Paper: "Comprehensive Geriatric Assessment (CGA) in Healthcare of older people in UK care homes"

When something is described as 'comprehensive' this might suggest the need for an aide-mémoire?

"Rubenstein et al defined CGA as a ’multidisciplinary diagnostic process intended to determine a frail older person’s medical, psychosocial and functional capabilities and limitations in order to develop an overall plan for treatment and long-term follow-up’. CGA has been shown to improve outcomes for older people in hospital and community settings. It encompasses health and social care needs and facilitates multidisciplinary working. However, evidence regarding its effectiveness in care homes is limited, and there are limited data describing what needs to be in place for uptake and sustained implementation in this setting."

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

Care home (Lived experience?) PURPOSEs  (synergy across the multidisciplinary team, consistency - communication) Resident access to expertise Ethics - PEACH project Individual reasoning [ What about the "Health Career" of residents? FROM: date of admission TO: date now. Residents who can perceive 'continuity of care' more likely to be assessed as having mental capacity. What of others? ]

Care home 425 000 people live in care homes Comprehensive assessment Realism, The situation, Context as it is (and across all the domains; e.g. all health care currently conducted amid Brexit uncertainty). Context-Mechanism-Outcome (CMO) configurations Coding NVIVO - reasoning & resource components Health-related Quality of Life (HRQoL) Programme theory (development) Frail Basic and personal care needs PROCESS Causes, Synthesis .Physical access

Care Homes PRACTICE Patient Public Involvement Proxy, Next of Kin Care plan Group reasoning "Mechanism reasoning developing a unified view and shared aims and goals for the resident."

Care Homes "Mechanism reasoning: delegation from the multidisciplinary team to care home staff provides authority to deliver care according to the care plan." POLICY Outcomes: Quality, Safety (Do see Conclusion of Paper)

The review sought papers on "multi-domain assessment".

"The practices and processes of assessment inform the whole CGA ... . Assessment of many domains of health status and impairments was represented as crucial in building a picture of an individual’s complex needs and views about their personal priorities and goals. Unlike discipline-specific needs assessment that may focus on a particular syndrome or care pathway, structured comprehensive assessment requires an overview of all domains."

Figure 2: Nested arrangement of  Context-Mechanism-Outcome (CMO) configurations

Ref.
Chadborn NH, Goodman C, Zubair M, et al Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review BMJ Open 2019;9:e026921. doi: 10.1136/bmjopen-2018-026921

Special Issue: Critical Realism and ICT4D

The Electronic Journal of Information Systems in Developing Countries (EJISDC)

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Philosophy Subjectivity	Planning #ICT4D research or writing it up: then check the recent open-access special issue on #CriticalRealism and ICT4D Research in EJISDC. Analysis, reflections and case study applications of critical realism in ICT4D https://t.co/TiG4ju4dlC pic.twitter.com/AEitFggA8d — Richard Heeks (@CDIManchester) February 22, 2019
SOCIO - technical?

My source: https://twitter.com/CDIManchester/status/1098962321471348736

Threshold Concepts: Pre-conference Health and Social Care

Yesterday afternoon there was a video-linked workshop between Glasgow, Halifax, Nova Scotia - Dalhousie University and an interest group member in Plymouth. This was to try to further thinking on threshold concepts in healthcare and one of two pre-conference workshops at:

6TH BIENNIAL THRESHOLD CONCEPTS CONFERENCE

Our agenda:

Workshop: To disaggregate or not? The dilemma of complex threshold concepts

• What do we mean by complex thresholds?
• Is this particularly relevant to healthcare and if so how?
• Can we identify some examples in health and social care?
• What problems do complex thresholds bring for teachers, learners, the curriculum?
• Is disaggregation helpful (and how) or unhelpful/reductionist/simplification?
• Do we have any evidence or theories that can help us?

We did not cover all the points in depth, but in respect of the first point I could define 'complex thresholds' with recourse to Hodges' model. The paper I'm working on includes a table that alludes to this. I could take this question more literally in that draft.

Thinking about complexity and aggregation, by complex is this the same as compound? Compound suggests something that can be taken apart (it is composite), but complex involves the whole (domain-based?) situation / context?

The example I have in mind is learner's recognition, appreciation and understanding of:

• mental capacity
• best interest
• deprivation of liberty

By learner's I am thinking of student nurses (plus other disciplines), healthcare assistants and future associate practitioners. In the era of lifelong learners, public engagement and patient involvement/engagement I have include others (despite the academic demands for specificity).

Philosophy Now 113

On the last question - Do we have any evidence or theories that can help us? - I still feel evidence can be found in Hodges' model. As ever: data, data, data!

Feelings are never enough (until they are all we are left with).

Discussion included the curriculum as the questions indicate, and again one of the original purposes for the model was in curriculum development. but in addition the position and role of the 'big picture'.

Issue 113 of Philosophy Now featured New Realism. I'm cherry picking from pragmatism, idealism and realism. New realism questions whether a unified picture (in philosophy) is available (p.7). While this is a damaging critique to Hodges' model, it might also be an opportunity.

Steinbauer, A. (2016). Interview: Markus Gabriel, Philosophy Now, Apr/May, 113; pp.6-10.

Doubles or Quads in < perspective >

Bruno Latour describes the double role of perspective as a tool of realism and illusion as the "four-way freeway" of representation: perspective does not only allow us to realistically represent a scene (one-way freeway) or to pragmatically act upon an external reality (two-way freeway); not only can we "displace cities, landscapes, or natives and go back and forth to and from them along avenues through space, but we can also reach saints, gods, heavens, palaces, or dreams with the same two-way avenues and look at them through the same 'windowpane' on the same two-dimensional surface. The two ways become a four lane freeway! Impossible palaces can be drawn realistically, but it is also possible to draw possible objects as if they were utopian ones."* p.26.

*Latour, B. (1986) Visualisation and Cognition: Thinking with Eyes and Hands. In H. Kuklick (editor) Knowledge and Society Studies in the Sociology of Culture Past and Present , Jai Press vol. 6, pp. 1-40.

My source:
Sheil, B. & Pearce, T. (2014) Digital doubles, colliding in mid-air prototyping a post-human scenography, In P.E.A.R. Paper for Emerging Architectural Research, ISSN 2041-2878 (print) Issue 7, pp. 26-31.