Hodges' Model: Welcome to the QUAD: January 2011

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

Friday, January 28, 2011

Proximity: Relationships, Records, e-Health - Person-centredness near and far

When data protection and confidentiality is debated "the need to know" is often wheeled out as a rationale for access to personal identifiable data.

See the following:
NHS Confidentiality Consultation - FIPR Response (esp. #18).
DoH, Confidentiality, UK

In addition, if I need to access the record of patient held at hospital 'x' from hospital 'y' what is the health care relationship that prompts and justifies this need?

At present visiting nursing and care homes, you go knowing that data capture and recording (care assessment) is a fundamental requirement. Having a secure laptop for community has long been promised. While tech solutions are available and implemented elsewhere, my lack of such technology prompts me to imagine a future visit. ...

Pulling up at the nursing home I walk up the drive, ring the bell. While I wait the new tablet device in its bag has already introduced itself to the home. As I am allowed in - my identity assured - the tablet continues its dialogue, it:

  1. Downloads and updates existing active client data.
  2. Downloads additional data as per the agreed dataset on the new referral.
  3. Checks on items 1-2 with a review of recent prescribing for key psychotropic medicines.
  4. It checks the most recent NICE, Cochrane evidence and reconciling the local care knowledge. (This may seem excessive at present, but come personalised medicine this will be crucial).
  5. Will check on most recent clinical reviews and due dates.
  6. The h2cm template is there ;-) ready to present the care domain summary for the general physician ... and possibly (roles?) the next care professional to visit this home and this resident.
The significance of relationships is usually denoted by distance. Personal space is rather obviously spatial. This is how we recognise (well one of the ways!) the meaning and significance of an intimate relationship. In care situations with individuals who are confused and potentially aggressive we are conscious of the need to have due regard and respect for that person's personal space. Spaces and boundaries have to be negotiated in a variety of ways and means. 

Health information technology has already made effective use of role-based access to systems. If we take person-centred care to the nth degree, proximity can also count as it does in mobile health (m-health). Whilst to effect a role is to be in a certain location and context (sat at the office PC in the hospital) roles are organisationally and politically defined. Proximity is also contextual and situated in other ways, my proximity to:
  • the nursing home;
  • the individual's room;
  • the individual themselves.
  • (and their relatives)
While telecare / informatics can deliver a dividend in remote care, it is essential that it can also demonstrably support person-centred care. The best way (clinically assured) to do that for many activities is person-to-person contact. Just because one-side of the relationship may not recall the encounter as little as five minutes after, does not mean that there is no value in sustaining the ring of the bell, the exchange of s-miles, the record that results and other background conversations.

Image source:
Gestalt - proximity

Tuesday, January 25, 2011

1st Int. Congress of Nursing Models and Theories: Colombia 24th-25th Feb. 2011

I am delighted to report the news that the
Health Care Domains Model
will feature at this International conference.

In November I received an invitation to be one of the main speakers from the Grupo Gics Investigacion Team; and so next month I will be heading south to Paipa, Boyacá, Colombia.

This prospect would not be possible without the support of the conference organisers - GICS and Prof. Wilson Canon Montanez, Nursing Faculty of the University of Santander UDES (Bucaramanga-Colombia) and my employer Lancashire Care NHS Foundation Trust.

Recently a group of Nursing Faculties of three major Universities in Colombia (Universidad de Santander UDES, Universidad Pedagogica y Tecnologica de Colombia UPTC y Universidad de los Llanos UNILLANOS) have come together to organize the First International Congress of Nursing Models and Theories.

This congress will be held in the city of Paipa-Colombia 24 and 25 of February, 2011:

I very much look forward to this trip for several reasons:
  • New people to meet and things to learn.
  • This invitation literally puts h2cm on the map (so I must deliver)!
  • It is marvellous to see faculty and nurses in Colombia re-invigorating thought about models of nursing.
  • I have never travelled this far south - how will Orion look?
This will be a great adventure, but before then - where's my checklist: presentation(s), jab, tabs, passport...

Friday, January 21, 2011

Nursing: magnetic Force 5

Back in 2009 I came across a post - Nurse magnets crucial for recruitment and retention about the 14 Forces of Magnetism:

In 1983, the American Academy of Nursing conducted a survey of 163 hospitals to learn why some hospitals attracted and retained well-qualified nurses who were devoted to quality patient care.
The 14 Forces are listed and described by the ANCC. The forces themselves include:
  • Force 1 Quality of Nursing Leadership
  • Force 2 Organizational Structure
  • Force 3 Management Style
  • Force 4 Personnel Policies and Programs
  • Force 5 Professional Models of Care
  • Force 6 Quality of Care
  • Force 7 Quality Improvement
  • Force 8 Consultation and Resources
  • Force 9 Autonomy
  • Force 10 Community and the Hospital
  • Force 11 Nurses as Teachers
  • Force 12 Image of Nursing
  • Force 13 Interdisciplinary Relationships
  • Force 14 Professional Development

The professional, organizational, and political (policy) emphasis of the 14 forces is obvious and becomes clear when each is weighed in terms of where it sits within the domains of h2cm.

Try it as an exercise. ...

Recruitment is ALL about magnetism.

If you are unsure, ask a magnet about the meaning of retention.

Demographics are already applying pressure upon these forces of magnetism. Not just when referred to explicitly in the USA within organizational media; but globally. Demographics is another magnet - it approaches with increasing force.

From here in the UK (and readers elsewhere) we have to exercise care when models are mentioned. While the theorists and philosopher's of nursing nail their definitions to the mast (h2cm?) there remains a models muddle, not just in the variety of models of care, but in the levels at which they operate. This is not a criticism, it's an observation - consider Force 5:
Force 5: Professional Models of Care
There are models of care that give nurses the responsibility and authority for the provision of direct patient care. Nurses are accountable for their own practice as well as the coordination of care. The models of care (i.e., primary nursing, case management, family-centered, district, and holistic) provide for the continuity of care across the continuum. The models take into consideration patients’ unique needs and provide skilled nurses and adequate resources to accomplish desired outcomes.
In the US in particular 'models of care' (moc) often refer to finance and accountability of costs (the market process), in the UK moc might refer to commissioning. In Force 5 the addition of 'Professional' (as the original author's no doubt recognized) is crucial. If you repeat the above exercise, plotting Force 5 on the Health Care Domains Model then you see how Force 5 works for nursing and remains to this day a great achievement as a yardstick for quality, assurance and retentive power.

In the almost 30 years since the research on the 14 Forces, I do wonder though if there is a need to imbue the following with magnetic properties:
  • person-centred care;
  • self-care;
  • carers and public engagement;
  • prevention;
  • public (mental) health
  • and informatics?
Yes, many of the above can be assumed to lie within the existing Forces 1-14. Health and social care are not static. Nursing has much to contend with from the level of the individual practitioner through to the group within an organization. The 14 Forces of Magnetism are well established in the USA and deservedly so, they clearly deliver.

In the political and economical heat of an economic recession, however; magnets may reach their particular* Curie point. Then they cease to work.

The constant bangs and knocks of change, the incessant hammering of party politics and the 'market' on the door of "high quality nursing care" can also take its toll on magnetism.

Nursing needs to take care.

Related post on Healthcare IT News:

Top 10 trends for 2011 include IT, new care models

*OK it should be constant, but like our patients these magnets are not all the same - they have varying levels of vulnerability.

To follow some definitions from an olde book.

Friday, January 14, 2011

ERCIM News No. 84 Special theme "Intelligent and Cognitive Systems"

Dear ERCIM News Reader,

ERCIM News No. 84 has just been published at http://ercim-news.ercim.eu/

Special Theme:
"Intelligent and Cognitive Systems"
- coordinated by: Rüdiger Dillmann and Tamim Asfour, Institute for Anthropomatics, Institute of Technology Karlsruhe, and Antonis Argyros, FORTH-ICS

- featuring the keynote "Cognitive Systems and Robotics" in the ICT Programme of the European Commission, by Hans-Georg Stork, European Commission, Information Society and Media Directorate General, Unit E5 “Cognitive Systems,Interaction, Robotics.

Includes on p.20
Long-term Evaluation of a Mobile Remote Presence Robot for the Elderly
by Amedeo Cesta, Gabriella Cortellessa, Lorenza Tiberio

Next issue: April 2011 - Special Theme: "Unconventional Computing Paradigms"

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

Thursday, January 13, 2011

Help wanted: Broken links (and help upstairs)

Periodically on W2tQ I highlight the four care domain links pages, e.g.:


Simon Phillips emailed me, copied below: (edited removing the actual broken links)

I am writing to notify you of a small issue that I have just found on one of the pages of p-jones.demon.co.uk


There seems to be a number of broken links on this page. These are the links that I found were not working:

  • Nat. MH Info Center Substance Abuse and MH Services Admin. (SAMHSA)
  • Systematic Reviews: Centre for Reviews and Dissemination
  • Advancing literacy: A review of LIFE 2006–2009 UNESCO
  • Wearable Computer Lab
  • Keldy Forest
Obviously it is not a particularly great user experience when the links of a website don’t work, which is why I thought I would bring this to your attention. I trust you will be able to fix this issue soon.

Thanks for taking the time to read this email and for creating such a useful website.

Kind regards
Simon Phillips

Simon runs a website about stair lifts, which provides information on choosing a stair lift and a comparison table of UK stair lift manufacturers.

In response I've corrected the links. I do check them with some automated tools, but as mentioned since 1998... they have become something of a monster. Considering the total number the vast majority are valid.

Before you all dash to check and get in touch :-) which would be greatly appreciated, please note that I can't necessarily respond to all such contacts in this way - but I can see what I can do ...

Many Thanks Simon!

Tuesday, January 11, 2011

W2tQ: Wacky races - global health care and stereotypes

Since adding the clustermaps and flag counter I've been following the 'trends' of number of visitors. I'd hoped in summer 2009 I might in 6 months reach 500 daily readers of the feed for W2tQ. That total still eludes me. The flag counter is ongoing and 'scientific methods' aside it is interesting to reflect on progress there.

When I first thought of this post it was to be read to the tune and commentary of 'It's the Wacky Races!' This is not to cock a snoop at the participants, but the tongue-in-cheek nature of this post.

There are no surprises in the clear leader with the US way out in front. In terms of the target audience - everyone is very welcome as the message of this blog: is global. Within the flag counter there are some surprises. This may suggest the universality of English on the web and also the increasing effectiveness of translation tools. Or, people can see - and read - that there is a health, education and informatics currency in h2cm.

Here are the flag counter images from December 2009 (left) and January 2011 (right). In both the US, GB, Canada are out in front. India is right there as Germany puts on the gas. Despite being stuck in the sub 450 range with feedburner, it's great to see the global progress that W2tQ is making. I'm not sure what happened to the 'EU', it was there initially with '15'. It looks like they've punctured or something?
I wonder if to some extent there is the same stereotyping at work within the global health community as between the health and social care disciplines? Not just within some nations - but within local 'multidisciplinary teams'? How aware are we of what other disciplines do? How do they complement our role? How can we increase our combined impact?

Many of the developing countries are now represented as visitors to W2tQ. How well, from Lancashire, UK can I understand their daily ride? What problems are faced by health care workers in this range of nations? What resources do they have to call on - within and without their communities.

I hope this blog* can act as a springboard - not to a race, but to community building and collaboration. We all have much to learn from each other on our respective journeys. As you lean out of your car(e) window, I wonder what you see?

*Or more accurately the Drupal powered site that must follow!

Thursday, January 06, 2011

2011... looking ahead: Line of sight - Lines of insight



Fractal Drum

Image sources:

Wilkinson, F.J., Monkhouse, H. R. (1967). Maps and Diagrams; Their Compilation and Construction [Paperback], Methuen & Co Ltd. Intervisibility, Line of sight. p. 125 [scanned].
(Book purchased in Mevagissey, Cornwall, Hurley Books July 2010)

Fractal drum. Lines of INsight: http://classes.yale.edu/fractals/panorama/ManuFractals/FractalDrums/FractalDrums.html

Health and social care - listen!

Saturday, January 01, 2011

2010-2011 posts, papers, studies and Drupal

Happy New Year everyone!

2010 saw 211 posts, 183 in 2009. As ever a mix of original material concerning h2cm, conferences and call for papers. Fingers x'd 2011 should run to approx 150 posts as I focus on work, studies and Drupal. The good thing for me is that all three of these can run along together and I intend to forge a union if at all possible.

At work my full-time role is clinical - nursing; Nursing Home Liaison. Increasingly we are finding what nurses on the ground have recognized for a long time. With this job comes an educational role, despite efforts to upscale the skills and knowledge of the residential care / nursing home sectors. H2cm is a gift in these quarters, in prompting and facilitating reflection, holistic and person-centred care.

Studies: On this front I'm trying to identify a research question from a bewildering mix of possibilities. Previously I've referred to the relevance and my interest in conceptual spaces:

Hodges' model: Background - Foreground and the Space Between

The socio-tech and conceptual space papers

Next paper? Conceptual Spaces and Hodges' model

Nursing theory - conceptual spaces: Where's my T-shirt?

Gardenfors' book - a quote and can that be, surely not ...h2cm?

That other 2nd-hand book - 'Conceptual Spaces'

This is definitely a worthwhile focus. I'm making enquiries to try to find a mentor. Strange, or maybe not actually, that I am a nurse mentor and sign-off mentor too and here I am coughing and spluttering in need of a mentor myself to help sort the wheat from the chaff. The 10K words on conceptual spaces is now 13K.

The co-authored h2cm and forensic nursing paper is completed with two revisions, but still needs a home.

I missed an opportunity with the h2cm and substance misuse paper. Trying to complete it in the summer of 2009 before my eye surgery I did not stick to the brief. I'm hoping a co-author can take the 5K words and help re-frame the content from a practice and service perspective. It really is refreshing to work with other people. I look forward to providing an update here later in the Winter - Spring.

As to Drupal - I've hit the wall that has "styling" written all over it. It seems if you start with a basic theme like Zen you are rewarded with an easy to negotiate palette, that is - you do it yourself. With more complete themes you need to read and orientate yourself with somebody else's handiwork. This is the next job and then move to Drupal 7 - released on the 5th.

In October I received an invitation to present at an international nursing conference in Colombia. I've submitted a presentation and have offered to do a workshop too. This was accepted. It all depends on travel and confirmation of arrangements so we will have to see.

More to follow on all the above and wherever you are
may I wish you a very happy, healthy, 
peaceful and prosperous 2011!

To follow: Line of sight, lines of insight ...