Healthcare & Nursing: A select sport

Ed Smith: ‘We can’t risk stars’ mental health by playing too much’

Gruelling summer proved to England selector that player welfare is critical

Apparently, cricket is a late arrival to team building around a strong core and leader and then using a selection strategy. According to Wilde (below*), cricket is playing catch up with baseball (1880) football (1990) and rugby in 2010s. Even with a squad and substitution some players can play too much with physical and mental impacts. Delivery of healthcare is no 'game' even though certain aspects are open to gamification. Everyone understands the need to stay 'fresh' and avoid injury (burnout too). Nurses are not the only professionals and team players to experience the paradox of a break. On the one hand it's like you've never been away; on the other it is great to pick up the threads of cases, caseloads, referrals old and new. Key here too is the cover provided by colleagues while you were temporarily 'off the field'.

"Eddie Jones was asked after England's quarter-final
win over Australia if he felt vindicated in his decision
 to drop George Ford. He said, we didn't drop him, we
changed his role - welcome to modern rugby."

In health, the appliance of sport's 'win ratio' is not in dispute. We can test this! What is the satisfaction rating of the patient and family? But, let's broaden things to include the tax-payer and the patient's recovering, staying that way and becoming self-caring as far as possible. What has to be considered is the context, for example, palliative, end-of-life care and the aims of care.

Nurses have no choice but to 'play'. Sometimes an astute manager will recognise that a specific staff member is best suited to deal with a specific referral, or re-referral even.

As you guessed it, 'selection' does not end there. 

If Hodges' model is the compound field of play, then the selection of care concepts is the vital strategy to assure -

• person-centredness;
• integrated care;
• parity of esteem;
• reflective practice;
• critical thinking;
• a learning encounter;
• preventive approaches
• addressing health and other literacies ?
• teamwork ...

Yes, care assessment, evaluation can be a team effort. The significant care concepts (social determinants ... ), associations and priorities, risks and opportunities can be identified by an individual practitioner and also as a collective effort (group case discussion) and always with the patient / carer - guardian.

So, let Play commence  - and congratulations South Africa!

INDIVIDUAL

|

INTRA- INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP

Simon Wilde, Cricket correspondent, The Big Interview. ‘We can’t risk stars’ mental health by playing too much’. The Sunday Times. October 27 2019. p.9.

https://www.thetimes.co.uk/article/ed-smith-interview-risk-mental-health-cricket-brw2t8lxk

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 survey: Nurse Lecturers undergraduate students, e-learning, e-portfolios, innovation in reflective skills

For the latest module in my TEL studies at Lancaster University Researching Technology Enhanced/Networked Learning, Teaching and Assessment I'd wondered about a focus group combined with a survey. The constraints remain non-trivial doing this part-time and from outside academia - in practice. This past week I've also attended the final residential of part 1 (more on this soon). Returning to the module's study, the focus group isn't going to happen and with Easter upon us this is not the best time to engage in studies, but of the course this applies for all students.

As the blog nears its ninth birthday in several posts I've mentioned the many assumptions that are exercised in certain items. Here I am in Wigan (WN4), Lancashire (all flat caps, pies and Northern Soul) and also looking South, East and West with global health a key concern. The same applies to my experience of nurse education as a mentor and sign-off mentor. I'm making what may be some very large assumptions based on the studies so far, work with students on placement and as was pointed out, nursing and health make up a small part of the strategic adoption and influence relating to an institution's learning management system [LMS]. Does anyone have any figures on this?

The assumptions are that many lecturers do not have the time, or possibly the skills to make full use of the features and potential of the LMSs. So, I am wondering about the scope for innovation to support our student's reflective skills and practice; that is, beyond written essays and forums on the LMS. Is this symptomatic of feature bloat as per office applications? Does this make the 'walls' higher? These are issues I can investigate in the brief literature review within my report submission.

So I am pursuing a qualitative study with an interpretive stance. If you are nurse lecturer for undergraduate student nurses, or other courses and including social care I would greatly appreciate your assistance with the survey already posted in the sidebar. This is an experiment too in terms of using Survey Monkey for the first time and a basic account. I'll look at Bristol Online Survey in future.

...

Many thanks
Peter

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.

Review: Philosophical And Theoretical Perspectives For Advanced Nursing Practice

If you are a miner for insight, a pearl diver for knowledge or seeking blue sky wisdom this book can deliver and sign-post in plenty through its references. In summary: this book is a history book that nods at futurology.

I had high expectations for the text, also anticipating an exacting read. After all, as a 5th edition this is a well established text. The expectations were not wholly realized, however; many of the papers are quite dated being published originally in the 1990s.

The book is an important collection and can certainly be regarded as essential reading for advanced nursing practitioners and those pursuing post-graduate nursing studies. Several chapters hail from the same journal publisher and perhaps - as a positive - this contributes to the readable and accessible style throughout the book. The text format and size are also easy to read. I found one spelling mistake within the index entry for 'diagnosis' p.387. In addition to the historical development in part 1 the book's division into five parts - 31 chapters in total - acknowledges the reliance on the past and from it appears from a previous edition the arrival of the 21st century. Apart from the current date of issue 2013 I cannot accurately place the most recent additions to the volume. The contents listing and preface are limited in this respect. Judging from the references they are not that recent. 2010 is one of the most recent references I could find, and this, the 75ed of Toby & Mariner.

Many of the papers are seminal and include an overview of particular aspects of nursing thought - analysis and synthesis. Unsurprisingly, there is philosophy and ethics in great abundance, together with ecocentricism, several forms of feminism, aboriginal peoples and their world views, evidence, health, beliefs, art, professionalism, research, patterns, advanced practice, theory and much more. The distinction between evidence based theory and evidence based practice is something of which all nurse students should be aware.

There is specific reference to Advanced Nursing Practitioners. There could obviously be some variation in how this professional group are considered as opposed to Advanced Nursing Practice. Having just returned from Belfast and the University of Ulster there is ongoing currency in McCormack's chapter 17 A Conceptual Framework for Person Centered Practice with Older People. While dated 2003 McCormack's work was emphasized at a recent conference in Ulster I was able to attend (and there are plans for another). I am sure other chapters may be enlivened by such reviewer found co-incidences as this.

I wonder if the scope of the book and acknowledgement of the passing of time seems to shout for a two-volumed approach. As suggested above, the previous acknowledgement of the future seems to have hailed from the 20th century and got lost. We are now after all more than a 1/10 of the way into the 21st century.

Having started my nursing career in the RN, chapter 22 on military metaphor in nursing and the need for another. A researcher contacted me several years ago about using Hodges' model (a conceptual framework) in a study on bullying in nursing. I've never heard anything since, but Hodges' can help in such research in two respects. The inclusion of a political domain and the organization of groups of people, emphasizes process, procedure, protocol, routine, and may proceed to regimentation, discipline, hierarchy so to a degree language games will follow. As this chapter notes, several professions, including nursing are said to eat their young. A commentary after the chapter provides a useful balance and makes this point. The chapter is nonetheless a reminder of the role of language and how professionalism arises and is sustained (disciplines too?). The proposal of frontier as a new metaphor is fitting as Hodges' model identifies five conceptual fronts - frontiers that must be integrated. 

As a frontier - Chapter 21 on rapture and suffering with technology in nursing holds many lessons and insights. Heidegger's "standing reserve", the human-technology interface, what it means to live like a human being and the distinction of being a human being. Mobile technology, m-health, e-health are making a huge contribution to global health and need a place here. I found Macurdy's four principles 326-327 on what patients need to assume power and control over their care very illuminating, especially in highlighting information access and the importance of health literacy.

In the text and the index I could not find specific reference to capacity, as in mental capacity, informatics, global health, information (access), justice, law, legal, management, human rights, literacy, mental, political, psych-, long-term medical conditions and recovery. While the book would become incoherent if a disease/diagnosis-based approach was adopted, we might ask: does dementia deserve specific inclusion? This is an interesting (and potentially vociferous) debate in itself - to what extent should such a book record change through several decades? Of course the book is not an encyclopedia and it is easy to critique according to omission. These are pressing times demographically, however; while there is a population focus: global communities and aboriginal communities in chapter 23 and 24, this merely scratches the surface of very large world.

This book is a valuable asset and has stimulated many ideas here (and potential blog posts). I am very pleased to have read it and would recommend it to students and practitioners alike. I am grateful to the publishers for the review copy.

The Enormous Theorem meets The Enormous Conceptual Framework

with Best Wishes for the Season and 2013...

Hodges' Health Career - Care Domains - Model is not a theory of health and social care.

It can however encompass the conceptual space that comprises not only health and social care, but the lived experience of individuals, and the existence of corporate and political entities (notably policy).

So while mathematicians have The Enormous Theorem, in Hodges' model we can at least reflect on what might be the enormous conceptual framework.


Prize awarded for largest mathematical proof. New Scientist, Sept 10 2011, 211, 2829. p.5.

End of Life Care (Pathways), Nursing and Thresholds

There is a controversy (was in Telegraph) that has been growing for some time, concerning the Liverpool Care Pathway for end of life care. This is a very demanding and yet rewarding aspect of nursing. I have experience of end of life nursing care in a non-specialist capacity, having worked on wards for older adults and being involved with people who have mental health and life-threatening physical health problems.

It pains me greatly not just as a scouser that something with 'Liverpool' in it should become a cause of distress, a center for debate and review. Is the pathway green and shady? Is it comprised of stepping stones, with room for two, and with time granted for your next step? Or is there a danger in some instances the path can become tarmac clad, without the succor of a services stop for basic sustenance? Can a pathway become a motorway? What does that sign say? "DON'T HOG THE MIDDLE LANE!"

What pains me seriously is that what can be a invaluable, evidenced based palliative care resource can be undermined due to the complexity of the generic and palliative care situation.

If we truly practice person-centered care then there are no care pathways.

Or, to put it another way: there are as many care pathways as there are patients and carers.

Whether you believe in social medicine, or private; whether you are laissez-faire, or leave such matters to a higher power there is no escaping the need for organisation - for order.

The mix and concentration of people, knowledge, resources and time dictates that tasks, roles and processes be delineated and assigned. We need to assure a given level of quality, and to predict things, not everything is as difficult as the weather: or death. Pathways can assist in specific contexts.

Is there scope for personalisation on a pathway? ...

Steps and pace can vary and to the left and right of center. There are many pathways though: some valid - evidenced, award winning; while others might be broad, narrow, twisted - to become a disorientating ethical loop...

Being placed on a pathway denotes a decision point, a threshold. We need to remember in all fields of health and social care practice that there are multiple thresholds to be taken into account, communicated effectively and revisited:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

'me' - existence, resilience, assets, personhood, ethics, personal values, mood, personalised care, understanding of treatment, communication skills, self-expression, loss, orientation, observation, distress, psychological assessment, sedation, beliefs, choices, :theology PURPOSE	'me' - existence, feeding, nutrition, fluids,  evidence base, Liverpool care pathway, quality of life measures, referral thresholds, prediction, resilience, reductive - holistic assessment, medication, distance, where: home-hospital-hospice? pain management, decision locale, specialism, basic nursing care, resilience PROCESS
memories, good-byes, love, compassion, carer under stress, reassurance, counselling skills, meetings with family, empathy and rapport, patient and relative engagement, life history, relative's recognition that loved one is dying, care strategies,  patient experts, patient - carer experience, communities of PRACTICE	consent, advocacy, mental capacity,  integrated working, effectiveness, independent autonomy, service access, bed availability, health & nursing in the media, scope of nursing, scope of medicine, law, medicolegal issues, whistleblowing, complaints, formal review, appeals, organisation, argumentation, professionalism, ageism, POLICY (re-PURPOSED)

The relative position of concepts above does not indicate priority.

"The LCP is not the answer to all our needs for care of the dying but is a step in the right direction."

Marie Curie Palliative Care Institute
Liverpool Care Pathway for the Dying Patient (LCP)

A World Record for Health Care: The 4 minute reflection

Of all the things that can be done within 4 minutes one of the most significant in the history of sport is undoubtedly who would be the first to run a mile in under four minutes:

In health care four minutes is both an age and an instant in someone's health career.

If we took four minutes to reflect upon a person's care across the care domains what difference might that make?

Just one minute per care domain to help deliver - personalised care, self-care, carer support, integration, health promotion and how to stay well. ...

In healthcare we are constantly seeking GOLD.

Wherever you are have an amazing Olympics!

Health & Social Care - Shoeing the Horse*

Anvil

*humanistically ...

Anvil image:
http://en.wikipedia.org/wiki/File:Blacksmith_anvil_ganson.svg

Original horseshoe image:
http://www.ranchomilagrokansas.com

Now I am - IST

Since January 9th 2012 I work in IST, that is the Intermediate Support Team.

This means my colleagues and I try to facilitate early discharge, prevent admission, relapse and also have a gate-keeping role for the local in-patient beds.

Working in IST and being a nurse makes me think about all those other –ists that are out there.
Several immediately fall out of Hodges' model:

Human-ist, human biolog-ist, technolog-ist, psycholog-ist, educational-ist, public-ist - for public [mental] health, socio-technolog-ist.

As per the many nodes, edges and dimensions within Hodges’ model being an IST means:

taking the edges off the things that count but 

visiting all the edges

So, yes I am a social-ist too. You have to be working in health and social care:

As you do your bit to deliver safe, lean and yet high quality nursing and social care - engage in discussions about an individual's health care, care placements, care transitions you are also a polic-ist^*. You take the government’s policies, the welfare reforms, the savings, and latest legislation and sell them to the public.

While you do this you try to ensure you are not ageist, sexist, racist, elitist and those many other ists that try to prevail - especially amid chaotic change.


^* Policist is I believe a neologism in English. What I mean is the way that workers on the ground (inevitably) enact health and social care policy, thereby also selling it to the public. There may be a word that fits the Bill, but it's eluding me ...

Masquerade in health care but on which level?

There is a Drupal module called Masquerade, the project page explains:

The masquerade module is designed as a tool for site designers and site administrators. It allows a user with the right permissions to switch users. While masquerading, a field is set on the $user object, and a menu item appears allowing the user to switch back. Watchdog entries are made any time a user masquerades or stops masquerading.

Life frequently asks more of us and the same applies for employees in whichever employment sector. For teachers and nurses they know the call. As a nurse you adopt the mask of the uniform and the role. You may not actually carry the lamp, but it's there. Sometimes it helps light the way; for the public, for you. If you are a 'bad' nurse - whether your attitude put the lamp out this morning, yesterday, or several years ago -  the darkness that follows you about speaks volumes.

It prompts Prime Ministers to make announcements:

PM announces new focus on quality and nursing care

06 January 2012 12:54

A new drive to free up nurses to provide the care patients and relatives expect has been announced today by Prime Minister David Cameron and Health Secretary Andrew Lansley.

The push will see nurses spending more time on front line care in wards and other services, a senior ward nurse with whom the buck stops, patients leading on inspections and a new 'friends and family test' to show whether nurses and patients had a good overall experience, or would want loved ones needing care to be treated at each hospital.

Prime Minister David Cameron said:

“We know the vast majority of patients are very happy with the care provided by the NHS. And I’ve seen the NHS at its very best. But we have heard recently that in some hospitals patients are not provided with the level care or respect they deserve and I am absolutely appalled by this.
“If we want dignity and respect, we need to focus on nurses and the care they deliver. The whole approach to caring in this country needs to be reset. And it needs to start with this simple fact. Caring for patients is what nurses do. Everything else comes second."

<->

While we all play masquerade there are many levels. As a 'nurse' it's difficult (but never impossible) to play the caring, skilled, knowledgeable, patient, warm, efficient ... representative AND ensure all records are maintained, letters written, all communications logged, targets achieved, electronic records and data gathering requirements met. ... If you need a steer-clear from the stereotypical image of Angels, then you should see the faces nurses pull behind the mask trying to satisfy the audience.

That audience does not just include managers, patient representatives, inspection agencies but policy makers and politicians. Of course the latter are expert proponents of masquerade (they practice through a 4-5 year cycle).

Closer to home and the Drupal module? Well, I can't see a role for masquerade on a new h2cm website, but the thought crosses my mind of general nurses masquerading as mental health nurses; social workers masquerading as nurses. ... Although I'm playing games :-) it makes you think about what we mean by 'multidisciplinary'. To what extent, for example, is care of people living with dementia being missed because these disciplinary distinctions - silos really do still prevail? Surely the nursing issue isn't just a lack of light?

This announcement is not exactly news given what has gone before in the UK media through 2011.

What is strange is that this policy should emerge in 2012: The Alan Turing Year.

Yes, nurses DO need time to care, but perhaps we also need a test for empathy and rapport and not just intelligence?

Time Magazine's 2011 'Person of the Year': The Protester

This image released by Time Magazine, Wednesday, Dec. 14, 2011, shows the cover for Time Magazine's 2011 'Person of the Year' issue. The Protester is this year's choice.

Thinking about this recognition of The Protester I believe that -

the Protester is an example of a true holistic practitioner...

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

How does an individual decide 'enough is enough'? When does the one act on behalf of the many? What happens when a Person clenches their fist, decides to fight for their rights? In a digital world "NO" and denial of individual human rights is not an answer.	When is the individual a mere 'particle'?  When are they a 'wave'?
The Protester TAKES IN ALL THE CARE DOMAINS.  They reflect -  but they do not see themselves -  they see the future for family, friends, nation: and then they act.	When the State clenches its fist what does it strike?  Who tends to the mental health of the world's leaders? What price for home, land, human rights, education, health information and justice?

MEMO:
TO: The Editor, Time Magazine
FROM: Welcome to the QUAD

Congratulations on your publication and this annual media event. It is fascinating to note the changing cultural, social and political influences evident in the history of 'Person of the Year', most evident in being originally 'Man of the Year'.

I note you have twice selected former president Ronald Reagan in 1980 and 1983 respectively. The former president disclosed that he was diagnosed in 1994 as having Alzheimer's disease. It is quite a coincidence that in-between Reagan's selection the means to a global memory The Computer was appointed as Machine of the Year in 1982. One thought: how many other individuals listed were, or are affected by the dementias?

I believe at some point in the next five years you could do a great service to the many Persons (younger as well as older adults) and their families who are living with dementia in acknowledging them as PERSON of the year.

To people living with this dreadful condition you can help highlight the importance of health, research, funding, policy, socioeconomic impact and most of all - person-hood where it really does matter.

Thank you for your consideration.

Yours Sincerely,

Peter Jones

Sources:
http://en.wikipedia.org/wiki/Time_Person_of_the_Year


http://en.wikipedia.org/wiki/Ronald_Reagan

Gardner's 5 Minds for the Future (and the Question)

In order to pursue post graduate study you need a project, which demands a question. Formulating a research question is central. I wonder however whether there remains a bias - hard sciences vs humanities (and triangulation) - towards a class of questions that are closed and so can be answered in X-words : Y-time : with Z-funding? Thereby passing through the necessary academic hoops. Of course I realise that if there are no constraints then chaos would ensue. I just wonder if the journey (creativity, discovery ...) might be lost for the sake of assuring the end product?

My questions (apart from 'beware reflex moves') tend to be framed in broad terms. You could say that as yet I am not disciplined (specific) enough to come up with a question that passes "GO!"

In Howard Gardner's Five Minds for the Future the issue of educational programmes is raised and I read the following:

The second antidote entails the creation of educational programs directed specifically at certain individuals of promise - for example, leaders of tomorrow. Chief executives and general managers are expected to be able to see the big picture - to look beyond their own background and specialization; to understand the various components in their organization or constituency; to think systematically about what is working, what is not working, and how goals can be more effectively achieved. ...

Other individuals - for example, those exhibiting a "searchlight" or "bricoleur" intelligence - might be attracted to such programs as well. They would make use of their enhanced skills even if they do not occupy explicit leadership roles. Perhaps, as educator Vartan Gregorian has suggested, we need a specialization in becoming a generalist. p.75.

Gardner, H. (2008) Five Minds for the Future, Harvard University Press.

Health, social care and informational emaciation

We hear a lot about information and how important it is, being in what is described as the information age, the information economy. ...

Nurses, patients and carers (plus managers) would instantly recognise that if a care plan and subsequent care delivery was based on the following assessment:

oriented, not depressed	hypertension, falls, dizziness, headaches, pyrexia
carer due hip operation	admitted 1st May 2010 1200hrs to clinical decisions unit

- we would be acutely concerned.

Clinically this is a case of informational emaciation. The information above is rather thin on the ground, this in turn affects the knowledge that can be gleaned in formulating, negotiating and agreeing actions. Even in the information sparse example above each of the care domains has some content; is that always the case?

Use of the word emaciated in this context is not intended to diminish the plight of people who are physically emaciated, poorly nourished.

This post is intended to highlight another aspect of poverty.

As the Global Healthcare Information Network (HIFA 2015) argues and campaigns - information is a means to emancipation - a way to overcome information emaciation.

CARE: Whether NHS or Social Care ...

C	A
R	E

Whether -
NHS or Social Care^*
what
C.A.R.E.
is crying out for is a
universal, shared, holistic and wholly integral conceptual framework.
Then and only then will the currencies^# of care be
transferable, translatable and transforming!

* Private, 3rd sector, religious order, or social enterprise ...
# Currencies does not just refer to finance.

Drupalcon Paris 2009 "big picture..." x 5 "holistic..." x 6

Today at Drupalcon my keyword count by the speakers of day 3 sessions I was privy to (assuming I was awake throughout) is something like:

"big picture" = 5
"holistic (+ or - thinking)" = 6

These were stressed repeatedly especially by keynote speaker Chris Heuer. Like last year in Hungary I have looked at the BOF (birds of a feather) board and wondered about sticking Hodges 'framework' up there. Why 'framework' and not 'model'? Well framework, product and service are amongst the other keywords at Drupalcons past, present and future no doubt.

Hodges' model is a framework to carry, represent and disseminate big pictures.

While it is very encouraging to me to hear these terms I get the impression this is window dressing. At the end of the day the 'big picture' is the paper around the fish and chips. Its value is quickly spent - especially in this most apparent recycled mode. Chris Heuer alluded to this in his very interesting talk.

There is more to see in the big picture than what seems to be there.


This is why Hodges' model is so readily passed over for its simplicity.

When we gather the constituent parts of the big picture they are invariably 'recycled materials'.

The converted can see the re-purposed value, the need to re-visit the frame and tinker with the contrast, horizon(s), sky and colour; but critically do those who really need to create, see and utilise the resource?

The thing about 'big pictures' is
they are not enough in themselves,
it depends not only on how you fold them,
but on how hard you can throw them.

Image sources:

Fish and chips in paper: http://www.roadfood.com/Restaurants/SearchResults.aspx?st=photos&ob=RestaurantName&ps=1&s=XX
Paper plane: http://www.clker.com/clipart-4601.html

Holistic care and 'where' it means....

Delivering holistic care does not mean being -

here	here
here	- or here

Holistic care is not even
about being in all these
places at the same time.

It means you have already
been to these places and you
will be going back again.

Holistic care also means
none of the participants travel alone ...

The moon, Saturn V, policy and holistic care

The last time human kind ventured to the moon it took a three-stage rocket to get us there.

Unlike the space race and Kennedy's breathtaking commitment, there never has been a political objective akin to - "We choose to achieve holistic care in this decade, and do the other things like multidisciplinary, integrated, electronically supported collaborative care. ..."

Perhaps the UK's series of National Service Frameworks goes some way towards this, with the Next Stage Review over the next decade set to make the holistic difference?

So, it appears that the objective of holistic care isn't easy, like going to the moon it is hard and in this problem domain - care engineering - we have had more than a decade to get there.

There has been a space race in nursing. A race to fill curricula, wards and the heads of many with models and theories of nursing.

Like Apollo this race has petered out.
Like Apollo this programme is safety critical.
Like Apollo ambition can be re-kindled.

We need a new imperative. Something to charge policy landscape of our time. There is still a need to deliver on this and the other things....

Hodges' model is a marvellous delivery system.

Unlike the Saturn V it boasts four stages.
Like the Saturn V it incorporates the means to take us to some place and make the journey back: quantity - quality and the universe between.

The stages of h2cm are interchangeable their use dictated by the situation and context. There is even recourse to a virtual fifth stage as required, since as the astronauts found:

you can find bliss up there : looking down here

Image source: ABC News

Ack: John F. Kennedy Moon Speech - Rice Stadium

1st Contact: ET and care on the front line

ET as in 'extraterrestrial' may seem remote from nursing and health care, but where there's a will....

Health and social care appears to become ever more specialised with each turn of the policy machine. People's lives are experienced as being ever more complex. Health care is filled with uncertainty and the public present with multi-diagnostic, person-centred, choice bearing, (usually) recovery directed problems, needs and strengths.

Pity then the care workers on the front line, at the point of 1st contact. Like the baseball catcher it helps if they can field the knowledge and skills required to cover physical, mental health and possibly learning disabled clients. You have to hope that coaches recognise that Hodges' model can help the team be aware and fully prepared to cope with 1st contact supporting and facilitating what follows. So, how does your team get to grips with complex care?

Additional links:

Baileff, A. (2004) Developing high quality first contact nursing in Southampton NHS Walk-in Centres. At, Innovations in Partnership, Practice and Education, 3rd Annual Scholarship Conference, Portsmouth UK, 2 Jul 2004. Southampton, UK, University of Southampton. http://eprints.soton.ac.uk/9197/

Declaration of Principles Concerning Activities Following the Detection of Extraterrestrial Intelligence http://www.setileague.org/general/protocol.htm

Image and source: Louisville Slugger OXFB Omaha Pro Series 13 Inch First Base Baseball Mitt from
Formerly - anaconda sports

Road safety vs Patient safety

For effective road and rail safety the advice is....

Sometimes though looking "both ways" isn't good enough...

In health and social care and other situations in
addition to utilising holistic frameworks like Hodges' model,
we also need to look inside and outside of ourselves
- the 5th 'spiritual' domain.
Have a safe and happy 2009!!

Acknowledgement:
Photo used with permission (and thanks): Portland Ground
Crossroads sign from commons.wikimedia.org.