Patient education and human rights in Hodges' model

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

"Patient education is Article 25 of the universal Declaration of Human Rights, and Article 4 of Patients' Rights Law - The right for information, the ethical principle of respect and a component of the nursing professional standard that prove the examples of good practice. The patient, with the exception of life-threatening situations, and when the relatives or contact persons are not available, receives educational information on expected handling, treatment and care processes, medication, and all that is followed by the agreement on the part of the patient to receive treatment, rehabilitation or prevention process." (p.1957)

Reference:
Beta, G., & Lidaka, A. (2015). The Aspect of Proficiency in the Theoretical Overview of Pedagogical Practice of Nurses. Procedia - Social and Behavioral Sciences, 174, 1957–1965. http://doi.org/10.1016/j.sbspro.2015.01.861

Piloting (online) health literacy - 'easy as she goes?'

On Thursday afternoon I introduced Hodges' model to six student nurses. In wrapping up the session I suggested the students look up 'health literacy' indicating how Hodges' model can incorporate reflections on the many literacies essential for life (and death) in the 21st century. For one student this small kernel of news was unfortunately too late, a piece of work having just been handed in.

Great to see the following item in this week's HSJ - Health literacy training on offer for 100,000:

The NHS Commissioning Board will work with a charity to offer 100,000 people access to training in online health literacy over the next year, it has announced.

The board’s national director for patients and information Tim Kelsey said on Thursday it had made the agreement with UK Online Centres, an organisation which specialises in tackling digital exclusion.
The work comes in the run up to the board’s deadline of 2015 for patients to have access to their GP health records. ...

Health literacy training on offer for 100,000, Health Service Journal. 14 March 2013, p.10.

In terms of health literacy as a whole this is one aspect, but as the previous post point out we need to consider human factors. Innovation  also involves physical and cognitive access, relationships, referral, the interplay and dependencies between existing literacies (poor functional literacy and yet high health literacy?), differentiating between literacies, motivations and to what extent can participants themselves be mobilised as a force for change beyond 100,000 ...?

The Telehealth supplement in the same issue of HSJ notes that small companies struggle when they are offered yet more pilot projects with 30 patients.

100,000 - well that should be a good shot in the arm.

Trueland, J. (2013) The six billion dollar question, Telehealth supplement. HSJ, 14 March, 8-9.

Information Prescriptions: Just don't say "job done" or "next!"

The information prescription (IP) is not new. It is what should be a routine intervention that benefits from such initiatives as the specific IP project in 2007, which also produced a final report in 2008.

If people today are expected to self-care, there are recognized problems when they self-information prescribe (or is that paternalism at work?). The provenance of information on the web is a key concern.

In the 1980s and 90s the prescriptions and the management of benzodiazepines in community mental health gradually emerged as a problem. Today (for our children and their children) there's an acute problem with the frequency of antibiotic prescribing. Listen to the informative and sobering BBC Radio 4 programme:

The Path of Least Resistance

As people are directed to validated and creditable information resources we need to consider the bigger picture that a prescription ('plan') of any sort represents.

A response in the form of a drug/treatment or information prescription does (of course) not mean "job done".

Some follow up may be needed (duh!) as to what has been done with said information. When we speak to people we quickly make global assumptions about their understanding, literacy, motivation and the constraints within which they can operate when outside the clinical encounter. General Practitioners usually have the benefit, and in this context - a great benefit, of having known the patient and the family for many years. Other practitioners may not have that informational reservoir upon which to draw. General practice may itself see changes - pressures on the established patient - family doctor relationship.

The quote below is from the information prescription website:

Information prescriptions contain a series of links or signposts to guide people to sources of information about their health and care – for example information about conditions and treatments, care services, benefits advice and support groups.

Information prescriptions let people know where to get advice, where to get support and where to network with others with a similar condition. They include addresses, telephone numbers and website addresses that people may find helpful, and show where they can go to find out more. They help people to access information when they need it and in the ways that they prefer.

Working in nursing homes I know how demanding and challenging information exchange can be. While the above quote lists suggested content, I've had to signpost in person, once, twice, three times before the time was right for a carer to approach a specific agency for a resource.

Whatever your lingo, personalised information prescriptions are really cool - and hot. We need them.

After all isn't a prescription for drugs just another form of information prescription, molecular, biochemical? One that is also destined to become more personalised and yet on a different informational (genetic) level. More than anything else though we need a public, citizenry who can understand the value, potency of the infoscript in their hand. Is there an antidote for advertising?

 Although the informational exchanges in nursing homes and elsewhere are challenging: we keep trying. To do that the prescriptions should not be used as a means to say "Next!".

Crossroads have historically been meeting places. A space of choices (information) and signposts, make the right choice don't hurry.

Quality outcomes take time, but then I would say that ...

International Journal of User Driven Healthcare (IJUDH) CfP

Dear Mr. Jones

In view of your work in patient-centered care, I’d like to invite you and/or your colleagues to submit a paper to this Special Issue of the new journal described further below and via the web link provided. I think our global readers would be very interested in your thoughts (and projects) on innovative ways to get relevant healthcare information into the hands of ‘users’ (both patients and providers), within the user-driven EBM paradigm, per below.

Please also share this call for papers with your colleagues.

Thanks for your consideration,

Susan Ross, MD

International Journal of User Driven Healthcare (IJUDH) Call for Papers

Editor-in-Chief:
Rakesh Biswas,
Center for Scientific Research and Development (CSRD),
PCMS Campus, India

Published: Quarterly

Call for Papers - Special Issue:

Submission Due Date: July 1, 2010
Special Issue On User Driven Healthcare and Evidence-based Medicine

Guest Editors:
Susan Ross, MD, FRCPC

Introduction

User Driven Healthcare (UDH) is part consumer-driven healthcare, part narrative medicine, and part Health 2.0. It stems from a concept of participatory healthcare whereby all stakeholders, enabled by information, software, and cyber-community, focus on healthcare value. But where does Evidence-based Medicine (EBM) fit into this framework? It is sometimes forgotten that EBM is a three-legged stool, comprised of the triad of evidence +provider expertise + patient preferences. In this EBM framework, provider expertise is needed to bridge the inferential gap between population-based evidence and the individual patient. And each patient's values and preferences should narrow that inferential gap further. But since the introduction of EBM nearly two decades ago, the primary focus of EBM proponents has been on Evidence, at the expense of patient preferences and provider expertise. Perhaps this is why the promise of EBM to foster the most efficient and high quality healthcare has not yet been realized.

Objective of the Special Issue

This Special Issue will focus on the following questions: Is the recent emergence of User Driven Healthcare really a new, post-EBM paradigm for healthcare, or just an overdue consideration of the other two legs of the original EBM stool? How might this trend affect all stakeholders?

Recommended Topics

Topics to be discussed in this special issue include (but are not limited to) the following:

• Developing valid patient-level evidence using the Web
• Evidence generation—clinical research strategies using social media and mobile technologies
• Examples of UDH to a) help formulate the right questions to ask in EBM; b) develop answers to those questions; c) disseminate the answers to patients and providers with a need to know; and d) test the impact of UDH-generated Evidence on patient outcomes
• Helping online patients sift the ‘wheat’ from the ‘chaff’—information management for patients in an EBM world
• How to incorporate patient preferences and values into ambulatory care decision-making (i.e., into the 10 minute visit)
• Measuring the impact of UDH on patient outcomes
• Patient-level decisions vs. population-level evidence (bridging the inferential gap)
• Pharmaceutical communication strategies using social media—impact on healthcare quality and costs in an EBM framework
• Place of social media in EBM—patient and physician online communities
• Practice of UDH vs. EBM around the world
• Regulatory issues of evidence dissemination by industry using social media in healthcare Statistical and other evaluative methods to assess the validity and reliability of evidence developed using social media and mobile technologies
• Trends in N-of-1 studies, and their relevance to EBM and UDH
• Use of collective intelligence to solve healthcare problems for individuals and communities

Submission

...

All submissions and inquiries should be directed to the attention of:
Susan Ross, MD
Guest Editor

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.

Health & holistic care in the 21st and 22nd Century

With the technical means at our disposal it is relatively easy to provide information to the masses. Facebook, Google and advertisers are increasingly better versed to target information not just our way, but your way.

Health education and preventive medicine programs depend on the dissemination of health and well-being information, that in turn also relies on access to an expanding digital infrastructure. Equality of access to information communications technologies is now the province of human rights and not just manifestos whether ambitious or binned.

There is much talk of trying to categorise the stage (and hence maturity) of our civilization: hence we talk about being in the information age.

In health care terms this is clearly the case. The provision of information is a key operation and goal of the UN and WHO as per the Millennium Development Goals. Amid the MDG and multiple other related initiatives we need to take care that the habits of many thousands of years do not dilute our efforts.

There is a danger that just as we have broadcast seeds to grow crops,
we will repeat the exercise with technology's reach and
so many seeds will fall on stony ground and
so not take root and
grow.

As people working in the development field know only too well, initiatives like Health Information for All by 2015 and national efforts are not just about the provision of information. In some respects that is not as big a problem as it once was (though is still presents a huge challenge) with community, urban and developmental informatics. Mobile phones and various technologies can get information to people. Increasingly though the problem is one of sufficient or extended literacy. This extends the conventional educational literacy and notion of the 3R's - Reading, wRiting and aRithmetic.

What knowledge do I need about my health and that of the 'other' gender and ethnic groups with whom I share this 'home'. What knowledge do I need in order to live long and then be able to prosper and do so sustainably?

Allied with the problem of literacy is seeking the attention of individuals. This perhaps is why infant, primary and secondary schooling are so important - learning to attend is the most important lesson of all. Especially as health and well-being messages must compete in the multi-spectral communications channels polluted with so much dross.

The MDG make clear the above requirement in Goal 2: Achieve universal primary education:

2.1. Net enrollment and retention in primary education
2.2. Proportion of pupils starting Grade 1 who also reach the last grade of primary education
2.3. Literacy rate of 15-24 year old #

With the requisite baseline - personalised literacies and the information that HIFA2015 and others can provide then individuals can achieve a level of health and well-being knowledge commensurate with living (and dying well) in the 21st century:

and 2nd-by-2nd the

growing proportion of the global population that will know the
22nd century. ...

# Thanks to Remi Akinmade and HIFA-2015 list
http://mdgs.un.org/unsd/mdg/Host.aspx?Content=Indicators/OfficialList.htm

Literacy on W2tQ
http://hodges-model.blogspot.com/search/label/literacy

Midwifery Materials for Haiti - in French/Creole - NEEDED

My source as posted to the GANM and on HIFA 2015 lists:

I am writing the (GANM) community to ask for assistance in gathering online midwifery and nursing materials - in the French or Creole language, for Haiti.

The National Nurse School University and Faculty of Medicine in Haiti has collapsed and they have lost most of their training materials. Dr. Larouche was killed in that collapse - he was teaching an OB course to the midwifery class at the time. I do not know the fate of the nursing/midwifery students, but one can imagine that the outcome is probably not a good one. Dr. Larouche was filling the void left by the untimely death of Madame G.Francoeur last year (she died in an auto accident).

Midwifery in Haiti was just recovering after the sadness of the loss of Mme Francoeur - and the earthquake has now destroyed most everything that they had.

Agnes Jacobs, UNFPA survived and has been emailing from Haiti. She and her colleagues are working to pick up the pieces and try to reconstruct materials for training midwives and nurses in life saving skills.

I am writing to members of the GANM asking for support in finding DIGITAL materials that we can provide to Agnes for the time being. It is VERY hard to get shipments of books and things to Haiti right now, but in the future, I suspect that Agnes will be able to use books, and guides, and computers to rebuild midwifery in Haiti. So eventually we will ask for books and things, but right now it is very hard to get these types of things to her. I know she is not alone, I know that COHI, PAHO, and many others are on the ground. I think the GANM can work with all these others to help in whatever way we can.

Johns Hopkins is sending a team to Haiti, including Dr. Beth Sloand who has been travelling to Haiti with students for over a decade. Beth does not have room to take printed materials, but she can maybe take a packed hard drive or CDs/DVDs that we load with teaching materials. Agnes does have a computer and internet (sporadically) - so I have been discussing with her the potential of sending digital materials which she can start to use right away until printed materials can be provided.

She welcomes health materials in French and or Creole primarily. They should be materials that can *instantly be used to teach midwives and community health workers* - so scientific articles that require interpretation and reconstruction into teaching materials are not what I am asking for at the moment. Right now there are no resources to turn scientific literature into teaching materials. Do you have teaching materials that you would be willing to share?

I would like to ask that people send either direct links to online resources that we can copy down to a CD or send useful teaching materials that we can put on a CD.

Please email them to the GANM or to me (pabbott2 @ son.jhmi.edu)

Regine Marton wrote already directing us to look at Hesperian and the WHO Reproductive Library (in French). We have the Hesperian material now. The WHO library is helpful.

If you have any quality materials for training of midwives that you would like to donate or direct us to find, please let us know. Please send scientifically sound materials - the last thing that Haiti needs are questionable methods or what we call in the US "hocus-pocus" (unproven claims or "magic").

I hope this makes sense and that the GANM community will come together to help Haiti in a “different” way. I think what we are doing is unique – while of course there are huge needs for emergency care and the like we are looking one step ahead to helping Haiti rebuild its educational infrastructure.

Best Regards,
Patti Abbott
GANM Moderator and "Electronic Midwife"

Call for papers: IFLA Health and Biosciences Libraries Section open session

Colleagues from around the world are invited to submit an abstract for consideration for the HBS Open Session:

Health and Biosciences Libraries Section

Aim and Scope of the Session

It is hoped that papers will cover a wide range of areas - for example:

• Partnerships and collaborations that support free access to health information.
• Health libraries/health information professionals role in promoting open and / or equitable access.
• How health information is disseminated to the general public?
• How useful is free health information? Is it evidence based?
• How evidence based information is incorporated into freely available health information?
• Is there a decline in the use of health information that is not freely available e.g. library subscriptions?
• How do consumers prefer to access health information e.g. mobile devices, magazines, newspapers?
• What role health information literacy may have in health information?

It is anticipated that presentations be 15 minutes with time for questions at the end of the session.

Important dates: ...


Submissions are to be submitted before February 1st 2010 by email to:

Paivi Pekkarinen
National Library of Health Sciences
Haartmaninkatu 4
FI-00290 Helsinki, Finland



My source:

HIPNet Listserv

h2cm - Being at the center of things [I]

The center of Hodges' model can represent many things:

an epistemological nexus for the transdisciplinary dependencies of our times
multidisciplinary coffee shop
self-care engagement stage
the chaos of all things
holistic harmony
integrated idyll*

More down to Earth and acknowledging this cruciform '+' structure as a mythic device, in addition to searching for the mysteries of the universe at the center we can also place the 'well' person there.

As the previous post on ADLs suggests the 'well' person can function on a basic level and has negotiated the four axes and the four and five fold knowledge domains. They can therefore be considered (sufficiently) wholly integrated. We are all travellers, constantly traversing these domains of experience consciously, unconsciously, expertly or with the awkwardness that denotes the novice.

Conversely and reflecting the model's utility: it is also possible to locate the unwell individual in the center too. In this instance the placement suggests impoverishment of experience, ongoing personal and social stasis and in the case of substance misuse the presence of specific disruptive focus and preoccupations. The person becomes lost to their potential, stuck in a 4:5-fold minima. They continue to travel chronologically, but the journey is spiral, self-iterative and diminishing by return.

However: what you can see you can change, or come to terms with.

*from Greek eidyllion, little picture (h2cm as a snapshot).

Original image source: http://www1.lsbu.ac.uk/water/protein2.html

Self-care in e-space and the need to Impress

Working with older adults you realise how unselfish a group they are with regards to their care needs: "spend the money on the children who need it, they are the future."

You also realise that although there are growing numbers of 'silver surfers' (sorry) and their number will swell - the use of digital technology by the general public remains yet another potential source of inequality.

Many years ago I came across HealthSpace (UK) as a fledgling approach and application. I was really impressed as it underlined the need for a generic conceptual framework for health and social care - from senior school through to older age.

It is often said that effective communication needs a channel that is noise free - well here in Hodges' model is a resource to reduce noise for health information across many contexts:

• education
• prevention
• consultation
• social marketing
• self-care
• care planning, evaluation and management
• carer support
• supervision

Demographics also underlines the opening remark in this post and for older adults and many younger that matter of choice arises when it comes to the deployment of digital technology. Yes, many forward thinking people will readily jump on board and use ICT to study, learn, commission, record and co-ordinate their own care - or that of a relative. But what about those who will not use HealthSpace or another personal health records [PHRs]?

For those who do not want to engage - are they to be literally pressed into service? Obviously not - and besides recruitment to the UK services is growing. Jokes aside though the pressure to get the public to add value to their own care is critical to the future sustainability of the health and social care system.

Which brings me back to HealthSpace and the following news on e-Health Insider:

'HealthSpace expansion plans shelved'

Last year’s Health Informatics Review outlined a wide-ranging role for HealthSpace, but the DH has now done a U-turn and demanded more evidence of the site’s value to patients before pushing ahead with further expansion.
...
An outline business case worth £80m to £90m – one source puts the figure at £98m - had been developed by CfH, which was to have been submitted to the Treasury earlier this year.

However, the DH is understood to have spiked the business case, seeking more evidence for the value of HealthSpace, which has not received the backing of Christine Connelly, director general of informatics.

Dr Neil Bacon, founder of the doctors’ website doctors.net and the patient website iwantgreatcare.org, said he was unsurprised that the DH had shelved its plans.

“I think this is their way of quietly getting rid of it,” he told EHI Primary Care. “In the commercial world, if a solution with more than 250,000 potential users had only been used by 400 people it would already have been put out of its misery.”

Dr Bacon said he believed there was a clear and growing demand for patients to manage their own health records but that innovative, entrepreneurial solutions rather than government-led solutions would meet that demand.

More to follow no doubt - but do take care even now if you live by the coast ....

Additional links:

Google Health
 
Microsoft - Health

Digital Britain

The Impress Service

The Royal Navy

Image source: Press Gang stamp

Informatics - Nursing: Closer than you think...?

On the face of it the world of IT seems a long way from nursing. There's a world of difference between the nuances of therapeutic touch and the usability of the latest user interface. As highlighted on W2tQ already these humanistic and mechanistic realms have information in common. People, and especially those in health and social care have a need to communicate and that involves information. If health and social care was a computer program then communication would really mess things up by being both a CONSTANT and a VARIABLE (think about it).

It is when communication breaks down that problems often arise - from the slightest misunderstanding or mishap, through to the more serious or dare we suggest fatal mistake. What we hopefully communicate is meaning and we do this through data, information and knowledge.

Information has been described as a mystical fluid ⁽¹⁾. It is information that is the common factor between caring and informatics (and much more). Physics has its mysticism in the quantum shinannighans of Schrodinger's Cat: information - knowledge really is the key to that thought experiment. You realise the significance of information - of news - and its assimilation into knowledge for a person and their family in nursing.

Like many clinicians you find yourself in the (privileged?) position to have access to information before the individual whom it concerns. This is more about the general nursing side of the fence (if there has to be one) with its lab results and the findings of diagnostic medicine; but mental health is not without its moments. The 90+ year old finally faced with the fact that they no longer have the capacity to decide their best interest and how they make sense of that today, tomorrow. ..?

When we talk about reducing or shortening care pathways it is worth reflecting upon what that entails - beyond efficiency and outcomes? When you have life critical news of profound significance to another person, how that situation is handled, that is - with you and the 'team' operating as the 'mission critical communications channel' then it is the human-human interface that matters and you better get it right.

So don't think of IT as something remote. Don't just think of IT-informatics as a tool full-stop: think of IT as a tool that can help us with timely, accurate, secure, data processing and information sharing. Helping us individually and collectively to convey meaning, an antidote to the uncertainty often found in the clinical domain. There is a whole essay here, looking afresh at commmunication, data, information and knowledge in a clinical and social care context.

Health and social care staff are of course in the front line as information users. Yes, the agenda has shifted to knowledge as per evidence-based and knowledge management resources. For me though, constructive knowledge (and its revision, management) is the end result.

I am interested in how we -
the health and social care team and our patients, carers ...
get there.

(1) Stamper, R.K. (1985). Information: Mystical Fluid or a Subject for Scientific Enquiry, The Computer Journal, CUP, 28,3,195-199.

https://web.archive.org/web/20070602105752/http://www.p-jones.demon.co.uk/inflevel.html

NHS: Welcome to the world of churning?

In February's HSJ, a news item about the NHS Constitution warned of the huge bill that looms in the need to provide choice information for patients. Quoted figures c/o health economists at the Department of Health put "the best case scenario of a cost of £5.2m per year (£33,000 per PCT) 5.5 per cent of patients would need to switch providers".

We are all accustomed to switching providers when it comes to telephone, gas, electricity, TV, internet-broadband in various combinations. Some 'real' markets need their business models to recognise and take account of the fact that a proportion of the market switch service providers - in other word they churn.

You have to ask I suppose are the +ve and -ve qualities and impact of churners in these markets equivalent to those in health and social care? The future is a place and time of complex deals no doubt...

Crump, H. (2009). Huge bill looms for choice information, HSJ, February 5, p. 5.

Squaring circles: Compressed patient care pathways = rich(er) patient experiences?

The use of Lean and Six-Sigma, their combination and other service improvement approaches has resulted in much more effective patient care pathways. A shining example is that of diagnostic medicine and subsequent out-patient appointments, apparently patients can attend for diagnostic services such as imaging and on the same day also attend for their first out-patient appointment. This saves time for all, with expensive imaging technology also proving its worth and RoI by working from 0700-2200.

Trust Boards are well pleased with such progress, but there is no such thing as a free lunch. Managers and execs know the lunch (diagnostics and imaging) isn't free, but quantitative aspects aside what does does this mean in terms of quality and assurance? Quality in the sense of:

• patient (and carer) experience;
• staff capacity to find and take advantage of patient learning (self-care, patient health career management) opportunities;
• assessment and evaluation of patient (carer) comprehension;

There is a circle to be closed by relating quality to quantitative aspects; such as, re-referral rates, re-admission, medication / treatment concordance, plus the infusion of intelligence from local and national patient related outcome measures [PROMS] to new patient journeys.

In information science there is the concept of information compression, taking out the redundancy - repetitive data in an image or text to save on processing, transmission, and storage. As Lean Six Sigma assists teams to remove tasks, processes that do not 'add value' then the result is a richer experience. The patient journey has in this sense been compressed. The patient has fewer hospital and clinic visits with fewer bus, taxi journeys, or they pay less in car park fees. Health personnel and specialists are primed to help and deliver services that really count.

What does this compressed - 'denser' experience - mean though? Does it mean that:

• patient's are exposed to more information (2-3 significant interviews / leaflets / instructions)?
• there is less time available for education, health promotion, info Px giving?

- or alternately:

• does this 'value packed' patient journey help by providing rapidly successive hooks - experiential threads to integrate patient (carer and staff!) learning?

It will be interesting to see answers to these questions and how extensive the scope of benefits are of these patient experiences across different care contexts.

Is there an optimal number for 'clinical encounters' before things start to go awry?

PROMS are quite specific (as they need to be initially), but amid richer and varied patient journeys there will be a need for other (national and local) measures. What about the extent and level of 'care complexity' and 'holistic care'?

Image source: http://www.navyenterprise.navy.mil

A techno-spiritual world with agnostic needs

Whatever our own personal beliefs
we live in spiritual times.

Agnosticism
is a frequent and ongoing subject of debate in
the philosophy of religion, science and ideas.

It also features - duly tempered for purpose -
in other fields notably technology.

In the early days of IT and ICT those buying information systems grew tired and wary of being locked-in to particular platforms, with consequent dependency upon vendors. This also put the technology to the fore, with the risk of relegating business requirements to 'out of hours'. While many business relationships did undoubtedly prosper, the market soon recognized the need for standards and the need for technology to be agnostic, increasing freedom and choice in the marketplace.

Among the retinue of central tenets in medicine, health, social care and nursing is the need for unconditional positive regard and a non-judgemental approach. So caring is most definitely not without beliefs and values. In the same way that vendors to companies and academia want to be free and determine their requirements around their business and needs, so too there is a perceived need for the health care 'industry' to be agnostic. Re-framing a bullet list in a 'lost' post elsewhere: ''Increase knowledge innovation and manage technology change' agnostic in a health context becomes:

1. As per the need for evidence-based x, y, z... fully research your status, direction and tools not only before you adopt them, but also while you’re using them*;
2. Don’t get emotionally attached to a particular assessment, planning, intervention (therapy) or evaluation toolset;
3. Continuously research (horizon scan* - look over the fence) at other research possibilities and alternatives;
4. And as Lucas McDonnell make clear: Don’t build yourself into a corner*.

*Of course, that last point is hypercritical - since there are at least four corners!

This is where Hodges' model comes into play, (not quite with underpants on the outside, but certainly with utility belt firmly in-situ).

Hodges' model - as a model to support and integrate care - is agnostic in the following ways:

DISCIPLINE: unless its origins prejudices its case, Hodges' model can be applied by any and all disciplines. This is crucial in times when multidisciplinary and even transdisciplinary team work is needed.
THERAPEUTICS: whether physical, social or biopsychosocial - Hodges' model is agnostic regards particular therapy interventions. It is not married to gene therapy, cognitive therapy, primary nursing, family therapy, gestalt therapy.
PHILOSOPHY: 'care- nursing- ward- philosophy' is probably a much misused term, but once again Hodges model is philosophically neutral - unless it is deemed that its generality - pantological aspirations - is itself a philosophical stance?
SUBJECT: in being person-centered the model is agnostic in respect of the individual using the model or who happens to be the focus of the model. This is quite critical at present with the engagement of patients in education, self-care and individual budgets in cases of long-term medical conditions.
AUTHORITY: Although disciplines with their professional legacies and politics can and do (justifiably) lay claim to authority and legitimacy Hodges' model can negotiate this divide.
SOCIO-TECHNICAL: this form of agnosticism for Hodges' model is not given the credence it should be afforded. Being context sensitive and situated the model can perform a definitional volte face appealing to a socially or technically oriented user-base, or both.
CULTURAL: Finally, it is essential that our tools are not 'tainted' from the perspective of a particular community or ethnic group. Apart from the structure of the model with its historical (mythic) iconographic associations, the model is open and not directly allied to any specific ethnic group, set of cultural or religious beliefs. Ideologically AND practically then the model provides a neutral ground upon which values and beliefs can be shared.

Additional links:

Becoming a Technology Agnostic, by davidleeking (My primary source through twitter)

Technology-agnostic approach to Service Oriented Architecture: back to the essence of SOA?

Oh dear! I forgot to ask the nurse (doctor)....

Hodges' model introduction II:

The view from the other side of the fence

Have you ever been to see the doctor or nurse and shortly after leaving the surgery, or clinic you've remembered something? These days - very sadly - many people go to the doctor to seek help for their memory, but for others this is a fact of that frustrating mix of vital questions and issues to raise amid recognition that the time of nurses and doctors is very precious.

This post introduces a framework that can help people to prepare for a consultation and maintain a record of just where their care situation is up to. The framework in question is called Hodges' model. It is named after a retired Senior Lecturer - Mr Brian E. Hodges who lives in Sheffield, England. Brian Hodges created the model to help nurses and community staff ensure the care they deliver is holistic. Holistic in this sense means covering all the essential aspects that contribute to health and well-being, so that includes physical, emotional and mental and even spiritual health.

If you need to go into hospital you do not want to be treated like a faulty machine. Of course, in an emergency those machine-like things we do like heart beat, respiration, temperature regulation are of central importance. Should you ever need emotional care for a severe mental health problem then you would also expect that your physical needs are taken fully into account. Amidst these aspects of care the health care team must also pay attention to culture, equality, diversity and access to services.

Although the model was developed in the 1980s its relevance and potential increases in all the time. This is because of the following:

* health care and medicine is increasingly complex;
* people may have long term and multiple chronic problems;
* education is essential to 21st century care management - as people are expected to 'self-care';
- people may also be managing their own care budget and so need information and 360 vision;
* policy makers stress the need for 'patient choice';
* high quality health and social care is very expensive;
* as people live longer and may have several relationships spanning cultures and belief systems the notion of a health career is the career.

Hodges' model builds on two basic facts of life (and death):

From your point of view and that of any health or social care professional your health is about you - an INDIVIDUAL.

Your health affects other people - most significantly your family. Rather than you being ill, you may of course be a carer having to look after a relative. Also affected are work colleagues, the wider community through to whole GROUPS of people.

We now talk about medicine, well-being, and health in terms of global health since the population of Earth is so tightly linked and interdependent.

In order to maintain health there is a need to diagnose and intervene - or assess, plan, intervene and evaluate. Here the model can also take into account ethnic and transcultural aspects of health. Diagnosis and intervention in Western medicine is frequently MECHANISTIC and this is balanced (remember that HOLISTIC part of the model) by the need for HUMANISTIC interventions. This is what we mean by 'bedside manner' and people being 'caring'. The ability to empathise with others and develop a therapeutic rapport after physical and emotional trauma is a great gift - that while often innate can also be learned and honed.

Once Brian Hodges had identified the following dimensions of care:

INDIVIDUAL - GROUP and HUMANISTIC - MECHANISTIC

he considered the types of knowledge that health and social care workers need to not only do their job safely, effeciently and effectively, but also help people to help themselves. This led to the FOUR CARE or KNOWLEDGE DOMAINS, each covers a key aspect of care:

SCIENCES: e.g. anatomy, physiology,healing process, drugs, risk, diagnosis...

INTRAPERSONAL: e.g. mood, thinking, beliefs, communication, education, learning, coping...

SOCIOLOGY: e.g. relationships, roles, meaning, groups, resources

POLITICAL: e.g. choice, consent, autonomy, policy, legislation, finances

Students - young and mature - who decide to study health and social care can use the model to help them reflect on critical events in their training and learning. The model can help them gain some insights in completing essays and case studies integrating knowledge and experience. When you think about it: if it essential that care professionals are able to have an effective dialogue with patients and the public then they should also be capable of having an effective 'dialogue' with themselves.

Members of the public can also be taught the model to help them appreciate the factors involved in their care programs, solutions and ongoing management if required. Hopefully this brief explanation sheds some light on the model's mantra:

Hodges' Health Career (Care Domains) Model: h2cm
h2cm: help 2C more - help 2 listen - help 2 care

Hodges' model is no universal panacea it is just a tool; but while services stress the need for person-centered, integrated, value-for-money, high quality services ... built on respect, dignity, trust and choice - YOUR health career matters.

h2cm can help pull the many threads together....

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On the website's homepage there are four introductions based upon the care domains. Each one addresses a particular audience: learners (SCIENCES); patient (INTRAPERSONAL); carer (SOCIOLOGY) and policy maker / manager (POLITICAL). They all need updating (re-writing?!).

If you would like to contribute to this exercise please contact me through twitter or at h2cmng at yahoo.co.uk

Mental health problems and worklessness

Change at work tends to be viewed as just that - change within the sphere of your profession and colleagues. The changes inevitably affect your clients, but the bubble by-and-large stops there. In the 1990s community mental health resource centers were being built with kitchens to cater for day care/hospital patients. Now many of those kitchens are not needed as mental health services have stepped away from day care provision. This move is a smart one, since if you read (and contribute to) mental health news groups you note that current and former users of mental health services recognise for themselves the dependency that prolonged day hospital attendance can promote. That said there are many acutely worried people out there. Having lost day care services, they face interviews that seek to address their level of disability. Depression and anxiety need no introduction to helplessness and hopelessness.

Enter a further phase of change and one with much wider ramifications - tackling worklessness.

There is a new EU strategy for 2008-2013 which includes (with my emphasis):

The Commission report to the 2006 Spring European Council urged Member States to reduce the high number of people inactive through ill-health13. It stressed that policy in many sectors has a role in improving health for the benefit of the wider economy.

Spending on health is not just a cost, it is an investment. Health expenditure can be seen as an economic burden14, but the real cost to society are the direct and indirect costs linked to ill-health as well as a lack of sufficient investment in relevant health areas. It has been estimated that the annual economic burden of coronary heart disease can amount to 1% of GDP15, and the costs of mental disorders to 3-4% of GDP16. Healthcare spending should be accompanied by investment in prevention, protecting and improving the population's overall physical and mental health, which, according to OECD17 data currently amounts to an average of 3% of their Member States' total annual budgets for health compared to 97% spent on healthcare and treatment18. [p.5]

Does overall planning, action and evaluation in physical and mental health call for an overarching framework? When possible the drugs may be replaced or combined with information prescriptions, but care is still needed in preparation, administration and monitoring the positive and negative side-effects....

Brussels, 23.10.2007 COM(2007) 630 final
WHITE PAPER Together for Health: A Strategic Approach for the EU 2008-2013

São Paulo - A City Without Ads + BBC Paxman and secular sanity*

It's not often I get to bookshops and less often still that I buy anything. I did both recently - walking out with a copy of the latest Adbusters magazine. I've listed their website for quite a while [POLITICAL: activism] and must say as a consumer, community mental health nurse and would-be human ecologist there's a lot to read and think about....

Sustainability : Advertising : Well-being : Public Mental Health

Now, subscribed to their e-letter the Sao Paulo item proved a real revelation. A breathe of fresh... fresh... vision no less!

“The Clean City Law came from a necessity to combat pollution . . . pollution of water, sound, air, and the visual. We decided that we should start combating pollution with the most conspicuous sector – visual pollution.”

So, add to this the news at the end of 2006 or early this year of European cities starting to take light pollution seriously, to the extent of turning the lights off for a night and hey change really can happen.

If amid the advertising information overload what Adbusters refers to as mental pollution ('brain damage') there is a vacuum in terms of values, self-respect and social responsibility...; others will fill that void with what is most likely to be another form of pollution.

Jeremy Paxman, BBC presenter and media luminary was on the Beeb's radio 4 this a.m. highlighting the need for media with a conscious. His lecture at the Edinburgh TV festival made the news. He criticised the BBC and the media in general regards quality, public service and the pursuit of the bottom-line. An Adbusters article describes problems in the Canadian media. This appeal has been heard before: but I wonder if there's a realisation finally sinking home that in a 21st century society how do you achieve secular sanity? In the UK the spate of terrible gun-crime killings, youth gangs, the TV phoney phone-in scandals and the need for inspirational creativity in the media is really fuelling debate. If the media reporting is correct this past week then some elements of the media - music industry included - are into trafficking. From a very early age the public is subject to an info-toxic OD. Is this the real reason why in health care we need information prescriptions?

How can society change to become sustainable, while struggling to swim in this advertising torrent?

I've no universal panacea Mr Paxman for the rehab of the prison population, the feral kids on the streets and the quest for an agreement for quality standards and public service throughout the media; but if as you say you want to hear from people - well, amid your busy schedule take a look at this interpersonal-social resource.

Look upon it as one of the cognitive antidotes for our times.

Signatures: Patient* and professional get engaged

These days signatures are a prime time issue.

For personal, professional, business, political and electronic accountability the dotted line in one shape or form still rules. In health and social care there's another signature that contributes to security and certainty: the relapse signature. Whether you see this as stark pessimism or realism there's no doubting its ... erm ... significance.

Relapse is an unfortunate prospect across the care spectrum, but especially for people with severe and enduring mental health problems and those with long-term medical conditions [LTMC]. For these people and their families the risk of relapse is a fact of life. As new health and employment policy encourages people to return to work, employers are affected too.

Health economists and commissioners of care recognise how in the UK of about 17 million people living with LTMC, just 2% of them account for 30% of unplanned hospital admissions. [Carlisle, D. (2006) Predicting the Future, HSJ, 2 Nov. p.24-26] Add to a LTMC a mental health problem (very likely!) and you have a mega care 'transaction' with multiple signatories involved.

If you listen carefully you'll hear the arrows whiz by towards the financial targets that follow.

Hodges' model can help target those arrows and assist with in-flight corrections across the care spectrum, especially when staying-well needs to be emphasised and enhanced. This does not mean you pull a flip chart or laptop from your pocket and commence a presentation on the model. If engagement at this point is rather like paddling up-river, then h2cm can help you navigate and locate the best channel for communication. If family and carers are also on-board that is great. Together, you can map the physical, emotional, social and service aspects of a previous crisis. Alternately, you can anticipate future difficulties in each of the care domains, identify and agree courses of actions and solutions were possible.

Nurses have a penchant for injections and - increasingly - prescribing. There is also the matter of how best to deliver and reinforce social and information prescriptions? So inject some realism by having the participants use their imagination. Given events last year are x and y really likely at 02:30 AM? There are several benefits in using Hodges' model:

• Using the model can help both internalise and externalise problems and solutions -

patient: "This is my fault!"
carer: "I can cope with this myself."

• Formal arrangements, documents and agreements can follow this global yet gentle introduction.
• The model can capture physical signs and symptoms, side-effects, interpersonal and behavioural changes.
• Strengths & Weaknesses: Pros & Cons, Warning Signs.
  
• Outline plans, actions for X,Y,Z ...
• Share expectations.
• Service coverage 24 hours?, alternatives. Respite provision.
  
• This is not about you the professional (or volunteer!) displaying your knowledge, the patient and family are the experts.
• Even though you set boundaries on the session (time, objectives, 'taboo topics - for another time & place' ...), you may be surprised by what the four+ care domains help reveal for future reference and benefit. (This also extends to palliative care, where relatives and carers needs are further emphasised.)
  
• If the patient and family struggle to understand h2cm, don't forget you can still use the model as a guide, an aide mémoire.
• And OK flip chart paper would help! ...
  

Now, if you can please sign here ............................... confirming this message received:
it's over to you - and make that care count!

*And carers too of course.