Hodges' Model: Welcome to the QUAD: autonomy

Hodges' model is a conceptual framework to support reflection and critical thinking. Situated, the model can help integrate all disciplines (academic and professional). Amid news items, are posts that illustrate the scope and application of the model. A bibliography and A4 template are provided in the sidebar. Welcome to the QUAD ...

Showing posts with label autonomy. Show all posts
Showing posts with label autonomy. Show all posts

Thursday, February 19, 2026

2026 Lancaster Philosophy of Psychiatry Work in Progress Workshop

I am looking forward to, and preparing for this event next week:

====================================================

Thursday 26 February 2026, 11:00am to Friday 27 February 2026, 3:30pm

Venue: Storey Lecture Theatre, Lancaster , LA1 1TH
Open to: Postgraduates, Staff

Event Details:
 
Sponsored by the British Society for the Philosophy of Science.
This workshop provides an informal forum where PhD students, and more experienced researchers, can present and discuss short works in progress. All paper slots are taken for 2026. 
Please email r.v.cooper AT lancaster.ac.uk if you'd like to attend.
THURSDAY 26th  FEB

10.45-11 Welcome
11-11.30 Hane Maung - Philosophy in Healthcare Practice: A Case Study.
11.30-12 Peter Jones - Hodges' model: A work-ALWAYS-in-progress and this is why...
12-12.30 Matthew Williams - The failure of the harm-minimisation argument for BID Surgery and the necessity of therapeutic justification
12.30-1 Clive Duddy – Autonomy in mental health care
1-2 LUNCH
2-2.30 George Turner - Difference denied.
2.30-3 Dieneke Hubbeling - Different ways of medical knowing in Walzer's different spheres of justice?
3-3.30 Ali Walker - Forget Fictionalism: Psychiatric Disorders are Quasi-Real
3.30-4 Ewa Grzeszczak - Philosophy of psychiatry and the methodology of social ontology.
4-4.30 Break
4.30-5 Alessandra Civani - What kind of concept is ‘incongruence’?
5-5.30 Anna Golova - Self-illness ambiguity without a self-illness distinction.
5.30-6 Break
6-7 Prof Miriam Solomon – Royal Institute of Philosophy talk ‘Stigma as an actant in the history of psychiatry’

FRIDAY 27th Feb
11-11.30 Sam Fellowes - Modelling psychiatric diagnoses when self-diagnosing - how does this work?
11.30-12 Giulia Russo - Epistemic and political role of experience
12-12.30 Frank Denning - Using Stebbing’s Directional Analysis to Evaluate ‘Mentalizing’.
12.30-1 Gloria Ayob - Flourishing as mental health
1-2 LUNCH
2-2.30 Richard Hassall - Hermeneutical Injustice and Damaged Intellectual Self-Trust in Psychiatric Service Users.
2.30-3 Lara Calabrese - Exploring epistemic injustice in dementia care: a scoping review and a qualitative study
3-3.30 Jacob Barlow - Epistemic borders: experts, communities, communication

<>

Friday, August 02, 2024

The 'future' ... it's up to you* (i)

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

Chief Future Self-Care Officer





Chief Future Officer - CFO


*Well not entirely! ii to follow.

My source: TV - https://www.bloomberg.com/btv/series/chief-future-officer

Friday, June 28, 2024

Call for Papers for Special Issue "Philosophy and Disability"

"HUMANA.MENTE Journal of Philosophical Studies"

https://www.humanamente.eu 

Call for Papers for Special Issue "Philosophy and Disability"
Editors: Brunella Casalini; Chiara Montalti

deadline for submissions: 30th September 2024

In the past fifty years, the concept of disability has productively transcended the medical, psychiatric and rehabilitative domains. It has been defined, to name some examples, as the result of social exclusion, as a cultural trope, as a territory of political struggle and resistance, as a multi-faceted experience that emerges from the several inter-relational aspects of daily life, or as a neutral or even positive space.

Since Disability Studies is a trans-disciplinary area, the research on disability has benefitted from the contributions, methodology, and conceptual tools of many different fields. Disability has been explored from the perspectives of Sociology, Art, Anthropology, Law, Literary and Cultural Studies and the Humanities at large.

Regarding the latter field, it has been pointed out that disability, even though not always explicitly addressed, “pervades” nonetheless “language and literature”: as a concept, as an image, or as a metaphorical crutch (Mitchell, Snyder, 2000; Snyder, Brueggemann, Garland-Thomson, eds., 2002). Despite this intrinsic abundance, however, disability is still largely unrecognised as a topic of academic interest, especially in the Humanities, in what David Bolt and Claire Penketh define as a form of “disciplinary avoidance” (2015) – the reasons for which should be investigated.

The scholars and researchers would therefore be invited to deepen our understanding of the possible intersection between Philosophy and disability. They would be invited, on one hand, to examine how Philosophy can be a suitable starting platform in order to address several issues related to disability, and, on the other hand, to explore how the analyses on disability may significantly impact Philosophy. We aim therefore to bring forth philosophical inquiries that investigate, among the possible topics, disabled people’s lived experiences; emerging ethical challenges; social and political implications of ableism; theoretical foundations of disability, examined through a philosophical lens.

The Special Issue aims to explore a wide range of philosophical topics related to disability, including but not limited to:
I) Examinations of various philosophical perspectives and frameworks for understanding disability, including the social model, the cultural model, the relational model and the capabilities approach.

II) Ethical considerations concerning disability, such as questions related to autonomy, dignity, justice, violence, and the ethics of care.

III) Epistemology inquiries into how disability affects knowledge, perception, and cognition.

IV) Explorations of disability's influence on art, aesthetics, and the perception of beauty.

V) Discussions on disability rights, social policies, and disabled people’s participation or exclusion from citizenship.

VI) Phenomenological analyses of lived experiences, that include the embodiment of disability and the material encounters with the world. Philosophers’ first-person experiences and accounts would also be positively valued in this regard.

VII) Analyses of the role of disability in language, in the discursive realm, in the creation of meaning, and in the construction of metaphors, including the investigation of how philosophical language and theorization could contribute to ableism, disablism, and disabled’s people exclusion.

VIII) Investigation of disability through the lens of humanism and/or its critical stances (Anti-Humanism, Philosophical Posthumanism, Transhumanism, New Materialisms, and so on).
Intersectional analyses, which explore how disability interacts with, and impacts, other social categories such as race, gender identity, sexuality, and class, would be greatly welcomed. Furthermore, contributions could cover a wide array of historical and geographical frameworks, from Ancient Philosophy towards Contemporary Philosophy – not only from a Western perspective.

Information

Deadline for submissions: 30 September 2024

Publication of the Special Issue: July 2025

We anticipate that submissions will come both through solicitations and this open Call. Papers should be between 8000 and 10,000 words (including abstracts, footnotes, and references). Only papers in English will be accepted. For further information do not hesitate to contact the editors (brunella.casalini[at]unifi.it; chiara.montalti[at]unisalento.it).

My source: 
Philos-L "The Liverpool List" is run by the Department of Philosophy, University of Liverpool https://www.liverpool.ac.uk/philosophy/philos-l/ 
Follow the list on Twitter @PhilosL. Follow the Department of Philosophy @LiverpoolPhilos 

Tuesday, November 15, 2022

My Body, My Decision: Accountability for Bodily Autonomy and Self-Care in a Rapidly Changing World

 Dec 6, 2022 08:00 AM in Eastern Time (US and Canada)

Bodily autonomy and decision-making are critical for the realization of everyone’s sexual and reproductive health and rights and are the cornerstone of self-care. Join the SCTG Country Advocacy Working Group (CAWG) for an in-depth discussion on mechanisms and strategies to promote accountability for bodily autonomy, agency, and self-care. What have been opportunities and challenges for the Generation Equality Forum to mobilize action in these areas and how can we strengthen accountability for local impact? What are examples of successful advocacy and accountability efforts to enhance bodily autonomy and self-care at the country level?

Find the answers to these questions and more at this virtual, SCTG CAWG event organized by White Ribbon Alliance, CEHURD, Fòs Feminista, and Global Fund for Women.

Live simultaneous interpretation in French and Spanish will be available

Topics & Speakers

  • Co-designing a feminist accountability initiative to hold governments to account for Generation Equality Commitments
    Emilia Blancarte Jaber, Global Fund for Women
  • Advocacy milestones for institutionalization of self-care and Generation Equality Commitments. A case study from Uganda

Annah Kukundakwe, CEHURD, Uganda

  • Implementing innovative models of self-managed abortion and responding to the needs of the most marginalized: Lessons from Latin America

Nina Zamberlin, Fòs Feminista, Argentina


About the Self-Care CAWG


The Self-Care CAWG is a dynamic forum for sharing effective approaches, promising practices, and lessons learned on policy and advocacy efforts to advance self-care at the country level. CAWG is housed under the Self-Care Trailblazer Group (SCTG) and is chaired by SCTG member White Ribbon Alliance. Each quarter, the CAWG meets to explore a theme of wide relevance to self-care advocates, including building off topics covered in the 2021 Self-Care Learning and Discovery Series. ...

My source:
IBP Network Global

Saturday, October 29, 2022

Gaia and Philosophy – international seminar

Dear all,

Here is the program for an upcoming international symposium: 

Jean Michel Etchecolonea, CC BY-SA 3.0 via Wikimedia Commons / Cropped
Jean Michel Etchecolonea, CC BY-SA 3.0 via Wikimedia Commons / Cropped
Gaia and philosophy

1-3 December, Donostia – San Sebastián
Basque Country University (UPV/EHU)
Organised by IAS-Research – Outonomy project

 

The recently edited volume of James Lovelock's and Lynn Margulis scientific correspondence will be presented for the first time at the occasion. Different lectures will discuss the scientific and philosophical status of Gaia theory and contemporary approaches to the understanding of the Earth as a self-organised entity. 

The seminar will be available to follow online. Feel free to distribute to however might be interested.

Registration form.

best regards
Alejandro Merlo 

---
IAS Research Centre for Research on Life, Mind and Society
Department of Logic and Philosophy of Science
University of the Basque Country UPV/EHU

---

n.b. I plan to attend online.

Friday, April 22, 2022

Ageing with Smartphones in Urban Brazil

UCL Press is delighted to announce the publication of a new open access book that may be of interest to list subscribers: Ageing with Smartphones in Urban Brazil, by Marília Duque.

Download it free: https://bit.ly/3MhgteU

*************************************************

Ageing with Smartphones in Urban Brazil

By Marília Duque

*************************************************

With people living longer all over the world, ageing has been framed as a socio-economic problem. In Brazil, older people are expected to remain healthy and autonomous while actively participating in society. Based on ethnographic research in São Paulo, Ageing with Smartphones in Urban Brazil shows how older people in a middle-class neighbourhood conciliate these expectations with the freedom and pleasures reserved for the Third Age. Work is what bonds this community together, providing a sense of dignity and citizenship.

Smartphones have become of great importance to the residents as they search for and engage in new forms of work and hobbies. Connected by a digital network, they work as content curators, sharing activities that fill their schedule. Managing multiple WhatsApp groups is a job in itself, as well as a source of solidarity and hope. Friendship groups help each to download new apps, search for medical information and guidance, and navigate the city. Together, they are reinventing themselves as volunteers, entrepreneurs and influencers, or they are finding a new interest that gives their later life a purpose. The smartphone, which enables the residents to share and discuss their busy lives, is also helping them, and us, to rethink the very representation of ageing.


Free download: https://bit.ly/3MhgteU

----------------------
uclpress.co.uk | @uclpress

My source: Alison Major 
 
VIRTUAL-METHODS list - www.jiscmail.ac.uk/VIRTUAL-METHODS
 
(It appears there is a series of related texts. PJ)

Friday, February 19, 2021

Editorial: ".. Situating ‘illness narratives’ in recovery and mental health treatment"

"Models that put patients’ narratives at the core could perform as a connecting mechanism that provides a process to take account of ‘personalisation’, which is likely to create a better fit with individual context, structure and the complex diverse realities of recovery-oriented practice and routinely provided interventions." p.1.
 

Khan, N., & Tracy, D. (2021). The challenges and necessity of situating ‘illness narratives’ in recovery and mental health treatment. BJPsych Bulletin, 1-6. doi:10.1192/bjb.2021.4
 
INDIVIDUAL
|
INTERPERSONAL : SCIENCES
HUMANISTIC----------------------------------------------- MECHANISTIC
SOCIOLOGY : POLITICAL
|
GROUP - COMMUNITY - POPULATION
 co-concepts: 'recovery' & ‘illness narratives’-
 ‘Person-directed’ -
Define 'recovery' psychologically (my understanding of this?) -
Acceptability of terms 'service user', 'patient'... -
Patient autonomy* -
CHIME framework:
Connectedness, Hope - -
Identity, Meaning values - -
Symptom reduction & individual recovery? -
Measuring Recovery -
reflection and critical thinking -
personal individual storylines -
'Access' to information -
personal narratives & construction of meaning -
‘narratives on social reality’ -
'Lived experience' Peer Support -
Advanced planning: IF  THEN ... for me ... -
‘palliative psychiatric care’ -
- co-concepts 'recovery' & ‘illness narratives'
- 'Professionally directed’ treatment
- Define ''recovery' clinically (my understanding  of this?)
- Conceptual Framework: CHIME
- -
Connectedness, Hope – optimism, Identity, Meaning – purpose, and Empowerment.
- Symptom reduction & individual recovery?
- pathology, clinicians as ‘chemotherapists' Px pad
- Measuring Recovery
- Mental Health (Min) Dataset (decades) Data?
- h2cm: as simple/complicated as needed?
- - a measure of holism, integration ...recovery?
- - can conceptually encompass all 'spaces'
- h2cm remains a response to legacy issues
- - person-centred care
- - holistic care/ ['holistic bandwidth']
- - integrated care
- COVID-19 a corollary in ‘long-COVID’?
- 'Biology' coercive and  impersonal
Practitioner Socialisation - (learned paternalism?)
CHIME framework:
Connectedness, Hope, Meaning - values
‘Person-directed’
Patient/Carer experience of CPA collaboration -
care planning - -
case formulation - -
and small group work - -
Meaningful illness narratives are a gift exchange:
providing meaning, emotive steadiness - -
narration & collective experience - -
Anthropological models of Recovery -
'Illness behaviour' -
pre-existing underlying relationship between the person and their illness - -
healthspan, health career, career span -
dialogues remain contested: patiency, recovery -
‘authentic alliances’ -
- 'Professionally directed’ treatment
- 'Recovery' spans Quality and Quantity
- Professionals ‘mainstream’ recovery concepts to their advantage?
- Recovery-orientated practice guidelines for service provision include:
--personal recovery
--recovery-oriented services
--provider competencies
- *Patient autonomy: can it be 'exercised' here?
- CHIME framework:
- - Empowerment, Identity (am I seen/heard here?)
- Care Programme Approach as Policy c.1991...
- - Assessment, Care plan, Review, Care Coord.
- - Role in Personalisation & Recovery?
- ‘Illness management’ 'Illness problems'
- ‘corporate’ recovery/criticism

  

My source: Twitter

'Recovery' on W2tQ:

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

Jones (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. Int J. of Person Centered Med. 3,4,305-311.

Monday, May 18, 2020

"Care Package" 4 the C.21st ?

"The CARE Package was the original unit
of aid distributed by the humanitarian organization
CARE (Cooperative for Assistance and Relief Everywhere)."
individual
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group - population

Disaster Conflict Refugee context?
Individual choices - 
facilitating autonomy 
whenever possible - Sign Language?
Mental health Care Plan
includes relapse prevention /
 Staying well / Self care
Mental capacity / Decision making
Physical health check
Patient Reported Outcomes*
Specific management of medication - lithium, psychotropics and safety completed and health literacy demonstrated with support if needed.
Making Every Contact Count -
in every care context
Psychological therapies 
One narrative: told recorded once
Cognitive access:
Health Information
Access to my health record
My Care - Why?
Understanding, Awareness
C[P]-Suite "I Consent" - My data,
Genetic Profile, Reimbursement?

INTEGRATED -
Disaster Conflict Refugee context?
Avoid admission, over-treatment
Quaternary Prevention
Preparation for Admission?
Physical Care Plan
includes relapse prevention /
 Staying well / Self care
If in-patient THEN is medication ordered and ready for discharge? e-Prescription?
Electronic Health Record
Mobility - aids, Transport
Advice / instructions
Wound / 
Dressing management
Making Every Contact Count -
in every care context
Clinic location: urban / rural
 transport 
Virtual - Telemedicine, e-Health
m-Health
Patient Reported Outcome Measures
Patient involvement in Research
Trials
Physical therapies - access
Physical access services/devices?

- CARE ?
Care IN the Community?
Housing :: Homeless?
Pre-discharge home visit -
e.g. Occupational Therapy?
Living alone?
Safety
Carers involved with due 
consent in care planning. 
Engaged in recognition and role of warning signs and actions to follow.
Recovery, Rehabilitation, Reablement
Awareness and shared competency in medication, in event of physical illness.
Patient/Family audit of clinical record: accuracy if/when appropriate BUT check completed.
Plan of care - activities, groups, information, arts, studies, 
volunteering.
Carers assessment
Social care.
Advance (anticipatory) care planning
Progress (this time) PRO*
Introduce respite care, day care, volunteering
Avoidance of admission:
this time :: next time?
[Finance of Health Service Delivery]
Care Package for specific groups / populations / circumstances: 
Forensic, Prison, Homeless, 
Substance Misuse, Veterans
Need for interpreter, advocacy?
Feedback on care experience:
patient and carer(s)
Management of Belongings, Cash
Community care - follow up instigated - introductions made with continuity of care (personnel) were possible.
Communication with (family) GP/Doctor
Out-of-hours services 
and contact details.
Patient & Carer invited to phone
purely as a trial-run.
Law - Policy? 72 hour, 7 Day -
follow-up at home.
Incidents - Complaints? Apologies?
Organisational Learning 
Welfare - Employment
Data capture and reporting of care spell/episode.
De-identified.
Reports submitted stats.
Reporting plans to Public re. Health Services
Public involvement in Services



The above is not comprehensive and in itself begs questions of scope and what is a 'comprehensive' care package?

The mapping above to Hodges' model includes many assumptions - existing health service provision, governance, finance, housing, social infrastructure - social determinants of health and how these are mitigated (if at all).

Monday, September 04, 2017

Ethical concerns: Four principles approach (in Hodges' model)

individual
|
INTERPERSONAL : SCIENCES
humanistic --------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group
autonomy
non-maleficence
beneficence
justice


Noordraven, E.L., Maartje H. N. Schermer, M.H.N., Blanken, P., Mulder, C.L. & Wierdsma, A.I. (2017). Ethical acceptability of offering financial incentives for taking antipsychotic depot medication: patients’ and clinicians’ perspectives after a 12-month randomized controlled trial. BMC Psychiatry, 17: 313. https://doi.org/10.1186/s12888-017-1485-x

Priebe, S., Bremner, S.A., Lauber, C., Henderson, C. & Burns, T. (2016). Financial incentives to improve adherence to antipsychotic maintenance medicationin non-adherent patients: a cluster randomised controlled trial. Health Technology Assessment, 20 (70). pp. 1-122. ISSN 1366-5278 DOI: 10.3310/hta20700

My source:

Gillon (below) highlights a debate that is ongoing and even more acute given the ethical challenges of today. Interesting also that in 1994 attention to scope could provide a level of assurance(?):

Gillon, R. Medical ethics: four principles plus attention to scope. BMJ. 1994;309(6948):184–8.


Monday, May 22, 2017

Wednesday, July 20, 2016

A Checklist for Personhood

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

"Philosophers disagree on exactly what it would 
take for an animal to qualify as a person. 
Kristin Andrews at York University in Toronto, Canada, 
suggests searching for the six attributes listed here." p.17


SUBJECTIVITY
(REASONING) --------------

PERSONALITY

NARRATIVE SELF

AUTONOMY

(OBJECTIVITY)
--------------- RATIONALITY








RELATIONSHIPS





HI Peter,

Oh, that's interesting! I'd move Rationality to objectivity/science, though, as it refers to the ability to engage in logical reasoning, solve problems, etc. There's been a lot of interest recently on the logical abilities of babies (Sue Carey's team) and chimpanzees (e.g. Josep Call's team) and they both seem to be able to engage in exclusion reasoning (i.e. disjunctive syllogism).  I discuss animal rationality in my book The Animal Mind. 

Rationality isn't consciousness; I could add consciousness to the list, but it's there already, just subsumed by narrative self and relationships too.

cheers,
Kristin

___________________________________________________________
Kristin Andrews
Associate Professor
Philosophy/Cognitive Science
York University
4700 Keele St.
Toronto, ON M3J 1P3
CANADA

www.yorku.ca/andrewsk

Rutkin, A. (2016). Almost human? New Scientist, 2 July. 231:3080. 16-17.

Additional link:
BBC Future: 'Wisdom of the crowd'; The Myths and Realities

Sunday, January 03, 2016

Autonomy Cube(d)

OBSERVATION
|
INTERPERSONAL : SCIENCES
OBSERVATION  ---------------------------------------  OBSERVATION
SOCIOLOGY : POLITICAL
|
OBSERVATION




Rosa Menkman from amsterdam, Netherlands, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons

"When installed in a gallery, the cube creates an open Wifi hotspot that uses the alternative Tor network to anonymise internet use."
Jobey, L., (2016)  Trevor Paglen What Lies Beneath, FT Magazine, 2-3 January. p.20.

Trevor Paglen: Autonomy Cube (2014)

Whitechapel Gallery, London, January 29 to May 15.

Photo source: e-flux - Edith-Russ-Haus for Media Art


                             Autonomy-Advocacy Cubed?
     Late 1970s                      1980s-1990s                         2000s...
   Nurse Advocate                 Nurse as Advocate?             Independent Advocacy
                           
             Ongoing nurse advocacy role amid the politics of healthcare...

Friday, October 30, 2015

Down at he-el (parity of esteem)

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


he-


-al



heel
talon

Wednesday, August 19, 2015

Book: The Man Who Closed the Asylums

individual
|
INTERPERSONAL : SCIENCES
humanistic --------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group
The Man Who Closed the Asylums: 
Franco Basaglia and the Revolution in Mental Health Care

Acute care
Physical care







Mental health policy


Another book for the reading list!

Parity of Esteem
a function of:
distance, transparency, opaqueness, answerability, accountability ...?

A related resource on this theme.

Image source: Verso.

My source:
Wise, S. (2015) Taking over the asylums, FT Weekend, Life&Arts, 15-16 August. p.8.

Saturday, February 01, 2014

Care pathways: 15 minutes on Monday - how far is that?

On Monday I have a quick visit for 15 minute slot on care pathways at an interprofessional study day for 2nd and 3rd year students.

After the short presentation I'll ask the question of what difference the students can make to the patient's care pathway. There may be value in continuing the 'journey' metaphor?

They can ensure the care pathway is well-documented (otherwise it doesn't exist, and travel on it never happened) they can check it is accessible (an achievable goal) and that it does not trip anyone up (we don't do - iatrogenic).

There are further tests: is it navigable, tried and tested, a safe (evidenced-based) route? As the student's contemplate a major step in their health career, we really need them to focus on the health career of the persons in their care.

[ There won't be time for this: but do we need to wait until the 'end' for the outcome and capturing that (feedback). Or can do we this verbally, incrementally (positive impact on quality)? ]

I could ask them all to stand and make like sign-posts, but for the risk of poked eyes. It's true though, sign-posting is an important job, but how we do that is another post (the value of self-discovery as learning).

Once medically fit the key thing should be checking the person's (not viewing them totally as patient) wayfaring skills.

OK, who took my care pathway?

Can they read the map (are they health literate)? Can they find a map? Do they have a stay-well, recovery and well-being ... compass (a conceptual framework, an app, care plan)? If there literally is no self-care pathway under the patient at present, then the student can help them and their carer if necessary to find or create this compass - across the required care domains.

THEN this person (potential future patient) can avoid having to step off their self-care pathway and onto the health care pathway. You see there's a risk and a cost in that particular transfer.




Image source: http://www.farlandgroup.com/customer-journey-mapping/

Thursday, January 09, 2014

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).

Saturday, December 14, 2013

H2cm - Beauchamp and Childress (1994) four principles of healthcare ethics

I'm clearing the decks of books at the moment, one of which is McGonigle and Mastrian's Nursing Informatics and the Foundation of Knowledge, Second Edition (2012). I notice a 3rd edition is in preparation.

A review will follow, but in chapter 5 on Ethical Applications of Informatics on page 73 (pb.) the four principles healthcare ethics of Beauchamp and Childress (1994) are mentioned in a very concise, informative discussion.

Although the exercise that follows involves 'putting concepts in boxes', doing so helps us to see beyond the boxes, to see the links between.

Although harm takes several forms it is physical harm (for nonmaleficence) that is most commonly thought of. This is the ethics concerning an individual so why have I placed beneficence in the sociology domain? Justice should be straight forward, but only if reinforced by law, and then only if that law is exercised. Autonomy should be straight forward. I must have the mental capacity, the insight to have choices. In the eyes of others these choices may be rationale or irrational. Although justice is place in the political (group / population) domain, rights are ascribed to individuals. This is useful property of Hodges' model the way that the individual and their mental life are diametrically placed (opposed?) and linked. It is others who are having determine the ethics of a given case, evaluating what is in the person's best interests; also having to take into account any advanced directives, or living wills.

What do you think? If you have some comments, can improve this or feel there is a correspondence here please let me know.

INTERPERSONAL : SCIENCES
SOCIOLOGY : POLITICAL

individual
autonomy nonmaleficence
beneficencejustice
group - population

  • Respect for autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
  • Beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
  • Non-maleficence - "first, do no harm" (primum non nocere).
  • Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
Above text:

Friday, October 26, 2012

End of Life Care (Pathways), Nursing and Thresholds

There is a controversy (was in Telegraph) that has been growing for some time, concerning the Liverpool Care Pathway for end of life care. This is a very demanding and yet rewarding aspect of nursing. I have experience of end of life nursing care in a non-specialist capacity, having worked on wards for older adults and being involved with people who have mental health and life-threatening physical health problems.

It pains me greatly not just as a scouser that something with 'Liverpool' in it should become a cause of distress, a center for debate and review. Is the pathway green and shady? Is it comprised of stepping stones, with room for two, and with time granted for your next step? Or is there a danger in some instances the path can become tarmac clad, without the succor of a services stop for basic sustenance? Can a pathway become a motorway? What does that sign say? "DON'T HOG THE MIDDLE LANE!"

What pains me seriously is that what can be a invaluable, evidenced based palliative care resource can be undermined due to the complexity of the generic and palliative care situation.

If we truly practice person-centered care then there are no care pathways.

Or, to put it another way: there are as many care pathways as there are patients and carers.

Whether you believe in social medicine, or private; whether you are laissez-faire, or leave such matters to a higher power there is no escaping the need for organisation - for order.

The mix and concentration of people, knowledge, resources and time dictates that tasks, roles and processes be delineated and assigned. We need to assure a given level of quality, and to predict things, not everything is as difficult as the weather: or death. Pathways can assist in specific contexts.

Is there scope for personalisation on a pathway? ...

Steps and pace can vary and to the left and right of center. There are many pathways though: some valid - evidenced, award winning; while others might be broad, narrow, twisted - to become a disorientating ethical loop...

Being placed on a pathway denotes a decision point, a threshold. We need to remember in all fields of health and social care practice that there are multiple thresholds to be taken into account, communicated effectively and revisited:

INTERPERSONAL : SCIENCES
SOCIOLOGY : POLITICAL

'me' - existence, resilience, assets,
personhood, ethics, personal values, mood,
personalised care, understanding of treatment,
communication skills, self-expression,
loss, orientation, observation, distress, psychological assessment, sedation,
beliefs, choices, :theology
PURPOSE
'me' - existence,
feeding, nutrition, fluids, 
evidence base, Liverpool care pathway,
quality of life measures, referral thresholds, prediction, resilience, reductive - holistic assessment, medication, distance, where: home-hospital-hospice?
pain management, decision locale,
specialism, basic nursing care, resilience
PROCESS

memories, good-byes,
love, compassion,
carer under stress, reassurance, counselling skills, meetings with family,
empathy and rapport, patient and relative engagement, life history,
relative's recognition that loved one is dying,
care strategies,  patient experts,
patient - carer experience,
communities of PRACTICE

consent, advocacy, mental capacity, 
integrated working, effectiveness, independent autonomy, service access, bed availability,
health & nursing in the media, scope of nursing, scope of medicine, law, medicolegal issues, whistleblowing, complaints, formal review, appeals, organisation, argumentation,
professionalism, ageism,
POLICY (re-PURPOSED)

The relative position of concepts above does not indicate priority.

"The LCP is not the answer to all our needs for care of the dying but is a step in the right direction."
Marie Curie Palliative Care Institute
Liverpool Care Pathway for the Dying Patient (LCP)

Friday, June 01, 2012

Hodges' model in Murphy & Welford (2012) Agenda for the future: enhancing autonomy for older people in residential care. Int. J. of Older People Nursing

ABSTRACT: This is the concluding paper of a three paper publications. Paper 1 focused on specifically understanding what autonomy for older people in residential care means. Paper 2 discussed the various factors that either facilitate or hinder residents autonomy and directed readers to reflect upon their practice. This final paper outlines the findings from the action research phase of a study aimed at enhancing resident autonomy. It describes just one way in which residential care units can work on enhancing residents autonomy and enables the reader to reflect upon nursing practices, which with the right approach can be resident-centred.

Murphy and Welford write:

Hodges (1997) model is essentially concerned with the person (resident) in a social context. The notion of it derives from the intervention of the nurse being future orientated, increasing the health choices, health chances or health prospects of individuals or groups (including families) taking cognisance of the biography of the person or persons being helped. The person already has a biography that has been influenced by their physical and psychological make-up, the kinds of families and social networks they have experienced and the culture or geographical location in which they live. The nurse then is also influenced by personal factors of their individual physical or psychological origin and factors relating to their social world and the policies that govern their daily life. The nurse (assessor) must take cognisance of the attributes the person (resident) brings with them in their current presentation (problem) and how this affects their future choices both in terms of ability to make them and the range of choices available. Thus, this approach to care planning recognises the importance of negotiating care.  (online source - see doi link below)
I am not just very grateful to Murphy and Welford for their adopting Hodges' model in their study, but this supports my own use of the model in teaching staff about person-centred care and communication skills in residential and nursing care homes. The inclusion of a political domain and individual and group (populations) dimensions is a great asset in this context. Their conclusion also identifies the limitations of individually directed change, something that seems apparent from my own experience in nursing home liaison.
 
Murphy, K., Welford C. (2012) Agenda for the future: enhancing autonomy for older people in residential care. International Journal of Older People Nursing. 7, 75–80. doi: 10.1111/j.1748-3743.2012.00309.x

Thursday, March 08, 2012