Hodges' Model: Welcome to the QUAD: August 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

Tuesday, August 30, 2011

Patient? Client? Consumer? Some thoughts....

Below is an edited version of a response to an item posted on LinkedIn Working Nurses, the issue raised by Genevieve M. Clavreul, RN, Ph.D. is as follows:

One day I came across “The Martha Stewart Show” as it aired a segment dedicated to nurses and Nurses Week. It began with a brief discussion of the history of nursing over the past century or so, and I recognized many of the instruments from my youth and my early career in nursing. But what caught my fancy was how the nursing school representative, a nurse herself, continually referred to the patient as the “client,” and how she seemed to struggle while using the term, as if it was a foreign concept.

The replies thus far have already addressed this question and and its ramifications very well, reflecting the scope of experience and expertise of many working nurses. We have this issue in the UK - NHS also, indeed it is no doubt a global matter.

Mental health has 'client' and 'service user'. Health care IS a business, but a business that must be allied with professionalism. I know that goes without saying, but please bear with me. Use of 'patient' seems to denote dependency and not partnership and collaboration. Being a 'patient' you are compliant with your treatment, rather than concordant with insight into your care plan and the pros and cons of medication (intervention or non-intervention).

As nurses though we have a duty of care. Each nurse represents the profession and the terms we use reflect the values we hold in theory, practice and management (the business again).

On one level perhaps the multiplicity of terms reflects upon the complexity of health and social care and the many contexts 'nursing' takes place. The emphasis on 'recovery models', self-care, the expert patient, relapse prevention, well-being is a sign of the demographic trends and the rise of social media and e-health.

I understand that patiency is a key concept and question in formulating models of nursing: When does a patient become a patient and when does that period end? It is not wholly fashionable for nurses to act as advocates and yet I would argue that being in a 'business' nurses can / should / must advocate not just for the patient but for the health of the general population. Nurses should also look over their shoulder (that's business politics) and take cognizance of the first rule of first-aid. In this case you cannot be an advocate for personal, family, local, regional, national and global health if you become the casualty. By implication the profession - nursing - suffers too.

Will we reach a point were access to and the salience of 'patiency' as a -
human currency - has to be enshrined in human rights? What title do we grant to our seniors in whatever environment: their home of twenty years, their hospital bed, their Room 123 of The Nursing Home?

In any business the ethos and strategy for success should be to make the 'business' transparent. I'm in London at the moment at an IT event. One presentation focussed upon the 'user experience' - UX. Customer service in health is essential [ CX - CareX ! ], but this should not be a 'business' add-on. This is crucial to all caring professions. Rather than be thrown from side-to-side by the science OR art of health and its client OR patient equivalent we can embrace the dialogue and make a positive difference as we do so.

The astute student / learner will ask the person concerned how they wish to be addressed. As future nurses and nurse leaders in the 21st century they might also consider those populations around the world who would very much like to hear the utterance of 'patient': not in reference to themselves, but their infants and children ...

Friday, August 26, 2011

Drupalcon London - Day 4 Thur. A Keynote heralds Wedding Bells & Fashion

The final keynote Designing the Sustainable Web was delivered by two guys gents Christopher Murphy and Nicklas Persson, they teach interactive design at the University of Ulster at Belfast.

The Web Standardistas covered design, fonts and resources both online and books. Like Tom Standages' presentation they talked history. I think I lapsed into an awake, but non-note taking mode; but on their site they provide resources. There's a full and good review on Ubelly. Given the way the web struggles to re-invent rip-the-paper with grids still preeminent in design the books mentioned inc. HTML5 for Web Designers, Responsive Web Design and Ordering Disorder. There's hours of reading and visual delight at http://www.thegridsystem.org/ and Subtraction.

Two things I did spot in the keynote; one a site design, it was quite minimal on the graphics side - apart from a black header with text logo - but using fonts + and as described information architecture to emphasize the content and indeed the overall semantics of the page (and site). I must catch the video again. The other was a slide drawing on newspaper design and proportions that makes me wonder about switching things around.

After the keynote it was another look for me at mobile and theming: Adaptive, Responsive, Mobile First and Drupal Theming for the Future with HTML5, CSS3 and Omega. This session included a surprise for a young lady - a marriage proposal. Congratulations! The Omega theme was a topic at BarCamp in Leeds and I've looked at it for the DJ site. There I've settled on Black Piano. Omega is definitely worth a revisit. Many visitors to the old site arrive c/o mobile devices (possibly as an example of poor design?). Mobile first! indeed.

The Organics Groups session commenced with the lift pitch and the 2nd Drupal fashion show. Organic groups and panels make a lot of sense for a Hodges' model site. The model is a grid, the domains are panels. The links pages are currently tables. So... (whatyawaiting4)! Somebody mentioned - their first Drupalcon - that with this being my 4th a lot of the session content should be familiar.

The documentation BoF did not quite go as planned over dinner time - at least for me. This is a vital project as support, help and documentation does matter in people voting with their feet. I think the project will get a real fillip as some higher level dependencies kick-in and the potential of DITA.

As I write this it's Friday the last day and the code sprint. I'm not coding, but helping review an issue associated with #drupalEdu. (So not coding but still learning and trying to help a little.) This tag covers Drupal training, mentoring, support and general education - K12, Higher Education...

It's been great here in London. Heading North soon. I'll see if I can add a photo or two over the w/e. Tomorrow I will unpack and check the PC which has arrived home apparently, now with working graphics cards? Also to sort hosting. Liverpool on Sunday: the Matthew St Festival. 

Thursday, August 25, 2011

Drupalcon London - Day 3 Weds. Tom Standage keynote, sessions, + BoF ...

Wednesday was a funny day at Drupalcon - literally. The cuppa tea at break was truly divine and delivered with that quintessential British style - very traditional.

At the morning's keynote Tom Standage of The Economist gave us an insightful and historical perspective on social media. This took in the Romans and their scribes (photo below and video), Martin Luther and English Civil War and America's fight for independence. There's  a book to follow. Given the emphasis on ethnography and anthropology in successful informatics - IT we should always be open to the lessons of history, but not constrained by it.

(Videos are appearing online now). My session pick started with Multilingual Drupal Solutions: Use Cases and Modules. This isn't the first session on this topic I've attended, but it was a helpful update - especially the use cases and modules. After dinner Jeff Noyes is clearly clued in on Creating and Measuring the User Experience. This is a must do, with a real potential dividend, but for hobbyists like me it was encouraging to hear Jeff describe a range of resources that included DIY testing.

Early on Jeff noted  the benefit of having a project charter - so last evening I started  one. Basically, what are my projects aims. Actually a things other things emerged from doing this.

I slipped up with node.js and Drupal, great stuff I'm sure but rather beyond me in terms of need and understanding. The principles were a good take home. For the final session the meeting on theming was packed out, so I headed to a BoF pivotal for the Drupal documentation team:

Doing Multiformat publishing & single source content with DITA in Drupal - status and roadmap
It's been a bit more than a year now that we started working on a DITA module for Drupal. In this session we'll review the current status, talk about the good & the bad and look forward to what we are going to be doing in Drupal 7.

DITA (Darwin Information Type Architecture) is an Oasis XML standard started at IBM that has become a major standard in enterprise technical communication. It's used in industries with modular products to publish documentation in a range of formats in minutes in stead of days while saving up to 60% of translation costs.
My new site requires new data items and on Tuesday after Entities - Emerging Patterns of Usage this was given as a key use case for entities. Of course 'entities' have been around ages in RDBSes (1969), but in Drupal they have a specific status now (a dialogue that also seems to bring in nodes, fields and taxonomy). The DITA BoF proved very relevant to me and h2cm as a health and social care -
  • website;
  • learning experience;
  • application (!) 
- demands documentation. Not only that but standards based documentation (and classification system(s)). There's another BoF this dinner time - I'll try and get there.

Drupal's documentation is a recognised mess, hence the investment in DITA and seeking a solution. Back in Szeged 2008 I remember sitting down on that final code sprint day. I had it in mind to read some stuff and try and contribute. I do have an eye for docs. Well, I've been Editor here since April 2006. Previously (1995 - 2007) I read through and reviewed data definitions and information standards (and not just proof reading). In 2008 though I couldn't focus (really as I found out a year later). Maybe it wasn't just me! One thing: the next monitor I purchase will be optimised for text and portrait, or is that old hat these days? 

With RDF, translation, and modules like Features, Panels, Entities, DITA, Organic Groups, Context ... there are so many lucky dice to play; but there is no single roll that proves a winner: there are several!

My photo: c/o the keynote speaker Tom Standage who stated the image has not been altered in what it represents.

Wednesday, August 24, 2011

Drupalcon London - Day 2 Tues. Dries's keynote & HTML5

The first day of Drupalcon London 'proper' is done and there is still so much to take in (but I am staying in the kitchen!). Dries' keynote reflected the current state of Drupal in contrast to the previous European gatherings which have really focussed on the next version. Last year that was only five months away. Dries did attend to Drupal 8, but maybe two years or so till release is a helpful breathing space.

In Drupal 8 attention is being given to specific scorecards and other strategies to manage core (gates) to assure quality and co-ordination. I'm pleased to see HTML5/CSS3 up there as a priority. Last week in .net magazine I read an article (p.104-108) by Jen Simmons on HTML5 in Drupal and some of the challenges in fully updating a Drupal 7 site to this latest standard.

There were many other great sessions. Already I've strayed from 'my' schedule posted previously. After speaking to people I must check Display Suite, and Entities - the latter which I attended. While there is still lots happening re. job and 'home' after four (European) Drupalcons it's high time for me to find some cheap yet cheerful hosting to experiment more meaningfully. I've a (very) basic Drupal 7 brochure and enquiry site, trying to finish and host that will finally bring HD to this experience for me. Anyway must go - another keynote 0900...

Monday, August 22, 2011

Drupalcon London - Day 1 Education Open Space #drupalEdu

Today at Drupalcon London there was an Education Open Space organised by Mixel:


Amongst many discussions and points raised is the state of play of 'learning environments', LMSes, SCORM ..... and where / how Drupal might fit in?

In terms of engaging the wider education community this p.m. I suggested the Digital Humanities community as one who could benefit from Drupal's capabilities with media, extensibility and other positive qualities. This evening I received a message from Digital Humanities developer list about CMSes and Drupal 7. How timely! So this post is based on the flag waving there - already some very helpful replies inc. CMS course or content - and on http://www.digitalhumanities.org/humanist/.

Mention was also made of previous meetings outside of a Drupalcon and within (e.g. 2009). What can we learn from the organizers of other sessions? Of course at Drupalcon 'education' must compete for a slot with the other submissions.

mixel et al. are using #drupalEdu

The table I joined was on LMSes and other points. On one level I don't need an LMS, but on another I do. I need to manage the learning experience of users on a new Drupal driven website. Drupal offers a great many educational modules. Do I need SCORM? What is the latest on such standards? What needs to be in the h2cm learning core?

h2cm is an item on the [cross ;-) ] curriculum, it is not a curriculum. 

Mention was made of current and target knowledge and how we get from the one to the other. I also liked the mention of designing learning experiences. This is where (for me) h2cm comes in: in a care situation what is the current - target knowledge taken across the four* - care - knowledge domains? h2cm isn't vested in managing the administration of learning experience, but I believe it can play a positive role in facilitating reflection and the design of learning experiences.

I hope some momentum can be gained. Education is a massive edifice, but if interested parties can nudge and pass around #drupalEdu that's got to help?

* Five with the spiritual domain.

Friday, August 19, 2011

Top 5 worst EMR myths: c/o Healthcare IT News

I came across this post by Molly Merrill, Associate Editor and thought I could add some comments.

I'm usually wary of posts of the list of ... and top 5, top 10 variety. You see much of social media is cordial - not the concentrate form - but the dilute as observed in many of the comments. Anyway ....

You can read the original full text for each of the five on Healthcare IT News, here are some additional thoughts:

1. EMRs are bad for “bedside manner".

They can be BAD it all depends on usability, engagement, attitude, requirement, the overall environment and the extent to which the EMR is considered in all its socio-technical glory. Whatever the research does show item #2 admits the qualitative differences that exist in the marketplace - some EMRs are easier-to-use. If we expand the engagement beyond the professionals then the bedside equation demands the patient is factored in.

With the right care philosophy and conceptual framework (#h2cm?) e-health records of all varieties (EHR, PHR, EMR, Summary ....) can also support a positive, person centered bedside manner - transforming it to one that chomps at the bit ;-) to become a community based manner.

2. You can't teach old doctors new tricks.

Continuing professional development (or its equivalent) dictates that older doctors and other senior members of the multidisciplinary health and social care team can (should and must!) learn new tricks right up to retirement. Lifelong learning applies to all.

3. Only hospitals use EMRs.

I've little experience here working in the community (and in mental health), but judging from the applications and the infrastructure that an older EMR may demand, I suspect that they are indeed hospital (organisational) centered. That clearly is changing as mobile, mhealth applications mature to meet the rigorous demands of this market.

4. Having my data stored in an EMR is a security risk.

The security of electronic records cannot be assured. Data on devices that is not encrypted - is an open door, especially when those devices are portable. (If the use of encryption leads to complacency then I am uneasy.) Disciplinary measures may follow, but they are not a remedy. The human link in the chain aside - electronic records can be security assured to international standards. Far better than paper records and the photographs (anybody?) of paper hospital files sitting at the side of a corridor and other horror stories.

(Former link: The New York Times, 21 August 2011, New Data Spill Shows Risk of Online Health Records)

5. EMRs are expensive.

There are beholders, stakeholders, budget holders and tax payers. Despite the need for research findings I like the reflection of reality in item 5 that presages new players using new architectures and approaches. I've always felt that standards are essential and yet how do they relate to the scope for innovations? What is the relationship and how does that impact the market and in turn costs?

I've come across an item in .Net magazine that relates to EMRs - indeed all health informatics - I'll post on this while in London and attending Drupalcon.

Image source:

Thursday, August 11, 2011

Civilization, Virtue, Culture, Responsibility, Thinking, Health

Bizarrely the week before the riots hit London and spread to other cities and towns I came across three related resources. I started to read John Armstrong's In Search of Civilization. It isn't a long book, it's very readable and the print's pretty clear too. There are several threads to glean from the text, points that highlight the civil need for h2cm. Armstrong's book on Goethe is on the shelf, so come the winter it will see the light of night.

I also heard of the Journal of Modern Wisdom. I've received a review copy and already a student nurse will hopefully benefit from one article on the concept and meaning of 'depression'. A tag line for this publication reads - for public thinkers and the thinking public. Events here clearly demonstrate that while the acquisitive crime (as described on BBC Radio 4) was taking place the thinking public were indoors. They were no doubt safely and law-abidingly thinking. Listening to some of the people interviewed on the news you appreciate the challenge of public health, individual health and personal responsibility. The televised dialogue (harangue) between a shop keeper and those who are quite rightly angst ridden about the death of a young man in London apparently at the hands of the police starkly reveals the interpersonal gaps - the vast distances that exist in (this) society.

Watching the Prime Minister step forth to pronounce on events, the distances involved transcend the political, racial and spiritual colour of No. 10. While the world over a single death is one too many. Listening to the news over the past few days you realise that a license-to-kill should belong to fiction and film; a license-to-thrill belongs in the privacy of one's home (I could expand on this - but not here); but using the events as a license-to-riot reveals a patent inability to think, to reflect and critique matters even in a basic 'responsible adult' way. That is the way of the mob.

Politicians: you* should be very worried. What exactly is a broken society symptomatic of?

This brings me to the third source. Oxford University Press are kindly forwarding a review copy of Bortz' Next Medicine - The Science and Civics of Health. I'm really intrigued with the apparent emphasis in this book on the civic - the public as patient and the role of personal responsibility in health care. I look f/w to reading and writing more on these themes ...

*we all

Thursday, August 04, 2011

my notes (2) Public 2.0 Culture, Creativity and Audience in an Era of Information Openness

Next up (my notes 1) at Public 2.0 Simon Rogers of the Guardian appeared to know my calling. His first slide was of Florence Nightingale, clearly Florence led by example in research and use of data to effect social awareness, political and welfare change.

For Simon - data is about curating. Data journalism is a norm:

Touching on public health Simon sees and utilizes bigger datasets that can then pick out smaller things - poverty and deprivation.

Simon's presentation reminded me of the way populations for study in public health are built up from agreed areas, these can in turn be presented in geographic information systems. While free data tools have changed markedly in the range of their functionality he said that good design really matters. Given my own fascination with visualization, computer graphics I've often wondered about the seductive quality of the visual. In the 70s the computer generated animations on Horizon of Voyager tripping off to the outer solar system and beyond had me hooked. Simon stressed that it is about stories and words not just pictures. Looking at the themes the Guardian covers while the images created are very striking, especially in interactive form it is the issues, the people and stories that give the data voice.

Questions for Simon included the provenance of data.

Tuesday, August 02, 2011

The Longitude and Latitude of health c/o BBC [ and h2cm? ]

The axes of Hodges' model, the bisection of HUMANISTIC ----- MECHANISTIC by INDIVIDUAL----GROUP provides a location in the sense of 'x' marks the spot. The axes form a reticle a cross hair scale from which things might be identified and located.

You could say that the axes lay out conceptual and contextual lines of longitude and latitude. Just to recap the full title of the model is:

Hodges' health career 
- care domains - model

The operative word here is 'career' referring to life chances. Like the global map with its universal application, h2cm can be used from birth, teens, adulthood and seniority.  H2CM can capture snapshots of an individual's life - (w)rite up to end of life: whatever the conceptual resolution. Think of a stacked series of H2CM frames.

A lifetime view of health is what researchers pursue in longitudinal research studies. There was a programme on Radio 4 this a.m. which I've just enjoyed Science: From Cradle to Grave with Ben Goldacre and there's the prospect of more to follow (Generations Apart).

Since the still ongoing 1946 cohort study there have been several others with the recruitment of parents and children for a 2012 cohort to be commenced. What I found particularly interesting is the way the emphasis of the cohorts in-between has emphasized medicine then shifted towards the needs of the social scientists. The programme highlights how given the increasing complexity of cause and effect, rapid developments in genetics, and the environment ... striking a balance is very important.

It certainly is - across the spectrum of individual health, community, population and ultimately global health.

Addendum (c/o Catherine Coleman LinkedIn):
Harvard researchers recruiting 100,000 nurses!

RNs and LPNs (US and Canada only) age 22-45 join Harvard researchers in the largest, longest study of women's health.

The Nurses Health Study (no longer) invites you to become part of its newest group. Participation only requires one online survey a year.

Since 1976, more than 200,000 US women in Nurses Health Study 1&2 have influenced what we know about cancer, diet, heart disease, and hormones.

In only an hour a year, you will be able to make a difference for your colleagues and for future generations!

Additional links:

UK Longitudinal Studies Centre (ULSC)

Understanding Society: Early findings from the first wave of the UK’s household longitudinal study

ESRC: The future of longitudinal studies
Lifelong Health & Ageing: LHA

National Survey of Health and Development: NSHD

Globe image source: http://www.worldatlas.com/aatlas/imageg.htm