Musings... axes in hand and mind

...

Axes in hand and mind
[Accounting for the I-G (individual-group) axis and the need for the H-M axis]

Clearly there is a need for a basic scaffold. One that reflects the real world and the real time to which we are all exposed and are a part; and one that can also represent the model(s) we wish to create - the products of our health care, nursing activities. The scaffold we build must be one on which we can hang concepts and for simplicities sake human (care) concerns. Specifically a conceptual scaffold and a human scaffold. The latter can be represented simply as a continuum from INDIVIDUAL to GROUP, hereafter referred to as I-G.

The other, the conceptual scaffold, calls for what might be termed conceptual inflation. If we imagine the I-G as the vertical challenge (remember the health & safety issue!) and draw with the 'individual' at the top, then there is much we can model based on this basic dichotomy. This is too simple however. We cannot capture the part of the rich tapestry that is life - well-being, health - and death. For this another axis is needed.

(Which begs me to ask myself:

is there a law that suggests that one axis however oriented invites another?)

With this further partition and heralding of a further dichotomy what is lost? What is gained, if anything? In scribing this first line we explicitly separate the 'one' - the self from the other. The addition of another axis is where and how we define a center. With this center and from it we can find the energy to fuel our conceptual inflation. We literally draw out the foundation by considering what these persons do? ...

Conceptual inflation: Four-fold nursing agnostics
...
PJ Dec 2010

Musings... building models, health & safety, group and individual

....

Basic foundations and minimal defaults
[Accounting for the I-G (individual-group) axis]

Since nurses and technologists are concerned with communication then the foundation from which they begin to (build and model their) work is of fundamental importance. The foundation needs to be generic in the first instance. Generic in the sense of the commonality that language instills, enables and facilitates within and between communities. Not only that, but if we take the property of 'generic' to its extreme then the foundation must be stripped down to the barest of defaults: there are no 'types'.

To use the safety analogy we need to risk assess the extent of our model building activities.

We can do this by asking: is this a one, or at most two dimensional venture; such that we can rest secure on terra firma? Or are we above 'ground' floor and immediately required to address health and safety legislation?

Since medicine and nursing are concerned with safety and so must be evidence based, there is an immediate vertical challenge in the hierarchies inherent in the sciences and the structure of knowledge.

Science is not the only influence here. The foundation of what we are modelling and building must reflect the ultimate subjects (the person - patients, carers, communities, whole populations) must incorporate the individual and collective nature of our activities. So, the individual (whose very safety is our concern!) must be factored in and the public's health. Systems of assurance are then needed and founded in human rights. This in turn is a measure of the level of social coherence, coherence through a level of social and political organisation that allows leaders to effect positive change and betterment. The person, the individual is built not upon the shoulders of giants, but ordinary people - our ancestors and peers. ...

Axes in hand and mind
...
PJ Dec 2010

Shared Approach: 3 keys (and a certain conceptual framework)

Before we trip into 2011 let's make a quick return to 2008 and the three keys to the Shared Approach in mental health assessment [NIMHE, 2008] which are copied below.

In between each one I have highlighted how the Health Care Domains Model can contribute ...

1) active participation of the service user concerned in a shared understanding with service providers and where appropriate with their carers;

In the end (or at the beginning!) a model of care or assessment tool is only as good as the person using it.

To progress with key #1 there are in fact two locks to open. These are in the form of 'using' and 'user'. H2CM incorporates the individual from the outset. The model encourages consideration of the client's beliefs, preferences, and experiences ... Can the client and carer actually use the model themselves to help understand their needs, their care plan and interventions? Is there a homework exercise there for them?

Do they have capacity to decide? Do they need support - an advocate? How do we ensure the carer is factored into the care equation? Well, in h2cm that's through the social domain.

2) input from different provider perspectives within a multidisciplinary approach, and;

Do you know what "different provider perspectives within a multidisciplinary approach" look like?

Well just envisage that for a few moments. ...

A scary exercise, eh?

In order to take those different perspectives and integrate them a common framework is surely needed?

Artists are lucky they use perspective as an integrative lever on paper, canvas, or whatever medium.

Clients, carers, health and social care professionals need a canvas of their own, BUT one that is sufficiently generic and agnostic to be 'owned' by all. 

3) a person-centred focus that builds on the strengths, resiliencies and aspirations of the individual service user as well as identifying his or her needs and challenges. NIMHE (2008)

H2CM can support and foster person-centred care. The model is situated: there is one (changing) situation with the person at the center. Whatever the context -

strengths, resilience, stresses, vulnerabilities, aspirations, needs, challenges

- the care domains model is fit for purpose. Health and social care is dynamic, in person-centred care that focus needs to change accordingly. Our assessments and evaluations need to resolve the SCIENTIFIC, SOCIOLOGICAL, POLITICAL, INTERPERSONAL and SPIRITUAL dimensions of care while assuring the BIG picture.

Reference:
The National Institute for Mental Health in England (NIMHE) and the Care Services Improvement Partnership. 3 Keys to a shared approach in mental health assessment. London: Department of Health; 2008.

Call for Maps: Mapping Science Exhibit, 7th Iteration on "Science Maps as Visual Interfaces to Digital Libraries" (2011)

Background and Goals

The Places & Spaces: Mapping Science exhibit was created to inspire cross-disciplinary discussion on how to best track and communicate human activity and scientific progress on a global scale. It has two components: (1) physical exhibits enable the close inspection of high quality reproductions of maps for display at conferences and education centers and (2) the online counterpart (http://scimaps.org) provides links to a selected series of maps and their makers along with detailed explanations of how these maps work.

Places & Spaces is a 10-year effort. Each year, 10 new maps are added, which will result in 100 maps total in 2014. Each iteration of the exhibit attempts to learn from the best examples of visualization design. To accomplish this goal, each iteration compares and contrasts four existing maps with six new maps of science. Themes for the different iterations/years are:

  * 1st Iteration (2005): The Power of Maps
  * 2nd Iteration (2006): The Power of Reference Systems
  * 3rd Iteration (2007): The Power of Forecasts
  * 4th Iteration (2008): Science Maps for Economic Decision Makers
  * 5th Iteration (2009): Science Maps for Science Policy Makers
  * 6th Iteration (2010): Science Maps for Scholars
  * 7th Iteration (2011): Science Maps as Visual Interfaces to Digital Libraries
  * 8th Iteration (2012): Science Maps for Kids
  * 9th Iteration (2013): Science Maps for Daily Science Forecasts
  * 10th Iteration (2014): Telling Lies With Science Maps

Places & Spaces was first shown at the Annual Meeting of the Association of American Geographers in April 2005. Since then, the physical exhibit has been displayed at more than 175 venues in over 15 countries, including eleven in Europe, plus Japan, China, Brazil, Canada, and the United States. A schedule of all display locations can be found at http://scimaps.org/exhibitions

Submission Details

The 7th iteration of the Mapping Science exhibit is devoted to science maps that serve as visual interfaces to digital libraries. These maps might communicate the

  * quality and coverage of data sets,
  * the structure (ontology, taxonomy, classification hierarchy) of data sets,
  * (semantic) linkages between data sets,
  * the evolution of a data set, or
  * access and usage patterns of data sets.

They are intended to support the navigation, management, and utilization of mankind’s scholarly knowledge and to make it more readily available to researchers, educators, industry, policy makers and/or the general public.

We invite maps that show a visual rendering of a dataset together with a legend, textual description, and acknowledgements as required to interpret the map. Science map dimensions can be abstract, geographical, or feature-based, but are typically richer than simple x, y plots. Scientific knowledge can be used to generate a reference system over which other data, e.g., funding opportunities or job openings, are overlaid or be projected onto another reference system, e.g., a map of the world, but must be prominently featured.


Each initial entry must be submitted by Jan 30th, 2011 and needs to include:

  * Low resolution version of map
  * Title of work
  * Author(s) name, email address, affiliation, mailing address
  * Copyright holder (if different from authors)
  * Description of work: Scholarly needs addressed, data used, data analysis, visualization techniques applied, and main insights gained (100-300 words)
  * References to publications in which the map appeared
  * Links to related projects/works

Entries should be submitted via email to the curators of the exhibit: Katy Börne (katy at indiana.edu) and the exhibit designer Michael J. Stamper (mstamper at indiana.edu) using the email subject header “Mapping Science Entry”.

Please feel free to send any questions you might have regarding the judging process to Katy Börner (katy at indiana.edu). Please keep subject header (as used here).

This call - with additional details -  is also available at http://scimaps.org/call

h2cm = Bayesian Quarters?

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

"The Bayesian approach allows human insight, subjective though it is, to be combined with statistical information, limited though it may be. It is not surprising that this blurring of the line between the methodologies of the sciences and the humanities has attracted passionate supporters as well as furious enemies on both sides of the cultural divide."

Von Baeyer (2003) p.79.

von Baeyer, H.C. (2003) Information: The New Language of Science, Weidenfeld and Nicolson, London.

Recipe for tension: Left-of-center values - Human (lower) Rights

Sometimes the invisible is most visible ...

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

Person visible - invisible in the conceptual frame	Where is your science now?
'Peace' the ultimate meme? Discuss.	"Human (lower) Rights"

Image source: Heiko Junge [20/27] Kansas City Star
http://www.kansascity.com/2010/12/09/2509904/empty-chair-left-for-jailed-chinese.html

Recipe II: Holistic care - Care pebble overhere!

...

WouldBeUser: Well there's no shortage of pebbles, the referrals come thick and fast.

ActualUser: That's why reflecting on that particular pebble is important, turning it - them, their situation over. Asking yourself is there anything I and the team have missed?

WouldBeUser: OK, the beach is still full of them!

ActualUser: Is it the pebble you are trying to see?

WouldBeUser: Ah, of course! Individualised care?

ActualUser: That's right. Nursing, health, social care and in fact good governance everywhere is about seeing the person. Sometimes it isn't easy; but if you pick that person out then you can count the rewards as you would the pebbles on the beach ...

Original image sources - see Recipe I

Recipe: Holistic care - Care pebble turnover*

WouldBeUser: How can you sum up use of the health career - care domains - model?

ActualUser: Well it's a bit like you are picking and throwing some pebbles on the care plan or game board.

WouldBeUser: What - as simple as that!

ActualUser: Yes, but - NEVER underestimate the value of turning each of those pebbles over and reflecting, sharing...

*Also great for a game of nudge - nudge.

Original image sources:

http://imagecache.artistrising.com/artwork/lrg//4/417/7CV9000A.jpg
http://www.crglass.ca/images/dark%20green%20pebbles.jpg
http://www.crglass.ca/images/dark%20blue%20pebbles.jpg
http://www.crglass.ca/images/red%20pebbles.jpg

h2cm and clinical equipoise

The past few weeks reading the Journal of Evaluation in Clinical Practice - I've encountered the concept of equipoise: specifically the clinical form.

The Health Career - Care Domains - Model is all about 'poise'.

The model's care domains provides the perfect workout.

Medicine, health and social care constantly exercises us. We are, whether or not we recognize it, on a balance board. In fact if you consider that image and then factor in the complexity of health care today you realise just how much stuff (technology), how many people (subjects, agents) need to be on that same board. Who does the board belong to though? Well of course it's -

Jo Public's (... and often off-balance, strengths depleted, sick (and tired), relapse prone...)

The April 2010 issue of the above journal is a fascinating read. I noticed today that some of our placement students were not aware of the recent and current position regarding health policy: that is the 'long view' of decades such as: Health of the Nation, the National Service Frameworks, Darzi ... They need to address that and I'm sure they will.

This journal issue prompts me to consider evidence based medicine anew, especially:

• Its history spanning 20 years.
• Its occupying the SCIENCES domain, with its weight threatening to overbalance all (you could say it's a significant singularity).
• The realization that the Emperor is short on clothes.
• Given the above it can mature. Bogdan-Lovis and Holmes-Rovner (2010)

Back to that board: and stepping onto the health care domains - all four of them so spread your feet - you can see instantly (feel that feedback) how EBM, shared decision making and (person) patient-centered care are all related. As Bogdan-Lovis and Holmes-Rovner (2010) highlight:

Equipoise is the heart of the shared decision making movement, and it embodies the problems for which patient decision aids are most often developed to explain the risks and benefits of competing alternatives. p.377.

h2cm is well suited to this task on so many levels.

The past week or two I've also noticed several mentions of the need to nudge people - here and there - both in the media and in Bogdan-Lovis and Holmes-Rovner's paper and references.

More to follow - and as you step-off take care ....

Wilson, K. (2010) Evidence-based medicine. The good the bad and the ugly. A clinician's perspective. Journal of Evaluation in Clinical Practice, 16, 398-400.

Bogdan-Lovis, E., Holmes-Rovner, M. (2010) Prudent evidence-fettered shared decision making. Journal of Evaluation in Clinical Practice, 16, 376-381.

And for the week ahead:

One mind, many minds - ONE PLANET. One need, many needs - ONE PLANET: what price stability?

http://hodges-model.blogspot.com/2009/02/one-mind-many-minds-one-planet-one-need.html

Rhinos, evidence based medicine and 'out-reach'

It would be be marvellous to be able to introduce h2cm to the nursing, health and social care communities in Asia, including China of course.

Working in health we are surely aware of the need to base what we do on evidence. Although nurses are not necessarily independent as the patient advocate. Advocacy is still an important part of the nursing role and one requiring specific advice in some instances.

Earlier this month a Guardian article related the ever more precarious position of the South African rhino and how claims about the curative properties of rhino horn as a medicine fuels poaching. The UK is nowhere near South Africa or China so what gives? What gives is the Planet, the tiger too and the biosphere in general. Apparently rhino horn is just compacted keratin and has no medicinal properties.

Nurses tend to be a green, ecologically minded group and the best source of change comes from within. It is never easy to change the beliefs of others, especially when your culture venerates its elders. Belief also remains a powerful factor in health. Despite this do nurses not have a duty to challenge beliefs that are wrong, to educate their communities even while taking tradition into account?

What price true literacy: spiritual, 3Rs, ICT, health, environmental and cultural ...?

There must be a way for nurses to unite on this - 

across cultures, borders, traditions, animal welfare standards,
digital barricades, politics, beliefs ...

As nurses there is always the question of dignity and respect and being non-judgemental and sensitive to cultural attitudes and practices that differ from our own. A 'truth' here is that you do not have to travel far for your own values and opinions to be challenged.

As we make a difference individually with patients and carers ... collectively can we extend our reach to other communities too? While there's still time - and we try not to bite our nails.