Nursing observations: the need for Political inoculation in "Intro 101"

"Hockey's (1989b) typology of nursing activities as consisting of autonomous, derived and delegated elements suggests we should focus on the interventions which are initiated as well as undertaken by nurses. This is the core of nurses' work. It is what nurses do which is not done by other people. Nursing has always found it difficult to describe this core. Goddard's (Nuffield Provincial Hospitals Trust 1954) choice of the term 'basic' to describe this element of nursing work has had a disastrous influence not only on nurses' perceptions of the value of their work but also on the way in which nursing is regarded by other professional groups. It has been suggested that the term was used as a shorthand for 'fundamental' or 'essential' and that is has been systematically misinterpreted over the last three decades* by those who wish to use it to justify the horizontal division of nursing labour. Goddard demonstrated that basic nursing was undertaken by the least qualified and the lowest skilled. This observation might have sparked off a revolution in the delivery of nursing care but instead it has been and is used to justify the continued employment of unskilled labour in direct patient care." p.128.

*My emphasis: "... over the last three decades .." hence, since the early 1960s.

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

"The struggle between the twin poles of professionalism and bureaucracy is mirrored in that between the holistic, therapeutic approach in nursing, and that which is reductionist and functional (e.g. the task-centred approach to care). To work successfully in such a climate demands considerable skills of nurses, for they must seek to change the nature of the organisation, or at least to neutralise its effects so that they can concentrate on therapeutic practice. Amongst these skills must be those of change agency." p.107.

"Much of health care and particularly nursing is still organised along hierarchical and bureaucratic lines. To work professionally in such a system may in some way be seen as a contradiction in terms. The nurse may seek to exercise professional autonomy and make decisions about patient care (and indeed the organisation may seem to be encouraging him or her, at least superficially, to do so). Yet at the same time the nurse receives conflicting signals as others endeavour to exercise control over nursing practice such as doctors, senior nurses, finance directors, supplies officers and so on." p.107.

In this book's final chapter: Paterson and Zderad's five Phases of Phenomenological Nursology.^

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

1. Preparation for the nurse knower coming to know. (Hodges' model as a template - 'clean slate' also facilitating unconditional positive regard - openness to a new encounter - whether the first or subsequent.) 2. Nurse knowing the other intuitively. (Intuition still has a role. A message: speak to a colleague - seek supervision!)

3. Nurse knowing the other scientifically. (Reductionism is needed yet balanced with the humanistic esp. as the march (float ...) of the robots/AI follows apace.)

4. Nurse complementarily synthesising known others. 

(This is a purpose for Hodges' model, supporting the user to identify salient concepts and the relationships between them and their quality; then to reflect, think critically and move towards formulation.)

5. Succession within the nurse from the many to the paradoxical one. 

Nursing as Therapy

  (Tied to #4 above, but can emphasize health education, health literacy, co-production and co-creation with the patient - client. A collapse - in the synthesis with simultaneity of the individual and collective. Arriving at a conclusion and for the future of Hodges' model in theory and practice: an abstraction.)

Paterson J.G., Zderad L.T. (1976). Humanistic nursing. New York: John Wiley. 

The conceptual scope of Hodges' model is demonstrated in how it can encompass other (all?) models of care and frameworks, including humanistic nursing.

McMahon, R. and Pearson, A. (1991) Nursing as Therapy. London: Chapman & Hall.
^Chapter 8 - Breaking the mould: a humanistic approach to nursing practice. pp.170-191.

Bought secondhand, 'Nursing as Therapy' caught my attention as I have read and wondered about 'assessment as therapy' across disciplines.

'Pad culture' ...

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

DEMENTIA SELF ORIENTATION - INSIGHT Listened to .. 'Hear me'? dignity and respect Mental capacity (awareness?) emotional distress Appears confused - Physical cause: dehydration, delirium..? [A shared convenience?: How many persons are assumed to be diagnosed with a dementia?]	in-CONTINENCE Place: [Home, Community Hospital, Residential care, Nursing Home] IT/Record systems 'Parity of Esteem' i Mental Health and Physical health 'Parity of Esteem' ii [Mental Health and Physical Health] AND Social Care Time: ASSESSMENT, Care Plan, Evaluation ...
'Pad Culture'	'My Pad' Culture - buy/sell £££ $$$ Standards of Care Nursing - Social Care policy - funding

File on 4 BBC Radio 4 21 June 2022 - 20:00hrs

Dementia: The Final Indignity

"Around 800,000 people have dementia in the UK. For those suffering from the illness, incontinence can often be seen an inevitable consequence - but that’s not always the case. Deemed as too embarrassing or taboo, it’s a topic that rarely hits the spotlight. Experts say preserving someone’s ability to go to the toilet is crucial to maintaining their dignity and quality of life and should be a priority in care settings. But is that always happening? A new report shown exclusively to File on 4 has looked at how continence care is being managed in hospitals – and how, in some cases, those who are continent are actively encouraged to soil themselves. Datshiane Navanayagam speaks to families who say their loved ones were ignored when it came to their continence needs in hospital and that the consequences have left them with health issues and requiring additional support. Nurses and medical staff say that continence training is often seen as a ‘Cinderella subject’. We also hear from dementia patients themselves about why maintaining your own dignity and independence is so crucial with this disease. With the government set to reveal a new dementia strategy this year, will continence care be placed higher up the agenda?"

Featherstone K, Northcott A, Boddington P, Edwards D, Vougioukalou S, Bale S, et al.
Understanding approaches to continence care for people living with dementia in acute hospital settings: an ethnographic study. Health Soc Care Deliv Res 2022;10(14). https://doi.org/10.3310/
QUVV2680

 
Source: Today BBC Radio 4, 21st June, 2022.

Nurse - Health - Education Theorists and Researchers: A question ...

The theoretical and practical basis for Hodges' Health Career - Care Domains - Model

[A living project or all Petered out?]

1. Assumptions underlying the conceptual model are made explicit.

Please see below:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

INTRA- INTERPERSONAL domain	SCIENCES domain
SOCIOLOGY - CULTURE domain	POLITICAL domain

2. A complete description of all four concepts of nursing's metaparadigm* are presented.

*person, environment, health / illness and nursing

 

Please see, or search - the relevant tags on this blog for posts on the above concepts and the bibliographical listing.

 

If in addition you would be interested in addressing this assumption specifically please get in touch.

 

3. Propositions of the conceptual model completely link the four metaparadigm concepts.

 

 

Hodges' model can be used to do this and link the health and related challenges as exemplified in the sustainable development goals.

 

4. The internal structure of the conceptual model is logically congruent.

 

 

As required, Hodges' model could utilise several 'logics' applicable across disciplines, domains and contexts; the challenge would be the interface and translation of logics and criteria by which 'congruence' is evaluated?

 

5-7. The conceptual model is socially congruent, socially significant and socially useful.

 

 

There are numerous posts on this blog that (to varying degrees) address assumptions 5-7 and in the bibliography to date.

 

8. Empirical evidence in support of the model has accumulated.

 

In 2020 it was encouraging to learn of two new papers - listed in the bibliography [sidebar] - the authors of which applied Hodges' model.

 

As noted above if I can help you apply Hodges' model, or assist you please let me know.

Fawcett, J. (1984). Analysis and evaluation of conceptual models of nursing. Philadelphia: Davis.


My source:
Personal notes c. 1988.

Care with a Smile: For a Smile in Care Homes

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Self-esteem, self-image anxiety, worry, depression Able to express needs communication Ability to ask, remind, argue - self-advocate Challenging behaviours, agitation, aggression Irritability, poor sleep reduced attention and concentration Observation of staff - pain? Loss of dentures, memory

Changes in gums, gum disease, weight loss cleaning teeth, false dentures, fit, marking dentures, care plans Access to toothbrush, toothpaste, mouth wash, Oral hygiene Sugar – sweets (one of few pleasures?) Risk of thrush and other infections (cardiac?) Mobility of the resident Appearance and sense of well-being Pain of toothache, analgesia – tiredness Avoiding eating and drinking properly Access to dental surgery Changes with speech Equipment challenges of remote care, technology changes Mobile clinics

Responding to expressed distress - whether explicit or implicit (listening - caring) Confidence. Isolation Avoiding other people. Having friends and family to advocate for dental care Impatience with others, argumentative, shouting Family expectations

Guidelines Commissioning of dental care in the residential / nursing home sectors Local authorities, Health, CQC Asessment - Evaluation Referral process Staff  awareness and knowledge The nursing home make the referral? The family must make the referral? Payment National standards Domiciliary visits paid in advance. Dental service packs packs circulated to residential and nursing homes across a Region. Global access to Dental care?

NMC Code and Guidance on using social media responsibly

NMC: Guidance on using social media

In March the Nursing & Midwifery Council published a new Code for nurses and midwives.

There is also guidance on the use of social media for this group of health professionals.


https://www.nmc.org.uk/standards/guidance/social-media-guidance/

Social Care is dry in January

I bought The Times today and on the front page is the news from University of Oxford:

Dehydration ‘common’ among patients admitted from care homes:
http://www.ox.ac.uk/news/2015-01-16-dehydration-%E2%80%98common%E2%80%99-among-patients-admitted-care-homes

When nursing and residential homes are struggling to manage an individual's care and look to refer to mental health services (usually) they know they need to asked the 'question'. This is about physical health: does the resident have an infection, are they eating and crucially drinking, are they in pain, constipated. ...

Although the headline augers badly and points to an ongoing (politically) 'inflammatory' problem within the sector, there is a great deal of compassion out there.

A resident's marked emotional distress and torment can upon investigation become a matter of how to also manage the staff's distress as they try to meet the individual's care needs. The latter does not help the former and amongst other things points to an educational need. This is especially so, if residents are to be able to continue to 'age' in their new 'home' with the additional complex needs that might follow.

Fluid balance used to be an element of basic nursing care.

Now of course - social care is not nursing care.

It is not always 'basic' either.

HCA training: Knock, knock, knocking on the political domain's door

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

individual

emotional care	physical care
social care	FRANCIS - a year on:  How much training do healthcare assistants have before their first shift on a ward? 25% = none

group - population

Although that 25% sits nicely in the POLITICAL domain, what is the impact of this finding across the domains overall? Whether or not the impact is equally shared across the interpersonal, sciences and social domain, upon which domain will it end up knocking?

Calkin, S. (2014) Francis impacts on culture and patient safety, HSJ, 7 February. 124, 6376, 4-5.

International Nurses' Day 2013: "The drama of it All"

There is a new nursing drama series starting on BBC TV next week - Frankie:

District nurse Frankie Maddox is a saint. At least she would be if it weren’t for her fondness for red wine, loud music, ghastly singing and fast cars.

Whether it’s an elderly man with dementia, a pregnant woman whose husband is on duty in Afghanistan or a sickly young child who’s never at school, nothing is too much trouble for this caring, smiley character. “Why do you always insist there’s something we can do, when sometimes there isn’t?” snaps Dr Evans (Jemma Redgrave). Because “the world is my patient,” Frankie explains, although she has the grace to grimace after delivering such a clunking line (from Radio Times).

That line may be clunking as a piece of dramatic prose, but there is a need to make some noise that extends beyond nursing's one-to-one encounters.

We are well aware of the challenges that the NHS faces, the themes are well known and read like a script that is increasingly played out on wards, the media and in parliament. The latest playwright is Francis. This is the drama we cannot ignore locally.

What of nursing globally on IND 2013?

The nursing communities within the various nations must also listen to the world. We can make a difference as individuals by challenging our often parochial perspectives; by trying to travel, seeking to engage with others electronically and learn what global nursing organizations are doing on our behalf.

Best wishes to nurses everywhere.

International Council of Nursing

Global Alliance for Nursing and Midwifery Communities of Practice (GANM)

Global Health Network

HIFA[2015] ‘Healthcare Information For All by 2015

Global Health Workforce Alliance

'Nursing the Nation' poem Molly Case at RCN Congress 2013

The past fortnight has been quite intense in terms of conferences and the focus upon nursing education; plus as was pointed out to me I travelled from Jordan to Jordanstown. The conference in Jordan began with a beautiful prayer and I heard of this poem while away:

2013 Year of Piri Reis & Navigating the world of nursing care - in Jordan

The conference in Jordan is over it has been an intense and excellent two days, with a free day tomorrow. It has been a brilliant opportunity to share and learn not just about nursing, but travel, culture and some of the people that make up the global nursing community.

I am truly grateful to the Jordanian Nursing Council for accepting my abstract. The welcome and hospitality has been truly amazing.

In the flight magazine on the way here there was an article about Piri Reis, which reminded me of Paul Cunliffe's book about Pytheas.

From the UNESCO website:

The United Nations Educational, Scientific and Cultural Organization (UNESCO) has agreed to declare 2013 the year of Piri Reis on the occasion of the 500th anniversary of a map he drew up that included seven continents, reported the Anatolia news agency. 

“This map marks a significant event in the history of the country and has enabled its collective knowledge to be transmitted through generations. As a rare world map from the 15th and 16th centuries, Piri Reis World Map is an invaluable piece of the world's documentary heritage as it provides insight on the history of its time. It is therefore part of the Memory of the World and should be made better known,” stated UNESCO.

The world-renowned Ottoman captain and cartographer Reis is best known for world maps and charts collected in his “Kitab-ı Bahriye” (Book of Navigation).

Source: http://www.todayszaman.com/newsDetail_getNewsById.action?newsId=294065

Source: http://en.wikipedia.org/wiki/Piri_Reis_map

I have written before about Hodges' model as a map -

a cognitive periplus 

- for navigation through the complex world(s) of health and social care.

Would a new mariner take to the sea without a clear sky, a compass, map, or satnav? What then of our students?


Additional link: Please see the entry for Iran -

http://www.unesco.org/new/en/unesco/events/prizes-and-celebrations/celebrations/anniversaries-celebrated-by-member-states/2013/

"The Deprofessionals" BBC radio4: nursing, teaching and social work

Driving to Milton Keynes late afternoon for DTMD2013 Mon-Weds, I listened to a BBC radio 4 programme about the political assault on several public professions - The Deprofessionals

What does it mean to be a professional today, at a time when the public services are in a state of turmoil?
Time was when a professional was easily recognised for what he or she did by virtue of their qualifications and experience, when their competence could be measured against ...

It should be available for the next week.

When I think about community mental health nursing since 1985 I can identify with many of the points raised. How the role has changed, the former therapeutic skills focus, the change in skill mix, the advent of Agenda for Change and the existence of staff who may miss being clinically 'banded' altogether.

Inaugural Symposium on Person-centredness in the Curriculum May 2nd - 3rd

Dates
Thursday 2 May and Friday 3 May 2013
(starting at lunch time on 2 May with a full day on 3 May)

Venue
Loughview Suite, Jordanstown campus, University of Ulster, Northern Ireland

The School of Nursing at Ulster has a strong tradition of national and international leadership in the field of person-centred practice. The Institute of Nursing and Health Research at Ulster incorporates the Person-centred Practice Research Centre directed by Professor Brendan McCormack. Against this backdrop the School has been developing a programme of work with a focus on person-centredness in nursing education. It is our contention that in order to achieve maximum effect in practice, person-centredness should be embedded within and across all programmes of education for health care professionals.

This year the School of Nursing at Ulster will host its Inaugural International Symposium on Person-Centredness in Nursing Education. The one and a half day symposium will include presentations and workshops that will appeal to those involved in nursing education in academic and practice settings.

Symposium themes 
The three key themes of the symposium are:

• To explore ways of infusing a culture of person-centredness through effective, contemporary higher education
• To share innovative approaches to the facilitation of person-centredness in practice learning
• To reflect upon how the experiences of teaching teams and service users and to consider how these can shape educational approaches and teaching strategies

Target audience
The symposium will be of interest to colleagues who have an interest in promoting person-centred practice through education in practice or academic settings.

To reserve a place or for further information please contact:
Julie Cummins at the Institute of Nursing and Health Research

-----

I plan to attend this event on a topic central to h2cm.

Manet & the art of nursing - never unresolved: (and The Francis report)

Yesterday I travelled to London for a nurse related meeting and used the opportunity from 8pm - 11pm to take in the Manet exhibition at the Royal Academy of Arts. Brilliant! It is a great event. There really is no comparison apart from the very high resolution close examination that our technology makes possible; but then that is a difference experience, a different purpose.

Manet's work at the RA includes paintings that do appear unfinished. Areas of the canvas being unresolved brings home the relationship and dependency of the artist with the subject, and the artist's approach to portraiture. Manet was quite demanding on his subjects apparently and while not completely averse, he did not routinely rely on the new opportunities that photography afforded. Here are some thoughts from the Art Fund website:

'Summer' or 'The Amazon', by Edouard Manet

Manet was a great risk-taker and critics of day rallied against his inconsistent approach, as you will see many of the works seem 'unresolved' or 'unfinished' but one of Manet's great skills was this ability to stop painting at the right moment, and it is this technique which gives the works a sense of movement and life.

Manet once said to his friend Antonin Proust, 'I must be seen whole. Don't let me go piecemeal into the public collections; I would not be fairly judged.' This exhibition, which brings together the largest selection of works by the artist to be exhibited together in a UK museum, is a great opportunity to judge Manet's extraordinary talent as a 'whole'.

In nursing we are accustomed to impatient patients. Many though have no choice but to 'sit' and 'lie'. They are static, not able to walk or run away.

Unconscious patients - we speak to them: redrawing the outlines. Searching verbally where we cannot go, reaching for the centers of personhood. We sculpt them back to their optimal health. Sometimes the brush strokes are urgent, sometimes we improvise with touch.

All the time an ideal: a portrait of care. No matter how busy we are basic nursing care should never remain unresolved.

That part of the canvas is always completed. The outline is integrated. The horizon, foreground, middle and background may be sketchy in the extreme cases, but the real mission critical bases are covered.

What we should never countenance, collude, or indirectly sanction are the cutting of those bases.

If we do the work of art is not just unfinished: it is corrupt.

The Francis Report

Anagram graphic c/o Wordsmith

Manet's 'The Amazon' from: Reproarte.com

Extrasolar planets, x-phi and The Francis report

I'm sure there is a planet out there - extrasolar - with the physical make-up such that be it an incredible water fall, tidal surge, or rolling polished mega-rocks - the noise, could we hear it, would do far more than make your ears bleed.

Today, here in England there is a legal, health and political media event of very serious import. The ruckus in health and political circles might also make for more than bleeding noses and definitely thousands of continuing broken hearts.

The Francis report will be published today. Further insights and findings will be revealed c/o the Public Inquiry with recommendations on the Mid Staffordshire NHS Foundation Trust health care debacle.

In Philosophy Now Jan/Feb 2013 Tibor Fischer's editorial mentions the need for marketing within philosophy and literature, with the suggestion of placing x-phi on a T-shirt.

'X-phi' of course reads as experimental philosophy.

In health care, nursing and social care evidence counts for everything (and for h2cm too). Evidence based practice that is founded upon research is essential. Experiments are needed that can be reproduced, extended, validated. ...

Today is a profoundly sad day for everyone in the NHS, as many commentators have already predicted. The future constantly beckons, but today reflect we must that in the clamour for evidence based care, does this mean we must don T-shirts?:

x-care

Have we forgotten the principles of what it is to care: compassion - our duty of care?

No, but amid the cacophony of technology, technical care, the targets, statistics, budget cuts, the challenges to morale and nursing's values we need to be ever more vigilant.

We must learn how to x-listen and x-shout in the 21st century health care environment(s).

But experiments in how to listen, how to blow a whistle? Surely not.

Well yes: as clearly here basic care systems did not work they failed terribly: individually, organisationally and across the FIVE care domains of h2cm.

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)

A World Record for Health Care: The 4 minute reflection

Of all the things that can be done within 4 minutes one of the most significant in the history of sport is undoubtedly who would be the first to run a mile in under four minutes:

In health care four minutes is both an age and an instant in someone's health career.

If we took four minutes to reflect upon a person's care across the care domains what difference might that make?

Just one minute per care domain to help deliver - personalised care, self-care, carer support, integration, health promotion and how to stay well. ...

In healthcare we are constantly seeking GOLD.

Wherever you are have an amazing Olympics!

Locating the Spiritual in Care: (very big) Plantpots vs Green Windows

Last summer, July 13 2011 to be precise, the cover of RCN bulletin #278 declared 'Prioritise spirituality'.

I am not a religious person, but quite a spiritual one (I think). This RCN news item reported Professor in Dignity of Care for Older People at Staffordshire University, Wilf McSherry's views on spirituality. It is central across health and social care, (it is also vital in terms of cultural and spiritual literacy):

The practice of spiritual and religious care is about meeting people at the point of deepest need,' Professor McSherry said. 'It's not just about religious practices but preserving dignity'.

Also in that month, the 30th in The Times (page 19):
'Sacred forests bear witness to religion's unsung role in fostering a rich variety of life'.

This news concerned the extent of religious forests, with a project by scientists in Oxford to create a global map of forests under religious ownership and control. Now under the guardianship (whether intended or not) such forests have assumed importance as examples of biodiversity. Ruth Gledhill writes: From the Garden of Eden to Avatar, sacred groves have been central to religion and myth ... between 8 and 15 per cent of the world's land is regarded as sacred or religious.

With many remaining exceptions places of care have changed remarkably over the past 30-40 years. There remain many residential and nursing homes that prove challenging for health care professionals (I know they have told me over several years), never mind the residents and their carers. Challenging in the spiritual sense of the surroundings. I posted in 2010 about the wail of call systems. Visually though we must ask: how green is that care home?

Count - plants real [3]* : artificial [13]^#
  
This isn't just the colour of walls and use of curves to soften the environment, but access to outside, to grass, to trees and flowers. The benefits of real plants in the office environment are well established.  Being able to see a green vista greatly improves employee productivity and well-being. For those people in care what is the view outside their window, the lounge(s), the dining room? How can it be improved? For those essentially bed-bound can the furniture and bed be moved around periodically to achieve a new perspective?

It is still upsetting to see that those physically less capable of reaching the outdoors are elevated to first and second floors. Even with positive spiritual acuity of staff (the outdoors matters to all) readiness to hand and soul - a sideways glance through a window, the sound of rustling leaves through an open window - can make a huge difference:

Spirituality, dignity and respect. ...

*And in need of water. ^#Five over-watered.

Image source:
http://www.fanpop.com/spots/avatar/images/9492947/title/avatar_promo-screenshot-screencap

States of mind and policy [I]: 25% of hospital beds...

The repeated things that some people say, what does that denote?

The repeated things that other people say, what does that demonstrate?

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

In which care domain does the Person living with dementia reside?	1 : 4 - 25% of occupied beds [ diagnosis? ]
... and what of their carers... with their expertise?	there is a strategy - yet more hospital champions are needed and training.

My source:
BBC Radio 4 & RCN Students mail list

The Care Campaign

The Care campaign is a joint drive by the Patients Association and Nursing Standard magazine to improve fundamental patient care across the UK.



CARE stands for:

C – communicate with compassion
A – assist with toileting, ensuring dignity
R – relieve pain effectively
E – encourage adequate nutrition


The campaign recognises that everyone who goes into a care setting is entitled to these four fundamental aspects of care – they are a human right.

We hope patients, relatives and nurses will use this Care slogan as a care checklist. Patients and relatives can use it to pinpoint shortcomings in care; nurses can use it to articulate a case to their managers for more support, for example, more staff.

The Care campaign asks all nurses, nursing directors, chief executives and non-executive directors of NHS trusts to sign up to the Care Challenge so that ‘Care’ becomes a universal expectation for patients.

The campaign’s aims are:

• For nursing staff to adopt the Care Challenge, based on our four-point tool.
• To highlight obstacles nurses face in delivering the Care Challenge.
• For organisations to sign up to the Care Challenge.
• For patients to recognise the Care checklist and to use it to challenge poor care.
• To support nurses who expose failures to deliver the fundamentals of care.

Contact The Care Campaign: carecampaign AT rcnpublishing.co.uk

===========
Some thoughts:
What is crucial of course is what the above C. A. R. E. depends upon - and this has been considered within the campaign:

C: Attitude, self-awareness, professionalism and training in theory and practice.
A: Time and adequate staff assignment to enable patient - person-centred care not task allocation.
R: Time to observe and interact with patients and relatives - acknowledging patient reports and training in the recognition of pain and management. Pain management should not be incidental - neither should dignity and respect.
E: Too posh to wash - Too senior to help feed a patient, ensure they have a drink?

c/o BBC Radio 4: Emergency Foods - the very youngest-vulnerable and eldest

Food is the commodity after water that so many of us are able to take for granted. At the moment in the Horn of Africa a famine is raging. BBC Radio 4's Food Programme this week deals with Emergency Food. This provides great insight into the infrastructures, communications, technologies and developments that are being brought to respond to such crises. This programme takes us beyond the images of sacks being dropped by air, supplies being delivered by truck; chaotic situations that also demand crowd control to the actual foods, their form and content.

For nurses nutrition is a key element on the curriculum, a routine part of ward / community assessment and care delivery. Sadly meeting the nutritional needs of patients is a key nursing care activity that is the subject of marked criticism. How do you draw nurse's attention to nutrition beyond stating the obvious? How do you motivate students and assure competency is signed-off in that final year? Learning is a very personal thing what with self-directed study, lectures and blended learning ...  but it seems the emphasis on basic nursing care that includes nutrition can be lacking.

I know we can argue there is no comparison: the scale.

A few patients on a ward.

A country on the brink of famine - Somalia (BBC).

You know the real images that count: from rust coloured lands, the youngest skins and ravaged lands parched through to those infant's eyes that can still just wonder while so many others are closed.

I wonder if listening to this programme and reflecting on the very youngest-vulnerable might also help engage attention on the older-vulnerable - indeed all our patients?

Isn't increased awareness of nutrition AND global health what 21st century nursing should be about?

DEC: http://www.dec.org.uk/