog represent a call for research, evidence and verification of the model (I did this yesterday!).

Is my proselytizing virtually, to placement students and at events such as the HEA justified, or the result of over-valued idea? This model definitely has a role to play. It is one of many tools, in a way it is the toolbox.

Browsing the HEA website and other SIGs I found one devoted to reflection. As we wrapped up in the afternoon Charles Kasule (Communications & Resources Officer) brought in an occasional paper produced by the group:

Occasional Paper No 10 (PDF access)
Connecting Reflective Learning, Teaching and Assessment (250KB)
October 2009 by Helen Bulpitt and Mary Deane

This is a brief (pp.76) but very useful introductory reader on reflection. Reflection is central to the creation and application of the health career model being one of the original purposes. My presentation included a 15 minute powerpoint breather when we collectively reflected on dementia care across the model's care (knowledge) domains. I will read OP #10 and share my thoughts here over the coming months. Should anyone be interested in exploring reflection in theory, practice, or both please get in touch. Finally, I am very grateful to Bill Penson the mental health SIG facilitator for the slot and the HEA for making this and other occasional papers freely available. More to follow ...

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Sunday, May 16, 2010

Nursing: Art and Science ... Fra Angelico to Leonardo

I arrived in London at noon in preparation for the Higher Education Academy mental health SIG meeting tomorrow at King's College, which includes a presentation on the health career model.

The afternoon was spent at The British Museum exhibition Fra Angelico to Leonardo: Italian Renaissance drawings

Early in the life of W2tQ visits to the Tate in London and Liverpool prompted a blog post or two.

Visiting this stunning exhibition even before I fastened and feasted on the first drawing, the subtitled walls announced the various exhibition themes and for me instantly suggested links to health care:

Drawing the father of our three arts -
architecture, sculpture and painting

Georgio Vasari. Lives of the Artists, 1568.

sculpture equates to medicine-surgery
painting to nursing
our care models provide the architecture and palette*

We all draw (model) individually in thought and reflection, these are then shared in our various collaborations and engagements, media forms and records.

Do we need a 21st century renaissance
in the study and appreciation of models of care?

Additional links:
Financial Times: Review

*Red, Green, Blue, (Black & White)

There are a few more prospective posts arising from this museum visit - time - will draw them out.

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Saturday, May 15, 2010

Holistic bandwidth (and the dangers) of political care

The attack on MP Stephen Timms here in the UK highlights not only the ongoing importance of personal safety for public service personnel, but how much politicians value their constituency work. It is no accident that these sessions are called "surgeries".

The politician meets not just a citizen, but a political obligation and duty to care. In the media reports it was interesting to hear of how much satisfaction MPs get from their constituency work. Listening to the reporting and debate prompted me to realise that although politicians vary in how well they engage and empathise with their constituents the problems they are asked to deal with covers a broad holistic spectrum. Consider this listing written by Tony Wright MP:

  • The education system
  • The transport system
  • The social services
  • Health services
  • Housing
  • The environment
  • Government bodies
  • The justice system
  • Immigration and asylum
  • Finances and employment
  • Trade unions
  • The media
I am a community nurse five days a week.

Our MPs are community politicians one day a week with 'Constituency Friday'.

So to The Rt Hon. Stephen Timms (and his staff) I wish you a speedy recovery and congratulations on the extent of you and your peer's constituency work.

Holistic in a word and deed.

Congratulations also to the Green Party on the success of their leader Caroline Lucas MP.

The Health Career Model: POLITICAL domain resources

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Friday, May 14, 2010

Health, social care and personal map making

Vermeeer painting

There have been two series running on BBC 4 in the UK over recent months and currently with a cartographic and historical focus:

see - The Beauty of Maps

This Vermeer - The Art of Painting - was featured in one programme and reveals the power and status of maps as Wikipedia also explains.

It is natural to see the health career model as a map, but this map is not just the preserve of the wealthy. Hodges' model can be used universally by all - a common framework.

Use of the term map and its synonyms is in turn common in medicine in many forms:

The above sites reveal how maps, charts and atlases relate the individual, geography and health.

In addition to its geographic connotation projection also has a psychological meaning. Hodges' model provides a substrate* on which to project personalised, national and global health.

An individual; a people; a nation: for each a journey .... and for each a map ....

Image source:

* You have to love that floor ;-)

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Wednesday, May 12, 2010

Drupal musings 3: PHP, Textmate, h2cm and Forms

Happy International Nurses' Day!

For quite a few months I have not connected the MacBook to the external monitor. I did so last night using:

(Experienced programmers may at this point want to go review some political party broadcasts - coalition news as there's a lot more happening there.)

I typed in a PHP file, purposefully trying Textmate's 'Bundles' > 'HTML' > options to mix some PHP and HTML.

The file does not do a lot, but like creating, reading and writing a file it's a start. All this effort does is display four text box input fields (Chapter 11 Form Handling) with submit buttons. Previously I have mirrored the laptop screen to the external 24" Acer, that appears to be the default. ;-) Tinkering with the display options and turning off mirroring I found that I could pick up the Textmate window and move it to the big screen on my right. Meanwhile on the laptop I could preview the output in the browser. Apple's Spaces is a related facility to master.

Not only that, but suitably editing the PHP file in Textmate resulted in updates on the browser (Refresh after change. Delay 0.40 s.) To me - that's Magic!

On the Drupal front - despite the title of this post - there's not much to report. The news is brief and yet kind of major in that I've bought my ticket for Drupalcon in Copenhagen. I am really gutted that this year I did not get to the Scottish Ruby Conference in March, after '08 and '09. At least getting to grips with Textmate will also help with Ruby (and Rails) too.

OK, back to Textmate to try the other PHP input types: text area, check boxes, hidden fields, select and labels.

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Tuesday, May 11, 2010

Injustice: Why social inequality persists by Daniel Dorling

InjusticeI first came across the work of (Prof.) Danny Dorling in the 1990's in connection with workshops on visualization in the social sciences and Geographic Information Systems (GIS). The other week I read a feature on his (very timely) book in the Society section of The Guardian (O'Hara, 2010).

You do wonder exactly where we are in policy terms given the interval since the Black Report. Dorling's book then sounds like a must-read, with the information posted below from the publishers.

In addition in Waterstones at the weekend I found The Spirit Level, available on their 3 for 2 offer. The links also posted below with an insightful 2009 review of The Spirit Level by Daniel Ben-Ami on sp!ked; plus a related LGC & HSJ event:

Implementing the Recommendations of the Marmot Review:
Reducing Health Inequalities

Injustice: Why social inequality persists

About This Book

Few would dispute that we live in an unequal and unjust world, but what causes this inequality to persist? Leading social commentator and academic Danny Dorling claims in this timely book that, as the five social evils identified by Beveridge are gradually being eradicated, they are being replaced by five new tenets of injustice, viz:

  • elitism is efficient;
  • exclusion is necessary;
  • prejudice is natural;
  • greed is good; and
  • despair is inevitable.

In an informal yet authoritative style, Dorling examines who is most harmed by these injustices and why, and what happens to those who most benefit. Hard-hitting and uncompromising in its call to action, this is essential reading for everyone concerned with social justice.

"His attack on elitism and despair is impressive, his factual evidence undeniable." Rt Hon David Blunkett MP

Additional resources for Injustice: http://www.policypress.co.uk/injustice_appendix.asp

Dorling, D., Orford, S. and Harris, R. (1998) Visualization in the Social Sciences, A Report for the ESRC/JISC Advisory Group on Computer Graphics, AGOCG Technical Report No 41 (ISSN 1356-9066). Report as a PDF

O'Hara, M. (2010). Why Britain's battle to bring down social inequality has failed, p.1 of the SocietyGuardian section of the Guardian on Wednesday 21 April 2010.

The Spirit Level: book

The Equality Trust, established by the authors.

Distorting the spirit of equality, sp!ked review of books.

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Sunday, May 09, 2010

International Journal of User Driven Healthcare (IJUDH) CfP

Dear Mr. Jones

In view of your work in patient-centered care, I’d like to invite you and/or your colleagues to submit a paper to this Special Issue of the new journal described further below and via the web link provided. I think our global readers would be very interested in your thoughts (and projects) on innovative ways to get relevant healthcare information into the hands of ‘users’ (both patients and providers), within the user-driven EBM paradigm, per below.

Please also share this call for papers with your colleagues.

Thanks for your consideration,

Susan Ross, MD

International Journal of User Driven Healthcare (IJUDH) Call for Papers

Rakesh Biswas,
Center for Scientific Research and Development (CSRD),
PCMS Campus, India

Published: Quarterly

Call for Papers - Special Issue:

Submission Due Date: July 1, 2010
Special Issue On User Driven Healthcare and Evidence-based Medicine

Guest Editors:
Susan Ross, MD, FRCPC


User Driven Healthcare (UDH) is part consumer-driven healthcare, part narrative medicine, and part Health 2.0. It stems from a concept of participatory healthcare whereby all stakeholders, enabled by information, software, and cyber-community, focus on healthcare value. But where does Evidence-based Medicine (EBM) fit into this framework? It is sometimes forgotten that EBM is a three-legged stool, comprised of the triad of evidence +provider expertise + patient preferences. In this EBM framework, provider expertise is needed to bridge the inferential gap between population-based evidence and the individual patient. And each patient's values and preferences should narrow that inferential gap further. But since the introduction of EBM nearly two decades ago, the primary focus of EBM proponents has been on Evidence, at the expense of patient preferences and provider expertise. Perhaps this is why the promise of EBM to foster the most efficient and high quality healthcare has not yet been realized.

Objective of the Special Issue

This Special Issue will focus on the following questions: Is the recent emergence of User Driven Healthcare really a new, post-EBM paradigm for healthcare, or just an overdue consideration of the other two legs of the original EBM stool? How might this trend affect all stakeholders?

Recommended Topics

Topics to be discussed in this special issue include (but are not limited to) the following:

  • Developing valid patient-level evidence using the Web
  • Evidence generation—clinical research strategies using social media and mobile technologies
  • Examples of UDH to a) help formulate the right questions to ask in EBM; b) develop answers to those questions; c) disseminate the answers to patients and providers with a need to know; and d) test the impact of UDH-generated Evidence on patient outcomes
  • Helping online patients sift the ‘wheat’ from the ‘chaff’—information management for patients in an EBM world
  • How to incorporate patient preferences and values into ambulatory care decision-making (i.e., into the 10 minute visit)
  • Measuring the impact of UDH on patient outcomes
  • Patient-level decisions vs. population-level evidence (bridging the inferential gap)
  • Pharmaceutical communication strategies using social media—impact on healthcare quality and costs in an EBM framework
  • Place of social media in EBM—patient and physician online communities
  • Practice of UDH vs. EBM around the world
  • Regulatory issues of evidence dissemination by industry using social media in healthcare Statistical and other evaluative methods to assess the validity and reliability of evidence developed using social media and mobile technologies
  • Trends in N-of-1 studies, and their relevance to EBM and UDH
  • Use of collective intelligence to solve healthcare problems for individuals and communities

Researchers and practitioners are invited to submit papers for this special theme issue on User Driven Healthcare and Evidence-based Medicine on or before July 1, 2010. Submissions received after this date will be reviewed for possible publication in subsequent issues of the journal. All submissions must be original and may not be under review by another publication. INTERESTED AUTHORS SHOULD CONSULT THE JOURNAL’S GUIDELINES FOR MANUSCRIPT SUBMISSIONS at http://www.igi-global.com/development/author_info/guide.asp. All submitted papers will be reviewed on a double-blind, peer review basis. Papers must follow APA style for reference citations.

All submissions and inquiries should be directed to the attention of:

Susan Ross, MD
Guest Editor

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Friday, May 07, 2010

Comment: session at Beyond These Walls - Public Engagement Colloquium

I am of course really pleased that Prof. George Kernohan employed h2cm in his presentation last month - Beyond These Walls - Public Engagement Colloquium which I posted on W2tQ.

Considering his abstract I have added some observations below that I hope will further highlight the model's potential utility in this and other areas.

To begin George is quite right to describe the model as -

'a relatively simple way to think about and summarise the variety of engagement types.'
This explains the model's use as a student resource, a foundational framework on which to superimpose their learning and map placement and professional development experiences. As a learning activity reflection is greatly concerned with the student's accounts of engagement with patients, colleagues, carers and the public at large. This also flags up the belief that the model has some generic educational purposes in health and beyond with patients, carers and the public.

The model should not however be restricted to simple representations and applications. Granted the safety, efficacy and value of the model remain to be proven, but hopefully the directions indicated here on W2tQ and in publications to date are worthy of further exploration? More complex - lifelong learning - uses of the model might include:
  • case formulation
  • psychological therapy formulation (CBT, family)
  • self-directed care planning and budgeting (sign-posting)
  • complex systems in health care
  • policy and politics in health care
  • reflection: students, client life story work
  • integrating care recording
  • and clearly public engagment in many contexts; research, management and service development.
I am adding my (italicised) comments to Prof. Kernohan's original abstract below:
The first quadrant [SCIENCES] deals with scientific response to individual signs and symptoms: where engagement aims to ensure that people comply with the healthcare intervention: engagement is about informing the patient and their informal carer about their physical needs and responses.
People comply when they understand treatments and this understanding needs to be demonstrated. There has been much emphasis on concordance, but this has to be earned as Prof. K. indicates.
The second quadrant [POLITICAL] deals with mechanistic and group activity: for example political interventions to agree rules, policy and systems. Engagement here refers to members of groups working under a specific governance system or approach– activists and unions lobby for change, in this care domain. Arrangements for protection of vulnerable people are set through engagement here. Ethical issues guide the group mechanistic activities.
The past couple of years has seen a whole new group of people acting in this domain. The Mental Capacity Act has resulted in various protections for individuals who are assessed as lacking mental capacity. Whilst this is quite specialist and the province of secondary care and social services, the public will increasingly be exposed to vulnerable adults in their community, on their street. (I saw a gent walk past last night - to be collected by a care worker and taken back to the near-by care home. There was some resistance as they reached the corner. Deprivation of liberty and best interest sprang to mind. ...)

There are numerous other examples: membership of the public in Foundation Trusts, consultation processes on service locations, the provision of information resources for the public.

Another critical policy factor here is QUALITY, how this is measured and the public engaged in those measures and their EVALUATION.

A hybrid approach WILL be needed. A single measure is insufficient and within h2cm inevitably skewed.

Thirdly [SOCIOLOGY], there are more humanistic aspects of care: speech, thought, narrative and free text: stories contribute to group actions. Here we have the social and cultural components to remind us that engagement must work in a social context.

I tend to ground speech and thought in the interpersonal domain (related to cognition) as the primary focus of nursing (health and social care) is the individual. Although communication (society) is impossible without thought and speech and there is a special link here in that the individual cannot acquire appropriate thought and speech without being socialised.

Stories have a definite home in this care domain. Stories are the foundation of what people share, who we are, heritage. Stories differentiate familiars and strangers - stories old and new. Narrative medicine is here, right now. Significantly, the rise of science is in diagonal opposition to the domain of stories.
The final domain [INTER-intraPERSONAL] emphasizes the role of the individual in needing tailor-made care, requiring dignity and respect. Here lies a more holistic type of care and is more ‘mind’ than ‘body’ where interpersonal aspects of engagement are more person-centred.
This domain and the proximity of the 'individual' axis is the focus of nursing care. The rationale for individualised, personalised, person-centred, client-centred care is found here. We need to cross the individual axis repeatedly in order to achieve holistic care. There is no single destination. This journey is never a 'single' in two senses: neither one-way, nor travelled alone hence George's objective in public engagement.
Across all four care domains, public engagement is a key sustaining action to make the model meaningful but also to provide some reassurance that engagement although complex and varied, can be managed in a logical way to enhance care.
I can see what George means by stating that engagement can be managed in a logical way.

Logic's extent varies across the care domains of Hodges' model; from the logical affirmation and assurance that underpins evidence based interventions to the decision algorithms that inform NHS Direct. There is also a need for recourse to several forms of logic as the model is traversed and negotiated. Folk theory, dreams, the chaos of elections and economic uncertainty, and the public's sense of demographic trends also have their place.

I understand that Prof. Kernohan's slides will be posted on the event website in due course.

Many thanks to Professor Kernohan for his recognition and publicizing of the health career model.

Image source:
Gogeometry.com - http://www.gogeometry.com/problem/p076_square_circle_area.htm

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Wednesday, May 05, 2010

Hodges' model: subject of a session at Beyond These Walls - Public Engagement Colloquium

Hodges' model found a place in a session at:

Beyond These Walls - Public Engagement Colloquium
Faculty of Life and Health Sciences
22nd April 2010 at the Ross Park Hotel, Kells

Theoretical review of public engagement in Nursing: Abstract

by George Kernohan, Professor of Health Research Nursing, University of Ulster

Nursing & health professional have wide roles in care of people in need, in sickness and in health and in supporting their informal carers. These roles, by necessity involve people in various ways: in this paper Hodges Health Career Model (Jones, 2009) is used to provide a framework to underpin public engagement in nursing. The model provides a relatively simple way to think about and summarise the variety of engagement types. It comprises two lines and eight words which appear to provide a graph with two axes. The vertical axis involves the recipients of care: individuals and groups, the other involves the care provider and what they do: from mechanistic to humanistic.

The first quadrant [SCIENCES] deals with scientific response to individual signs and symptoms: where engagement aims to ensure that people comply with the healthcare intervention: engagement is about informing the patient and their informal carer about their physical needs and responses.

The second quadrant [POLITICAL] deals with mechanistic and group activity: for example political interventions to agree rules, policy and systems. Engagement here refers to members of groups working under a specific governance system or approach– activists and unions lobby for change, in this care domain. Arrangements for protection of vulnerable people are set through engagement here. Ethical issues guide the group mechanistic activities.

Thirdly [SOCIOLOGY], there are more humanistic aspects of care: speech, thought, narrative and free text: stories contribute to group actions. Here we have the social and cultural components to remind us that engagement must work in a social context.

The final domain [INTER-intraPERSONAL] emphasises the role of the individual in needing tailor-made care, requiring dignity and respect. Here lies a more holistic type of care and is more ‘mind’ than ‘body’ where interpersonal aspects of engagement are more person-centred.

Across all four care domains, public engagement is a key sustaining action to make the model meaningful but also to provide some reassurance that engagement although complex and varied, can be managed in a logical way to enhance care.

Jones, P. Hodges Health Career - Care Domains – Model. 2009.
http://www.p-jones.demon.co.uk/ accessed 25/03/2010

Chambers, R. Involving Patients and the Public. How to do it better. 2000. Radcliffe, Oxon

Related links:

Kernohan, G. Theoretical review of public engagement in Nursing. Proc 1st Public Engagement Colloquium, Kells, Co Antrim, 22 April.

Science in Society

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Sunday, May 02, 2010

Update - King's College London mental health SIG 17 May

With the title of my talk sorted here is the programme for the Mental Health SIG meeting:

Health Sciences and Practice Subject Centre
Room: 1.17 Franklin Wilkins Building (1st floor)
Franklin-Wilkins buildings, King's College London,
150 Stamford Street, London SE1 9NH

Monday 17th May
10- 4pm
King’s College London, Waterloo

10:00 Arrivals and Refreshments

10.30 Welcome and introductions
Bill Penson
Teacher Fellow/Senior lecturer in Mental Health,
Faculty of Health, Leeds Metropolitan University

11.00 ‘The Darzi Dementia care pathway- competencies’
Professor Paul Kingston
Faculty Director for Research and Scholarship
Staffordshire University

12.00 Lunch and Networking

13.00 ‘Hodges' model: a conceptual framework’
Peter Jones
Community Mental Health Nurse NHS,
Independent Scholar & Informatics Specialist

1400 Refreshments

14.30 ‘e-PsychNurse’ an EU funded project
Professor Mary Chambers
Director of Nursing
South West London and St George’s Mental Health NHS Trust

15.30 Future meetings and summing up
Bill Penson

16.00 Close

I can expand on my plans - broadly three 20 minute sections:
  • Re-introduce the model, history, background;
  • Explain h2cm's relevance, scope and applications - possibly with a brief exercise;
  • Discuss publications to date, future publication plans to include the website and use of Drupal, with time for questions.

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Saturday, May 01, 2010

Health, social care and informational emaciation

We hear a lot about information and how important it is, being in what is described as the information age, the information economy. ...

Nurses, patients and carers (plus managers) would instantly recognise that if a care plan and subsequent care delivery was based on the following assessment:

oriented, not depressedhypertension, falls, dizziness, headaches, pyrexia
carer due hip operationadmitted 1st May 2010 1200hrs
to clinical decisions unit

- we would be acutely concerned.

Clinically this is a case of informational emaciation. The information above is rather thin on the ground, this in turn affects the knowledge that can be gleaned in formulating, negotiating and agreeing actions. Even in the information sparse example above each of the care domains has some content; is that always the case?

Use of the word emaciated in this context is not intended to diminish the plight of people who are physically emaciated, poorly nourished.

This post is intended to highlight another aspect of poverty.

As the Global Healthcare Information Network (HIFA 2015) argues and campaigns - information is a means to emancipation - a way to overcome information emaciation.

Additional links:

Picker Institute Europe

Patient Information Forum

Patient Information Advisory Group

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