Blankets and DNR . . .

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

Initially not person-centred, I -	Blankets
- recall several 'conversations' with junior doctors. The situation was 'recovered'.	"Blanket use of forms"

22:00-22:30 BBC News at Ten. DNR - Do Not Resuscitate 

DNR is a critical aspect of health care that will not go away. It can't as part of the interface (to put it mechanistically) between life, death, and quality of life and death. Ever since and even prior to the Liverpool Care Pathway, the issues raised in medical care, humanity, dignity and respect, ethics, professionalism, integrity and governance are challenging to reconcile.

Hodges' model can play a part in critical thinking about not just a troublesome concept, but the interaction of several and making sense of them and the situation to hand - and heart. 

As such Hodges' model isn't going away either.

Knights D, Wood D, Barclay S. The Liverpool Care Pathway for the dying: what went wrong? Br J Gen Pract. 2013 Oct;63(615):509-10. doi: 10.3399/bjgp13X673559. PMID: 24152449; PMCID: PMC3782767.

Planning tool for Early Onset Dementia - Mapped to Hodges' model

 This post is prompted by a tweet:

Please re-Tweet this #stillmylife planning tool for early stage #Alzheimers and other forms of #dementia from the incomparable @3SpiritUKNZ! #wellness #wellbeing #aging #geriatrics pic.twitter.com/lHd6hj1Wkh

— Ian Kremer (@LEAD_Coalition) January 27, 2018

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Self-knowledge of symptoms - Learn about my condition Learn and stimulate the brain Use lists, what I am doing, what interests me music, places, work-experiences ... Consider interventions, record in my biography Feel safe, confront fears and anxieties What does 'well-being' look like for me Positive thoughts, dreams, aspirations Use Mental Capacity for Future Planning	- and signs  Seek environments that support me; avoid those that drain or inhibit me Use technology to create biography (Research into diagnostic journey) Take control - strategies on nutrition and health
Share biography with loved ones, friends. Tell them how they can help -  Ensure (assure) future needs are/will be met as I would like them (Hey!) I can still contribute to society so ..	- consider getting help e.g. Dementia Advisors (Guidelines for health services, esp. primary care, GP, family physicians) Mental Capacity Act, Power of Attorney, Advanced Decision Making Yes: to occupation, earning or volunteering

Apologies in advance, as the formatting may be disrupted on some devices so two lines may not scan across the care domains as intended.

As you can see this brief 'sketch' of #StillMyLife shows that the emphasis of this planning tool is well-placed. This also highlights what I have referred to as 'holistic bandwidth'. There are many claims regarding the centredness of various things, for example; student education and learning, health and nursing care, government and the way business is conducted. In this instance, the question of what is the conceptual, disciplinary and professional extent of a tool, approach, theory or practice. Is its claimed philosophical, ethical, social or other objective fully deserved? Is it person-centred, or task centred? Does it deal with the political dimensions of significance to an individual with a disabling health condition as it claims?

n.b. Note the boxes and the absence of ticks.

"Values in Advanced Directives" mapped to Hodges' model

Hechter, et al. (1999) consider values in respect of advanced directives and medical treatment. The authors discuss an old debate in social science that still divides objectivists and subjectivists. Below, with my emphasis the four designated values are mapped to Hodge' model:

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

(ii) self-concept values involving feelings of dignity, self-control, and/or physical capacity (designated as function);	(i) hedonic values about pain, aversive physical states, chances for recovery to some minimally satisfactory level, and so forth (designated hereafter as pain);
(iii) allocentric values referring to concerns with creating an emotional burden for family and/or loved ones (designated as burden)	(iv) financial considerations (designated as cost) (p.409).

Since 1999 and considering the above I have added the following additions to reflect elements of change and a more generic view:

identity, self-expression (of needs), consistency in expressed wishes, intentionality, mood, alternative-adaptive forms of communication, time - active listening	distance, logistics (family, friends), what telecare might offer in terms of communication, evidence-based interventions, measures, assessment
independent advocacy, standards of social care, 'appropriate' placement for ongoing care, social - life history;	legislation - mental capacity, advocacy, evidence-based care - policy, pension, safeguarding;

While the focus of Hechter, et al. is specific these values also apply in a more generic sense. As students and lifelong learners engage with patients, carers and public they must learn to have due regard for the totality of values that might be encountered.

Hechter, M., Ranger-Moore, J., Jasso, G., & Horne, C. (1999). Do Values Matter? An Analysis of Advance Directives for Medical Treatment. European Sociological Review, 15(4), 405-430.