Working title: 'Can Hodges’ model provide a foundation for a mathematically informed ...

... epistemology and relational ontology? Part 1'

Abstract

Aims: To begin a process of examining a ‘model of care’ and conceptual framework known as Hodges’ model as a mathematical object. This paper examines the structural elements of this model, its axes and domains through a formal, logical and mathematical lens. To establish the extent to which a combined relational understanding and mathematical approaches can provide avenues for further research.

Design: This study adopts the design of a two-part exploratory and descriptive paper, using an inquiry-based approach throughout.

Methods: The method is interdisciplinary, descriptive, and involves conceptual analysis. Rather than Hodges’ Model acting as a model of, and for care, here the model is used to investigate how health and social care can be better conceptualised. The question is: What is the result when Hodges’ Model is treated as a mathematical object? Here, Hodges’ model is used as an inquiry-based model with reflection and critique.

Results: Readers will see the development of ideas, driven by the structure of a model of care, existing taxonomy defined by nursing theory, associated with foundational mathematical concepts.

Conclusion: The questions introduced and deliberated here will identify avenues for further study. And highlight Hodges’ model to other researchers; less familiar with Hodges’ model, and yet more skilled – adept mathematically.

What does this paper contribute to the wider global clinical community?

Re-assert the importance of theory development in nursing and health disciplines.

Draw attention to the relational (and reflexive) potential of Hodges’ model and in healthcare to abstract the collective dimensions of healthcare, especially those that are political.

Given the problems faced in the century to follow, encourage researchers within and without healthcare to further develop these ideas.

Impact:

Extend the relevance and scope of mathematical abstraction, in healthcare disciplines and the humanities, beyond statistical analysis.

This paper confirms: the conceptual utility of Hodges’ model; the challenge of requisite mathematical skills; the need for interdisciplinary cooperation.

Theorists in health and social care, policy makers and researchers seeking to apply mathematical techniques, especially category theory in the social science may find this work helpful and encouraging.

Reporting Method: N/A

Patient or Public Involvement: This study did not include patient or public involvement in its design, conduct, or reporting.

Keywords: nursing, theory, relational ontology, health, Hodges’ model, mathematics

See also: Draft notes - 'Hodges' model - Locus of Care & Control?'

Survey: Identifying and Fixing Undesirable Behaviors Across Software Versions

Hello,

As part of my PhD at the University of Lille, I am currently conducting a study on how developers handle certain bug scenarios. 

The goal is to better understand current practices, the tools used, and developers' needs regarding debugging in a specific scenario. 

You can find the survey at the following address:

https://sondages.inria.fr/index.php/462191?lang=en

Your participation in this short questionnaire (5 - 10 minutes) would greatly help us analyze existing methods and identify potential gaps in the available solutions. 

This survey will be open for 6 weeks (until May 15th, 2025). The responses will be analyzed and included in a scientific publication. The results will be available here.

If you can, please feel free to share this questionnaire with other developers who might be interested. 

Every response counts and will contribute to a better understanding of the community's practices! 

A big thank you for your help and time. 

Best regards, 

Rémi Dufloer

PhD Student, University of Lille 

---------------------------------------------------------------------------------------------------------------------------

Bonjour,

Dans le cadre de ma thèse à l’Université de Lille, je mène actuellement une étude sur la manière dont les développeurs gèrent certains scénarios de bugs.
L’objectif est de mieux comprendre les pratiques actuelles, les outils utilisés et les besoins des développeurs en matière de debugging sur un scénario précis.

Voici le lien du questionnaire:

https://sondages.inria.fr/index.php/462191?lang=en

Votre participation à ce court questionnaire (5 - 10 minutes) nous aiderait énormément à analyser les méthodes existantes et à identifier les éventuelles lacunes dans les solutions disponibles.
Ce survey est ouvert durant 6 semaines (fermeture le15 mai 2025).Les réponses obtenues seront analysées et feront l'objet d'une publication scientifique.Les résultats seront publiésici.

Si vous le pouvez, n’hésitez pas à partager ce questionnaire avec d’autres développeurs susceptibles d’être intéressés.
Chaque réponse compte et contribuera à une meilleure compréhension des pratiques de la communauté !

Un grand merci pour votre aide et votre temps.

Bien cordialement,

Dufloer Rémi
Doctorant, Université de Lille

________________
My source: Esug-list mailing list & checking with Rémi.

NURSING -:- INFOTECH - worlds apart? Software testing

Another draft from over a decade ago ... duly revisited and updated:

https://www.statista.com/statistics/793628/worldwide-developer-survey-most-used-languages/

Reading up on Ruby and Rails and attending Scotland on Rails, I've been struck by the emphasis on testing. Testing in this context is about reliable software and building this into the 'product' from the outset. A book on Rails gets criticized because it leaves the chapter on 'Testing' until the end (even if the authors had their reasons - as they explained).

This take on testing is sufficient if (of course) it is appropriate and it is applied (as per the manual) to the application concerned. There are other more formal methods that extend to writing a specification for code which entails the use of formal specification languages such as Zed (as encountered in BA(Hons.) studies. This arises in situations were software is being developed for safety-critical situations. Clearly, robotic surgery, nuclear energy, and keeping an aircraft in the sky, take-off and landing are mission-critical. In the latter case a company is still dealing with life threatening loss of life that can follow, should the software system fail or more covertly introduce an error.

Reading about Rails, there are specific tests and these are provided as a result of scaffolding, a process whereby the bones of a web application are created within the Rails framework: with tests.

Rails creates a test directory for you as soon as you create a Rails project using bin/rails new application_name. If you list the contents of this directory then you will see:

$ ls -F test
application_system_test_case.rb  controllers/                     helpers/                         mailers/                         system/                          fixtures/                        integration/                     models/                          test_helper.rb

Source: https://guides.rubyonrails.org/testing.html

Rails uses a popular convention to organise and integrate the elements of a web application that includes a database, and dynamic interface. The approach is known as:

Models, Views and Controllers - MVC

MVC underpins several programming languages and frameworks. As displayed above, the tests that Rails creates have specific names and you can quickly see where they come from and how they encompass Rails (an essential property of course).

Today, I still wonder [ what's new! 😉 ] what is the equivalent to MVC in nursing? Models seems to fit! Over the years at many IT events, you can't help but reflect on nursing and its 'API' - application programming interface. Worryingly, in humanistic terms there is an instrumental potential in Hodges' model. If Nursing on Rails was a thing, what would the tests look like? Identity would be a feature, to demonstrate person-centredness, safety in medication and other treatment procedures. Is there a way to demonstrate the integration of care, and for a patient - the extent of holistic bandwidth? Of course, nursing comprises just a part of a clinical information system. It must be in sync in accord with other disciplines, medical and pharmacy and other multidisciplinary team members and yet ensure that 'nursing is visible'.

Previously: API : 'Waste not - want not'

There is this thing - 'universal construction'

The problem of bugs in software is an ongoing problem across all IT industries. For application that are safety critical we are still reminded of the risk implications and consequences if bugs are software is not tested and bugs - errors identified and corrected.

Back in the 90s during BA(Joint Hons. Philosophy & Computing) studies, I was introduced to the formal specification language 'Z'. It was designed for definition, and modelling of computer software, working from specification to implementation, as per these images:

https://personalpages.bradley.edu/~young/CS592M120_OLD/handoutZed.pdf

https://personalpages.bradley.edu/~young/CS592M120_OLD/handoutZed.pdf

To be clear I've never worked as part of a software project and my 'tinkering' - Drupal, Pharo, online groups, hosting platform - reveals how the development stack and work processes have developed apace. The challenge is keeping up. Simultaneously, there is the sense of being on the bank of deep water; or, a vertiginous cliff:

A little learning is a dang’rous thing;
Drink deep, or taste not the Pierian spring:
There shallow draughts intoxicate the brain,
And drinking largely sobers us again.
Fir’d at first sight with what the Muse imparts,
In fearless youth we tempt the heights of arts,
While from the bounded level of our mind,
Short views we take, nor see the lengths behind,
But more advanc’d, behold with strange surprise
New, distant scenes of endless science rise! 

Pope. https://interestingliterature.com/2021/09/a-little-learning-is-a-dangerous-thing-meaning-analysis-origin/

 Acknowledging the need for an 'evidence-base' and theoretical underpinning the effort to 'push' Hodges' model forward is ongoing. Maths remains an alien territory to me, but the 'secret garden' is as tantalizing as ever. Over the years I have posted - with much overlap about:

• maths
• relation
• logic

- and more recently:

• isomorphism
• category theory
• and as previously posted - laws of form.

In an effort to get to grips with the above, I'm following various online videos, books and papers. Bartosz Milewski's videos, blog and publications are aimed at programmers, but are very interesting nonetheless. The first video provides an introduction to the motivation and philosophy of category theory. In another, Milewski refers to 'universal construction' on YouTube and in a blog post about 'Function Types'.

The 'universal' figures in healthcare too: universal health access, and universal health coverage appear to over-shadow 'universal health care'. The quality of 'universal' also creeps into assessment. Data gathering is not merely complete, it is comprehensive. It has to be, to contribute not just to a care plan, for one that is (supposedly) person-centred, with risks identified, strengths, weaknesses - needs, history, social network, and much more. The care plan informs and orchestrates the interventions; then evaluation follows. Are we delivering? What is the patient's (client's, carer's) level of satisfaction. Have care stages and actions been completed as per policy (in time!)? (More on this to follow later this year in light of UK mental health/illness news.)

So as I consider (wrestle with...) initial, and terminal objects, sets and categories … I can hopefully, especially with help, extend the number of posts tagged 'universal' here on W2tQ. In this vein, is Hodges' model a universal construction? There may not be a universal truth to reveal, but it will prove a marvellous learning journey.

Hodges' model: A tool for Curation

CURATION

"Curation helps solve the problems of today and tomorrow. It's the mass sourcing of the expertise needed to navigate and comprehend the saturated, complex markets* of the twenty-first century." p.166.

Bhaskar also lists (and briefly introduces) the principles of curation:

• Saving time
• Freeing cognitive resources
• Sparing us anxiety
• Maximising utility
• Cutting down complexity
• Finding quality
• Overcoming information overload
• Creating contrast 
• Redefining creativity
• Channeling attention
• Providing context
• Beating overproduction (pp.167-168).

*To markets above, I would add disciplines and professions.

By definition an aide-mémoire should save us time. 

The structure of Hodges' model provides a conceptual scaffold, a substrate affording us cognitive economy.

Through selection (self guided discovery) we are assuring data, information gathering, properly supervised this should spare us anxiety.

We are trying to ensure the effective use of our time, and efficiently zero-in on the concepts that are salient.

By reducing complexity, we increase the relevance and value of what is noted, recorded, acted upon. Data, facts, observations that are not redundant can be dismissed.

Contrast is co-confirmed by using innate oppositions, polarities and dichotomies with attention on the other and the middle.

When needed, Hodges' model can explode subject headings, concepts assisting exploration and creativity, potentially assisting at a transdisciplinary level.

Context rationalisation by testing and filtering a situation, helps to focus attention.

Duplication and repetition do not foster sustainable services, but there should always be scope for verification and person-centredness.

"As the eighteenth-century English painter Joshua Reynolds put it, 'Simplicity is an exact medium between too little and too much.' Curation helps ensure that exact medium." p.159. 

Bhaskar. M. (2016) Curation: The power of selection in a world of excess. London: Piatkus.

Book image: Waterstones.

See also: Is Hodges' model a selection machine?

"Models, Theories and Concepts" c/o Smith (1994). Plus ça change ...

"Whilst the impracticality of unified approaches has been noted for some time (McFarlane, 1976), it is still considered that many theories, in their efforts to explain everything, succeed only in explaining nothing (Draper, 1990). Therefore, as Kenny (1992) points out, the use of theories and models in nursing has resulted in sweeping generalizations which 'are not always personally, culturally or contextually appropriate'.

In overcoming this difficulty many authors advocate that theories of lesser scope and abstraction are considered (McFarlane, 1976; Clarke, 1986; Draper, 1990; Moore, 1990; Ingram, 1991; Reid & Bond, 1991). Such theories have been termed 'mid-range' and address a more limited number of variables in particular situations (scope), whilst being empirically grounded and focusing on practical problems (abstraction) (Rogers & Shoemaker, 1971; Walker & Avant, 1983; Fawcett, 1984; Lowenberg, 1984). According to Clarke (1986), mid-range theories should appeal to practitioners as being more directly accessible conceptually and linguistically. Reed & Robinson (1991) contend that, given the diversity of nursing practice, the search for grand theory is inappropriate and nursing would be better served by developing mid-range theories that are 'more precisely stated, more easily treated and produce more specific indications for practice'." pp. 59-60.

Smith, J.P. (1994) Advanced Nursing Series - Models, Theories and Concepts. Oxford: Blackwell Scientific Publications.

While the structure of Hodges' model is global - 'grand' in scope, the model, as a template is blank and open to whatever conceptual content follows in the practice situation, or context. 'Precision' can be assured using Hodges' model as it can facilitate person-centred care, integrated care, reflection, critical thinking and conceptual development. 

Delivery of high-quality health care is not a given. 

Safe, effective and equitable care is variously dependent upon staffing, the skills and attitudes of individual nurses, staff numbers, skill-mix, team effectiveness and resource allocation. Hodges' model can also assist users to recognise and call-out unmet needs, deficits in the quality of care, and risks to the safety of patients, the public, staff and the profession.

At risk of sounding grand if not grandiose ...

Change will and must follow - in respect of models and theories, not just of and for nursing but health and care at scale.

Evidence-based care: What are 'we' missing?

Perhaps, proof of (what) works? 

Blockchain Revolution

"The mechanism for reaching consensus is critical. 'Consensus is a social process,' blogged Vitalik Buterin, pioneer of the Ethereum blockchain. Human beings are fairly good at engaging in consensus . . . without any help from algorithms." He explained that, once a system scales beyond an individual's ability to do the math, people turn to software agents. In peer-to-peer networks, the consensus algorithm divvies up the right to update the status of the network, that is, to vote on the truth. The algorithm doles out this right to a group of peers who constitute an economic set, a set that has skin in the game, so to speak. According to Buterin, what's important about this economic set is that its members are securely distributed: no single member or cartel should be able to overtake a majority, even if they had the means and incentive to do so.

To achieve consensus, the bitcoin network uses what's called a proof of work (PoW) mechanism. This may sound complicated but the idea is a simple one. Because we can't rely on the identity of the miners to select who creates the next block, we instead create a puzzle that is hard to solve (i.e., it takes a lot of work), but easy to verify (i.e., everyone else can check the answer very quickly). Participants agree that whoever solves the problem first gets to create the next block. . . . For each block they find, miners receive  bitcoin as a reward." p.31.

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

	'proof of activity' 'proof of work' 'proof of burn' 'proof of capacity' 'proof of disk' 'proof of storage' 'proof of existence'
	'proof of asset' 'proof of storage' 'proof of stake' 'proof of property'

Hodges' model = Proof of Care^* ?

Proof of Concepts (at least?)

How do we prioritise and focus
our energy expenditure, and energies in the 21st century?

*And education?

Tapscott, D. and Tapscott, A. (2018) Blockchain Revolution How the Technology behind Bitcoin Is Changing Money, Business, and the World. Penguin, New York.
[See also index, p.355 'proof of a,b,c...'.]

The Longitude and Latitude of Care ...

... and what lies between

As I continue to reflect upon Hodges' model (PROCESS 0 : 4 DOMAINS and other posts) I can see two influences on what it contains and how it works practically and more formally - what logic(s) might apply? The first is the binary state of: blank template, or empty set. The other is initiated when we start to populate the model with care concepts. Whether '0' or '1' the situation - context of the clinical encounter, has a bearing on both. Imagine, a student armed with an explanation of Hodges' model - having just 'created' the model through a seminar (Socratic dialogue); then, presented with a blank template they are ready to begin, while they listen to their mentor and a patient/client/carer? Alternately, a qualified practitioner examines their previous 'notes', with a patient, evaluating progress.

Imagination aside, I'm wondering (as ever!) about the what, how and why of the significance implied in placing concepts x,y, and z. What is the justification, if any, beyond seeking to assure person-centred, integrated, safe and high quality care? Restating the question, when concepts are placed in the 'INDIVIDUAL' domains what are the relationships between them, the model and the interactions that determined them?

Perhaps, I ask too much of this model? Are there underlying properties that characterise concepts placed in a domain and so distinguish them from others: (INTRA-)INTERPERSONAL - SCIENCES?

The model is acknowledging, incorporates the Cartesian divide: Mind-Body. When I write and advocate that the model supports integrated care, at one point do, can these two domains merge, 'collapse' into one?

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

Hubris syndrome: Daedalus Project [Psycho-Political]

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

Hubris Syndrome "Democratic politicians as diverse as Woodrow Wilson, Franklin D. Roosevelt, Churchill, Kennedy, Johnson, Nixon, Pompidou, Mitterrand, Blair, George W. Bush, Chirac, and Sharon all lied about their health. ...

... Between 1906 and 2008 seven Presidents are judged to have been mentally ill while in office: Theodore Roosevelt (bipolar disorder), Taft (breathing-related sleep disorder), Wilson (major depressive disorder), Coolidge (major depressive disorder), Hoover (major depressive disorder), Johnson (bipolar disorder), and Nixon (alcohol abuse). Many despots-such as Hitler, Stalin, Saddam Hussein, Pol Pot, Idi Amin, and Robert Mugabe-have been branded by the press and public opinion as suffering mental illnesses. Lord Owen argues neither Hitler nor Stalin were mad in any sense the medical profession recognizes (whereas Mussolini and Mao had depression, possibly bipolar disorder)."

'Faith' in leadership? 'Choice'?

In Sickness and in Power by Owen David

I remember Lord Owen's book being published, over a decade ago and heard radio interviews at the time (BBC Radio 4, Start the Week?). Not sure why I didn't pick this up as the disciplinary bridges are stark and clear (now!): PSYCHO-POLITICAL and GEO-PSYCHIATRIC. The importance of the issues the Daedalus Project addresses, now within Maudsley Philosophy Group is not just suddenly 'self' evident*, but is of importance for the world's population- impacting upon global safety and security.

Even since Lord Owen's book the rise of AI adds complexity (as ever).

 *irony intended.

Text: https://www.goodreads.com/book/show/3205306-in-sickness-and-in-power

Owen, D. (2009) In Sickness and in Power: Illnesses in Heads of Government during the Last 100 Years, London: Methuen Ltd.  ISBN: 978-0-413-77689-1

Plus via twitter: 

Thanks!

This is great talk from David Owen on Hubris syndrome we organised at @The_BNPA meeting a few years backhttps://t.co/73qGD42oQY

— Tim Nicholson (@Tim_R_Nicholson) March 6, 2022

Jones Act(s)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

Jones act - to highlight to the worlds of education, health - social care, informatics, global health, politics, ecology...	... a way and means to step beyond comfort zones, familiar ports of call and turn the stones to assure and grasp the whole, the big, the rich picture ...
... to see people in their context, their environment, what matters to them, their families and communities. To see and acknowledge past, present and envision a new future individually and collectively.	Jones Act - "which requires that only American-flagged ships carry goods between domestic ports." p.22

 

See also previously on  W2tQ:

https://hodges-model.blogspot.com/search?q=periplus

My source:

Briefing: Joe Biden's economic plans, The pragmatist, The Economist, 3rd-9th October, 2020, 437:9214. pp. 19-22. 

What's in a Name?

  Or, The First Rule of First Aid* ... #SafeStaffing

Health care is often described as complex ...

there are tools to help simplify, conjoin 

and help care navigation and learning ...

Despite this and even if people are listening

politics, politicians and policy makers seem determined to turn health care into a maze ...

INDIVIDUAL

|

INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP

*Protect yourself first.	"WAITING ROOM" "WAIT HERE"

RCN Safe Staffing Campaign:
https://www.rcn.org.uk/employment-and-pay/safe-staffing

patient safety learning hub:
https://www.pslhub.org/

'Named Nurse' 25 years ago.
Mitchell G, Strain J. The role of the named nurse in long-term settings. Nurs Older People. 2015 Apr;27(3):26-9. doi: 10.7748/nop.27.3.26.e679. Review. PubMed PMID: 25809049.

My source (and image):
https://twitter.com/helenh49/status/1210956380636663813

Hodges' model: a New Invention

Created in the early 1980s, Hodges' model is clearly not a -

'New Invention' P. Halling

While Hodges' model is not a new invention, we have always needed to way-find. Maps are very powerful and even more so now that the world is literally within our grasp. What forms of way-finding can Hodges' model encompass ...

Psyche's journey: All aboard!?

The journey that is life and death... within which and beyond is the arrival of love.

The anatomy and physiology of the human body - the journey called development.

The wound healing journey, the granulated path.

The many skills to become more acutely aware of and honed to be a more effective communicator.

The ways and means by which a clinical procedure MUST be followed - with the essential detours that must include psychological considerations and assuring that 

dignity, respect and privacy are upheld.

This ineffable stuff called information how do we arrive there from data?

From information what is the direction of travel to knowledge - 

is W1S D0M a postcode?

This ineffable stuff called evidence, where is that to be found 

and then by what routes can it be applied?

The journey of the health and social care record from blank to comprehensive.

The journey past the signage (paper ... IT systems) that denotes local vocabularies.

The student's journey from novice to expert.

The patient's journey from illness to recovery; relapse to recovery, 

through palliative care to end of life.

Transitions: from care at home, to hospital, home or residential setting.

The patient's journey to hospital: paramedics, ambulance, corridors and bays, 

accident & emergency, ward, transfers, home.

The patient's narrative journey repeated to own doctor, paramedics, nurse, another doctor, social worker, physiotherapist, occupational therapist (not as long as it used to be?).

Crisis informational: worry - going for tests, scan ... attending clinic for results.

 Informational and temporal compression of the above due to headwinds of pressure on beds.

Self-referral journey to destinations (services) and agencies to be confirmed.

The medication journey (not yet personalised) absorption, distribution, metabolism, and excretion.
The other medication journey that precedes (reconnoitre) rationale, information giving, consent, titration, established regime, withdrawal, medication stopped.

The terrible journey that sees family losing their loved ones twice over.

Explicit and implicit journeys how closely observed formally and informally.

The trip around the other hubs that also turn: the bed hub, social services hub...

The journey through the calendar that is reflected in so many diaries.

The journey called supervision and why is the start session square so hard to find - time for?

The journey called allocation from referral to assignment of care coordinator. 

The journey through procedure land which includes a territory called complaints.

There is the healthcare journey that claims respect as it is predicated upon the postcode.

The journey of idealism and legacy that is called integrated, 

person centred, holistic care and reflective practice...?

Care programme approach review - initial, intermediate, discharge meeting and community review.

The path clearly delineated but less (not yet) travelled

 - health promotion, preventive medicine, self-care, self-efficacy and health literacy (education).

The journey through so many environments: inner - outer space.
The journey that is hope... and Psyche's way-finder...

How many of the care domains of Hodges' model 

do you ensure you pass through - including the spiritual?

Of course, this list only scratches the surface...

All these journeys can be found and navigated through Hodges' model.

NORTH

|

INTERPERSONAL : SCIENCES

WEST--------------------------------------- EAST

SOCIOLOGY : POLITICAL

|

SOUTH

As for the sign 'New Invention'...

Last Saturday at 0700 I left WN4 and headed south for Hay-on-Wye. I arrived at 0930 after passing through Clun and the hamlet of New Invention. I returned with a box of secondhand books, including a couple on education history purchased on my last visit in November 2015. These were useful in the studies at Lancaster. Once sold, 22 books in all, I had £20. Six other books went to the charity shop. An enjoyable trip.

Photo by Philip Halling, CC BY-SA 2.0, Link

Editorial: Assuring the Capture of Standardized Nursing Data... Ponte, Somerville & Adams (2016)

In their editorial Ponte, Somerville and Adams (2016) focus on the US nursing care situation and contrast with the UK experience from the outset:

As the U.S. health system moves toward value-based care, chief nursing officers (CNOs) are pressured as never before to demonstrate nursing’s contributions to improving the cost, quality, and efficiency of care, key elements of the value equation. The shift from fee-for-service to value-based care and reimbursement has been made possible through the implementation of electronic health records (EHRs), and the emergence of Big Data analytics, in which payers and healthcare organizations mine the streams of data produced by clinical and administrative systems to understand and evaluate care inputs, processes, and outcomes (Westra, Clancy, et al., 2015).

The contrast is implicit and is not the purpose of the editorial: Assuring the Capture of Standardized Nursing Data: A Call to Action for Chief Nursing Officers. From a still summery Lancashire the above really does seem a continent away, if not a world. It should not be this way. Questions of value for money, the quality of nursing care and outcomes are also central here and digital aspirations are ongoing: NHS Digital.

Perhaps Hodges' model lacks appeal not just because of its historical (mid-1980s) qualities, but a 4x4 checkbox appearance that seeks to standardize care concepts and the nurse's approach? Not only that but maybe the model dictates where they should be placed? The push for data to 'let the light in' and make nursing visible, can also seem a major, externally driven and intrusive distraction from nursing care. That is, doing the job, being a nurse, nursing delivery, caring ...

That Assuring in the title is important. It is the kernel of recursion, the crucial check that is governance and engaged management. Not remote via a screen - dashboard, but in-process - in-situ assuring that the nursing role can and is delivering. In the dash to data vision can become blurred. Socio-technical perspectives are skewed, what might be termed holistic bandwidth is constrained as per the system.

Ensuring that standardized, encoded nursing data are captured in EHRs is critical if nursing is to realize the potential of big data analytics. Having nursing data available for analysis will allow us to gain a better understanding of nursing practice, demonstrate nursing’s contributions to patient care and outcomes, and facilitate evidence-based practice and nursing research. Indeed, we will no longer be driving blind. Rather, we will be driving smart.

Somewhere in this big data lies person centered, holistic and integrated care. This needs to be transformed to self-care. Can these incremental positive changes be captured (once debated and defined)? Will nurses be empowered with access to this data: the big, little and what lies between? Where are the analysts? Who makes the decisions based on this data? Is transparency assured?

As technology advances we have much to do in the UK, lest we nurses find ourselves sat in what has suddenly become a self-driving vehicle that is bound who knows where....


Ponte, P. R., Somerville, J. G., & Adams, J. M. (2016). Assuring the Capture of Standardized Nursing Data: A Call to Action for Chief Nursing Officers. International Journal of Nursing Knowledge, 27(3), 127.

Musings... building models, health & safety, group and individual

....

Basic foundations and minimal defaults
[Accounting for the I-G (individual-group) axis]

Since nurses and technologists are concerned with communication then the foundation from which they begin to (build and model their) work is of fundamental importance. The foundation needs to be generic in the first instance. Generic in the sense of the commonality that language instills, enables and facilitates within and between communities. Not only that, but if we take the property of 'generic' to its extreme then the foundation must be stripped down to the barest of defaults: there are no 'types'.

To use the safety analogy we need to risk assess the extent of our model building activities.

We can do this by asking: is this a one, or at most two dimensional venture; such that we can rest secure on terra firma? Or are we above 'ground' floor and immediately required to address health and safety legislation?

Since medicine and nursing are concerned with safety and so must be evidence based, there is an immediate vertical challenge in the hierarchies inherent in the sciences and the structure of knowledge.

Science is not the only influence here. The foundation of what we are modelling and building must reflect the ultimate subjects (the person - patients, carers, communities, whole populations) must incorporate the individual and collective nature of our activities. So, the individual (whose very safety is our concern!) must be factored in and the public's health. Systems of assurance are then needed and founded in human rights. This in turn is a measure of the level of social coherence, coherence through a level of social and political organisation that allows leaders to effect positive change and betterment. The person, the individual is built not upon the shoulders of giants, but ordinary people - our ancestors and peers. ...

Axes in hand and mind
...
PJ Dec 2010

Ticks in boxes and triplicate thinking

Having things in triplicate may be reassuring from an admin perspective. ...

That said, 1st year learners on wards can relax to focus on learning, not having to worry (too much) about the administration - the running of the ward 24/7.

Very soon though years 2... 3 come knocking and they must consider due process, they have to question and get to grips with the established routine that sets and keeps several plates spinning.

Of course IT has by and large (?!) removed the need for paper carbon copies (although those three copies should have three distinct purposes).

Despite that an obsession with ticks in just three boxes may not be enough when it comes to high quality multidisciplinary, holistic and integrated care - it's ticks in the mind and attitude that count.

Additional links:
Records Management Society

The Productive Ward

Image source:
Triplicate Girl - http://upload.wikimedia.org/wikipedia/en/6/63/Triplicate_Girl_LSH3.jpg

Road safety vs Patient safety

For effective road and rail safety the advice is....

Sometimes though looking "both ways" isn't good enough...

In health and social care and other situations in
addition to utilising holistic frameworks like Hodges' model,
we also need to look inside and outside of ourselves
- the 5th 'spiritual' domain.
Have a safe and happy 2009!!

Acknowledgement:
Photo used with permission (and thanks): Portland Ground
Crossroads sign from commons.wikimedia.org.

Evidence Based Medicine & Care and the I-G Nexus

Great store is placed upon evidence based medicine (EBM), nursing and care. There are dedicated centers, conferences, journals, policy pronouncements and much more besides.

The evidence based approach has been subjected to critical review in leading health, medical and research journals and blogs. The status and presence of EBM as the bridge between clinical theory and practice is not in question, it is only right however that nothing is taken for granted. EBM is not necessarily as scientific - as objective - as the clinical trials and meta-analyses... make it appear.

Dr Nicholas Hicks provides a brief and yet informative piece on the definition and scope of evidence based health care on Bandolier.

The success of EBM depends however on the GROUP: the sensitive aggregation of results with the personal details stripped out (anonymised). EBM is still (rightly) subject to debate, its method and methodologies constantly scrutinised. In terms of contemplating the complete care spectrum Hodges' model places the natural home of EBM as being grounded in the SCIENCES domain. The POLITICAL domain provides a vital, supportive and reinforcing role through policy, governance and reporting, nationally and internationally. Subsequent studies are modified and refined to ensure lessons are learned.

The ongoing challenge that the application of EBM&HC presents can be found in h2cm, if we choose to reflect there. What we must never forget is that the benefits of EBM are delivered to INDIVIDUALS. Ultimately, it is they who benefit from improvements in treatments and care. It is the individual who remains at the centre of care.

"Evidence based" approaches are being applied in a great many disciplines, but it is the notion of EB care (EBC) as Hicks writes that deserves our special attention. Thinking back to basic physical nursing care c. late 1970s: whilst the best treatment for pressure sores is prevention, this is one area that has benefited enormously from evidence based research. For decades pressure sore treatment and care variously relied upon custom and practice, the myth of Sister x, y, z (or "we do it this way..."), to scientific scramblings, argument and debate.

EBM has recognised the need for quality as well as quantity.

There may also be a stark contrast between the time-scales of EBM and EBC?

If we split "EB" and the "C", we see that there is a danger that the 'I' may get lost:

• To what extent is EBM situated, such that the patient would also recognise the context?
• To what extent is EB(x) a baton for best practice? -
• That is, from the start lines in research lectures, learned journals, research supervision and international study centres - how easily is EB(x) transferred to wards and other clinical areas? (Having 'best practice' examples is the just the start: how will these be communicated?)
• Are the notions of 'holistic assurance and bandwidth' applicable and of value here?
• Is EBC patient AND staff empowering? Is EBC like EBM supported by the underlying (political domain's) foundation of policy and audit to ensure that change does happen and staff can deliver safer, more effective, individualised, person-centred care?

The best evidence is that gleaned from the source. This does mean the non-trivial task of juggling subjective and objective health. It means engaging with the patient and community. It means that the best evidence for care should also be timely. This may be a fuzzy form of EB(x), but in contrast to the steel bearing that EBM can often present, there are plenty of hooks that can make a real difference.

Source:
Sullivan, M. (2003). The new subjective medicine: taking the patient's point of view on health care and health. Soc. Sci. Med. 56(7), 1595-604.

Resource:
http://www.pickereurope.org/

Image sources:
(were listed.)

W2tQ shortlisted for Computer Weekly IT Blog Awards!

...

Voting is 'now' closed... :-)

This is a really amazing development.
Thanks to the CW team for the recognition!
And in anticipation of our visitor's votes!
It's great to see that Rod Ward is also listed informaticopia
Nursing & Community Informatics - let's spread the care!

h2cm - supporting reflective practice

Image source (formerly): http://www.funkyfurnitureandstuff.com/FunkyMirrors.html

Socio-technical ticket stubs

Psychologists are a busy bunch. The number of tests, assessment schemes and theories to help explain intrapersonal and socio-political phenomena are legion. All strive to be scientific, constantly refined and evidence based.

It was recognised a long time ago how we humans have a tendency to polarise, dichotomise - left-right, good-bad. ... We have to dice and slice the world in order to make it accessible and understandable. Life and death decisions have always depended upon this ability, which is one of the reasons why we're all here today.

This vital capacity also assures the creation of socio-technical structures. A ticket that provides entry to several problem domains, each with two, three, four, five .... viewpoints. And as safety dictates there are at least two entrances-exits.

The problem is of course that as is customary only half the ticket is actually 'used'. So many stubs end up on the floor. Such a waste.

Make sure you use and retain yours. Happy memories of a project well done!