RCN Congress: Ebola, privacy and 'care bundles'

The first discussion at RCN Congress #RCN26 on Nursing as a STEM profession, or STEAM, with the arts added, became a resolution:

https://www.rcn.org.uk/congress/congress-events/nursing-as-a-stem-profession-2026

This was marvellous as it touched so many aspects that Hodges' model readily encompasses.

There is scope for the addition of emergency items:

https://www.rcn.org.uk/congress/Submit-an-emergency-agenda-item

Yesterday I wondered about the latest ebola outbreak, national and international aid^. Plus, privacy, having noticed a stream on twitter regards the NHS and a contract with Palantir. Yes, 'X' as a source is a problem, but concerns about access to confidential clinical information is found in the quality press. What does the Information Commissioner's Office say? Well, it seems there is a history:

https://icosearch.ico.org.uk/s/search.html?collection=ico%7Esp-search&query=PALANTIR&profile=_default

While searching for 'care bundles' I came across this:

 'The scope and force of medical privacy is further supported by a secondary layer of protections based in sectoral and other forms of regulation. Anti-discrimination laws, disability rights, and employment law, for example, all recognize and operate to preserve medical privacy by restrictions of use of medical information outside of the medical setting. 

 These intersecting normative strands of medical privacy, derived from different sources, together form a set of norms designed to protect a bundle of interests that is essential to the maintenance of an effective healthcare system that encourages and protects appropriate care-seeking and treatment. Whether and how technological changes in the collection, storage, and processing of data affect the construct of medical privacy is a pressing question. Just as a bell cannot be unrung, erosion of the sphere of medical privacy is unlikely to be restored.' p.330.

I realised over the past twenty years or so I've paid less attention to the fact that sections of a population, those often most in need of healthcare will not engage, be care-seeking - if they have no faith and trust in how their information is managed and protected. Minority groups, the digitally excluded (whether by choice, or literacy, economics) the influence of media are all vulnerable. Protection of data and the integrity of health services and systems is surely a matter of professional import both clinically and informaticians? As a registrant, I've always put it to student nurses that they should be aware of what happens to the data they as a registered nurse, enter in the electronic health record.

Pierce, R. (2018). Medical Privacy: Where Deontology and Consequentialism Meet. In B. van der Sloot & A. de Groot (Eds.), The Handbook of Privacy Studies: An Interdisciplinary Introduction (pp. 327–332). Amsterdam University Press. https://doi.org/10.2307/j.ctvcmxpmp.17

 

^What, only one sentence? Yes, but I'm still worried; geography - distance now matters little. While, on the other-hand: care-seeking...?

 

Previous posts: 'ebola' : #RCN26

RCN Congress iii 2025 - Accountability for patients in ambulances

The resolution (with a reading list) on Accountability for patients in ambulances

- drew attention to language once again (yes, well there's a truism: what do you expect!). This time highlighting how corridor care is now variegated. In addition, politically you can circumvent addressing an issue, by referring to 'never events', and 'zero tolerance' as we read:

'This agenda item addresses the urgent issue of accountability, for both registered nurses and the organisations they work for, when patients are cared for in ambulances waiting to access emergency departments.

The resolution comes at a time when, across all four countries, there are unprecedented ambulance handover delays with patients left in vehicles which are neither appropriately staffed nor resourced outside overwhelmed emergency departments. Despite the prolific nature of this practice, there is no clear guidance on accountability. Who is responsible for the care and safety of those patients - the ambulance service, the hospital, the emergency department, or the individual registered nurse providing care?

These delays accessing care and the lack of guidance on who is accountable for the waiting patients, compromises the ability of health care staff to provide good quality care and risks patient safety. It also exposes registered nurses and other health care professionals to professionally, ethically and legally ambiguous situations. It could also contribute to the crisis in nursing wellbeing, raising issues such as moral distress and professional, emotional and physical burnout. It may, therefore, also impact the already perilous recruitment and retention.'

Student nurses, paramedics ... please take note: There is a paper to be written on Hodges' model and the gaps we encounter in health and social care. For Brian Hodges this started with the theory-practice gap; one of four original stimuli for the creation of the model. 

As the idealised standards, quality and safety of care being delivered are surrendered; this gap stands out as the virtual keystone.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

individual - PURPOSES patient safety - distress nurse wellbeing emotional burnout moral distress personal ethics individual responsibilities	procedure delivered care - observation mattress, trolley .. ambulance design instrumentation, noise time - duration logistics - PROCESSES - handover physical resources - beds
communities of PRACTICE team working - coherence team experience - students THE DAMAGE - that is 'BOOK-PASSING' The public's - carer's experience (wither friends and family)	law - guidance - ambiguity POLICY professional accountability risk management organisational responsibility workforce recruitment & retention

Previously: 'RCN' : 'gap' : 'accountability' : 4Ps

Dramatherapy iii - A Specification for Care: Nye

Individual
|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

"Classical psychodrama requires five instruments, the stage, the subject, the director, the auxiliary egos and the audience. Although Moreno frequently stated that psychodrama could take place in many natural settings, he advocated the use of a stage of his own design, circular, 12-15 feet in diameter, 1-2 feet high with two surrounding stepped lower levels, seating for the audience, a 'Juliet' gallery and equipment for varying the colour and brightness of the lighting. This format was was aimed at providing a space and generating an atmosphere in which the subject could rise up to move and act with increased freedom and imagination. 'The locus of a psychodrama, if necessary, may be designated everywhere, wherever the patients are, the field of battle, the class-room or the private home. But the ultimate resolution of deep mental conflicts requires an objective setting, the therapeutic theatre. ...'". p.107-108.

Nye - National Theatre

Davies, M.H. Dramatherapy and Psychodrama, Chap. 5. pp.104-123. In Jennings, S. (Ed.), (1987) Dramatherapy. Theory and Practice for Teachers and Clinicians. Routledge, London. p.106.

"All in the Mind" (and model): Ambiguous Loss

"Have you ever lost a loved one who was still a part of your life in some way? Did it leave you feeling confused or frozen about how to continue with life? Claudia Hammond examines the distressing phenomenon known as ambiguous loss – the enormous challenge of dealing with a loss when you aren’t sure what’s happened, leaving you searching for answers, unable to move on." 

BBC Radio 4 "All in the Mind" 1st December, 2020 (Available for one year)

 individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

psychological ambiguous loss ambivalence, grief, loss guilt, reality, meaning BOTH-AND thinking -	physical ambiguous loss a body is missing head injury - the impact of dementia on a person

 

Grammar in Visual Language

I've just watched a Vizthink podcast which I found on Neil Cohn's blog 'The Visual Linguist':

What qualifies as visual language anyway?

As usual - click when running - and the podcast will fill the screen. In addition to the discussion and slides there are many other sources to explore. A news map example had me thinking about Hodges' model and problems within the four care domains. If in addition to clinical staff, managers and policy makers really do want to see evidence of person-centred care and carer's views being taken into account; then how fine-grained should the care map be?

(Or is it just a tick in 'a' box?)

News is one thing, but is there an optimum level for care? Plus of course problems are not the only fruit - there are strengths too...