Health literacy around the world - please distribute

My source: HIFA2015

Hello!

At the request of the U.S. Institute of Medicine Roundtable of Health Literacy, I am preparing a background paper on health literacy activities around the world. To support that effort, I have created an online survey tool to gather information on how health literacy is being put into policy and practice in national, state, and local governments, the European Union, the United Nations, the business community, non-governmental and non-profit organizations, and within the education sector.

Our goal is to learn what is going on in the field of health literacy in as many nations as possible [*see note below] - and your assistance in both responding to the survey and sharing the survey with your colleagues is critically important. Please respond to the survey and please forward this survey link and request for participation to your peers and colleagues working in the field around the world.

You can find the survey at ....

A report will be made available based on the outcomes of this effort.

Please let me know if you have any questions about this project or encounter any problems with the web site.

If you have previously received this invitation, you do not need to respond to the survey again if you already have done so. If you have not already done so - please do!

Thank you!
Andrew Pleasant
Andrew Pleasant, Ph.D.
Health Literacy and Research Director
Canyon Ranch Institute
8600 E. Rockcliff Road
Tucson, AZ 85750


HIFA2015 profile: Andrew Pleasant is Director of Health Literacy and Research at Canyon Ranch Institute, United States. Professional interests: Health literacy, Prevention of disease, Integrative medicine, Health system reform. andrew AT canyonranchinstitute.org

[*Note from HIFA2015 moderator:

At the end of the survey is the following question:

'Please tell us what you think would be the best next steps for the field of health literacy. What could other health literacy researchers, practitioners, and academics located around the world do that would help you to make a greater impact and further advance health literacy in your work?'

I would like to invite comments on this question for discussion here on the HIFA2015 forum: hifa2015 AT dgroups.org

Health literacy is a critical issue to achieve the HIFA2015 goal - to ensure that lack of availability and use of basic healthcare knowledge is no longer a major contributing factor to needless death and suffering. What more can be done to improve health literacy in low and middle income countries? And what more can be done to ensure that healthcare information is presented in ways that are appropriate to those with low health literacy?

Thanks, Neil PW]

Reflections [VII] Conceptual Spaces At Work: OntoSpaces - A Perspectivist Approach to CS

This session started fairly quietly but was one that rather shouted out in the end because of its possible relevance to Hodges' model. There was a clue having recognised one contributor from a reference already found:

Hautamäki, A. (1992). A Conceptual Space Approach To Semantic Networks, Computers and Mathematics with Applications. 23, 6-9, 517-525.

Kaipainen and Hautamäki began by asking what is the origin of quality dimensions? They proceeded to explain their use of perspectivism and the perspectival nature of cognition directing the audience to Giere (2006). The history of this is based on philosophy and the work of Nietzsche, Goodman and Putnam.

The work of Kaipainen and Hautamäki proposes the OntoSpace as a means to further extend Gärdenfors' work. An ontospace is an n-dimensional metadata space. In this space a perspective is an array of weights. The weights express the interest or attention towards each onto-dimension.


A transformation can be made from Ontospace A to lower dimensional space B. There are many technical points here to get to grips with. A figure was provided (I have gone over the yellow square 'Topical Domain' as it was indistinct; the green circle reads 'b Representational Space B').

This is an ecological and manageable means to conceptualization of a topical domain in ontospace A. Mention of ecological and manageable prompted me to clarify what this means, as I can see h2cm as being ecological and manageable. In the sense of breadth and depth of knowledge and possibly reducing the data context (as ever), patient, carer, nurse, learner....

The presentation included a software demonstration insofar as time allowed. The context was banking. The interface both applied dimensions and prioritised them. In the break I was able to explain Hodges' model to Mauri (Kaipainen), using a board in the upstairs dining room. By email Mauri subsequently noted that the home page of the old website actually reflects the model down to the placement of the menu links. (This is a struggle with Drupal and its themes, trying to come up with something that is original, represents the model and yet is not gimmicky the interface being obscure.) I approached Mauri and his colleague regards referencing their draft paper and they are happy for me to do so.

In health and social care of course we are very used to 'perspectives'. Especially seeking a caring perspective through empathy and rapport, putting on the shoes of the other and trying to appreciate the perspective they may or may not see. As I have said before I wonder at times if my passion for h2cm is an overvalued idea. I feel at times I am clutching at straws to find a theoretical underpinning for Hodges' model. At this conference there were no warts, and this presentation added more very useful ideas and in this case interdisciplinary bridges:

Solomon describes Nietzsche’s perspectivism so that it’s a view that “one always knows or perceives or thinks about something from a particular perspective - not just a spatial viewpoints, but a particular context of surrounding impressions. influences, and ideas, conceived of through one’s language and social upbringing and, ultimately, determined by virtual everything about oneself, one’s psychophysical make-up, and one’s history” (Solomon 1996, 195). Kaipainen and Hautamäki (to follow)

Ontospaces also seems to reflect the resulting dialogues found in health and social care and the need to constantly attend to and reconcile the same:

As Baghramian sees it, there can be more than one correct account of how things are in any given domain (2004, Chapter 10). Thus the issue is not which perspective is correct or true, but how to explore and mutually relate multiple perspectives.

Kaipainen, M., Hautamäki, A. Ontospaces: A Perspectivist Approach to Conceptual Spaces (to follow).

Giere, Ronald, N. (2006). Scientific Perspectivism. Chicago and London: The University of Chicago Press.

Images: Peter Jones (with thanks to the presenters)

Drupal Education Camp Oxford (School's out)

Well it is over and it was a great experience. So many thanks to the Drupal Oxford Group, Finn @finnlewis and the sponsors. The boxes are all ticked: the sessions, lunches, St Catherines' College surroundings and staff (excellent), and as ever the Drupal Community. Amongst many really good sessions ...

Yesterday, Johan Gant listed the pros and cons of Migrating data into Drupal using the migrate module, when you might care to use it and when not. When not to use it is a definite take home (a take care). There's a potential overlap here with semantizing content in Drupal 7 which Philipp Schaffner explored today. His presentation included not just the relevant modules, but Drupal's core RDF status out of the box and how to extend this. Philipp's English is very good; I wish I could present in another language as well as he did.

Many of the 'take homes' have not changed. They are glaringly obvious: build your site get on with it. That aside in the previous efforts to enter content from the old website into Drupal (4.7, 5.x, 6.x ...) the decisions about style, fonts, colours have been and remain an enjoyable task. In Bring that designer over to the Drupal side of the force Tom Bamford provided a description of styling and a listing of resources. Definitely something to follow and use.

Martin Bush introduced his work as a lecturer Use of Drupal at London South Bank University and the creation of QuizSlides. I have an eye on the existing Quiz module. The QuizSlides' approach utilises Powerpoint as the basis for the quiz. Prior to this Martin outlined his course on Internet Technologies across lectures, labs, MCT and individual assignments. Speaking to him afterwards I mentioned how I would love to take my stuff (re. h2cm) and formalise it in a structured way. How could you link Hodges' model into nursing, informatics, and educational curricula?

Another key session for me was How we built a Virtual Learning Environment with Drupal 7 with Lee Willis. This is way beyond my purposes in the sense of scale but not in terms of - intended - user experience. Lee made some vital points about Drupal's educational potential and the lessons he and his colleagues have gleaned from projects to date. There is still great variation in the user interface of Drupal and this is compounded with the number of contributed modules used. Drupal is powerful in providing related navigable content, but this should not mean forcing an order on the learner. In addition to the need to plan the interface, another point Lee made also draws me to Drupal and reflects a central ethos of some psychological therapies. We learn best through self-discovery. So in addition to structured and unstructured content, there is a case for leveraging Drupal to facilitate discovery. (I've just thought of another post...)

As well as education, the keynote yesterday by Prof. David Upton was informative and entertainingly delivered (a lesson in itself) stressing the complexity of corporate scale IT projects and the problems (disasters) that can and do ensue. I did wonder (and nearly asked) if Prof. Upton had any views on a particular project he didn't mention. Which reminds me: I must cast an eye on the new NHS information strategy.

Visual Methodologies Workshop in Newcastle

After Oxford Drupal Education Camp this Friday-Saturday proceedings move on to a NE workshop.

If your focus is on person-centered health care then the volume of data involved that pertaining to the individual can be readily apprehended. At least the example of a single episode of care. Of course, there are exceptions, people who might be the subject of special case studies so complex is their condition and pathology. Data volumes do vary markedly from person to person. A great deal of generated data in an individual instance might be taken for granted. In the reported findings, for example, of an MRI scan that is included in a referral. When provided existing diagnoses do much to enrich the information and knowledge contained in a referral, whilst reducing possible avenues for further data gathering.

Once we move from individuals to groups and populations then the volumes involved quickly become massive. Purposes and context reflect this change in scale; codified, anonymised, aggregated the individual is lost.

Both my day-to-day work and study of Hodges' model (in nursing, informatics, literacy...) are centered on individuals. 'Caseness' in a clinical word: a referral, home visits for the day, face-to-face interaction, care concepts in assessments, plans. ... Then there is envisioning a nurse-patient (carer) interaction, or individual's episode of care through Hodges' model. As per the model's structure, however, groups and populations must also be represented. This duality of personal and data scales makes this workshop on visual methodologies of instant relevance. The two days next week cover (with my emphasis):

Introduction to working with visual methodologies: understanding epistemologies and disciplinary boundaries

• Mapping
• Story-boarding
• Artefacts

Quality in visual methods: ethics, validity and reliability
Doing visual methods: lived examples of managing data capture, synthesis, analysis and dissemination
Modes of analysis: focusing on methodological and epistemological influence on the research process

Workshop part 1: working with self-created data
Workshop part 2: creating shared analytic frameworks for self-created data
Overarching ideas and ways forward for thinking about visual methodology

Hodges' model can be readily interpreted and presented as a map and a series of story boards. The model can also support analysis, synthesis: well, this is my belief that is shared by some people.

I have completed modules on research methods, but it seems increasingly that research methods, methodologies, data structures and algorithms overlap. It may be that advances in media, technology, data gathering and improved access to data sets is having this effect. Perhaps more integrative and open attitudes (interdisciplinarity) towards quantitative and qualitative research also accounts for this blurring; or it could just be me? Whatever is the case, I'm really looking forward to the programme, meeting the facilitators and students. I am hoping this will inform my project as per the aims of the workshop:

• Consider the role of visual methods in data collection, research ethics, synthesis, analysis and dissemination;
• Explore the theoretical prospectives, epistemological traditions and latest practices that have shaped the development of visual methodologies; and
• Enable participants to translate how visual methodologies can be used to support their own research.

I'll try and post from Oxford this Friday - Saturday and from Newcastle next week. From Newcastle I'll be heading to Edinburgh for the Scottish Ruby Conference. Lots to follow as I put 10 days unpaid leave to use.

Musings on a mixed and busy fortnight: Oxford Drupal Education Camp

There is a busy fortnight coming up here. If all goes according to plan it runs like this: Drupal, Visual Methodologies and Ruby.

On Thursday evening I will travel down to Oxford for Drupal Education Camp. My first Drupal effort is taking shape. There are five photos in a jCarousel. I think I'm almost there but after the five scroll through there are five empty placeholders or blanks. It's probably just a tweak to the settings. The enquiry form is completed. I'm not happy about the formatting which seems to characterise many Drupal pages: that of the long series of fields. Listening to discussion at Drupal NW this month also reminded me of the need for spam capture.

I'm hoping one or two Drupal mental health contacts from Cambridge in January may also attend. The accepted sessions for Oxford present a very useful mix (timing permitting), especially:

Drupal 7 Semantizer

How we built a virtual learning environment

There was a debate on the longevity of VLEs in Wolverhampton in 2008-09. As I tried to look up that event I noticed that variations on the theme of "The VLE is dead, long live the VLE" are still doing the rounds. Clearly a case of the undead.

So, three - four years on this should insightful: What is a VLE? Is there a hybrid form? How far can Drupal be pushed? Why do students use FB and by-pass the institutional 'tools'? Perhaps it's because the institutions are busy deliberating the existence of this TLA versus that?

Migrating data into Drupal using the migrate module

NeuroHub: The information environment for Neuroscientists

The content of a new h2cm website will (yes, I know....) combine archive material - Brian Hodges' notes - with new work. For student users a means to assess and measure understanding of the content makes sense. I implemented a crude multiple choice test. The questions were probably not too bad, but there was no log-in, administration. If assessment can be done in a standardised way then that would be a huge bonus. What a new site should be about though is facilitating students in developing their knowledge and application of Hodges' model. The context of that knowledge and application need not be wholly limited to nursing.

After Oxford, on Monday 25th and after work I'm heading east to Newcastle for two days. I'll reflect on that soon. The trick is going to be threading all these together.

Reflections [VI] Conceptual Spaces At Work: Adams & Raubal - CSML

The final day of the CS@W conference started with a topic I was really anticipating as per a previous blog post. Ben Adams and Martin Raubal had indicated by email that CSML was a work in progress and a chat after their session emphasized the same. The existence of CSML and looking at some code examples holds great promise.

Direction in Lund, Sweden May 2012 by Peter Jones

The motivation for their work stems from geographical information systems [GIS] and how to formalise conceptual spaces. Palmer (1978) was cited as providing one form of representation. Palmer's mental model being matched with formal conceptual spaces. As per Gardenfors' book Minkowski's vector space is central to this work and informs a previous paper by Raubal (2004).

Way-finding provided an example: how there are different domains with semantic distances and weights that can change according to context. The facades of buildings and the contexts of day and night. What features stand out in terms of the shape, colour, visibility, area of buildings?

Adams and Raubal moved to differentiating topological relations that emphasise dynamic concepts. Piaget's contribution was noted in how we perceive conceptual change and the work of Torsten Hägerstrand whose time geography was illustrated (the geographical aspect of their work).

Behind CSML is a conceptual space algebra that is still being developed. On conceptual spaces and the semantic web, Adams and Raubal observed through their slides that:

Description logics are limited in ability to represent semantic content (RDF, OWL).
They fail to easily express
    Semantic similarity which plays an important role in cognitive categorization.
    Complex concept combinations.
Present Semantic Web technologies are restricted in their ability to answer queries and make inferences.

My BA(Philosophy and Computing Joint Hons.) project was on the application of semantic networks in nursing. The hard work was done for me in that it was directed by existing work in GRAIL. The dissertation I produced was essentially descriptive looking at nursing examples, identifying care issues and modelling them using is_a relationships. Among a great many slides and fascinating explanations Adams and Raubal note that:

Is-A, Instance-Of
Strong – based on topological relationships
Weak – based on similarity relationships

- so the advent of conceptual spaces, CSML and their efforts to engage with the existing semantic web community shows the ongoing dynamic of the semantic web's development. They are pursuing a reification of OWL 2 CS file to OWL 2:

Unique IRI for OWL classes, individuals, properties
Unique IRI for CS domains, concepts, and instances

There may be a future website to follow in addition to the CSML source. Questions followed about whole spaces, contrast classes and support vectors.

Reflecting back, my studies from 1996-97 and the examples produced - mobility... did not really even scratch the surface. Ben and Martin's work begs the question of trying to develop CSML examples that go beyond the surface(s) and enter the conceptual space (or spaces) that is Hodges' model.

Adams, B., Raubal, M. (2009). Conceptual Space Markup Language (CSML): Towards the Cognitive Semantic Web. ICSC '09 Proceedings of the 2009 IEEE International Conference on Semantic Computing IEEE Computer Society Washington, DC, USA.

RCN survey on NMC fee increase: what do you think?

FROM the RCN:

BREAKING: The RCN has today launched a new survey to find out what YOU think about the proposal by the NMC to increase your annual registration fee from £76 to £120.

We oppose the move strongly, but we need to know what you think too. You answers will help shape our official response to their consultation so it's vital that you have your say.

Complete the survey now, it takes two minutes. (Alex)

http://frontlinefirst.rcn.org.uk/page/s/NMCsurvey

My comment:
No doubt like a huge majority of the population I have personal reasons for total disbelief, disrespect in the banking - finance sector. This is in addition to the bailouts that we are ALL still paying for and it isn't over yet of course.

This NMC fee increase makes me very angry too. If you're a UK nurse you should be incensed.

As the public sector cuts continue with worse to follow apparently the pressures on nurses will increase. As a result resources will be further pinched, with short-cuts in care mistakes will inevitably follow. So the increase in costs incurred in managing disciplinary matters are bound to rise as a consequence. This is a trend that must be stopped and properly addressed now.

Now you want me to contribute to an NMC bailout?

This is no way to manage professionalism, accountability and governance. ...

I appreciate that as an organisation the NMC's hands are tied - it must seek funds to maintain its work, fulfill its role. But, please don't hold me and the UK nursing workforce hostage at the same time.

Additional link:
http://www.rcm.org.uk/midwives/news/unions-rally-against-proposed-nmc-hike/

What is the foundation of h2cm? Gabora & Aerts 2009

I've described h2cm as a foundation, a substrate for the health and social care assessments that follow. And that's the question: what is there before the conceptual framework is populated? As a foundation the model is initially empty, void, null. In terms of theory, practice, values and judgements there are none. The piece of paper is blank. So is the screen. Once (quickly) learned, the professionals have the conceptual framework in mind (ready to call upon), but it is not exercised. Until they encounter a patient, client, carer amid a situation, the conceptual space is empty.

Lund, Hobykrok B&B in the distance - the farm track

If we allow for the structure to permanently reside what then? Does this situation produce an array of potential? An array of potential concepts? Nurses are used to potential and actual problems (often re-framed as strengths). It seems this is the case with language, the amazing compositional scope of different words to produce sentences and meanings.

In a way I don't want to venture into this space. There are monsters there. I know the above is far removed from nursing. Where is  compassion, dignity, respect, plans and empathy in all this? ... Once the care concepts are realised then: yes - do lead the way. But before the light is turned on: no.

No: but there is no choice. The question needs to be asked and settled.

Liane Gabora gave a talk at Conceptual Spaces At Work. Checking back on her previous work I found this (SCOP: State COntext Property theory of concepts):

An important notion in SCOP is the ground state of a concept, denoted p. This is the ‘raw’ or ‘undisturbed’ state of a concept; the state it is in when it is not being evoked or thought about, not participating in the structuring of a conscious experience (such as, most likely, the concept ZEBRA when you began reading this paper). The ground state is the state of being not disturbed at all by the context. One never experiences a concept in its ground state; it is always evoked in some context. The notion of ground state is somewhat similar to the notion of prototype. The ground state is a theoretical construct; it cannot be observed directly but only indirectly through how the concept interacts with various contexts (which may include other concepts). p. 436.

Gabora, L., Aerts, D. (2009) A model of the emergence and evolution of integrated worldviews, Journal of Mathematical Psychology. 53, 434–451.

Case formulation and Reflection in Hodges' model

Case formulation is a process in which I believe Hodges’ model can be used. Johnstone and Dallos (2006) help conjoin case formulation with an original purpose of Hodges’ model, that of supporting reflective practice, as follows:

Formulation and reflective practice. The notion of reflective practice is becoming increasingly important in all therapeutic traditions; that is, the necessity of being aware of one’s own feelings and reactions as a therapist as well as one’s own position in terms of professional status, gender, class, ethnicity and so on, and how these impact upon the therapeutic process. How might these ideas be taken on board in formation? What kind of biases is formulation open to, and how can we minimise them? p.2.

There are of course many concepts mentioned above that are key in staging a therapeutic interaction. As a series of conjoined conceptual spaces Hodges’ model provides a stage were reflections can be made personally, professionally and therapeutically moving to the development of formulations that are shared with clients.

Johnstone, Dallos and contributors also describe the issue of integrative formulation an aspect also of relevance to further study of Hodges' model.

Johnstone L., Dallos, R., (Eds.) (2006). Formulation in Psychology and Psychotherapy: Making Sense of People's Problems, Routledge, Oxford.

Reflections [V] Conceptual Spaces At Work: Zwarts

As per previous CS@W posts Joost Zwarts' Constructing Conceptual Spaces for Lexical Semantics provided one of several examples at the conference of data analysis derived from large datasets. The abstract included:

The similarity structure of a conceptual space can be determined using lexical data or pile sorting, but it can also be based on some sort of analysis of the values involved. Using the work of Geeraerts et al. (1994) on Dutch clothing terminology, Zwarts (2010) demonstrates how a space of “shirts” can be constructed (either using graph or MDS techniques) along such lines, with fruitful results.  

This talk outlined the way features can be identified and decomposed. Key to this are classifiers which Zwarts listed as:

1 Psychological classifiers (piles)
 From similarity judgments or sorted piles
2 Lexical classifiers   (words)
 From common lexical descriptions
3 Analytical classifiers  (features)

The presentation provided a small example based on containers, which for me was very helpful as data is a real issue for my study of Hodges' model. There are datasets out there - nursing, classification systems - and secondary data sources to consider. As mentioned above Zwarts took a dataset comprised of 38,000 possible items from the clothing domain and used 244 from the sub-domain of shirts. [Geeraerts, Grondelaers, Bakema (1994). The Structure of Lexical Variation. Berlin: Mouton de Gruyter. ]

I am probably simplifying things but discussion of Hamming distance recalled for me old Byte articles on bit-classifiers. Whether a sign of progress (maturation) or my focus, but in the 1980s there were many articles on data structures and algorithms, for some reason quad trees proved quite an attraction. There was an approach to clinical classification by Johnson (1987) that adopted a ZIP code format. As Zwarts related his presentation I wondered where a primary care problem might reside in Hodges' model: (1000, 0100, 0010, 0001)? Alternately where is the emerging problem that is nudging this individual towards possible relapse?

Graphviz was used and multidimensional scaling. The talk became more technical, understanding aided by graphical examples as classical categories were introduced: A category C is classical iff it can be defined by a particular set of feature values. The conclusion brought together the technical aspects of the data examined: convexity is too strong, connectedness somewhat too weak, but that there is a clear notion of coherence. There was much here to learn from.

Johnson, B. (1987) Health Code, The Guardian, 23 July, 16 (see also (1990) Journal of Health Care Computing).

The following page is out of date but cites Johnson:
http://www.p-jones.demon.co.uk/infselct.htm [no longer available]

(I don't want to upset searches on Google for 'conceptual spaces', so I've two more further posts this month on the conference concerning CSML and OntoSpaces.)

Here is the view from my B&B I enjoyed some lovely walks into Lund, plus using the bus. With a map that stayed in my laptop bag, I enjoyed getting lost on two occasions.

The view from Hobykrok B&B

Reflections [IV] Conceptual Spaces At Work: Parthemore, Unified Conceptual Space

In my notes on Hodges' model, nursing theory and conceptual spaces I've referred to Rosch, Gärdenfors and there is much of note in my copy of The Big Book of Concepts. There are gaps to fill, key sources to find and digest including the history of concepts. In Empirical Investigations in Conceptual Spaces Theory and the Unified Conceptual Space Joel Parthemore really helped this effort. His presentation began with: What is a concept? Which (for me) begs the question: What is a concept within Hodges' model? Is it a single entity?

Joel's slides included the following:

In the Beginning Was...

• Classical definitionism: concepts are like entries in a dictionary.
• Classical imagism: concepts are like pictures in the mind.

And then came their descendants:

• Prototype and exemplar theories (Rosch)
• Informational atomism (Fodor)
• Proxytypes theory (Prinz)
• Conceptual spaces theory (Gärdenfors)

Listening to Joel introduce his work on unified conceptual spaces I can relate several points to Hodges' model especially the following.

• Attempt to describe how all of an individual conceptual agent’s conceptual spaces map or weave together into a single unified space, a “space of spaces” describable along certain common axes.
• By extension, how all of the individual conceptual agents’ unified spaces map together, in linguistic human society, into a single, common unified space.
• Unlike CST, UCST is explicitly enactive: concepts are located not in the agent nor in the environment but in the interaction of agent and environment.

A couple of speakers brought up the question of a 'space of spaces'. Centeredness also preoccupies us in health and education. We are desperate to pick up the patient and the student and put them at the center of things. I keep wondering (see link below) about the extent to which structure and a theory of cognition are interdependent in terms of the resulting conceptual spaces? Since the late 1980s Buzan's mind-mapping has struck me as not being 'grounded'. This may not be an issue in many applications, but for a generic conceptual framework some underlying structure (dimensions) seems essential.

Joel also considered this:

• One major shortcoming of currently available mind-mapping software is the lack of any well-defined theory of cognition (let alone theory of concepts) underlying the application.

I hope I can make contact with Joel and return to this. He indicated papers and further projects with colleagues and a piece of software.

Additional link (Hodges' model - nexus, structure):

http://hodges-model.blogspot.co.uk/search?q=nexus

Hodges' model in Murphy & Welford (2012) Agenda for the future: enhancing autonomy for older people in residential care. Int. J. of Older People Nursing

ABSTRACT: This is the concluding paper of a three paper publications. Paper 1 focused on specifically understanding what autonomy for older people in residential care means. Paper 2 discussed the various factors that either facilitate or hinder residents autonomy and directed readers to reflect upon their practice. This final paper outlines the findings from the action research phase of a study aimed at enhancing resident autonomy. It describes just one way in which residential care units can work on enhancing residents autonomy and enables the reader to reflect upon nursing practices, which with the right approach can be resident-centred.

Murphy and Welford write:

Hodges (1997) model is essentially concerned with the person (resident) in a social context. The notion of it derives from the intervention of the nurse being future orientated, increasing the health choices, health chances or health prospects of individuals or groups (including families) taking cognisance of the biography of the person or persons being helped. The person already has a biography that has been influenced by their physical and psychological make-up, the kinds of families and social networks they have experienced and the culture or geographical location in which they live. The nurse then is also influenced by personal factors of their individual physical or psychological origin and factors relating to their social world and the policies that govern their daily life. The nurse (assessor) must take cognisance of the attributes the person (resident) brings with them in their current presentation (problem) and how this affects their future choices both in terms of ability to make them and the range of choices available. Thus, this approach to care planning recognises the importance of negotiating care.  (online source - see doi link below)

I am not just very grateful to Murphy and Welford for their adopting Hodges' model in their study, but this supports my own use of the model in teaching staff about person-centred care and communication skills in residential and nursing care homes. The inclusion of a political domain and individual and group (populations) dimensions is a great asset in this context. Their conclusion also identifies the limitations of individually directed change, something that seems apparent from my own experience in nursing home liaison.
 
Murphy, K., Welford C. (2012) Agenda for the future: enhancing autonomy for older people in residential care. International Journal of Older People Nursing. 7, 75–80. doi: 10.1111/j.1748-3743.2012.00309.x