BBC Radio 'File on Four' - DASH to Instrumentalise

Of course, I'd like to see Hodges' model applied to many purposes.

As probably posted at some point, the thought of Hodges' model being instrumentalised goes back a long way. To the time of microcomputers in fact and 'CAPA' which stood for 'Computer-Aided Patient Assessment':

Jones, P. (1986) Computing in Nursing NEWS. Computerised Patient Assessment. Nursing Times. 85: 5. Sep 3-9;82(36):63-5. PMID: 3532039

[Describes 'CAPA', a BBC BASIC microcomputer program for student nurses.]

Even before discovering Hodges' model in the late 1980s, I was sensitive about being seen to mechanise nursing and care delivery. Nursing was still preoccupied with the nursing process and individualised care. The last thing I would want is to be seen as supporting the processing of patients. The person, their social context and identity becoming lost. It was a long-term and ongoing co-author who drew my attention to Hodges' model as an instrument. Which I've considered for each and across the care domains. CAPA was simplistic, even beyond the programming language employed. A dependency score from 1-5 was allocated (it's a long time ago!) to each of the activities of daily living for a patient:

Roper, N., Logan, W., & Tierney, A. J. (2000). The Roper-Logan-Tierney model of nursing: Based on activities of living. Churchill Livingstone.

In healthcare we are trained and become accustomed to the use of many assessment tools, checklists; this includes mental health nursing and specific therapies. Emphasis, is rightly placed upon the safety, validity and hence testing of tools. Some are 'broad brushes'. Others are specific - outcomes, anger, a carer's knowledge, conviction of belief, mood, impulsivity and many more. Drift away from the original goal and purpose and problems can (predictably) ensue. Training will and must be updated, but do all assessment tools have a 'Use By' date? Hopefully there is ongoing development, version control and sustained trials and testing of the instruments themselves.

'File on Four' BBC Radio 4 this evening concerns DASH, which stands for "Domestic Abuse, Stalking and ‘Honour’- based abuse".

Hodges' model: A tool to watch the complications of Care

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How many complications here?
... here?	"Despite its achievement, Vacheron Constantin has not filed a patent, on the Chinese perpetual calendar, saying it doesn't want to reveal details." p.S9. ... and here too?

Foulkes, N. Inside Vacheron's exclusive cabinet of complications, Watches & Jewellery, Financial Times, 9 April 2024, p.4.

Image and text: https://www.hodinkee.com/articles/introducing-vacheron-constantin-berkley-grand-complication

The Complications, 1 Through 63

"There's likely some part of you that's curious about each of the 63 functions that have totaled a record-breaking level of complication. I'll list the functions below, broken down by type, to simplify things.

Time measurement (9 Total): 1. Regulator-type hours, minutes, and seconds for mean solar time 2. Retrograde second for mean solar time 3. Day and night indication for reference city 4. Visible spherical armillary tourbillon regulator with spherical balance spring 5. Armillary sphere tourbillon 6. World time indication for 24 cities 7. Second time zone hours and minutes (on 12 hours display) 8. Second time zone day and night indication 9. System to display the second time zone for the Northern or Southern hemispheres

Gregorian Perpetual Calendar (7 Total): 10. Gregorian perpetual calendar 11. Gregorian days of the week 12. Gregorian months 13. Gregorian retrograde date 14. Leap-year indication and four-year cycle 15. Number of the day of the week (ISO 8601 calendar) 16. Indication for the number of the week within the year (ISO 8601 calendar).

Chinese Perpetual Calendar (11 Total): 17. Chinese perpetual calendar 18. Chinese number of the day. 19. Chinese name of the month 20. Chinese date indication 21. Chinese zodiac signs 22. 5 elements and 10 celestial stems 23. 6 energies and 12 earthly branches 24. Chinese year state (common or embolismic) 25. Month state (small or large) 26. Indication for the Golden number within the 19-year Metonic cycle 27. Indication for the date of the Chinese New Year in the Gregorian calendar.
Chinese Agricultural Perpetual Calendar (2 Total): 28. Chinese agricultural perpetual calendar. 29. Indications of seasons, equinoxes, and solstices with solar hand.

Astronomic Calendar (9 Total): 30. Sky chart (calibrated for Shanghai) 31. Sidereal hours 32. Sidereal minutes 33. Sunrise time (calibrated for Shanghai) 34. Sunset time (calibrated for Shanghai) 35. Equation of time 36. Length of the day (calibrated for Shanghai) 37. Length of the night (calibrated for Shanghai) 38. Phases and age of the moon, one correction every 1027 years.

Split-seconds Chronograph (4 Total): 39. Fifths of a second chronograph (1 column wheel) 40. Fifths of a second split-second chronograph (1 column wheel) 41. 12-hour counter (1 column wheel) 42. 60-minute counter.

Alarm (7 Total): 43. Progressive alarm with single gong and hammer striking 44. Alarm strike/silence indicator 45. Choice of normal alarm or carillon striking alarm indicator 46. Alarm mechanism coupled to the carillon striking mechanism 47. Alarm striking with choice of grande or petite sonnerie 48. Alarm power-reserve indication 49. System to disengage the alarm barrel when fully wound.

Westminster Carillon (8 Total): 50. Carillon Westminster chiming with 5 gongs and 5 hammers 51. Grande sonnerie passing strike 52. Petite sonnerie passing strike 53. Minute repeating 54. Night silence feature (between 22.00 and 08.00 hours – hours chosen by the owner) 55. System to disengage the striking barrel when fully wound 56. Indication for grande or petite sonnerie modes 57. Indication for silence / striking / night modes.

Additional features (6) 58. Power-reserve indication for the going train 59. Power-reserve indication for the striking train 60. Winding crown position indicator 61. Winding system for the double barrels 62. Hand-setting system with two positions and two directions 63. Concealed flush-fit winding crown for the alarm mechanism."

Also: Naas, R. New and extremely complicated. Watches. The New York Times International Edition, April 9, 2024, p.S9

Craftsmanship. "It took a watchmaker a year to assemble the Complication's 2,877 parts, including 31 hands, nine discs and 245 jewels." p.S9. Plus, quote regards the question of a patent.

Vacheron Constantin

(Just to be clear - this post, as with all others is not paid/sponsored.)

International Women’s Day: Kalia Vandever - "Temper The Wound"

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Temper the Wound	Wound
	Wound

Kalia Vandever

BBC Radio 3: J to Z International Women’s Day Special

Time - for care to commute [an appendum]

Addendum: Because we are (still) living in a post-Project 2000 World ...

"The whole thrust of nursing in the last decade [1981-91] has been directed towards seeing the patient as an integrated, individual human being rather than as a piece of malfunctioning anatomy. The patient is a person not 'the mastectomy in bed 3' or 'the man with the leg'. This means that any model of nursing must take into account the patient's psychological and social functioning as well as anatomy and physiology." p.53.

Ack. Walsh, M. (1991). Models in clinical nursing: The way forward. London: Bailliere Tindall.

[Book now bound for students.]

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psychology	anatomy, physiology
social	employment, studying ... life chances / end of life choices

We need to consider concepts of care for a person, patient, and carer, not only in terms of their respective, or primary care domain [ e.g. leg, mastectomy; anatomy, physiology; sciences ] and associations with the academic disciplines; but in Hodges' model, focus upon the horizontal, vertical and diametric relation across and between care domains.

As described by Walsh, talk of  'the mastectomy in bed 3' or 'the man with the leg', is a dated trope; yet sadly it can signify the nature of staff (team) attitudes, the quality of care and experience of patients and their families. 

 

Technically, I see Hodges' model as a relational ontology. What this means basically, is that the model facilitates, encourages the user of the model to consider what they identify in a situation as objects (entities), events, concepts, relationships, data, and so on. An important assumption here is that what 'stands out' is what has salience (what the patient says - non-verbally too, what they mean, what they don't say?); that is, meaning and significance. 

 

Returning to Walsh's example: What does this event, diagnosis, prognosis (including anatomy and physiology) mean for this person as an individual? (If it means 'nothing' this may still - in a mental health context - be important.) What will it mean for the person's friends and family? What do the person it will mean to friends and family - significant other? What about their ability to work, and study? Can they resume their life plans and what of the person's life chances and those also affected? 

 

Crucially, there may not be a connection, a relation, across the care domains of Hodges' model. Asking the question is key, however; to go beyond what can be(come) task-based care. The ability of the model to assure and improve health care rests on this. The same applies for self-care too, with the model's support of reflection and critical thinking, essential to health and other forms of literacy.

Parity of esteem means we have to travel across the model. If we are 'collapse' the model's domains - four sets, into one that actually means something for the nurse, patient, manager, policy maker and researcher. This something, at least conceptually; is no less than person-centred, holistic and integrated care.

Q. Can care commute?

The QUALCARE Scale - in Hodges' model

 Clearing yet another piece of notepaper from the 1990s, when I wrote (from the abstract):

"The QUALCARE Scale is an observational rating scale designed to quantify the quality of family caregiving to home-dwelling elders in six areas: physical, medical management, psychosocial, environmental, human rights and financial."

 (extra note - 53 item Likert scale format.)

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PSYCHO-	PHYSICAL ENVIRONMENT MEDICAL MANAGEMENT
-SOCIAL ENVIRONMENT	(MANAGEMENT) HUMAN RIGHTS FINANCIAL

 

Phillips LR, Morrison EF, Chae YM. The QUALCARE Scale: testing of a measurement instrument for clinical practice. Int J Nurs Stud. 1990;27(1):77-91. doi: 10.1016/0020-7489(90)90025-e. PMID: 2312237.

I had encountered Hodges' model in 1987-88 [ Manchester Polytechnic College, now Manchester Metropolitan University, CPN(Cert.) course ], but the initial (and thus far only) website appeared in 1998 (-2015):

https://web.archive.org/web/19990501185433/http://www.p-jones.demon.co.uk/index.htm