Hodges' Model: Welcome to the QUAD: November 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

Saturday, November 29, 2014

Reflexive strategy realised in policy: from hokey cokey to hocus pocus

Strategy is usually about the longer term, as such it needs to be reviewed, but it is hardly a matter of reflex. Crisis management within a strategy should be an operational contingency, the implementation of contingency plans.

As posted several years ago, I've been fascinated by the need for vulnerable people to 'beware of reflex moves'. The example I have comes across repeatedly is due to the people community mental health services encounter. Older adults who are newly bereaved (and suddenly become vulnerable) and for whom it is (also) suddenly judged by well-meaning family members that they should move their home to be nearer the family. This decision is often made quickly, when the grieving if it is ongoing, has only just started and decision-making is impaired to say the least.

It is a bit of stretch, but we can relate this to health, social care and policy. Let's see ...

As an evidence-based activity health care is far removed from "hokey cokey". To be precise its Levenshtein distance (or edit distance) is 8 :-)

Unfortunately, a recent HSJ/Serco Commission on Hospital Care for Frail Older People concluded that health and social care integrated care is a "myth" in terms of being the "silver bullet" for the NHS's financial difficulties (Barnes, 2014).

I'd been wondering about the problems that have been solved and those still ongoing since I began my nursing career in the late 70s. You could call the latter personal legacy career issues. The commission's report describes the current flagship project the better care fund, as having been planned in a "hokey cokey" fashion.

Of course, integration is as many-splendored in its transformational promise, as it is many tentacled in its complexity. What is being integrated? To what extent does this include disciplines, finances (budgets), philosophy, location, record systems, management, policy, accounting, reporting and accountability ...? How do we measure and recognise success?

On a positive side the Levenshtein distance for "hocus pocus" from "health care" is 10, so that maybe reassuring?

The worry is that there is form elsewhere, also highlighted in HSJ (Illman, 2014).

The 3 Million Lives telehealth programme has been scrapped. If it is a measure at the time of this post, the last tweet was 18 March 2013.

Given the major upheaval that the NHS has been through this is hardly the ideal environment for policy making that must engage staff and the public.

Engagement - crucial!

Barnes, S. (2014) Landmark report criticises integration policy. Health Service Journal, 21 November, 124: 6424; pp. 4-5.
Illman, J. (2014) NHS England outlines telehealth successor, Health Service Journal, 26 September, 124: 6416; p.13.


Friday, November 28, 2014

Papers 2 study: The longitudinal effect of concept map teaching on critical thinking of nursing students

Lee, Weillie; Chiang, Chi-Hua; Liao, I-Chen; Lee, Mei-Li; Chen, Shiah-Lian; Liang, Tienli (2013) The longitudinal effect of concept map teaching on critical thinking of nursing students. Nurse Education Today, Vol.33(10), pp.1219-1223.

From the summary (with my emphasis):

... The intervention of concept map teaching was given at the second semester in the Medical–Surgical Nursing course. The results of the findings revealed student started with a mean critical thinking score of 41.32 and decreased at a rate of 0.42 over time, although not significant. After controlling for individual characteristics, the final model revealed that the experimental group gained a higher critical thinking score across time than the control group. The best predictive variables of initial status in critical thinking were without clinical experience and a higher pre-test score. The growth in critical thinking was predicted best by a lower pre-test score, and lower scores on surface approach and organized study. Our study suggested that concept map is a useful teaching strategy to enhance student critical thinking.

Thursday, November 27, 2014

Threshold Concepts - one of '10 trends set to shake up education'

Professor Ray Land emailed the Threshold Concepts community following up on the conference held in July 2014. I can't believe that very soon another month and the 2016 conference in Nova Scotia will be 'next year', but there we go...

Prof. Land updated us on a prospective book, and when available I will post news of the book and the next conference here.

While I am sure Threshold Concepts are (very) applicable to Hodges' model and my research interests, I am not trying to contribute to the planned text. I'm busy enough with the third graduate study module. Reading, discussion, a 4k word draft essay, two peer student reviews...

Prof Land also highlighted the following, which he's happy for me to share with you [I've added the image]:

... We were pleased to see that Thresholds were identified as one of '10 trends set to shake up education' as reported in The Times Higher magazine last week.


http://www.open.ac.uk/iet/main/files/iet-web/file/ecms/web-content/Innovating_Pedagogy_2014.pdf
Innovating Pedagogy 2014 - Report
The report, produced by the Open University and called 'Innovating Pedagogy 2014', is free to download here:

https://iet.open.ac.uk/file/innovating-pedagogy-2014.pdf

Kind regards and hope that all is well where you are.

More shortly

Ray
____________________________________________________
Professor Ray Land
Director, Centre for Academic Practice (CAP)
& Professor of Higher Education,
School of Education, Durham University,
Leazes Road, Durham DH1 1TA
United Kingdom

Monday, November 24, 2014

Big Hero 6 - clip (Healthcare is never 'Frozen')

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group











My source:
Educate the Young - Disney and Pixar Understand Patient-Centered Care

House of Care model

... the House of Care model - a coordinated, patient centred system, in which patients and carers work with healthcare staff, supported by organisations, to optimise their care. HSJ (2014)

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group

Patients

Healthcare staff

Carers


Organisations


NHS England: House of care -
http://www.england.nhs.uk/house-of-care/

King's Fund: House of care -
http://www.kingsfund.org.uk/publications/delivering-better-services-people-long-term-conditions


My source: 
Trueland, J. (2014) How to tackle the workforce planning issue, Health Service Journal. 124, 6418: pp.16-21.

Sunday, November 23, 2014

Antipsychotics & Dementia: Managing medications (across Hodges' model)

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group
person-centered care, communication

diagnosis
medication management
assessment - review
premature deaths, stroke
side-effects
observation
Anti-psychotics:
Traditional - 1st generation
Atypical - 2nd generation
de-prescribing
pain, analgesia, 
research
anti-depressant
cholinesterase inhibitors
titration
trial reduction
avoid benzodiazepines if possible
Team working, collaborative care, family
nursing homes
challenging behaviours -
shouting, aggression, psychosis, agitation
Behavioural and psychological symptoms of dementia (BPSD)
psychosocial interventions, reassuring staff, knowledge and skills
Policy, Reports, Governance, Audit, Consent, Capacity, Consultation, Multi-disciplinary approach, institutions, choice

My source: AlzheimersAustralia via twitter
https://www.dementia.org.au/

Monday, November 17, 2014

Response to: Pros and cons of pulling behavioral and social data into EHRs [Government Health IT]

Mike Miliard Editor of Healthcare IT News posted an item:

Pros and cons of pulling behavioral and social data into EHRs

To put my reply in context here is the start of Mike's post:
Should more types of health data figure into electronic health records?

On the one hand, the Institute of Medicine put out a call for doing just that on the grounds that behavioral and social data can benefit population health practices to ultimately improve the care of individual patients. For physicians who already complain that EHRs are burdensome and distract from care delivery, on the other hand, the idea of making electronic records more complex, perhaps even cluttered, will inevitably be unwelcome news. ...

Talk about a work in progress? How long does it take to get this right? Of course health and social care data is always ongoing, as governments change, policy, medicine, local government, social care, technology and society too.

As Mike notes for many physicians the EHR is already burdensome. My context is quite different being nursing, mental health, and crisis-oriented in the community. I've defined small research-based datasets in the past and it is a fascinating pursuit. Trying to have the data defined and reporting ready before the 'door opens'. Doing this retrospectively is no fun at all.

At work when I visit someone in a residential care or nursing home, do I record this as 'home', or 'community' in the absence of the aforementioned categories? Is this ageism?

Is there a digital dividend to come to the physician's aid? Surely increasingly the physical measurements and observations in medicine, surgical... can be automatically captured, disseminated and presented accordingly? Surely, it is possible today to bring in other data as the context changes? If we can autofill on words, we should be able to auto-fill the dataset as context shifts? There are many algorithms out there already 'alive and countin-the-clickin'  in the milliseconds.

It seems Mr Miliard is writing about one way to define 'integrated care'?

It isn't just 'public health' though;
it must combine, be inclusive of - 'public mental health'.

The focus of the article is the Institute of Medicine's report:

Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2

Mike lists eight domains from the report and these are mapped to Hodges' model below:

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group
educational attainment, stress, depression
physical activity, stress

social isolation, intimate partner violence (for women of reproductive age)

financial resource strain,
neighborhood median household income

I've included stress twice as there are at least two forms: anxiety - internal; and environmental - external.

Sunday, November 16, 2014

Woman says goodbye to beloved horse from hospital bed hours before she dies

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group

Sheila Marsh is reunited with her horse Bronwen one last time.
Photograph: Andrew Foster/Twitter






The Guardian:
Woman says goodbye to beloved horse from hospital bed hours before she dies:
http://www.theguardian.com/uk-news/2014/nov/07/sheila-marsh-horse-reunion-goodbye-hours-before-she-dies

Image source:
http://www.theguardian.com/uk-news/2014/nov/07/sheila-marsh-horse-reunion-goodbye-hours-before-she-dies

Saturday, November 15, 2014

Report: Personalised Health and Care 2020 - National Information Board

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group

self-help, self-care, person-centredness, personalised care

task-centredness, administration, time, processes, events, data capture

"Patients told to go online in
radical NHS reform"


"Government withholds
35m nursing technology fund"



Report: Personalised Health and Care 2020. National Information Board. November 2014.
https://www.gov.uk/government/publications/personalised-health-and-care-2020

Sources:

The Times, Patients told to go online in radical NHS reform. 13 November 2014. London. p.1.

The Nursing Times, Government withholds 35m nursing technology fund. 12 November 2014. p.2.

Thursday, November 06, 2014

'Voronoi treemap' by Michael Balzer, (2005)


http://www.brainpickings.org/2014/07/17/the-book-of-trees-manuel-lima/
'Voronoi treemap' by Michael Balzer, (2005)


Images courtesy of Princeton Architectural Press via Brain Pickings

The Book of Trees - on a table in Waterstones, Manchester this evening.

Monday, November 03, 2014

Learning model for International Health - progress since 2005?

In the third module of my technology enhanced learning studies I have been reading:

Henry, B., & Ueda, R. (2005). Learning model and curriculum designs for international health in nursing. Japan Journal of Nursing Science, 2(1), 17-24.

The aim of the paper is:

Nursing’s domain of inquiry for international health is unclear. A learning model to frame this specialty is unavailable. The goal of this analysis was to open debate worldwide on the nature of concepts, relationships, and analytic constructs that can serve as a foundational blueprint for international nursing curriculums. The aim was to define and operationalize international health in nursing by constructing a learning model.
The results included the identification of five main concepts:

 environment, demography, culture, technology, and research.

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group

environment, technology, demographics
culture

Using Hodges' model above I have mapped these concepts to the model's domains. The influence of context looms large of course, so we can also for example consider the sociological aspects of the environment and the politics of the environment which is currently newsworthy on a global scale.

I've placed the concepts in the primary domain. We can extend them in many ways. Diagonally, technology can be extended to what is (should be?) socio-technical. Usability brings in the interpersonal domain and subjective experience. Funding and access politicizes many concepts and no-less here.

I'm being deliberately contrary with research. Usually I'd split research between the sciences and sociology. My doing so equates to the dated, but still significant distinction between quantitative and qualitative forms of research respectively. Basically this means that using Hodges' model we can replace the humanistic (subjective) and mechanistic (objective) labels above with 'research'.

We can take 'environment' and be person centered looking at the individual experience. We can do the same but for a group, or population.

As I investigate culture, nursing, Hodges' model and educational technology I do wonder what progress has been made since 2005: where these concepts sit within the care domains (and why), and what about the gaps? Back to the literature...!

Sunday, November 02, 2014

Sohei Nishino - Dioramas: Tokyo, Kyoto, Osaka, Hiroshima, Shanghai, London ... Jerusalem

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group
Jerusalem © Sohei Nishino

Jerusalem 2012-13
Nishino's maps aren't supposed to be geographically accurate. "It is simply the town seen through the eyes of a single individual," he says, "a trace of the way I walked through it." He uses a film camera and develops the images himself before painstakingly cutting and assembling them into a collage.

The Sunday Times, Magazine, p.50-51. 19 October 2014.

[politics of (some) places] pj



Michael Hoppen Gallery (30 October - January 7):
http://www.michaelhoppengallery.com/

My source: Scenes from the cutting room floor, 19 October 2014, Spectrum, The Sunday Times, 49-52.
Image - Jerusalem, source:
http://www.michaelhoppengallery.com/artist,show,3,161,485,2753,0,0,0,0,michael_hoppen_contemporary.htmlJerusalem

Saturday, November 01, 2014

Ebola: impact across the care domains

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group

grief, mental trauma, stress

ChildFund International opens first Interim Care Center for children orphaned by Ebola:
https://www.childfund.org/ChildFund-International-opens-first-Interim-Care-Center/
Dear Friends,
Ebola is  frightening.  Most information from TV, Facebook, and from our governments is poor. We want to change this by providing to you the best possible scientific information  about Ebola from leading scientists from Nigeria, Africa, the Library of Alexandria and experts world wide.

We have created a cutting edge lecture on Ebola for you to teach your students, share with your faculty and distribute to your friends. The Lecture has been translated by 20 scientific experts  into  Arabic, Chinese, English, Farsi, French, Hebrew, Japanese, Malay, Pashtu, Russian, Spanish and Urdu. It present the best possible scientific knowledge about this disease.

http://www.pitt.edu/~super1/lecture/lec52511/index.htm

...
We provide this to you as a “gift that is meant to be given”. Please share this with your students and faculty, and post the lecture on Facebook, tell others about  it through Twitter, etc.  The Library of Alexandria Lecture is free, developed by the global scientific community. Include links to this from Universities, Libraries, schools media, etc.

Let us continue to learn and share the scientific facts about Ebola.

Drs. Elegba, Kana, Bello-Manga and Adiri
Faculty of Medicine
Kaduna State University, Nigeria
Ismail Serageldin, Ph.D., Director Library of Alexandria
Ronald LaPorte, Ph.D. Director Emeritus WHO Collaborating Centre, Pittsburgh
Al Jazeera America
The biggest concern of the Ebola outbreak is POLITICAL*, not medical:
http://america.aljazeera.com/opinions/2014/8/ebola-virus-liberiasierraleonepolitics.html


Additional links:

Understanding the Ebola Virus and How You Can Avoid It:
https://alison.com/course/understanding-the-ebola-virus-history-treatment-and-prevention-revised

The Economist: Ebola and big data - Waiting on hold:
http://www.economist.com/news/science-and-technology/21627557-mobile-phone-records-would-help-combat-ebola-epidemic-getting-look

Ebola Resources:
http://ebolaresources.org/

Ebola Deeply:
http://www.eboladeeply.org/

Ebola, David Quammen, Bodley Head:
https://www.davidquammen.com/

Sources:
HIFA2015
https://sci-techuniverse.blogspot.com/2013/01/terrifying-facts-about-ebola.html
*my emphasis