Hodges' Model: Welcome to the QUAD: evidence based care

Hodges' model is a conceptual framework to support reflection and critical thinking. Situated, the model can help integrate all disciplines (academic and professional). Amid news items, are posts that illustrate the scope and application of the model. A bibliography and A4 template are provided in the sidebar. Welcome to the QUAD ...

Showing posts with label evidence based care. Show all posts
Showing posts with label evidence based care. Show all posts

Monday, July 21, 2025

"Passport please!"

Press release

'Innovator passports’ set to accelerate cutting-edge NHS care

The move is a key part of the government’s Plan for Change and its 10 Year Health Plan, which will transfer power to patients and transform how healthcare is delivered, creating an NHS fit for the future.

For too long, cutting-edge businesses avoided working with the NHS and went elsewhere, weighed down by slow timelines and reams of processes. Now, organisations will be able to join up with the NHS quicker than ever before through the removal of needless bureaucracy. Not only is this better for patients but also for our NHS and economic growth.

A ‘one-stop shop’ thorough check from the NHS will now allow businesses to get to work as quickly as possible and deliver on what matters most to patients across the country. It means NHS patients will get more effective treatments and support quicker, and the NHS will make the most of its finite assessment resource, all while businesses are given a boost through the government’s industrial strategy.

Treatments including special wound dressings - already reducing surgical site infections by 38% at Barking, Havering and Redbridge University Hospitals - could be adopted more widely, benefiting patients across the country.

At Barts Health NHS Trust in London, use of antimicrobial protective coverings for cardiac devices has cut infections and saved over £103,000 per year. At University Hospitals Dorset, adopting rapid influenza testing reduced bed days and antibiotic use, freeing up vital resources.

The new passport will eliminate multiple compliance assessments, reducing duplication across the health service. It will be delivered through MedTech Compass, a digital platform developed by DHSC to make effective technologies more visible and widely available.

MedTech Compass will make these innovations and the evidence underpinning them clear to buyers within the NHS.

The initiative builds on the government’s drive to slash waiting lists and ensure people have access to health and care when and where they need it under the Plan for Change.

Wes Streeting, Secretary of State for Health and Social Care, said: 

For too long, Britain’s leading scientific minds have been held back by needless admin that means suppliers are repeatedly asked for the same data in different formats by different trusts - this is bad for the NHS, patients and bad for business. 

These innovator passports will save time and reduce duplication, meaning our life sciences sector - a central part of our 10 Year Health Plan - can work hand in hand with the health service and make Britain a powerhouse for medical technology.

Frustrated patients will no longer have to face a postcode lottery for lifesaving products to be introduced in their area, and companies will be able to get their technology used across the NHS more easily, creating a health service fit for future under the Plan for Change.

Dr Vin Diwakar, Clinical Transformation Director at NHS England, said:

We’re seeing the impact improvements to technology are having on our everyday lives on everything from smartwatches to fitness trackers - and we want to make sure NHS patients can benefit from the latest medical technology and innovations as well.

The new innovator passports will speed up the roll-out of new health technology in the NHS which has been proven to be effective, so that patients can benefit from new treatments much sooner.

It also forms an important element of the industrial strategy through the upcoming Life Sciences Sector Plan, which will turbocharge Britain’s life sciences sector and cement the UK’s position as a global innovation leader.

MedTech Compass helps speed up decision-making in trusts, allowing technology to scale faster - making it easier for trusts across the country to find, assess and adopt proven technologies that improve and speed up patient care.

The passports mean that once a healthcare tool has been assessed by one NHS organisation, further NHS organisations will not be able to insist on repeated assessments, reducing the need for local NHS systems to spend their limited resources on bureaucratic processes that have already been completed elsewhere.

The digital system will act as a dynamic best buyer’s guide, making it easier for trusts to compare products side-by-side in one place.


Read the full press release:
https://www.gov.uk/government/news/innovator-passports-set-to-accelerate-cutting-edge-nhs-care

In my source (below) Laura Hughes also notes:
'However, the Financial Times has reported on calls by frontline workers for basic NHS infrastructure to be brought up to a minimum standard before politicians extol the virtues of cutting-edge tech.

Matthew Taylor, head of The NHS Confederation, which represents health managers, said not all NHS organisations were at the same stage of digital maturity, which would "affect their ability to either innovate or implement preapproved innovation in this passport model."'


Individual
|
      INTERPERSONAL    :     SCIENCES               
HUMANISTIC  --------------------------------------  MECHANISTIC      
 SOCIOLOGY  :    POLITICAL 
|
Group
innovation

personal passport

awareness of existing state / processes

innovation

'innovation passport'

duplication

innovation

public safety

waiting lists / times

accountability - standards - assurance

innovation

bureaucracy - multiple Trusts

procurement
of infrastructure and innovation -
cutting-edge technology




Laura Hughes NHS use of medical innovations streamlined. FTWeekend, 2 July, 2025, p.3.
https://www.ft.com/content/1d025579-990a-4d58-9e0b-6d0d29d27dab

Previously:

Wednesday, June 25, 2025

ICN - Definition of 'Nursing' & 'a Nurse'

Renewing the Definitions of
 'Nursing' and 'a Nurse'  


 Defining 'nursing' and 'a nurse' has always had a place in both theory and practice. This is one thing that can bridge the theory-practice gap, but still needs to be explained and made sense of. Especially when the values that underpin our definitions are challenged by social, political, physical and attitudinal change.

 

Of course see the report for the latest definitions. 


Previously:

'nursing' : 'nurse' : 'definition' :


Individual
|
      INTERPERSONAL    :     SCIENCES               
HUMANISTIC  --------------------------------------  MECHANISTIC      
 SOCIOLOGY  :    POLITICAL 
|
Group

PERSON-CENTRED CARE 
Ack. Identity of Others
Balance Subjective - Objective 

Care for and Compensate for
Emotional and Psychological Needs

Knowledge and (Interpersonal) Skills

Emotional labour, Compassion, Courage

Self-Awareness - Competence (recognise limits), When/If stressed :: Act for Safety of All, Please See your Strengths too! Commitment

Active Listening - Attention
Mentor Students - Newly Qualified Nurses

Philosophical stance Ethics & Values

Exercise Emotional Literacy

Collaborate when possible
Supoport Self Care improve Health Literacy
PERSON-CENTRED CARE
Care for and Compensate for Physical Needs 

Skills and Knowledge of Sciences, Technology, Devices, treatments, drugs, procedures, processes

Seek Evidence-based Care and Record

Observational Acuity
Situational Awareness
Anticipate Needs

Foster SELF CARE -
'See' Strengths, Recovery'
- and PLANETARY HEALTH

Be aware of Information Disorder

Assure Parity of Esteem

Document Care - Gather Data for Reporting/Research/Outcomes

Consider Patient's/Individual's
Journey - Health Career
PEOPLE-CENTRED - Inclusive

Seeing Others and Promote Wellbeing of Colleagues inc. All Students/Newly Qualified Professionals

Understand (your) Community 
as Resource & needing Care

Recognise Family - Friends but ensure Confidentiality
Exercise Empathy & Rapport

Seek Public Involvement

Public Safety & Protection

Maintain Professional Confidentiality

See Person as a 'Whole' - Integrate Care

Advocate for Social Justice
Exercise Duty of Candour

Seek Psychological Safety for all Team

Work Relationally within/across  Communities of Practice - Foster Therapeutic Relationships

Envision Patient at 'Home' in the Community - Seek re-housing placement as early as possible
SERVICE-CENTRED CARE
Advocate for Equity, Equality in Access to Care and Universal Health Coverage

Seek to Assure Safety of Self, Colleagues
 & Public (1st Rule of 1st Aid) esp. in Conflict Environments - Refugees/Migrants

Nursing - Profession - Registered
Protected Occupational Title

Seek Supervision & Feedback
Manage Services
Seek to Improve Quality - Monitor Policy

Security of Care Environment, Data, Record, Confidentiality (Vigilance across the domains*)

Practice as per Professional Standards, 
Code of Conduct

Ack./work to reduce impacts of ALL Determinants of Health to increase Sustainability

Accountability - Transparency

Continuing Professional Development

Revalidation of Registration/Licensing

Advocate for Future Generations - Humanity
Population & Biospheric Health



*This is why nursing, being a nurse is 'emotional labour'.

Hodges' model can be embedded within the SPIRITUAL, as per cultural and situational context.

P.S. By the way, if anyone asks - you can just be 'a nurse'.


White, J., Gunn, M., Chiarella, M., Catton, H., Stewart, D., (2025). Renewing the Definitions of 'nursing' and 'a nurse'. Final project report, June 2025. International Council of Nurses.
https://www.icn.ch/resources/nursing-definitions/current-nursing-definitions

Tuesday, April 08, 2025

Book TSR ii - Mental illness/health: History, process and progress

As posted yesterday through a book review, I developed an awareness for the role of process much earlier than previously thought. It wasn't Enid Mumford's work on the benefits of a socio-technical approach to successful deployment of information systems. I only discovered this well after the advent of home computing with the ZX81 and BBC micro 1981-1995.

It was 1978-79 to be more exact; on an admission ward during my three year student Registered Mental Nursing course at Winwick Hospital. On first recollection, I thought it was a clinic, with patients coming in for Clomipramine (Anafranil) infusion on to the ward. As students on placement we were allocated to support the clinic, completing regular observations, including pulse and blood pressure. Clearly, it was a long time ago. There is a paper (paywall), quite a significant one for me:
O’Flanagan PM. A Clomipramine (Anafranil) Infusion Unit. Journal of International Medical Research. 1973;1(5):375-381. doi:10.1177/030006057300100519 
I remember this Consultant's name being mentioned, but this was before my time(?). From the paper's first - accessible - page I can see the patients involved were actually in-patients. Which given the procedures, safety, observation makes better sense. There is reference to a film, in a hospital newsletter 'The Standard':
'Anafranil Film
In response to the interest shown in the film on Anafranil Infusion, Dr. P. O'Flanagan was present in the In-Service Training Room on Monday, October 29th for a second showing of the film, and to answer any questions from the audience.'
I wonder if the film is archived somewhere?

It isn't a surprise to see my former Community MH manager and friend David McKendrick listed on the Publications Committee. I do miss David - a great mentor!

In the previous post about 'The Sleep Room' I contrasted the mind-body dichotomy. In terms of evidence on 'both sides' of this divide, many people have made the observation of how you can see a broken arm, or leg, and other physical ailments, but mental health issues are often not obvious:
Powell J, Clarke A. Information in mental health: qualitative study of mental health service users. Health Expect. 2006 Dec;9(4):359-65. doi: 10.1111/j.1369-7625.2006.00403.x. PMID: 17083562; PMCID: PMC5060370.

The evidence-base of general medicine - physical health and psychiatry must be dynamic. The volume of publications bears testimony to the relentless change across all the sciences, research, technologies, knowledge, theory, practice, management and policy. On Twitter there is constant 'debate' between psychiatry and anti-psychiatry. 

Studies of intravenous clomipramine continue, the intervention much changed from the 1960-70s:

Fallon BA, Liebowitz MR, Campeas R, et al. Intravenous Clomipramine for Obsessive-Compulsive Disorder Refractory to Oral Clomipramine: A Placebo-Controlled Study. Arch Gen Psychiatry. 1998;55(10):918–924. doi:10.1001/archpsyc.55.10.918

Persson M-L. Adler Mats y Hetta J. Pulse Intravenous Clomipramine as an alternative antidepressant treatment to ECT: A pilot study. Eur. J. Psychiat. [online]. 2007, vol.21, n.4 [citado 2025-04-07], pp.263-267. Disponible en: <http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632007000400003&lng=es&nrm=iso>. ISSN 0213-6163.

Karameh WK, Khani M. Intravenous Clomipramine for Treatment-Resistant Obsessive-Compulsive Disorder. Int J Neuropsychopharmacol. 2015 Jul 28;19(2):pyv084. doi: 10.1093/ijnp/pyv084. Erratum in: Int J Neuropsychopharmacol. 2016 Apr 27;19(10):pyw031. doi: 10.1093/ijnp/pyw031. PMID: 26221004; PMCID: PMC4772819.
Perhaps, someone can please enlighten me? Given the time between William Sargant's practice, and today how much more do we know? We know the gap can't be fully closed (phenomenologically?), but has the evidence-gap been reduced? What are the evidential mile[Km]stones in psychiatry - mental health nursing? What are 'the standard' measures? If we look at a model that is bio-psycho-socio-political, what difference might this make, to the 'debate', theory, practice, research, management and politics (policy)? 

'Woke' is a tainted word these days, but in mental health care and nursing we all need to wake up and in a safe space.

Sunday, June 30, 2024

Learning Health Systems/AcademyHealth 2024 SUPPLEMENT now available

 Dear Readers of Learning Health Systems,

We are pleased to announce the first-ever Supplement Issue of Learning Health Systems! 

 

You may view the complete Supplement online at:

https://onlinelibrary.wiley.com/toc/23796146/2024/8/S1

 

Guest Editors for the 2024 Supplement were: 

Lucy A. Savitz,  Sarah M. Greene,  Michael K. Gould,  Harold S. Luft

 


The LHS/AH Supplement is the result of a collaboration and memo of understanding between Learning Health Systems (University of Michigan), AcademyHealth, and John Wiley & Sons.

 

***********************************************************

 

Guest Commentary

The Right Stuff:  Getting the right data at the right time and using that data to drive evidence-based practice and policy

 

Lucy A. Savitz,  Sarah M. Greene,  Michael K. Gould,  Harold S. Luft

May 27, 2024

 

Experience Report

Leveraging data to support health equity in an integrated delivery and finance system

 

Jane Kogan, Joan Eichner, Hyagriv Simhan, Erin Dalton, Alex Jutca, Beth Quinn, Jennifer Chaney, Anna Patterson, Donna Keyser

April 15, 2024


Continued...

Wednesday, November 22, 2023

Your story about the use of the Resilient Health Systems evidence collection

Championing evidence-based humanitarian action

Evidence Aid aims to save lives and livelihoods in disasters by providing decision-makers with the best available evidence and by championing its use.


On Wednesday, 22 November 2023 at 10:12:26 GMT, Claire Allen, UK <callen AT evidenceaid.org> wrote:

Kind request - Do you have 5-10 minutes to complete our survey about the Resilient Health Systems evidence collection

https://evidenceaid.org/evidence/resilient-health-systems
Your insights and opinions are incredibly valuable to us.

The form will be available until Monday 27 November 2023, but in the meantime, if you have any issues, please do not hesitate to contact - 

Epa La Bella at elabella AT evidenceaid.org.

As always, we value your insight and opinions, all of which are essential to the functioning of Evidence Aid.

Claire Allen, Operations Manager Evidence Aid: Championing evidence-based humanitarian action. Please note that my regular working days are Monday, Tuesday and Thursday. Please do not expect a response outside of those days.

Support our activities by donating here.

Email: callen AT evidenceaid.org | Skype: claireallencochrane | Website: www.evidenceaid.org | Twitter: @EvidenceAid

Our evidence collections can be found here: https://www.evidenceaid.org/evidence/

HIFA profile (and my source): Claire Allen is Operations Manager at Evidence Aid, UK. Professional interests: Evidence Aid (www.evidenceaid.org) provides evidence for people in disaster preparedness and response to make better decisions. Areas of interest = humanitarian crises, natural disasters and major healthcare emergencies (disaster = when a country is unable to cope with the disaster/crisis or emergency). She is a member of the HIFA Working Group on Access to Health Research. http://www.hifa.org/working-groups/access-health-research Email: callen AT evidenceaid.org

Friday, June 23, 2023

Evidence-based care: What are 'we' missing?

Perhaps, proof of (what) works? 

Blockchain Revolution

"The mechanism for reaching consensus is critical. 'Consensus is a social process,' blogged Vitalik Buterin, pioneer of the Ethereum blockchain. Human beings are fairly good at engaging in consensus . . . without any help from algorithms." He explained that, once a system scales beyond an individual's ability to do the math, people turn to software agents. In peer-to-peer networks, the consensus algorithm divvies up the right to update the status of the network, that is, to vote on the truth. The algorithm doles out this right to a group of peers who constitute an economic set, a set that has skin in the game, so to speak. According to Buterin, what's important about this economic set is that its members are securely distributed: no single member or cartel should be able to overtake a majority, even if they had the means and incentive to do so.

To achieve consensus, the bitcoin network uses what's called a proof of work (PoW) mechanism. This may sound complicated but the idea is a simple one. Because we can't rely on the identity of the miners to select who creates the next block, we instead create a puzzle that is hard to solve (i.e., it takes a lot of work), but easy to verify (i.e., everyone else can check the answer very quickly). Participants agree that whoever solves the problem first gets to create the next block. . . . For each block they find, miners receive  bitcoin as a reward." p.31.

INDIVIDUAL
|
     INTERPERSONAL    :     SCIENCES               
HUMANISTIC --------------------------------------  MECHANISTIC      
SOCIOLOGY  :   POLITICAL 
|
GROUP


'proof of activity'
'proof of work'
'proof of burn'

'proof of capacity'
'proof of disk'
'proof of storage'
'proof of existence'






'proof of asset'
'proof of storage'
'proof of stake'
'proof of property'



Hodges' model = Proof of Care* ?

Proof of Concepts (at least?)

How do we prioritise and focus
our energy expenditure, and energies in the 21st century?

*And education?

Tapscott, D. and Tapscott, A. (2018) Blockchain Revolution How the Technology behind Bitcoin Is Changing Money, Business, and the World. Penguin, New York.
[See also index, p.355 'proof of a,b,c...'.]

Saturday, November 26, 2022

Int. Congress on Evidence-based Parenting Support (6-8 June 2023)

CALL FOR ABSTRACTS

Abstract submissions date for the International Congress on Evidence-based Parenting Support (6-8 June 2023) has been extended to 23 December 2022. This global initiative will focus on effective evidence-based parenting support. It will bring together academics, policymakers, practitioners, consumers and service providers to advance research, policy and practice in the field of parenting and family intervention. This international collaboration aims to create global impact that will benefit parents and children now and for the next generation.

We welcome your insights from research, policy and practice that address a wide range of themes. See more on the themes: https://www.i-ceps.pafra.org/submission

Exciting news for submissions from low- and middle-income countries. The organising committee is pleased to offer free registration for the 20 top ranking abstracts from these countries.

Submissions close: 23 December 2022

More guidelines on abstracts: https://www.i-ceps.pafra.org/submission

Regards, Maria Battaglia

BEd, GradDip Ed&Pub, MComms Communications Officer Institute of Child Protection Studies Australian Catholic University Pronouns: she/her

Level 1, 232 Victoria Parade East Melbourne VIC 3002 Monday to Friday P: 03 9230 8732 E: Maria.Battaglia AT acu.edu.au W: www.acu.edu.au/icps W: safeguardingchildren AT acu.edu.au T: @ACU_ICPS L: Institute of Child Protection Studies

I-CEPS Congress (hosted by PAFRA) W: https://www.i-ceps.pafra.org/ Twitter: @PAFRA_Official LinkedIn: ICEPS2023 Facebook: https://www.facebook.com/ICEPS2023

I acknowledge the Traditional Owners of the lands on which I live and work, and their continuing connection to land, sea and community. I pay my respects to Elders past, present and emerging.

HIFA profile: Maria Battaglia is Communications Officer at the Institute of Child Protection Studies, Australian Catholic University. https://www.i-ceps.pafra.org/ E: Maria.Battaglia AT acu.edu.au 

My source: https://hifa.org/

Monday, July 18, 2022

Sept 2022: 'An introduction to evidence-based health care'

Students 16-18 years old.

School leavers

A career in health care

'Health Career' - 'Life Chances'



Tuesday, April 17, 2018

Enough Nurses - Special Collection c/o Journal of Research in Nursing

http://journals.sagepub.com/page/jrn/collections/virtual-special-issues/enough-nurses



"JRN is pleased to introduce this online special collection of papers. Edited by Jane Ball, this collection comprises previously published papers and reviews that give a taste of the constellation of issues that contribute to having 'enough nurses'. They illustrate the complexity and interdependency of the many elements that must be addressed to achieve the elusive goal of having the right staff, in the right place, at the right time."



My source: https://twitter.com/JRN_latest/status/985889478882578432

Monday, April 02, 2018

Fundamentals of Care - mapped to Hodges' model

I came across a paper on 'fundamental care':

Jackson, Debra & Kozlowska, Olga. (2018). Fundamental care - the quest for evidence. Journal of Clinical Nursing. 27. 10.1111/jocn.14382. 

The definition Prof. Jackson subsequently pointed to is as follows:
"Fundamental care involves actions on the part of the nurse that respect and focus on a person’s essential needs to ensure their physical and psychosocial wellbeing. These needs are met by developing a positive and trusting relationship with the person being cared for as well as their family/carers."
I've taken the fundamentals of care from the International Learning Collaborative and mapped them to Hodges' model. The psychosocial list has been divided across the two applicable domains - you'll see what I've done.

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

PSYCHOsocial fundamentals of care

  • Communication (verbal and non-verbal)
  • Privacy
  • Education and information
  • Emotional wellbeing
  • Choice
  • Having values and beliefs considered and respected

Physical fundamentals of care

  • Personal cleansing (including oral/mouth care) and dressing
  • Toileting needs
  • Eating and drinking
  • Rest and sleep
  • Mobility
  • Comfort (pain management, breathing easily, temperature control)
  • Safety (risk assessment & management, infection prevention, minimising complications)
  • Medication management

PsychoSOCIAL fundamentals of care

  • Being involved and informed
  • Dignity
  • Respect
  • Education and information
  • Having values and beliefs considered and respected
  • Social engagement, company and support
  • Feeling able to express opinions and needs without care being compromised
  • Having interests and priorities considered and accommodated (where possible)

Relational fundamentals of care

  • Active listening
  • Empathy
  • Engaging with patients
  • Compassion
  • Being present and with patients
  • Supporting and involving families and carers
  • Helping patients to cope
  • Working with patients to set, achieve and evaluate progression of goals
  • Helping patients to stay calm

As this domain seems to be 'empty', I  will add some thoughts in the POLITICAL domain... 

You can imagine a series of layers here. 
As per the physical fundamentals above include - safety and homeostasis would be uppermost. Difficulties in the above instantly raise alarm bells and the old chestnut construct of dependency. 

The lack of specifics on mental health suggests something that is incomplete and appears to assume a certain degree of functioning?

The psychosocial actions invariably overlap and with the relational. We are hopefully socialised into dignity, respect, compassion, empathy and related attributes. What impacts  on a person's privacy, dignity may vary from person to person to some extent. This however introduces the humanistic care of engaging with people, their carers and the need to be person-centred. On privacy ... and preserving the integrity of an individual (and their 'group'), there are of course (duty of care and) professional standards (in this domain) that help guide our advocacy and accountability.

Clearly, there is much to do..


Previous posts on 'fundamental-ism'


Thursday, January 26, 2017

2001 and counting... A Public Health Odyssey c/o Rabbi Julia Neuberger

individual
|
INTERPERSONAL : SCIENCES
humanistic -------------------------------------------  mechanistic
SOCIOLOGY : POLITICAL
|
group-population
Changes in the way that health professionals are being trained should help future doctors, nurses and others to think more holistically and to share more knowledge. p.77-78.
If a genuinely holistic approach is being taken, it is probable that several activities will be happening simultaneously to tackle any given problem, and that more than one measure of success would be appropriate. Collecting evidence to prove what works and what does not may also take a varied approach that mixes different methodologies and creates some new ones. p.77.



The growing understanding that health should be seen holistically - as being more about general wellbeing than the absence of disease - has not yet been equipped with evidence that policymakers and practitioners can respect.
Throughout the history of the NHS, there has been a tension between the imperative to treat disease in the individual and the need to promote general good health in the population. p.77.


Tackling health inequalities has become a cornerstone* of British government policy. From the corridors of Whitehall to the local board meetings of primary care groups and trusts, the imperative to reduce the health gap between rich and poor is ubiquitous. Yet when action is proposed to turn the rhetoric into reality, particularly when significant investments are required, the cry of "not enough evidence" is invariably heard in opposition. p.77.



*Whatever the state of current Government policy, tackling health inequalities has been a 'cornerstone' within Hodges' model since the model was created in the 1980s. It remains so today in 2017.

Rabbi Julia Neuberger. Where's the Evidence? Making the Case for Public Health.
Source: Journal of Epidemiology and Community Health (1979-), Vol. 55, No. 2 (Feb., 2001), pp.
77-78.
Published by: BMJ
Stable URL: http://www.jstor.org/stable/25569362

Monday, September 05, 2016

Editorial: Assuring the Capture of Standardized Nursing Data... Ponte, Somerville & Adams (2016)

In their editorial Ponte, Somerville and Adams (2016) focus on the US nursing care situation and contrast with the UK experience from the outset:

As the U.S. health system moves toward value-based care, chief nursing officers (CNOs) are pressured as never before to demonstrate nursing’s contributions to improving the cost, quality, and efficiency of care, key elements of the value equation. The shift from fee-for-service to value-based care and reimbursement has been made possible through the implementation of electronic health records (EHRs), and the emergence of Big Data analytics, in which payers and healthcare organizations mine the streams of data produced by clinical and administrative systems to understand and evaluate care inputs, processes, and outcomes (Westra, Clancy, et al., 2015).
The contrast is implicit and is not the purpose of the editorial: Assuring the Capture of Standardized Nursing Data: A Call to Action for Chief Nursing Officers. From a still summery Lancashire the above really does seem a continent away, if not a world. It should not be this way. Questions of value for money, the quality of nursing care and outcomes are also central here and digital aspirations are ongoing: NHS Digital.

Perhaps Hodges' model lacks appeal not just because of its historical (mid-1980s) qualities, but a 4x4 checkbox appearance that seeks to standardize care concepts and the nurse's approach? Not only that but maybe the model dictates where they should be placed? The push for data to 'let the light in' and make nursing visible, can also seem a major, externally driven and intrusive distraction from nursing care. That is, doing the job, being a nurse, nursing delivery, caring ...

That Assuring in the title is important. It is the kernel of recursion, the crucial check that is governance and engaged management. Not remote via a screen - dashboard, but in-process - in-situ assuring that the nursing role can and is delivering. In the dash to data vision can become blurred. Socio-technical perspectives are skewed, what might be termed holistic bandwidth is constrained as per the system.
Ensuring that standardized, encoded nursing data are captured in EHRs is critical if nursing is to realize the potential of big data analytics. Having nursing data available for analysis will allow us to gain a better understanding of nursing practice, demonstrate nursing’s contributions to patient care and outcomes, and facilitate evidence-based practice and nursing research. Indeed, we will no longer be driving blind. Rather, we will be driving smart.
Somewhere in this big data lies person centered, holistic and integrated care. This needs to be transformed to self-care. Can these incremental positive changes be captured (once debated and defined)? Will nurses be empowered with access to this data: the big, little and what lies between? Where are the analysts? Who makes the decisions based on this data? Is transparency assured?

As technology advances we have much to do in the UK, lest we nurses find ourselves sat in what has suddenly become a self-driving vehicle that is bound who knows where....


Ponte, P. R., Somerville, J. G., & Adams, J. M. (2016). Assuring the Capture of Standardized Nursing Data: A Call to Action for Chief Nursing Officers. International Journal of Nursing Knowledge, 27(3), 127.

Wednesday, May 04, 2016

"End of Guidelines - a parody of End of the Line"

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





Original source (edited):

James McCormack, BSc(Pharm), Pharm D
Professor
Faculty of Pharmaceutical Sciences
UBC, Vancouver, Canada
Co-host - Best Science (BS) Medicine Podcast

Mohammad Zakaria Pezeshki, M.D.
Associate Professor
Department of Community Medicine,
Tabriz Medical School, Golgasht Avenue, Tabriz, Iran.

Sunday, April 17, 2016

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

Monday, December 28, 2015

Newton and Einstein had it right - Reflection in H2CM

In the New Year I've a series of posts that almost seemed to write themselves after reading:

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/
What (I believe) Hodges’ model does provide through its combined structure and care (knowledge) domains is ready cognitive access to three forms of thought as discussed by Johnson:
  1. Dualist
  2. Multiplistic
  3. and Relativistic Thinking
In selected papers within the bibliography and here on W2tQ since 2006 I've made many claims about Hodges' model. The old website (defunct) introduced Hodges' model from the standpoints of patient (intra- interpersonal); carer (sociology); student - life long learner (sciences); lecturer, institution (political - did I mention 'citizen' in there?).

Johnson has provided a fresh impetus to consider the model anew and with it threshold concepts and other ideas. In the posts to follow there are for example at least four ways in which Hodges' model supports dualist thinking and (importantly) mitigates against its possible excesses.

Wednesday, December 04, 2013

The EQUATOR Network: Support for “Declaration of transparency”

http://www.equator-network.org/

Following publication in the BMJ, in October 2013, of a proposed declaration of transparency a number of journals have now expressed their support for the transparency declaration and now ask lead authors to sign a declaration affirming that:
"this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained".

The following journals have now expressed their support:

BMJ
BMJ Open
BJOG: An International Journal of Obstetrics and Gynaecology
Canadian Journal of Anesthesia
NIHR Journals Library

Reference: Altman DG, Moher D. Declaration of transparency for each research article. BMJ 2013;347:f4796 [free full text].


My source: equator network - newsletter December 2013

Sunday, November 17, 2013

[hifa2015] How can we stop ICANN decision that could profoundly damage global health?

Dear HIFA colleagues,

A few weeks ago I posted the Lancet article below, which highlights the threat of a commercial sale of the new top-level domain ".health".

The authors point out that ICANN (Internet Corporation for Assigned Names and Numbers), which controls all internet naming, could be about to make a decision to sell ".health" to the highest commercial bidder. The decision is imminent. I have indeed heard that an ICANN meeting that will include discussion of ".health" is being held over the *next few days*.

As the authors of the Lancet article point out, sale of ".health" to a commercial enterprise "could have a profound effect on health information access and quality for generations to come". This is something that should concern all of us, everywhere.

ICANN hosts a wiki which apparently can only be edited by them and which briefly describes the issue in rather difficult-to-follow language, without actually explaining the nature of the objections that have been raised by leading health organisations, including WHO, and by national governments:
http://icannwiki.com/index.php/.health

These objections may be found elsewhere by googling. Essentially, there is a *great* deal of concern among health agencies worldwide, and a small handful of governments, of the public health consequences of commercialising ".health". In particular, there will be little if any assurance that the content of websites carrying the ".health" domain name will contain reliable health information. There is a serious risk that misinformation and/or commercially biased information could be propagated using the ".health" suffix. It is likely that many citizens worldwide will see the ".health" suffix as an indication that the information is primarily intended for their health, whereas the reality would be that much of the information would inevitably be wholly unreliable, and driven by commercial (or even ideological) motives.

I was especially concerned to read the latest news on this wiki, which read as follows: "The IO [Independent Objector - see below] lost its objection to Afilias' applicant for .health in a ICC determination by 3 panelists made on 6 November 2013. The determination was the first Limited Public Interest Objection to be decided, as well as the first objection filed by the IO to be decided. [19]

I am not entirely clear how the proceedings work, but the wiki tells us that "[ICANN's Independent Objector] is an appointed authority on international law whose role is to object to strings on the grounds of Community harm and Limited Public Interest were detailed in the applicant guidebook. His objections are official objections and are funded by ICANN, though his office is otherwise independent. Reasons for the specific case against .health were not initially given, but, in the case of Limited Public Interest, "the applied-for gTLD string must be contrary to generally accepted legal norms of morality and public order that are recognized under fundamental principles of international law. The expert panel appointed by the ICC will base its decision on the existence of such a contradiction." The applied for string must threaten an incitement to violence of lawless action, discrimination, child pornography, or "be contrary to specific principles of international law as reflected in relevant international instruments of law.""

This reference to "violence of lawless action, discrimination, child pornography..." is bizarre and I cannot claim to understand how this is relevant. What is at issue here is the availability of reliable versus unreliable healthcare information. I hope that others on HIFA may be able to enlighten us further.

Regrettably, there has been an almost total absence of advocacy and awareness-raising about the issue, apart from The Lancet article. Other than the authors of the Lancet article, there is no advocacy leadership of which I am aware. This is the kind of issue that needs a prominent global health leader to speak out. I do not know whether Margaret Chan, Director-General of WHO, is free to speak out on this, but I feel that we need a strong statement from someone at the highest level.

In the meantime, what can we (HIFA members) do to stop ICANN making - or at least deferring - a decision that could profoundly damage global health?

Best wishes,
Neil
HIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA2015 campaign and co-director of the Global Healthcare Information Network. ...
[ As mentioned above Neil also posted the Lancet article - I have just copied the link below ]

Below is the citation and extracts of a new article in The Lancet. The full text is freely available here:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62215-1/fulltext

Ensuring the future of health information online
Tim K Mackey, Bryan A Liang, Amir Attaran, Jillian C Kohler
The Lancet, Volume 382, Issue 9902, Page 1404, 26 October 2013
doi:10.1016/S0140-6736(13)62215-1Cite or Link Using DOI