Hodges' Model: Welcome to the QUAD: January 2014

- 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, January 29, 2014

Race Yourself for Google Glass transforms exercise

From ISPR - my source:

Get Fit This Year by Fleeing From Augmented Reality Zombies: Race Yourself Transforms Exercise Into a Game on Google Glass

Race Yourself is a New Fitness Startup for Google Glass, Aiming to Turn Exercise Into a Game.  By Racing Against a Virtual Projection of Yourself, Attaining Personal Bests, and Burning Calories, You Can Unlock New Game Modes Such as Running Away from Giant Rolling Boulders. Race Yourself has Already Raised £200,000 from Investors Lead by DN Capital, and is Now Launching a Crowd-Funding Campaign Via Their Website, www.raceyourself.com on the 8th January.  ...


humanistic ------------------------------------------- mechanistic

Am I dreaming?

technology    virtual reality    physical health

Dreams of Peace
group - population

Monday, January 27, 2014

'Intellectual brutalisation' and the saving grace and power of poetry

BBC Radio 4 Today: An eminent cardiologist has organised and funded a poetry competition for his medical students to stop them becoming, in his words, intellectually brutalised.
Gabrielle Gascoigne, pictured, is a previous winner.
The BBC’s Jane Dreaper discovers more.

[no longer available] Listen to ‘Poetry competition for 'intellectually brutalised' medics’ on Audioboo

PBS: For these medical students, poetry nurtures the soul

Here's (source: http://www.bbc.co.uk/programmes/b03s6mdp/live ) the full version of Mastectomy - For His Wife, by Gabrielle Ruth Gascoigne:

It will be an honour
to bathe the scars.
Don’t think my tears imply
an ounce of sorrow -
only joy
could fill my eyes.

It will be a pleasure
to hold you close.
Know this – your precious flesh
calls the bluff on gold
and silver -
makes me a king.

It will be a delight
to talk with you
into the night we thought
stolen, clean away -
until day
renews our hope.

It would be too heartless
if all this love,
these sinner’s prayers and more
should fall to nothing
more than rain
on empty streets.

humanistic ------------------------------------------- mechanistic

insight, rapport, empathy
emotional control, detachment, engagement
risk of burnout
anatomy, physiology         
physicality, processes, mechanistic
intellectual brutalisation
communication, relationships
(medic) poetry

funding, crowded curricula
hidden curriculum
group - population

Saturday, January 25, 2014

Syria's Trojan women


The Syria Trojan Women project began by creating drama workshops in Amman, Jordan in autumn 2013, and put on a theatrical production of Euripides’ anti-war tragedy, 'The Trojan Women' in December with a cast and crew of Syrian refugees. The first performances were a great success, and we hope to stage further performances in and around Amman, and a tour of Jordan and the region. http://www.syriatrojanwomen.org/

My source: Charlotte Eagar, Syria's Trojan women. FT Weekend, Life&Arts, 4 - 5 January 2014. pp.1-2.

humanistic ------------------------------------------- mechanistic

parallels" p.2.

drama therapy

group - population


Wednesday, January 22, 2014

Better information means better care

BBC Radio 4: Inside Health 21 January 2013

Margaret McCartney and Mark Porter ask whether the anonymity of patient records on a new NHS database can be guaranteed?
NHS: Your records:
Using information about the care you have received, enables those involved in providing care and health services to improve the quality of care and health services for all. The role of the Health and Social Care Information Centre (HSCIC) is to ensure that high quality information is used appropriately to improve patient care. 
NHS England has therefore commissioned a programme of work on behalf of the NHS, public health and social care services to address gaps in information. Our aim is to ensure that the best possible evidence is available to improve the quality of care for all.  ...

humanistic ------------------------------------------- mechanistic

my interests

scientific interests

social interests

commercial interests
group - population

Monday, January 20, 2014

ERCIM News No. 96 Special theme: "Linked Open Data"

Dear ERCIM News Reader,

ERCIM News No. 96 has just been published at

Special Theme: "Linked Open Data"
Guest editors
: Irini Fundulaki (Institute of Computer Science, FORTH) and Sören Auer (University of Bonn and Fraunhofer IAIS)

Keynote: "Linked Data: The Quiet Revolution" by Wendy Hall

This issue for download
epub: http://ercim-news.ercim.eu/images/stories/EN96/EN96.epub

Next issue: No. 97, April 2014 - Special Theme: "Cyber-Physical Systems"
(see the 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.

Best regards,
Peter Kunz
ERCIM News central editor

An initiative for the ERCIM members: Call for Participation - identifying the emerging grand challenges in ICST http://kwz.me/74

Sunday, January 19, 2014



T.S. Eliot

(No. 2 of 'Four Quartets')

The wounded surgeon plies the steel
That questions the distempered part;
Beneath the bleeding hands we feel
The sharp compassion of the healer's art
Resolving the enigma of the fever chart.

    Our only health is the disease
If we obey the dying nurse
Whose constant care is not to please
But to remind of our, and Adam's curse,
And that, to be restored, our sickness must grow worse.

    The whole earth is our hospital
Endowed by the ruined millionaire,
Wherein, if we do well, we shall
Die of the absolute paternal care
That will not leave us, but prevents us everywhere.

    The chill ascends from feet to knees,
The fever sings in mental wires.
If to be warmed, then I must freeze
And quake in frigid purgatorial fires
Of which the flame is roses, and the smoke is briars.

    The dripping blood our only drink,
The bloody flesh our only food:
In spite of which we like to think
That we are sound, substantial flesh and blood—
Again, in spite of that, we call this Friday good.

T.S. Eliot Nobel Prizes biography

Source copy:


Thursday, January 16, 2014

Book review: Values-Based Commissioning of Health and Social Care

This book was a welcome change from the last review, being quite brief in comparison at 155 pages including the index. This isn't a criticism, it just helps in clearing the decks for other reading and distance learning.

The text is no lightweight, however; and should be mandatory reading for all health and social care personnel. Well maybe not all; but that is part of the problem. The clinical and social care workforce are trained to care. Commissioning (and clinical coding) is something done in another location, by other personnel.

If there is a recurring criticism of public services it is that they are cossetted, protected, removed from many of the financial realities of the world. The book, published in 2012, was written anticipating the structural and financial change brought in by the Coalition government and the need for austerity. Therefore, the public sector and clinical staff are not  immune from the vagaries of finance as might be assumed. For the past couple of years I've witnessed the regular shakes of the sieve and heard of the same within local authorities.

Christopher Heginbotham's book provides the background and tensions of commissioning and delivers much needed insight on several fronts by conjoining what so often seems remote. The lesson of the book for me is how distinct finance and commissioning are. I can sum this up as: if person-centred clinicians are concerned with sense-making for and with patients and their families, then commissioning is the sense-making of the available finance. Viewed this way you see the importance of commissioning.  Clinicians are concerned with evidence-based care, ethics, the health reforms, outcomes, quality, and of course values. Add to this patient involvement and public engagement and you have a read that opens a field that many clinicians dash by (in the public sector?*) as they manage various clinical priorities.

Chapter 1 and 2 set the scene of values-based commissioning, definitions, the fact-value distinction; and the post-Labour NHS. The health reforms (chapter 3) are central to the text, but despite the date of publication which the author acknowledges there is little loss of significance. The health and social care commissioning landscape is still taking shape, outcomes based commissioning (chapter 9) can make the news as implementation is delayed (Williams, 2013). Chapter 4 describes the seven fat years followed by seven lean years; an excellent overview with the major influences at work, The Wanless Reports and Marmot Review for example. It is salutary in these times to see NPfIT as a footnote, with IT benefits still to be accrued (p.32). The need to respond to the public health challenges are noted (chapter 6), as with the potential mental health impact of climate change.

The book's figures and tables are a great asset, very useful to educate student nurses about commissioning, value and values. There are a couple of references to colour (p.72) in what are black and white - grey illustrations. 'Reading' the diagrams you can follow them. The author's background comes across, as with location and mental health experience. The book is I believe relevant to readers across all sectors. Heginbotham also indicates that the book is one of a series by CUP, and points to Fulford et al. as a sibling. There are a couple of repeated words but otherwise the production is excellent.  I was a little surprised to find a catastrophe in the text - catastrophe theory (p.51). It is well deployed in explaining complexity and values. When I say surprised perhaps I would really like to see more on this theme of complexity and emergence, but Mr Heginbotham stays clearly on track.

My bias - Hodges' model - found the following standout points:

http://www.cambridge.org/gb/academic/subjects/medicine/medicine-general-interest/values-based-commissioning-health-and-social-careThe number of sentences and figures that describe the individual, group, community and population (the structure of Hodges' model). The way that values can act as a counterpoint and essential adjunct to evidence (subjective - objective; qualitative - quantitative).

Some situations are more biological than others - in certain sorts of surgery, for example - and some have a much larger values base - such as in psychiatry (p.40).

 Reference to (Cronje and Fullan, 2003):

The medical literature demonstrates an equivocal attitude which suggests a 'collective need to better integrate scientific quantitative data . . . and the art of human judgement . . . into a common definition of "rational" medical practice (p.40).
Figure 7.8 Filtering the evidence through a values-based matrix (values across four care domains?).

The use of models to test the real world and reference to a values space.

I posted previously about the nhm - new holistic model (p.80).
(back to the review..!)

Technical aspects (a law and index) and ethical issues that beset commissioning are introduced (space is limited), and recur helping to integrate the book as a whole. Chapter 5 deals with public involvement and engagement and how it can be enacted. Chapter 7 on integrative commissioning invariably raises patient and service user care pathways.

Is this the Rorschach test for patient, care professional and commissioner: please draw your care pathway? 

The book admirably deals with the ideal and realised in the space available. As such even when there is a linear care pathway it is how it is experienced that counts (values and outcomes...). (It is sadly the person-affirming life-story pathway that is so often lost.) 

Perhaps, this is what I have in mind above in referring to emergence. Despite the existence of care pathways in practice the route in-through health and social care is probably found in a rather chaotic way (sudden care transitions); with delays, placement changes, ward movement(s)-stasis, choices to be taken into account, lack of attendance, missed appointments. ... This is why trying to define pathways may certainly assist, but it is the granularity of those definitions and their experience that snags at our clothes along the way. As Heginbotham advises - care pathways are not something to use in a slavish way. This excellent and well referenced book should provoke and establish interest in this very important health and social care activity. An activity and process that must be informed by the values of the public and those of patients and be more than a process, but realised in shared purposes and practise.

*When we stop and reflect we also recognise ourselves as tax-payers and so seek value-for money, and the other e's of efficiency, effectiveness, efficacy...

Many thanks to CUP for the copy.

Williams, D. Trust forces delay in outcomes based commissioning plan, Health Service Journal, 6 December 2013. p. 4-5.

Heginbotham, C. (2012) Values-Based Commissioning of Health and Social Care. Cambridge, Cambridge University Press.

Sunday, January 12, 2014

Book: Thinking as Communicating - Sfard (the intra- interpersonal domain)

Previously I wondered about a term that might combine thinking and the formation and process of mental mapping, the creation of a conceptual map - a mental conceptual geography - cogneography?

Thinking as Communicating
Finding Anna Sfard's 1998 paper this past week led me to her book. The following is from the introduction:
I define thinking as individualized form of interpersonal communication. The disappearance of the time-honored dichotomy is epitomized in the term commognition, which combines communication with cognition. The commognitive tenet implies that verbal communication, with its distinctive property of recursive self-reference, may be the primary source of humans’ unique ability to accumulate the complexity of their action from one generation to another.

Sfard's work will have to go on the 'to read' pile (part-time studies begin tomorrow), but it may help provide ways to understand and unravel the intra- and interpersonal domain within Hodges' model. The mathematical emphasis (even though I may struggle with this) is an added bonus.

Sfard, A. Thinking as communicating: Human development, the growth of discourses, and mathematizing. Cambridge, UK: Cambridge University Press.

Sfard, A. (1998). On two metaphors for learning and the dangers of choosing just one. Educational Researcher, 27(2), pp. 4-13.

Saturday, January 11, 2014

moon, resources and Materialism

humanistic ------------------------------------------- mechanistic


group - population

Republic of the Moon
(I missed this when it was in Liverpool!)

Additional links:

NASA Releases New Earthrise Simulation Video

UNODA: Treaty on Principles Governing the Activities of States in the Exploration and Use of Outer Space, including the Moon and Other Celestial Bodies

UNOOSA: 34/68. Agreement Governing the Activities of States on the Moon and Other Celestial Bodies

Leonid Tishkov, Personal Moon - Republic of the Moon

Omega Speedmaster Moonwatch -

Thursday, January 09, 2014

Resistence is futile: give in to the obvious need for the 'nhm'

humanistic ------------------------------------------- mechanistic


ohm + nhm


nhm (+ ohm!)
group - population

ohm: The ohm (symbol: Ω) is the SI derived unit of electrical resistance, named after German physicist Georg Simon Ohm. (Wikipedia)

nhm: The nhm (symbol: +).
However, the principles do not extend to problems posed by cognitive impairment as a result of the illness and the ever present danger of wandering, seeking old and familiar surroundings, or acting on memories from years gone by. Some patients become aggressive at times; the service must have mechanisms for managing patients effectively in ways that recognise their inherent worth and humanity. The stigma and abbreviated autonomy that is implied in managing people with dementia requires a new holistic method of managing their care that relates the care to the patients'/service users' values. p.80. [my emphasis]

Heginbotham, C. (2012) Values-Based Commissioning of Health and Social Care, Cambridge, CUP. (Review to follow).

Tuesday, January 07, 2014

ESRC PhD North West Doctoral Training Centre (NWDTC) CASE Studentships 2014: The spatial and social dynamics of public inclusion for people with dementia & Masters HI Sweden

The Faculty of Health and Medicine, Lancaster University offers an exciting opportunity for an ESRC funded +3 collaborative studentship for PhD research: The spatial and social dynamics of public inclusion for people with dementia

Suitably qualified candidates are invited to apply for this fully-funded three-year PhD CASE studentship which is a collaboration between the Centre for Ageing Research, at Lancaster University, and AgeUK Lancashire. The studentship covers full fees plus a Basic Maintenance Grant (£14,421 p.a.). The student will receive a small contribution for research costs.

The CASE studentship will draw on innovative participatory mixed methods to assess the impact of a range of dementia friendly community initiatives to explore how people with dementia experience social and spatial inclusion, across personal and public spaces. The research offers an opportunity to engage with important policy initiatives and how they impact upon people’s lives. The successful applicant will also benefit from the work placement opportunity within AgeUK Lancashire.

The studentship will be supervised by a team lead by Dr Katherine Froggatt and Professor Christine Milligan at Lancaster University and Mrs Diane Armstrong, Dementia Support Coordinator at AgeUK Lancashire.

Eligible candidates will be UK/EU honours graduate students with a good 2.1 from a recognised University, who show evidence of exceptional ability; they must have completed research methods training as part of an ESRC recognised Masters (or demonstrate research training to an equivalent standard) in a relevant health and social sciences discipline. Students who are currently undertaking a Masters degree (or equivalent) and are expecting to graduate during the 2013-14 academic session are also eligible to apply. Candidates should demonstrate a committed interest and experience in the field of dementia ageing research, preferably in community contexts.

Candidates must satisfy the ESRC's academic and residential eligibility requirements and be UK or EU citizens who have been resident in the UK for three years. Further information on eligibility can be downloaded from the ESRC web site: ...

To apply please submit the following documents electronically, by 5.00pm Thursday February 13th 2014, to Dr Katherine Froggatt: k.froggatt AT lancaster.ac.uk with ‘ESRC CASE studentship’ in the subject line:

  • An up-to-date CV: including two named referees (one of whom should be your most recent academic tutor/supervisor); the applicant will be expected to have approached their referees to arrange for references (including anticipated grade if Masters is ongoing) in advance of shortlisting.
  • A letter of application (not exceeding 2 pages) outlining your suitability for the CASE studentship and how you would anticipate approaching the research.
  • A copy of your first degree and Master’s degree transcripts.
Shortlisted candidates should be available for interview on February 21st 2014

PLUS from LinkedIn

On 01/06/14 1:53 PM, Sabine Koch wrote:
In case you know somebody interested in advanced studies in HI please forward this message.
Interested in a two year Master Programme in health informatics at Karolinska Institutet/Stockholm University in Sweden?

Apply online latest January 15th at ...

Monday, January 06, 2014

Saturday, January 04, 2014

Ballets of corporate, Governmental, Social and Individual conscience

humanistic ------------------------------------- mechanistic

c ons cien ce
Health services and services infrastructure

Why do we pay taxes as a society?

Apple UK turnover £1,178m
Corporation tax paid on UK profits £1.7m
(2011: £1,013m £15.7m)
group - population

Q. Does the current state of corporate taxation globally influence the scope, efficacy and ability of governments and WHO to recommend and direct global public health and positive health promoting policies?

My source: Houlder, V., Pickard, J. (2014) Tech giants' £54m bill fuels tax row, Financial Times, FT Weekend, 4-5th January, 2014. p.1.

Thursday, January 02, 2014

CfP Visual In-Sights Conference, Newcastle University, June 2014

Sent: Monday, 30 December 2013, 10:24
Subject: CfP Visual In-Sights Conference, Newcastle University, June 2014

Call for Papers/Proposals
Visual In-Sights: Theory, Method, Practice 26-27 June 2014
Newcastle University, Newcastle Upon Tyne, UK
Deadline for Abstracts/Proposals: 31 January 2014

Keynote Speakers:
Marcus Banks (Oxford University)
David Campbell (http://www.david-campbell.org/ )
Sirkka-Liisa Konttinen (Amber Collective)

Organised by the Visualities Research Group at Newcastle University, this interdisciplinary conference aims to bring together an international community of established and emerging scholars, creative practitioners, visual artists and arts-based, community project leaders who research, use and work with visual materials and visual methods. Contributions are invited that demonstrate the cutting edge in research and practice around the multiple spaces of the visual, and which explore the porous boundary between the theory, method and practice of the visual.

We seek academic papers and/or proposals for multi-media presentations, break-out sessions using arts/performance/installation, contemporaneous fieldwork exercises and workshops, and exhibitive displays. Contributions may speak, but are not limited, to the themes of:
  • Art and Aesthetics
  • Visual Cultures
  • Visualities and Ethics
  • Visual Communication and Visual Practice
Please submit an abstract or artist proposal of up to 250 words to visual.insights AT ncl.ac.uk
by 31 January 2014.

Notifications of acceptance will be sent out on or before 28 February 2014.

Registration ... will open on 31 March 2014. The conference fee is £80 (academics), £50 (artists), and £30 (students and unwaged)

For more information please visit:

Wednesday, January 01, 2014

Book review: "Nursing Informatics and the Foundation of Knowledge" (long book - long review)

Happy New Year to everyone!

Last spring I requested a book for review and received three c/o and with thanks to Jones & Bartlett Learning Nursing. Finally, I've picked up the second - and about time it seems - as on this first day of 2014 the publishers are planning the 3rd edition. This book provided a break from virtual matters being a door-stop of a book; 538 pages, excluding abbreviations, glossary and index. In addition to this physical rendering the publishers emphasize an online presence for this and other books. Inside the cover there is a card with an access code to unlock the companion website for online resources for readers, students and lecturers. The account setup is straightforward and there are additional student exercises beyond those in the book.

Informatics is by definition a challenge for authors and publishers. Even though published in 2011 - 2012 time is at work. From the outset then the team involved in this text are to be congratulated on what is a monumental task in scale and time.

The foundation of knowledge in the title refers to the adopted conceptual framework - the foundation of knowledge model, which is illustrated at the start of the book's sections and especially section I on the building blocks of nursing informatics.

The foundation of knowledge model was itself quite a hook for me.
The model includes bits, bytes, data and information and from this arise:
  • knowledge acquisition
  • knowledge processing
  • knowledge generation
  • and knowledge dissemination
- with all of these influenced by and influencing feedback (there is an illustration in the sample chapter). The model describes people as information systems. Although the diagram presents a structure for the model, and it fits this informatics context very well and provides a link throughout the book it is not convincing in terms of subjects, agents, and knowledge disciplines. Admittedly the foundation of knowledge model is high level like Hodges’ model. Similarly, it is not prescriptive in terms of how events, phenomena are characterised. Data, information, knowledge and wisdom are however, the most fuzzy of concepts and subject to ongoing philosophical debate. I'll reflect a little more on this later. As already noted the model works here and I see online that a couple of students (and no doubt a great many more) have utilised the model in e-portfolios.

Each chapter has a listing of key terms, which are highlighted in the text. There are reflective questions at the end of each chapters. Chapters are concise, well referenced across various media and are all accessible and evident of a great editorship. There are a couple of longer treatments of certain and well chosen topics. Within chapters there are brief diversions in boxes on a related theme, for example in chapter 3, box 3.2 on ‘storage capacities’. I’d almost forgotten about EPROM and RAM, even though I used to purchase computer programs on EPROMS and ROMS in the 90s. Although abbreviations still abound, these abbreviations have become rather transparent now - and may say more about the generational scope of the authors - including this one? If these are going to be included then where is ‘GPU’, ‘SSD’ …? This is a difficult balance to strike, but mention of these struck me as antiquated and date the text. ('GPU' is hardly new - 1998 c/o Nvidia)

With two major companies referred to early on, open source is explained on page 43 and in the examples of software programs that are listed. The book is courageous in several respects introducing the model, listing software and specific technology examples, some of which can be brief in terms of market longevity. The emergence of the cloud is discussed and provides a current flavour, as with usability (‘UX’). Although the authors are clearly leaders and advocates for nursing informatics and the technologic, the enthusiasm is tempered.

The limits and complexity of AI artificial intelligence are raised in addition to the revolutionary progress. Chapter 4 on cognitive informatics I found personally fascinating, as it reassures me about my interest in the potential of combining conceptual spaces, threshold concepts with Hodges’ model. As a result I previously posted items from the book about cognitive informatics and another relating Beauchamp and Childress’s four principles of health care ethics to Hodges’ model.

Chapter 5 continues the consideration of the limits and challenges posed by technology in exploring the theoretical approaches to health care ethics. The standards for e-health ethics will now be tested with the fate of the .health domain (deliberated online at HIFA2015 to follow...). I wonder if this debate will figure in the 3rd edition? Clearly there are implications for the governance of such a domain. As the chapter points out many ethical e-health standards are voluntary.

As an individual and a reviewer of book with international scope and a discipline with international global aspirations you are acutely aware of your parochial situation. When I look at the UK (Northwest England!) and nursing informatics it seems, with some exceptions to have failed to make a mark in nursing. Yes, colleagues and I use an electronic health record, but there is so much more that could be provided in terms of purposes, functionality and reports. The majority of student nurses I speak to do not seem to be primed let alone tutored for the wider informatics world they will enter as practitioners. So much more that could be done with mobile technology, caseload management tools, research tools. Perhaps this is why as I read of - the use of decision support systems and expert systems (p.77) – I thought “Get real!”. How accessible are such tools to the majority of nurses? Speaking from Wigan Pier at least, if it is 'nursing informatics' you seek then you must be westward bound. It appears there is quite a difference in the esteem of nursing informatics in the USA and UK? - and my review reflects this. Jocularity aside there are two serious points here.

1. The book is clearly USA centric, but it really is relevant to readers elsewhere (I thought there might be a problem registering on the website, but there was no .
2. The other point concerns activism.

When there is an opportunity should we advocate for nursing? Is there scope for this within a nursing informatics text? Even in ‘developed’ nations we should take nothing for granted be that the UK - rickets, TB, sexually transmitted diseases in older adults, obesity; or the United States with the potential impact of climate change and health inequality (MacKenzie, 2013, America's hidden epidemic of tropical diseases). The complexity of nursing and health is also apparent while reading that informatics can serve to check compliance with antibiotic regimes, you simultaneously reflect on the need to reduce the general prescribing of antibiotics and the correct administration and management when they are utilized.

My interest in and exposure to informatics and the humanistic-mechanistic axis within Hodges’ model brought me to the socio-technical literature. Even though socio-technical aspects of nursing and nursing informatics abound implicitly in the book (chapter 6, page 100 and elsewhere – chapter 16) ‘sociotechnical’ or ‘socio-technical’ does not have a place in the index. Although they rarely come across it – hence my thoughts above – I explain something of classification and coding to the student nurses who visit our team. Chapter 7 is a very informative contribution on this subject by one of several international contributors (all listed at the book’s start). How can nursing informatics make an impact if nursing students are not aware of the existence of nursing terminologies and approaches – enumerative and ontological - to the same? Nurses should be aware of the international standards associated with their profession - nursing terminologies included. Chapter 8 on nursing roles, competencies and skills prompted me to wonder about other forms of informatics and to what extent there can (should) be dialogue between these other disciplines?

In, Information and Knowledge needs of nurses in the 21st century (chapter 9), as an individual practitioner you are always situated (p.531) in a local nursing experience. I think this is where the model needs to be extended to facilitate the incorporation of local, global and glocal perspectives. Surely informatic's role as the latest technical means to communicate across a diaspora and it seems create a reverse diaspora through online communities and virtual worlds is worthy of a political stance? Global initiatives such as Health Information for All 2015 (what year is it next and still so much to do...) and other groups (maternal and infant care) need nursing's support and this extended information-informatics awareness (wisdom!) might also pay local and national dividends?

Chapter 10 is lengthy as befits legislative matters which nevertheless maintain the readable tone, clearly there is an ongoing evaluation by systems suppliers and users on the potential of the Cloud (Chapter 17). Chapter 11 was a nice surprise and the impact of which I have already referred to in e-portfolios. Individuals act as their own portal – p.187. This is a subject that (I hope) will occupy me for the next couple of years. The use of e-media by nurses for reflective commentary using web publishing tools is addressed very well. Having just ordered a second hand copy of Etienne Wenger’s book on communities of practice I find this discussed here:
In the future it is hoped that the use of communities of practice in nursing will grow beyond knowledge sharing and promote more knowledge discovery and sense making. p.189.
I’m not sure if e-portfolios have affected the EU populace with the rapidity and extent expected (by 2010), but there is a series of ongoing conferences dedicated to the cause. In the 1990s and early 2000s you could not miss the emphasis on benefits realization. If this concept has had its day what exactly happened? (There is no longer a need to prove the worth, potential of the computer at the bedside, nurses station.) We should still focus on outcomes as noted in several  chapters.

The sections also take on a practical – application focus across administration and nursing functions. Open source is further examined p.212. If SQL is mentioned would it help to acknowledge the development of noSQL approaches? Memory and processing power (for indexing) are less of a constraint on systems now. There is another challenge presented to editors: is 2004 really a ‘recent’ study? ‘Recent’ and its synonyms ‘currently’ need to be checked throughout the book and revised accordingly. The same applies to references to demographics and changes in nursing numbers (p.320-321). The trends in the numbers are established and remain, but perhaps there are more up-to-date sources? Throughout the book there are also case studies and pointers to research that provide practical and personal insights to the subject at hand.

While the context is nursing and informatics I think the discussion on ‘health literacy’ requires a critical review. It seems that health literacy may be being construed as synonymous with health technology literacy, computer and information literacy which are also noted in the text. There is admittedly a great deal of overlap.

‘Health literacy’ needs to be considered before a specific health problem arises – it is too late then. Health literacy does not mean, should not be equated with the deployment and use of e-tech applied to people with diabetes, coronary heart disease. Is this specific health education aimed at self-care, relapse prevention, staying well? Is health literacy concerned with positive health?

I’m sure the authors – editors are only too aware of this but this understanding of the wider context of ‘health literacy’ as a field of research and practice is not conveyed at present. I also don't necessarily see a wiki as a search tool, yes you can search a wiki but it is a type of repository and as such the effectiveness of a search must depend on the contributions made and the preceding searches. Perhaps a dedicated wiki could become a form e-grey literature?

A highpoint for this reviewer was to read: Learning is a multispatial function, … (p.406). It certainly is. The discussion on creating learning resources is an excellent introduction, especially on using the electronic health record as the learning resource.

In considering the future chapter 29 does not explicitly utilize the framework of knowledge. This may provide an opportunity to extend the framework to more readily integrate bio-psychosocial-political and spiritual perspectives through time. The framework of knowledge within informatics is a great resource. As mentioned this drew my interest to the book, in 1996 I sought to relate informatics concepts to nursing and mental health (redundancy, entropy.... see bibliography). Whatever the differences between the USA and UK nursing informatics the framework might benefit from a way to integrate context, specific concepts and practices, self-care, interprofessional education and wisdom.

This is a great book, one that is also courageous in its scope and execution. The third edition will be very well worth not just purchasing, but applying. Thanks again to Jones & Bartlett Learning for this copy.

MacKenzie, D. (2013). America's hidden epidemic of tropical diseases, New Scientist. 11 December 2013, 2947.
McGonigle, D., Mastrian, K.G. (2012) Nursing Informatics and the Foundation of Knowledge, Second Edition. Jones & Bartlett Learning, Burlington, MA.