- 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

Wednesday, October 31, 2012

A model, HTML5, games, the normal and the pathological

In the UK the powers that be finally recognise the need to introduce children to computer programming. Our future economic viability depends on no less. So many children are too locked into playing games to consider how games are created. New developments including the Raspberry Pi should help change this.

Here's a possible book intro....
While this book is considered an introduction to building HTML5 care applications with Hodges' model a conceptual framework, it is also intended to be a companion guide to help get you started making, and more importantly, finishing your care applications.
Now I'm not seriously proposing that a care application could be written in HTML5 (am I?). In trying to encourage a teen game player to try game programming, I came across a sentence in Jesse Freeman's short book Introducing HTML5 Game Development which I've revamped above.

The book is about Impact (not open source), a javascript framework. Skimming through the text's potential as a present, you appreciate the potential of games and simulations in health care.

In health care we talk about levels of care. In Impact there is Weltmeister a level editor.

The reader is also encouraged:
"Think of the canvas as an image, that we can bitmap data into." p.8.
There are maps: background and collision. There are Classes, Person is an inevitable example. Admittedly there is also a zombie, but then one of the domains of Hodges' model is frequently described as being populated by zombies (well, look at their movement and the fact that they are non-living).

There's talk of a GDD - a game design document. There is a need for a high concept, plus an asset pipeline, and if the design includes complex levels the likely need for a background, middle ground and foreground. If Life is about sprites running ragged around levels of game play, Death is in there too.

Additional link: Normal and Pathological

Sunday, October 28, 2012

Open access: everyone has the right to knowledge

SOURCE: The Conversation

By Alessandro Demaio, University of Copenhagen; Bertil Dorch, University of Copenhagen, and Fred Hersch, University of Sydney

This week, we celebrate open access week – an event aimed at bringing attention to this rapidly emerging form of scientific publication and its ethical imperatives.

Traditionally, knowledge breakthroughs and scientific discoveries are shared through publication in academic journals. Peer-reviewed and highly competitive, careers are made and broken on the number and impact of these publications.

With the complex, long-standing hierarchy of journal ranking, scientific publishing is big business. From a distance, one might assume that scientific publications aim to maximise the dissemination of ideas, break down barriers to science and make knowledge accessible to the masses – but this is not actually the case.

The publication process

When a scientist, whether in the field, the laboratory or the hospital, makes a discovery, she puts her ideas into an academic paper and submits it to a journal. The journal’s editors decide whether it’s relevant to the scope of the publication, and if it is, they (usually) send it on to a small group of the researcher’s peers.

These are other specialists in the field who will read and give feedback on the paper. If they think the work is worthwhile, and they have no changes to suggest (which is seldom), then the paper will be published in a future issue of that journal.

At this point, no one has paid for anything. The authors don’t pay to submit the article, the journal doesn’t pay for the scientists’ work and the peer reviewers are voluntary. Even the editors are often unpaid, unless they can integrate this service into their professional work.

Journals seek remuneration through subscriptions or once-off access fees by the user – often in the order of US$30 per paper. Those of us lucky enough to have an affiliation to a university, or live in Denmark where the government spends many millions on subscriptions for the entire population can access scientific knowledge free of charge.

Open access

Open access publication differs in one very important way from “traditional” academic publishing. Instead of the individual paying to access an article, or buying a subscription, researchers pay for the publication of their work, often out of their research funds.

In the order of US$1,000-$2,500 per publication, this article processing fee is payable when and if the paper is accepted – and it’s routinely waived for researchers from low and middle-income nations.
This means that while the editorial and peer review process are the same as above, access to the published work is free forever and available openly (hence, open access) online.

The traditional publishing paradigm can be regressive and exclusive. Think for a moment how it works: I am a researcher, I do research in developing countries. What if I was to go there; take the time, resources, ideas or even blood samples from thousands of local people; take the information back to my university; access all the scientific knowledge I need in order to develop the work; and then publish my findings in journals for which there’s an access fee of one week’s wages for the people involved in my study.

Sure I might be able to send them a copy, but for the vast majority of people in that community, science remains out of reach. Now, these study participants may also have no internet access for open access sourcing, but many now do and at least the barrier to knowledge is not put up by the scientific community itself.

Similarly, in high-income nations, it’s still the wealthy, the highly educated or those at higher-education institutions who have greatest access to the vast majority of published science. How is this just?

And what happens when we add an additional layer of ethical consideration: that these researchers and their work is often is paid for by society, by taxpayers, through public funding. How can we then justify publishing it in academic media inaccessible to the vast majority who paid for it?

We can’t just blame researchers or the research community for this – and we’re not saying that because we’re researchers. Academic performance and assessment, in the large part, is determined by the amount and impact of one’s publications. The older “traditional” journals have greater histories and so researchers are almost coerced into publishing with these journals.

Some good news

The good news is that things are changing. In the first decade of the 21st century, we have seen an explosion in open access publications. During this time, we’ve observed a ten-fold increase in publications (almost 200,000 at 2011) and more than a six-fold increase in the number of open access journals, to almost 5,000.

Things are clearly moving in the right direction, but this impressive number still accounts for only around 20% of all publishing.

Simultaneously, global leaders have acknowledged the ethical dilemmas of our current system and backed open access. The European Union, for example, is currently piloting a project to encourage all EU-funded research to place their results in an open-access repository or publish them in open access journals.

And some nations, including the United Kingdom, Denmark and Australia, are either planning or implementing policies making publication of publicly-funded research in open access journals mandatory.

The call for change is being echoed by the academic community, which is asking for greater open access and the removal of economic barriers to science.

Research should be about furthering knowledge for all. And there’s no reason why open access publication shouldn’t be routine.

There are also strong economic arguments for investing in a knowledge economy. We are confident that with enough support, we will see more nations, companies and organisations mandating open access publication – a move that’s likely to bring social and economic benefits.

And who knows, maybe we’ll also begin to see the “traditional” academic journals change their business model and one day make knowledge open to all.

Dr Alessandro Demaio is PhD Fellow in Global Health with the Copenhagen School of Global Health at the University of Copenhagen. In addition, he is a Director of the Global Steering Committee for the Young Professional Chronic Disease Network and NCD Action. For The Conversation, Alessandro expresses his own views only.
Bertil F. Dorch is currently senior executive adviser to the university librarian at Copenhagen University Library Services (part of The Royal Library, Denmark), and have previously been Head of Center for Research Support Services as well as a research scientist at University of Copenhagen (The Niels Bohr Institute), within the field of astrophysics.
Fred Hersch does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

The Conversation
This article was originally published at The Conversation. Read the original article.

Friday, October 26, 2012

End of Life Care (Pathways), Nursing and Thresholds

There is a controversy (Telegraph) that has been growing for some time, concerning the Liverpool Care Pathway for end of life care. This is a very demanding and yet rewarding aspect of nursing. I have experience of end of life nursing care in a non-specialist capacity, having worked on wards for older adults and being involved with people who have mental health and life-threatening physical health problems.

It pains me greatly not just as a scouser that something with 'Liverpool' in it should become a cause of distress, a center for debate and review. Is the pathway green and shady? Is it comprised of stepping stones, with room for two, and with time granted for your next step? Or is there a danger in some instances the path can become tarmac clad, without the succor of a services stop for basic sustenance? Can a pathway become a motorway? What does that sign say? "DON'T HOG THE MIDDLE LANE!"

What pains me seriously is that what can be a invaluable, evidenced based palliative care resource can be undermined due to the complexity of the generic and palliative care situation.

If we truly practice person-centered care then there are no care pathways.

Or, to put it another way: there are as many care pathways as there are patients and carers.

Whether you believe in social medicine, or private; whether you are laissez-faire, or leave such matters to a higher power there is no escaping the need for organisation - for order.

The mix and concentration of people, knowledge, resources and time dictates that tasks, roles and processes be delineated and assigned. We need to assure a given level of quality, and to predict things, not everything is as difficult as the weather: or death. Pathways can assist in specific contexts.

Is there scope for personalisation on a pathway? ...

Steps and pace can vary and to the left and right of center. There are many pathways though: some valid - evidenced, award winning; while others might be broad, narrow, twisted - to become a disorientating ethical loop...

Being placed on a pathway denotes a decision point, a threshold. We need to remember in all fields of health and social care practice that there are multiple thresholds to be taken into account, communicated effectively and revisited:


'me' - existence, resilience, assets,
personhood, ethics, personal values, mood,
personalised care, understanding of treatment,
communication skills, self-expression,
loss, orientation, observation, distress, psychological assessment, sedation,
beliefs, choices, :theology
'me' - existence,
feeding, nutrition, fluids, 
evidence base, Liverpool care pathway,
quality of life measures, referral thresholds, prediction, resilience, reductive - holistic assessment, medication, distance, where: home-hospital-hospice?
pain management, decision locale,
specialism, basic nursing care, resilience

memories, good-byes,
love, compassion,
carer under stress, reassurance, counselling skills, meetings with family,
empathy and rapport, patient and relative engagement, life history,
relative's recognition that loved one is dying,
care strategies,  patient experts,
patient - carer experience,
communities of PRACTICE

consent, advocacy, mental capacity, 
integrated working, effectiveness, independent autonomy, service access, bed availability,
health & nursing in the media, scope of nursing, scope of medicine, law, medicolegal issues, whistleblowing, complaints, formal review, appeals, organisation, argumentation,
professionalism, ageism,

The relative position of concepts above does not indicate priority.

"The LCP is not the answer to all our needs for care of the dying but is a step in the right direction."
Marie Curie Palliative Care Institute
Liverpool Care Pathway for the Dying Patient (LCP)

Saturday, October 20, 2012

Slides from IPH Conference Belfast 11 Oct 2012

Here are the slides from the IPH Open Conference in Belfast. There were several very helpful questions from the floor. With fifteen minutes for the presentation and ten for questions, the 23 slides were ambitious but they were delivered in the allotted time. Many aspects could be developed further and emphasized. In particular the way that public health policy and practice has switched from needs based approaches to assets. This also reflects the trend in self-care and the recovery model in mental health. (I have added needs-assets to one slide.)

If any public health - public mental health practitioners are interested in exploring the possibilities then please get in touch. After several presentations the issue here is to extend this work so as to be able to test and apply existing and found knowledge to say something new... 

I greatly appreciate the votes received for the abstract, the organisers for what was a free event to attendees, and the support and hospitality of Prof. Kernohan. 

Additional link: The Health Well

Tuesday, October 16, 2012

Self-care: The Long Answer (Ack. HSJ)

Here is another item from the HSJ:

"There is often a Berlin Wall between formal and informal caring environments both in the NHS and in social care," he says [Alex Fox, Shared Lives Plus]. He argues that patient care needs to be de-institutionalised.
"If we are going to get anything from all the effort and heartache that has gone in to the NHS reforms, CCGs need to take a holistic view of a person, like good GPs do, and understand that a range of factors go in to someone's health and wellbeing and it is finding models that fit personalised and self-care."
Helen Mooney, (2012). The Long Answer, Health Service Journal supplement (Long term conditions). 28 June. p.1.

Staying with the vertical axis of Hodges' model there is something beyond the delineation of INDIVIDUAL and GROUP (POPULATION) that this axis performs. It bisects the horizon of external reality that is frequently differentiated into what is HUMANISTIC and what is often described as MECHANISTIC. If not these terms then the humanities and the sciences.

From a mental health perspective and taking the above reference to 'institution' literally we can reflect upon how the Victorians sought to standardise provision of care for the mentally ill with the asylums. This was a scientific and political solution to an interpersonal and social problem. Institutions continue to be disempowering, in physical and psychological care. In a way this Victorian solution is still ongoing. On the journey from institution, to community, to home, to self... there is still a long way to go.

The system created to the mechanistic right within the model was custodial. As far as society was concerned the people there were forgotten. A community within a community was re-created. The person, the individual was lost and we are still trying to find them. Progress has been made and can be mapped across Hodges' model. As one example how has the student nurse's learning experience changed over the decades?

That INDIVIDUAL-GROUP axis, the red line in the figure is the Berlin Wall that we are still trying to tear down.

There is another view on this which I'll save for the future.

Monday, October 15, 2012

Snakes & Ladders - Health & Safety: Blog Action Day - The Power of We

This year's theme for Blog Action Day is The Power of We. Andy Roberts over at DARnet posted about his not taking part given this particularly ambiguous title. I can see what Andy means. I'd signed-up for this year and wondered what to write; but then last Friday morning returning to work up the A59 at the Tickle Trout I was behind a van carrying two ladders...

I used to be a bit reckless in terms of heights, but I was kid then. Can you imagine the sudden lease of mental life from a row of terraced houses in Liverpool to fields and woods? Friends used to climb and go from tree-to-tree, in the summers our football pitches became dusty patches.

In my mid-teens helping out I thought nothing of staining the side of the dorma extension one-handed with about 30cms of standing clearance. In the decade from 1970 to the 1980s attitudes changed markedly as health and safety become firm buddies (see for example HSE). If the ladders were out to stretch their legs then my dad or younger brother were on station ensuring the ladder stayed put. There's the power of we keeping me safe.

The health and independence that the majority of us takes for granted seems to give individuals that childhood tree-to-tree disregard for safety.

H2CM central axis IND - GRP

I can illustrate what I mean; for example, look where this individual has got themselves! Of course, we often depend upon others to get to many places. Our very existence depends on others. 

Central to Hodges' model is a structure built from the key humanistic, that is the psychological and social perspectives of 'I' and 'We'.

This gives the model its spine. Everything else in health and social care follows from this axis. We need the social and political foundations of relationships, families, communities to take us to organisations, political movements, government and global governance. Previously, I pointed to the effort required to deliver person-centred care. We have to conceptually take the individual from the ascendant point in the model and put them at the model's center. Doing this collaboratively that is the communication that counts.

There is however, a responsibility that rests with the person. The Power of We is also not a given. It is possible for individuals to opt out of society, being a citizen is something for others. What difference can I make to political outcomes? There is the political debate about individual responsibility regarding life-style choices. If people are to achieve self-efficacy they need to climb down from that crow's nest and traverse the humanistic and mechanistic dimensions of life.

This responsibility is really telling though when an individual seeks to take, or maintain power for themselves within a nation. They trample on the freedoms, lives and choices of others. The people taking power back, doing so peacefully and gaining evidence of abuse of power that is the real power of we.

A room with a view from on high can still bring unique insights for individuals from which we can all learn:
"I know the whole world is watching right now and I wish the world could see what I can see. Sometimes you have to go up really high to understand how small you really are." Felix Baumgartner, 14 October 2012.
Baumgartner image: BBC
Ladder brush c/o: http://www.trendyrobot.com/brushes/000343/popup.html

Saturday, October 13, 2012

ERCIM News No. 91 Special Theme: "What is Computation? — Alan Turing’s Legacy"

Dear ERCIM News Reader,

ERCIM News No. 91 has just been published at http://ercim-news.ercim.eu/

Special Theme: "What is Computation? — Alan Turing’s Legacy"

Guest editors: Gilles Dowek, Inria, and Samson Abramsky, University of Oxford

Keynote: "The Impact of Alan Turing" by Andrew Hodges

This issue for download in pdf:

Next issue: No. 92, January 2012 - Special Theme: "Smart Energy Systems"
(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.
Peter Kunz
ERCIM News central editor

Wednesday, October 10, 2012

World Mental Health Day & Hodges' model

Today is World Mental Health Day. Here are some mental health related concepts mapped to Hodges' model that I have encountered over the past few weeks (I could list many more of course).


depression, suicidal ideas, motivation, beliefs, agitation, assessment tools,
understanding of treatment,
communication skills, confusion,
aggression, lability of mood, loss, disorientation, orientation, concordance,
stress and vulnerability, observation, distress
risk assessment, electroconvulsive therapy
benzodiazepines, anti-depresssants,
side-effects, gait, pain, care environment, 
diagnosis of depression, anxiety, dementia, records - behaviour charts, electronic health record, security
carer under stress, reassurance, counselling skills, respite care, family therapy
empathy and rapport with residents (colleagues...), patient and relative engagement, activities, distraction, engagement, life history, touch, care strategies and recommendations, smiles, companionship

commissioning, funding of services, consent, integrated working effectiveness, referral-on,
care vouchers, advocacy, service access, compliance,
use of Mental Health Act, staff survey, gatekeeping - access to beds, work allocation, health & nursing in the media

Hello? University of Northumbria at Newcastle - and others ..

Although school terms and university semesters vary especially between the northern and southern hemispheres, I can often tell when a new academic year is upon us again. Not only that, but possibly a new cohort of nursing or other health care related students.

The signal is the visitors to the old website. The past week or so there's been a lot of traffic from University of Northumbria at Newcastle. Only the institution is listed, not individuals. And don't get excited about the numbers: we are talking 10s here not 100s and 1000s.

Those tens (still greatly appreciated!) could be even more significant if I could connect with someone. So if you are revisiting this blog and from UoN or any other institution please get in touch: h2cmng at yahoo.co.uk

I would really help to hear your views on:

What prompted your visit?
Who are you - what's your role, course and stage of learning?
How are you using the site and model (if at all) is it:

  • as part of an exercise merely identifying models of nursing, aspects of nursing theory...?
  • as part of a piece of (reflective) written work?
  • applying the model to a specific context, case study, nursing (or other) discipline?
  • as a critical nursing or informatics exercise?
  • as an initial exercise to help assure holistic care?
  • some other discipline and purpose perhaps?
What would you expect to find, what is missing?
What is useful and should be archived?
What sucks!
Is there something that you could add to a future site?
Do you have work on h2cm that I could highlight here on W2tQ?

There are many rich seams to dig here and if we can work together we might find some light.

There is someone at UoN I will approach if they are still there: quite possibly!

Friday, October 05, 2012

Book review: Nursing Knowledge: Science, Practice, and Philosophy

Searching for an up-to-date nursing theory book I wanted something different from the usual fare. The usual fare being a description of the various nursing theories, models and frameworks to date. I needed a text that would help me in two ways: firstly, deal with and critique the foundations of nursing theory; secondly, to provide some insights that would inform my own study into Hodges' model. I quickly found a book with a bonus: it is written by a philosopher.

Mark Risjord's - Nursing Knowledge: Science, Practice, and Philosophy (Wiley-Blackwell, 2010).

This is not a large book considering the literature within its potential purview at just 246 pages in total. The text is very readable both visually and in style. Even if points need to be re-read this isn't a chore. Evidence of structure and discipline runs from paragraphs to the overall division into seven parts, with the usual reference listing and index. As a nursing student of the late 70s and early 80s this book needed to reframe this subject for lifelong learning student of the 2010s. Risjord starts by examining the history - prehistory no less - of the problem

Key questions that have arisen in nursing and directed thought are discussed. The influence of what was happening simultaneously in the philosophy of science and culture is also related. The writing is succinct (as already suggested) on page 18 we have an explanation for the appearance of the relevance gap, how this gap endures and how it might be closed.

Central to the demographic, media and political challenges that nursing faces part II covers values. This brings in nursing's standpoint and more direct reference to cultural influences on nursing knowledge in particular feminism. This discussion is again brief, standpoints are very relevant for me. The combination of depth of analysis, brevity with a clear focus are a great achievement. A lesson in how to write, how to argue, how to communicate. You can only do this if you know your subject.

If I missed anything it is technology and information, but the book is probably all the better for this whether considered an omission or diversion. Seeing specific reference to multidisciplinary in the index and a discussion of nursing knowledge in relation to other disciplines would be helpful. Risjord's purpose for this book is however, clear from start to finish. It's there in the title. The book is no glossary, or dictionary, and yet the treatment of many concepts here, such as; axioms, borrowed theory, coherence, context, grand theory, and paradigm (a chapter)... will help reader's appreciate their definition and use. Seminal papers from the literature are identified and re-examined. Much of the book is devoted to research and methods with illustrative examples.

There is much to inform my studies, in particular chapter 15: Conceptual models and the fate of grand theory. Here I can conclude from Risjord that Hodges' model creates an orientation picture rather than an abstraction picture:
On this understanding, nursing models are expressions of the philosophical background to nursing research. Conceptual models orient research and practice by guiding the selection of problems or making phenomena salient. They make no theoretical pronouncements. A conceptual model can guide research and practice only in the light of some values and goals. Nursing values and goals are thus crucial components of the conceptual model on the orientation picture. They set the agenda for nursing research by articulating what is important. p.173.  
I've long considered Hodges' model to be a map. Initially, a blank map - a space within which values can be deliberated. In pedalling this particular bike since 1998 I know how tired nursing theory is. Now students don't need to get on the bike, they stand on one pedal and freewheel the short distance that represents the curricula space devoted to nursing theory (and philosophy). A packed curriculum provides the momentum for the (values) by-pass. Mark Risjord concludes with new questions about nursing theory, new maps and new directions. I've outlined other points from the text for future reference. This book will remain a companion for quite some time: a great compass.

Acknowledgement: Many thanks to Wiley-Blackwell for the review copy.

Tuesday, October 02, 2012

Hodges' model: Lazy data, organisations and domain outreach (HSJ Ack.)

In the (northern) summer Dr Mark Davies (NHS Information Centre) noted that:

We have lots of data but it's lazy data. We have to make it work and turn it into actionable data - data we can do something with.
Interview: The hard data man's soft spot. Health Service Journal, 2 August, 2012. p.17.
There are many ways that we can put data to work. In the interview with HSJ Dr Davies also highlighted the common and not unexpected emphasis upon the organisational views of the world. Here in England in management the current preoccupation is the preparation for April 2013 of clinical commissioning groups. The NHS has an incredible resource in its data. Whether or not the volume involved qualifies as big data is debatable, but in the interview Dr Davies continues:
 Professionals have a duty to measure, to compare and open up their data to scrutiny. "We talk about the purchaser provider split," he says. "But I think that is the wrong purchaser and provider. It is the split between the tax payer and public services that is important. ..." p.17.
I've mapped this to Hodges' model below. You could say that taxation is POLITICAL and it clearly is, but it is also part of what is frequently termed the social contract. For me this is why Dr Davies' views matter.

Looking at the model we can also see the task ahead in the many ways (domains) in which data can be put to work.


lazy data (inertia!)
actionable data
(information - knowledge)

tax payers
/                    \

public services