Blankets and DNR . . .

INDIVIDUAL

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     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

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GROUP

Initially not person-centred, I -	Blankets
- recall several 'conversations' with junior doctors. The situation was 'recovered'.	"Blanket use of forms"

22:00-22:30 BBC News at Ten. DNR - Do Not Resuscitate 

DNR is a critical aspect of health care that will not go away. It can't as part of the interface (to put it mechanistically) between life, death, and quality of life and death. Ever since and even prior to the Liverpool Care Pathway, the issues raised in medical care, humanity, dignity and respect, ethics, professionalism, integrity and governance are challenging to reconcile.

Hodges' model can play a part in critical thinking about not just a troublesome concept, but the interaction of several and making sense of them and the situation to hand - and heart. 

As such Hodges' model isn't going away either.

Knights D, Wood D, Barclay S. The Liverpool Care Pathway for the dying: what went wrong? Br J Gen Pract. 2013 Oct;63(615):509-10. doi: 10.3399/bjgp13X673559. PMID: 24152449; PMCID: PMC3782767.

The Art & Science of Health: [conceptual scraps ii]

The contrast here within health care is quite stark, we can distinguish between scraps of paper in two ways ...

1. Whatever we do with care needs; confirm them from the referral and possibly (usually) identify additional care needs (and educational opportunities also..?), assess, plan, intervene, and evaluate - that scrap of paper (or its digital analogue) should initially be blank, untainted by judgements, bias and assumptions.
2. As soon as the scrap of paper is populated - scribed-upon then its value and the responsibility of those who access it subsequently is suddenly weighed and measured by law and accountability.

In the first case, ownership is not relevant, in that there is nothing, as yet, to 'own'. Values however can still be represented, if the staff's attitude towards the new patient, client, service user or administration terms referral, contact, triage case is similarly 'neutral'.*

In the second case, when the print hits the page by whatever means the stakes are suddenly raised. The law has a say in what is expected, permissible and reasonable conduct by those gathering data, creating a record, holding, copying and transferring the record in part, or whole and its accuracy, destruction and disposal.

*Of course, even when blank, forms - templates can have proprietary value and may well be protected, copyrighted and trademarked.

to be continued ...

Related post - Part 1:
The Art & Science of Health: [conceptual scraps i]

Drupal musings 3: PHP, Textmate, h2cm and Forms

Happy International Nurses' Day!


For quite a few months I have not connected the MacBook to the external monitor. I did so last night using:

• MAMP (server software)
• Textmate (an editor Mac only)
• prompted by reading - Robin Nixon's, Learning PHP, MySQL & Javascript, O'Reilly.

(Experienced programmers may at this point want to go review some political party broadcasts - coalition news as there's a lot more happening there.)

I typed in a PHP file, purposefully trying Textmate's 'Bundles' > 'HTML' > options to mix some PHP and HTML.

The file does not do a lot, but like creating, reading and writing a file it's a start. All this effort does is display four text box input fields (Chapter 11 Form Handling) with submit buttons. Previously I have mirrored the laptop screen to the external 24" Acer, that appears to be the default. ;-) Tinkering with the display options and turning off mirroring I found that I could pick up the Textmate window and move it to the big screen on my right. Meanwhile on the laptop I could preview the output in the browser. Apple's 'Spaces' is a related facility to master.

Not only that, but suitably editing the PHP file in Textmate resulted in updates on the browser (Refresh after change. Delay 0.40 s.) To me - that's Magic!

On the Drupal front - despite the title of this post - there's not much to report. The news is brief and yet kind of major in that I've bought my ticket for Drupalcon in Copenhagen. I am really gutted that this year I did not get to the Scottish Ruby Conference in March, after '08 and '09. At least getting to grips with Textmate will also help with Ruby (and Rails) too.

OK, back to Textmate to try the other PHP input types: text area, check boxes, hidden fields, select and labels.

FROM: Personal Forms, Paper Forms and e-Forms TO: Forms of Transparent and Opaque Support

It is hard to outrun paperwork.

Even though the promise of a great E-scape has been around for so long that the original pronouncement has become an eerie technology-enhanced echo.

Even before we arrive at the paper forms that are the bureaucrat's delight, there is in our mind's eye a personal idealised version.

This is in turn a product of the professional training and experience to which we are subjected. The quality of this personal idealised version is also affected by individual traits (aptitude and attitude) that are further shaped by the situation and the unique individual(s) who becomes the focus of our undivided attention.

This personal form, its gestation and sustenance is important because it affects the other forms:

• paper forms - policy, legacy (we've always done it this way);
• theoretical (academic-the idealised standard) form(s);
• electronic forms:
• the computer based record
• scanned - archived forms (electronic document management systems)
• and other variations (e-mails)

- and how they are received, adopted, owned and used. ....

Very frequently we need to listen. No. I mean really listen. Not just to one person, but two and more people verbally (with yet others non-verbally). People like to play tennis and when they start slugging it out they often seek a referee. There you are, having to 'write' things down, but you are still learning the(ir) rules. And anyway, writing things down on paper or e-form is a distraction for all. This IS NOT a problem (the problem's the grunting you can hear in the background). It is just a natural interface. As with any communication hand-over or transition point we need to take care, to be safe, efficient and effective.

Another personal form has of course arrived in the very humanoid (person-centred!) shape of self-assessment and the personal health record. There are new challenges in how these hybrid, composite record forms are defined, interoperate, cooperate, and how they will be governed and are seen to accrue measurable (holistic) benefits.

If these different forms prove seamless in use and achieve transparency, well that is quite a trick. If alternately the forms are opaque then the misfit will quickly become apparent. So, have you got the forms? Or is that just the way you walk?