Buller and Butterworth: Skilled nursing practice - four domains?

The health care domains model identifies four domains within health and social care and medicine. What evidence is there to support the model's inclusion of:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

- plus the spiritual within and without? Steve Buller and Tony Butterworth undertook a ethnographic study in 2001 'Skilled nursing practice - a qualitative study of the elements of nursing'. With skilled nursing practice at the center (Fig. 5.) they identified:

relating and communicating	doing the job
being professional	managing and facilitating

There is some overlap, reflection arises in relating and communicating and doing the job. Overall however there is a definite correspondence between these domains and those within h2cm - the health care domains conceptual framework. I have equated being professional with the SOCIOLOGY domain as for the authors this includes being with patients, conveying confidence, handling situations, being informed. Managing and facilitating is undoubtedly POLITICAL with supervising, auditing, making sure things get done. Doing the job - is based upon planning, informing, assessing, intervening, and being confident (with equipment, procedures, manual dexterity..?).

Having been thinking and writing about h2cm for many years it is a shame that other models have benefitted from funding and gain "ward and community (research) cred" while here evidence is retrofitted. Looking at the paper just in the decade since submission and publication I wonder which elements remain local, and where other elements of the skills base (care concepts) have migrated to ethnographically?

Steve Buller, Tony Butterworth (2001) Skilled nursing practice — a qualitative study of the elements of nursing. Int. J. of Nursing Studies. 38, 4, 405-417.

The Beauty of Diagrams: Vitruvian Man BBC Four

Tomorrow a new six part series begins on BBC Four.

Diagrams, conceptual frameworks and cognitive spaces have driven my interest in models of care and h2cm for decades:

1996

Peter attends 'Thinking with Diagrams' Colloquium, IEE, Savoy Place, London.

18 Jan BCS-SGES et al. Professional Group C4: Digest No: 96/010

I also maintain a 'diagrams' listing on the sciences domain listing, suggestions welcome.

So, really looking forward to this!

Comets, holistic care and peripheral vision

Comet Hartley 2 is still bright and yet throughout its visit by Earth quite diffuse, so I have yet to try to find it with my binoculars. To effectively use binoculars, a telescope (or even a microscope) and enjoy the astronomical delights (especially as Councils save money and switch off street lights) it helps to develop your peripheral vision.

Nursing, medicine and social care calls for its own kind of peripheral vision. Peripheral vision that nonetheless enables us to really see. It is ironic that in order to see the big picture that includes the person, that allows us to coherently assess, plan, deliver and evaluate person-centred care we must look off-center.




Comet image source: http://maineastro.com/2010/10/binocular-comet-now-high-in-the-sky/

Grand Challenges for Global Health: 15th - access to clean, clear, knowledge

Dear HIFA2015 colleagues,

The news item below is forwarded from the Global Health Council, which reports the mHealth Summit taking place this week in Washington DC. It is especially good to see that Bill Gates is giving a keynote address. This suggests that the Gates Foundation may be poised to address the 15th Grand Challenge for Global Health, as proposed by international health leaders in The Lancet:

"The Gates Foundation identified fourteen challenges [Grand Challenges for Global Health] but a fifteenth challenge stares us plainly in the face: The 15th challenge is to ensure that everyone in the world can have access to clean, clear, knowledge - a basic human right, and a public health need as important as access to clean, clear, water, and much more easily achievable."

Tikki Pang (WHO), Muir Gray (NHS, UK), and Tim Evans (WHO): 'A 15th grand challenge for global public health.' The Lancet 2006; 367:284-286.
http://www.thelancet.com/journals/lancet/article/PIIS0140673606680501/fulltext

When HIFA was in planning back in 2006, the lead author of the above paper, Dr Tikki Pang (Director of Research policy and Cooperation at WHO) said: 'HIFA2015 is an ambitious goal but it can be achieved if all stakeholders work together'. Bill and Melinda Gates are critical stakeholders. I look forward to see Bill Gates' presentation. Will the Gates Foundation take up the 15th Challenge? Will the Gates Foundation prioritise the challenge of health information for all by 2015?

Bill Gates keynote yesterday is not yet available on the web, but it will be soon at: http://mhealthsummit.org/conference/live-webcast

I hope that Bill Gates will use this opportunity to articulate a clear and specific vision from the Gates Foundation: a vision of a world where people are no longer dying for lack of access to appropriate, reliable healthcare information. With their support, there is no doubt this vision can and will be realised.

With best wishes,
Neil

HIFA2015 profile: Neil Pakenham-Walsh is the coordinator of the HIFA2015 campaign and co-director of the Global Healthcare Information Network. He started his career as a hospital doctor in the UK, and has clinical experience in rural Ecuador and Peru.  For the last 20 years he has been committed to improving the availability of healthcare information for health workers in developing countries. He has worked with the World Health Organization, the Wellcome Trust, Medicine Digest and INASP (International Network for the Availability of Scientific Publications). www.hifa.org  neil.pakenham-walsh AT ghi-net.org

My source:  www.hifa2015.org

Drupal musings 19: DrupalCamp Edinburgh, Panels, another prize book! and a 'mu'.

DrupalCamp Edinburgh was just one day, but a Drupal drenched day. So, camping can be fun even when it rains - community spirit and ethos, tips and things you never knew.

The first session on PHP namespaces with Jonathan was on the technical side, but this is a topic to watch for Drupal 8.

Up RPC - upgrading was also technical in the sense of being for people with sites to upgrade. Joachim went through the process from Drupal 5 to 6.

Drush - the DRUpal SHell (Mac) was presented by snufkin and with the frequency Drush crops up at Drupal events, inc. NW England it's a mu - must use.

A question was raised around multimedia in Drupal, this centred upon images.

The afternoon was built around Chris Muktar's session on WikiJob. Chris described the site's birth, growth and move to Drupal. Wikijob utilises the PressFlow distribution of Drupal optomised for performance and scalability. What was fascinating here were the insights into the use of Pantheon and Amazon Web Services. The good news for Chris and WikiJob is that hosting costs are dropping month-on-month while the lessons: you need to know what you're doing and AWS is self-service.

Providing for mobile users came up and here I was actually able to contribute (well sort of) with my notes from Copenhagen and Martin Joergensen's session.

At the end there was a prize draw. I won another book! Drupal 6 Panels Cookbook, Bhawin (Vin) Patel, Packt. Having read this there's no doubt that combining Views and Panels packs some punch, especially as in Chapter 10 a travel website is created and the recipe uses the PressFlow distribution. This chapter also uses the Location and GMap modules, which I am currently looking at. Since first hearing there were modules called Panels, Views and Context I've automatically attributed h2cm related functionality to them. The care domains are 'panels'. Organic Groups, another example has proved quite different to what I thought and I only learned that this summer (that's why using really is learning). What the book brings home - without picking up the shovel - is the way these modules leverage each other.

At 10am when everyone first met with two sessions scheduled with the rest of the 10-5 day a blank I worried: 200 miles! (I didn't attend, but the morning also saw Addison Berry of Lullabot running a "Beginners Track"). My faith deserted me only for a moment. Great job Duncan and all.

h2cm: Globalization, Accommodation theory and Relativism (Grayling, 2010)

From A.C. Grayling's Ideas that Matter, 2010, Phoenix.

Globalization: p. 235-236.

A more neutral account of globalization describes it as the process of making things known, done, available or possessed worldwide - such as Internet access, telecommunications, medical knowledge and benefits such as vaccines, transport technologies, political ideas, art and music, books and much besides.

Grayling also explains how the increased distribution associated with globalization is unequal, hence the sense of injustice that is felt resulting in protest.

The health care domains model is concerned with making things known - helping to make knowledge available on a personal, group and family level. This is no Mercator projection, not even Peter's projection but it is a global map.

Accommodation theory: p. 3-5.

Accommodation theory states that when people talk to each, they adjust their behaviour and manner of speech to take account of (to accommodate themselves to) the topic, the circumstances, and the other people engaged with them in conversation.

There are many theories to explain how we communicate and thereby model(?) ourselves, others and the world. Imagine a doctor's surgery and the morning's clinical consultations, it is easy to envisage the role that accommodation routinely plays. The one-to-one conversation (dialogue, argumentation, debate) can be extended, and viewed as the combined chatter, the whole series of multidisciplinary Q&A with the breaks (the silences when we are listening!). Accommodation theory has proved of value in multiculturalism, especially on policy concerning immigration and integration. p.5

The care domains provide an ethnoculturally neutral space (it could be argued) for the accommodations that are demanded in the 21st Century. 

Relativism: p.433.

There is a distinction to be drawn between moral or cultural relativism, on the one hand, and cognitive relativism on the other. The former concerns the difference between cultures, or between different historical phases of the same culture, with respect to religious, social, and moral values and practices, that is, with respect to what might be called the 'superstructure' of the culture's conceptual scheme. Cognitive relativism concerns the 'infrastructure', the level of basic beliefs about the world, such as that there are perception-independent, re-identifiable and individually discriminable objects or events, occupying space and time, interacting causally, and bearing properties of various kinds.

Much is said of the games that people play. Whether the care domains model provides a game board that can accommodate both the super- and infrastructural conceptual levels is open to question. In the health career model the infrastructure level concepts are light - as we find that they reside in the upper part of the model: perceived, individually discriminable (INTRApersonal) objects occupying space and time (SCIENCES) with mass, weight, inertia. ... The political domain prompts access to values and how these shape the total conceptual landscape(s), the conversations and silences that go on there ...