Book: The Fourfold Remedy

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

The Fourfold Remedy

 

My source:

O'Grady, J. (2021) Think yourself better, Reviews. The Daily Telegraph, 9 January. pp.12-13.

Sellars, J. The Fourfold Remedy, London: Allen Lane / Penguin.

'Space' - 'travel' and aftercare

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

'Of Course I Still Love You' "Aftercare"	5 4 3 2 1 0 . MAX Q .. 1st STAGE (MECO) ... 2nd STAGE   (SECO) .... 1st STAGE ENTRY BURN .....
Governments must know there are many spaces to understand and assure  that human rights are upheld for all.	Congratulations USA!

Patient-centred + Treatment = Self Care Week

This week 18-24th November is Self Care Week

Hodges' model might tend to have us equate 'self care' with the humanistic half of the model. As Self Care Week begins I could not help but suggest on twitter that what self care means to me is 4-fold care (or 5-fold taking in the spiritual also).

Then, continuing to read Kinchin more on threshold concepts, care and caring:

"In the case of 'caring' within the clinical sciences (e.g. Clouder, 2005), the concept may link the salient points of the personal perspective (patient-centred discourse) with the biomedical (treatment) discourse (Figure 32).

Here 'care' is seen to occupy the space that links caring as a therapeutic intervention (to the left) and caring as the nurse-patient interpersonal relationship (to the right), as described by Morse et al. (1990). This positioning enables the carer and the patient to be active partners in linking the chains of clinical practice with the networks of understanding that relate to the patient's wider needs. The key factor within this model is the 'care' that includes consultation with the patient and carer that allows them to relate the two halves of the model - something that is required for learner agency (Kinchin & Wilkinson, 2016)." p.90.

The halves referred to in Figure 32 are those within Hodges' model, merely switched left-right. I will add a photograph soon.

Self care must encompass ALL of Hodges' model.

INDIVIDUAL

|

INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP

The patient (questions) Capacity, Motivation, Ability - Knowledge and Skills to Self Care	Medical science Clinical medicine
Carers	Consultation Choices, Engagement

Clouder, L. (2005) Caring as a ‘threshold concept’: transforming students in higher education into health(care) professionals, Teaching in Higher Education, 10:4,505-517,DOI: 10.1080/13562510500239141

Kinchin, I. M., & Wilkinson, I. (2016) A single-case study of carer agency. Journal of Nursing Education and Practice, 6, 34–45.

Morse, J.M., Solberg, S.M., Neander, W.L., Bottorff, J.L., Johnson, J.L. (1990) Concepts of caring and caring as a concept. Advances in Nursing Science. Sep;13(1):1-14.

Kinchin, I.M. (2016) Visualising Powerful Knowledge to Develop the Expert Student: A Knowledge Structures Perspective on Teaching and Learning at University, Rotterdam: Sense Publishing. p.90.

When a Double-Page Spread is not Enough ...

individual

|

INTERPERSONAL : SCIENCES

humanistic ---------------- the HEALTH RECORD --------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

VA ".. how important is the notion of the book or the page to your research and outcomes?" AGV "They are fundamental to my research.

I explore the double-page spread as a material support and a discursive space for visual ideas within an exhibition context. ...

The double-page spread is for me an extended space, a place to develop a site-specific practice.

... My intention is to generate meaning through symbolic signification, enhancing its material qualities through mirroring, folds, reflections and echoes."

Source: In Conversation, PRINTMAKING TODAY, Spring 2018, Cello Press Ltd. Volume 27, No. 1 Issue 105, p.4. Victoria Ahrens talks to Altea Grau Vidal about her PhD research and the format of the double-page spread as an opening for all her work.

HSJ: The NHS and fundamental change ...

 ... governments typically try to will the end but not the means: they try to shift the habits of the NHS while protecting buildings and people; or in Lord Darzi's pithy phrase, they change "the anatomy of the NHS rather than its physiology". p.16.

Finding the pith in Hodges' model (and the problem of refactoring - where would you like to start?):

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

PURPOSE cognitive geography (the 'physiology' of mindsets)	Anatomy & Physiology PROCESS  structure, buildings,geography time, events, space
(habituated - ) PRACTICE (collective purposes) team integration	the NHS (organisation) POLICY workforce, funding  local, regional, national, global

group - population

Seddon, N. (2013) Opinion: Learning from international innovators, HSJ, 12 April. 123: 6346; 16-17.

Personalised care and gravitas (literally)

The Einstein Cross Gravitational Lens
Original Image Credit & Copyright: 
  J. Rhoads (Arizona State U.) et al.

Today's Astronomy Picture of the Day is described as follows:

Most galaxies have a single nucleus -- does this galaxy have four? The strange answer leads astronomers to conclude that the nucleus of the surrounding galaxy is not even visible in this image. The central cloverleaf is rather light emitted from a background quasar. The gravitational field of the visible foreground galaxy breaks light from this distant quasar into four distinct images. The quasar must be properly aligned behind the center of a massive galaxy for a mirage like this to be evident. The general effect is known as gravitational lensing, and this specific case is known as the Einstein Cross. ...

Health care problems can weigh very heavy on the individual affected by them and their loved ones. To deliver personalised care we first need to resolve the four care domains (five including the spiritual). If personalised care is to be realised (aligned and integrated) in practice and not just two words in policy (political lensing), then we need to remember personalised care can be an illusion in itself.

Additional post:
Person centred care, wormholes, pesterers, care domains (iii)

Reflections on: Designing for Self-Care - the home-clinic difference

As much as I might like to I will not be able to attend Copenhagen and the workshop details of which I posted yesterday. Reading the call for papers prompted the following reflections - many of which may not be relevant to the actual workshop content, but hopefully help illustrate Hodges' model:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

literacy - health literacy, cognitive access, insight, memory, education, communication, attitudes, motivation*, beliefs, BEFORE-AFTER holistic measures, mental health, mood, context, therapeutic modalities, self-recording, person-al purposes - process reconciliation, coding / classification, self data capture, expectations, general health perception, sleep, leisure, independence level (self-efficacy), individual 'clinic' need / attendance, rating of existing clinical relationships, DOO - (presence of) differences of opinion*

physical interface modalities: touch, gesture, eye movement, video interviews; clinical diagnoses (primary), observations, assessment-measures, data capture, medications, lab tests, pain, 'distances' (several not just home-clinic); treatment/drugs - training, mobility (room count, vistas), info prescription, other media - learning materials, self-care tasks (granularity, number, complexity, ...), clinic-al purposes - process reconciliation, evidenced interventions, coding / classification, home adaptations?, experience of telecare? mobile apps? home IT / comms, chronological:pathological age definitions: long term- / chronic

life story, narrative medicine, quality of life, care history - duration / exposure to care systems, domestic relationships, primary care / nursing (multidisciplinary care) relationships, perceived integration of care, social network, access to day care / respite care, definitions - shared vocabulary, self-care folksonomy? (virtual) community creation (outcomes)? affordances, meaning of 'clinic' attendance, 'CKO-X' Carer's Knowledge of

autonomy, power in the home: My space?, service interfaces, available specialist services, responsiveness, support, best interests, privacy, budgets (self), protocol - referrals, political emphasis: physical-mental health? predefined benefits, economic impacts, savings, policy reach, implications for commissioning

As the workshop concerns home - clinic difference and designing for self-care this prompted me to a more detailed consideration of the 'distances' involved. Not just in the physical geographical sense of home-clinic travel (car, walking, public transport, disabled transport) but when last the citizen (patient) visited various locations.

There are many other dimensions of course ... the final context reduces the above to something manageable.

Report - Guiding patients through complexity: Modern medical generalism RCGP & The Health Foundation

Evaluation report

PUBLISHED: October 2011

Report of an independent commission for the Royal College of General Practitioners and the Health Foundation


An independent commission, chaired by Baroness Finlay, has concluded that more of the most talented doctors must be encouraged to make careers as generalists rather than specialists to meet people’s changing health needs.

The Commission was set up by the Royal College of General Practitioners and the Health Foundation to examine the state of general medicine. It had the following terms of reference:

• Define medical generalism, with particular reference to general practice;
• Explore the intrinsic values of medical generalism;
• Define the role and value of medical generalism in contemporary clinical practice.
• Formulate a description of the medical generalist that:
• Is widely recognised
• Defines what patients and the public should be able to expect
• Clarifies how the medical generalist interfaces with other health care professionals
• Make recommendations about the future development of medical generalism.

Understanding and developing the role of the generalist alongside specialists is important for the quality of patient care, particularly ensuring the health service provides patient centred care and supports people with co-morbidities well.

Public vs. Private health care: sustainable integrated health and social care

OK the title here is a cheat as the focus is social care not health. That said given the overlap -  dependencies - and appeals for health and social care 'integration' this basically makes the terms synonymous - at least in this context.

The debate about the merits between public and private care provision in the residential and nursing home sector is a constant dialogue. At the moment it is once again a cacophony. It will die down. It will be back. I've never worked for the private sector and of course as with the events of the past week in Bristol both public and private sector have their horror stories to tell.

The debate is supposed to be about quality, but the noise of the dialogue and terrible events disrupts and distracts us from the real issues of training, motivation, personal ethics, values, human resources, pay, care environments and yes - quality of care.

We live in evidence based times and yet the weight of evidence seems to lie in the interpersonal and science care domains, not necessarily in that order.

There is evidence in the social care domain and the political care domain:

the news catches it. 

There is a test though - call it ultimate viability. This is what must support those real issues.

This test is the same one that allows us to say how disgusted we remain with the financial institutions that adorn our lives. Whether in the form of a necklace ("on credit"), or a ball and chain ("already in debt") there is a tab to pick up.

If the private sector is failing in some quarter, or in jeopardy where is the pressure felt? The government, local authorities ... will be on stand by. As with the banks, health and social care are also grounded in the social and political care domains (you could call that the public bottom line).

Reliance on private equity might prove the basis of corporate undoing in the residential and nursing care sector. There must be evidence of economic - financial care management standards that can provide assurance? When we talk about sustainable health care, we must assure that the social care service is itself sustainable. Surely care of older adults, care of the vulnerable is mission critical? Then those other vital care issues can be addressed (and urgently!):

funding, status	investment, training, recruitment and retention, human resources, pay, finance, economics,  human rights

People talk about there being a bigger picture.

There is always a bigger picture.

Hodges' model and three slides in Spanish: Paipa, Colombia Feb 24-25 2011

From the presentation of the Health Care Domains Model in Paipa last month here are three of the slides in Spanish - with many thanks to Luz Stella Saray and Prof. Wilson Canon Montanez for the translation. (Any mistakes below are mine in data transfer / formatting).

These slides were produced to illustrate how the model's care domains relate to some indicative health concepts, supporting the overall presentation.

The presentation was uploaded to Slideshare but I have deleted it as the formatting was slightly disrupted. I will revise and upload it again soon posting it here and no doubt in another post.

INTERPERSONAL creencias     estado de ánimo empatía     motivación       personalidad              estrés dolor                          buenas relaciones	CIENCIAS informática  nutrición temperatura      diagnóstico    neuropsiquiatría                          tecnología
SOCIOLOGÍA comunidad        relaciones crianza de los hijos semántica       cultura, arte, danza            costumbres     Familia,     lenguajes historia socia	POLITICA derechos humanos     autonomía presentación de informes Financiación $£€ Instituciones OMS    UNESCO  NACIONES UNIDAS:  OBJETIVOS DEL MILENIUM

PURPOSE PROPÓSITOS priority, care plan, choice [prioridad, plan de cuidados, selección]	PROCESS PROCESOS events, time, cause – effect [eventos, tiempo, causa - efecto
PRACTICE PRÁCTICA Counselling, team work, carers [asesoramiento, trabajo en equipo, cuidadores]	POLICY POLÍTICA professionalism, deprivation of liberty [profesionalismo, privación de la libertad]

PROPÓSITOS estado de ánimo Los pensamientos, las creencias proceso cognitivo salud mental, estrés, ansiedad comunicación educación, aprendizaje	PROCESOS Modelos y Teorías Inyecciones intravenosas e intramusculares, salud física anatomía, fisiología mediciones, distancia tiempo, peso Estadísticas, lógica Farmacología, medicinas objetivo
subjetivo Culturas Compromiso público Comunidades de PRÁCTICA funciones Idiomas redes sociales amistades privacidad	POLÍTICA quejas Cert Internacional de vacunación Administración y gestión Liderazgo, poder, registros Legislacion en salud mental, pobreza Organizaciones Normas - CIE 10 interoperabilidad consenso

2011... looking ahead: Line of sight - Lines of insight

LINE OF SIGHT:

LINES OF INSIGHT:

Fractal Drum

Image sources:

Wilkinson, F.J., Monkhouse, H. R. (1967). Maps and Diagrams; Their Compilation and Construction [Paperback], Methuen & Co Ltd. Intervisibility, Line of sight. p. 125 [scanned].
(Book purchased in Mevagissey, Cornwall, Hurley Books July 2010)

Fractal drum. Lines of INsight: http://classes.yale.edu/fractals/panorama/ManuFractals/FractalDrums/FractalDrums.html

Health and social care - listen!

Drupal musings 15: modules and Drupalcon videos

Since picking up the health career model and publishing the model online in 1986 the term holistic bandwidth has emerged. The blog in 2006 and to date has seen other loosely defined terms:

care architecture
4-fold care
cogneography
holistic competency

Using Drupal 6 I've got to a position were I am getting to know core plus some contributed modules. One of the latter is webforms. It's bound to be help seeing what webforms can do in terms of one-way data submission, compared to using CCK - the content construction kit. In webforms the grid component holds great promise, but in creating a grid for music genres I notice there is no validation (which would be quite a trick!). Users should only be able to select one type of music they want to hear most of the time. The validation question is going to help force the issue of getting under the hood. All that reading revealed in previous posts is also needed to sort the theme too.

I remember first coming across the word instantiate. As I write, think about a h2cm glossary and experiment for real with Drupal 6 - I wonder whether the content types I create (in Drupal 7 especially) may help define some of the above and other terms?

Drupal(con) musings 14: design, UI, UX, thinking and care

In his funny and very engaging session 'Designing UI with Seven' at Drupalcon CPH Mark Boulton discussed four user experience (UX) principles and introduced us to ten user interface (UI) guidelines.

Mark highlighted the need for a mental model and the challenge within publishing of there being someone who has the big picture. Who knows exactly what is going on? The health career model provides a model and can provide a canvas to support the big picture.

What really caught my attention though was as soon as Mark asserted -
"Don't make people think." -

I immediately thought -
'Make people care instead'.

Well, I'm not sure if an interface can do what public (mental) health policy, government public funded education programmes and the concerted efforts of the health professions has largely failed to achieve. The users of e-health information systems do need the design of the system to be transparent to them. IT mustn't get in the way. Mark's point of course is the the user's should be free to focus on the problem the system is to help solve. In health this includes:

• recording of a health (and social) care record;
• secure information / file management and access;
• information governance, reporting and archiving;
• timely, ready access for those who need to know;
• ability to manipulate the record to obtain knowledge: from data > from information;
• to provide patient (carer as advocate) access and verification;
• remote access with rugged devices.
• ...

This does not mean that people are oblivious to design: far from it (iThis - iThat!). My point is that as we follow Mark and other design expert's advice then users should be able to focus on care design and the care outputs arising.

So in health we need interfaces and user experiences that DO encourage reflection, thought: thinking.

P.S. In another session (or magazine!?) on creating mobile versions of sites the advice included getting rid of the crap - the clutter, the >1000px width adornments. Rhetoric aside - my design thought would be not to include anything that could be described in this way whatever the media type (maybe I should lighten up!) ;-)

To follow: update on my Drupal efforts.

Cost savings: 4-fold literacy = care literacy

The RCN's campaign I posted yesterday highlights the belief in and potential of nurses to 'think out of the box'.

There are many people, in many walks of life who are currently racking their brains and flipcharts to come up with ideas for cutting costs. In addition to the RCN, the government has its on-line campaign with the 'Spending Challenge'.

As for nurses there is an extra rabbit to pull from the hat: improving patient care.

Media discussion about the cloned beef - food supply story this week brought a point regarding the relative scientific literacy of the general population of USA and UK. This prompted me to consider discipline based literacy, what usually passes for 'basic grounding in ...' or competency. ('Literacy' has already been corrupted, now for another kick.)

For nurses with their subject disciplines, which can be represented in the health career model - what current public sector health (and social) care requires (demands!) is care literacy.

It is the ability of nurses (and other professionals) to be aware of what happens in the two adjoining boxes, or that one remote enclosure that can simultaneously engender and deliver:

• new insights - creativity and innovation;
• holistic integrated care;
• care literacy;
• and - cost savings that can still improve patient care.

See also:
http://hodges-model.blogspot.com/search/label/literacy

Holistic bandwidth (and the dangers) of political care

The attack on MP Stephen Timms here in the UK highlights not only the ongoing importance of personal safety for public service personnel, but how much politicians value their constituency work. It is no accident that these sessions are called "surgeries".

The politician meets not just a citizen, but a political obligation and duty to care. In the media reports it was interesting to hear of how much satisfaction MPs get from their constituency work. Listening to the reporting and debate prompted me to realise that although politicians vary in how well they engage and empathise with their constituents the problems they are asked to deal with covers a broad holistic spectrum. Consider this listing written by Tony Wright MP:

• The education system
• The transport system
• The social services
• Health services
• Housing
• The environment
• Government bodies
• The justice system
• Immigration and asylum
• Finances and employment
• Trade unions
• The media

I am a community nurse five days a week.

Our MPs are community politicians one day a week with 'Constituency Friday'.

So to The Rt Hon. Stephen Timms (and his staff) I wish you a speedy recovery and congratulations on the extent of you and your peer's constituency work.

Holistic in a word and deed.

Congratulations also to the Green Party on the success of their leader Caroline Lucas MP.

Putting 'care' in a holistic frame

How many frames do you need?

*infocare: care demographics, directories, media, literacies...

care communication, self care, care ethics, care philosophy, emotional care, pastoral (green) care, therapeutic care, care beliefs, interpersonal care, MENTAL HEALTH CARE cognitive care, holistic care, care responsibility, care ecology	emergency care, physical care, care model, theory, plan, care assessment, evaluation, care curricula, intervention, care process, evidenced care, BASIC NURSING CARE intensive care, coronary care, special care baby unit, *infocare, nursing care, medical care, health care, e-care, surgical care
collaborative care, child care, personal care, older adult care, informal care, SOCIAL CARE, family care, care education, community care, care community, residential care, care dependency, abusive care, care risks	duty of care, care policy, care provision, inspection, standards, care economics, care outcomes, care legislation, care home, care contract, care advocacy, care quality, CARE AID, care qualification, regulation, State care, private care, care insurance, CARE RIGHTS, care service engagement, prison care

Don't forget the 5th, virtual, spiritual frame?

Where is that?
It is wherever you need it to be. ...

Additional suggestions welcome: h2cmng at yahoo.co.uk

'situated' in Hodges' model #1

I'm not exactly sure how many times I've cut and pasted the paragraphs that introduce Hodges' model as person-centered and situated. Quite a few!

Thanks to the HIFA-2015 list I realised last week that there is no tag for 'situated' on W2tQ. Well, this post corrects that omission, but what does situated mean in Hodges' model?

Here is a definition c/o Google:

• situated/s'ɪtʃueɪtɪd/
  Synonyms:

  • adjective: located
  • If something is situated in a particular place or position, it is in that place or position. ADJ adv ADJ v-link ADJ prep
    ...

Related phrases

• situate
  If you situate something such as an idea or fact in a particular context, you relate it to that context, especially in order to understand it better.
  ...

Hodges' model is based on the belief that health and social care are multicontextual. Without wishing to substitute one term for another context and situation are inter-related and bear closer examination here on W2tQ.

Hodges' model prompts the user to consider that the person (-at-the-center) of care is simultaneously residing within four primary situations or contexts (five - if we include the spiritual aspects). Veterans and new recruits appreciate from the dizzy heights of the model, how quickly we find complexity in the multiple contexts that exist in health and social care. The many perspectives and views that must be taken into account to achieve safe, integrated and holistic care. Together with the above there are other definitions of relevance to scholars, champions and users of Hodges' model:

located: situated in a particular spot or position; "valuable centrally located urban land"; "strategically placed artillery"; "a house set on a ...
wordnetweb.princeton.edu/perl/webwn

In artificial intelligence and cognitive science, the term situated refers to an agent which is embedded in an environment. ...
en.wikipedia.org/wiki/Situated

Located in a specific place; Supplied with money or means
en.wiktionary.org/wiki/situated

The first definition about location is important as Hodges' model puts the person at the center. It is from there that the care domains are considered in turn and revisited as required. Hodges' model provides a locus around which care activities can be placed. Usually we view self-centeredness in a pejorative way. When you think about it though this is precisely what is needed to achieve person-centered care. In this case we need something that constantly re-centers - reorientates the subject(s) and agent(s) of care.

The second definition which looks to A.I. for inspiration is relevant as the concept of embodiment, embeddedness already has academic form* as a means to explore self-centeredness. Not only is the individual embedded in a (the) situation, but the carer (formal - informal) must also reside there and share to an extent the experience, if empathy, rapport and communication are to arise.

That final definition can be utilised due to the inclusion of means. People have skills, strengths and coping strategies and this sense of situated rings very true at present, with the emphasis on recovery, staying well, relapse prevention and adjusting to what may be permanent change. People also need knowledge as a means to maximise their health and well-being, which takes me back where I started with Health Information for All by 2015.

So, amid all the complexity, over-arching infrastructures, policies,
debate (and definitions!) it is refreshing that as I revel in the
scope of Hodges' model - two axes, four domains,
its holistic bandwidth... I can find the
word 'situated' planted
firmly
at the model's
center.

* Ref:
Paley, J. (2004) Clinical cognition and embodiment, International Journal of Nursing Studies, Volume 41, Issue 1, Pages 1-13.

Image source - with thanks: Ariel Bravy - http://www.arielbravy.com/photoblog/
http://www.arielbravy.com/photoblog/images/20060719214447_glenn%20x%20millenium%20park.jpg

Care is a 4 perspective business ...

Health care as practised in whichever sector prides itself on being business-like and professional. As we are often reminded health care costs. Health care is a business and like finance a very serious one.

On the computer graphics card notice the four display ports? This card - the NVIDIA® Quadro® NVS 450 is apparently capable of driving up to four 30" displays and is designed to meet the needs of today’s most demanding business user.

I wonder if there is another application that could also utilise
four perspectives? What about the business of care?

h2cm - Being at the center of things [I]

The center of Hodges' model can represent many things:

an epistemological nexus for the transdisciplinary dependencies of our times
multidisciplinary coffee shop
self-care engagement stage
the chaos of all things
holistic harmony
integrated idyll*

More down to Earth and acknowledging this cruciform '+' structure as a mythic device, in addition to searching for the mysteries of the universe at the center we can also place the 'well' person there.

As the previous post on ADLs suggests the 'well' person can function on a basic level and has negotiated the four axes and the four and five fold knowledge domains. They can therefore be considered (sufficiently) wholly integrated. We are all travellers, constantly traversing these domains of experience consciously, unconsciously, expertly or with the awkwardness that denotes the novice.

Conversely and reflecting the model's utility: it is also possible to locate the unwell individual in the center too. In this instance the placement suggests impoverishment of experience, ongoing personal and social stasis and in the case of substance misuse the presence of specific disruptive focus and preoccupations. The person becomes lost to their potential, stuck in a 4:5-fold minima. They continue to travel chronologically, but the journey is spiral, self-iterative and diminishing by return.

However: what you can see you can change, or come to terms with.

*from Greek eidyllion, little picture (h2cm as a snapshot).

Original image source: http://www1.lsbu.ac.uk/water/protein2.html

Point of care? The King's Fund - patient experience

The real 'point of care' is that there are several points with many perspectives:


Patient (person) - Care professional - Manager - Carer
Public (citizen) - Student - Lecturer - Service User Groups
Physical - Emotional - Political - Social
Patient - Inspectors - CEO information governance - Commissioners

Don't drown seeking gaps in processes. All of the P's count!

The King's FundThe Point of Care: Improving Patients' Experience.


Image source:
Multiple Faces: Insight Management Group