Interprofessional Collaborative Care Will Be Key to Meeting Tomorrow’s Health Care Needs

Maryjoan Ladden, Ph.D., R.N., F.A.A.N., Robert Wood Johnson Foundation Senior Program Officer

A little over a year ago, the Institute of Medicine’s landmark Future of Nursing: Leading Change, Advancing Health report put forward a series of recommendations for transforming the nation’s health care system. Among them was a call for a system in which “interprofessional collaboration and coordination are the norm.” That’s no simple assignment in a system that often operates in silos, from schooling through practice. But a number of innovators around the nation are already making headway.

Their work is the subject of a new policy brief from the Robert Wood Johnson Foundation, part of its Charting Nursing’s Future (CNF) series. The brief delves into what the IOM recommendation means for health care systems, offers case studies of several collaborative care models already in place, and examines the implications of the recommendation for how we train nurses and other health care professionals.

According to the brief, Implementing the IOM Future of Nursing Report–Part II: The Potential of Interprofessional Collaborative Care to Improve Safety and Quality, the “silo” approach must soon give way if we are to meet coming health care challenges. For example, chronic conditions are increasingly common—not surprising given an aging population. But the health care system is poorly structured to provide the sort of coordinated care and preventive services needed to give these patients quality care while reducing costs. Some health care institutions are gearing up for the challenge.

• In Boston, where Harvard Vanguard Medical Associates developed its Complex Chronic Care (CCC) program, primary care has become interprofessional, collaborative and noticeably more efficient. Each CCC patient is assigned a nurse practitioner (NP), a registered nurse with advanced education and clinical training. The NP consults with all the patient’s subspecialists and incorporates their guidance in a single plan of care. The NP then manages and coordinates that care, connecting patients to nutritionists, social workers, and other professionals as needed. The model is dynamic, allowing patients to meet more or less frequently with the NPs and their primary care physicians, who remain responsible for the patients’ overall care.
  

• In New Jersey, the Camden Coalition of Health Care Providers is “revolutionizing health care delivery for Camden’s costliest patients,” according to the brief. These individuals, sometimes called super utilizers, typically rely on hospital emergency rooms for care. Not surprisingly, such patients account for an outsized share of local hospital costs, often with diagnoses that would have been more properly handled in a primary care setting. The Coalition developed its Care Management Project to reduce these unnecessary emergency room visits by treating patients where they reside, even when that means treating them on the street. A social worker, NP and bilingual medical assistant work as a team to help patients apply for government assistance, find temporary shelter, enroll in medical day programs and coordinate their primary and specialty care.
  

Training the Next Generation to Collaborate

Of course, the silo effect usually begins in school. In May 2011, six national education associations representing various health care professions formed the Interprofessional Education Collaborative (IPEC) and released a set of core competencies to help professional schools in crafting curricula that will prepare future clinicians to provide more collaborative, team-based care. Such efforts are already under way at a number of institutions.

• Maine’s University of New England has developed a common undergraduate curriculum for its health professions programs in nursing, dental hygiene, athletic training, applied exercise and science, and health, wellness and occupational studies. The curriculum includes shared learning in basic science prerequisites and four new courses aimed specifically at teaching interprofessional competencies.
  

• In Nashville, Vanderbilt University is also pursuing an interprofessional education initiative that unites students from the medical and nursing schools with graduate students pursuing degrees in pharmacy and social work at nearby institutions. Students are assigned to interprofessional working-learning teams at ambulatory care facilities in the area.
  

• The Veterans Health Administration (VHA) is piloting an interprofessional initiative, as well, focused on preparing medical residents and nursing graduate students for collaborative practice. As part of the initiative, five VHA facilities have been designated Centers of Excellence and received five-year grants from the U.S. Department of Veterans Affairs. Each VHA Center of Excellence is developing its own approach to preparing health professionals for patient-centered, team-based primary care.
  

• In Aurora, Colorado, the University of Colorado built its new Anschutz Medical Campus with the explicit objective of creating an environment that promotes collaboration among its medical, nursing, pharmacy, dentistry and public health students. It features shared auditorium and simulation labs, as well as student lounges and other dedicated spaces in which students from different professions can pursue common interests such as geriatrics in a collaborative fashion.
  

Such initiatives are clearly the wave of the future, if only because the pressures of caring for a larger, older and sicker population of patients in the years to come will drive efforts to identify efficiencies. In the words of Mary Wakefield, PhD, RN, head of the Health Resources and Services Administration, “As the health care community is looking for new strategies and new ways of organizing to optimize our efforts—teamwork is fundamental to the conversation.”

...

My source: Matt Freeman (PRS)

[HIFA2015] Women and Children First

As we draw towards the end of the year, Ros Davies, executive director of
Women and Children First (www.wcf-uk.org) reminds us:

'This Christmas Day, 1000 women will die in childbirth.
1000 women will die this way on Boxing Day too.
In fact 1000 women die every day whilst pregnant or giving birth.

... the vast majority of these deaths could be prevented by the provision of simple information and equipment which many of us take for granted.'

http://hosted.verticalresponse.com/786283/74890f4030/1470640645/8fd055e22b/

My source:
HIFA2015: Healthcare Information For All by 2015: www.hifa2015.org

Social Impact Bonds (SIBs) in Health

The following text is from the report:

Social Impact Bonds
A new way to invest in better healthcare

PURPOSE

This report is about the potential applicability of Social Impact Bonds (SIBs) in the health field. The SIB is a financial mechanism where investor returns are aligned with social outcomes. The SIB is based on a
contract with government in which the government commits to pay for an improvement in social outcomes for a defined population. Investors fund a range of preventative interventions with the goal of improving the contracted outcomes. If and as the outcomes improve, investors receive payments from government.

To widespread interest, the first SIB was launched in September 2010. Its aim is to reduce reoffending among short sentence male prisoners leaving Peterborough prison.

Social Finance believes that the reach of the Social Impact Bond model is wider than Criminal Justice. We asked Professor Paul Corrigan, a leading health adviser, to assess the suitability of the SIB model for
the NHS. This report presents his thoughts. We hope that his report provokes a thoughtful debate on how, or alternatively if, financial mechanisms such as Social Impact Bonds, might fund new interventions, improve people’s well-being and ultimately lead to a real change in the health system.

https://yoursri.com/users/570478ce8443743bff8b7e51c4d7ba60/b8984d6a364dadf0ff6c5d869f8f0cb8/@@download/fs


My original source: HSJ

Time Magazine's 2011 'Person of the Year': The Protester

This image released by Time Magazine, Wednesday, Dec. 14, 2011, shows the cover for Time Magazine's 2011 'Person of the Year' issue. The Protester is this year's choice.

Thinking about this recognition of The Protester I believe that -

the Protester is an example of a true holistic practitioner...

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

How does an individual decide 'enough is enough'? When does the one act on behalf of the many? What happens when a Person clenches their fist, decides to fight for their rights? In a digital world "NO" and denial of individual human rights is not an answer.	When is the individual a mere 'particle'?  When are they a 'wave'?
The Protester TAKES IN ALL THE CARE DOMAINS.  They reflect -  but they do not see themselves -  they see the future for family, friends, nation: and then they act.	When the State clenches its fist what does it strike?  Who tends to the mental health of the world's leaders? What price for home, land, human rights, education, health information and justice?

MEMO:
TO: The Editor, Time Magazine
FROM: Welcome to the QUAD

Congratulations on your publication and this annual media event. It is fascinating to note the changing cultural, social and political influences evident in the history of 'Person of the Year', most evident in being originally 'Man of the Year'.

I note you have twice selected former president Ronald Reagan in 1980 and 1983 respectively. The former president disclosed that he was diagnosed in 1994 as having Alzheimer's disease. It is quite a coincidence that in-between Reagan's selection the means to a global memory The Computer was appointed as Machine of the Year in 1982. One thought: how many other individuals listed were, or are affected by the dementias?

I believe at some point in the next five years you could do a great service to the many Persons (younger as well as older adults) and their families who are living with dementia in acknowledging them as PERSON of the year.

To people living with this dreadful condition you can help highlight the importance of health, research, funding, policy, socioeconomic impact and most of all - person-hood where it really does matter.

Thank you for your consideration.

Yours Sincerely,

Peter Jones

Sources:
http://en.wikipedia.org/wiki/Time_Person_of_the_Year


http://en.wikipedia.org/wiki/Ronald_Reagan

States of mind and policy [I]: 25% of hospital beds...

The repeated things that some people say, what does that denote?

The repeated things that other people say, what does that demonstrate?

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

In which care domain does the Person living with dementia reside?	1 : 4 - 25% of occupied beds [ diagnosis? ]
... and what of their carers... with their expertise?	there is a strategy - yet more hospital champions are needed and training.

My source:
BBC Radio 4 & RCN Students mail list

Student placements and public engagement - over the years

Mentoring student nurses has always been and remains a non-trivial professional obligation. It is something that I have always enjoyed. I make a point of not wittering on and on about h2cm - well maybe a little :) . To save the student's patience and assure my time it is good to ensure a well-rounded placement.

Over the years I've engaged in community service and research projects so looking to the humanistic domains comes naturally. It's been quite interesting watching the various efforts the health sector has made to engage the public. There's no imperative, but I make a point of highlighting the possible learning to be had in contacting the local public involvement and engagement people. Students have found this to be quite enlightening. Encounters with the Community Health Council [CHC] especially so, although that seems a long time ago now.

The Health Service Journal (still catching up) reminded me of all this in the summer, c/o Calkin & West, 4 August 2011 pp. 4-5. This news item spanned my whole career outlining the history of such bodies:

• Community Health Councils: 1974 - 2003
• Patient and Public Involvement Forums 2003 - 2008
• Local Involvement Networks 2008 - 2012
• HealthWatch 2012 - ?

I even remember the demise of the CHC being reported. Actually no, correct that: I remember the report of the CHC's teeth being taken out before their end. As you look at the timeline represented above it seems to suggest either less stability, or less significance has set in; maybe both. The title of the above piece reads: Plans for engagement are 'insulting'.

Whether or not the CHC ever had sharp canines (with an extra full-moon glisten) and a bite force like a croc is something for the archaeologists to check. One thing for sure, it seems subsequent bodies have no need of dental check-ups, being sans teeth.

Working in the community it was heartening to see the CHC doing its work locally. I also read recently (HSJ I'm sure) how public involvement was finally enshrined in the The National Health Service Act 2006. So you see how progressive the CHC was. It is a great shame this momentum cannot be maintained - for reasons we'll return to in 2012.

For now, as students enter their third year I think it helps to bring life to the POLITICAL care domain. It matters. This ongoing issue is central to health services provision, planning, innovation and the commons ...

The astrolabe, programming and big pictures

The astrolabe was a
mechanical implementation of
an object-orientation
model of the sky. p.47.

Eric Evans, (2009). Domain-Driven Design: Tackling Complexity in the Heart of Software, Model-Driven Design. Addison-Wesley.


Image source: http://planetariubm.wordpress.com/2011/03/01/femei-celebre-in-istoria-astronomiei-1/

Green Collar Jobs: The Big Picture (Infographic)

I like big pictures :) especially those that point the way to a greener global future.

For text and my source please see:
...

Infographic by Jobvine Jobs

Woolly vests, Engines and Health care: One stroke or two?

The cover of Nursing Times this week declares helpfully and positively that nursing is not broken. Stressed on several fronts, but not broken. The feature explores the contribution that skill mix makes to nursing practice, quality and outcomes.

With the past day of industrial action and the economic climate you hear repeated commentators extolling the need for and benefits of investment in services be that: health and social care, house and road building, high speed rail, green energy, ...

The economy is often described as an engine. The knowledge and skills of the workforce (and students) help fuel prosperity through creativity, innovation and ultimately productivity.

As the looming winter settles in - I start to think about vests. The woolliest I can find.^* You wonder to what extent the in-vest-ment in skill mix on the wards and other clinical encounters are oriented  towards tasks, activity and how much that skill mix has the necessary redundancy in place to afford high-quality patient education and person-centered care? You see we need to revest patients and the public at large with the knowledge and self-efficacy to keep well and stay well.

Economies that rely on two cylinder engines are usually considered as a bit behind the times. Noise. Pollution. Waste. How many cylinders do our health care systems run on?

Well, it looks and sounds like one.

One poorly machined cylinder with CURE at one end and PREVENTION at the other. So, the irony. We need a two-cylinder engine not just in health and social care, but people's lives. What a dream machine that would be. Is there a conceptual prototype out there...? You hope that Local Authority changes can refactor the engine, because looking at re-admissions (Milne and Clarke, 1990; Dowler, 2011) a radical redesign is greatly needed.

The truth is that as things stand (and the masses sit) this isn't enough.

(Interesting to note that apparently some 'one-cylinder' designs actually depend on two operations that overlap.)

Milne, R., Clarke, A. (1990) Can readmission rates be used as an outcome indicator? BMJ, 301, 17 NOV. 1139-4.

Dowler, C., (2011) Penalties fail to cut readmission rate, HSJ, 24, 11, 11, 4-5.

*Only kidding.

Musings - The Caring Tableau: there's a method in conceptual overloading

[Still trying to figure some things out. ... ]

... Our foundation and scaffold must serve two purposes then. On the one hand it must facilitate conceptual modelling, and on the other hand it must be able to reflect the real world, the real time experiences we encounter.

Our models are built using words, specifically concepts. A minimalistic-holistic approach for the foundation [of h2cm] helps achieve balance, neutrality, agnostic credentials and avoids the additional danger of conceptual overloading.

In computer programming languages conceptual overloading has a specific meaning and application. It refers to the facility of some programming languages – Java for example (Bergel, 2011) – to have methods that have the same name. Methods are re-usable pieces of code that process data in a specific way. In conceptual overloading methods that share a common name are differentiated by different number and types of data specified as parameters. From a minimalist point we can readily expand the model thereby introducing conceptual overloading. The care domains can be viewed as methods, each with their own parameters. In the case of health care the parameters whilst indicated are not fixed. They are instantiated when invoked through a specific context, event or process. This is the challenge facing new recruits as they learn, and the expert as they continue to re-learn, forget, re-learn.

[If we continue the overloading process here, we arrive at the inevitable(?) philosophical junction of truth. In the health career domains model we can look upon the model with its domains as being filled with pebbles. I have frequently described the model as a mental means to turn over the cognitive – conceptual - pebbles and check their relevance. It is as if we have to include all concepts. Then many pebbles are automatically excluded by the very act of the initialization referred to above. This reduction, the emergence of conceptual dimensions is critical, it also reduces conceptual overload. What we have in effect then is a truth table – a care tableau.]

Bergel, A. (2011). Reconciling method overloading and dynamically typed scripting languages. Computer Languages, Systems & Structures. 37, 3, 132-150.

Musings... axes in hand and mind

New authoritative overview of Social Computing by Tom Erickson, IBM Research Labs

Dear friends,

I'm happy to announce a new, *completely free*, and authoritative overview of Social Computing, which is highly relevant to anyone designing interactive products. It's written by Tom Erickson - veteran researcher at IBM Research Labs - and includes 9 HD videos filmed in Copenhagen. It also includes commentaries by renowned designers/researchers like Elizabeth Churchill - manager of the Internet Experiences group at Yahoo! - and Andrea Forte from Drexel University.

These materials have taken 10 months to produce and involved 3 editors, 2 peer-reviewers, a camera crew of 2 people, 1 sound technician and 1 video editor. We've decided to continue to create world-class educational materials by elite professors and elite designers and give them to you for free. We would, however, be really grateful if you would share these materials, blog about them, or help us in other ways.

You can watch the videos and read the full overview here:
http://www.interaction-design.org/encyclopedia/social_computing.html

Have a great day!

Best wishes from Denmark,

Mads Soegaard
http://interaction-design.org/about
-------------
My source: SOCIOTECH-INTERACTIONDESIGN Digest

Calling NHS personnel: free Knowledge Management online learning resources developed for and by the NHS

Hello everyone,

I’m writing to you in your capacity as a member of the Knowledge Management group on eSpace. I would like to bring to your attention a series of new, free Knowledge Management online learning resources developed for and by the NHS at: www.ksslibraries.nhs.uk/elearning/km. The resources are jointly developed by the Department of Health Informatics Directorate (DHID) Knowledge Management team and the NHS Library and Knowledge Services at KSS & Deanery, Brighton & Sussex University Hospitals NHS Trust. The resources are designed to help you to:

• Develop a strategy for knowledge retention and sharing
• Plan how an individual, team or organisation can learn from the experience of others
• Capture, share and preserve resources from individuals or teams
• Record and share learning and experience gained from project or work
• Understand how knowledge management techniques have helped other organisations

Select the modules that most suit your learning needs. Each module lasts between 15 and 40 minutes.

Visit www.ksslibraries.nhs.uk/elearning/km to get your knowledge management learning started. To find the resource in the NHS eLearning repository, navigate directly .... or go to: http://www.elearningrepository.nhs.ukand browse to KSF -> Information and Knowledge -> IK2 Information collection and analysis, and you will find the resource listed as: Knowledge Management eLearning Resource.

Each module provides a feedback form; let me know if you have thoughts or comments in general about the resource.

Kind regards,
Andrew
___________________________________________________________________________________
Andrew Lambe
Knowledge Management Lead
DH Informatics - Informatics Capability Development
1st Floor, Princes Exchange
Princes Square
Leeds LS1 4HY
e-mail: andrew.lambe AT nhs.net

The Care Campaign

The Care campaign is a joint drive by the Patients Association and Nursing Standard magazine to improve fundamental patient care across the UK.



CARE stands for:

C – communicate with compassion
A – assist with toileting, ensuring dignity
R – relieve pain effectively
E – encourage adequate nutrition


The campaign recognises that everyone who goes into a care setting is entitled to these four fundamental aspects of care – they are a human right.

We hope patients, relatives and nurses will use this Care slogan as a care checklist. Patients and relatives can use it to pinpoint shortcomings in care; nurses can use it to articulate a case to their managers for more support, for example, more staff.

The Care campaign asks all nurses, nursing directors, chief executives and non-executive directors of NHS trusts to sign up to the Care Challenge so that ‘Care’ becomes a universal expectation for patients.

The campaign’s aims are:

• For nursing staff to adopt the Care Challenge, based on our four-point tool.
• To highlight obstacles nurses face in delivering the Care Challenge.
• For organisations to sign up to the Care Challenge.
• For patients to recognise the Care checklist and to use it to challenge poor care.
• To support nurses who expose failures to deliver the fundamentals of care.

Contact The Care Campaign: carecampaign AT rcnpublishing.co.uk

===========
Some thoughts:
What is crucial of course is what the above C. A. R. E. depends upon - and this has been considered within the campaign:

C: Attitude, self-awareness, professionalism and training in theory and practice.
A: Time and adequate staff assignment to enable patient - person-centred care not task allocation.
R: Time to observe and interact with patients and relatives - acknowledging patient reports and training in the recognition of pain and management. Pain management should not be incidental - neither should dignity and respect.
E: Too posh to wash - Too senior to help feed a patient, ensure they have a drink?

CARDI conference Dublin 2011: Hodges' model - a poster element

Here is one element of the poster from last week's conference. This part is A3 in size and the linked preview below is to an archived copy on the Internet Archive. I will post the glocal version on W2tQ  in due course. As ever I wish I had more time to devote to producing such work. The symbol common to memory and giant global graph is intended to highlight a person's memory and the distributed 'memory' that is the Web. Such a representation can never capture all the subtleties involved, the overlaps, the contexts and perspectives.

The placement of some concepts is an invitation for reflection. For example, dementia and the use of anti-psychotic drugs also demands consideration of policy, liaison, primary-secondary-residential care interfaces, shared cared protocols, formal reviews, target behaviours, definitions of challenging behaviour, observation skills, clinical records, therapeutic interventions and the care environment ...  Some of the content, such as under Interpersonal Define 'safety', 'health'... seek to stress the same.

Acknowledgement:
Many thanks to the CARDI Committee for the opportunity to present, my employer Lancashire Care NHS Foundation Trust for study leave, and Prof. George Kernohan (Ulster.ac.uk) for assistance in supporting my attendance and in the production and printing of the poster. We plan to produce a paper based on the same.

Bortz's Next Medicine: Defining 'health' and h2cm

On page 137 of Next Medicine, Walter Bortz assembles the Health Equation:

Genes (A) + Extrinsic Agency (B) + Intrinsic Agency (C) + Aging (D) = Health

After providing values for the other elements Bortz notes that:

Intrinsic Agency = Health - 0.45

In other words, such reckoning, though admittedly coarse, means that internal agency accounts for around 55% of the values we need for health, which is similar to the figure obtained by Mike McGinnis of the Institute of Medicine and Bill Foege of the Gates Foundation. (p.137)

'Conceptual frameworks' are referred to frequently in the literature and in a way quite distinct from h2cm. I've just posted about h2cm as a conceptual framework - a potential conceptual space. Bortz stresses the value of having several conceptual frameworks that, for example: enable pursuit of preventive strategies; and the conceptual framework provided by thermodynamics that informs our understanding of life, health and not surprisingly - ageing.

Bortz's conclusion above however also serves to highlight:

1. The need for a global, generic, universal (data-, information-, knowledge-centric) conceptual framework to pull the elements of this equation together (and much more besides).
2. This IS essential as those elements include the various disciplines. agents (stakeholders)  involved.
3. Bortz's conclusion that internal agency accounts for around 55% also acts as a definition of person-centered health care.

From 1 - 3 perhaps h2cm can also serve as an indicator of a (the) prerequisite literacy level that an individual needs to achieve self-efficacy in health terms?

Chapter 10 next and posts on last week's Cardi conference - which was excellent.

Acknowledgement: I am very grateful to Oxford University Press for the review copy.

TED: Nic Marks - The Happy Planet Index

As a brief exercise you might wish to take the five positive things that Nic Marks mentions and map them in terms of h2cm.

Additional links:

New Economics Forum

Foresight: BIS

PJ's project [ii]: Hodges' model An aide mémoire, or candidate Gärdenforsian conceptual space? Or would you like a mint?

This 'project' has in reality been ongoing through some thirty years. Although Hodges' model is by its very nature - broad and generic - I'm sure there is a specific research question here. For me this question combines nursing (theory and practice), informatics, health and public engagement. One possible question that h2cm provokes concerns whether the model can be considered a conceptual space?

Over a couple of years I've been adding to some notes which for want of another I've framed under the question above. These notes inevitably languish for a while given a full-time nursing job (plus learning Drupal, this blog, doing posters ...). Picking the text up recently though the intro material seems to have fallen into place. An introduction should cover the recurring issues, challenges - opportunities found in nursing. Although I have the secateurs in hand and the spring is warm, Hodges' model requires that education and cognitive science are also be considered in this way. Anyway, here is the current working outline:

Hodges' model: A mere aide mémoire, or candidate Gärdenforsian conceptual space?

Abstract

Part 1: Introducing Health & Social Care, Education, Hodges' model

1 Introduction
 1.1 Health and Social Care
 1.2 Recurring Issues in Health and Social Care

2 Education
 2.0 Introduction
 2.1 Education in the 21st Century
 2.2 Issues arising in Education

3 Health Care and Nursing Theory and Hodges' model
 3.0 Introduction
 3.1 Models of Nursing (Care)
  Definitions
 3.2 Hodges' Health Career - Care Domains - Model
 3.3 Information, energy?, records

Part 2: Cognitive Science & Conceptual Spaces

4 Cognitive Science and Computing
 4.0 Introduction
 4.1 Models, contexts, situations, the Project and (Darwinian) Justification
 4.2 Forms of Literacy, Requirements and Socio-Technical Perspectives
 4.3 Computation and Computer Graphics

5 Gardenfors' Conceptual Spaces

 5.0 Introduction

Drawing upon the cognitive science and computing literature the objectives of Gärdenfors’ Conceptual Spaces are made clear from the outset:

‘… is to show that a conceptual mode based on geometrical and topological representations deserves at least as much attention in cognitive science as the symbolic and associationistic approaches’ . p.2.

To what extent is h2cm a geometrical and topological representation? It appears on a simplistic level to qualify as a complex plane (Derbyshire, 2008). In this case, however, the closest we get to imaginary numbers in the negative sense are the null hypotheses of clinical research and reasoning amid uncertainty (REF). Gärdenfors continues:

‘This is a book about the geometry of thought. A theory of conceptual spaces will be developed as a particular framework for representing information on the conceptual level.’ p.2.

Hodges' model provides a framework, but as already noted it is not as yet theory based. It is based on practice, with appeals to experience and the knowledge and skills deployed in the health and social care sector. Could the h2cm framework work with Gärdenfors theory of conceptual spaces and his resulting framework for representing information? When Gärdenfors refers to his book being about the geometry of thought, here I would ask: What have nursing theorists sought? In addition to the stated motivations, surely a geometry of nursing thought? Nursing theorists seek rules and laws for a 'geometry' of care. A geometry of care is no less idealised, no less Platonic in form ultimately reflecting the values of the profession. A geometry of care would clearly be an achievement of harmony in the midst of discord and suffering. Additionally as the nursing discipline appears to some to be compromised in respect of practice, training, attitudes and professionalism.

 5.1 Representation, Explanation and Construction
 5.2 Background on key research methods
 5.3 Gärdenfors conceptual spaces - selected definitions
 5.4 Purposes, Holistic Bandwidth, Safety, Benefits and the Socio-Technical (repetition, move?)

Part 3:

6 Nursing, Care Theory and Care Domains
 6.0 Introduction
 6.1 Indicative literature review
 6.2 H2CM, Research methods and Data, Data, Data, (Data!)

Conceptual Spaces: Process, Practice and Domains - Hodges’ model

Part 4:

Coding and Classification, Ontologies, RDF, Semantic Web
Icons, glyphs, blobs
Patterns, wholes and parts
Users, Purposes and Scope of Application
Drupal and Ruby
Domains and Domain Specific Languages
Closing Discussion

(Back to this post:)
Don't ask why I am doing this. Chaos does reign here - 'Indicative literature review' in the midst...! In my defence these are notes, what's the question? Bits of the text move about, some disappears. Part 4 could become two, or three new parts, but no more than that! To what extent is there a case for M.I.N.T. a Modern Information-oriented Nursing Theory?*

Can you get there from a conceptual framework? When you get on the "conceptual framework" bus, can we simply change the destination to "conceptual space"? Has the academic bus already been and gone, or it drove right past: "Not in Service". Is this too big an ask of a bus? You need a ship to cross an ocean - even one that is illusory.

One thing I am sure of is that the model - #h2cm, this blog #W2tQ, my picking out Drupal, Ruby and the potential of visualization in the social sciences must come together in some way. One can inform the other. There is something really worth doing here. If in the end I don't get to do it well maybe others can finish the piece (the ambiguity here is intentional). Where's that illusory ship....

* M.I.N.T. sounds better than F.I.H.T. - you know cool and refreshing; but I do prefer and we really do need a Future & Information-oriented Health Theory?

Derbyshire, J. (2008). Unknown Quantity, Atlantic Books. p.12.

Gärdenfors, P. (2000). Conceptual Spaces, Cambridge.

What's the difference between 6 and 7? About 11 years ...

Gradually over the past few months I've checked the care domain links. Deleting those where the domain is now "For Sale", broken, or the content is plain out of date. The final domain was the SCIENCES. It's the largest still and while the links are monsters, it is interesting working through them occasionally.

One change caught my eye last month in the 'Environment, Sustainability, Ecology & EcoSystem Health' listing (now former h2cm website). I clicked on Six Billion and Beyond and duly found that it has been retired from pbs.org. A few weeks ago I'd shared with students and have included on the CARDI conference poster the fact that today it is believed that the Earth's human population reaches 7 billion.

Looking back Six Billion and Beyond aired in 1999. So in 11-12 years there are an extra billion souls. You have to ask:

• What will we all drink and eat?
• Will we all have a (dry) home?
• Will we all read? (Have access to information and info technology)
• What will this latest generation believe in?
• Whose beliefs will they be?
  
• Can the 7 Billionth human being of Earth be a true citizen?
• Before that - for how long will they be allowed to be a child?
• Will they pray? Who to and why - choice?
• Will they have to fight (in a uniform)?
• What will their sense of quality of life be?
•  Will that 7 Billionth person and their family have access to:
• health information?
• basic health care?
• education?
• What space is there for their human rights?
• Can technology finally deliver Socially?

Checking the links this time around proved quite a lesson in global demographics - how long till the next...?

Additional links:

https://www.worldometers.info/world-population/

The world is home to 7 billion people but how far has it come?
The population milestone is a reminder that there is much work to do on sexual and reproductive health and HIV if we are to meet the millennium development goals by 2015, The Guardian, Monday 31 October.

Public health: Whole society, whole government - whole medicine

The Health Service Journal isn't cheap so here every issue as a subscriber is a valuable resource.

In a September issue (1st) there were some really good opinion pieces and articles. One by Graham Burgess (p.17) concerned the coherence of public health. He started with the struggle that has been public health in England for the past 50 years; it has failed to define the problem to be solved.

Things may be set to change with the shift to local government that helps define public health on a social level, not just as a medical preoccupation - a distraction in fact from the disease health service perspective.

The word holistic that we all band-about was brought into stark relief by Mr Burgess as he nailed some w-holistic ecologies in referring to the 'whole of society' and 'whole of government' approaches necessary to build on the finding by the National Audit Office that only 15-20% of the inequalities in mortality rates can be directly influenced by health sector interventions.

There is a need to look further field than the supposed macrocosm that is the NHS: physical health - mental health.

Mental health is a whole world so frequently set apart from 'medicine'. Mental health contains a range of services that all shout: 'I am Cinderella!' So, Mr Burgess both frames the public health line up; and as I see it highlights the holistic scope of what are crucial and still emerging concerns. Still emerging ...? Well in the sense of having new - local authority - legs and thus endowed - how much further can public health run - and what tools are needed?

NAO Department of Health:
Tackling inequalities in life expectancy in areas with the worst health and deprivation

Abstract translation (100 words): Exploring several dimensions of local, global and glocal using the generic conceptual framework Hodges's model

I need to produce translations of an abstract into French, Spanish and Russian with a 100 word limit. At present I'm relying on Google translate; any suggestions to improve what follows (the English too!) greatly appreciated. 'Glocal' should prove a bit of a test. (h2cmng at yahoo.co.uk):

Exploring several dimensions of local, global and glocal using the generic conceptual framework Hodges's model

Abstract
This paper introduces Hodges’s model a conceptual framework as a means to explore the  concept glocal and the more familiar terms local and global. Actual and speculative definitions of glocal are offered. Discussion will also deliberate on the compound meanings of these terms. The model's four knowledge (care) domains facilitate discussion of the physical, social, political and individual dimensions of local, global and glocal. The paper draws upon health, anthropology, history, science, informatics and geopolitics – especially the themes of globalization, literacy,  information technology and communication (voice). The purpose is exploratory with additional resort to philosophical reflection.

Explorar varias dimensiones de locales, globales y glocales utilizando el modelo conceptual genérico Hodges marco de

abstracto
Este trabajo presenta un nuevo modelo Hodges es un marco conceptual como un medio para explorar el concepto glocal y los términos más familiares locales y globales. Definiciones reales y especulativos de glocal se ofrecen. El debate también se tratará sobre el significado de estos términos compuestos. El modelo de cuatro conocimiento (atención) dominios de facilitar la discusión de las dimensiones físicas, sociales, políticos e individuales de los locales, globales y glocales. El documento se basa en la salud, la antropología, la historia, la ciencia, la informática y la geopolítica - especialmente los temas de la globalización, la alfabetización de tecnología de la información y la comunicación (voz). El objetivo es exploratorio con recurso adicional para la reflexión filosófica.

Exploration des dimensions de plusieurs locaux, mondiaux et glocal utilisant le modèle générique de cadre conceptuel Hodges

Résumé
Cet article présente le modèle Hodges un cadre conceptuel comme un moyen d'explorer le concept et le glocal termes plus familiers local et mondial. Définitions réelles et spéculative de glocal sont offerts. La discussion portera également délibérer sur les significations composé de ces termes. Les quatre modèle de connaissances (soins) domaines de faciliter la discussion de la physique, les dimensions sociales, politiques et individuels des locaux, mondiaux et glocal. Le document s'appuie sur la santé, anthropologie, histoire, sciences, informatique et de la géopolitique - notamment les thèmes de la mondialisation, de l'alphabétisation technologies de l'information et de communication (voix). Le but est exploratoires avec station supplémentaire à la réflexion philosophique.

Изучение нескольких размеров локальных, глобальных и глокальные использованием модели общих концептуальных рамках Ходжеса

абстрактный
В данной статье рассматривается модель Ходжеса концептуальную основу в качестве средства для изучения концепции и глокальные Наиболее известные термины локальные и глобальные. Фактические и спекулятивных определений глокальные предлагаются. Обсуждения будут также обсуждать соединения смысл этих терминов. Четыре модели знаний (ухода) области содействия обсуждению физических, социальных, политических и индивидуальных размеров локальных, глобальных и глокальные.Статья основана на здоровье, антропологии, истории, науки, информатики и геополитика - особенно темы глобализации, распространения грамотности, информационных и коммуникационных технологий (голос).Цель поисковой дополнительные прибегать к философской рефлексии.
 

CARDI conference ageing globally - ageing locally: Poster

The last poster I completed in June for the Health Literacy conference in Manchester was made up of four A4 pages. It was OK, but suffered next to the University produced presentations - maybe it was an imposter. So, I determined that the next would be a more professional A1 - A0 effort.

Thanks to George Kernohan - Prof. of Health Research in the Institute of Nursing Research at University of Ulster - next week's CARDI conference in Dublin will see this realised.

Nine A3 pages were produced in total (too many for insurance). The final 'composition' was not straight forward. George suggested Powerpoint and that clinched it after much aggravation. This will be easier next time! With a week to spare I forwarded the draft to George. As before I've tried to strike a balance between graphics and text. There are three diagrams of the model in total that hopefully capture some of the main conference themes:

Title, author details & acknowledgement

Introduction to Hodges' model with basic model graphic axes and domains

h2cm matrix including the 4P's and Global & Local aspects of ageing

h2cm matrix Glocal and notes, the future and bibliography

The overlap here is quite something: I believe that the 4,400 words on local, global and glocal now has some coherence and merit. The context for that 4K is community informatics. The poster has drawn on that draft and in turn a further paper on this theme but specifically addressing older adults, health care, nursing ... will take things further.

The conference is much more than the posters of course. There are some excellent sessions and speakers too. Apparently the poster has arrived across the Irish Sea and looks OK. The boarding passes are printed - Dublin next stop. I'll also find out what Guinness really tastes like and catch up with James Joyce on Friday.

h2cm, Bortz's Next Medicine and self-efficacy

Here on W2tQ I've written about the primacy of the individual within the health care domains model. The person, the unique human being is at the center of the nurses' focus and values.

I had a gut instinct with Bortz's book Next Medicine which I am now half-way through. This book is a real gift to me searching for evidence that supports the model's original creation and its purposes. As the book's title attests I'm also seeking evidence that highlights the model's potential today. On page 92-93 Bortz writes:

Self-efficacy. It sounds like an erudite, vacuous, scholarly term of little relevance. But just a moment's reflection leads to the recognition that self-efficacy is the centerpiece, the keystone on which all other body and mind functions depend. Self-efficacy: self-sufficiency, intactness, wholeness, autonomy, independence. These concepts embody the essence of what it means to be fully alive, fully functional.  ...  Self-efficacy, he [Albert Bandura] says, is health. Health is self-efficacy. Rather than being a remote scholarly label, it comes close to being the central axis for health and Next Medicine.
(My emphasis.)

Bortz also highlights Bandura's notion of self-efficacy and self-efficacy prescriptions.

Information Prescriptions: Just don't say "job done" or "next!"

The information prescription (IP) is not new. It is what should be a routine intervention that benefits from such initiatives as the specific IP project in 2007, which also produced a final report in 2008.

If people today are expected to self-care, there are recognized problems when they self-information prescribe (or is that paternalism at work?). The provenance of information on the web is a key concern.

In the 1980s and 90s the prescriptions and the management of benzodiazepines in community mental health gradually emerged as a problem. Today (for our children and their children) there's an acute problem with the frequency of antibiotic prescribing. Listen to the informative and sobering BBC Radio 4 programme:

The Path of Least Resistance

As people are directed to validated and creditable information resources we need to consider the bigger picture that a prescription ('plan') of any sort represents.

A response in the form of a drug/treatment or information prescription does (of course) not mean "job done".

Some follow up may be needed (duh!) as to what has been done with said information. When we speak to people we quickly make global assumptions about their understanding, literacy, motivation and the constraints within which they can operate when outside the clinical encounter. General Practitioners usually have the benefit, and in this context - a great benefit, of having known the patient and the family for many years. Other practitioners may not have that informational reservoir upon which to draw. General practice may itself see changes - pressures on the established patient - family doctor relationship.

The quote below is from the information prescription website:

Information prescriptions contain a series of links or signposts to guide people to sources of information about their health and care – for example information about conditions and treatments, care services, benefits advice and support groups.

Information prescriptions let people know where to get advice, where to get support and where to network with others with a similar condition. They include addresses, telephone numbers and website addresses that people may find helpful, and show where they can go to find out more. They help people to access information when they need it and in the ways that they prefer.

Working in nursing homes I know how demanding and challenging information exchange can be. While the above quote lists suggested content, I've had to signpost in person, once, twice, three times before the time was right for a carer to approach a specific agency for a resource.

Whatever your lingo, personalised information prescriptions are really cool - and hot. We need them.

After all isn't a prescription for drugs just another form of information prescription, molecular, biochemical? One that is also destined to become more personalised and yet on a different informational (genetic) level. More than anything else though we need a public, citizenry who can understand the value, potency of the infoscript in their hand. Is there an antidote for advertising?

 Although the informational exchanges in nursing homes and elsewhere are challenging: we keep trying. To do that the prescriptions should not be used as a means to say "Next!".

Crossroads have historically been meeting places. A space of choices (information) and signposts, make the right choice don't hurry.

Quality outcomes take time, but then I would say that ...

The International Health Protection Initiative (IHPI) - Resolution Sign-up

The International Health Protection Initiative believes that health care MUST be protected during armed conflict.

The International Health Protection Initiative (IHPI) is a collective movement of individuals, organisations, institutions and charities (including non-Governmental Organisations-NGOs) who have agreed to help to lobby the United Nations to act to uphold the Geneva Conventions, especially as regards safe-guarding health facilities/equipment/transport, and workers.  The Resolution was agreed following a meeting of the International Child Health Group held in November 2010.

Your support is urgently needed for an international resolution to protect healthcare during armed conflict

The resolution will ultimately be submitted to the United Nations (General Assembly, Security Council, and World Health Organization).

In order to achieve the objectives outlined in the resolution, we need the majority of the world’s healthcare organisations, institutions, NGOs and civil society, especially those in conflict afflicted countries to sign up to this important resolution.

We know that you are aware of the urgent need to protect healthcare during armed conflict, that is, to uphold the Geneva Conventions and we would be most grateful for your support.

Once you have read the resolution we respectfully urge you to sign up to it online, as an individual, or preferably, on behalf of your government, institution, or medical organisation. We also encourage you to state your reasons for supporting this resolution in the appropriate box.

So please Sign up now!

Many thanks for your time and attention and we look forward to working with you to help make this life-saving resolution a reality

The IHPI Team
info AT ihpi.org

"War... is when some adults who don't know what good is and what love is, are throwing dangerous war toys which injure innocent people" 

Tamara aged 10 years during the war in Bosnia and Herzegovena.

My source: Prof. David Southall via HIFA2015

My thoughts upon signing up:

This resolution saddens me: that we should need it in the 21st century after millennia of human conflict.

The resolution is an essential course of action that I will help to publicize. Resources by way of legal enforcement, financial and personnel as declared in the resolution to protect basic human rights and health care provision must be assured and enforced globally. As per #5 the trend of pursuing those who commit crimes against humanity should be escalated as the means to record and furnish evidence also increases. This is imperative as a deterrent to those who supposedly 'lead' and those who invariably follow. In this sense 'education for all' is also crucial to help prevent indoctrination - with the additional health dividend that education affords.

ERCIM News No. 87: Special theme "Ambient Assisted Living"

Dear ERCIM News Reader,

ERCIM News No. 87 has just been published at
 http://ercim-news.ercim.eu/

Special Theme: "Ambient Assisted Living"

Guest editors: Michael Pieper (Fraunhofer FIT, Germany), Margherita Antona (ICS-FORTH), Greece) and Ulyses Cortes (UPC, Spain)
http://ercim-news.ercim.eu/en87/special

Keynote by Constantine Stephanidis, Director, ICS-FORTH
http://ercim-news.ercim.eu/en87/keynote/

This issue also features a section on FET Flagships, introduced by Mario Campolargo, European Commission Director, Directorate F: Emerging Technologies and Infrastructures, Information Society and Media Directorate General.

The six FET Flagship Pilots - "Graphene", "Guardian Angels for a Smarter Life", "FuturICT", "IT Future of Medicine", "The Human Brain Project" and "Robot Companions for Citizens" present their vision and what they would like to achieve in the next ten years.
http://ercim-news.ercim.eu/en87/es

Next issue: January 2012 - Special Theme: "Evolving Software"
(see call at http://ercim-news.ercim.eu/call)

Thank you for your interest in ERCIM News.
Feel free to forward this message to others who might be interested.

Best regards,
Peter Kunz
ERCIM News central editor

Report - Guiding patients through complexity: Modern medical generalism RCGP & The Health Foundation

Evaluation report

PUBLISHED: October 2011

Report of an independent commission for the Royal College of General Practitioners and the Health Foundation


An independent commission, chaired by Baroness Finlay, has concluded that more of the most talented doctors must be encouraged to make careers as generalists rather than specialists to meet people’s changing health needs.

The Commission was set up by the Royal College of General Practitioners and the Health Foundation to examine the state of general medicine. It had the following terms of reference:

• Define medical generalism, with particular reference to general practice;
• Explore the intrinsic values of medical generalism;
• Define the role and value of medical generalism in contemporary clinical practice.
• Formulate a description of the medical generalist that:
• Is widely recognised
• Defines what patients and the public should be able to expect
• Clarifies how the medical generalist interfaces with other health care professionals
• Make recommendations about the future development of medical generalism.

Understanding and developing the role of the generalist alongside specialists is important for the quality of patient care, particularly ensuring the health service provides patient centred care and supports people with co-morbidities well.

WHO Mental Health Atlas 2011

Forwarded to the GANM from Ana Lucia Ruggiero at PAHO

WHO Mental Health Atlas 2011

Available online PDF [82.p] at: http://bit.ly/rocbFH

10 October 2011 – “…..New figures from the WHO Mental Health Atlas 2011 indicate that while the need for mental health care is large, with up to 25% of the population requiring it at some point in their lives, there is underinvestment in the sector.

The Atlas shows average global spending on mental health is still less than US$ 3 per capita per year and as little as US$ 0.25 per person per year in low-income countries.

It presents data from 184 WHO Member States, covering 98% of the world’s population. Facts and figures presented in Atlas indicate that resources for mental health remain inadequate.

The distribution of resources across regions and income groups is substantially uneven and in many countries resources are extremely scarce. Results from Atlas reinforce the urgent need to scale up resources and care for mental health within countries….”

Brochure: http://bit.ly/qvV9jN

My source: GANM (Global Alliance for Nursing and Midwifery)

Note to Steve ... Godspeed

I never met you Steve, I wish I had and the other people still working in the circles, squares, triangles and all those chaotic - contrail - lines you moved in - and still move in - now from a step afar.

Thanks for the Macbook I use every day. Since 2008 it's been a real pleasure.

A seminal movie moment for me is that scene - the match-cut - in 2001.

You know, the one with the app - ape - early hominid - learns to kill and throws a bone to the sky and it is transformed into a spacecraft.

http://www.imaginefx.com/02287754333349729529/retro-spacecraft.html

Tell me Steve: if I throw an iPhone 4S skyward, or one yet to appear - an i7 maybe - could you and your new friends change it into a starship?

Not just for me: for everyone.


Where have you been already? I'd be off to M31 looking back every so often. What a trip that must be. Perhaps you've already seen that double Milky Way yet to appear in the night sky?

I encountered Apple at the Which Computer Show so many decades ago and in Byte, a 3D star map program for the Mac. Not being able to afford a PC never mind a Mac someone let me run the program at the Show. I still have that disc somewhere (I hope). It was a marvel that little program. Now, of course there are astro apps galore.

I really know nothing of you Steve, and yet your work, ethos, drive, and contribution is plain to see. I have not pre-ordered your biography [but if family and friends are reading this... ]. Your passing has made me reflect though.

Your commencement address to the students at Stanford on the news media made me realize I am doing what I love to do: both full-time and part-time. How to reconcile the two!

Thinking about your passing (this way) you've definitely tapped my shoulder as you've passed by.

You prompted me not to think about how much things have changed in my field - community mental health nursing and information tech since I started working; but to wonder, to project myself into the future (as we always should - as you did with the knowledge...) and ask: How much will things have changed from now. What is questionable, wrong, archaic about our current attitudes and practices?

More than anything Steve - Mr Jobs - thanks for that. You will be greatly missed.

Jarvis's book 'public parts' [ii]: The sanctity of clinical data, INFORMATION, knowledge ....

This post extends the axes displayed in the previous post (i) and continues the discussion. These posts are prompted by the appearance of Jeff Jarvis's book - not a reading of it. I suppose they are an ante-review?

As before in the figure I have placed information (and the person) at the center. From (i) - transparency may be a public good in politics, local government and public life, but does the same apply for an individual person? It could be that Jarvis identifies the benefits that can be accrued from being transparent about my medical conditions.

Notable individuals, frequently those already in the public eye, have done so with an activist intent. A key example is Terry Pratchet with his disclosure and account of living with Alzheimer's disease. Mr Pratchet has been able to raise the public profile of dementia, quality of life in senior years, and also euthanasia and individual choice. If publicness effects debate in this way then that is clearly desirable. As we have seen with the internet however, there is a market for our data whether personal or merely our internet browsing habits. Where do we go? What are we searching for - a new digital camera, old book, a new HD TV?

Pre-internet a problem for people with condition 'X' or 'Y' was knowing: what to expect? (Even now due to their health and information literacy, a great number of people will still be stuck, excluded and disadvantaged.) What are good strategies to adopt? How have other people coped with this? What happens next? What are the odds? Are there other people living with this? The only opportunities to engage with other people who have something similar may be when sat in the out-patient department. An opportunity a further remove may be the medical diagnostic appointment for various forms of imaging and tests.

These days of course the whole pathway is person-centered and information focused (isn't it?). There are online communities for people living, coping and dealing with the full gamut of clinical disorders, recognized and even some as yet without a place in the medical lexicon.

Part of the debate here for me is that online communities, forums often have rules, they have spam detection and should be 'secure'. Plus of course users are usually encouraged not to use their real name, and be discreet as well as all the other points of etiquette that apply. If Facebook or LinkedIn was to include a new revision that caterred for my 'public' health record then I still wonder if this is publicness of another order. If you assume public office then it is beholden on you to be transparent. It isn't that I believe that transparency on an individual level does not apply. My job has me taking an opaque person and trying to make things transparent.

Perhaps this is the art in health care: 

learning to read that which is opaque such that it is rendered transparent?

For all that though I can't help but equate transparency with politics, companies, NGOs and the like.

There's another thing with the very public health record 4-U; will clinical terminology be affected? This may be a good thing. There are a lot of people, groups who want to shake up the medical establishment, the drug companies and modern practices. Here on W2tQ I wonder about the terms that will be needed in and around Hodges' model. Should a new website use an existing nursing classification, a folksonomy or a combination?

Medical progress has been hard won, many communities around the globe have yet to have access to basic health care, doctors, midwives and nurses. While the developed nations continue to talk about person-centered care, there remain places where ongoing community-centered care would be welcome.

Working in mental health for three decades you know of psychiatry in dissent and the debates ongoing around stigma, access to services, diagnosis and the use and abuses of medication. I am an idealist in health and informatics, both as distinct enterprises and in that yet to be fully realised combined formulation.

I worry about the trends in personal information disclosure, the rise of self-diagnosis online, and the growth of counterfeit drugs sold on the web. Effective and informed self-diagnosis can save health services time and money, but success, safety, and savings are not a given. So much depends on literacy.

I do hope at some point to read public parts - it is very timely. We have to ask however, just how far does the market want to reach? Where or what exactly are the envelopes involved? Do we really want to take advertiser's values as one edge of the envelope? If the genie is easy to get back into the bottle then no problem ...

But where do you go to my lovely

When you're alone in your bed

Tell me the thoughts that surround you

I want to look inside your head

Where Do You Go To My Lovely
Peter Sarstedt

Jarvis's book 'public parts' [i]: The sanctity of clinical data, INFORMATION, knowledge ....

In New Scientist last week another book, a brief review caught my eye. This one concerns a topic of great sociological, clinical and political interest to me. To be clear this is not a review; consider it raised eyebrows at the book's arrival and some speculations. Here is the intro from New Scientist's website:

WHEN writer Jeff Jarvis decided to tell the world about his prostate cancer he didn't spare the gory details: he happily blogged about his "malfunctioning penis" after surgery, and the adult diaper he had to wear.

Too much information, some may say. Not for Jarvis. He is an outspoken advocate for living one's digital life in the open and his latest book, Public Parts, is one of the first to analyse the shift towards more transparency thanks to Facebook, Twitter and the other big names of this new digital age.

(Niall Firth, CultureLab, New Scientist)

For quite a while I've been wondering about the informational form of 'climate' change. The existence of the NHS's HealthSpace, Google Health, and Microsoft HealthVault had me watching for erosion of the public's attitudes towards clinical confidentiality. Jarvis refers to this as publicness. Like a coast line this particular form of erosion occurs on many levels, given the vagaries of starting conditions (the patient-doctor relationship, the medical establishment), geography, tides, weather and local policies. Would the temperatures change within health care itself - professional values, disciplinary outcomes, The Royal Colleges?

Even if HealthSpace et al. are provided on the basis of being secure, encrypted, meeting the local requirements of data protection and information governance...; is this tantamount to making confidentiality soluble AND throwing it into the water? How big a step is it to the public's posting their personal health information in public online arenas: open and closed? Suddenly the patient becomes the data entry administrator, if that information can be shared and accessed by the health establishment. From a business model and policy perspective this also saves money in an Ikea flat-pack-transport-and-assemble-it-yourself kind of way.

Jarvis's book is evidence, that demonstrates the ability of social media like Facebook, LinkedIn and Twitter to alter attitudes towards disclosure of personal data. Medical details are usually restricted to the medical consulting room and centrally held clinical record. Google Health is closing down though; it has failed to have the broad impact they hoped for (see Google's blogpost). I wonder if this is reflected upon in the text? With the NHS behind HealthSpace perhaps these three 'solutions' are far from equivalent examples?

If we take information as the concept around which this debate revolves with an individual, a person also at the center ('data subject') then several dimensions can be found. Usually, I am increasingly transparent to a greater degree from my work colleagues, friends, family to my partner. This is one of the many ways that relationships are defined and differentiated. Certain things are opaque to the public and commercial world at large, because they are considered private. Clinically, such a class of information is vested in a professional relationship. This does not mean I have signed a contract to only divulge my medical history to my doctor. Even there - a need to know assumption usually pertains.

As Firth notes it is good that Jarvis is stimulating a debate about what is privacy. How has the concept changed, since the 1950s, 1980s in the media (old and new) and in health care?

Apparently Jarvis makes an analogy with Gutenberg's original printing press and its social and political effects. There may be other subtle aspects though that any such revolution must either work around or overthrow. In the first instance though I consider - without reading the book I have to add - some of the main points which are illustrated below.

Information exchange (disclosure) is always within some context or other: interpersonal, political, social; scientific (clinical) and spiritual hence the inclusion of the clinical - social axis. Tied with this is 'space'. Although the spaces defined by virtual and mobile have assumed primacy physical spaces still count: surgery consulting room, clinic, community health center, hospital ward, patient's home, nursing home. ... I've added transparent - opaque to contrast with public - private these are related yes, but analysis may reveal they are distinct in their application?

Although society has changed markedly in terms of technology and the communications it affords - the modes, tools, languages, access, networks, distribution; there is surely still a notion of what is personal and what might become social - (public)?

Technology, technological means and the arrival of social media does not itself constitute universal attitudinal change in health as Google have found (perhaps the pace of change in attitudes was not quick enough for Google Health so they moved on). Amid the hectic pace of life we should be pleased if some things - like public health disclosure - prove to be laggards in terms of change.

I'll expand on this soon with a few more axes - continua to flare.

Axes image original source from: https://den.dev/

PJ's project [i]: Hodges' model An aide mémoire, or candidate Gärdenforsian conceptual space?

I'll expand on this over the coming months ... first something a bit off the wall...

Now and again I revisit what started as my 'notes' on conceptual spaces. This could be an embarrassing case of mistaken identity (and an embarrassing series of blog post!).

As with everything what is the cost? Well in words .....

1,300    2,400          5,567                        10,534                                   20,340 ...

I add text. I subtract.

Possibilities are appended. Relevance is questioned.

Where IS the panoptic eye?

Where to find the supervision that can ground me?

(Their flies the constant: Astronautic dreams; Young, Cernan, Aldrin, Armstrong, Yuri, Tereshkova and you too Albert II)

Structure emerges.
Potential strategies form to combine interests and efforts.

bifurcates
suddenly

Te                  the                    xt 

So how is the nursing stack?

Funding?
Interdisciplinary?
Multidisciplinary?
Quality of Care?
Dignity & Respect?
Confidence in Care?
Qualified?
Skills mix?
Self-care?
Values?

1st in : last out - OR....?

How to shuffle the decks that are nursing, informatics, cognitive science, and education?

Some text (thoughts) fails to mature -
beyond redundancy -
IT withers.

References are found. Some are metallic - key - sources. Some are virtual.

Some pass un-realised.  Present but lazy, not furthering the case.

Some are never recovered:............................

...............................:from paper scraps; from grey matter.

LOdpST

(Limited Orientation [don't panic] Should b Temporary)

Recovery. Who can recover from: LIFE? No choice in that. But do exercise. Travel past : now :  future : now : past ... forth and back ...

Toys R Us

Yo-YoUR memories are U

For a long time it collected virtual dust. Encoded on the hard disc long since last accessed. A Frozen amalgam of bits. But then, a return -

Re-Entry

 The aRc of relief- fresh eyes, fresh thought, further insights ....

The overall structure changes. For a long time this project was h2cm, then additional thoughts a website, a blog, several papers with this - yet another. A possible submission, journal - conference?

Then a text; a project; a song*; possibly a thesis?  (* Only joking)

How many texts start this way?
How many are still born?
No cry, no joy, less holistic care.

I do believe h2cm is an example of a conceptual space.

It could be that there is ONE ' ' or several [Is it lexical, discursive, cognitive, enacted, ....?]

Where are the edges of h2cm?

The h+listic space

IMAGINE

That space is idealised across ALL nursing theories. ButT (my head hurts) what sort of space is it? Shuffle the cards again, take one, memorize it.... Have we landed yet? Am I moving, or is that you?

Where is that space in practice now - and where is it post-midnight?

It is there in all care theories, they all count towards local - global health. Rejoice in eclectic care realms; in pre-post training and lifelong learning.

Roots or tendrils: it's all growth.

Promise.

Sustainable

In books, on lecturer's lips, values carried forward in student's thoughts and deeds.