PROCESS 0 : 4 DOMAINS

No, 0 - 4 is not a sports score.   

Quite a while ago and over several years I associated 4P's with each of the domains of the model:

SCIENCES: process
SOCIOLOGY: practice
POLITICAL: policy
INTRA- INTERPERSONAL: purpose

 

Although, this brings home the model's being an idealisation - there remains much to learn and discover. In addition to physical processes there are political, psychological, social processes too. If you were to prioritise the concept of PROCESS across the model how would you do this?

 

My take - which could (will) differ tomorrow - and could well do so if the context was specific. 

 

I've tended to think of triage, physical and psychiatric emergencies the focus being on the SCIENCE domain (ABC medical emergency...!) and that is the starting point. If triage is excluded, then #MyNameIs follows crucially in obtaining a comprehensive assessment and addressing 1-1 parity of esteem. There is a need to (really) attend to the INTERPERSONAL domain.

 

In a way the 'individual' domains INTERPERSONAL - SCIENCES should (must) collapse into one. This is to help assure, strive to achieve person-centred and integrated care; and not to reduce, rationalise, and generalise the nurse curriculum. We need mental health nurses equipped for the 21st century.

 

Reflecting on this though I'm jumping ahead.

 

We actually start with the POLITICAL domain 0 - below. With nurses in the UK being balloted on strike action this is difficult medicine to swallow, but there we are. Globally, we saw the literal power of the POLITICAL domain in health during the (ongoing) pandemic. We will do so again in future security, health, and climate challenges to follow. We don't want future generations to face ours, they will have their own.

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

3	1
2	0

Spiritual - 4

So, in 0 is there an advanced directive? Even before this, can I as a nurse, or other practitioner - nurse, treat, care ... for this person? Do we have consent - can they give consent? Is there a Dr 'in the house', a responsible medic? Have they been admitted, their referral accepted and acknowledged? Are there cultural or religious reasons not to proceed as we might otherwise? POLICY, safety, protocol also dictates that if we are a first responder then we do not become a casualty - that is obviously undesirable. So we are checking the environment (SCIENCES domain 1*) - the specific context.

THEN - I'm selecting 2 the SOCIOLOGY domain. The information obtained from the person (if any) is crucial to what follows. The 'if any' is non-trivial too were the INTERPERSONAL domain 3 is concerned (and the aforementioned collapse [3-1]. Even if the person declines, or is unable to communicate with us, we can still glean essential details about physical AND mental status. So, yes, the specialist skills of the practitioner and lived experienced colleagues really do matter.

With the SPIRITUAL domain (which can encompass the model) we close a circle, back to the religious, cultural, human rights and values dimensions acknowledged above. This conjunction of political and spiritual is a little surprising in global terms, and so maybe encouraging too.

*Yes, the SOCIOLOGY domain 2 also. You may think you are only going to visit a 79 year old man/women; not realising that their grandchild also arrives with a forensic history. This could be a very positive rewarding encounter, or otherwise.