Degree Award in Reflective :: Reflexive Theory and Practice

Joint Hons. Running the Gauntlets in OverThinking

individual

|
INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

|

group 

See previous: 6th June 2010 - 'As one chapter closes another opens ...'

 
My source: Somerset House - 1st July 2026 M.C. Escher The Exhibition

Planetary Health (ii) (and the need for a global conceptual framework)

I have 5,000 words drafted on Hodges' model and threshold concepts, for which I've yet to find a home. Staying with the previous post's theme of planetary health the paper includes the following: 

A decade ago Groffman, et al., (2006) stated that ecological thresholds can be 'troublesome' in being important but in having no practical application. Threshold concepts are not, however alone; there are also threshold questions (Halldén and Lundholm, 2009). The answers to these questions are critical to global sustainability and planetary boundaries (thresholds) - an ongoing research effort (Rockström et al., 2009).

Groffman, P., Baron, J., Blett, T., et al. (2006). Ecological Thresholds: The Key to Successful Environmental Management or an Important Concept with No Practical Application? Ecosystems, 9(1), 1-13.

Halldén, O. & Lundholm C. (2009). 25-30 August. Conceptual Change and the Complexity of Learning. Threshold Questions, Meaning making and Contextuality. Paper presented at the 13th conference European Association for Research on Learning and Instruction, Amsterdam, Holland.

Rockström, J., W. Steffen, K. Noone, Å. et al. (2009). Planetary boundaries: exploring the safe operating space for humanity. Ecology and Society. 14(2): 32. [online] URL: http://www.ecologyandsociety.org/vol14/iss2/art32/

See also:

Jones, P. (2008). Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

Planetary Health (i) (and the need for a global conceptual framework)

(with thanks to Global Health Now)

In a pointed challenge, Lancet editor-in-chief Richard Horton warned Consortium of Universities for Global Health conference attendees Saturday that an exclusive focus on improving health will fail.

Horton argued instead for planetary health.

“We have to cross outside of health and think about the relationship between health and other dimensions being defined as sustainability,”

Horton said, in a keynote address at the annual CUGH conference, which opened Saturday in San Francisco and attracted more than 1,800 attendees from around the world.

Citing the work of a Lancet Commission that published a 2014 manifesto, Horton argued that the global health community and others need to embrace planetary health. “Our vision is for a planet that nourishes and sustains the diversity of life with which we coexist and on which we depend,” Horton and others wrote in the manifesto.

Brian W. Simpson, Global Health NOW

Full text:

http://www.globalhealthnow.org/news/horton-to-cugh-planetary-health-is-the-solution
[ See below: PJ ]

Best wishes, Neil

Let's build a future where people are no longer dying for lack of healthcare knowledge - Join HIFA: www.hifa2015.org


https://www.globalhealthnow.org/2016-04/horton-cugh-planetary-health-solution

Previously on W2tQ:

One mind, many minds - ONE PLANET. One need, many needs - ONE PLANET: what price stability?

Exoplanets, exobiology, exocortex, exocare ...?

Notes (ii) from Paipa Conference: Q & A

Blog Action Day: h2cm around the water whole

TED: Nic Marks - The Happy Planet Index

Video: Concepts for Nursing Practice, Giddens

With an email seemingly lost I have registered and applied for a review copy of Gidden's Concepts for Nursing Practice. The 2e is published next month. I do hope for a positive response.

Gidden's approach, also proposed by others clearly has a great synergy with Hodges' model in concept-based learning and the learner's career. The most interesting aspect of this is to try to respond to the short-comings of a purely conceptual basis for curricula. I'm sure this is possible combining a pragmatic view of knowledge, an evaluation research design, threshold concepts and conceptual spaces with Hodges' model.

Giddens, J. (2013). Concepts for nursing practice. St. Louis, Mo.: Mosby/Elsevier.

Rich Pictures - rich pickings?

Seeking conceptual anchors I've often thought of Hodges' model as a rich picture. Reading to complete my latest module and add to the threshold concepts draft I came across:

Berg, T., Pooley, R. (2013) Contemporary Iconography for Rich Picture Construction. Systems Research and Behavioral Science 30, 31–42. doi:10.1002/sres.2121

There are several points with implications for h2cm and future work. From the abstract:

The RP is a diagrammatic means of identifying differing world views with the aim of creating shared understanding of the organization. The RP has predominately been used as a freeform, unstructured tool with no commonly agreed syntax.

Our research suggests that the RP requires structure to become a contemporary knowledge elicitation device. p.31.

The application of rich picture is quite specific within soft systems methodology [SSM], but there is much to learn here. Let's use the abstract as a template:

Hodges' model could be a diagrammatic means of identifying differing personal care needs, with the aim of creating shared understanding of person-centred care aims and co-created health literacy which whenever possible includes the patient and carer.

Hodges' model provides a structure but one that is nonetheless freeform. You could say the coastline is mapped, but only to a degree. I have already likened Hodges' model to a cognitive periplus. A coastline is clearly definable: initially (it is also fractal). For a ship as in years of yore where can it go? Can it turn inland, to new discoveries (and disciplines)? Is this an estuary with a navigable river? Can the ship find a way out to a new sea through this strait? Even if the ship hugs the coast navigating potentially treacherous waters when newly found? Does this flexibility in Hodges' model arise because it is in effect templatized (axialised)? I have often wondered about my concluding that the user of Hodges' model wants to have their cake and eat it too. By this I mean h2cm is simplistic and so it is dismissed by many, but it can serve complex purposes once populated. By deriving the care domains from the structure, h2cm provides conceptual spaces within which users can orchestrate the concepts pertaining to a particular situation, or context.

Back to paper: there is no syntax as yet since there are no designated icons for Hodges' model. There are many sources and libraries including possibly a subset of RPs, the Noun Project too.

Berg and Pooley write that: RP requires structure to become a contemporary knowledge elicitation device. There is a problem here in what we mean by contemporary, given how long RPs have been around. Of course the same applies to h2cm, hence my efforts. Can we, dare we be more ambitious?

From the paper itself:

This holistic methodology [SSM] uses the rich picture (RP)... p.31

Hodges' model is a holistic methodology that combines threshold concepts, conceptual spaces...!?

More specifically Berg and Pooley write:

Avison and Fitzgerald propose that there is an unwillingness to engage in the rather lengthy requirement gathering process of the RPs and further suggest that management want to avoid political issues that could arise. In certain hierarchal organizations, it is suggested that the RP does not appear ‘business like’, and there is a lack of credibility with the approach (Daellenbach, 1994). p.32.

Judging from the graphics in the paper much of the 'political' may be interpersonal-relationships, but this will inevitably also refer to interdepartmental and interdisciplinary wrangling. Hodges' model gets^# politics. H2CM includes into its structure a POLITICAL domain. If we expand Berg and Pooley's observation could this account in part for the failure of so many IT projects and the need for socio-technical approaches? Computers feature quite highly as one of the most repeated icons in RPs (graph on p.35). There is also a striking similarity between Hodges' model and RP in the simplicity I referred to previously. Within the 'organization' and the hierarchy (even if levelled to pubescent bumps) there remains a need for efficiency (accounting for time), formality and being 'business-like'.

I suspect that for some people, depictions of RPs and Hodges' model are fine on the training room flipchart paper. Once the turn-is-given and the evidence is there to see on the A1 page then to expect more: time for drawing, reflecting, concept mapping, meeting of hearts and minds, problem solving... is a stretch of credibility for some. It may be that as Berg and Pooley do not refer to vocabulary, so often this is the stumbling block as there is no shared vocabulary. It may be close, but differences remain and technology waits for no organization.

Hodges' model attests that meaning comes from several sources and we need to listen in quadrophonic at least, and all before any pencil is licked.

<>

# Gets is used here in two senses: The model (I mean of course the user) gets politics  in terms of access to the political ramifications of whatever... This bare structure may not be doing anything but it has potential. Concepts, such as, consent, capacity, deprivation of liberty, 7-day follow-up, safeguarding, information sharing... can then be encountered in practice, learned and eventually integrated.
Students (and others) can get political as an activist; be that as a critical thinker, advocating for healthcare, or within union and professional bodies.

See also (a dated paper and still an excellent read):
Shaw, Mildred L.G., & Gaines, Brian R. (1989) Comparing conceptual structures: Consensus, conflict, correspondence and contrast. Knowledge Acquisition, 1(4), 341-363.

The SSM - RPs community should look f/w with relish to the advent of VR. This can surely overcome many of the difficulties highlighted in Berg and Pooley (2013) and address the point above about contemporaneity. Icons will be ready-to-hand (gesture, look, thought!...): the challenge then becomes shared VR, but then this is central to its purpose.

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...!

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

Joint Strike Care F-4(5)

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

individual(?)

Social Reflections on Power	Joint Strike Fighter F-35 Lightning II

group - population

Joint Strike Fighter F-35 Lightning II

Image source: https://www.f35.com/assets/uploads/downloads/13661/9777287314_9a87af14da_o__medium.jpg

End of Life Care: Gold Standards Framework (Heaven's door)

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

individual

PRIMARY CARE	ACUTE CARE
CARE HOMES	DEMENTIA (CARE)

group - population

Looking at a table 'GOLD STANDARDS SET BY BENCHMARK PROGRAMME' (p.23) in Prof. Thomas's HSJ article, I could see an instant fit between the four listed care contexts and the domains of Hodges' model.

There are also many overlaps and of course Hodges' model is an idealised resource. For example,  governance applies across all the above and in that way all can be placed in the POLITICAL domain.

Further points explaining the above includes:

• The GP and primary care seeing the person first not the diagnosis. Again in this sense - respect and dignity we can place all these care specialisms in the INTERPERSONAL. You would hope that primary care 'know' the patient as a person, an individual; or at least through recourse to the primary care record.
• If a care home 'works' it will be able to deliver care almost transparently, it is not a process but a social gathering. It is not the person's home (their home is not something to be forgotten, replaced like their past), but it seeks to emulate this as far as possible. Care is a routine that is also personalised and even at the end of life there is peace, calm and dignity.
• Dementia care is a political challenge, a priority and challenge across all the domains. As in the previous post - what training is provided to Health Care Assistants and other staff? How is the strategy for dementia progressing across all these care environments?

The National Gold Standards Framework Centre in End of Life Care

Thomas, K. (2014) 'End of life care is a litmus test for the whole of the NHS'.  HSJ, 31 January, 124, 6384, 21-23.

moon, resources and Materialism

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

individual

group - population

Republic of the Moon
http://southbanklondon.com/republic-of-the-moon
(I missed this when it was in Liverpool!)

Additional links:

NASA Releases New Earthrise Simulation Video

UNOOSA: 34/68. Agreement Governing the Activities of States on the Moon and Other Celestial Bodies
http://www.oosa.unvienna.org/oosa/SpaceLaw/gares/html/gares_34_0068.html

Images:
Leonid Tishkov, Personal Moon - Republic of the Moon
http://www.artscatalyst.org/projects/detail/republic_of_the_moon_Liverpool/

Omega Speedmaster Moonwatch -
https://www.omegawatches.com/en-gb/?search=speedmaster+apollo

Resistence is futile: give in to the obvious need for the 'nhm'

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

individual

nhm	ohm + nhm
nhm	nhm (+ ohm!)

group - population

ohm: The ohm (symbol: Ω) is the SI derived unit of electrical resistance, named after German physicist Georg Simon Ohm. (Wikipedia)


nhm: The nhm (symbol: +).

However, the principles do not extend to problems posed by cognitive impairment as a result of the illness and the ever present danger of wandering, seeking old and familiar surroundings, or acting on memories from years gone by. Some patients become aggressive at times; the service must have mechanisms for managing patients effectively in ways that recognise their inherent worth and humanity. The stigma and abbreviated autonomy that is implied in managing people with dementia requires a new holistic method of managing their care that relates the care to the patients'/service users' values. p.80. [my emphasis]

Heginbotham, C. (2012) Values-Based Commissioning of Health and Social Care, Cambridge, CUP. (Review to follow).

Cognitive Informatics and other forms?

Over the past couple of months I've posted on topics that include an example of Hodges' model related to the post's particular theme. In McGonigle and Mastrian's Nursing Informatics and the Foundation of Knowledge, Second Edition (2012) on page 63 the editors cite Wang (2003):

Cognitive informatics attempts to solve problems in two connected areas in a bidirectional and multidisciplinary approach. In one direction, CI uses informatics and computing techniques to investigate cognitive science problems, such as memory, learning and reasoning; in the other direction, CI uses cognitive theories to investigate problems in informatics, computing and software engineering (p.120). 

I will leave it to you to consider the INTRA-INTERPERSONAL and SCIENCES domains, and not (just) how Wang's cognitive informatics 'fits' within Hodges' model, but what of the many other informatics fields. Here they seem like stepping stones, but taken together where do they lead to, from, ... about ...?


Wang, Y. (2003), Cognitive Informatics: A New Transdisciplinary Research Field, Brain and Mind: A Transdisciplinary Journal of Neuroscience and Neurophilosophy, Vol.4, No.2. pp.115-127.  

H2CM new website - A short-form project brief

In Dani Nordin’s Drupal for Designers, chapter 4 is includes a short-form project brief.

As I pack for Prague and another Drupalcon (my 6th!) and with PHPNW conference fast approaching it's time I re-visited my project brief:

1 Identify the Project Goals

According to Nordin a good list of project goals should be no more than about three bullet points.

1. To provide a new archive for Brian Hodges’ lecture notes and make these accessible and multilingual
2. To share / signpost papers to date and invite others to collaborate and share work
3. To highlight why Hodges’ model matters

Then Dani moved to personas and here I'll extend the above goals.

2 Identify the Audience

I am looking for student nurses, that is under graduates and post grad, indeed life-long learners within the field of health and social care. In seeking students the natural progression of this is to connect if possible with lecturers and faculty. Nordin lists several ways to characterise the personas through common aspects:

• Who they are
• What will win them
• What I need them to know
• Content focus

So immediately I can broadly identify and develop two personas:

Learners

Who they are: Student nurses, social work students including medicine and other health and social care disciplines. They will be seeking evidence in theory and practice, with sources and resources to apply to assigned work. They will also be open to ideas and techniques that can help them to structure and recall their learning.
What will win them: Make it easy for them to see what is offered, find what they seek, Brian Hodges' lecture notes, provide feedback on learning if students are willing to register and invest their time. Provide a responsive contact form to answer questions promptly. Link the content to evidence if, or as soon as possible. Make content relevant by allowing users to contribute to website's development and direction.
What I need them to know: I want to convey to them an understanding of Hodges’ model its purposes, structure, content and how the model might be applied in theory and practice.
Content focus: Lecture notes text and video; Quiz; Test; Certificate; h2cm grid; Case study template; Presentations; FAQ; Registration; Contact form; Polls; Bibliography; Biographies; Timeline; Photos.

Lecturers

Who are they: Health and social care related faculty, teaching on nursing, social work, learning disability and other programmes. A diverse range of subjects and disciplines could be included from mental health, acute care, community and across the life course.
What will win them: Illustrate the ways h2cm can facilitate learning the aspects of (for example) nursing, not only reinforcing the key concepts of nursing (care) but why they care.
What I need them to know: Understanding how h2cm fits within their respective curriculum. Gaining awareness of how can the model can potentially stimulate and challenge their students and complement assignments. Why Hodges' model is relevant at this particular time.
Content focus: Brian Hodges' lecture notes; Outstanding questions; Research directions; Blog; Contact form; Registration; h2cm examples.

On the old website I possibly over-egged the pudding in terms of 'audiences'. There is an introductory page for -

• students and lecturer; 
• patients and carers;
• the public (citizens);
• and managers with policy makers.

Nordin has a persona for The Sharer. There are people for whom this is their forte. Here though I would try to include sharing tools that might be utilised by specific audiences. So for lecturers ways sharing might be Academia.edu, ResearchGate and LinkedIn. Likewise there are student (social media oriented) communities.The content of the old was fixed - by me. This needs to change, so polls and discussion may help define what the students / lecturers would like to see, hear ...

3 Focus on Information Architecture and Content Strategy

Nordin is describing a website re-design and so am I with some simplifications. Taking step 3 literally and from reading having an information architecture is very important to me. Its importance is not just in earning a scout badge, but it may need to vary slightly across the site. Nordin's step three seems to emphasize content. I'm wondering about headings, subtitles and other structural and aesthetic points. How might these work and hopefully cohere across the archive and rest of the site? It is also the case of separating (in my head) information architecture and styling.

As to content strategy I've played and doodled with this on several occasions. There's even an A, B, C, ... about it if you check above.

4 Identify New Features or Technologies You Want to Include

Responsive design is as Nordin also indicates a must have for me. In successive Drupalcon keynotes Dries Buytaert has stressed the rise of mobile devices. It would be a major gain to have the archive readable by mobile and tablet users.

Thus far I've not made full use of video, Skype and even audio for delivering content. At Drupalcon Prague there's a session media management and the Scald module. I'm hardly a radio or TV station but as people say DO consider those things that you are not skilled at, or naturally drawn to. Slides and presentations both existing and contributions (or links) would also be a key content feature.

If a community can emerge this might also be that as Nordin suggests users can share internally within the site using (unconsciously) specific structures within Drupal. The latest means of classifying and searching a site will also be essential. Seeking to share h2cm with the world I've scheduled some sessions on leveraging the multilingual capabilities of Drupal 8.

Accessibility is another essential feature.

5 Upgrade, or Start from Scratch

This, thankfully, is not an upgrade. To the list in #4 I could have added database - a dynamic website because this is the primary need, the enabler. With that though comes complexity and responsibility. Website management then demands data be protected, secure, backed up, and this involves migration and upgrades. So, starting from scratch - yes, but with an eye to upgrading.

The NW Drupal meetings in Manchester and Drupalcon Prague program bring the news of the many new tools and changes in Drupal 8:

• Views in core;
• New configurable fields e.g. entity reference, date, e-mail and others;
• Multilingual changes;
• Blocks & Layouts;
• Responsive images and breakpoints.
  
  From Drupalcon Prague "Drupal 8 for Site Builders" session

In addition there is Symfony, the loss of some hooks, Twig a templating engine.

6 Figure Out Theming and CSS Issues

If .Net and Web Designer magazines inform us of two things it's the pace of change in tools and the range of tools. It's helpful then when those choices are reduced. This may be the case with CSS within Drupal and adopting a grid system, a point made by Todd Nienkerk (p.79).

There are some excellent themes and sub-themes within Drupal 7. Drupal 8 extends this potential. I posted previously about Omega.

To conclude:
I think there is an interesting project here, but thinking alone isn't going to get this done!

Jordan JNC Conference: Mental health and stigma, Student nurse's aptitude and the MDGs

There were a great many fascinating talks at the conference in Amman. The following caught my attention:

Dr Heyam Dalky on Perception and Coping with Stigma of Mental Illness: Arab Families' Perspectives

Since I trained in the late 1970s there has been a marked positive change in the social stigma associated with medical and mental health conditions. People are by and large more enlightened regards epilepsy for example. Although perhaps some of the progress can be related to medication, medicine management and community follow-up. Mental health professionals and services are aware of the potential damage that a diagnosis of 'schizophrenia' can inflict on young adults. Despite any sense of progress I might see, there is much still to be done as campaigns such as Time To Change attest.

It was very useful then to revisit the historical development of thought in stigma. Dr Dalky also shared global insights into stigma perception within families by citing research in a range of countries; for example, in Jordan, Morocco, Sweden, Germany, China, Malaysia, and Ethiopia.

Within Hodges' model the individual, as in the self, is given a pivotal and yet mobile place (transferable from the top of the model to the center) this led me to the concept of self-stigma (Corrigan, 2009) as I draft a paper on h2cm, case formulation and diagrams.

In her presentation Dr Dalky notes:

• Link and Phelan (2001) defined stigma as the co-occurrence of the components of: 
• labeling, stereotyping, separation, status loss, and discrimination.
• “self-stigma” or “stigma perception,” is the extent to which individuals believe others stigmatize them because of who they are.

They say travel broadens the mind and listening to this presentation you really see the difficulties, objectives and aspirations that not only practitioners share but families and our clients too.

Heyam F. Dalky, PhD, RN, Jordan University of Science & Technology, Irbid, Jordan
 

Ever since my engineering aptitude was measured in the mid 1970s by predicting the movement of a series of gears I've always held a special place for aptitude and attitude, as reflected here on W2tQ.

Mrs. Maxie Andrade, et al. presentation Aptitude Towards Nursing: Is it Measurable? highlighted a central challenge within nurse education.

Nurse training represents a major personal investment for the student (their family too in many cases), the educational institutions and societies concerned. As a sign-off mentor I assess third year students on their final placement. This is a great responsibility that is usually a privilege, but it can be a frustration at the loss entailed for a failing student.

Mrs Andrade defined aptitude:

Is a condition, a quality or a set of qualities in an individual, which is indicative of the probable extent to which one will be able to acquire under suitable training some knowledge, skill or composite of knowledge, understanding and skill

Ref: Mangal S L. General Psychology. Fifteenth reprint. New Delhi: Sterling Publishers Pvt. Ltd; 2008.

The main questions:

Do nursing students possess the required ability (aptitude) to become an effective nurse?

What abilities do we really expect from nursing students?

The development of a tool to measure aptitude was described, reviewing the literature. Are there any existing tools within nursing? What exactly should a tool measure? Statistics and results were listed. This was a very interesting presentation and of particular interest to me.

Mrs. Maxie Andrade, Asst. Professor, Manipal College of Nursing Manipal, Manipal University


There was also a reminder of the time left to achieve the Millennium Development Goals [MDGs] c/o Prof. Hester C. Klopper's keynote: The nursing education tipping point: Forces of change. 

Less than 1,000 days and that was last month.

One thing I noticed and a sign of the issues in the Eastern Mediterranean is that the JNC conference website has proved unavailable at times. It is accessible as I post this.

Andrade M. Perceptions of health care consumers, deliverers and nurse educators on nurses, nursing practice and nursing education system. Manipal University, Manipal: 2010. (Dissertation work).
Andrade M. Choice of nursing career: Pleasure or pressure. International Journal of Nursing Education. 2012; 4(1); 42-44. 
Corrigan, P.W., Larson, J.E., Rüsch, N. (2009). Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry. 8(2): 75–81.

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.

Piloting (online) health literacy - 'easy as she goes?'

On Thursday afternoon I introduced Hodges' model to six student nurses. In wrapping up the session I suggested the students look up 'health literacy' indicating how Hodges' model can incorporate reflections on the many literacies essential for life (and death) in the 21st century. For one student this small kernel of news was unfortunately too late, a piece of work having just been handed in.

Great to see the following item in this week's HSJ - Health literacy training on offer for 100,000:

The NHS Commissioning Board will work with a charity to offer 100,000 people access to training in online health literacy over the next year, it has announced.

The board’s national director for patients and information Tim Kelsey said on Thursday it had made the agreement with UK Online Centres, an organisation which specialises in tackling digital exclusion.
The work comes in the run up to the board’s deadline of 2015 for patients to have access to their GP health records. ...

Health literacy training on offer for 100,000, Health Service Journal. 14 March 2013, p.10.

In terms of health literacy as a whole this is one aspect, but as the previous post point out we need to consider human factors. Innovation  also involves physical and cognitive access, relationships, referral, the interplay and dependencies between existing literacies (poor functional literacy and yet high health literacy?), differentiating between literacies, motivations and to what extent can participants themselves be mobilised as a force for change beyond 100,000 ...?

The Telehealth supplement in the same issue of HSJ notes that small companies struggle when they are offered yet more pilot projects with 30 patients.

100,000 - well that should be a good shot in the arm.

Trueland, J. (2013) The six billion dollar question, Telehealth supplement. HSJ, 14 March, 8-9.

HealthTap: Invited to add their widget... I asked a question...

No doubt it was a bulk email, but I received an invitation from HealthTap to add their widget here on W2tQ. The widget provides the means to access their service, that of putting questions to medical experts.

I have minimized the side bar content, stripping out buttons and other media paraphernalia and yet suitably intrigued I asked a question - ;-)

Q. Is there a conceptual framework that can help

 assure holistic (physical - mental, social) and integrated care 

that is also person-centered? 

Fourteen hours later an answer duly arrived by email:

Holistic Medicine
I believe that Holistic Medicine, when properly practiced, assures all of that. For the principles delineated by the American Holistic Medical Association see ...

Also see ...


I greatly appreciate Dr. Randy S. Baker's response and the above links. This is helpful in several respects despite not exactly being the answer I was hoping for.

The answer is itself holistic in a sense in wrapping the question up in an organisational wrapper. That's a safe response, with medicine in there for wholistic measure. Who ever said medicine is reductionist! Judging from his profile holistic medicine is Dr Baker's forte.

Also interesting in the answer is the way the hook in the question was deemed to be the reference to 'holistic' and not the conceptual framework element.

Another point in Dr Baker's reply that reflects on Hodges' model and the health news media in England (UK) next week* is the bit about when properly practiced.

The adoption of Hodges' model is no guarantee of 

person-centered, 

integrated, 

holistic care.

Although the term conceptual framework (Hodge's model !) is not given in the answer: assure is.

What ever conceptual framework (care model, care philosophy...) is adopted to deliver health care, they must contribute towards the assurance of high quality care - that which ultimately positively engages the patient, carer, family and communities.

My question still remains and is usefully extended, passed to the above organisations.

So does the AHMA and the American Board of Integrative Holistic Medicine have a conceptual framework that helps support their holistic objectives and assurance of care? I will contact them to see if I can obtain a further response.

Thanks again to Dr Baker and HealthTap.

* The Francis Inquiry Report is anticipated on Wednesday.

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)

Snakes & Ladders - Health & Safety: Blog Action Day - The Power of We

This year's theme for Blog Action Day is The Power of We. Andy Roberts over at DARnet posted about his not taking part given this particularly ambiguous title. I can see what Andy means. I'd signed-up for this year and wondered what to write; but then last Friday morning returning to work up the A59 at the Tickle Trout I was behind a van carrying two ladders...

I used to be a bit reckless in terms of heights, but I was kid then. Can you imagine the sudden lease of mental life from a row of terraced houses in Liverpool to fields and woods? Friends used to climb and go from tree-to-tree, in the summers our football pitches became dusty patches.

In my mid-teens helping out I thought nothing of staining the side of the dorma extension one-handed with about 30cms of standing clearance. In the decade from 1970 to the 1980s attitudes changed markedly as health and safety become firm buddies (see for example HSE). If the ladders were out to stretch their legs then my dad or younger brother were on station ensuring the ladder stayed put. There's the power of we keeping me safe.

The health and independence that the majority of us takes for granted seems to give individuals that childhood tree-to-tree disregard for safety.

H2CM central axis IND - GRP

I can illustrate what I mean; for example, look where this individual has got themselves! Of course, we often depend upon others to get to many places. Our very existence depends on others. 

Central to Hodges' model is a structure built from the key humanistic, that is the psychological and social perspectives of 'I' and 'We'.

This gives the model its spine. Everything else in health and social care follows from this axis. We need the social and political foundations of relationships, families, communities to take us to organisations, political movements, government and global governance. Previously, I pointed to the effort required to deliver person-centred care. We have to conceptually take the individual from the ascendant point in the model and put them at the model's center. Doing this collaboratively that is the communication that counts.

There is however, a responsibility that rests with the person. The Power of We is also not a given. It is possible for individuals to opt out of society, being a citizen is something for others. What difference can I make to political outcomes? There is the political debate about individual responsibility regarding life-style choices. If people are to achieve self-efficacy they need to climb down from that crow's nest and traverse the humanistic and mechanistic dimensions of life.

This responsibility is really telling though when an individual seeks to take, or maintain power for themselves within a nation. They trample on the freedoms, lives and choices of others. The people taking power back, doing so peacefully and gaining evidence of abuse of power that is the real power of we.

A room with a view from on high can still bring unique insights for individuals from which we can all learn:

"I know the whole world is watching right now and I wish the world could see what I can see. Sometimes you have to go up really high to understand how small you really are." Felix Baumgartner, 14 October 2012.

http://www.telegraph.co.uk/science/space/9607604/Skydiver-Felix-Baumgartner-attempts-to-break-sound-barrier-live.html 

Baumgartner image: BBC
Ladder brush c/o: http://www.trendyrobot.com/brushes/000343/popup.html

Book review: Nursing Knowledge: Science, Practice, and Philosophy

Searching for an up-to-date nursing theory book I wanted something different from the usual fare. The usual fare being a description of the various nursing theories, models and frameworks to date. I needed a text that would help me in two ways: firstly, deal with and critique the foundations of nursing theory; secondly, to provide some insights that would inform my own study into Hodges' model. I quickly found a book with a bonus: it is written by a philosopher.

Mark Risjord's - Nursing Knowledge: Science, Practice, and Philosophy (Wiley-Blackwell, 2010).

This is not a large book considering the literature within its potential purview at just 246 pages in total. The text is very readable both visually and in style. Even if points need to be re-read this isn't a chore. Evidence of structure and discipline runs from paragraphs to the overall division into seven parts, with the usual reference listing and index. As a nursing student of the late 70s and early 80s this book needed to reframe this subject for lifelong learning student of the 2010s. Risjord starts by examining the history - prehistory no less - of the problem. 

Key questions that have arisen in nursing and directed thought are discussed. The influence of what was happening simultaneously in the philosophy of science and culture is also related. The writing is succinct (as already suggested) on page 18 we have an explanation for the appearance of the relevance gap, how this gap endures and how it might be closed.

Central to the demographic, media and political challenges that nursing faces part II covers values. This brings in nursing's standpoint and more direct reference to cultural influences on nursing knowledge in particular feminism. This discussion is again brief, standpoints are very relevant for me. The combination of depth of analysis, brevity with a clear focus are a great achievement. A lesson in how to write, how to argue, how to communicate. You can only do this if you know your subject.

If I missed anything it is technology and information, but the book is probably all the better for this whether considered an omission or diversion. Seeing specific reference to multidisciplinary in the index and a discussion of nursing knowledge in relation to other disciplines would be helpful. Risjord's purpose for this book is however, clear from start to finish. It's there in the title. The book is no glossary, or dictionary, and yet the treatment of many concepts here, such as; axioms, borrowed theory, coherence, context, grand theory, and paradigm (a chapter)... will help reader's appreciate their definition and use. Seminal papers from the literature are identified and re-examined. Much of the book is devoted to research and methods with illustrative examples.

There is much to inform my studies, in particular chapter 15: Conceptual models and the fate of grand theory. Here I can conclude from Risjord that Hodges' model creates an orientation picture rather than an abstraction picture:

On this understanding, nursing models are expressions of the philosophical background to nursing research. Conceptual models orient research and practice by guiding the selection of problems or making phenomena salient. They make no theoretical pronouncements. A conceptual model can guide research and practice only in the light of some values and goals. Nursing values and goals are thus crucial components of the conceptual model on the orientation picture. They set the agenda for nursing research by articulating what is important. p.173.  

I've long considered Hodges' model to be a map. Initially, a blank map - a space within which values can be deliberated. In pedalling this particular bike since 1998 I know how tired nursing theory is. Now students don't need to get on the bike, they stand on one pedal and freewheel the short distance that represents the curricula space devoted to nursing theory (and philosophy). A packed curriculum provides the momentum for the (values) by-pass. Mark Risjord concludes with new questions about nursing theory, new maps and new directions. I've outlined other points from the text for future reference. This book will remain a companion for quite some time: a great compass.

Acknowledgement: Many thanks to Wiley-Blackwell for the review copy.