Hodges' Model: Welcome to the QUAD: July 2019

Hodges' model is a conceptual framework to support reflection and critical thinking. Situated, the model can help integrate all disciplines (academic and professional). Amid news items, are posts that illustrate the scope and application of the model. A bibliography and A4 template are provided in the sidebar. Welcome to the QUAD ...

Tuesday, July 30, 2019

Book: In Praise of Walking - The new science of how we walk and why it’s good for us


Count: the number of steps...?

You don't have to count - just walk ...

individual - self
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group- population
"The sea squirt starts life boring, and gets more so, but along the way it does one thing that is very interesting indeed. In its larval stage this creature swims around the rock pool, its tail propelling it much like a tadpole's. Its talents at this time are not impressive, being  limited largely to staying upright and hiding from predators. At least it moves, though. When adulthood approaches that changes. It sticks itself to a rock, where it will stay fixed for the rest of its life. And the first thing it does upon finding a suitable site, the one interesting act in its life? It consumes its brain." Whipple, 2019.
In Praise of Walking






As you walk, let Hodges' model provide a cognitive map for your reflections ...

My source (several)
Whipple, T. (2019) Walking - our super power, Saturday Review, The Times, p.14.

Monday, July 29, 2019

The number of pages count (in a medical MOT)

Received in the post: an invitation.

For a medical MOT that would cost me £129 - which is a saving of £141.

I am informed that a competitor charges £564 for a "360" Health Assessment and £424 for an "Essential" Health Assessment.

Recently I spoke to someone who had major surgery and they remarked on the lack of assessment not on the medical side, but the social, especially in relation to discharge and the circumstances they would be returning to.

This example of apparent disinterest in a social assessment contrasts with practice in the past - several decades ago.

Apart from an awareness of  'silver clouds' and rose-tinted glasses what struck me was securing a sale by a manifest of paper:


The various blood tests that would be completed are detailed using medical terminology across four A4 pages. Depending on age there is a free respiratory screening too.

The following quotations (Alber, et al., 2017) state clearly the risks:
"There is a growing awareness among clinicians and health care scientists, that medical overuse comprises unnecessary health care lacking benefit for patients [3] or putting them at risk of harm outweighing a potential benefit [4]. Moreover, unnecessary medicine adds to rising health care expenditures [5] and a misallocation of scarce resources [6]. Asymptomatic individuals are at risk of being labelled as patients, causing anxiety and affecting their quality of life [7]." ...

"Moreover, in secondary prevention, risk factors are increasingly treated as diseases [8]. There is a tendency to screen asymptomatic populations at low risk and to label pre-diseases as manifest diseases [1]. Serum cholesterol levels are a good example of threshold lowering by shifting the boundary between health and disease [9]."


Over-treatment is also a problem in two critical and concurrent senses, as follows:

Developed health
systems

Need to transform to
health promoting, educational, preventive,
self-caring systems.
Developing health
systems

Need to prevent the inheritance of commodified health care and over-treatment.*


Alber et al. also provide a useful diagram preceded with more background:
"In primary care, the “quaternary prevention concept” [11] was introduced (see Fig. 1 ) in order to protect individuals from unnecessary investigations and treatment. Quaternary prevention is a “new term for an old concept: first, do not harm” [12]. It refers to actions “taken to identify [a] patient at risk of overmedicalisation [= in the sense of medical overuse, author’s note], to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable” [13]."

Fig 1
The concept of quaternary prevention. Source: [11] Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoulle M. Quaternary prevention: a task of the general practitioner. PrimaryCare. 2010;10:350–4, and [12] Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. Int J Health Policy Manag. 2015;4:61–4

Without being dismissive of screening and its relation to health and well-being, I have removed myself from this particular mailing list.

At some point I must really apply Hodges' model to this discussion. The model is ideally suited to navigating and arguing this debate; from self-care, primary care, prevention, population and global health. I have posted previously about the damaging ideal of the comprehensive health record and the way that records seem oriented to assessment and risk reduction with outcomes and relapse prevention an after-thought. This defensiveness is critical for public safety, professionalism and accountability, but as a thread on twitter shows it can have a negative impact too.


*There is an additional confounding factor at work in developing nations, the incursion of digital technologies from outside.


Alber, K., Kuehlein, T., Schedlbauer, A., & Schaffer, S. (2017). Medical overuse and quaternary prevention in primary care - A qualitative study with general practitioners. BMC family practice, 18(1), 99. doi:10.1186/s12875-017-0667-4

Tsoi, G.W.W. (2014). Update On Prevention - An Introduction to Quaternary Prevention, Medical Bulletin 19, 11, NOVEMBER 2014.

Ack.
I am subscribed to a mail list that is an invaluable resource on the status of medicine and health care, with contributors including, Mohammad Zakaria Pezeshki, Juan Gérvas, Karenleigh A. Overmann, Gene Tsoi and others.

MOT: Ministry of Transport test

Sunday, July 28, 2019

Physico-Political: as realised by Tony Heaton

individual - self
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INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group- population


My source:
Steps, Championing Disability Arts, Lancaster Alumni Magazine 2019, pp.17-18.
https://www.lancaster.ac.uk/alumni/


Image:
https://www.1418now.org.uk/commissions/does-it-matter/great-britain-from-wheelchair-tony-heaton/

Wednesday, July 24, 2019

Marrakesh Treaty - NZ responding to global 'book famine'

individual - self
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INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group- population










Marrakesh Treaty to Facilitate Access to Published Works for Persons Who Are Blind, Visually Impaired, or Otherwise Print Disabled

Monday, July 22, 2019

PRIMEtime CE: a multistate life table model for estimating the cost-effectiveness of interventions affecting diet and physical activity

When I saw Adam Brigg's tweet and thread the figure below stood out.

I have modelled some of the concepts using Hodges' model. I have added some additions, flagging gender* to highlight way this and other factors (often) need to be considered in a multicontextual manner.

There is a lot more of course, including the reference list; for example Squires, et al. which pose some interesting questions.

81. Squires H, Chilcott J, Akehurst R, Burr J, Kelly MP. A framework for developing the structure of public health economic models. Value Health. 2016;19:588–601.

Fig. 1 The PRIMEtime CE conceptual model



individual - self
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group- population
Interventions
over time

individual behaviours
motivation

model: outputs
AGE, GENDER*
Active People Survey

DIET - PHYSICAL ACTIVITY

cardio-vascular disease - heart disease,
 stroke, diabetes,
 liver disease, cancers, raised blood pressure, cholesterol, and body weight

TIME: chronological-pathological
PROCESS
 PRACTICE

behaviours - social
over time

social care


socio -

population health

POLICY
health economics
health care costs
social care costs
return on investment
- economics


My source (and do follow Adam's full-thread):

Friday, July 19, 2019

My Moon Mission? "The Stack"

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

I
choose 
...
[still]
to
try
.
4.6
.
.
.
8.7.5
and
c o u n t i n g
.
WAMP
Windows
Apache
MySQL
PHP
Command Line Interface
[VirtualBox, Vagrant ...]
PHPMyAdmin
 JQuery
git
HTML5
CSS
Drupal APIs
Themes & Modules*^
Create Custom T&Ms #?
.
to journey ...
to explore ...
to learn ...
http://heroicrelics.org/info/saturn-v/saturn-v-general.html
Saturn V Reference Dimensions: http://heroicrelics.org


The Drupal slogan is:

"Come for the software,
stay for the community."


The Stack



*What are the requirements of your project?
^What themes and modules are available 'out of the box'?

#If the themes and modules you require are not available you can create your own.

The idea of using Drupal (or other CMS) is to use the software to do the 'heavy lifting'.


Image source:
http://heroicrelics.org/info/saturn-v/saturn-v-general.html

Thursday, July 18, 2019

ERCIM News No. 118 Special theme "Digital Health"

ERCIM News No. 118 has just been published at https://ercim-news.ercim.eu/

Dear ERCIM News Reader,

ERCIM News 118

This issue features a special theme that provides a vibrant illustration of a sample of the multi-disciplinary research activities which underpin the upcoming revolution of digital health.

Guest editors: Sara Colantonio (ISTI-CNR) and Nicholas Ayache (Inria).

This issue is also available for download in pdf and ePub.

Thank you for your interest in ERCIM News. Feel free to forward this message to anyone who might be interested.

This issue includes:

SmartWork: Supporting Active and Healthy Ageing at Work for office Workers

"“Work ability” has been developed as an important multi-factorial concept that can be used to identify workers at risk of an imbalance between health, personal resources and work demands[2]. An individual’s work ability is determined by his or her perception of the demands at work and their ability to cope with them. The current challenge in using the concept is to establish adequate tools to evaluate and measure work ability continuously, in order to capture the changing and evolving functional and cognitive capacities of the worker in various contexts.  ...

The holistic approach for work ability modelling captures the attitudes and abilities of the ageing worker and enables decision support for personalised interventions for maintenance/improvement of work abilities. ...
The modelling of work ability will consider:

• generic user models (groups ofusers),
• personalised patient models,
• personalised emotion and stress models of the office worker,
• personalised cognitive models,
• contextual work tasks modelling,
• work motivation and values." p.35-36.

WellCo: Wellbeing and Health virtual Coach

"The WellCo European H2020 project (2017-2021), delivers a radical new information and communication technologies (ICT) based solution in the pro-vision of personalised advice, guidance,and follow-up for its users. Its goal is to encourage people to adopt healthier habits that help them maintain or improve their physical, cognitive, mental, and social well-being for as long as possible. Advice is given through behaviour change interventions tailored explicitly to each user. These interventions range from setting social goals to recommending activities around the seven areas defined in WellCo: cognitive stimulation, leisure and entertainment, supporting groups, physical activity, health status, nutrition, and tips (Figure 1). The behaviour change concept leverages the Behaviour Change Wheel model [2]." p.37.

Research and Innovation: A Language for Graphs of Interlinked Arguments

Next issue:
No. 119,  October 2019
Special Theme: Smart Things Everywhere


Peter Kunz
ERCIM Office
2004, Route des Lucioles
BP93
F-06902 Sophia Antipolis Cedex
 
Thank you to ERCIM and Peter Kunz.

[WellCo reminds me of the efforts of the AffecTech initiative.]

Wednesday, July 17, 2019

Book: National Populism - The Revolt Against Liberal Democracy

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

"Universities are not here to make people feel comfortable or to allow only research that avoids causing offence. Nor are they here to coddle young minds and present to them an ideologically homogenous view of the world. Universities are here to pursue truth, engage in reasoned argument, support freedom of inquiry and nurture the development of critical thinkers." Goodwin, 2019.
This post also links with Prof. Land's keynote in Dundee.

Book review by LSE Review of Books


My source:
Goodwin, M. Mob rule is crushing the campus, The Sunday Times, 30 June, 2019, p.25.

Sunday, July 14, 2019

2 + Everyone Else -1: Thank you Michael

individual
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INTERPERSONAL : SCIENCES
humanistic ----------------------------------- mechanistic
SOCIOLOGY : POLITICAL
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group
Michael
All of humanity in one picture except for Michael Collins. Apollo 11, July 1969
Collins

"We choose ..."


Photo:
https://www.reddit.com/r/spaceporn/comments/63ztoy/all_of_humanity_in_one_picture_except_for_michael/

Saturday, July 13, 2019

Motivating the Gut to Walk, to Run

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

motivation:
"I must go for run again
 - regularly - 
build up the distance to long ..."



*Walk, run, do something ...

On long distance runs:
the body produces lactate -
 a by-product of muscles working
in reduced oxygen.

Guts of marathon runners nurture
colonies of bacteria that
can consume lactate.

The bacteria transform lactate into propionate.
Propionate "has been shown to
increase the heart rate and maximise
 the rate of oxygen consumption,
making it essentially a natural
performance-enhancing drug."
Whipple, p.13.









Scheiman, J. et al. (2019) Meta-omics analysis of elite athletes identifies a performance-enhancing microbe that function, via lactate metabolism, Nature Medicine.
https://doi.org/10.1038/s41591-019-0485-4
Fitbiomics
https://www.fitbiomics.com/
*I'm sure I recall reading in Bortz's 'Next Medicine' stressing the importance of movement to independence.

My source:
Whipple, T. (2019) Gutsiest endurance atheletes have the running bug, The Times, 25 June, p.13.


Friday, July 12, 2019

Ekistics - Special Issue: Indonesia and the New Habitat: Urban and Environmental Challenges

Ekistics, one of the world's oldest scholarly journals for human habitat research and practice, was developed by C.A Doxiadis with the goal of creating liveable cities and thriving urban environments. The journal has provided an interdisciplinary forum for the scientific study of human settlements since the 1950s. It has recently been revived into an online version as Ekistics and the New Habitat. The journal is planning a series of special issues for various regions of human habitation around the world. In this call, we seek papers on the topic of Indonesia and the New Habitat: Urban and Environmental Challenges.

Cities in developing countries have become more urbanized and create complex urban problems and challenges. UN-Habitat introduces sustainable urbanization as concentration for future human settlements which is in line with the changes of the world scale. As a developing country as well as most populous nations in the world, Indonesia also experienced human settlements challenges particularly in the area of urban planning, basic infrastructure, housing and slums as well as the urban policies. However, the government of the Republic of Indonesia has shown its commitment to be part of the Habitat Agenda by actively involved and implementing the six themes of the Agenda.

This Special Issue seeks papers from academics, researchers, practitioners as well as observers which posit and analyses the problems of the cities and the new habitats in Indonesia in relation to planning and implementation of the six topics of UN-Habitat:

  1. Urban Demographics
  2. Land and Urban planning
  3. Environment and Urbanization
  4. Governance and Institutional
  5. Urban Economics
  6. Housing and Basic Services
Particular attention will be given to perspective that explores future agendas regarding sustainable urbanization and environmental challenges.

In this regard, the following topics are recommended to take into consideration:
  • Any aspect of the United Nations New Urban Agenda, in Habitat III, including reference to the Sustainable Development Goals.
  • Critiques on the local, regional and global policy of habitat development, design and planning, and urban transformation
  • Issues of architecture, urban design, spatial planning, housing, conservation, sustainability, livability, environmental planning and regeneration through a cross-disciplinary and/or global perspective.
We invite proposals engaged in the mentioned framework of topics above in the form of firstly, a short 250-word proposal/abstract by 1st Oct 2019. On-topic proposals integrating the above themes will receive an invitation to submit a full de-identified paper in Word.doc(x) file format for double-blind peer review.

Scholarly articles/reviews (full papers, double-blind review): typically, with title, authors, institutional affiliations, abstract, keywords, body text (5000-7000 words), and APA 6th References at the end of the article. Body text typically includes:
  • an introduction to a problem or topic outlining the need for the research,
  • relevant prior papers from Ekistics and other sources
  • the methodological or conceptual framework and methods
  • the summary of key results, findings, or reflective insights
  • a critical concluding discussion.
Scholarly extended Abstracts/Essays (1000-1500 words), Critical reflections of Practice (500-1000 words or so) and Book reviews (300-500 words) are also welcome: review priority will be given to full research papers with the criteria mentioned above. Please submit via the orange [SUBMIT PAPER HERE] button in this email.

Please note: there is a further concurrent call:

Saudi Vision 2030 - Habitats for Sustainable Development


Contact: Assist. Prof. Dr Yenny Rahmayati
Email: yrahmayati AT psu.edu.sa

individual - self
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group- population

EKISTICS


[ Smart 

Urban Demographics
Land and Urban planning
Environment and Urbanization


 Cities]

Housing and Basic Services

history ...
Ekistics 1957
Governance and Institutional
Urban Economics







'City'? Reflect on the city and cities as a structure and as content.


c/o Associate Prof. Kurt Seeman, Editor in Chief & Assist. Prof. Dr Yenny Rahmayati
(and my source)

See also:

Habitat 3

Ekistic Journal: Health and Mental Health

'ekistics' defined. 

[ an addition ] 

Wednesday, July 10, 2019

"Performance Piece" by Senga Nengudi

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


"Performance Piece" (1978) by Senga Nengudi







Thackara, T. (2019) Creative challenge, FT Weekend, Collecting, 27-28 April, p.3

Image:
https://news.artnet.com/exhibitions/senga-nengudi-1312703

Ethnicity - Pay Gap: in Hodges' model

individual - self
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group- population


Tuesday, July 09, 2019

Inaugural Scottish Threshold Concepts Conference: TCs in Action [iii]

Hodges' model is keyword or concept-based and so ideas, research with 'concept' in the title are a trigger for my attention, hence conceptual spaces, threshold concepts.

It sounds like the study and development of concept-based curricula would be a natural link, perhaps a question for a future conference?


The above comment was influenced by the title for next year's event:

Biennial Threshold Concepts 2020

"Threshold Concepts in the Moment"

University College London (UCL – London, UK). 8-10 July 2020


#UoDthresholdconcepts2019 prompted me to think about when a threshold is not a threshold but a liminal opportunity. Especially, when practitioners, learners and theoreticians look at concepts, new, or known in their own discipline but applied in other ways.

Perhaps, Hodges' model alludes to this with the distinct care (knowledge) domains. In each domain concepts are tainted in a certain way. Being sensitive to this and the effects of context is learning.


Brussow, J. A., Roberts, K., Scaruto, M., Sommer, S., & Mills, C. (2019). Concept-Based Curricula: A National Study of Critical Concepts. Nurse educator, 44(1), 15–19. doi:10.1097/NNE.0000000000000515

Sportsman, S., Pleasant, T. (2017) Concept-Based Curricula: State of the Innovation,
Teaching and Learning in Nursing, 12, 3, 195-200. https://doi.org/10.1016/j.teln.2017.03.001.


See also:
Inaugural Scottish Threshold Concepts Conference: TCs in Action [i]


Monday, July 08, 2019

Inaugural Scottish Threshold Concepts Conference: TCs in Action [ii]

After Prof. Land's keynote and the previous post on 'work-as-X' I can see the value of the academically agnostic - neutrality of Hodges' model in terms of the spaces it affords. It can be used to reflect as a safe space or problematic, troublesome or unsafe. As an example, consider the task of reflecting upon the current state of residential and nursing home care?

individual - self
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INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group- population











Next reflect upon residents and sexuality within these care environments. This could be from any perspective, or even work through several: resident, a new care worker, other team members, staff nurse, home manager, family member, GP, or inspector. ...













#UoDthresholdconcepts2019
Prof. Land raised the matter of extreme vulnerability and experience of Syrian refugees. Individual and Population are forced through a threshold that is catastrophic: that of identity. The scale of this event is being stressed as an urgent issue that must be accorded attention in parallel with physical relief

Perhaps, it is not just individuals who must encounter and pass through a threshold in their learning, their liminal journey. The problems we face demands that disciplines must find the disciplinary bridges that will enable them to solve the interdisciplinary and even transdisciplinary problems we face.

Geopsychiatry is a key bridge here. Research has determined that trauma can be intergenerationally transmitted. Governments, aid organisations and policy makers must take this into account and not just respond with physical relief. Unfortunately, the imbalance that is a lack of parity of esteem in general physical and mental health has its global-scale analogue in humanitarian crises and conflicts, especially those that displace populations.

Prof. Land referred to eduChaos and this is where 'lived experience' is found: not just in 'real time'.

#UoDthresholdconcepts2019

Uncertainty, kept repeating itself Prof. Land describing the work of Ilgen et al. (2018) and the need in (and through) education to find comfort with uncertainty. The challenge of this is acute in medicine and mental health care as Ilgen's work highlights. The previous post's nod to box-ticking and elsewhere the quest that is the 'comprehensive record' stresses at point of initial encounter - the initial assessment, perhaps to the detriment of an outcome oriented approach?

The question posed of "how professionals can manage the uncertainty arising from complex, ill-defined problems with conflicting assumptions, evidence and opinion" [another slide] is not just concept-bound as I tend propose. The terrain of Hodges' model can be used to map wells of uncertainty that help make the more certain, concrete data - information stand out. It helped me to see the situatedness of this discourse repeated. The definitions of 'uncertainty' and 'certainty' attributed to Ilgen et al. (2018) are a helpful adjunct to information science based sources.

In subsequent parallel sessions I switched rooms in  trying follow what was most relevant. First was,
'Where have all the empathetic professionals gone? An exploration of empathy as a threshold concept for the helping professions'. This provided a multidisciplinary insight into social work education, with overlaps that included safeguarding and child protection. Jayne Lewis's format had us engaged, well me clearly as I've no notes or photos. The talk of empathy made me recall twitter and student nurses remarks on their placements (accepting too that 'No news is good news') and student-mentor-placement relationships. If the practice/placement environment is stressed/contested for a variety of reasons, to what extent does this influence empathy role models, student experience and study of TCs? Do researchers need to record the emotional and political 'temperature' as a baseline measure?


#UoDthresholdconcepts2019


Next, on the programme; TCs, medical students and population health learning. From an acute angle (I was late arriving) Hothersall explained a study with a small sample, and yet findings that (as ever) call for more study, with implications for teaching in the lecture theatre, as a whole, in practice and relevance for me.

I'm sure there are many threshold concepts in public health and public mental health (to ensure inclusion). Even if specialty posts in public health are filled 2013-2016 (and amid recruitment pressures) I wonder if there is an issue for students (generally) in the perception of  'public health' and their respective discipline? Is there something in the old debate of pure - applied disciplines? Do medical and other students feel they must focus attention on the 'hard' learning rather than the 'soft' fuzzy concepts that public health encompasses? What has been the impact of the most recent series of re-organisations?



 #UoDthresholdconcepts2019

Of course, given the big themes identified, for me, the first lecture 101 should include a conceptual framework that can readily incorporate the (socio-)technical, (psycho- socio-) political, conceptual and much more.


The presenter also informed us that a paper is in press: 'The Clinical Teacher'. These findings of concepts that were troublesome for students appears to support my '101' role for Hodges' model - but then I would say that ...


Tierney's Exploring threshold concepts in the scholarship of teaching and learning was a rich source on a model of scholarship (Trigwell, et al. 2000) with tables also drawing on Perkins (1999, 2006) that I must try to follow-up as with Visual Art as navigation of affective thresholds: implications for the classroom.



The afternoon keynote discussed The dual development of professional identity as physicians and mentors, with Profs Hokstad and Kvernenes. Using a narrative reading (Reismann, 2008) the content and findings to me call for simultaneous duality in identity, the medical and the non-medical (practitioner - interaction with the patient and their family), clinician and mentor.

Being struck by the thought (on science, knowledge, holism - whole / part distinctions) of Goethe in the past it was a marvellous to attend Jonathan Code's session; Mind the Gap - Ontological discontinuity as threshold concept. I imagined Hodges' model and several leaves in various stages of growth.

It creates an overhead for conference organisers, but video recordings would be a great help. I think there is one more short post on this conference.


Ilgen, J.S., Eva, K.W., de Bruin, A., Cook, D.A., Regehr, G. (2018). Comfort with uncertainty: reframing our conceptions of how clinicians navigate complex clinical situations.
Adv Health Sci Educ Theory Pract. Nov 2. doi: 10.1007/s10459-018-9859-5.


See also:
Inaugural Scottish Threshold Concepts Conference: TCs in Action [i]

Friday, July 05, 2019

Fallacies of Work as Imagined: c/o Steven Shorrock - HSJ Patient Safety

I came across the following image on twitter. The tweet is also copied below.

This post is prompted by one from 'The Varieties of Human Work' on the Humanistic Systems blog 05/12/16 by Steven Shorrock. The focus is understanding and improving work, and in his opening there is a sense of very large net having to be deployed to capture all the disciplines and dimensions that are invariably involved in work.

"One of these is the simple observation that how people think that work is done and how work is actually done are two different things. This observation is very old, decades old in human factors and ergonomics, where it dates back to the 1950s in French ergonomics (le travail prescrit et le travail réalisé; Ombredanne & Faverge, 1955) and arguably the 1940s in analysis of aircraft accidents in terms of cockpit design (imagination vs operation). Early ergonomists realised that the analysis of work could not be limited to work as prescribed in procedures etc (le travail prescrit), nor to the observation of work actually done (le travail réalisé). Both have to be considered. But these are not the only varieties of work. Four basic varieties can be considered: work-as-imagined; work-as-prescribed; work-as-disclosed; and work-as-done. These are illustrated in the figure below, which shows that the varieties of human work do usually overlap, but not completely, leaving areas of commonality, and areas of difference."

The varieties of human work.

It immediately struck me how well the diagram can be translated and transposed on to Hodges' model on several levels and as per Steven Shorrock's excellent post. I acknowledge I am playing with language, but initial thoughts included:
  1. As per Shorrock: the difference between how people think about work and how work is actually done.
  2. Shorrock explains how for example 'work-as-imagined' draws on the other forms of work.The level of overlap in between the forms of 'work-as-' is as diverse as the contexts that arise and constantly change.
  3. There are many 'gaps' identified in Steven's post [not in the sense of a fault with his post]. A subset of these may relate to the theory-practice gap which was one original purpose of Hodges' model, to help close this gap.
  4. Orders of scale: from a single action to a whole job and its specification.
  5. The way the 4Ps process, policy, purpose and practice can be used (I identified the 4Ps within Hodges' model, one per care domain, many years ago).
As has been pointed out to me (on twitter) the context here is 'work' and not healthcare, but as Steven notes there are many disciplines, with commonalities and differences. I am really grateful to Steven for his post, in which he also stresses the overlap. 'Work-as' is a flux. Hodges' model can be viewed through time as series of frames. Below are some rather unstructured notes [musings] relating and extending the context of Shorrock's image and post to Hodges' model:

individual - self
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group- population

'Work-as-Imagined': Of the four P's I have placed 'PURPOSE' here, since the individual's purpose must (ideally) achieve synergy with colleagues and the organisational objectives and goals.

'Work-as-Imagined' involves thought (and so is infinite in variety) whether use of imagination is day-dreaming, or radically innovative. Until AI does take over, this is the 'meta' - cognitive domain. Amid many, Shorrock makes an important point in how we imagine the work other disciplines do. Often so many stereotypes follow that are often revealed in referrals and expectations. Shorrock highlights this at the macro level of policy makers [lower right in #h2cm] having to imagine the operational aspects of work; and the simplified accounts of surgery for a patient by anaesthetist and surgeon (while meeting the requirements of informed consent).

This domain may be 'work-preserving' in humanistic terms as it is the realm of tacit knowledge, creativity and innovation.

Although the artifacts of simulation are ultimately produced in the SCIENCES domain, they are 'imagined' in case studies and scenarios. Shorrock helps make it clear how much of work is theorised and practised virtually, but with recourse to imagination not technology.

Mental illness and the systemic - organisational response is mediated diametrically in Hodges' model. Ongoing critique of psychiatry and mental health services in some quarters appears to suggest that being unable to work-as-imagined here, means loss of self and identity that is then outsourced and effected by proxies and advocates. [Discuss?]


'Work-as-Prescribed': Reading 'prescribed' literally then drugs and other physical treatments arise here in the SCIENCES domain. The 4'P is PROCESS suggestive of procedures, specifications, instructions and formal rules. Process is important allied with PURPOSE in that if (your) can be described formally, by a set of rules then you may be vulnerable to your job being taken by a robot through 'robotic process automation'.

When I started in the NHS in the 1970s there was a shift taking place from being task-oriented (mechanistic) to individual/patient-centred (humanistic). Shorrock notes how there are relatively fewer examples of work-as-prescribed. Developed nations are waiting to see how many existing jobs are lost to AI and robots, but how many new ones emerge. (Can the developing nations 'skip' several prescriptions?)

Here, we also apply time to work. The past, current work and the future. Will we still work the same hours? Is there a lesson in '0' hour contracts? An obvious aspect of work is day vs. night shifts.

'Work-as-Prescribed' also reinforces the presence and context of the SOCIOLOGICAL domain. Now, conferences are devoted to 'social prescribing'. By its nature this is more often than not 'public' and therefore 'disclosed'.

Citizen science and patient involvement provide a further angle on work-as-prescribed. As does what is prescribed (especially in what is used) must to some degree influence what is proscribed in what is not used.

'Work-as-Disclosed' Sharrock writes concerns how work is explained and communicated. This will also involve teaching formally and health professional to patient, carer and public.  The challenge is that thinking about work and actually doing work is a SOCIO-POLITICAL act - transaction (as the literature demonstrates).
Socially, whether or not someone is working is also disclosed in their domestic  comings and going to work. The socio-political dimension is evident in the assumptions that follow homeless peopleand their apparent 'staying' (many do work?)? There are those who opt not to disclose at all and live off-the-net.

SOCIO-ECONOMICALLY there are constant references to 'pay-gaps' especially by those groups and their representatives most affected by low pay and austerity. While the social care workforce toil in the community, social care funding, provision and integration is pushed into the long grass that is green papers. Despite the social value and importance of this work, the status of this sector is signalled - disclosed as poor.

Nurses globally are campaigning to establish in law the requirement for safe-staffing levels. Sharrock alludes to the challenge of nursing as PRACTISED on the 'shop-floor' and ongoing studies on staffing - establishments and skill-mix.

In the 1980-90s expert systems specialists interviewed workers  in an attempt to understand the knowledge acquisition and elicitation associated were their profession - community of practice.

These humanistic care (knowledge) domains reflect the qualitative approach to research.

Work-as-disclosed also communicates to would-be future recruits. How are the aspirations of teenagers and mature entrants first experienced, discussed and carried forward socially?


'Work-as-Done' simultaneously speaks of power, employment, accountability and regulation. 

As four conceptual spaces #h2cm indicates the 'distance' between concepts that shifts according to context. The space that work takes place within and how people are managed, organised, controlled for efficiency with reminders, queues, appointments, and waiting areas are signs of the institution. The person was a long way from the creators of the Victorian asylum, even as they sought to establish (stamp?) a 'standard' level of care.

What difference does it make when work-as-done is bound to an individual and collective sense of duty?

The counterpoint is precisely [mechanistic] work-as-done. Work-as in shift completed and recorded - clocked as such. Work-as-done: the 12 hour shift or as already mentioned work-as-NOT-done due to the flexibility afforded by zero hour contracts. Work-as-done also denotes [scientifically] the concepts of power, energy and effort. So, work-as-done must result in personnel actually feeling 'done': burnt-out when safe-staffing is not assured.

The old saying: "If it is not documented it was not done.", springs to mind. Shorrock refers to surgery and loss of life. What was 'done' and what does an inquiry reveal? What is actually done and the way it is done if varies - contravenes 'norms' rules then there is a issue of whistle blowing. The question then becomes was the work done as it should - must - be? The 4P in this domain is POLICY. 

Perhaps a box-tick here also accounts for 'work-as-' elsewhere?





Wednesday, July 03, 2019

RCN Congress 2019 ii "We are all Global Nurses"



The debate about public sector vs. private sector healthcare touches all healthcare professionals. There is no escape. Despite this, from my 40+ years in the NHS - the NHS can act as a cocoon. It's as if the walls are adorned with "Keep Calm and Carry On". For some of us there is a 'keep your head down' mentality. While as a nursing assistant and student nurse, the words "Make sure you join COHSE, NUPE or the RCN" rang out; it was the day job, learning and family that had my attention. I wish I'd got to Congress decades ago.



You can't do everything and this lack of involvement is a blessing in a way. For example, without ever taking anything for granted, I never imagined I would need the help of my union/professional body. When I did and 'we won' thanks to a brilliant RCN Rep. Being represented has this quality to it. Unless, you are an activist, it is a newsletter, journal, annual pay discussion, but this opened my eyes. As a consequence, I encourage students, even more so and others to ensure they are represented and get involved.

To Congress itself: I was surprised and disappointed to hear several years ago about the RCN's cessation of links to the International Council of Nurses [ICN]. Further surprise followed when a Congress debate revealed it was five-six years ago in fact:

Members vote to allow RCN to leave international nursing body

£600,000 is 'politics' in the raw for membership and the RCN Council. The cost of ICN membership  was debated at Congress. There are various arguments. This seemed a break on many levels; social, political, psychological and scientifically.

(Bizarrely, perhaps this state of affairs says something in support of reflection. When the latter is accused of fostering navel-gazing, finance and value for money ... speak volumes, but the RCN's global isolation is navel-gazing realised aggravated by the ongoing psychological experience of Brexit.)

In championing Hodges' model as a global resource for healthcare and education, my parochial perspective from Wigan Pier has felt acute. Online I've long nurtured links with global nursing and healthcare groups: HIFA, HIPNET, GANM, Nursing Now and others. In workshops with nursing students and other disciplines, the ICN and global nursing context is always stressed (the ICD too). [After all, as students and lifelong learners these people do have the World at their feet.]

The relevance of Hodges' model increases daily and - my bias aside - the model's significance is crystalised in this issue for the RCN and its members. As noted in the debate John Gilmore raises the matter of refugees. For those in crisis through natural disaster, conflict and crime amid chaos there is geopsychiatry and the mental health implications for children and future generations of this 'lived experience'. As we await further news on this, below I have mapped key elements of the debate in Hodges' model:

There is a digital archive for members to watch the debate.
individual - self
"My backyard"
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group- population
"The WORLD of Nursing"

Philosophical: Values,
Philosophies of Care
Mental Health
Mental Health of Nurses
Parity of Esteem -
geoPSYCHIATRY

Ethel G. Fenwick and others

[ Health Education & Promotion,
Sustainability ]


The 'GEO-' in Nursing
Nursing logistics
Research; Collaboration, Multi-center, Evidence,
The 'UNIVERSAL' in UHC
Definitions of Nursing Roles
Skills & Knowledge
Coding & Classification initiatives
Global: 20,000,000 nurses
ICN predates RCN

'transparency'

The Nursing Community
"Voice"
1899 ICN formed
SOCIO-[Economic] status of nurses

The global:
Community of Practice

Collegiality
Cooperation
Collaboration
Fellowship

"We are all global nurses."

'political'

POLICY: Workforce, Migration,
Recruitment crisis
Safe Staffing (National, Global)
Medical Emergencies,
Climate change
Working groups: Standards, Issues
Funding, ICN, RCN and other bodies
Support for Developing Nations LMIC
The Scope of Nursing
Stewardship
ICN - Membership model
PAY restraint, austerity
As of 2013: £614,470 / £1.42 per member
Business case



How do you measure the impact of an organisation?

2020 - International Year of the Nurse

20:20 vision IS global

https://en.wikipedia.org/wiki/Keep_Calm_and_Carry_On

Tuesday, July 02, 2019

GGI launches Special Interest Group on Governance at EHMA 2019

... with EHMA conference themes

individual - self
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group - population

personalisation
(starts here?)
identity
(assured by self,  proxy, or advocate)

digital transformation
(with socio-TECHNICAL benefits)

sustainability
(energy, amenities, transport, logistics;
across all four domains and the spiritual dimension)
integration
(social care, physical, mental health, across all four domains and including spiritual dimension)

SOCIO-technical

Value-based care (measures, outcomes, policy development ...)

Left to right: Andy Payne, Laura Botea and Ian Brandon at EHMA 2019 Annual Conference – Espoo, Finland.



Good Governance Institute – European Health Management Association (EHMA) Good Governance Institute Special Interest Group on Governance


My source:
https://twitter.com/GoodGovernInst/status/1145982812962590720

Monday, July 01, 2019

Developing a Palliative Care Model for People with Dementia in the Community c/o @PallC4Dementia

http://www.professionalpalliativehub.com/research/palliative-care-research-projects/dementia-model/dementia-community

Challenge

People are living longer, which means that more of us will get age-related illnesses such as dementia. Dementia is caused by different diseases of the brain. These diseases affect the parts of the brain which are normally used for learning, memory and language. Although Dementia usually affects people as they get older, it’s not a normal part of ageing. Many people don’t realise that Dementia is a terminal illness. People may die from dementia, not just die with dementia. Palliative Care aims to improve the quality of life of people and their families who are facing an incurable, life-limiting illness, such as dementia. Palliative care involves actively looking for symptoms of any kind- physical, social, spiritual, or psychological - and providing excellent care to lessen these symptoms. People with dementia need palliative care just as much as people with cancer, but they often don’t get it.

Research Project (currently ongoing)

This project aims to improve the palliative care of people with dementia, and their families, by developing a “model”. This model aims to support people with dementia to live well at home in the community for as long as possible. The model will map out what services, assessments and treatments the person might need and where, so the health system can better organise their care. To develop a model that will work in Ireland, we must first learn what is already known about “good” palliative care for people with dementia. This mixed methods study will be carried out in several phases:
  • We will conduct a review of the literature, to find all available research in this area. This will allow us to see what existing models and services are supported by research evidence.
  • We will conduct a survey of healthcare workers and researchers to ask them two things. Firstly, what do they think an ideal model of dementia palliative care would look like? And secondly, what existing services providing dementia palliative care are there?
...

Phase 1: The research team designed a survey to i) identify existing models for dementia palliative care in Ireland and the UK, and ii) to identify key components of effective models. The survey is currently live on this website. The research team has also developed a protocol for a scoping review to guide their search of the literature for relevant research. The protocol is registered with PROSPERO ID: CRD42018091158, and the search is currently underway.
...


Follow us on Twitter

@PallC4Dementia | #PallCare4Dementia

For further information contact

Email: s.fox AT ucc.ie
Email: info AT aiihpc.org