"Integrated - care": What's in a word, or two?

This blog post was sat in 'drafts' since 28/01/2007 (yes, I know what that suggests). It concerns an issue, or more properly a theoretical and experiential aspiration in health AND social care that should in truth have provoked many papers for Hodges' model by now.

In the almost 18 years since, I wonder about the total number of papers devoted to this subject, the service's delivery, policy, outcomes, reviews and reports on integrated care? In nursing theory, philosophy and the start of many 'learned papers', it is customary to begin with a definition of terms. What happens when we divide 'integrated care' and first treat integrated and care separately? Does this aid our understanding? Do we divide and conquer? Is there a difference in results? Conceptual analysis would see us do both, and conduct a literature search.

In practice, (and clinical - especially) we often use words in rather lackadaisical way. Not surprising really, after all we've got a job to do! When pronouncements are made regards health and social policy I hear it as good intentions. I also reach for my soap box. It is often hyperbole, rhetoric. The same applies to the related idea and ideal(?) of holistic care, and person-centredness. I'm biased, of course, but I believe that Hodges' model can help to scope, and define these idealised features of health and social care (and education). As noted, people don't have the luxury of time to stop and deliberate on the precise meaning of the language they routinely use. As noted, at the end of the day - if it gets the job done then that's sound.

In a poll of words that are both much used and the meaning taken for granted integrated must be near the top for several reasons:

• its seniority: it has been around for decades.
• its scope across sectors and day-to-day life.
• our dependence on its fulfillment.

N-Gram suggests some possible insights into integrated and related forms of care:

https://books.google.com/ngrams/graph?content=integrated+care,holistic+care,person-centered+care&year_start=1800&year_end=2022&corpus=en&smoothing=3 

[Trying to embed, results in 1/3 white space at the bottom?]

It seems that integrated care [IC] has been a standing agenda item in health and social care media, education, the workforce, conference, exhibition and policy for several decades. Perhaps, things have calmed somewhat? So either IC is either very important, complex, a hard thing in practice or maybe it's all of these and more besides? IC is a undeniably a compound concept. Is this a cop-out though? You declare something 'compound' then sit back - job-done? I've suggested the same of threshold concepts in health (and probably other contexts?). Time will tell. In the meantime I have reflected on 'integrated care' across the domains of Hodges' model:

self

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

other

INTEGRATION OF: PRACTITIONER; Team; service; org... Philosophy* assessments threshold for acceptance into service (referral criteria) patient experience & engagement health education / literacies programmes spiritual research involvement	INTEGRATION OF: health record (e- or paper) location - team base care disciplines geographical area referral sources assessments - tools/scales data and statistics research involvement
INTEGRATION OF: HEALTH & SOCIAL CARE public engagement hospital  carer (parent/guardian) experience community services social care - NHS family experience public engagement in research Patient / Public Community Advocacy Treat demand :: Support prevention	INTEGRATION OF: funding leadership / management accountability - complaints (not the same thing!) outcome measures ILLNESS - PREVENTION / education self-care <> planetary care -  Sustainability assisted dying! palliative care! Public - Private - Voluntary Sectors Provider :: Purchaser [Systems] All-Party Parliamentary Groups^

*ethics, values.

^One aspect of so-called 'joined-up government'.

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.

Harvard Medical School Primary Care Review

"I'm writing to invite you to contribute your
narrative stories of health, community, and equity!"

 

Dear Spirit of 1848:

I hope this email finds you well. I'm a Family Medicine Physician, Instructor at Harvard Medical School, and Editor-in-Chief of the Harvard Medical School Primary Care Review. I'm writing to invite you to contribute your narrative stories of health, community, and equity!

The Harvard Medical School Primary Care Review is an international community-facing publication, and our mission is to “Share stories to amplify the voices of health everywhere.” Publications are approximately 750-1200 words in length, and all references should have hyperlinks (rather than end- or footnotes). The following is a brief set of guidelines for the Review: https://info.primarycare.hms.harvard.edu/review/submission-guidelines. The following Review pieces are nice examples of the type of narrative and community health content we strive for:

• https://info.primarycare.hms.harvard.edu/review/trauma-informed-holistic-health-care
  
• https://info.primarycare.hms.harvard.edu/review/food-access-navajo-nation

Please also share this call with your community partners! We look forward to hearing from you!

Warmly,

Rebekah

-- 

Rebekah Rollston, MD, MPH  (she/her)

Family Medicine Physician, Cambridge Health Alliance

Instructor in Medicine, Harvard Medical School

Editor-in-Chief, Harvard Medical School Primary Care Review

--
Posted from the Spiritof1848 Listserv WWW.SPIRITOF1848.ORG #Spiritof1848

Paper: Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

"Implementing NCD care in humanitarian crises requires the development of a context-adapted approach or ‘model of care’. A model of care may be characterized as a conceptual and pragmatic framework that describes how services are delivered within a health system (Davidson et al., 2006; Agency for Clinical Innovation, 2013)." Models of care "We found that there was no single unifying model of care for HTN/DM care in humanitarian crises, and the variance in care models included in this review was highly dependent on context. In order to descriptively synthesize the diverse models presented in the included studies, we created a typology based on the type of crisis, region and integration with the health system, since these factors likely influenced model design"   patient’s expectations

hypertension and diabetes (HTN/DM) Crisis type and Region Natural: Hurricane, Flood, Earthquake Palestine, Lebanon, Jordan,  China, Pakistan,  India, Philippines, Syria, Iraq, Turkey, Nepal Camp, Non-Camp; Rural, Urban Location of services - Location of people in need, transport, travel time, distance Refugee population - Local population forced displacement, disruption of treatment and support, interrupted health services, movement and attrition of health care workers (HCWs), insecurity, destruction of infrastructure,  breakdown in supply chains and data processes "The domains of access — availability, affordability, accessibility, accommodation, and acceptability — were derived from previously described measures of coverage (Penchansky and Thomas, 1981; Hernández-Quevedo and Papnicolas, 2013; Levesque et al., 2013)."

Refugees and Host Communities Humanitarian crises "Responsiveness has been defined as the ability of health services meet a patient’s holistic needs; in this framework, it also encompassed a model of care’s ability to respond to changing patient needs in a volatile context (.Hernández-Quevedo and Papnicolas, 2013; Kruk et al., 2018). Integration described the linkage between different levels and sites of care, such as facility-based care and community-based support as well as coordination between providers and institutions, while continuity of care referred to uninterrupted care throughout the patient’s disease and life course."

Formal health system and community-based formal or informal systems Non-governmental organisations Crisis type and Region Political: Conflict, Disaster Affordability, income, worth of service Accommodation Person :: Service centrednesss

 

"Availability was defined as the volume and type of existing services and whether this was adequate for the volume and needs of service users. Affordability constituted the patient’s capacity to use financial resources to obtain care balanced against their income and the perceived worth of the service. Accessibility addressed the match between the location of services vs the location of people in need, including transport, travel time, distance, and cost. The accommodation was defined as the organization of service delivery, such as opening times and ability of service users to accommodate to this. Acceptability was considered as the relationship between the services and the patient’s expectations of appropriate care."

(My emphasis)

NCD  - Non-communicable disease

My source: HIFA list

CITATION: Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review, Michael S Jaung, Ruth Willis, Piyu Sharma, Sigiriya Aebischer Perone, Signe Frederiksen, Claudia Truppa, Bayard Roberts, Pablo Perel, Karl Blanchet, Éimhín Ansbro

Health Policy and Planning, https://doi.org/10.1093/heapol/czab007

What is your 'Best' domain ...?

There are times we need to think outside the box.

 

But, when necessary are there 'boxes' you tend not to think in?

 

If so, what is stopping you?

 

 individual 

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Best Notch (closed) showroom, 1975	Best Notch (open) showroom, 1975
?	?

 

My sources:

Images:

Architecture + Branding: The utilitarian box store and design fodder known Best

(source: siteenvirodesign.com)

Wines, J., Heathcote, E. Designing outside the box, Arts, FTWeekend, 21-22 November, 2020. p.15.

So, Hodges' model is all about Vision ...?

... It depends how you define 'vision'
and even then,
Hodges' model is about so much more ...

Inclusion, Holistic bandwidth, Holistic care ...

This is what we should all aspire to
especially as children -
to realise our person-al potential.


INDIVIDUAL

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INTRA- INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP

Dreams Empathy Rapport Attending Listening INSIGHT Knowledge / Learning Communication / Liaison Palliative Medicine Holistic Care DeafBlind Alexandra Elaine	Senses Sight- VISION 0% - 5% Touch Negotiation / Navigation Physical Physical examination Vital signs Observation Surgery  Patient assessment Total:  DeafBlind?
Adams Negotiation - Acceptance "A DeafBlind Doctor?"  Patient Reactions Colleagues - Reactions ‘A doctor said, what are you doing with a patient’s cane?’ DeafBlind	Negotiation Human Rights Law Employment Law Equality, Equity Governance Political Accessibility 'Tick Boxes' Activism: TEDMED DeafBlind

Sources:
BBC and Andrew Gregory, Healing touch of the deaf and blind doctor-to-be, The Sunday Times, September 29, 2019, p.3.


This post is a reminder for me about the accessibility of this blog...

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

In clinical administration and informatics the question of 'ownership of information' is one of what I've described as legacy problems. Here's a stab at a definition:

A legacy problem is characterised by being:

An aspiration that presents as a problem due to its scale, complexity, and the fact that they are passed-on from one generation of professionals to another. As such legacy problems are common across disciplinary and professional groups. They are embedded within professional education, teaching, learning, practice, management and are expressed in successive  policy developments and within public and media discourse. In scale legacy problems are inherited by new learners and governments.

This is admittedly a broad brush treatment - and a work in progress (I focus upon and list the characteristics). Here, I'm not concerned with the whys and wherefores, or the minutiae. (Perhaps this post is a result of not burn-out(!?) but professional and organisational exposure otherwise known as experience?)

Clinically then legacy problems include:

• integrated care;

- across physical, mental health and social care
- between disciplines (location, co-working - teams)
- as experienced by the patient, carer (as proxy)
- financially

• holistic care;
• person centred care;
• reflective practice;
• critical thinking;

To these we can add:

• the electronic health record
• and as mentioned above 'ownership' of the record (as a whole and the data within).

The question is - are the above being miscategorised? Are they problems or features of healthcare that no matter how much you might wish you cannot dodge them?

Records are critical to the definitions of being a professional and professionalism - public safety, care planning and delivery, accountability, responsibility, research... Perhaps though the existence and consequent longevity of the above are bound to give rise to their analogues and not just their solution, but how they are framed?

Comprehensive record anyone and is that a computer before me...?

What are your thoughts - h2cmng@yahoo.co.uk I'd be pleased to hear from you. Can you add to the list?

To be continued ... [ and there's the legacy conundrum that is the National Health Service? ]

See also:

Daniel Bayley: The problem with Patient Online and the NHS App
Related posts i & ii:

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

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

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 ...

... graph portability ...

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

care graph portability	care graph portability
social graph portability & care graph portability	care graph portability

Of course, social graph portability and care graph portability do not bear comparison. Social graph portability is still contested as the media reveals. But 'care graph portability' is stretching it...

In this post I wish to point out the internal transactions (conceptual portability - facets - patterns) that are needed to achieve person centred and holistic care at the individual level. This can then be integrated. Throughout an individual episode of care, to recovery and staying well this 'care graph portability' can be said to be achieved through reflective practice that also engages the patient and carer(s) to facilitate self-care and health literacy. This is true portability in the care context.

See also:
Is social graph portability workable?

My source: Harford, T. (2017) How to poke Facebook off its perch, FT Weekend, 4-5 November, p.12.

Evidence for simplicity, genericity, openness and holistic competence

N-th mover to Integrated, Person-Centered and Holistic Care

walk the talk, sour grapes, or holistic humbug?

Although, sadly (and all down to me) I stepped off the PhD programme with an MRes, the intention was not to bring my journey with Hodges' model to a close. The joke of course with this model is that you are always presented with a crossroads. As I've written previously (even in draft!) this model is a baton to pass on to others. If the workforce of the 1970s to date evaluates its contribution to health care change and progress, then while the achievements speak for themselves, the challenges^* that remain still shout out:

1. parity of esteem 
2. integrated - co-ordinated and collaborative care

This week I received an email, purely as a list member I must add:

NHS Innovation Accelerator 

Applications for the 2017 NHS Innovation Accelerator (NIA) are now open. For 2017, the NIA is seeking local, national and international innovations that address the following NHS priorities:

·         Mental Health
·         Urgent and Emergency Care
·         Primary Care

The above is now closed but I immediately thought about Hodges' model, given that from the information provided mental health is a priority and a top priority for citizens. Plus, the things that can make a difference to problems:

• Suicide and relapse prevention
• Access and availability with a focus on perinatal, children and young people, dementia and psychological therapies
• Early identification and intervention to minimise the impact on a person’s life, the likelihood of escalation and, in some cases, the chances of survival
• Care closer to home including self-care and access to services at home, in a primary or community setting
• Holistic care of both mental and physical health needs including prevention, screening and treatment for those at greatest risk of poor physical health   

"There are many innovations available to improve mental health services, however they are not always used..."

There are however a series of requirements, which present a stumbling block as high impact evidence is lacking.

The purpose of NHS Innovation Accelerator lies in the name. The target is established initiatives and projects that would benefit the NHS and others from a boost of further momentum and leadership support including funding and mentoring. Hodges' model is far from this, but the call is interesting nonetheless.

Reading the details I can argue, for example, that Hodges' model is immediately applicable across the life-span. The model is already designed, but in use the model could be said to meet the requirement of being co-designed with people (including carers, where appropriate). I have used the model with patients and carers (young and adult) who have lived experience of mental illness. With some consideration of the patient, carer, as I have stressed here before on W2tQ the model is accessible to a diverse population. Critically, the delivery of the most significant benefit in terms of outcomes and cost savings needs proof.

It seems that many of the world's problems could be ameliorated through education. This has been evidenced for decades and yet globally there are those who politicise their respective educational system, or even worse deny sections of a society access to education.

In healthcare how can we demonstrate the effectiveness of what is basically a back-of-an-envelope tool? While not a solution Hodges' model helps us to resolve the constituents of healthcare demand and supply, to critically analyse and synthesize - what is going on? I'm sure Hodges' model is just one of many local 'innovations' (in this case created in NW England) that are not evidenced and are therefore missed. Why is this? It may be that the model needs to be re-discovered since being invented somewhere else, by somebody else makes it a non-starter. Similarly, reading the information 'model of care' always grabs my attention:

Your innovation can be a device, digital app or platform, 

a service, process, pathway or model of care. 

But as is often the case, this is framed in service commissioning, funding, delivery and yes patient outcomes terms. Devices, apps, platforms and services can be specified to a high degree. This is essential to success in research (as is dissemination). Aims and objectives can then be clearly defined, outcomes can be recognised and measured. Processes and pathways are perhaps more fuzzy? These are all important tools, aspects and contexts in health care.

My frustration is that this and similar research formulations seem to exclude tools and resources that are by their nature intentionally simple, holistic, generic and cognitive-reflective. The "model of care" is broken. A whole systems approach^# is needed that incorporates education and with it prevention and staying well; plus caring for those affected by illness and disease. We have to honour the legacy problems that the political, education and health systems have 'delivered'. Even if not broken the model of care is missing its twin, the model of life-style choices'.

I still believe there is a model - a conceptual framework - that must precede the (politicised?) model of care, if health and social care are to be truly transformed. Without this, well yes the NHS can accelerate, staff have demonstrated this repeatedly while negotiating all sorts of obstacles. The line of travel will however be circular; circular, but without the discoveries and change gifted to the particle physicists.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

education mental health cognitive access benefits - outcomes subjective	Evidence process primary care, accident and emergency physical access objective
qualitative home social care co-design public engagement	quantitative strategy 'model of care' education system citizens cost savings

My source: 
Irina Johnston
CHAIN Administrative Assistant

If you wish to publicise information on the CHAIN Network please email your request to: enquiries AT chain-network.org.uk

CHAIN - Contact, Help, Advice and Information Network – is an online international network for people working in health and social care. For more information on CHAIN and joining the network please visit website: www.chain-network.org.uk

^*

1. parity of esteem (a very broad interpretation - the comparison and contrasts between mental health and physical care on several levels - demand, supply, funding, research, integration, staffing, policy, outcomes, evidence-base, social determinants...)
2. integrated - co-ordinated and collaborative care (this is not one thing, but several. These terms are sometimes used interchangeably. Care that is truly integrated will also be co-ordinated and collaborative.

^# This is not recourse to jargon, Hodges' model implies several systems from the outset.

Hodges' model: Parity of Esteem - ic ic ic Integrated Care

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Mental Health Care

Parity of Esteem ic

Physical Care

ic

ic

My source:

Parity of esteem: addressing the inequalities between mental and physical healthcare https://t.co/sFUxZ4NxkY

— Rajesh Mohan (@RajmohanLondon) May 6, 2017

Log-in or Institutional access required to access the paper.

Mitchell, A.J., Hardy, S. & Shiers, D. (2017). Parity of esteem: addressing the inequalities between mental and physical healthcare. BJPsych Advances, May 2017, 23 (3) 196-205;

DOI: 10.1192/apt.bp.114.014266

Dementia & Sleep: What the Papers Say

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

Sleep disturbance
Sleep disturbance 2

Just recently I came across a gentleman who in living with dementia and supported by his wife at home has been struggling with his sleep. Waking in the early hours 0330, 0400 in the summer is not too bad accompanied by the dawn chorus, but if it happens most days? And then in Winter: that is another matter.

Also fairly recently there are increasing instances of this man not being sure that the lady-  who is in their / his house and is taking him shopping - is his wife. She looks like my wife...? She knows what to buy and then she pays for the shopping.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

Who are you?	Have the doctor consider  prescribing a sleeping tablet
"Oh OK! Hello Sandra."	Arrange a medical review

This gent is up early anyway as there is a newspaper to collect which involves a walk. The problem is he leaves too early and is then outside waiting. His wife was struggling with all this so we discussed the need for a care review by the community mental health team. A sleep diary was provided to obtain some data upon which to base decisions. While I was in the garden with Mr. my student (thanks Katie) suggested to Mrs Y that this 'imposter' be passed as a friend. This has since proved very effective at reducing anxiety, social tension and distress.

Whilst we constantly strive for truth, honesty and respecting autonomy and dignity, sometimes sadly, 'truth' is compromised. It becomes less clear when it is being cognitively undermined.

We also want to maximise independence and support what are the usual daily activities of living: collecting the newspaper included. Risks were becoming evident however. So, Mrs Y came up with a strategic decision which has seen this gentleman adjust very quickly. Sleeping in until 8 o'clock is quite a surprise for the rest of the family to hear. And for us too. It is as if the (subscription) token for the newspaper was not only sitting waiting in a pocket or wallet. It also had slot in memory, where it had to be kept on constant refresh, whirring away; of such importance that it was proving quite disruptive introducing new risks, disturbing sleep. There are still many other activities and walks to be enjoyed. Nice call Mrs Y:

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

	Cancel the newspaper

Looking for a Career in Finance? Why limit yourself...

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

Know your patient	Know your patient
Know your patient and carer	Know your clients... and your patient

By knowing them you can help them to know themselves.

From self-knowledge to self-care when possible.

A rolling issue: Parity of esteem in physical & mental healthcare

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL
|

group

"What about social care?"	"Did you hear something then?"

Image source:
http://coconutheadsets.com/2009/12/29/sisyphus-for-startups/

A "science for safety": getting the formula - and the grid right

The grid holds great fascination for me.

TRON LEGACY

It didn't start with The Grid in TRON, nor obviously TRON Legacy - even though the realisation is superb.

No, the first grid was in the cobbled back alley at my grandparent's house in St Helens. As a kid staying over in the summer I would take a spoon and the melting tar between the cobblestones was a syrupy invitation.

I must have got in trouble, as spoons were lost down the 'grid'.

In the here and now the "science for safety" report^* bears further consideration:

If healthcare is to significantly reduce patient harm, a holistic perspective is necessary to capture the requirements and needs related to the culture, workflow, and technology associated with caring for patients. In this paper, we relate the problem to other industries and how these industries have addressed safety. We identify the current gaps in today’s healthcare approach and describe the actions that can be taken, and the change in mental models that must be made by the global healthcare community, to continuously improve patient safety. p.3 [my emphasis]

The Formula 1 season beckons. The cars tested to the max are still to be tested in anger. They will soon, be ready - on the starting grid.

The "science for safety"
also needs a starting grid.

A conceptual framework recognisable and relevant to all.


^*Transforming Patient Safety: A Sector-Wide Systems Approach
Peter J Pronovost, Alan D Ravitz, Robert A Stoll, Susan B Kenned
https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/public/Patient-safety.pdf 

See also: How do you Balance and Elevate Holism and Patient Safety?

Image source:
https://www.artofvfx.com/tron-legacy-chris-harvey-superviseur-vfx-prime-focus/

Social Care is dry in January

I bought The Times today and on the front page is the news from University of Oxford:

Dehydration ‘common’ among patients admitted from care homes:
http://www.ox.ac.uk/news/2015-01-16-dehydration-%E2%80%98common%E2%80%99-among-patients-admitted-care-homes

When nursing and residential homes are struggling to manage an individual's care and look to refer to mental health services (usually) they know they need to asked the 'question'. This is about physical health: does the resident have an infection, are they eating and crucially drinking, are they in pain, constipated. ...

Although the headline augers badly and points to an ongoing (politically) 'inflammatory' problem within the sector, there is a great deal of compassion out there.

A resident's marked emotional distress and torment can upon investigation become a matter of how to also manage the staff's distress as they try to meet the individual's care needs. The latter does not help the former and amongst other things points to an educational need. This is especially so, if residents are to be able to continue to 'age' in their new 'home' with the additional complex needs that might follow.

Fluid balance used to be an element of basic nursing care.

Now of course - social care is not nursing care.

It is not always 'basic' either.

Architecture and Design: 4 beds in 4 domains

'Privileged' is definitely the wrong word. Perhaps it is the advantage of experience and the passing of almost four decades and more....

Times have changed since arriving at Winwick Hospital on a bike as a student nurse for an early shift at 0655. I would  leave my bike just down a small corridor to the right of the main entrance. I don't think I locked it. Then depending on the ward allocation I walked through the red carpeted front of the hospital to the increasingly rough and seemingly lost corridors beyond.

Hospitals have changed markedly. Winwick and other asylums have gone - thank goodness.

Cockroaches, leaking roofs, two-storey blocks where when necessary the patients would carry the meals up the stairs. A charge nurse set about ensuring that the patient's were provided with proper safety equipment if there were no lifts. The dormitories were large: 40+ bedded and more. There were lockers of some description I think, but personalised clothing was still to follow in 1977.

Despite the emphasis on community care, a project that in reality is still a work in process, the need for hospital beds remains. I have worked to keep people out of hospital, to help provide crisis support at home. When beds are needed the experience for members of the public and their families is radically different today. As taxpayers we recognise the need for efficiency in design, procurement, commissioning and managing new buildings. So it is within the NHS. Visiting new modern facilities, and this includes private nursing homes, you really appreciate the benefits good design can bring for patients-residents, staff, students and visitors.

individual
INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

My space Private space - observations permitting/negotiated Space to wander Space for wheelchairs Colour Personalisation Temperature Why is Joe staying in bed? Why is Mary not going in the lounge? ...?	4 Bed Multi Bed Bay c/o ProCure21+
Public space Quiet spaces (who says?) 'Community' Lounge Dining areas Activities room Noise levels Meeting rooms Interview rooms ...?	Public Engagement Staffing Volunteers Project Management Value for Money Savings Security Policies Safety Services ProCure21+ ...?

Image source: http://www.procure21plus.nhs.uk/standardshare/

World Mental Health Day 2014: or...

https://www.time-to-change.org.uk/WMHD

http://www.mentalhealth.org.uk/our-work/world-mental-health-day/world-mental-health-day-2014/

or - World Parity of Esteem Day 2014?

Bleeding holism

Holistic, integrated and 

person centered care

 is what happens when 

 respect and empathy 

bleed.

Psychiatric Bulletin - Letter: Psychiatry for medical students: need for a more holistic approach to teaching?

From: Psychiatric Bulletin -

http://pb.rcpsych.org/content/38/3/138.2.full

Kristina Rodney and Laura Wilkinson

Kristina Rodney and Laura Wilkinson are both ST4 medical students, Newcastle University, Newcastle, UK, email:k.rodney AT newcastle.ac.uk.

We are two medical students who wish to offer a perspective on undergraduate education and psychiatry.

During our student placement, we attended the old age psychiatry module at the Northern Deanery MRCPsych programme focusing on dementia and ethics. This was aimed at trainees and not specifically medical students but we were surprised to find that this was not above our level of knowledge. This prompted discussion of undergraduate psychiatry training more broadly, which we felt focused too heavily on the diagnosis of mental illness and less so on the holistic approach to the patient and their presentation as covered by the MRCPsych course. From our experience of undergraduate psychiatry we feel that the assessment by means of a logbook of conditions encourages students to find patients with a certain diagnosis, and in doing so overlooks the true essence of psychiatry. To our mind this incorporates the ability to consider all aspects of a patient’s life and formulating these, while demonstrating compassion for another person at a time of most need.

Through choosing a 6-week placement in old age psychiatry we have been able to explore the specialty more thoroughly and broadly than facilitated within the standard undergraduate programme, and we have realised how little of psychiatry we have been exposed to as undergraduates. We have become more aware of the importance of considering the patient’s personal and social circumstances alongside their diagnosis, and how these can influence each other. Specifically, the importance of a sound ethical approach to practice has been highlighted through the higher-level teaching we experienced, where the Mental Capacity Act was discussed in detail.

We believe that it would benefit undergraduates to experience a more realistic and rounded placement in psychiatry and truly consider the social implications of mental illness. As it currently stands, undergraduate education in psychiatry is oversimplified to focus on diagnosis and does not acknowledge the capabilities of medical students to adopt a holistic approach. An opportunity to consider all aspects of a psychiatrist’s role may encourage more students to consider a career in this field.

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I have contacted the authors of this letter to inform them of Hodges' model and its scope in assuring holistic and integrated care. The model could also facilitate curriculum development. The authors of the letter are not endorsing Hodges' model, I am seeking to highlight the need for such a resource.

Thanks to:

Lucy Alexander
Rights and Permissions Manager
Royal College of Psychiatrists