Evidence and the increasing effect of parallax

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

from here ...	EVIDENCE
from here...	and here

group - population

Additional link: parallax

An International Bill of the Rights of Man (reissued)

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

How do we address the mental health status of our leaders?	How can science and technology work positively to assure the Rights of All, to secure evidence of war crimes? Where does the biosphere stand (side-by-side : hand-in-hand)?
Should war crimes once perpetrated be relegated to cultural memory: baggage carried forward for generations anew to avenge? How must they do this other than learning (remembering) how to hate? What are the important lessons; of what must be remembered and what we should forget?	An International Bill of the Rights of Man

group - population

50 years "I have a dream..."

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

"I have a dream."	Do things, science and technology have to dictate humanity's dreams?
We have a dream...	A man had a dream...

group - population

HIFA publishes paper in The Lancet Global Health: Governments are legally obliged to ensure adequate access to health information

The Lancet Global Health published a paper on 2nd August 2013 that we can all use in our advocacy to increase the availability and use of healthcare information in low- and middle-income countries. The paper was written by three HIFA Country Representatives for India – Soumyadeep Bhaumik, Tamoghna Biswas, Pranab Chetterjee – together with the HIFA Coordinator, Neil Pakenham-Walsh. The full text is freely available, open-access, here.

Here is a brief extract: ‘Should governments be held responsible for ensuring that every citizen and every health professional has access to the information they need to protect their own health and the health of those they care for? Should governments be held to account for, and to stop, any action that denies the availability of health information, or that misinforms the public or health professionals contrary to scientific evidence? The answers to these questions are yes and yes, as clearly stated in international human rights law.’

My source - above text: HIFA2015

High quality nursing care: Staff numbers + Management + Complexity = Goat (Rabbit or Duck)?

When did someone last get your goat?

For me I owe a vote of thanks to Mr Harry Cayton in the (print) Health Service Journal, 2012

 The wrong answer to the wrong question. 

I know it's hard to believe, but I've been simmering for a year and a half; especially watching, listening and reading about the NHS and the state of nursing in the media.

The subtitle of this short opinion piece (p. 16-17) reads:  

"There is no direct link between staff numbers and care quality, 

so a minimum staff ratio is a fig leaf performance measure." 

Online it is: 15 March 2012 'Mandating staffing levels is not the answer to reducing poor care'
 - so you get the gist...?

As a nurse, the subtitle did its trick, it rubbed against the whole tree of experience, not just a branch or two.

It is a long time since I was a deputy charge nurse on what was then 'psychogeriatrics'. Relatives would arrive on the ward for the first time and start to weep. We had to reassure and demonstrate that we cared not just in words, but actions: nursing care. We got things wrong: teeth, clothing. ... A variety of 'lists' and books signified institutional care. That Victorian institution is no more, this is progress. The change has been amazing. It is also a long time since I was a charge nurse on acute female admission. The thing is numbers always counted. How many times did we, the team, wonder what we could have done with another two, or four hands? Within mental health care risk is a positive and negative companion to all our patient contacts. There may be confusion in numbers, but there is safety too.

You know that numbers do count.

As Mr Cayton points out - poor management is a primary factor in poor care. He quite rightly refers to the complexity that arises. As I have posted here several times, staff attitudes and skills are central to the quality of care that follows. Mr Cayton highlights the same.

If evidence based health care is so powerful why are we still deliberating upon this?

This isn't just complex, it's complex as in complexity science. In the late 70s - 80s and even today there is discussion of dependency and workload measures. There is a real illusion at work.

As a nurse in this context you recognised the limitations of know thyself. You have to know yourself, especially: can I delegate effectively? Am I a manager's manager? How can I balance the office and the ward?

The limitation is: do I know my team? Since the 1980s I wonder how well ward managers know their team. What is the impact of agency workers - nursing and medical? How has this workforce development influenced the work and performance of the FY1s (foundation - first year doctors)?

We ensured we had covered the 'basics' as comprehensively as we could. Everyone was safe, warm, clean, skin clean and intact, dressings completed, fed, watered, given a smile, (if possible) gave a smile and as much reassurance as could be provided. Any care outstanding was reported to the next shift to ensure it was completed as a priority.

Returning to the question of evidence and the illusory, chimeric character of this debate. There is a great post-grad student essay on the relative and normative dimensions of nursing staffing to be written. Health services must wrestle with standards, local responsiveness, person-centredness, outcomes and umpteen other requirements in care delivery. If funding (staffing!) results in nurses having an arm tied behind their back, perhaps mandated staffing levels does the same for managers?

There is undoubtedly much to consider in relation to the equations that abound in staffing numbers and quality of care. As we think of trees of knowledge,  experience and branches, let's remember the leaves; everyone unique.

Update: 24 Aug 2013
News, Health Service Journal, 23 August 2013, Minimum safe staffing work yet to begin, 123, 6364, p.7. 123

"We need tools that are relevant to the care environment; we need leadership locally that has the resources and responsibility to meet the levels the tools are demanding and we need some degree of professional responsibility and decision making at ward level."
(Prof. Jim Buchan)

Additional links:

Policy Unit. Royal College of Nursing (2010) Guidance on safe nurse staffing levels in the UK
http://www.rcn.org.uk/__data/assets/pdf_file/0005/353237/003860.pdf

Safe Staffing Alliance

Kay, J. (2013). Making the case for more nurses, Health Service Journal, 123, 6355, 30-31.

Donnelly L., Mulhern, M., NHS pays £1,600 a day for nurses as agency use soars, The Telegraph, 14 Jul 2012.

http://hodges-model.blogspot.co.uk/2013/03/bbc-horizon-ii-processes-step-this-way.html

26/02/2014:
New [Lancet] study shows degree level nursing education cuts unnecessary hospital deaths
http://www.councilofdeans.org.uk/2014/02/new-study-shows-degree-level-nursing-education-cuts-unnecessary-hospital-deaths/#comment-28

'Monitor Me' BBC 2 Horizon

This is an excellent TV program:

Dr Kevin Fong explores a medical revolution that promises to help us live longer, healthier lives. Inspired by the boom in health-related apps and gadgets, it's all about novel ways we can monitor ourselves around the clock. How we exercise, how we sleep, even how we sit.

Some doctors are now prescribing apps the way they once prescribed pills. Kevin meets the pioneers of this revolution. From the England Rugby 7s team, whose coach knows more about his players' health than a doctor would, to the most monitored man in the world who diagnosed a life threatening disease from his own data, without going to the doctor. (BBC 2 website)

Drupalcon Portland session: Collaborative Learning Systems in Drupal & tpm

I'm still following Drupal here in NW England and around Europe since version 4.7. The next Drupalcon is in Prague next month and I'm all set. As what seems a lifelong learner of Drupal there are usually many sessions of relevance to me. There's repetition creeping in too (at Munich last year), which is a good sign for me. Perhaps it's a sign of Drupal's maturing but there are sessions of specific interest in health and education. This week the program for Drupalcon Prague starts to really emerge.

Until the 13th when the program appears, there was an educational-learning example from Portland in May 2013 embedded below, by Avram Sand and Fabian Franz. The introduction for which begins...

How can you use Drupal to add value to a Learning Management System? In this case study we will show how Trellon helped Population Services International (PSI), a leading global health organization, build a collaborative learning environment using common Drupal modules.

There are some great pointers in this session, modules to consider and insights into functionality.  Whatever TLA is employed - LMS (learning management system), VLE (virtual learning environment), TEL (technology enhanced learning) ... the lessons are transferable.

In the latest edition of the philosopher's magazine tpm 3rd Quarter there's a paper on TEL by David Mossley and Clare Saunders: A revolution in philosophy teaching? (pp. 40-45). Mossley and Saunders argue the case for tempering our expectations of TEL, framing their article around constructivism:

... TEL, presents entirely new and exciting learning environments which students can engage with in more ways, with greater self-motivation, and with more creative possibilities than ever before. If constructivist pedagogy is right, thr more "engagement" with a perfectly modelled environment of ideas in a virtual space a student can enjoy, the higher the quality of their learning experience will be; for they will be presented with just the "optimal" set of experiences needed to create their won meanings appropriately. However, once we start to analyse what the word "appropriately" might mean in this context, we suggest this starts to point us toward a different way of thinking about epistemology and pedagogy. p.42

More positively, they conclude that - technology enhanced learning:

... can and does furnish new spaces and opportunities for social learning - it opens up new avenues for us both to practise and enhance further our philosophical knowledge and capabilities and (thereby) to co-create the future of philosophy and of knowledge more broadly. p.45.

Mossley and Saunders also refer to Hegel's idea of Bildung:

describing education as the bringing into harmony of all one's thoughts, experiences, activities and practices in existing contexts; that is, education as shared approaches to ways of making meanings, of gaining competence, based on the meanings explored by others before us. p.43.

Here is another avenue to support the role of Hodges' model in education and practice.

Papers in process, book reviews and volcanoes

There are three papers currently in process. There is some good and bad news; plus some similarity with volcanoes. This is in the sense of active, dormant and extinct.

The papers are - with no prizes for guessing the common feature:

1. The Scope of Nursing and Hodges' model
2. Case Formulation (Conceptualization), Diagrams and Hodges' model
3. Recovery and Hodges' model

Two papers are active, that's Case Formulation and Recovery. On the stove is Recovery and it's cookin. I've two co-authors providing invaluable input.

I've just read Terry Marks-Tarlow's Clinical Intuition in Psychotherapy The Neurobiology of Embodied Response and a review will follow my recommending this book right now.

There's a review copy of another book in the post that I believe can inform the recovery paper:

Values-Based Commissioning of Health and Social Care (thanks CUP)

I'm sure the concept of values-based commissioning is a gift to Hodges' model and the recovery paper. A theme to return to on W2tQ. The paper includes the Recovery STAR and relates this to Hodges' model.

The case formulation effort is with my co-author, and after a meeting in Manchester one early evening may incorporate risk formulation too.

The good news is none of these projects are extinct. The first nursing scope paper was rejected. The nursing scope paper is dormant, but is stirring following the symposium on person centredness in nursing early in May 2013.

There are two other books to get to grips with and a project that is in danger of extinction. The sight of Vesuvius next month may help: shift matters.

A New Dynamic of Ageing: The NDA Programme & Age UK research showcase of the decade

London, The Business Design Centre, 52 Upper Street, Greater London N1 0QH

You’ll know that the UK population is ageing. You’ll know that there is significant work to be done to be better prepared for ageing in our society. So it’s crucial that all of us who work in and for later life use latest evidence on ageing to support those preparations. The New Dynamics of Ageing (NDA) Programme and Age UK are proud to provide a unique opportunity to present that evidence at our joint event, held on Monday 21 October, at the stylish Business Design Centre, Islington, London.

This is the ageing research showcase of the decade, presenting the most comprehensive selection of state-of-the-art ageing research ever seen in the UK. This includes active ageing, quality of life, independence, dignity, money, work, environments, participation and connectivity to name a few. Throughout the day, you can hear from high profile speakers, pick up latest knowledge through our themed sessions, interact with exhibits in our innovative marketplace and meet the researchers. It will also be your chance to network with a wide range of colleagues from the public, private and charity sectors.

http://www.newdynamics.group.shef.ac.uk/showcase.html

Hope to see you there! PJ

The Hundred-Year-Old Man Who Climbed Out the Window and Disappeared

 It all starts on the one-hundredth birthday of Allan Karlsson. Sitting quietly in his room in an old people's home, he is waiting for the party he-never-wanted-anyway to begin. The mayor is going to be there. The press is going to be there. But, as it turns out, Allan is not...Slowly but surely Allan climbs out of his bedroom window, into the flowerbed (in his slippers) and makes his getaway. And so begins his picaresque and unlikely journey involving criminals, several murders, a suitcase full of cash, and incompetent police.
 

As his escapades unfold, we learn something of Allan's earlier life in which - remarkably - he helped to make the atom bomb, became friends with American presidents, Russian tyrants, and Chinese leaders, and was a participant behind the scenes in many key events of the twentieth century. Already a huge bestseller across Europe, The Hundred-Year-Old Man Who Climbed Out of the Window and Disappeared is a fun, feel-good book for all ages.

Image: Sincerely, Anna
Text: Waterstones