The Health Career - Life Chances - Model as Critical Social Theory...?

"... the concept of knowledge that is central to critical social theory takes in all possible forms of knowledge, from implicit knowledge (tacit knowledge, know-how, etc.) to the knowledge that we find methodically sharpened and theoretically developed within science. As a conceptual tool of critical analysis applied to contemporary society, such a notion of knowledge makes it possible to study the way that interrelations between the various forms of knowledge are shaped by the relationships between knowledge carriers and between the social groups that they form (what Znaniecki has dubbed "social circles"). Interpreted as a form of cultural capital, knowledge comes to be seen as a factor in power relations, as a potent force driving social development, and as a fundamental determinant of life chances." p.44.

Invasive Technification

With my emphasis.

Carriers: individuals, groups, populations, knowledge (care) domains?

Information: ???


Gernot Böhme (2012) Invasive Technification: Critical Essays in the Philosophy of Technology, Bloomsbury: London.

My source: Waterstones, Gower Street, London, £6.99.
See also:
https://hodges-model.blogspot.com/search?q=fundamentalism 
https://hodges-model.blogspot.com/search?q=life+chances

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'

NHS fundamentals: a conference + some fundamental thoughts...

I received notice from the Health Service Journal of the following conference:

Fundamentals of the NHS

Get up to date with the latest changes in NHS structure, policy and reform

25th November 2009
Manchester

Does the rapidly changing world of the NHS leave you feeling overwhelmed? Do you need a solid introduction or an up-to-the-minute refresher to firmly underpin your understanding of all the recent policy changes, reforms and agendas?

Whether new to the world of the NHS or simply in need of clarification over recent advancements - this essential Health Service Journal learning forum provides a whistle-stop tour of where the NHS is now and where it is heading in the future. ...

<->

The HSJ's NHS focus is clear just from the snippet above.

As to the 'fundamental' in health care, well, I still wonder how (since August 1977*) with all this talk of:

• multidisciplinary care
• integrated care
• continuity of care
• holistic care
• individualised care

- there is still NO fundamental model, NO universal conceptual framework applicable for the whole of health and social care. Yes, there is the nursing process, CPA (Care Programme Approach), SAP (Single Assessment Process), CAF (Common Assessment Framework). ... We have and benefit from - it must be said - the NHS Core Values, Patient Charters. ...

But where is the conceptual primer, the underlying substrate that can be applied implicitly or explicitly, whatever a person's age, discipline, ethnicity, beliefs, employment, financial means, legal status, location. ...?

More than ever we need a model that is not just the preserve of nurses and their colleagues, we need a conceptual tool that is part of education programs world wide: helping to preserve individual, family and community in health and well-being.

Conceptual models are so abstract. Strange then that a model - simple, basic, underlying, fundamental - is needed that is much more substantial than a chapter in a book, or paper in a journal.

This conference is in Manchester.

Manchester - where Hodges' model was first taught.

For the sake of future health - a universal model should be one of the fundamentals:

our tools
and values
should indeed deliver
right on the doorstep.

* As a Nursing Assistant awaiting entry to Warrington School of Nursing, Winwick Hospital.

Please note: This blog post is not sponsored nor
endorsed by HSJ, its publishers, or the event sponsors.

Fundamental-ism lost to nursing

Nursing, health and social care are full of fundamentals:

- of care, aims, objectives, arguments, issues, targets, values ...- and much more besides. Fundamentals fuel and provide the oxygen that sustains the research literature and media. Fundamentals are the constant heat for education, practice and policy. Amongst the definitions of -

fun·da·men·tal (fŭn'də-mĕn'tl) [Answers.com] there is

Basic, base, foundation, central, core, essential, necessary, key, primary, significant ...

Language is amazing in how far a short detour can take us.

Fundamentalism has always been associated with religion and of course no less today; when the literal reading and interpretation of religious texts means that fundamentalism is tainted by beliefs and actions that extend from intolerance, through to extremist tendencies and terrorism. Fundamentalism in this extremist religious guise is not the focus here.

Looking at nursing text book titles fundamental still sells. At times seeking out high standards of nursing care makes you wonder whether a fundamentalist reading of nursing (and human rights) is needed?: and as you get older the need gets ever more acute.

In our informationally overloaded world maybe the message of high quality (fundamental) basic nursing care is lost in the noise. The problem I believe lies in the other meanings of fundamental -

Physics.a) Of or relating to the component of lowest frequency of a periodic wave or quantity.
b) Of or relating to the lowest possible frequency of a vibrating element or system.

This means that even though those low frequency, infrasound messages can travel an awful long way and strike an occasional significant ethical chord: the population at large is hard of hearing.

Holistic Bandwidth [I] - Where's the brush?

Apart from those intervals and instances (times!) when emergency intervention is needed, holistic care is seen as a primary goal in health and social care theory, practice and policy.

IF care is not holistic THEN it could be argued that there is care dissonance.

The high quality non-critical, general efforts in the PHYSICAL [SCIENCES] care domain -

fluids, diet, warmth, pressure sore care, comfort, security, infection control ....

can be compromised by lack of attention to the EMOTIONAL [Intra-INTERPERSONAL] care domain -

respect, empathy, unconditional +ve regard, non-judgemental attitude, time, space, attention ....

- what the patient (carers and others*) expect to follow does not occur.

Rather like cognitive dissonance acute discomfort results when care of the required high quality (holistic, timely, person-centred...) is not applied across the board (h2cm).

(In being human) everyone recognises the BASICs of CARE (discuss?):

It is the remembering that is the problem.

Remembering demands an assured space in the organisational memory - such that staff in those other spaces - wards, clinics, patient's homes, residential homes are able to fulfil the holistic spectrum of care needs.

Dissonance encourages game playing with beliefs [1-n players].

It is very easy and a fairly well understood human trait for us to become pre-occupied with what we do. (As you will have noticed I have a problem with brackets and italics...) When at work (i.e. not day-dreaming) "It is what we do that counts."; but care variances bound to professional disciplines and particular clinical settings should not be wielded as a foil.

So, perhaps this dissonance can be represented as distance:

• patients and carers may not articulate their discomfort - at the time

(and hence is perceived of less consequence to the service - at the time);

• as the distance between concepts and their meanings.

Could this distance provide a measure of holistic bandwidth? No doubt, it already has somewhere in the literature? The first holistic bandwidth metric suggested above is acknowledged in policies around the response to complaints, which stress the need to deal with the complaint there and then if possible. Is this enough and what about the distances between concepts and meanings?

more to follow....

I Googled 'organisational dementia' and found the following reference:
‘Sustaining New Industrial Relations in the Public Sector: The politics of trust and co-operation in the context of organisational dementia and disarticulation’ (with M. Martinez Lucio), in P. Dibben, P. James, I. Roper, and G. Wood (eds.) Modernising Work in Public Services London: Macmillan. 2007.

*There is probably a major cost on staff morale here also.