Bio-Psycho-Social model: The L-shaped room

Qualification, induction, together with continuing professional development and mandatory training should see all health professionals having due regard for the 'political' in their respective roles. The 'Law and the Nurse' session, used to be, and remains a welcome reminder; also appropriately scary for this time of year. While at work the meaning of 'political' is nuanced with so many aspects and dimensions, e.g.

Public Service

Safety - Statistics - Quality

Zero tolerance - Never events

Leadership

Operating Procedures

Audit - Reports

churn of policy cranked by governments / parliaments

cost - savings - budgets - the plan

pay negotiation - Unions, Professional Organisations

Litigation

Administration Human Resources

Recruitment & Retention 

Disciplinary processes

Planning

Estates - Procurement - Supplies

The organisational tree - communications

structures - providers, commissioners, integrated

News: NHS, private sector, Social Care, Gov. 'Papers'

organisational (footprint) footprint

sustainability, green initiatives

signage - national - local

combined local policy initiatives and national emphasis e.g.

equality, equity, inclusion, 

management of violence abuse in the workplace, bullying, 

managing complaints, confidentiality
changes in reporting incidents, data returns,

information systems, governance and records management)

Is it me, or do the medical model, bio-medical model and the bio-psycho-social model somehow seem lacking?^

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC =========================  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

psycho	bio
social	?

In surgical terms, how is the political domain best realised within a model of health and social care: anastomosis or transplant?

^As seen by a certain lens.

Previously: 'models' : 'bio-psycho-social' : surgery

Hodges' model: The Art & Science of Care Choreographies?

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

	Introduction to Choreographies
Merce Cunningham: Changes: Notes on Choreography

Last month attending the UKSS conference in Portsmouth, I stopped in Oxford on the way South arriving 0800. Visiting Blackwell's bookshop - what bliss! I spotted Montesi's book and found a comfy armchair for more comfortable look. On the return journey, two days later, I used Park and Ride again and returned. It was worth it.

Over the years I've thought of Hodges' model as a theatre (in every sense), dance floor and the performance of health care practitioners. The wear of shoes bears testimony to the many steps about the hospital, clinic, nursing home, patient's home and community.

Choreography as a discipline naturally follows, and is more extensive than I thought.

UKSS is scheduled for Oxford in 2024, details - when I have them.

Cunningham cover: Amazon.

Seeds in 'architecture' i

For many years I've held a copy of:

Younés, Samir. “Constructing Architectural Theory.” Philosophy 78, no. 304 (2003): 233–53. http://www.jstor.org/stable/3752046.

Previously, missing a few (photocopied) pages, the paper is now complete as I continue to sort and clear 'stuff'.

Recto: The heart compared to a seed.
Verso: The vessels of liver, spleen
and kidneys c.1508

There is something dynamic, literally world-defining* in architecture, a view that has influenced my thoughts about Hodges' model, and it appears other disciplines.

The source lost, I recall reading somewhere about a trend of  'architecture' being added to titles and disciplines. It may have been in an information technology, programming source, but I'm not sure. The point made, was that when this is the case the result is NOT architecture. If you have a source for such ideas I would love to hear from you.

This statement probably stood out, because I'm guilty too:

'architect-ure' - care architecture, care design ...

Buildings are fascinating, sometimes as important as the art inside, getting from side A to B and so on. If properly curated though the building shouldn't overwhelm the work inside? While I love the arts, drawing and painting, Leonardo's technical work is awesome, as witnessed in Oxford and London, I was never keen on 'technical drawing' at school. It's not in my nature to blame the teacher, but - for once - I was a runner not a footballer. In hindsight, the time was almost up on technical drawing as we were taught in the 1970s and Leonardo, well he is in another class.

In health and social care, we plan and plan again; and resort to design (case formulation) too.

So, models and frameworks - anyone..?

The axes of the model are like a mast.

The care (knowledge) domains - with their nebulous edges - are like sails.

The concepts (data, information, disinformation, uncertainty, null! ...)
caught in the domains are the wind that drives, disrupts, or in its absence bestills us.

The direction of travel the context, the situation - always adjusting.

And often subject to change, misdirection and correction.

ii Seeds in 'architecture'.

*A potential for good or ill.

Seeking Care & Global Cultural Neutrality in White Houses(?)

The email concerned a book
- | White Houses | -
 and posed a question.

Needless to say it caught my attention ...

Is White a Statement or a Neutral Surface for Expression?

This is a question I ask myself, but in respect of Hodges' model.

To what extent is Hodges' model neutral across cultures?

Remove the green, blue and red colours I adopted for the care domains  and what you have is a blank sheet; an empty conceptual space.

Is it empty? 

Very quickly it can become filled with what the person, patient, client, group ... brings with them.

Hodges' model is a stage. Several stages.

It is a theater.

It is a challenge for the performer, as they take their turn. As they navigate the space, they seek to ensure, assure, obtain feedback that the other - listener(s) are with them; whether in agreement or not.
Hodges' model is an arena for personal, group reflection, debate, argument(ation) or as described these days - co-production.

How suitable is #h2cm as a tool to support global health objectives, such as, the Social Development Goals and the Social Determinants of Health (and their ongoing development)? For me, Hodges' model is not just a neutral surface, it is a neutral substrate for the many forms of knowledge needed to solve the problems of the 21st Century.

individual - self

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group- population

	Polite House, Trondheim, Norway, 2012. JVA. The house appears to be made of three stacked and slightly skewed volumes, with touches of colour inside contrasting with the white walls. Photographer credit: © Lars Evanger

My source: Thames & Hudson

Later in the summer - autumn I might post another photo in memory of my father and a holiday ...

The Compass Rose in Care

^*"A compass rose

is a diagram of

directions that is located

on every map or globe."

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

The Health Career rose

is a diagram,
a conceptual map of care 

that can be located within every 

care plan and health record?

^*Source: https://slideplayer.com/slide/5847408/

Health Systems Design: Service Vs Personal Responsibility

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Personal Responsibility
	Service

We have been schooled to regard health as a service delivered to us, when it should primarily be a responsibility we all exercise. In The Limits to Medicine Ivan Illich described a health system based on personal responsibility rather than service.

"Success in this personal task is in large part the result of the self-awareness, self-discipline, and inner resources by which each person regulates his own daily rhythm and actions, his diet and sexual activity... The level of public health corresponds to the degree to which the means and responsibility for coping with illness are distributed among the population."

My source: Leadbeater, C. (2009) WE-THINK. 2nd ed., London: Profile Books. p.152.
(... and an interesting way to write and produce a book):

See also - related to media:
https://hodges-model.blogspot.co.uk/2009/01/book-review-gary-halls-digitize-this.html

https://hodges-model.blogspot.co.uk/2009/02/digitize-this-book-book-review-follow.html

... graph portability ...

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

care graph portability	care graph portability
social graph portability & care graph portability	care graph portability

Of course, social graph portability and care graph portability do not bear comparison. Social graph portability is still contested as the media reveals. But 'care graph portability' is stretching it...

In this post I wish to point out the internal transactions (conceptual portability - facets - patterns) that are needed to achieve person centred and holistic care at the individual level. This can then be integrated. Throughout an individual episode of care, to recovery and staying well this 'care graph portability' can be said to be achieved through reflective practice that also engages the patient and carer(s) to facilitate self-care and health literacy. This is true portability in the care context.

See also:
Is social graph portability workable?

My source: Harford, T. (2017) How to poke Facebook off its perch, FT Weekend, 4-5 November, p.12.

Refugees: one word or two?

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

	Now here
	Nowhere

'Welcome'
Origin
Old English wilcuma ‘a person whose coming is pleasing’, wilcumian (verb), from wil- ‘desire, pleasure’ + cuman ‘come’. The first element was later changed to wel- ‘well’, influenced by Old French bien venu or Old Norse velkominn.
https://en.oxforddictionaries.com/definition/welcome

Grid Design: The architecture of care? c/o Brinson (2007)

The context of Brinson's (2007) thesis is graphic design, but there are many insights, overlaps and references in a study that ...

"explores the logical integration of conceptual meaning into the grid structure" (p.61). 

 “All innovation and most design is the result of connections—the link between experience and action, between deductive logic and inductive insight, between the analysis of a problem and the verification of its solution”1 (p.2) 

“The important thing to remember is that while a grid can help to generate a sense of unity and continuity in a design, it is within itself creative. In the hands of unskilled designers, grids can become straightjackets that inhibit creative concepts.”4 (p.5)

 “Ostensibly, the best grids are based on a general evaluation of content and reflect the particular character and presentational requirements of that content.”78 (p.105)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

While analysis is to the fore in the thesis there is less emphasis on synthesis amid talk of deconstruction. Hodges' model can (I believe) be used for conceptual analysis and synthesis. A tool to deconstruct, to identify the parts and integrate the whole. As a representational frame Hodges' model could also represent change through time.

Brinson, Valorie Michelle, "An evolution in grid structures: a study for conceptual grid structure design" (2007). Retrospective Theses and Dissertations. Paper 14805.

A rolling issue: Parity of esteem in physical & mental healthcare

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL
|

group

"What about social care?"	"Did you hear something then?"

Image source:
http://coconutheadsets.com/2009/12/29/sisyphus-for-startups/

Sensing Spaces: Care architecture - memories of choice

Good architecture is often invisible,
but it allows whatever is happening in that space to
be the best experience possible.

Pezo von Ellrichshausen

Good architecture may have something in common with good health; it is something that can be taken for granted. When things go awry and are wrong then architecture and health suddenly impose upon us, a major intrusion.

As I may have mentioned before, in the past I've been asked how I've managed entering such and such care facility for so long. Within health there is recognition of heartsink patients. There are still heartsink buildings too. Not purpose built, seemingly either all narrow dark corridors, interrupted when doors let in shafts of light and assault dignity and privacy; or large 'lounges' that still invite armchairs to be flung against walls.

Architecture like this is not invisible. Walls are walls, blanc, flat and solid. Pictures removed due to safety concerns. Two holes and exposed plaster testify to what? Now, after six months....?

Even for the confused there are few potential found spaces, spaces to sit, stand, be; spaces towards which some personal impetus might have a person gravitate. A space of relative quite, looking out on some-thing relaxing even if not a small garden feature.

"Where's Joan, her friend's here to see her?"

"It's OK, I know where she'll be."

Royal Academy: Sensing Spaces
Education guide

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/

Cognitive continua ( ... just a sentence of promise)

The idea of a cognitive 

continuum 

has much to offer nurses 

and its potential 

has yet to be fully exploited. p.136.

Thompson, C. (2001) JAN Forum: Clinical decision making in nursing: theoretical perspectives and their relevance to practice - a response to Jean Harbison. Journal of Advanced Nursing, 35(1), 134-137.

My coat, Your coat, the Community cloakroom

'Untitled' 2012 (coats, wire, screws), by Jannis Kounellis

"Such wall-mounted three-dimensional pieces seem to me to talk the language of painting rather than sculpture. So does a massive, poignantly flopping black cross created from several navy coats tied together with wire and screws, hung against a wall. Each coat is a human measure, a stand-in for a human presence." p.20.

Wullschlager, J. (2012) Arts: Beauty in a burlap sack, Financial Times, 8-9 December. p. 20.




Bunzl, J. (2001) writes:

"Expressed in terms of a community-building process, we could thus identify the entity of the nation state as representing the equivalent of the individual person: the prime agent through which community or chaos in the world will ultimately be determined." p.20.

Additional link:
Parasol unit (Jannis Kounellis exhibition)

Bunzl, J. (2001) The Simultaneous Policy – An Insider’s Guide to Saving Humanity and the Planet. New European Publications.
Image source:
Wullschlager, J. (2012) Arts: Beauty in a burlap sack, Financial Times, 8-9 December. p. 20.

Gestalt, patterns and models: pressing buttons

The three recent events have all in different ways emphasized the role of patterns.

Patterns were there at the Drupal Education Camp, then the Visual Methodologies Workshop and the Scottish Ruby Conference.

There is a lot of very informative content in .net magazine. In the two most recent issues a single page has proved a great help (Buttons gestalt, .net August 2012, p.74) and in the current issue (.net Summer 2012) page 72.

Gene Crawford notes that gestalt in graphic design refers to how a person will recognise and react to an element of something we've designed. Buttons are discussed as an essential part of any design. Crawford points out how a button is the end point in submitting a form, completing an action, or transaction of some form.

A button has to fit in with an overall design - so that as an individual element it shouts out its function, its potential; whether or not that potential is realised.

In case of a medical emergency there is only one button to press: that which activates emergency procedures.

When we are concerned to deliver health and social care the button we should press is: Hodges' model. This is a compound operation. One press activates four (five) buttons: four care domains. This is the umbilicus, not just the nexus, the physical 'belly' button, but the mind, the social, political and spiritual.

For holistic, reflective and integrated care viewing h2cm as a button begs we contemplate the potential that lies beneath. Beneath in the sense of what follows after the button is activated. This is precisely Gene's focus in the summer 2012 issue of .net Mental Models on page 72.

He points to a book: Mental Models Aligning Design Strategy With Human Behaviour, which I also learned of from a lady staying in Lund at the same B&B. Here the thought processes of a visitor to a web site are central. I have some old content - archive material, but vital and still central to understanding and the history of h2cm. How are visitors to navigate their way to find original content, what mental model do they bring even before they seek out menus and buttons. What expectations will they associate with the words and vocabulary of the website: Hodges' model, conceptual framework, structure, content, and conceptual spaces?

I often think of h2cm as a care (information) architecture and Crawford notes the need for empathy with users as a website is designed. So, closer than ever these worlds: nursing and websites. ...

Health Care - drawing lines

Multidisciplinary care

Original image source:
http://www.jointline-group.co.uk/councils.php

KT EQUAL event 'Design ahead: design for an ageing population'

Dear KT EQUAL Supporters,

We are pleased to announce the latest KT EQUAL event entitled 'Design ahead: design for an ageing population' to be held on Friday 2nd March 2012 at the Innovation Centre, Bath.

We have an ageing population, but a reducing health and social care budget. Increasingly individuals will be expected to self-purchase products and services that will allow them to live independently. This will provide a large ‘silver’ consumer market for products that are designed and priced appropriately. Although there is some awareness amongst industry of this market opportunity, there is significant scope for more inclusive design of mainstream products that enhance independent livening or support specific living tasks and activities.

In collaboration with KT EQUAL, ALAN (Assisted Living Action Network) will jointly host this event to raise awareness of the scale of the market opportunity; explore the needs of this population; how they are translated into design requirements to drive product innovation; and what kinds of design tools and approaches can support design for an aging population. The event will bring together commercial partners, users and academics.

Please find a provisional programme for 2nd March ...

In addition to the conference, there will be an evening three course dinner and networking reception on Thursday 1st March. Both events will be held at the Innovation Centre in Bath.

To register for the conference and / or dinner, please visit:

...

£80 conference and dinner
£50 conference only

There are limited spaces for the networking dinner, so please register quickly.

Regards,

Heather Williams
Project Officer (KT EQUAL)
University of Bath

Nursing ideas somewhere between Drupal & Ruby

It's been a busy week:

• getting ready for the Scottish Ruby Conference [SRC] three fascinating days 7 - 9 April.
• checking with the client of the Drupal site, confirming that the following CSS3 adornments are not required: coloured lettering : 3D text : and others. KISS - OK!

SRC started with the charity day a day long tutorial from Chad Fowler author of The Passionate Programmer and Keavy McMinn. They delivered too - indeed it's all great! The venue - The Royal College of Physicians is quite amazing, full of history in its architecture and the portraits of esteemed members. Whether or not I attend a session in there today I must visit the library. The charity day covered:

• Blocks and bindings
• The Ruby object model
• Meta-programming
• Hooks, callbacks, and reflection.

When it came to the exercises I let the experts do their thing and followed the solutions. I missed last year's Ruby bash so it's good to be back.

Swapping to Ruby while tinkering with Drupal is not a help and yet there is overlap. GIT is the must-do within both communities. PHPNW's meeting on Wednesday on OOP with Lorna Mitchell highlighted some common aspects. I'm probably getting a lot of this (as in 'all' plain) wrong but Lorna's mention of $this and static methods sent me on a reverie. ...

Abstract classes are apparently incomplete and $this is not available to them. Suddenly I'm thinking well that's different. In nursing our abstractions on nursing care are complete - in the idealised sense. It's the concrete / practical (dynamic) delivery that sadly falls short.

PHPNW - the conference in October, a Saturday event in prospect and being here in Edinburgh reminds me I have this itch. Dave Hoover's keynote spoke about his career and finding his technical groove from a therapeutic role as a psychologist.

One thing I do know: from the books he mentioned I ain't got 10,000 hours. That's why I am trying to leverage Drupal and in Ruby - the Rails framework. There's an IDE I have just learned of JetBrain's Ruby Mine.

(Despite that) I'm reading Martin Fowler's book on Domain Specific Languages. Not because I'm going to write one (or like rashes), but because I'm totally intrigued and wondering about a research question. What question(s) can I ask that I might also be able to answer (or not)?

method_missing, meta programming and DSLs are still here in Edinburgh. No longer the latest and greatest (Jim Weirich suggested that was c.2006), but then neither are models of nursing. ;-)

In his book, Fowler identifies 'illustrative programming'. Spreadsheets are the key example and quite remarkable in how they are used and the niche they occupy from a programming, DSL, and an everyday tool perspective.

Hodges' model is a spreadsheet; or a decision table of sorts. Basically, does the patient have a problem in each of the care domains? Fowler writes:

The key benefits of a DSL - greater productivity and communications with domain experts - really kick in when you are using an alternative computational model. Domain experts often think about their problems in a nonimperative way, such as via a decision table. An Adaptive Model allows you allows you capture their way of thinking more directly in a program and the DSL allows you to communicate that representation more clearly to them (and yourself). p.116.

I'm really taking liberties with definitions. My domain experts might actually be student nurses.

I know book titles are intended to sell, but I look at the title of Chad Fowler's book above and wonder about the Compassionate Care Programmer and what alternative computational models may be needed to achieve that?

Fowler, M. (2010) Domain Specific Languages: Addison-Wesley Signature Series, Addison-Wesley Professional.

Caution! spanning the Theory - Practice Gap

As a new academic year begins and we endeavour to bridge the theory - practice gap we need to be cautious:


While we may not burn our bridges we need to be aware of which bridge spans are redundant and which are still active and serving their purpose.

As ever - standards, inspection, audit and governance are critical.

So in our efforts to bridge the theory - practice gap do we also maintain it?

Drupal musings 15: modules and Drupalcon videos

Since picking up the health career model and publishing the model online in 1986 the term holistic bandwidth has emerged. The blog in 2006 and to date has seen other loosely defined terms:

care architecture
4-fold care
cogneography
holistic competency

Using Drupal 6 I've got to a position were I am getting to know core plus some contributed modules. One of the latter is webforms. It's bound to be help seeing what webforms can do in terms of one-way data submission, compared to using CCK - the content construction kit. In webforms the grid component holds great promise, but in creating a grid for music genres I notice there is no validation (which would be quite a trick!). Users should only be able to select one type of music they want to hear most of the time. The validation question is going to help force the issue of getting under the hood. All that reading revealed in previous posts is also needed to sort the theme too.

I remember first coming across the word instantiate. As I write, think about a h2cm glossary and experiment for real with Drupal 6 - I wonder whether the content types I create (in Drupal 7 especially) may help define some of the above and other terms?