Special Issue: Health and Human Rights Journal

Dear Colleagues and friends

I am writing to share with you the special issue of the Health and Human Rights Journal, which we are publishing to commemorate the first anniversary of the death of Paul Farmer. 

https://bit.ly/HHRSpecialIssue

Special Section in Volume 25, Issue 1, June 2023, published on the first anniversary of the death of Paul E. Farmer, former Editor-in-Chief, who worked for the right to health for all.

Kulina girl
"A decolonial gaze" by Angel Martínez-Hernáez

In it, you will find articles that expand the conception of the right to health, with significant contributions from the global South. We gather contributions from Africa, South Asia, Latin America, Eastern Europe, North America, and Western Europe.

The articles are positioned from a wide range of critical perspectives, such as Social Medicine, Collective Health, Latin American Critical Medical Anthropology, the Indigenous Research Paradigm, Human Rights Pedagogy, and Structural Competency.

We hope that these works will inspire your reflections and practices. We'd like to thank you in advance for sharing them.

Yours faithfully.

Carlos Piñones-Rivera, Ángel Martínez-Hernáez, Michelle E. Morse,
Kavya Nambiar, Joel Ferrall, and Seth M. Holmes

Dr. Carlos Piñones Rivera
Departamento de Ciencias Sociales (DECSO)
Universidad de Tarapacá, Chile

Posted (and my source) from the Spiritof1848 Listserv WWW.SPIRITOF1848.ORG #Spiritof1848

(Edited from original - thanks to Carlos and Ángel).

Tweetchat - "Inter-Field Learning" 3rd November 2022

"There are four fields of nursing:

1. adult nursing
2. children’s nursing
3. learning disabilities nursing
4. mental health nursing"
   
   

NMC - Standards for competence for registered nurses

Share your experiences and innovative ways of implementing our @nmcnews standards of proficiency for registered nurses across the four fields of nursing. @JulieDi26744550 @paulajaneholt https://t.co/b9l6rUvQsX

— Susan Lynn West (@SusanwestSusan) October 27, 2022

Includes the questions:
How do you develop curricula to embrace holistic care? What examples of best practice can you share?

[ Competencies ( All nurses (field of registration) ) ]

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

professional values communication and...	decision making
...interpersonal skills nursing practice team working socialisation (professional values, identity...)	professional values leadership management

No endorsement of Hodges' model to be implied or intended.

Nursing: The Adult Patient 1966

"To the Student"

"To the Teacher"

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

"The ways in which the nurse helps people are infinitely varied, and she is being called on constantly to exercise the very delicate judgment." p.xiii "Nurses respond to pressure in many different ways. Some withdraw, going as far from patients as possible. (They clean the medicine cabinet; it does not complain.) Some go about their work mechanically, refusing to get involved emotionally because involvement brings too much worry." p.xiv "The  particular aim of the authors of this book is to assist you in understanding and helping each individual patient for whom you care. ...

"For a particular patient at a particular time, one aspect of nursing care may outweigh all others in importance." "We believe that nurses need to develop a broad orientation to the care of patients, wherever the patient may be." p.xii "All divisions in the study of nursing are arbitrary. There is unity of nursing, regardless of whether it is practiced at home, in a hospital, in a jungle or a desert; whether the patient is a child or an adult; whether the illness is physical, mental, or both." p.xiii "Neither the "intercom" system nor the monitoring device that indicates the patients' vital signs was meant to supplant the nurse. ... In the future there will be more machines to perform mechanical tasks, but no machine can establish the creative, sustaining relationship with people that helps them to get well." p.xiv.

... Whatever their differences in social and economic background, temperament or relative state of health, your patients will have in common certain basic human requirements - skilled care, understanding and respect." p.xiii  "Some try old social skills in new situations. These may or may not be applicable. Social chit-chat may make the nurse feel at ease but may be one way to avoid learning abount the patients' needs. Some nurses manage t ofind a a formula that is exactly right for them. They become involved enough to be concerned about helping patients, while continuing to grow and learn." p.xiv

"The nursing situation today is far from ideal. Many nurses face a staggering workload - not only in relation to the number of patients for whom they are responsible but also because of the greater responsibility that is being delegated to them as advances are made in medical science." p.xiv. "Chapters on disaster nursing and world health problems have been included in the conviction that the profession of nursing has an important role to play during any disaster." p.x-xi

There is a definition of 'health' in this book (p.53), but no specific reference to nursing theory or models of nursing. Reading the references, the definition of health is neither derived from nursing or a WHO source. The definition does refer to health being more than the absence of illness.

Addressing acute contemporary issues, Chapter 59 'Nursing in Accident Disaster' includes Nuclear Disaster pp.1103-1114; while Chapter 60 on 'World Health Problems' is more comprehensive than I expected in such a book and at this time. Although the Cuban missile crisis was only fours years prior to publication.

Smith, D. W., & Gips, C. D. (1966). Care of the adult patient: Medical-surgical nursing. Philadelphia: Lippincott.

Digital Wellbeing Educators - Online Summit

Higher Education has been transformed in recent months in response to the Covid-19 pandemic, as face-to-face teaching has been abruptly transformed into emergency remote teaching in virtual learning environments. For many, this has been a first-time experience, accelerating adoption of online education, often in a very agile way without the time and resources to allow for a carefully planned approach. Throughout this process students have also been compelled to change the way that they learn, and many may lack the competences required to fully participate in online education. 

More details and booking ...

See also:
http://www.digital-wellbeing.eu/

My source:
Dr Julie-Ann Sime
Centre for Technology-Enhanced Learning
Educational Research Department | Lancaster University

Eye tracking - the silver bullet..?

Eye tracking: 
the silver bullet of competency assessment 
in medical image interpretation?

Kok, E.M. (2019) Eye tracking: the silver bullet of competency assessment in medical image interpretation? Perspectives on Medical Education. 8:63–64.
https://doi.org/10.1007/s40037-019-0506-5

^*Jones, P. (2019) Eye tracking: the silver bullet of competency in achieving integrated, holistic and person-centred care through reflection and critical thinking? 2020 Vision in Care.1:1-25.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

^*Of course there is no such paper ...

c/o [hifa] WHO Webinar: Compassion - mapped to Hodges' model

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

sympathy, empathy, compassion mental states, feelings, emotions communication (verbal - non-verbal) experience, sorrow, suffering personal ethics, learning reflection, self-compassion psychometric instruments mentor, role model listening, non-judgemental student idealism  meditation, contemplation (drug concordance) Poor psycho-	Research Teaching methods and methodologies measure compassion Technical competence diagnostic accuracy studies - literature (drug compliance) QUANTITY health & compassion as a 'science'
social support  QUALITY culture peer support - sharing reflexive, desire to help rapport, PRACTICE based research Research on empathy > compassion role models teamwork	better outcomes, public demand (for more compassionate) health workers - high workload mission statements Health Institutions Regulatory organizations Medical councils harassment - poor team functioning compassionate leadership

See also and c/o HIFA:
c/o [hifa] WHO Webinar: Compassion – the heart of quality people-centred health services

Relativistic - Thinking checks and balances [V]

Effective nurses aspire to be time travellers.

Why should flash traders have all the adventure?

They also need to think relatively and be relativistic thinkers, the latter as described by Johnson (1994). If this sounds like faster than light travel in a sense it is, or at least it should seem like. Meeting the patient as they or someone reaches for the phone to seek help: is obviously taking the anticipation of care needs to the relativistic extreme - so what is this about?

This page at JHU "Perry’s Scheme – Understanding the Intellectual Development of College-Age Students" lists how Perry's formulation is reduced from nine to four levels of development:

1. Dualism – knowledge is received, not questioned; students feel there is a correct answer to be learned.
2. Multiplicity – there may be more than one solution to a problem, or there may be no solution; students recognize that their opinions matter.
3. Relativism – knowledge is seen as contextual; students evaluate viewpoints based on source and evidence, and even experts are subject to scrutiny.
4. Commitment within relativism – integration of knowledge from other sources with personal experience and reflection; students make commitment to values that matter to them and learn to take responsibility for committed beliefs. There is recognition that the acquisition of knowledge is ongoing activity.

Previous posts from January 2016 - with links supplied below - have reflected on dualistic and multiplistic thinking. I'm still exploring how work in educational psychology might inform my own. Picking up this thread again how does Hodges' model engender and contribute to relativistic thinking? Relativistic thinking as relates to Hodges' model is about a journey and not just one as item #3 above suggests. The student's journey may fly-by in time, but it is long and quite dense. Learners must negotiate lectures, self-study, simulation, patient, carers and public encounters, learning journals, clinical placements, assessed work and assessments, student-mentor sessions and all that the curriculum entails. Within the student's career there are innumerable situations and contexts if we cared to count them.

Responding to #3 Hodges' model can encourage immersion in a given context that presents a learning opportunity. They can also evaluate the situation as the care domains provide an epistemological platform from which to take in viewpoints and in the care domains scrutinize the knowledge that is shared and found through study. This includes the knowledge of experts. Whatever the care domain as a platform and viewport the student finds themselves in they should find a tendency to anticipate the other vistas nearby. Not only that but cognitively if not literally the patient and family when relevant can be with them. For person-centred care isn't just a matter of what is relativistic, but quantum too. 'Where' the patient is: so we are too.

Johnson, D.D. (1994). Dualistic, Multiplistic, and Relativistic Thinking as it Relates to a Psychology Major. Honors Theses. Paper 202.
http://opensiuc.lib.siu.edu/uhp_theses/202/

See also:
William Perry's Scheme of Intellectual and Ethical Development
A journey along the 9 "Perry" positions (as modified by Belenky et al. 1986) by William J. Rapaport

Thinking checks and balances [I]

Dualistic- thinking checks and balances [II]

Dualistic- thinking checks and balances [III] (or: The-hyphen)

Multiplistic - Thinking checks and balances [IV]

What does professionalism mean to me? #IND2017 (dnf: draft never finished)

Something along, within and across these lines...

INDIVIDUAL

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

POPULATION

Being self-aware, reflective and reflexive including aspects of your role that either you don't especially like, or you're just not 'good' at. Recognise when to ask for help, advice, supervision. Anticipating needs. Indicating pros and cons. Keeping up-to-date. *Have the courage to blow that whistle if you must. Communicate to the best of your ability and learn constantly as human nature dictates you must. Look after yourself: if ill Be ill. Take care of your personal ethics and values, don't be bullied into lowering them and running with the crowd. Nurse = Lifelong Learner ... then you will question your own competence. As you strive to be someone else remember you can be yourself. The things you take personally are those you open the door to. Learn from them. Never forget your shield, protect yourself and others in what you disclose about yourself and others.

Being compass-ionate requires 360 degree vision, hearing ... learning and forgetting... Your keen are you? So really observe. Care about time, your management of it as a resource and the time frames of past, now, future, hoped for and imagined. Remember you need to understand information systems, data management in so far as it supports or places at risk the care you deliver and the safety of your patients. If I use IT based media I bear in mind the scope of the platform. Open to innovation: but see the elephant as an elephant. When the robots knock on your door being professional means you won't be in: "Moved On" As you care, draw on learning regards where you stand -  you are a guest in someone's home, As your feet are then grounded politically, so too is touch and negotiating personal spaces.

Learn from others  Expectations Expectations Expectations Manage them in a way such that you do not make promises you can not keep. Be committed to what you do. Learn from your peers, especially for safety's sake, but also form your own opinion. Talk this and work through with colleagues. Not everyone will 'like' you; you in turn may not 'like' people. Working through this (without experiencing abuse) as your role demands is being professional. By all means be a team player, but don't let the games that people play distract you from being professional. Patient-Carer Community Care End of Life Care  As you learn from others  pay most attention to the lessons  in Love as you will witness many.

The trust and respect of others take time to earn, but can be lost in an instant; if you have 'it' use it to foster trust and self-respect in others. You have to remember constantly you are accountable here. Remind yourself of codes of conduct the legal aspects of your role. Know your lines - especially when crossed | STANDARDS. With your ID have your whistle ready*. What you do and who you are is a privilege. Know your scope of practice, but be ready to question it. If you do not the future will. This domain is the most powerful and neglected to the professional nurse. As a professional what are YOU going to DO here? The art of leadership is filled with wonder: at what together you can all achieve. Take stock and ask in Year 1 what are the legacy issues my seniors are wrestling with? In years 10 20 30 40 ... (robotics permitting) repeat and reflect.

... because, being professional means learning and unlearning when the lines are there for a purpose and when they need to be shifted, lifted or plain erased ...

Previous post c/o NMC

Book: Skills for Communicating with Patients

Skills for Communicating with Patients

Part 1 of my studies at Lancaster has been a busy two years. Picking up this book which I used in a research paper, the delivery note was a surprise. The book arrived c/o Radcliffe Health in April 2014. Since then Radcliffe is no more, but the title is available through CRC Press.

An established text given a 3rd edition it is accessible, thorough and well organised. The content presents the Calgary - Cambridge Guides as described on the back cover (PB).

Initiating the session. Gathering information. 
Providing structure to the interview. Building the relationship. Explanation and planning. Closing the session.

(As a non-medic) what I like about this CPD certified book is the clear path through the chapters that explain the Calgary - Cambridge Guides. Other models, frameworks and approaches are described. The Calgary - Cambridge Guides is process-centric as is evident in 'gathering information', but the complexity that arises in achieving competence is included and fully referenced (pp. 263-293) throughout the book. Framing questions in open and closed form is covered, with example dialogue between patient and doctor on many practical points. Person-centredness, uncertainty, motivational interviewing, mental health - psychosis, risk (suicide) are also explained. While person-centredness is not the main focus, 'patient' ... is very well served in the index. There is much here about shared understandings and planning and how to make suggestions and raise options rather directives (concordance, p.193). Although it might be viewed as 'cold', I liked the emphasis on information and inclusion of health literacy.

In a very brief break from my proposal I've brushed off two draft papers I've mentioned before on W2tQ at some point. They relate Hodges' model respectively to:

• threshold concepts 5,000 words 
• case formulation 4,000 words

In a way the Calgary - Cambridge Guides is a means to a formulation, but a formulation that is consultation (appointment, session) specific. Perhaps in future we will see developments that are more integrative and consider continuity as a vital part of this critical activity. This is the challenge in communication getting the scalability of communication and communication skills right. Clearly beyond the scope of this book but how much of that communication gets passed-along (communicated!)?

This is however a very complete, readable and informative read. Without expanding the book further: but more on technology-mediated communication (beyond computers in the consultation) must be essential in a 4th edition? I am biased but in dusting off the above papers, more on the challenges within mental health, especially self-harm, body-image, mental capacity, and forensic might highlight troublesome (threshold) concepts. Understandably, the disease-illness model is highlighted (p.65). Living well through self-care, living with chronicity, strengths and recovery perspectives may also deserve mention? Working towards a 'meeting of experts' (p.184) helpfully begins to address such developments. With my project in mind I also looked for 'evaluation'. If "research" had its own place in the index - what would the content be?

It proved helpful having a break from the draft papers I wished I'd picked this text up sooner and that I can look at my research proposal similarly refreshed...

Silverman, J., Kurtz, S., & Draper, J. (2013). Skills for Communicating with Patients, 3rd Edition, CRC Press.

Below I have mapped some of the elements of the Calgary - Cambridge Guides to Hodges' model (disrupting the original).

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

1. Initiating the session: Preparation Exploration of the patient's problems patients's perspective background information - context Aiding accurate recall and understanding Identifying the reasons for the consultation	Providing STRUCTURE: 2. Gathering information: biomedical perspective 3. Physical examination: Providing the correct type and amount of information
Building the RELATIONSHIP: Approp. non-verbal behaviour Developing rapport Involving the patient Achieving a shared understanding: incorporating the patient's illness framework 4. Explanation and planning:	Making organisation overt Planning: shared decision making 5. Closing the session: Ensuring appropriate point of closure Forward planning

Image source:
CRC Press

Paper - The effectiveness of internet-based e-learning on clinician behavior and patient outcomes: a systematic review

As I work on my research proposal this paper (in press) is a very useful and timely reference...


Abstract - Background

The contemporary health workforce has a professional responsibility to maintain competency in practice. However, some difficulties exist with access to ongoing professional development opportunities, particularly for staff in rural and remote areas and those not enrolled in a formal program of study. E-learning is at the nexus of overcoming these challenges. The benefits of e-learning have been reported in terms of increased accessibility to education, improved self-efficacy, knowledge generation, cost effectiveness, learner flexibility and interactivity. What is less clear, is whether improved self-efficacy or knowledge gained through e-learning influences healthcare professional behaviour or skill development, whether these changes are sustained, and whether these changes improve patient outcomes.

Sinclair et al. refer to:

"One suitable framework that is congruent with e-learning research is Kirkpatrick’s four levels of evaluation." (p.53).

I have taken the rest of the paragraph and mapped the stated levels to Hodges' model:

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

Level two pertains to learning and the evaluation of knowledge.	Kirkpatrick’s model is hierarchically based with level one relating to student reaction and how well the learner is satisfied with the education program.
Level three expands on this and considers whether the education has influenced behavior. In the context of this review, behavior change is any practice that is intrinsically linked with the outcomes of the e-learning program undertaken.	Finally, level four evaluates the impact on outcomes such as cost benefit or quality improvements.

The author's continue: "The majority of e-learning research has focused on participant experience and knowledge acquisition, outcomes that correspond with the first two levels of Kirkpatrick’s model. To date, few studies have examined the effectiveness of internet-based e-learning programs on HCP [health care profession] behavior, which aligns with Level 3 of Kirkpatrick’s model (p.54)."

Peter M. Sinclair, Ashly Kable, Tracy Levett-Jones, Debbie Booth, The effectiveness of internet-based e-learning on clinician behavior and patient outcomes: a systematic review, International Journal of Nursing Studies, Available online 4 February 2016, ISSN 0020-7489, http://dx.doi.org/10.1016/j.ijnurstu.2016.01.011
(http://www.sciencedirect.com/science/article/pii/S0020748916000122) 

Keywords: e-learning; Systematic Review; Education; Information Communication Technology; Health Care Professional

Borges & Forés: The Role of the Online Learners and the Four Competentional Clusters (Khan & Ally, Eds. 2015)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL
|

group

Metacognitive	Operational
Relational	Academic

Since receiving the e-learning handbooks edited by Khan and Ally (2015) in April there have been several challenges; studies, sickness in the family and full-time work. I'm up to chapter 13 of Volume 1 and I have learned a great deal thus far. The first volume is already serving as an excellent primer on e-learning for someone in full-time clinical work, studying by distance learning and with teaching and mentoring experience.

The above table is derived from chapter 13 by Federico Borges and Anna Forés.

I have superimposed Borges' four competentional clusters onto Hodges' model. There is also a figure (13.1) that seeks to show that:

• there is no hierarchy among the competences,
• competences are all interrelated,
• more than one competence can occur at the same time,
• competences are manifested when needed and as needed (p.199).

This can also be related to the 4P's

purpose	process
practise	policy

Borges, F. and Forés, A. (2015) The Role of the Online Learner, Chap. 13 In Badrul H. Khan, Mohamed Ally (Eds) International Handbook of E-Learning. Volume 1, Oxford: Routledge. pp. 197-206.

Six Threshold Concepts Anchoring the New Framework for Information Literacy (2014) ACRL

Amid several ongoing challenges I have been reading and writing on threshold concepts, Hodges model and Technology Enhanced Learning with 1800 words thus far. At the residential in April we had a talk on publishing so that is the aim.

The following reference -

Knapp, M., Brower, S., 2014. The ACRL Framework for Information Literacy in Higher Education: Implications for Health Sciences Librarianship. Medical Reference Services Quarterly 33, 460–468. doi:10.1080/02763869.2014.957098

- includes an interesting table, doubly so since the framework concerns information literacy. In the table below I have reversed the columns. The full framework documentation also provides more comprehensive references.

Five Information Literacy Competency Standards for Higher Education (2000)

Six Threshold Concepts Anchoring the New Framework for Information Literacy (2014)

The 2000 standards outlined five abilities an information literate student will possess. The information literate student...1 1. Determines the nature and extent of the information needed, 2. Accesses needed information effectively and efficiently, 3. Evaluates information and its sources critically and incorporates selected information into his or her knowledge base and value system, 4. Uses information effectively to accomplish a specific purpose, individually or as a member of a group, and 5. Understands many of the economic, legal, and social issues surrounding the use of information and accesses and uses information ethically and legally

Threshold concepts are defined as ‘‘those ideas in any discipline that are passageways or portals to enlarged understanding or ways of thinking and practicing within that discipline.’’3 1. Scholarship is a conversation, 2. Research as inquiry, 3. Authority is contextual and constructed, 4. Format as a process, 5. Searching as exploration, and 6. Information has value

Adapted from: TABLE 1 Information Literacy: Then and Now, p.462.

1. Association of College and Research Libraries. ‘‘Information Literacy Competency Standards for Higher Education.’’ January 18, 2000.
http://www.ala.org/acrl/standards/informationliteracycompetency

3. ACRL Information Literacy Competency Standards for Higher Education Task Force. ‘‘Framework for Information Literacy for Higher Education. Draft 2. June 2014.’’ 2014.
http://acrl.ala.org/ilstandards/wp-content/uploads/2014/02/Framework-for-IL-for-HE-Draft-2.pdf

new Essential IT Skills Programme - EITS

It's a refreshing change to learn of something IT on a mental health nursing list, but that is the case with a new IT skills initiative:

NHS Connecting for Health (NHS CFH) has announced that it will be introducing the Essential IT Skills (EITS) Programme on 3 March 2008, to replace its European Computer Driving Licence (ECDL) Service which is due to close on 21 March 2008.

Source: http://www.connectingforhealth.nhs.uk/newsroom/news-stories/eits

The PSYCHIATRIC NURSING list is 10 years old and currently deliberating upon its future, wider membership and the state of IT skills.

Ack: Thanks to Clive Simpson for his post.