Time - for care to commute [an appendum]

Addendum: Because we are (still) living in a post-Project 2000 World ...

"The whole thrust of nursing in the last decade [1981-91] has been directed towards seeing the patient as an integrated, individual human being rather than as a piece of malfunctioning anatomy. The patient is a person not 'the mastectomy in bed 3' or 'the man with the leg'. This means that any model of nursing must take into account the patient's psychological and social functioning as well as anatomy and physiology." p.53.

Ack. Walsh, M. (1991). Models in clinical nursing: The way forward. London: Bailliere Tindall.

[Book now bound for students.]

 INDIVIDUAL
|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

psychology	anatomy, physiology
social	employment, studying ... life chances / end of life choices

We need to consider concepts of care for a person, patient, and carer, not only in terms of their respective, or primary care domain [ e.g. leg, mastectomy; anatomy, physiology; sciences ] and associations with the academic disciplines; but in Hodges' model, focus upon the horizontal, vertical and diametric relation across and between care domains.

As described by Walsh, talk of  'the mastectomy in bed 3' or 'the man with the leg', is a dated trope; yet sadly it can signify the nature of staff (team) attitudes, the quality of care and experience of patients and their families. 

 

Technically, I see Hodges' model as a relational ontology. What this means basically, is that the model facilitates, encourages the user of the model to consider what they identify in a situation as objects (entities), events, concepts, relationships, data, and so on. An important assumption here is that what 'stands out' is what has salience (what the patient says - non-verbally too, what they mean, what they don't say?); that is, meaning and significance. 

 

Returning to Walsh's example: What does this event, diagnosis, prognosis (including anatomy and physiology) mean for this person as an individual? (If it means 'nothing' this may still - in a mental health context - be important.) What will it mean for the person's friends and family? What do the person it will mean to friends and family - significant other? What about their ability to work, and study? Can they resume their life plans and what of the person's life chances and those also affected? 

 

Crucially, there may not be a connection, a relation, across the care domains of Hodges' model. Asking the question is key, however; to go beyond what can be(come) task-based care. The ability of the model to assure and improve health care rests on this. The same applies for self-care too, with the model's support of reflection and critical thinking, essential to health and other forms of literacy.

Parity of esteem means we have to travel across the model. If we are 'collapse' the model's domains - four sets, into one that actually means something for the nurse, patient, manager, policy maker and researcher. This something, at least conceptually; is no less than person-centred, holistic and integrated care.

Q. Can care commute?