Global health: Care logistics in-deed

Although the previous post -

Care Logistics: have model will travel ...

- differentiated between what we might term mechanistic and humanistic logistics, there is a great deal of overlap:

communications, time, priorities, purposes, service, quality, processes ....

Global health has featured on W2tQ and it is here that the true dimensions of logistics can be defined. I may be confusing logistics and scale, but if I am then the challenge of logistics presents itself by virtue of scale and in global health the focus upon populations, nations, medical conditions and physical environments, climates and topography.

While the Wikipedia page on global health does not explicitly refer to logistics it is there in the shadows: it contributes to inequality, illiteracy, poverty, public ill-health (and mental too), pandemics ...

Logistics is there in the light too; the torch of disaster relief, the many development organisations, the ethos and values of the Millennium Development Goals. ...

'Well-being' and the dilution of 'caring'

This blog post was originally drafted on 15 October 2008. Back then I'd noticed how in the media - newspaper, internet, radio and journals - there was increasing references to 'well-being'. It was everywhere. Even now it graces lips, airwaves, video, digital and conference platforms.

I was prompted to write because I actually felt that perhaps the public were being somehow sold a pup. I mean 'well-being' - it sounds wholesome, reassuring and cuddly so go on - take hold, give it a hug and look after it. Maybe it literally is a case of - get up and take it for a walk. You know you need to!

What well-being does do is it forces acknowledgment of physical AND mental well-being. In the summer I bought a copy of the British Journal of Wellbeing [BJW]. BJW features physical and mental health with some really interesting features, reviews and interviews. So, I raised my hands, sighed, stretched (felt much better) and accepted "OK well-being (or wellbeing*) it looks like you will go far."

I just have a worry though. Because the concept of well-being is fuzzy, there is a risk that the care agenda could be diluted at a time when specific health and social care populations and issues arising need to be kept in clear and unequivocal focus. Looking at the content I am reassured - there is depth here too. I say this recognising that the concept of well-being can also serve the health career model very well.

More to follow on BJW and well-being ...

http://www.dictionary.net/well-being

*I like hyphens as in socio-technical

Drupal musings 16: 1% digital and analogue memories

At Drupalcon in his keynotes Dries Buytaert has highlighted that Drupal now powers approximately 1% of the web. While 1% is not much especially given the total size of the internet with its day on day, hour by hour growth this is nonetheless a significant milestone. Especially when Dries speculates on the growth of Drupal projected ahead to 2020.

Like all digital media Drupal is a tool that extends our personal and cultural memories. As all the keynotes showed Drupal, PHP, HTML[5] all have histories of their own and a role to play in providing a surrogate memory. The media and technology [IBM] regularly predict how technology will change our lives, including how we remember.

Amid such speculation memory still makes us who we are. You and I have a yesterday, today - and we pray - a tomorrow.

This is the bootstrap that counts

Bootstrapping or booting refers to a group of metaphors that share a common meaning:

a self-sustaining process that proceeds without external help. ...
en.wikipedia.org/wiki/Bootstrap

Striking then the news this week that - dementia costs 'equal to 1% of global GDP'.

Care Logistics: have model will travel ...

From: NHS Logistics - supplies, v4m, corporate, orders, consultancy, catalogue, process, delivery, stock, just in time, service, quality, priority, efficiency, customers, finance, contracts ...
	To: Care Logistics - access, choice, attitude, empathy, communication, values, outcomes, human rights, dignity and respect, quality care, professionalism, purpose, roles, holistic competency, standards, personal, measures, equity ...

Drupal musings 15: modules and Drupalcon videos

Since picking up the health career model and publishing the model online in 1986 the term holistic bandwidth has emerged. The blog in 2006 and to date has seen other loosely defined terms:

care architecture
4-fold care
cogneography
holistic competency

Using Drupal 6 I've got to a position were I am getting to know core plus some contributed modules. One of the latter is webforms. It's bound to be help seeing what webforms can do in terms of one-way data submission, compared to using CCK - the content construction kit. In webforms the grid component holds great promise, but in creating a grid for music genres I notice there is no validation (which would be quite a trick!). Users should only be able to select one type of music they want to hear most of the time. The validation question is going to help force the issue of getting under the hood. All that reading revealed in previous posts is also needed to sort the theme too.

I remember first coming across the word instantiate. As I write, think about a h2cm glossary and experiment for real with Drupal 6 - I wonder whether the content types I create (in Drupal 7 especially) may help define some of the above and other terms?

Launch of methods@manchester - research methods in the social sciences

methods@manchester is a web resource which brings together The University of Manchester’s internationally acclaimed expertise on social research methods. Visit www.methods.manchester.ac.uk to watch video clips of experts talking about specific methods: examples include Martin Everett’s leading work on Social Network Analysis, Wes Sharrock on Ethnomethodology, Nick Shryane on Structural Equation Modelling and Ian Plewis on Multilevel modelling.


You can also listen to a wide range of introductory methodological talks, whilst viewing associated PowerPoint presentations – for example Penny Harvey explains why and how anthropologists conduct ethnography and Vanessa May explains the rationale behind narrative analysis.

September 13 marked the start of the programme of events for the autumn semester, with seminars and short courses taking place.

On September 29 the Methods Fair includes methods-related presentations throughout the day (speakers include Martin Everett on social networks; Carol Smart on in-depth interviews; Nick Shryane on structural equation modelling); a display of posters by researchers and PhD students; stalls giving information on training opportunities, online resources, short courses and much more.

Go to the web-site www.methods.manchester.ac.uk and join the mailing list to receive a regular update on methodological events.


My source: ESA-ALL@JISCMAIL.AC.UK
Image source: http://www.methods.manchester.ac.uk/methods/sna/index.shtml

England: The future of the National Programme for IT

Department of Health - 09 Sep 2010 12:32
The future of the National Programme for IT
-----------------------------------------------------

A Department of Health review of the National Programme for IT has concluded that a centralised, national approach is no longer required, and that a more locally-led plural system of procurement should operate, whilst continuing with national applications already procured.

http://www.wired-gov.net/wg/wg-news-1.nsf/lfi/415392

My source: Wired-GOV

Gardner's 5 Minds for the Future (and the Question)

In order to pursue post graduate study you need a project, which demands a question. Formulating a research question is central. I wonder however whether there remains a bias - hard sciences vs humanities (and triangulation) - towards a class of questions that are closed and so can be answered in X-words : Y-time : with Z-funding? Thereby passing through the necessary academic hoops. Of course I realise that if there are no constraints then chaos would ensue. I just wonder if the journey (creativity, discovery ...) might be lost for the sake of assuring the end product?

My questions (apart from 'beware reflex moves') tend to be framed in broad terms. You could say that as yet I am not disciplined (specific) enough to come up with a question that passes "GO!"

In Howard Gardner's Five Minds for the Future the issue of educational programmes is raised and I read the following:

The second antidote entails the creation of educational programs directed specifically at certain individuals of promise - for example, leaders of tomorrow. Chief executives and general managers are expected to be able to see the big picture - to look beyond their own background and specialization; to understand the various components in their organization or constituency; to think systematically about what is working, what is not working, and how goals can be more effectively achieved. ...

Other individuals - for example, those exhibiting a "searchlight" or "bricoleur" intelligence - might be attracted to such programs as well. They would make use of their enhanced skills even if they do not occupy explicit leadership roles. Perhaps, as educator Vartan Gregorian has suggested, we need a specialization in becoming a generalist. p.75.

Gardner, H. (2008) Five Minds for the Future, Harvard University Press.

Drupal(con) musings 14: design, UI, UX, thinking and care

In his funny and very engaging session 'Designing UI with Seven' at Drupalcon CPH Mark Boulton discussed four user experience (UX) principles and introduced us to ten user interface (UI) guidelines.

Mark highlighted the need for a mental model and the challenge within publishing of there being someone who has the big picture. Who knows exactly what is going on? The health career model provides a model and can provide a canvas to support the big picture.

What really caught my attention though was as soon as Mark asserted -
"Don't make people think." -

I immediately thought -
'Make people care instead'.

Well, I'm not sure if an interface can do what public (mental) health policy, government public funded education programmes and the concerted efforts of the health professions has largely failed to achieve. The users of e-health information systems do need the design of the system to be transparent to them. IT mustn't get in the way. Mark's point of course is the the user's should be free to focus on the problem the system is to help solve. In health this includes:

• recording of a health (and social) care record;
• secure information / file management and access;
• information governance, reporting and archiving;
• timely, ready access for those who need to know;
• ability to manipulate the record to obtain knowledge: from data > from information;
• to provide patient (carer as advocate) access and verification;
• remote access with rugged devices.
• ...

This does not mean that people are oblivious to design: far from it (iThis - iThat!). My point is that as we follow Mark and other design expert's advice then users should be able to focus on care design and the care outputs arising.

So in health we need interfaces and user experiences that DO encourage reflection, thought: thinking.

P.S. In another session (or magazine!?) on creating mobile versions of sites the advice included getting rid of the crap - the clutter, the >1000px width adornments. Rhetoric aside - my design thought would be not to include anything that could be described in this way whatever the media type (maybe I should lighten up!) ;-)

To follow: update on my Drupal efforts.

compose, direct, conduct and 'dilute to taste' outcomes

In Drupal musings 12 I mentioned that the classification of nursing practice is not necessarily at the forefront of nursing's mind set against the turbulence and rush of clinical areas.* This is especially so at the moment as nurses on wards, clinics and community try to identify savings.

I am interested in classification in part as this is a raison d'être for the health career model; on a mental (cognitive) level, in practice and potentially in virtual representations of health care activities. For learners it is an extra to hold the bicycle saddle for those first turns of the pedals. Additionally, for those who have completed many rides and races (lifelong learners) they can reflect on how they got there, and plan for the next round.

As a conceptual framework then h2cm is, like classification, in the background. The model can help to compose, direct and conduct (c-d-c) nursing (health and social) care. Classification matters to ALL nurses because we need to know not only the c-d-c of nursing but the outcomes too.

If all the above is in the background, then together with classification the health career model can help differentiate nursing as a discipline and make nursing visible. We can only take heed of the adage "divide and conquer" by being able to differentiate nursing from other disciplinary contributions. Then perhaps we can truly identify and so define the facets of integrated, interprofessional and multidisciplinary care that must also be person-centred. As nurses and the team respond to the individual's trauma (assault, illness, chronic disease ...), they can also assure their combined values, which must be defined and articulated if there is to be a unified philosophy.

If the respective professions have not noticed (I am sure they have) 'professionalism' is itself under assault in terms of unique knowledge and skills, respect, power and status. To a degree this a good thing. It is also called 'progress': countering restrictive practices, improving service access and challenging institutionalised and state paternalism. Professionalism is accorded for reasons of accountability, education, responsibility, integrity and advocacy. Amid the public (mental) health disaster that we face - the professions - are needed more than ever and if the assault is taken too far ... ?

* Should you know of examples where classification IS at the forefront of nursing practice please let me know - h2cmng @ yahoo.co.uk.

Interprofessional education, philosophy and conceptual frameworks

I received a copy of the following - Interprofessional Education in Wales: case studies in health and social care - July 2010, Editors: Clare Kell and Marion Helme (Health Sciences and Practice). Published by the HEA.


As per other HEA publications there are many papers here of great interest. One stood out at a first reading as in addition to the quote below Mark Edward's also refers to the need for an holistic approach, and this particular MSc. course providing a critical space.

UK Professionals are trained and educated in their own disciplines, learning their own unique and specialist knowledge for their chosen profession. Therefore, although each profession is well equipped for its singular contribution, they find their 'educational preparation a total mismatch for the complex, interactive world into which they graduate and practice' (Sullivan, 1998: 428). Sullivan's view reinforces the WLGA's concerns, that professional boundaries *demarcate* social professions (and others) from each other and that resistance to collaboration and co-operation on any meaningful level has been compounded by the historical development of the uni-professional training model. We need therefore to agree a uniting philosophy and *conceptual framework* that facilitates a dialogue between these professional disciplines and gives reasons for these discrete services to work together in providing effective inter-professional solutions to shared social problems. p.53. Edwards, M.L. (2010). * -- * My emphasis.

I do not merely want to hang word associations here on the blog line. But, I have wondered about how we demarcate the disciplines. This is a major question. In the (previous) glossary I cite Resnik (2002) - A pragmatic approach to the Demarcation Problem. Wether deemed explicit or not Hodges' model seems to address this issue through the care domains.

On the new site a living (dynamic - as is implicit in internet based tools and resources) glossary is a must - the terms we use often vary from context to context, professional to professional. Clearly (or opaquely) I cannot provide all the answers hence the need for a community and a (Drupal) module.


Mark L. Edwards, Case Study 7: Issues in collaboration between undergraduate professional qualifying programmes of youth work and social work. pp.47-55.

Resnik, D.B. (2002) A pragmatic approach to the Demarcation Problem, Stud. Hist. Phil. Sci., 31:2,249-267.

Drupal musings 13: Packaged care and modules

Although I do not need to sit at the front for presentations anymore, I did so at Drupalcon as the electricity plugs were few and forward. There was a bonus. Being in the right place... I picked up a free book c/o Packt Publishing who were among the exhibitors and valued sponsors. The book is Michael Peacock's Social Networking (don't panic I'm not going to review it!). Since returning from Copenhagen I've been using Drupal 6 and 7 on a daily basis. Checking just what some of the key modules, such as Taxonomy, Taxonomy Manager, and Groups have to offer. What are the configuration options and how well do modules integrate?

In the book Michael lists the Drupal modules he relies on to create a site worthy of the book's title. He explains that many modules are themselves 'packaged' for example - the Activity module:

Activity: Activity
Activity: Activity history
Activity: Comment activity
Activity: Node activity
Activity: OG# activity (#organic groups) p.140

This highlights the multifunctional capability of modules which leads me to wonder about what functionality might be found in future modules:

Intrapersonal: Communication Intrapersonal: Mood Intrapersonal: Cognition Intrapersonal: Diagnosis Intrapersonal: Interests Intrapersonal: Risk Intrapersonal: Skills-Education	Sciences: Observations Sciences: Physical attributes Sciences: Mobility Sciences: Nutrition Sciences: Diagnosis Sciences: Physical safety
Sociology: Relationships Sociology: Ethnicity Sociology: Interests Sociology: Religion Sociology: Carer assessment	Political: Marital status Political: Employment Political: Benefits-Welfare Political: Capacity Political: Autonomy Political: Mental Health Act status

Ru! Ru! Ru! Ru! ..... alarmed by the noise? [ambient care]

Working in nursing home liaison I am a regular visitor to various residential and nursing homes.

As I respond to referrals I spend several minutes waiting to see residents, relatives and staff. At this point I can take in the ambience of the home and all too frequently what stands out is the home's call system.

Many are acutely effective.

Even though I am not there for long - 30-60 minutes, the volume, tone and the overall quality of some of these systems can be grossly irritating. Due to the care needs of the resident population the alarm calls are also a constant. This is not just my audiological experience, but one shared with students on placement with me.

Attracting the attention of staff is crucial. Caring staff do want to know who, where and when someone needs assistance. Ironically, sometimes that annoying, intrusive alarm call is supported with a plaintive shout for "someone!". As ever there are many ways to define person centred care. In response to the alarm's screech, scream and shrill the staff head to the panel and seek direction to Room 3 or 7.

If care is personalised then whatever happened to our signature tunes? Did this individual play a musical instrument? Gleaned from their life history record this might at least include Jo's musical favourites? It's true that existing alarms are anonymous, and so confidentiality is preserved. Meanwhile though peace, well-being and staff retention rates(?) are lined up against the walls and reverberated, rev erbe rat ed, re ve r be ra te d ... ...

Of course, at some remote future time I might embarrass myself as I press the red button and the Thunderbirds March rings out down the corridor, around a left, a right corner to light a panel.

Fellow residents and visitors might be given to say "Gee, there goes Alan Tracy needing help again!" Maybe by then the robots will have it sorted: the latest in-situ care units will save the day and people's ears.

Seriously though: designers, owners and managers of homes must consider the acoustic architecture of the care environment; or are they also anticipating a rise in the average age of employees with a consequent impact on the hearing acuity of employees? As to the quality of life of the residents go figure: 5, 4, 3, 2, 1!