Host|Guest by Hospital Rooms

To mark its 10-year anniversary, arts and mental health charity Hospital Rooms presents a major exhibition at Victoria Miro this September.

Bringing together leading contemporary artists from across the Hospital Rooms programme, the exhibition features re-creations of monumental new artworks created for hospitals this year, alongside artists the organisation has collaborated with over the past decade. It reflects on the impact of transforming NHS mental health environments through art, while looking ahead to expanding access to creative programmes nationwide.

Host|Guest

My source: Ellee Su, Gallery, HOSPITAL ROOMS, FT Weekend Magazine, Number 1,192. 5 September 2026, pp.10-11.

Interviews, playwriting, and clinical encounters: pause for breath - Roger Lewin

It can be surprising how you know something. Something that should be obvious to you. It's your 'Bread and Butter' as the saying goes. And yet for a variety of reasons, you persist in not seeing it, or you frame it in a way that ultimately reveals a bias, influence, and may even mask several aspects of truth. It might be the influence of work over four decades plus. Sitting down, or frequently finally getting out for a walk after several weeks of nudging, in a one-to-one therapeutic context. Or, ever since secondary school, that distant performed encounter with the Crucible. And, more recently as 'Ken', a Post Office subpostmaster and his wife (a brief 10-12 mins), and over the years a desire to write dialogue.

Reviews of Roger Lewin's Complexity, vary in their conclusions about the book's quality. No surprise there, but reading the book it was a revelation to see the method: a series of interviews and the resulting dialogues. 

'In this revision of his book originally published in 1992, Roger Lewin explains what the science of complexity is all about through interviews with some of its most important practitioners (and critics) organized around some of the central ideas. As such this is both a fine introduction to the subject and an interesting read. Lewin includes 16 pages of photos of the scientists he interviewed captioned with a significant quote from each. He has added an afterword on the application of complexity science to business, and an appendix about John Holland, whom he dubs, "Mr. Emergence."

"Everything works toward an ecology" is an old dictum of mine. I have the sense that I came up with that myself, but I probably read it somewhere years ago. At any rate, what is being said here is that complex systems work toward a state of equilibrium near a transition phase, near "the edge of chaos." This equilibrium can be an ecology (Darwin's "tangled web"); indeed it can be the entire planet, as in the concept of Gaia in which "the Earth's biological and physical systems are tightly coupled in a giant homeostatic system" (quoting Stuart Kauffman on page 109).'

Source: https://www.goodreads.com/en/book/show/384547.Complexity

There's nothing profound in this post, and yet this melange of interviews, playwriting, and clinical encounters gives me pause for breath.

Previously: 'Our broken sticks' c/o Roger Lewin "Complexity: life at the edge of chaos"

What! Nursing reduced to objects! Do you realise what you're saying?

Wittgenstein to the rescue?

Revisting a theme, and while it is not new - as in use of objected oriented approaches in health informatics; as a nurse, to suggest there's a need to view the elements of care systems as a series of objects surely runs counter to nursing's theory, practice, professional standing and values.

Or, does Wittgenstein come to the rescue in his 'Tractatus Logico-Philosophicus'?

'2.01231 In order to know an object, I must know not its external but all its internal qualities'.

[My emphasis - and as ever high degree of selectivity.] 

In reading 'internal qualities' I can equate internal with a person; and qualities with subjectivism, what is inherently seen as humanistic, a set of characteristics, and properties. Can it be argued that in the context of healthcare and person-centredness we can also take 'internal' as potentially referring to what happens in the mind, an individual's mental life, for example? This can be applied physically too. To bodily properties, which ultimately are internal genetically, and influenced by - expressed in-part - by the external environment.

While I sort books, creating space, there is the small matter that Wittgenstein walked away from philosophy after the Tractatus was published. Then, realising he had not answered the questions concerning human language and reality, he returned to Cambridge and his studies, with Philosophical Investigations published after his death.

Does this invalidate the thoughts above?

Another post to follow drawing from the Tractatus. 

Previous posts:

Reflection: programming and caring II

Abstract [working] Hodges’ model as a mathematical object, a lens for social care and inclusion: category theory or category mistake?

Person to object: Surely you're joking* ...!

ii On Sociology & Becoming a Nurse

Two final observations re.

Maclean, Una. (1974) Nursing in contemporary society. London: Routledge & Kegan Paul.
https://wellcomecollection.org/works/qhqc24fv

Firstly, there is a question for new student nurses:

'In the case of nursing, the Royal College of Nursing laid down the course of training and the final tests whilst the General Nursing Council held the solemn register to which aspiring professionals were ultimately to be admitted, and  the aim of these two powerful proponents of the nurse's unique role was to limit he epithet 'nurse' to those who had successfully navigated the straight and narrow path to registration.' p.67.

Q. Above, Maclean refers to a solemn register. What do you believe may have shaped the author's writing at that time in 1974? Is the nurse register, towards which you now aspire still 'solemn'? 2000 words.

There has been much debate of late regards the title 'Nurse'. 'Doctor' also.

Secondly, Maclean was prescient in acknowledging the 'Patient's right to information'. pp.119-120.

Globally - seeking the ink of scholars

The Ink of the Scholars:
Reflections on Philosophy in Africa

Since the late 1980s, in trying to understand Hodges' model, especially its political dimensions beyond nurses as advocates, the mental health act, choice and self-determination. To be followed by consent, then informed consent, mental capacity, human rights, equality, protected characteristics, safeguarding, equity, social in-justice; I've then questioned my assumed neutrality of the model. 

Allied to this is the fact that Hodges' model is one of many models and frameworks, largely created in the developed world. What alternative viewpointsof nursing, care and philosophies are there? Do these challenge Hodges' model? Or, can Hodges' model also encompass them, in a complementary manner?

Serendipity, or ADHD, seems to follow me around. In addition determined to extract value from my purchase and reading of the weekend FT, I learned of potential key read:

Prempeh, C. THE AESTHETE. Koyo Kouoh, The curator of 2026 Venice Biennale talks whisky sours, working from bed and being the "high priestess of the okra church". HTSI, FTWeekend, 3 May 2025,pp.21-22.

'THE BEST BOOK I'VE READ IN THE PAST YEAR is a book on African philosophers, The Ink of the Scholars: Reflections on Philosophy in Africa, by Souleymane Bachir Diagne, one of our most brilliant thinkers. He challenges the idea that there isn't a philosophical framework to African societies. There are ideas around Africans being the great architects of hospitality and Diagne reflects on what the African approach to humanity is. What does it mean to be careful, mindful and caring? It's not just about welcoming people to your home or feeding them. Hospitality is carrying people, making people feel comfortable in your environment - it's intellectual and emotional. Everyone should read Diagne, full stop.' p.21. 

 

Shocked: I have just read of Koyo Kouoh's passing - RIP. 

Souleymane Bachir Diagne, & Jonathan Adjemian. (2016, May 23). The Ink of the Scholars: Reflections on Philosophy in Africa. CODESRIA Books Publication System. CODESRIA
https://publication.codesria.org/index.php/pub/catalog/book/40

See also: 'hospitality'

RCN Congress 2025 Liverpool i

... the twists and folds of debates

Repeating myself (again) but worthwhile I think(?), the past week brought my second RCN Congress. If you are new student nurse, international (Std) nurse, or nursing support worker and not engaged with a professional body, or union; do try to get involved. Don't leave it as long as I have (I joined a union as a nursing assistant). By way of a small excuse, listening this week it seems I am not the only one to leave it 'late'. Based in Liverpool (again after 2019) means there's a torrent of potential content. So where am I/We? By their nature all the debates are worthy. I have picked a few:

Discussion - Celebrating a nursing career

You can read above the main focus for the discussion. For me it prompted the following (no doubt - familiar)  reflections ...

The number of potential careers in health and social care is amazing:

350 careers. One NHS.

Your future.

Not only what the NHS (for training, education) can 'offer', but within that the number of nursing roles and specialities. The discussion inevitably drew the 'longevity' card. Students do pick on the temperature of their chosen community of practice. They recognise when they are surrounded (not literally!) by colleagues who have careers numbered in the several decades. But like a card the side that presents the occupational safe harbour from the threat posed by artificial intelligence, is countered by the seemingly relentless pressures imposed on nursing staff. The debates also revealed the pressure and negative impact of 'lived' work experiences for students and newly qualified nurses. I remember in the late 1970s early 1980s student nurses being counted as 'staff'. Have we really not progressed? I wrote 'offer' above because many students cannot get jobs once they have qualified. Not the best start to a shiny career. Having to fold, as they qualify.

Speaking of "career", can we please twist that? There is a great deal of talk - soul searching - about how on earth the (so-called) health service truly transforms itself to be health promoting and preventive. In the NHS's history perhaps there was a window of opportunity to begin in the late 1960s. Not so much a 'moonshot' as a healthshot. Now with the demographics that potential is being lost, unless this is positive way that AI can make up the shortfall? Alternately, nursing can utilise the health career, as in Hodges' model which are invariably impacted by an individual's life chances. As such there may be signs and signatures in the person's familial background? We can imagine a timeline composed of Hodges' model as 2x2 frames through a person's life, even prior to their conception and their legacy. 

More to follow . . .

Previously: 'RCN' : 'nursing' : 'power'

Please pardon the 'gambling' analogies, but we are literally asking students to gamble with their careers, financial status and well-being (life chances - no less). Should they be lost to the service, you can't blame young people. They know the logic of care, also known as demographics. They can do the maths? So who is it who can't do basic arithmetic?

They keep saying - 'duty of care' . . .

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

duty of care	duty of care
duty of care	'fiduciary duty'

Fritjof Capra, Pier Luigi Luisi (2014) The Systems View of Life - A Unifying Vision. Cambridge: Cambridge University Press. (I will add the page number soon.)
https://www.cambridge.org/gb/universitypress/subjects/life-sciences/genomics-bioinformatics-and-systems-biology/systems-view-life-unifying-vision?format=HB&isbn=9781107011366 

Previously on W2tQ - 'duty'

Book for review: v "Philosophy of Care - New Approaches to Vulnerability, Otherness and Therapy"

I think this is the final post for Philosophy of Care (think! There is so much more ...). There are other chapters more salient to me personally, but for Hodges' model and the collective human enterprise, I think chapter 5 by Virginia Held is the most important. There's not just a chapter, but three in Part II 'Care and Economy'. I appreciate the reminder of Kate Raworth's Doughnut Economics which challenges;"the dominant assumption of the economy as a machine". I notice on Twi/X Kate Rowarth reflects on the UK's election:

The book 'Doughnut Economics' opens with the story of Yuan Yang who, as a young economics student back in 2008, was challenging the outdated theory she was being taught. Last night she was elected as the first-ever MP for Earley & Woodley. Huge congratulations @YuanfenYang!

    https://x.com/KateRaworth/status/1809216007518507248

I gave Keir Starmer a copy of Doughnut Economics just 10 days before he became Labour Party Leader. So will the book make it onto his bookshelves in Number 10? More importantly: will policies for a regenerative & distributive UK become real under this government?...

     https://x.com/KateRaworth/status/1809235013403136029

While in Philosophy of Care, another three words stood out:

"'Big-picture thinkers'^, Raworth notes, have offered alternative visions, but they have been dismissed by the field of economics." p.102.

continued ... 

Extraordinary People (2020)

 

the connor brothers

Extraordinary People, 2020

£120.00 

SOLD OUT

giclee print with silkscreen varnish 

41.5 x 29 cm unframed 

Edition of 300, signed and numbered 

Extraordinary People is an edition of 300 signed and numbered giclee prints measuring 41.5 cm x 29 cm and is sold unframed. All profits from the sale of this edition will be donated to the NHS Covid- 19 Urgent Appeal which supports NHS staff and volunteers caring for COVID-19 patients . The print is priced at £120 plus shipping and is available now. Due to the current pandemic we do not expect to be able to deliver this print until September 2020.

Like everyone else we are extremely grateful for the tireless work being done by our extraordinary NHS staff in near impossible circumstances. We owe them a collective debt we will never fully be able to repay. We'd like to offer our deepest thanks to each and every one of you.

giclee print with silkscreen varnish 

41.5 x 29 cm unframed 

Edition of 300, signed and numbered

http://www.theconnorbrothers.com/shop/extraordinary-people 

See also:

Pay "Nurse Kathy" ?

"Blind to the Big Picture" and Parity of Esteem 

My source:

The art world is back in business, MoneyWeek, 15 May 2020. Issue 999, p.35.

Book: Labours of Love

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

|

|

|

Labours of Love

"Good care shown to us in our most vulnerable moments can serve 'as an epiphany, not necessarily leading to new knowledge, but to recognition of the importance of something already known.	"The Lancet projects that the number of over-85s requiring 24-hour care will double by 2035."
Bad care, in contrast, can dehumanise us ... 'our sense of dignity is precarious'."	Economic precarity "the invisible heart" "in contrast to Adam Smith's "'invisible hand'"

 

See also previously on  W2tQ:

https://hodges-model.blogspot.com/search/label/social%20care

My source:

Urwin, R. (2020) Crying out for change, The Sunday Times, Culture, 27 September, pp.28-29.

The Contribution of Disciplines from the Arts and Humanities to addressing Antimicrobial Resistance: final report

The Contribution of Disciplines
from the Arts and Humanities
to addressing
Antimicrobial Resistance

 Dear RIPEN workshop participants

 

It is now over a year since our last main sets of RIPEN workshops and of course so much has happened in that time that I don't know quite where to begin (!!). So I won't start into talking about COVID. Only to say that I very much hope that you and yours are managing to get through this ok so far. I know that I speak for the rest of the RIPEN team when I say that recent events have only served to highlight the central place of nursing and caring in society which is a source of pride (if not so much monetary reward!).

 

Anyway, I thought that some of you might be interested in this link to the final report from a follow-on study that I've just completed. It draws together learning from all the 11 projects funded by the AHRC at the same time as RIPEN: http://radar.gsa.ac.uk/7418/ . 

 

The report is best viewed in double page layout (download, save then open). Obviously, it is of less direct relevance to hands on nursing applications, but I think our experiences on RIPEN showed how important the wider picture often is (as evident in the events of the last six months!).

Please feel free to share with others through any of your own networks as relevant. 

with best wishes

Colin

Dr Colin Macduff

Senior Research Fellow

School of Design

Glasgow School of Art

 

MacDuff, Colin (2020) The Contribution of Disciplines from the Arts and Humanities to addressing Antimicrobial Resistance (CODA AMR). Project Report. The Glasgow School of Art, Glasgow.  

n.b. I will have a read myself and post again before the end of the year.

iii RCGP’s 7th Health and Justice Summit ...

Returning to Juliet Lyon CBE, Chair of the Independent Advisory Panel on Deaths in Custody, who presented ‘Keeping Safe – how consultation with women and men in prison and health and justice professionals informs our work and advice to ministers.’

In February this year the Independent Advisory Panel on Deaths in Custody (IAP) and the national newspaper for people in prison, Inside Time, began a ground-breaking collaboration - Keeping Safe - to help keep people in prison safe. Supported by the Samaritans and Prison Radio, the IAP called on Inside Time readers to say how best to prevent suicide and self-harm. Prisoners’ recommendations in this Inside Time special report reflect evidence from, and recommendations made repeatedly by, amongst others, the Prisons and Probation Ombudsman, HM Chief Inspector of Prisons, the Chief Coroner and the National Audit Office.

Ms Lyon spoke of the clinical context, hope and time:

What was done in the  ::   Being in Prison  ::    What might be done in the

Past                        Now                             Future

Mention was made of a 'Keeping Safe' event in February 2020. If I learn more, I will add details.

Mark Langridge took us through some technology developments in healthcare as Care UK National Lead Pharmacist:

Socrates (with reference to 5-domains of well-being)
PharmaSelf24
PrisonAssist
Turning-On

There was discussion of "Opt-out" in respect to population screening for antibody positive screening tests and how the question is framed:

"Want your bloods done, luv?"

"We test everyone because    ...

is that OK with you?"

On day 2 Suzy Diamond-White, Governor at HMP Eastwood Park shared management experiences and the quest for change in ‘Delivering Health and Wellbeing in a Women’s Prison’

A look at how health services are delivered within the operational demands of daily life at Eastwood Park given its complex population and wide geographical catchment area. How we keep wellbeing on the agenda to support our contracted health teams. What is so specific about a women’s prison? What needs to be overcome to ensure equivalent service to the community.

Gender was obviously fundamental here, the fit and appropriateness of P.E. kits, the procurement and supply of sanitary towels and incontinence pads. What is 'hygiene' being accounted for through a 'cleaning' budget and other historical legacies to be challenged. The geographical range of Eastwood Park across nine counties and all the consequences for family and children. Talk of prison as a punishment and the public's view was echoed a few times at the summit.

Elizabeth Moody, Deputy Ombudsman at Prisons and Probation Ombudsman provided more reflection on deaths in custody, stressing the families affected by and need for action and lessons to be learned. High profile cases were mentioned in several presentations. The talk gave me a sense on one hand of what families must go through, especially when circumstances suddenly engulfs an individual in the criminal justice system. The work that independent agencies do behind the headlines and sometimes in the midst of them

Chantal Edge, NIHR Clinical Doctoral Research Fellow for Department of Epidemiology and Public Health described research on “Systems barriers to telemedicine in prisons”.

Experiences of systems barriers (prison and hospital/community) encountered in England whilst attempting to operationalise a local prison-hospital telemedicine model, alongside broader evidence on prison telemedicine implementation barriers drawn from a systematic qualitative literature review of published prison telemedicine evidence.

I was late arriving to this session. As per my thoughts concerning Dr Matthew Langley's presentation the potential socio-technical studies might provide some insights?

Although it is also a commercial vehicle, Raconteur published with The Times had a special report on 5G in June. In a similar way to my references to the 5-Care-Domains of Hodges' model, many people talk of 5G and its speed, without fully understanding the change and opportunities this can bring. The report's summary:

"5G is so much more than faster 4G, but the extraordinary hype surrounding it has left many confused over what it will actually do for them. The 5G special report, published in The Times aims to shine light on this, exploring how 5G can transform healthcare and make smart roads a reality ahead of autonomous cars. It covers how to address public concerns over the health impacts of 5G and examines whether the rush to be first in the 5G race is a fool’s errand, with comment on how it might be better to deploy 5G best, rather than deploy it first. Also featured is an infographic measuring the true impact of 5G and looking at the sectors which stand to benefit the most ..."

Chantal provided some copies of an associated paper:

Edge, C., Black, G., King, E., George, J., Patel, S., & Hayward, A. (2019). Improving care quality with prison telemedicine: The effects of context and multiplicity on successful implementation and use. Journal of Telemedicine and Telecare. https://doi.org/10.1177/1357633X19869131

Rachel Gibbs "Equalizing Spaces"

Rachel Gibbs, Assistant Director for Prison Healthcare Services for Northern Ireland shared a travel fellowship “Equalising Spaces”.

Rachel Gibbs was awarded a Winston Churchill Memorial Trust Fellowship in 2019. She will share learning from her visits to Prison Healthcare services/Transitions clinics/Harm reduction rooms in California, North Dakota, New York, Barcelona, Geneva and Stockholm over an eight week period in order to being back innovative ideas to the UK. She will share some of the user involvement work happening in Northern Ireland.

Churchill Fellowship

The title of this session including 'spaces' had my immediate attention and did not disappoint. Rachel's Gibbs also provided help in making me feel a little less guilty in the future. Rachel highlighted and reminded me of the value of travel in the exchange, transfusion and diffusion of ideas, a difficult equation to resolve in these flight-shaming days.

Rachel Gibbs - findings

I do wonder what a global consensus would be on models of care, nursing theory and what other continents have to say (if anything?) on this topic that might inform my study of Hodges' model. Rachel recounted her travels and learning not just from her peers but from prisoners and ex-prisoners. Existing awareness of international health and justice provision was used to focus countries to visit.

Rachel shared her time with:

Transitions Clinic Network (TCN), USA.

and 

One Day at a time
Empowering youth to lead positive lives

Hodges' model repeatedly 'takes' me to spaces of all kinds and also transitions:

Life course - infant - child - teens - adult - older adult - end of life

Life course - infant - child - teens - adult - older adult - end of life :: Diagnosis X (Rare?)

Health - Social Care

Critical information giving :: Pre - Post

Adult service - Older Adult Services

Looked after Children - Adult

Younger Adult, Adult, Older Adult :: Early Onset Dementia

Home care - Day care - Respite care - Residential Care

Continuing Health Care

Justice and Health

Veteran - Civilian

Risk

Formative education - Lifelong learning

Health - Trauma - Intensive Treatment - Return Home

and other Transitions (Prevention!) ...

We often think of tools and the need for them to be ready to hand, as in organising your workspace. Increasingly as the list above suggests there is a need for tools to help keep things 'close to mind' also.

Professor Graeme Henderson (School of Physiology, Pharmacology and Neuroscience for The University of Bristol) gave a serious and yet entertaining talk on“Why are fentanyls so deadly?”

Fentanyls are highly potent opioid agonists. Only small quantities are required to produce their effects and this may make them attractive drugs for smuggling into prisons. fentanyls have pharmacological properties that make them more likely to lead to overdose than other opioids – in addition to their high potency and rapid onset of action these drugs induce respiratory muscle stiffness making it difficult to breath, are less sensitive than heroin to naloxone reversal and may show reduced cross tolerance to other opioids.

Prof Henderson provided statistics that had you paying notice, supporting the first answers to the title:

• High potency
• Faster rate of onset of respiratory depression
• Muscle stiffness (wooden chest) making it harder to breathe
• Lower cross tolerance between heroin and fentanyl
• Resistance to naloxone reversal

The Chairs for the summit had quite rightly drew delegates attention to the exhibitors, so I was a bit late again here. The photo is not very good, but brings home the potency of fentanyl. (That is Prof Henderson in the biohazard suit.)

... (still) to be completed - part iv to follow ...

ii RCGP’s 7th Health and Justice Summit: Journeys Through Justice – Leadership and Transformation

Before moving to day 2 ...

- the keynote by Cllr Asher Craig Deputy Mayor (Communities, Equalities & Public Health) at St George West Ward and Bristol City Council provided a city-wide perspective on public health, public mental health, the lived experience of child poverty and with it adverse childhood experiences, the impact of institutional racism and deaths in custody. I've taken more notice locally of community initiatives and sadly note speaking to what was once a local authority day care centre is now a social enterprise with uncertainty about its future. Cllr Craig spoke of Bristol's One City Approach and Learning Circles.

I attended Dr James Matheson's workshop, a GP at Hill Top Surgery and three medical students at Manchester Medical School - “Resources for primary care support to people in contact with the criminal justice system and their equally-affected others”

"Whilst the GP workforce is short, never have we had so many GPs in training. Is general training enough without extra specialist skills training on top? How then do we create and deliver a curriculum to inspire and prepare the next generation adequately for the challenges they will face?"

With posts to follow reviewing Kinchin's book the care environment presented by prison health  seems to encourage a network approach to learning, not merely linear - procedural - chain like approaches. As air safety methods demonstrate (outside of recent design?) checklists have their vital place as a heuristic and decision-making algorithm, but prison immediately challenges a student's attitudes, their expectations of themselves and others. Meeting prisoners crystalises a focus on self-awareness, what is subjective, objective, verbal and non-verbal communication. As per the synopsis the enthusiasm and feedback of the students to their learning was great to hear.

In addition to the student's contributions Dr Matheson highlighted inequality and referenced the "Deaths of Despair" that we have reached.

Another by Dr Matthew Langley, Consultant Forensic Psychiatrist for Rampton Hospital addressed:
“Remote vital signs and activity monitoring”.

"Early experiences with remote vital signs monitoring technology in High Secure (Women’s) Coral Ward (NHSHSW) is trialling Lio Health (Oxehealth)’s remote vital signs and activity monitoring system. This is an innovative solution to support our staff but also presents challenges to integrate effectively. This presentation will discuss initial feedback from staff and patients and investigate our experience as a service with this new technology."

This project was already underway when Dr Langley returned to work at Rampton. Apparently the technology is very effective, Dr Langley trying it himself. Risk is a cost-rationaliser and here the risk is acute. Generally in health care professionals will need to weigh the ethical pressures in adopting technology. Technology will be a factor in making health care (and universal health care) sustainable, but as with electronic health records and their benefits the latter need to be assured. Does a technology 'solution' really free senior staff to focus on more 'complex' work?

I did not ask in session Dr Langley about his awareness of work on socio-technical approaches and Enid Mumford's work. At coffee we had a chat and will follow up with some information. I am very much an advocate for technology - students expect no less, the public look at what we do, the way we work and rightly wonder: wither the technology?

Another concern, however, is the word 'recognition'. Facial recognition is already politically and ethically loaded. States are deploying this technology with 'emotional recognition', so careful consideration and critique is needed (imho).

Sarah Bromley, National Medical Director Health in Justice at Care UK, covered:
“Patient Safety and Quality in Prisons”

"Deaths in Custody are still rising and the PPO have identified repeat recommendations that continue to contribute to deaths. How do we learn lessons and implement change and how do we know when we have been successful. Dr Sarah Bromley will discuss the challenges faced, the Care UK PROTECT programme and quality assurance measures in use."

Sarah appealed to my 'information-oriented' focus, as it was noted how teams can still reach a point with a new referral / patient ' client and question:

"Have we got more information"?

"No."

"Oh, right."

They then elect to carry on without this (acute - in contrast to the uncertainty it represents?) need being pursued and fulfilled. A useful distinction was made by Sarah between training for staff - Wellbeing approach, ASSIST training 2-days on self-harm and suicidality, TRIM training; and support for staff who experience extreme trauma, clinical supervision and clinical forums.

There are subjects that need regular update and so I was very grateful for:

Dr Iain Brew, Deputy National Medical Director of Health in Justice Medicines Safety and
“Hepatitis C – developments and outcomes”.

This was very helpful personally as a nurse, and in the national and global objectives that have been set. With Hodges' model incorporating an individual -- group (population) axis and a Political care domain two further talks were greatly appreciated:

Juliet Lyon CBE, Chair of the Independent Advisory Panel on Deaths in Custody, who presented ‘Keeping Safe – how consultation with women and men in prison and health and justice professionals informs our work and advice to ministers.’ Ms Lyon explained feedback from prisoners on how "... you get the odd officer who really takes care and really wants to do something but there should be an officer on every landing who spends at least twenty minutes with one prisoner at a time through the time he is there and understand him and get to know him rather him just being a number ...".

A comment Ms Lyon made concerned the training of prison officers. The time is limited. I spoke briefly to Ms Lyon as there is a resource that imho should be a part of all course 101's and again I will reach for the email. This resource might help many prisoners too. One of the needs identified was prevention, improving prisoner - officer relationships and preparation for release. It must surely help in all of these if prisoners themselves were better equipped to reflect and have a better relationship with themselves? Self-esteem counts for a great deal and whether inside or out it seems many prisoner's self-esteem is challenged, even if sufficiently coherent and emotionally mature?

A quote also struck a chord: "All my life just got the better of me since aged 13" and a self-harmer.

And, Dr Brad Hillier, Consultant Forensic Psychiatrist at Heathrow Immigration and Removal Centres on “Mental Health and Substance Misuse in the Immigration Estate”. A topic that is clinically remote to me and yet conceptually 'visible'. Visible through geopsychiatry, the impacts of conflict, enforced migration.

Dr Hillier outlined the history of immigration removal in the UK from "Immigration Act Prisoners"
1970 - small detention unit in Harmondsworth, similar units in Dover and Gatwick.
Most IAPs held in prisons (180 in 1982).
1993 - Campsfield House converted from prison to IRC
Current system dates from around 2001-6
Home Office Policy to detain and deport developed
Detention Centre Rules (2001 - statutory instrument)
Immigration Detainees

More background on 'Routes into Detention'; the impact of detention on mental health (Von Werthem et al. 2018; Adult at Risk and Rule 35 - consideration for release on medical/professional evidence that there is a history/evidence of

• Torture/trauma
• self-harm
• Health condition (mental and physical) ...;

and Issues on removal / release.

This insight was new for me.

Although the programme is primarily divided between plenary sessions and workshops, the workshops - at least those I attended are essentially presentations. The room layouts reflected this. A workshop for me should have an audience work.

More to follow ...

i RCGP’s 7th Health and Justice Summit: Journeys Through Justice – Leadership and Transformation

Day one of my second Health & Justice Summit (with Convenzis) was very enjoyable and informative. The title even had me wondering whether I have inadvertantly referred online, or in conversation to the conference as 'Justice & Health'. This one, like January's in Liverpool demonstrates the balancing act that is: health (care) and justice.

Sometimes given the all-encompassing nature of Hodges' model you might think nothing stood out on day one. There is key learning here for me as on Monday I take on a ready-made caseload with an 'Adult' Community Mental Health Team. The team / service designations (Adult / Older Adult) are not mine (but, yes I am part of this 'system') and within teams due attention is given to ageism and 'where' patients are best suited whatever their age. While not specifically prison health, the new part-time role includes references to substance misuse, self-harm, history of violence, personality disorder and post-traumatic stress disorder. (The current political context was also acknowledged and applied on several occasions.)

As I start to write this (25th Nov) PM on BBC Radio 4 is deliberating on violent incidents and the need to toughen up on sentences, the glamourising of certain lifestyles and expectations for life chances, employment, police numbers, youth services, political manifestos, social media and understanding 'all this'. Amid what is a complex background the event's agenda was context packed, but for me several sessions stood out.

Suicide and Self-Harm across the Criminal Justice Pathway
with Dr Louise Robinson

Prison health is a challenging context. The prison health community are not just asking hard questions, they are clearly researching them, as in 'Suicide and Self-Harm across the Criminal Justice Pathway' with Dr Louise Robinson. The research pathway was outlined. Interventions discussed included 'skin camouflage' for self-harm; and Psychodynamic Interpersonal Therapy [PIT].

The development of the study from feasibility to WORSHIP I & "Women Offenders Self Harm Intervention Pilot I":

Walker, T., Shaw, J., Turpin, C., Reid, C., & Abel, K. (2017) The WORSHIP II study: a pilot of psychodynamic interpersonal therapy with women offenders who self-harm, The Journal of Forensic Psychiatry & Psychology, 28:2, 158-171, DOI: 10.1080/14789949.2017.1301529

- through to the latest WORSHIP III. It must be marvellous to be part of evidence-based thought and practice development and with future plans delineated: Complete WORSHIP III, COVER RCT; Cell-Soothe and PrisScope.

Miranda Davies of the Nuffield Trust reported work on "Prisoners' use of hospital services in 2017/18. Many were shocked hearing that 31% prisoners miss out-patient appointments, in contrast to a general did-not-attend - DNA rate of 8.6%. Was this due to the 'patient', or prison reasons? With frequent talk of the need for increased productivity and its neighbours of efficiency and effectiveness: this is painful. Miranda Davies also questioned the limits of hospital data: what (and how) healthcare is provided in prisons; wider aspects of the prison environment; whether researchers are capturing all the activity associated with prisoners from post code alone and coding quality.

Defining trauma

Emma Facer-Irwin explained “The role of trauma and PTSD on negative behaviours among male prisoners: Toward a model of Trauma-Informed Correctional Care in the UK”. When revising and updating - definitions are always welcome.









This definition is useful as on twitter and elsewhere you cannot fail to notice an addition to the debate, critique and vitriol on PTSD with the companion of Complex PTSD.

Differentiating between PTSD and Complex PTSD

This slide 'gave' me the lead for this blog post. It stresses the 'self' and interpersonal difficulties which can create humanistic chaos, by undermining relationships old and new 'in' the Sociological domain. The intra-personal and reflexive aspect is found in the re-experiencing centred on the inter-interpersonal domain as memory, emotional response, dreams (nightmares) and avoidance behaviours that can also affect other people.

In another session the bias, stigma and damage associated with the diagnosis of personality disorder as a 'bin' was noted. This was very positive to hear and later ('elsewhere') on twitter, negative responses in cases of self-harm in casualty by nurses were also called out. I remember this being highlighted in the late 1990s - early 2000s, a surprise that such negative attitudes from mental health professionals can still be expressed and felt.

Here in a tweet are organisers, supporters and sponsors who made the event possible:
https://twitter.com/h2cm/status/1199459402446712832?ref_src=twsrc%5Etfw


More to follow ...

Wellcome Collection: Handle with Care

Health care is complex
because
care delivery
involves the
handling
of a variety of forms of
knowledge, information and data. 

individual

|

INTERPERSONAL : SCIENCES

humanistic ---------------- ...WHAT IT MEANS ... ------------------ mechanistic

SOCIOLOGY : POLITICAL

|

group

to be cared for	to be caring
to care	to be a carer

The handling becomes specialised 

because of those

be's

the 'patient', the 'nurse', the 'carer'...

identities

loved, lost, earned and learned ...

The integration of all this 

can be summarised as so many forms of 'why'

often described as the spiritual -

Let us handle the Planet With Care.

Fink's Taxonomy: Significant learning

By L. Dee Fink, University of Oklahoma

...

Learning goals: Significant learning

For half a century, teachers at all levels of instruction have used Bloom’s taxonomy to generate learning goals beyond “understand and remember” kinds of learning.

This taxonomy has been extremely helpful, but it does not encompass all the kinds of learning that society and educators today believe is important. So I propose a new taxonomy, one that identifies six different ways in which learning can be significant for students:

1. Foundational Knowledge: students should understand and remember the basic content of the course (e.g., terms, concepts, principles). 
2. Application: students should use the content and engage in effective and appropriate kinds of thinking. 
3. Integration: students should integrate different disciplines, major ideas, and realms of life. 
4. Human Dimension: students should identify the personal and social implications of this knowledge. 
5. Caring: students should develop new feelings, interests, and values in relation to the subject. 
6. Learning How to Learn: students should keep on learning about the subject after the course is over.

...

Source article

<>

Fink's taxonomy will be very useful to help frame my studies and create an online platform for Hodges' model.

Papers - reading: Metalearning, Case-Based Learning, Reflection and Threshold Concepts

Working on the latest paper for module 4...

Jones, P. R. (1995) Hindsight bias in reflective practice: An empirical investigation. Journal of Advanced Nursing, 21(4), 783-788.

Within any web tool-resource based on Hodges' model can I try to ensure that reflection is a more 'contemporaneous' activity?

Ward, Sophie C., & Meyer, Jan H. F. (2010) Metalearning Capacity and Threshold Concept Engagement. Innovations in Education and Teaching International, 47(4), 369-378.

Metacognition, metalearning, reflection, reflective practice?

Kinchin, I., & Miller, N. (2012) ‘Structural transformation’ as a threshold concept in university teaching. Innovations in Education and Teaching International, 49(2), 207-222.

McDonald, K. (2013) Is reflective practice a qualitative methodology? Nurse Education Today, 33, 13–14. doi:10.1016/j.nedt.2012.07.011

Reflective practice as a single case study?

Kantar, L.D. & Massouh, A. (2015) Case-based learning: What traditional curricula fail to teach. Nurse Education Today, 35(8), E8-E14.

Three learning practices that were developed by the case study approach: (a) recognizing the particulars of a clinical situation, (b) making sense of patient data and informing decisions, and (c) reflection. Indepth analysis of these practices helped unravel four professional attributes that form the tenets of case-based learning: (1) a salience of clinical knowledge, (2) multiple ways of thinking, (3) professional self-concept, and (4) professional caring.

Several forms of situatedness are also described.

I am wondering about the possible role of 'worked examples', but am also aware through Kantar  & Massouh and others of the labour intensive nature of producing case studies (as worked examples). Is there another way to present them? One that is also student produced?

Situated Noticing
Drawing on students’ experiences in CBL, three categories emerged from the data to describe the sequence of noticing activities: (1) grasp of patient data, (2) holistic grasp of every aspect of the patient, and (3) clinical imagination (e10).

Assumpta, A. (2015) Transdisciplinary technology education: a characterisation and some ideas for implementation in the university, Studies in Higher Education, 40:9, 1715-1728, DOI: 10.1080/03075079.2014.899341

No mention of 'holis*' interesting for that?
Figure 1. Conceptual framework to understand complexity theory (Jackson and Ward 2004).

Figure 2. Traits of transdisciplinarity as a process group (Wenger 2000, 233) - includes 'A set of maps'.

(btw - the first paper is not mine.)

Nightingale forgotten: Leaving the optimism to others...

individual

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

?	One in four 18 - 24-year-olds failed to identify Florence Nightingale as a nurse in a survey that also revealed that one in five people chose not to go into the profession because they felt nurses were unappreciated. ... The Times, p.4.
?	?

Bates Center Blog:

What Would Florence Nightingale Do (WWFND)?: Nightingale and 21st Century Health Care Reform

 c/o IPONS


The Times, Nightingale forgotten, Tuesday May 12 2015. p.4.(Poll, London Clinic)

Hodges' model = Four care domains + Spiritual

If you must rumple the care domains - rumple them together

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

group

'A Man’s body and his mind, 
with the utmost reverence to both I speak it, 
are exactly like a jerkin, and a jerkin’s lining; – 

rumple the one	– you rumple the other.’ 1

¹ Sterne L. The Life and Opinions of Tristram Shandy, Gentleman (1761), vol. 3, ch. 4 (eds M New, J New). University of Florida Press, 1978.

Source: Royal College of Psychiatrists (2013) Whole-person care: from rhetoric to reality Achieving parity between mental and physical health. Occasional Paper 88, March 2013. p.2.

FOUR QUARTETS T.S. Eliot from EAST COKER - IV

FOUR QUARTETS

T.S. Eliot

EAST COKER
(No. 2 of 'Four Quartets')

IV
The wounded surgeon plies the steel
That questions the distempered part;
Beneath the bleeding hands we feel
The sharp compassion of the healer's art
Resolving the enigma of the fever chart.
    Our only health is the disease
If we obey the dying nurse
Whose constant care is not to please
But to remind of our, and Adam's curse,
And that, to be restored, our sickness must grow worse.
    The whole earth is our hospital
Endowed by the ruined millionaire,
Wherein, if we do well, we shall
Die of the absolute paternal care
That will not leave us, but prevents us everywhere.
    The chill ascends from feet to knees,
The fever sings in mental wires.
If to be warmed, then I must freeze
And quake in frigid purgatorial fires
Of which the flame is roses, and the smoke is briars.
    The dripping blood our only drink,
The bloody flesh our only food:
In spite of which we like to think
That we are sound, substantial flesh and blood—
Again, in spite of that, we call this Friday good.


T.S. Eliot Nobel Prizes biography
http://www.nobelprize.org/nobel_prizes/literature/laureates/1948/eliot-bio.html

Source copy:
http://www.davidgorman.com/4Quartets/notes.htm

http://www.davidgorman.com/4Quartets/2-coker.htm