Hodges' Model: Welcome to the QUAD: August 2010

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

Friday, August 27, 2010

Drupal musings 12: Semantic Web, ICNP, Case studies and Care domains

Drupalcon 2010 Copenhagen is over for me. It's been a really useful week: awesome indeed. My head is dizzy with all the options, sources and resources to consider. I will contact the London Drupalcon group for 2011 with some suggestions regards beginners, networking and outreach.

Ever since setting off on the Drupal road, the semantic web has been a constant item of street furniture. In Szeged '08, Paris last year and this past week in Copenhagen the semantic web, RDF and terminologies have had a pivotal presence. I did not attend all the rdf / SW sessions but Wednesday's Semantic Terminologies was sit on the floor popular (even though at that point the program hit a bottleneck from 6 to 3 streams). Whatever the cause - I was there, late and my pivot ached (no padding!).

As a Drupal 7 prelude I'm creating a Drupal 6 site, a basic homepage for someone. The content for the latter is fixed - sorted. Apart from the pages for the archive, the new h2cm content involves me figuring out how to combine:

  1. the health career model;
  2. nursing - in theory and practice;
  3. external sources and resources;
  4. and Drupal.
Johannes Wehner's terminology session above did not emphasize RDF, but highlighted Open Linked Data by means of Open Calais as a tool to extend existing content. I've downloaded the Drupal OC module and obtained a key.

As for the list: #1 The health career model is straight forward really. Four care domains - get on with it! From there though it is quite a reach to encompass #2 & #3. My options appear to be:
  • free tagging, auto tagging - let the users of the site decide;
  • pre-define a data set, a terminology (classification) for the health career model;
  • use an existing nursing classification / terminology scheme - perhaps a subset.
Before I decide I need to be aware of what is available. I e-mailed Derek Hoy in Scotland - contact for the International Classification for Nursing Practice® [ICNP]. This is another thing I pick up, put down. ... Now thanks to Derek I'm sorted now with ICNP downloaded (and I will need a module to import .csv files). There are videos on the ICNP website.

I have followed the development of nursing terminologies for quite some time. The most striking thing to me is how removed they are from the day-to-night life on wards and other care encounter situations. With mental health as a Cinderella in terms of the politics and recognition of nursing service provision I am in effect professionally twice removed. For the vast majority of nurses on the ground and from where I work in community mental health the ICNP, SNOMED CT, Omaha and other schemes are rather esoteric things. They are there in the background, part of management and reporting 'function'. This is not to say that the above initiatives have few followers, or lacks experts in this field. Make no mistake nursing has its own geeks, nursing classification its experts!

The scope of ICNP makes it a great candidate (from the website) -



Individual 7 axes

  1. focus
  2. action
  3. client
  4. judgement
  5. location
  6. means
  7. time
  • it's International;
  • it's by nurses, for nurses;
  • it has momentum (political and financial support);
  • So it is credible, and research based.
Despite this, I must take a critical look at what is available for my needs and time available. All the above provide way too much for a first bash - prototype, proof of concept. I have the luxury of not worrying about safety. My project does not constitute an electronic health record or other variant. Yes, I want to prove the health career model and to this end I must also find or create several nursing case studies to interrogate within Drupal and h2cm.

Perhaps as things improve economically, nursing classification will be revived and will allowed the time to fully mature? I recall in 2006 plans to explore mental health within SNOMED which unfortunately did not materialise. So, when I say mature, I mean like cheese in the holistic senses of the ingredients: nursing care concepts across contexts that also incorporate self-care, recovery, demographic trends ...; and the process across communities of practice (integrated care) through to academic and management applications - research / reporting.

In March 2010 plans were announced of plans to harmonize the efforts of the ICNP and SNOMED CT nursing.

So, with a possible jumpstart - a sprint for my site this autumn in Manchester, UK and work afoot to make nursing classification matter on the 'ground' there is more to follow on several fronts. ... I remember a presentation Derek did in the 1990s about classification and making nursing visible - let's do it!

contact: h2cmng @ yahoo.co.uk

Thursday, August 26, 2010

PC footprints 1981 - 2010

Peter Jones 2010 Eden ProjectAt the Eden Project there is a sculpture which depicts the e-hardware an average Jo will use and dispose of in a lifetime (those teeth are made up of computer mouse). Overall this amounts to 3.3 tonnes.

I've listed this before on W2tQ, but my micro - PC footprint runs as follows:

  • Sinclair ZX81 - 1981
  • BBC microcomputer model 'B'
  • BBC Master 128 - 1986
  • Elonex 286 PC
  • Dell 486 PC
  • MacBook Pro - October 2008
  • Evesham Pentium 4 PC - November 2002
This w/e after Drupalcon I am adding to my pile. I've managed very well, but it is definitely time for a new PC.

Additional link:

Wednesday, August 25, 2010

Care design: c/o DDC Copenhagen

On Monday afternoon I explored the city of Copenhagen walking to several sites - the Tivoli Gardens, the Tycho Brahe Planetarium and other parts of this lovely city. I ended up spending a couple of hours at the Danish Design Center.

Like my occasional visits to London's museums, the DDC although very small provided a couple of pearls. One display across a wall upstairs outlined the main forms of design theory and practice:

  • The USER as designer
  • TECHNOLOGY in the design process
  • New MATERIALS and smart design
  • SOCIAL design and CARE design
  • GREEN design
  • ART design
  • EMOTIONAL design
  • REPLACEMENT due to changing fashions (built in obsolescence!)
  • SERVICE and CONCEPT design
The following text was displayed to describe SOCIAL design and CARE design:
The population pyramid has changed shape. The working-age group is shrinking compared to the group of people of retirement age. In addition, there is the large segment of the so-called weak - particularly in the 3rd world. Thus, social design and care design will be big and important design areas in the future, because the solutions will seek to strengthen the health care sector and improve conditions in the 3rd world and for underpriviledged people in general. Parameters such as increased dependency, quality of life and dignity are crucial elements in solutions relating to social design and care design. DDC display; August 23 2010.
Many themes come together here. Some are represented in the tags below. Care design is much more than what we might consider as 'standard design' aspects, such as; user interface [UI] and user experience [UX]. Care design is even more dependent upon user engagement.

There is another dependency that as yet has a '?' in the data entry box.

Care design needs coherent forms of personal, social and civic responsibility. These are yet to emerge as think tanks, governments and health experts seek (urgent) solutions.

In comparison to the above the 200 character limit on labels (tags) on Blogger presents a very small challenge. I can well imagine the outline of a book on 'care design': the result would be a big tome; but this would not just be (PJ inspired) hyperbole. Care design is not new, but the DDC text above must accentuate the individual, and not just care design at the public and private sector hospital level. Care design in an individual context is mission critical. Heady content - for books, websites and policies - as befits our times.

Thank you DDC, Copenhagen: wonderful indeed...

Monday, August 23, 2010

Concept albums and voice signatures

In .net magazine (Sept 2010, p.42) Jeffrey Zeldman makes reference to the web we grew up with being as obsolete as concept albums. It's true that music distribution has suffered a series of step-downs from the format that previously conveyed the concept album visually. Many LP covers are classics in themselves. The switch from LP record covers, to CD, and then to mp3 ... downloads means concept albums are indeed fewer; but maybe the reduced visual impact means that new concept albums are less noticed too?

Could the concept album experience a renaissance: online? Story telling has never been completely lost. The web and world's media depends on content: the appetite for stories and music is voracious - Hollywood is famished. Successful narratives prove their worth by doing surprising things with concepts that prompt re-telling down the ages. The concepts may change, but the structures and elements of the stories are timeless.

Concepts obviously remain central to making sense of everything: self, others, the world and the future that includes the new web. In Hodges' Health Career - Care Domains - Model we have a concept album. It is a care concept album comprising several snapshots or frames. It is also person-centred.

It has a voice that has its own musical signature, it is unique - that is if the album is truly person-centred and listened to.

.net September also includes a brief interview with the creators of The Specials website, which takes the form of a docu-soap about five friends with learning disabilities.

When we listen stories can be told:

great things can follow.

Saturday, August 21, 2010

Rooms with a View (and without) ...

Rooms: Book cover

There are times ... when to understand body, mind - and the things that people do to themselves and others - we need to consider the four care domains.

Then we can appeal to the fifth. ...

Friday, August 20, 2010

Retirement, memories of work & Bacon numbers

In the UK in July 2010 the much anticipated news about the government's plan to scrap the default retirement age in the UK from October 2011 throws up a complex future work place and nursing care space.

At the moment if a member of the staff in the NHS needs a psychiatric assessment and admission, then there is often a protocol that determines how their care is managed. Various factors are taken into account. For example, the work history of the person and the distance of available beds. This may entail admission for them to another area. Such arrangements help protect the staff member, their families and the local staff for whom being both carers and colleagues could be quite difficult.

Over two decades I have encountered health professionals who are diagnosed with dementia maintained in the community - in their homes - and in residential care. So far I have not known these individuals in their work capacity and professional lives. This is due in part of course to the incidence of dementia increasing with age and my previous status as a spring chicken. Today of course things have changed:

  • Early onset dementia is more common as the overall older adult population rises.
  • Suddenly (well at least after October 2011) we may find - despite the physical and emotional demands of the job - that the staff in residential and nursing homes are also older - working through that previous work | retirement barrier.
  • There's another change: now I am a mature chicken.
  • I wonder what the churn rate is in our nursing homes?
  • While we usually think of high turnover for staff and the associated poor quality of care. As care and nursing homes are also businesses there are two churn rates:
    • - senior and junior staff leave the sector, or move to other homes;
    • - residents are moved for reasons of re-location - increased care needs, and the choices of family.
So....? Amid all this I wonder how many workers in the care sector working their extended years may potentially come across former work colleagues? This could be a delicate and haphazard negotiation. ...

Additional link:
The Oracle of Bacon

Tuesday, August 17, 2010

Drupal musings 11: Git up and go ...

For more than I care to remember I've recognised that version control is an essential facet of software development. During this time though I've not had a need for version control. Renewed awareness of this tool was inevitable as I decided to identify a content management system [CMS], which brought me to Drupal and I simultaneously also discovered Ruby.

Now I'm pleased that over the past three years I did not commit to Concurrent Versions System [CVS] as used by the Drupal community. I listened to talks, downloaded, and tinkered, but now - the (old) news that Drupal 8 development will use GIT.

So, for me it is time to jump on-board with git for version control: a book and presentations next week.

It's not that I'll be contributing to D8, it just makes sense to git up to speed on this (sorry!). I've been through the program and created my schedule for next week in Copenhagen. There is so much to look forward to!

Version control is one thing, having the need and discipline for testing is another ...

Monday, August 16, 2010

Paper: Patel et al. (2009) Clinical complexity and medical education

The following item about a paper from last year was posted by Rakesh Biswas on the COMPLEXITY-PRIMARY-CARE list. After Rakesh's comments I have included a quotation.

The paper in question by Patel, et al. will be an important reference for me, even though the definition of domain and discipline remains problematic. (A glossary for the health career model will follow on the new site.)

Suddenly, the passing of time is also clear given that:

Shortcliffe, E.H. (et al.) Ed. (1990) A History of Medical Informatics, Wokingham, Addison-Wesley Publishing Co.

- appeared twenty years ago. Ten years ago I cited Shortcliffe et al..

Twenty years! How long is that in technology / internet terms?

The bold text below is my emphasis:

From: Rakesh Biswas
Sent: Thu, 12 August, 2010 16:41:06
Subject: Clinical complexity and medical education

As our society progresses in the accumulation of knowledge and as the complexity of this knowledge increases, it becomes more important to determine how to structure education to provide individuals with the most comprehensive base of knowledge without sacrificing either depth and complexity or broadness of material.

Human beings have an extraordinary capacity for storing large volumes of organized information in memory. How does one apply such detailed knowledge to practical, real-world problems and situations?

What is the optimal mode of learning that will promote flexibility and transfer of general knowledge across domains during problem-solving?

For more, see the article by Dr Patel whose focus area is Medical Cognition (how doctors think and develop their so called expertise).


Here is a quote from the paper:

Much of the early research in the study of reasoning in domains such as medicine was carried out in laboratory or experimental settings. There has been a shift in more recent years toward examining cognitive issues in naturalistic medical settings, such as medical teams in intensive care units [2], anesthesiologists working in surgery[89], nurses providing emergency telephone triage [90], and reasoning with technology by patients [91] in the health care system. This research was informed by work in the area of dynamic decision-making [92], complex problem-solving [93], human factors [94,95], and cognitive engineering [44]. Naturalistic studies reshaped researchers’ views of human thinking, as expressed in ‘‘situativity” theory’s terms (as described in Section 2.1.4) [23–26], by shifting the onus of cognition from being the unique province of the individual to being distributed across social and technological contexts. p.186.

Whilst as Rakesh points out Dr. Patel's focus is medical cognition, then through the health career model it would appear my interest is nursing cognition. As per the legacy of models of nursing - which did recognize the patient through the concept of patiency (Stevens, 1979) - we realise that now all disciplines must demand much more of their respective models in the 21st century.

Patel, V.L., et al. (2009) Cognitive and learning sciences in biomedical and health instructional design: A review with lessons for biomedical informatics education, Journal of Biomedical Informatics, 42, 176–197.

Stevens, B.J. (1979) Nursing Theory: Analysis, Application, Evaluation. Boston: Little, Brown and Company.

Friday, August 13, 2010

Frontline or tightrope?

As the various media outlets and commentators discuss health care, nursing, medicine and social care they often refer to the frontline -

Where exactly is the frontline these days (and nights)?

Who is on the frontline?
Is the frontline always visible?
Is there a 2nd, 3rd or 4th line?
Are there any gaps in the frontline?
Is it twisted at any point?
When health care economics is squeezed
how does this affect the frontline?
Does the frontline have an optimal tension?
If the frontline is Lean, in lean times
does it have a harmonic?
How has the frontline changed over
the past 20 years?
How is our frontline forecasting?
Is there space on that (front-) line for
partners, information technology,holistic
bandwidth, values, policy, safety ..., ....?

All doodles welcome.

Thursday, August 12, 2010

History, pocket facts and diffusion

Roger's Diffusion of InnovationsI can't remember exactly which shop it was - Blackwell's at Liverpool University I think - but quite a while ago I picked up a secondhand copy of Roger's Diffusion of Innovations.

I've maintained a link* to The Diffusion of Innovations Model and Outreach from the National Network of Libraries of Medicine to Native American Communities for many years. So I instantly recognised Roger's book as an important text. I've been reminded to pick this book up soon by a rather musty 'message' postmarked 1828.

In June I was invited to a workshop - 'Funding learning for better health and social care information' which was held at UCLAN (University of Central Lancashire). On a table with various informatics brochures, newsletters and DVDs was one of those small 'pocket facts'; a little multi-folded mini-epic. Of the 22 sides compressed into 6 x 5 cm was one devoted to the history of the university.

There at the top: the start. UCLAN began its life as the:

Institution for the Diffusion of Knowledge
in 1828.

Knowledge, Innovations, Ideas, Concepts
- nothing new under the sun.

* Listed under 'Health & Social Care, Nursing & Related Theory & Practice'.

Tuesday, August 10, 2010

Achieving the health-related MDGs. It takes a workforce!

Dear colleagues,

With reference to the upcoming MDG Summit and the UN Global Strategy for Women's and Children's Health, Dr Manuel Dayrit would like to share with you the above-mentioned page that was published today on the HRH website, which highlights the human resources for health situation in the 49 focus countries.

Achieving the health-related MDGs. It takes a workforce!

Density of doctors, nurses and midwives in the 49 priority countries

Please note that the link to the chart is:

Kind regards,

Rebecca Bailey on behalf of Dr Manuel Dayrit
Rebecca J. Bailey, MSPH, CEd
Technical Officer
Health Workforce Education and Production

My source:
Ellen BONITO: bonitoe at wpro.who.int
GANM (Global Alliance for Nursing and Midwifery): GANM at ibp.wa-research.ch


In Mevagissey, Cornwall last month browsing in Hurley Books, I came across a copy of Maps and Diagrams: Their Compilation and Construction by F.J. Monkhouse, et al. (1967). At three pounds - a historical bargain. Prompted by the charts above I will scan the cover and share some of the text/ideas here in the near future.

I was saddened to see that in Padstow The Strand Bookshop has closed - apparently in January 2009. As a listed building who knows perhaps it might smell of books once again!

Saturday, August 07, 2010

Drupal musings 10: Archive & FAQ

There are now three archive pages more or less complete. I'm using HTML 5 and CCS3 (well trying) to mark and style the pages, with the addition of the new semantic tags:

article, aside, figure, footer, header, hgroup, menu, nav, section {display:block;}

(I'm not sure if these disappeared at one point in the editor, so everything is a work in progress.)

Next up - the FAQs. As a live document this will be styled differently. As yet I am not quite sure how, but I still need to sort the way to handle quotes. The method I found includes blockquote: hover: after in the style sheet, then combines blockquote, cite and p on the page. The problem is you can't copy and paste, something that visitors may wish to do. A related issue is how to display when the page was updated and accessed - an essential piece of page furniture. A search reveals many other examples and now is the time to experiment.

I also have to remember that I still don't know what the final theme and look for the site will be. So global settings, columns and such like need to be kept in-check for the moment. There may be Drupal modules to add page access / updated details, so time to check on this and accessibility. And all with just ten days more to work - then Drupalcon! :-)

The questions and answers are being be completely revised; so if you have any you would like to see please get in touch: h2cmng at yahoo.co.uk

Friday, August 06, 2010

Cost savings: 4-fold literacy = care literacy

The RCN's campaign I posted yesterday highlights the belief in and potential of nurses to 'think out of the box'.

There are many people, in many walks of life who are currently racking their brains and flipcharts to come up with ideas for cutting costs. In addition to the RCN, the government has its on-line campaign with the 'Spending Challenge'.

As for nurses there is an extra rabbit to pull from the hat: improving patient care.

Media discussion about the cloned beef - food supply story this week brought a point regarding the relative scientific literacy of the general population of USA and UK. This prompted me to consider discipline based literacy, what usually passes for 'basic grounding in ...' or competency. ('Literacy' has already been corrupted, now for another kick.)

For nurses with their subject disciplines, which can be represented in the health career model - what current public sector health (and social) care requires (demands!) is care literacy.

It is the ability of nurses (and other professionals) to be aware of what happens in the two adjoining boxes, or that one remote enclosure that can simultaneously engender and deliver:

  • new insights - creativity and innovation;
  • holistic integrated care;
  • care literacy;
  • and - cost savings that can still improve patient care.
See also:

Thursday, August 05, 2010

Frontline First campaign: cost-saving innovations whilst improving patient care

Dear Peter,

Innovations are the key to saving the NHS money. Every day, nursing staff on the frontline are finding new and better ways to deliver patient care.

As one nurse recently wrote to us:

"Without a working knowledge of clinical care provision how can ideas be practical and ensure quality of care is maintained? Nurses are in a prime position to look at care provision to identify better ways of working and therefore identify cost savings without sacrificing patient care and experience."

As part of our Frontline First campaign, the RCN is collecting examples of cost-saving innovations at NHS services across the UK. What nursing solutions have you seen in your workplace that could achieve savings without sacrificing patient care?


There are two ways the NHS can find billions of pounds in efficiencies:

discover innovative ways to save money
make cuts to staff and services

Every day, UK nurses are helping to devise and implement cost-effective solutions saving their employers money and helping to protect jobs. We've already heard from dozens of nursing staff who told us about innovations in their workplace, from changes to day-to-day practices to
whole new ways of working.

Please take a moment to report any cost-saving innovations you've seen at the workplace:


Thanks for speaking up and helping to protect patient care.

Yours sincerely,

Janet Davies
Director of Nursing and Service Delivery

My source:
Subject: Improving patient care
From: "Janet Davies, Royal College of Nursing"
Date: 04 August 2010 16:53:30

Monday, August 02, 2010

From: Harvard Business Review - The Four Phases of Design Thinking

I came across the following post on the Harvard Business Review Blog Network - The Conversation:

10:54 AM Thursday July 29, 2010
by Warren Berger

What can people in business learn from studying the ways successful designers solve problems and innovate? On the most basic level, they can learn to question, care, connect, and commit — four of the most important things successful designers do to achieve significant breakthroughs.
Having studied more than a hundred top designers in various fields over the past couple of years (while doing research for a book), I found that there were a few shared behaviors that seemed to be almost second nature to many designers. And these ingrained habits were intrinsically linked to the designer's ability to bring original ideas into the world as successful innovations. All of which suggests that they merit a closer look.
You can read the whole of Warren's original post, while below I have taken his focus concepts CONNECT, CARE, COMMIT and QUESTION and associated them to the care (knowledge) domains of Hodges' model. Following that there is a rationale. ...


Placed in the intra-interpersonal domain this is the domain of concepts, thoughts, ideas, creativity and innovation. This is the essence of Warren's reference to 'connect' -
Designers, I discovered, have a knack for synthesizing--for taking existing elements or ideas and mashing them together in fresh new ways.
The INTERPERSONAL links page also highlights other conceptual 'inhabitants' here; in particular knowledge management, the semantic web and psychology. If analysis and reduction is the outcome of the hard sciences, then here as Warren writes is synthesis, integration and invention. We can see how self-belief is critical to many innovators who pursue their dreams regardless of rebuffs by the establishment, to whom - within the health career model - they are also diametrically opposed.

The ability to question lie at the heart of human activity, and although thought and mind are represented in the interpersonal domain, questions also exemplify the output of human reasoning powers in the SCIENCES. Evidence based care depends on an ongoing process-ion of questions that drive research. Problem solving with its iterative sequence of assess (question), plan, action, evaluation (question). The health career model reminds us though of the need to consider not only quantity, logic and objective measures, but the role of qualitative research and methods.

Seeing Warren's inclusion of 'care' drew me to his post. Here he concludes:

Focus groups and questionnaires don't cut it; designers know that you must care enough to actually be present in people's lives.
Health and (social!) care are social activities. Our students are socialised into the professions and disciplines as they pursue their careers. Our work depends on the effectiveness of human communication and relationships. You can read about 'counselling' and only get so far; ultimately health care is experiential. It is something to be practised.

Warren deals with the way designer's view risk and committing early to an idea and the project that might follow. For me 'commit' and being committed has explicit political - power - connotations. So, Warren's reference to commit in the sense of producing a model or prototype and working through problems can be extended. Invention and design may be cognitive pursuits, but they are non-trivial in that they must ultimately and literally be negotiated. Being able to 'commit' needs to be sanctioned. Individuals need to be empowered, or recognise when to either proceed or seek advice and guidance. Furthermore, Warren notes:
The designer's ability to "fail forward" is a particularly valuable quality in times of dynamic change. Today, many companies find themselves operating in a test-and-learn business environment that requires rapid prototyping. (?)
Perhaps the recognition in health policy of the need to balance negative and positive risk taking, self-care and personalised budgets can also be discerned in the above?

Thanks to Warren Berger and HBR