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Thursday, January 26, 2012

Scope, Space, Nursing, Informatics: Fusion II (care)

After Paolo Perrotta (see post January 20, 2012):

and Paolo Perrotta, (2010). Metaprogramming Ruby, The Pragmatic Bookshelf. p.75.

Imagine being a care coordinator making sense and sense making (Dervin, 2005) your way through a new health and social care referral: here is the care program(me) approach. You jump from care problem, to strength, to further assessment question ... until the care domain priority is resolved. A decision point. That's the initial scope (and in an urgent / crisis situation this is resolved in an instant).

The scope is not defined in a single program, but several in parallel. This is why health and social care is often described as complex. You find yourself in a complex. At this decision point you are at the center of a range of local variables.

You can see bindings all over the scope. p.75.
There are assumptions, hypotheses and bits of data yet to be fully apprehended. It's hard but vital to be aware of what is objective and what is subjective. Why?
Raise your head, and you see that you're standing within an object,
[ a very special object ]
with its own methods and instance variables; that's the current object, also known as self. p.75.
To your immediate left and forward there are instance variables: beliefs, choices, motivation, aspirations, memories ... and the unique ability of this self to use its methods to communicate and interact with other selves, the world and future. You notice a problem. Many of the methods you might expect are not intact. There is a problem with the capacity of memory. Where there should be several parameters in sequence: there is. One. This may even then be lacking. Reading and writing is a problem here.

To the right and forward there is a monthly weight chart, a medication administration chart, BP and pulse are also recorded. There is a history of falls, a fractured femur, and bruising. There is a diagnosis - an inguinal hernia. Two postcodes have you momentarily perplexed. Ah, one is static 'home'; the other is current location and that's a close to home telecare mediated match.
Turning first to your right and over your shoulder there is an issue with care management and wandering at night: a vulnerability for this person. Another instance variable then flags mental capacity for a that hernia which needs repair. Respite care vouchers have been issued, but the year's allocation remain unused.

Next, turning around to your left there are details of next of kin and the fact that the carer involved is under a great deal of stress.
Further away, you see the tree of constants so clear that you could mark your current position on a map. p.75.
You are in fact encircled by a series of official identifiers. First at 10 o'clock two first names - these are the names that are given. The names for the person, the individual who is the focus of the referral. At two o'clock a key event for this individual their DOB - date of birth. At four o'clock the digits of the NHS number and a local case record number are captured. Completing the "Full name" at 8 o'clock you find a surname, the family name. It's double-barreled too. An explicit effort to preserve and extend family history and lineage.
Squint your eyes, and you can even see a bunch of global variables off in the distance. p.75.
Global variables.
What lies behind them?

It sounds strange to describe the person as an object, even if the context alludes to informatics.
To confirm this object is special. When you think about it though this object, the patient, the person, the individual, this self has a partner: the healthcare professional.

When we say that positive, high quality care values are global that makes sense. They should be: globally. To say they are variable seems to invite poor quality care, slack standards, inequality, inequity. Acknowledging that standards do vary can help ensure vigilance and that high quality care remains the key aspiration for new learners and experts alike. Nursing and other values are then a global variable that need constant attention and governance.

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