Forms and Dimensions of Care: 20 Gs of Politics

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

?	?
?

group - population

Image: Timeout.com

Health & Social Care - Shoeing the Horse*

Anvil

*humanistically ...

Anvil image:
http://en.wikipedia.org/wiki/File:Blacksmith_anvil_ganson.svg

Original horseshoe image:
http://www.ranchomilagrokansas.com

Nurses & Social Media - mise en scène

... health on the thrust stage

From: Wordsmith.org

1. The setting of a scene in a play, movie, etc.
2. The setting or background of an event.

ETYMOLOGY:

From French mise en scène, literally "put on stage".

The health care domains model provides a 2 x 2 stage.

It may be a conceptual stage, but it is nonetheless demanding. It demands we perform the translation from theory to practice and check constantly exactly where we are AND where we need to be.

Should we become so ill that hospital treatment is needed the dependency and the sense of vulnerability this provokes often makes us feel that we are 'performing'. Not only that but as a  patient we find our selves on a thrust stage. When illness strikes it seems we are surrounded by this audience of clinicians who can potentially see us from all angles and be privy to very personal information about us.

The demands cut both ways though. Modern health care IS collaborative. Stagecraft here then means there should be minimal furniture and scenery to hide behind. Strange then that in terms of personalised care background details really do matter.

So, everyone matters. Teamwork counts. We try to keep patients off the stage. Patients and carers as expert carewrights may already know their lines - they can teach us. Suddenly everyone is an actor. Suddenly all the players must pass by way of the vomitory and the responsibilities that passage demands. On this stage care also needs to be exercised as per the direction of the NMC.

Original image source:
http://hs-theatre-ib1.ism-online.org/2010/10/14/night-of-the-assassins-thrust-stage/

(many) Care Transitions and The Little '-' That Could

Some people looking at Hodges' model may believe that the model perpetuates the dichotomies of old:

Human --- Machine
Individual --- Group
Sick --- Healthy
Supply --- Demand
Home --- Hospital
Self care --- Nursing care

In the 1990s as a community mental health nurse I was involved with a group of general nurses looking at ways of improving:

• discharge planning
• continuity of care

These issues remain and with the dichotomies of care above we can see how Hodges' model can assist our thinking and planning about transition. Not just one transition, but several.

This past week I was fortunate to attend one of a series of workshops -
Delivering High Quality Health Care for All: Bringing the social and technical together for a joined-up approach to deliver supporting systems and technologies
10th/11th December 2009, Leeds, UK

Organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group

The event was very good, stimulating and challenging. In the closing debate the appeal of 'socio-technical' and how to market a much needed joined-up approach in health IT came down at one point to the difference between:

'socio-technical' and 'sociotechnical'

In trying to find an alternative title, the hyphen was lost, and whilst it is not a crucial issue - for me that hyphen represents the axes of Hodges' model. Hodges' model acts as a high level aide-mémoire and that little hyphen can perform the same trick. The hyphen reminds us of the differences. The dichotomies that need to be navigated and negotiated in our dialogues about care AND caring. These are most evident in transfers and transitions (after all - "getting out of bed is a risk").

There are mini and macro transitions. Care pathways are not yellow-bricked unbroken splines from cottage to cottage hospital. They should be tortured if they do reflect person-centered experiences and needs.

Some transitions are process laden and repetitive, such as drug administration and must be protected - free from interruption. Although grounded in a social exchange of (correct) identities: a registered nurse, the right patient, right drug, right dose, right duration and right time these can be framed within the SCIENCE domain. That is where (for me) the conventional 'drug round' can be found. Counselling is another transition (if effective it also moves people on). 'Counselling' can be found in the INTRAPERSONAL domain - close to the border with SOCIOLOGY.

Other transitions and transfers are more involved:

• person's home to attend day care (for the first time!)
• person's home to residential home
• hospital ward to home
• home encounter with the crisis team
• telecare consultation
• ...

Care is constantly passed hence the need to write and record. Passed from -

person-to-person
team-to-team
team-to-carer
time-to-time
discipline-to-discipline
self-care

This is the outcome that is sought. Ultimately passing responsibility back to the individual and when applicable their family. Having formal integrated care pathways is one thing, but they are never truly continuous, clear and true. And as they say crossing bridges you may have to break step and surely different disciplines march to different tunes? Today though the most audible tune must be socio-technical. ...

Additional link: The Little Engine That Could
Image source:
Drug round tabard http://internet-workwear.co.uk/acatalog/Drug_Round_Tabard.html

What wright to care?

At senior school I had the challenge and pleasure of appearing in Arthur Miller's The Crucible at the age of 15. My part was of course that of Francis Nurse. I can still remember most of my lines [as I didn't have many ;-)]. I have always been interested in drama, but even more so - dialogue, which helps as a member of this family and a mental health care professional.

Over several years, the above plus studies in literature and philosophy prompted me to dabble with dialogues of my own. One from way back when concerned nurse training and virtual environments; while another was set in Athens addressing the impact of informatics upon nursing.

The professionals of dialogue - playwrights - feature on BBC R4 Start The Week and this made me think of another dialogue as I recognised that my colleagues and I are in fact carewrights.

Now though with long term medical conditions, self-care, recovery, personalised care, individualised budgets and other policy permutations we are not just concerned with the words we say. With patients and carers seen and heard as experts no longer are we just putting words into their mouths - they are putting words in ours.

So together -
lets literally go taste the health and social care culture and break a leg!

Image sources:
book cover Amazon
Drama mask image: Saskatchewan Drama Association

Additional links:

Top 30 languages of the world

Top 20 countries by number of languages

International Mother Language Day 21 February

I note there are several instances of 'carewright' as a surname, trade / commercial name - my use and the context should be clear.