Living and Loving Dangerously

individual

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INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

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group

identity - choices   Memory - Cognition DEMENTIA - Early onset Inability to consent   inhibition-disinhibition  mental capacity	My liberty, my choices "What! I'm married to you? Oh!" Treatment - medication  'Secure (safe)' environment 'Holistic assessment'?
Marital/Initimate Relationships Social (our) identity Existing relational behaviours Interrelational needs Interpersonal grief Social identity/expectations Yes, but we're married ... had 40 years together ... Family bias, prejudices.. A 'new' step-parent ... Access to support:  relational - mutual vulnerability	Informed consent Assumed consent Rape, Sexual abuse, crime Capacity to give consent Consistency in decisions Lasting power of attorney - finance; health External safeguards Human rights Access to supervision - clinical & management

Prompts:

Previously post: Living and Caring Dangerously

Danny Leigh. Critic's choice - Films on release: Queen at Sea. Life&Arts, FTWeekend, 19/20 September, 2026, p.18.

https://depijp.rialtofilm.nl/en/films/queen-at-sea

So many difficult conversations. All on their own unique continuum in terms of sense-making for all concerned. 

A 'new' diagnosis at age 60; versus one at 44. Families seeking to control disclosure of the diagnosis from the patient. Clinical and family debate about this.

Finding a person locked-in the house, while their partner 'nips' to the shops. A person having their freedom to go out, on their regular walk  -despite acknowledged risks. (When they are known by people on their route - community care in action. Receiving a call from a neighbour; or the neighbour who knows where you park and can intercept you, on arrival or departure to express concerns. Or, even as you venture out for a walk with their neighbour of many a year. Categorise them as you will: [nosey, caring, concerned, public spirited, neighbourly, or (healthily) curious]?

Other discussions of grief at the loss of a person they have loved - in every way. A grief that presents new dark dimensions to what has gone before. Complicated by a state of early onset of memory loss. An ongoing disintegration of personhood and identity. An inability to consistently express thoughts, wishes, and choices. An inability to give informed consent. A loss taunted by retained physical desirability. What does love, sex, compassion mean now? What is the sum now, of love expressed over 'x' years? Hearts hollowed out, of what can be so important to a couple. Not vital to all. But for others, a source of conjoined affirmation, joy, warmth, companionship, a celebration of life and being human.

How to share that grief even amid close friends and family, who cannot cope themselves and withdraw? What of the preparedness of professions to manage such situations? What structures are in-place for team meetings, clinical supervision and inclusion in training, especially safeguarding?

From the bibliography (lower sidebar):

Hodges, B.E. (1989) The Health Career Model, IN, Hinchcliffe, S.M. (et al.) 1989 Nursing Practice and Health Care, 1st Edition only, London, Edward Arnold.

Adams, T. (1987) Dementia is a family affair. Community Outlook, Feb, 7-8.

Merritt MK, Procter N. Conceptualising the functional role of mental health consultation-liaison nurse in multi-morbidity, using Peplau's nursing theory. Contemp Nurse. 2010 Feb-Mar;34(2):158-66. doi: 10.5172/conu.2010.34.2.158. PMID: 20509800.

Murphy, K., Welford C. (2012) Agenda for the future: enhancing autonomy for older people in residential care.International Journal of Older People Nursing. 7, 75–80.

Kernohan, W. G., & Jones, P. (2023). Hodges’ Health Care Model as a Framework for Quality. Paper presented at Interprofessional work: developing oral care and the health workforce for the future, Brescia, Italy.
https://pure.ulster.ac.uk/en/publications/hodges-health-care-model-as-a-framework-for-quality

Jones, P. (2025). A Conceptual Mapping Exercise of Deprivation of Liberty Safeguards in Residential & Community Care Using Hodges' Model and Threshold Concepts. Journal of Evaluation in Clinical Practice, 31: e70085. https://doi.org/10.1111/jep.70085

Jones, P. (2025), A Generic Model and Conceptual Framework to Prime Curiosity Across Health and Social Care Disciplines to Facilitate Lifelong Learning. Journal of Evaluation in Clinical Practice, 31: e70252. https://doi.org/10.1111/jep.70252

Previously: 'capacity' : 'consent' : 'law' : 'safeguarding'

The Flying Cholitas c/o Luisa Dörr

 INDIVIDUAL
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 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

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GROUP

THE FLYING CHOLITAS

"In traditional Bolivian dress, on the outskirts of El Alto, the Flying Cholitas launch themselves at each other. At first, I was fascinated by the skill of these indigenous women flying through the air, reclaiming the clothing their community was forced to wear as servants for Spanish occupiers. But then I saw it went beyond the ring. They are fighting for their rights, for recognition, for equality. They're fighting for their lives." Luisa Dörr 

This image, would also 'sit' in the POLITICAL domain, if the women would stay still; but they clearly have individual and collective purpose.

My source:

Luisa Dörr ON THE FLYING CHOLITAS (2019). The Daily Telegraph, 4 March, 2023. p.9.

[Please note: I contacted Luisa Dörr, seeking permission to use the photograph above, but received no response.]

See also:

'What We See: Women and Nonbinary Perspectives Through the Lens' (White Lion, £22). 

Details: womenphotograph.com

New WHO Quality Toolkit - 'Take ii"

Further to last months post, I've worried at times about the axes of Hodges' model and their status and function. Can I let the axis stand for itself?

INDIVIDUAL

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|

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GROUP

Do I expand (explode) the conceptual labels?

self - INDIVIDUAL - person

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relationship - family - GROUP - community - population

There seems to be an asymmetry, when you traverse the axis - and its horizontal counterpart; from wherever you start. Perhaps, I worry too much as if the axis was regular then the generic property of the model overall would be diminished. Is this an axis at all?

The website for the Quality Toolkit at: https://qualityhealthservices.who.int/quality-toolkit

- explains the toolkit's scope that includes:

"This new online resource is a user-friendly toolkit to support action on improving the quality of health services at every level of the health system, from national and district to facility and community levels."

I have only scratched the surface here and hope to revisit again - in more detail. Please see below for reflections on the levels by which the toolkit can support action to improve the quality of health services. I have tried to suggest proximity and distance between the SOCIOLOGICAL and POLITICAL (policy). Perhaps, what is a 'clinic' has a name, that it is known by - a key part of the community. The community is closer to the people - to the would-be users of the facility. You can appreciate(?) here the challenge of getting the local community involved in their services. What is 'NATIONAL' should not be remote. Can people compare and contrast with what they are offered? 

 

On the website I note there are video presentations also. The prospect of regular updates for the toolkit is also welcome.

INDIVIDUAL

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 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

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GROUP

psychological access 'My' clinic Trust, I feel safe) (feeling safe) Tell others - my experience..	physical access clinic (appearance, facilities, safety) controlled environment (cleanliness, sterile.., or more social)
'the centre' COMMUNITY DISTRICT national	facility (policy translation / coherence?) community district NATIONAL

Original source: Jules Storr, Independent Consultant, S3 Global & working with WHO as part of the Quality Toolkit development team - via HIFA

Previously: New WHO Quality Toolkit

'Take II'? Quality means getting it right first time (even as you persist in what you are doing - your aspirations and quality improvement). Vitally, this means you, the team make a positive impression for the person, the individual, client .. carer, group. 

If they need to - they will recognise their own ability, knowledge, follow advice, they will come back, they leave not to return soon as they can now self-care and care for others in their home, community ...

 Please note: This post and that previous is not intended to denote endorsement of Hodges' model.

 

New WHO Quality Toolkit

"On Monday 20 June WHO launched the Quality Toolkit - a new interactive, online resource for anyone at any level of the health system interested in improving the quality of health services.

The Quality Toolkit provides users with tools to facilitate specific actions to enhance the quality of health services. It is a companion resource to WHO Quality Health Services: a planning guide which provides an outline of key actions to be taken across the health system. The Toolkit then supports these actions with numerous tools. It also enhances understanding of the key interlinkages across the health system when implementing any tool.

The Toolkit incorporates key WHO-published tools and other materials related to quality of health services. It will be updated periodically to reflect new and emerging information relevant to improving quality of health services, including WHO technical products currently under development.

The Quality Toolkit is available at: https://qualityhealthservices.who.int/quality-toolkit

HIFA members are invited to navigate the Toolkit and consider how they might use the tools as part of their improvement efforts. WHO welcomes feedback on the Toolkit qualitytoolkit AT who.int "

Via - HIFA - https://www.hifa.org/

I - IDENTIFY tools and resources relevant to quality of care
M - MAP those tools against improvement needs or identify gaps
P - PLAN implementation of activities for improving quality of care
R - RECOGNIZE interlinkages between technical areas and the process of change
O - OPTIMIZE multi-level action
V - VISUALIZE journeys for improving quality of care
E - ENGAGE stakeholders across the health system

INDIVIDUAL

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 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

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GROUP

IDENTIFY (context) PLAN^ (mental health) RECOGNIZE* needs gaps	IDENTIFY (context) MAP / VISUALIZE PLAN^ (physical health) OPTIMIZE technical areas gaps needs
IDENTIFY (context) ENGAGE needs gaps	IDENTIFY (context) RECOGNIZE* needs gaps

Above rendering idealised and all embedded within spiritual and ethnocultural context.

*Recognition required politically to avoid individual frustration and facilitate (policy ...) coherence.

^Planning should (must) take into account need for parity of esteem between mental and physical health (with triage situations acknowledged).

Source: Jules Storr, Independent Consultant, S3 Global & working with WHO as part of the Quality Toolkit development team - via HIFA

Petition "Protect the title Nurse in UK law"

individual
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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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group

	"The term nurse can be used by anyone in the UK. They can use this term to offer professional advice and services even if they have no nursing qualifications, experience or have been struck off a professional register." More details

My source (and signed):

Anyone in the UK can call themselves a nurse. Even if they have no nursing qualifications or experience. They can even call themselves a nurse if they have been struck off. This is a #PatientSafety issue
If you are concerned too please sign #ProtectNurse https://t.co/FD9MS1JZpu

— Prof Alison Leary 💙 (@alisonleary1) June 15, 2021

Alzheimer’s spotted early using AI cookie theft test

self - individual - person

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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dyad ... family - group 

 

Changes in how people describe this simple drawing can be analysed using AI

Cummings, Louise. (2019). Describing the Cookie Theft picture: Sources of breakdown in Alzheimer's dementia. Pragmatics and Society. 10. 151-174. DOI: 10.1075/ps.17011.cum  https://www.researchgate.net/publication/332061806_Describing_the_Cookie_Theft_picture_Sources_of_breakdown_in_Alzheimer%27s_dementia

 

My source (and image):

Knowles, T. (2020) Alzheimer’s spotted early using AI cookie theft test, The Times, 24 October, p.47.

"Care Package" 4 the C.21st ?

"The CARE Package was the original unit
of aid distributed by the humanitarian organization
CARE (Cooperative for Assistance and Relief Everywhere)."

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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group - population

Disaster Conflict Refugee context? Individual choices -  facilitating autonomy  whenever possible - Sign Language? Mental health Care Plan includes relapse prevention /  Staying well / Self care Mental capacity / Decision making Physical health check Patient Reported Outcomes* Specific management of medication - lithium, psychotropics and safety completed and health literacy demonstrated with support if needed. Making Every Contact Count - in every care context Psychological therapies  One narrative: told recorded once Cognitive access: Health Information Access to my health record My Care - Why? Understanding, Awareness C[P]-Suite "I Consent" - My data, Genetic Profile, Reimbursement? INTEGRATED -

Disaster Conflict Refugee context? Avoid admission, over-treatment Quaternary Prevention Preparation for Admission? Physical Care Plan includes relapse prevention /  Staying well / Self care If in-patient THEN is medication ordered and ready for discharge? e-Prescription? Electronic Health Record Mobility - aids, Transport Advice / instructions Wound /  Dressing management Making Every Contact Count - in every care context Clinic location: urban / rural  transport  Virtual - Telemedicine, e-Health m-Health Patient Reported Outcome Measures Patient involvement in Research Trials Physical therapies - access Physical access services/devices? - CARE ?

Care IN the Community? Housing :: Homeless? Pre-discharge home visit - e.g. Occupational Therapy? Living alone? Safety Carers involved with due  consent in care planning.  Engaged in recognition and role of warning signs and actions to follow. Recovery, Rehabilitation, Reablement Awareness and shared competency in medication, in event of physical illness. Patient/Family audit of clinical record: accuracy if/when appropriate BUT check completed. Plan of care - activities, groups, information, arts, studies,  volunteering. Carers assessment Social care. Advance (anticipatory) care planning Progress (this time) PRO* Introduce respite care, day care, volunteering Avoidance of admission: this time :: next time?

[Finance of Health Service Delivery] Care Package for specific groups / populations / circumstances:  Forensic, Prison, Homeless,  Substance Misuse, Veterans Need for interpreter, advocacy? Feedback on care experience: patient and carer(s) Management of Belongings, Cash Community care - follow up instigated - introductions made with continuity of care (personnel) were possible. Communication with (family) GP/Doctor Out-of-hours services  and contact details. Patient & Carer invited to phone purely as a trial-run. Law - Policy? 72 hour, 7 Day - follow-up at home. Incidents - Complaints? Apologies? Organisational Learning  Welfare - Employment Data capture and reporting of care spell/episode. De-identified. Reports submitted stats. Reporting plans to Public re. Health Services Public involvement in Services

The above is not comprehensive and in itself begs questions of scope and what is a 'comprehensive' care package?

The mapping above to Hodges' model includes many assumptions - existing health service provision, governance, finance, housing, social infrastructure - social determinants of health and how these are mitigated (if at all).

Nursing, history and (future) travels

From: Stu Young c/o Facebook, Royal College of Nursing Students, 3:28pm Jul 19

Dear All,

Please look up the "Mary Seacole Memorial Statue Appeal" page on facebook it has moved to a new page, please support this cause for a nurse often forgotten by history.

Mary Seacole Memorial Statue Appeal

Mary Seacole born in Jamaica in 1805, died in London 14th May 1881: Jamaican / Scottish nurse, doctres.

<->

PJ: The other week I took my mother and aunt to Tywyn, Wales to trace family history and meet some friends. On the way back we stopped in Bala. I had heard of another nurse and a bookshop reminded me: Elizabeth Cadwaladr - with a movement for another memorial.

The lady in the shop explained the way to Betsy Cadwaladyr's home. That's a walk for the next trip.


UK Centre for the History of Nursing and Midwifery (disbanded 2018)

RCN: History of Nursing Society community

Point of care? The King's Fund - patient experience

The real 'point of care' is that there are several points with many perspectives:


Patient (person) - Care professional - Manager - Carer
Public (citizen) - Student - Lecturer - Service User Groups
Physical - Emotional - Political - Social
Patient - Inspectors - CEO information governance - Commissioners

Don't drown seeking gaps in processes. All of the P's count!

The King's FundThe Point of Care: Improving Patients' Experience.


Image source:
Multiple Faces: Insight Management Group