Hodges' Model: Welcome to the QUAD: telecare

Hodges' model is a conceptual framework to support reflection and critical thinking. Situated, the model can help integrate all disciplines (academic and professional). Amid news items, are posts that illustrate the scope and application of the model. A bibliography and A4 template are provided in the sidebar. Welcome to the QUAD ...

Showing posts with label telecare. Show all posts
Showing posts with label telecare. Show all posts

Wednesday, August 02, 2017

Nurses ... console, console, yes; but don't become one ...

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









subjective

console
noun
​
a surface on which you find the controls for a piece of electrical equipment or a machine:

a gaming console



console
verb
​
to make someone who is sad or disappointed feel better by giving them comfort or sympathy:

He tried to console her, but she kept saying it was all her own fault.
I tried to console her with a box of chocolates.
I was consoling Liz on having broken up with her boyfriend.


objective









[ political objectives? ]



My source:
Whiston Hospital: Accident & Emergency & Resus, Laminated FLACC.
Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children

See also:
Crellin D.J., Harrison, D., Santamaria, N, & Babl, F.E. (2015). Systematic review of the Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children: is it reliable, valid, and feasible for use? Pain. Nov;156(11):2132-51. doi: 10.1097/j.pain.0000000000000305.

Dictionary entries:
http://dictionary.cambridge.org/dictionary/english/console


Monday, July 11, 2016

Atlas of eHealth country profiles: The use of eHealth in support of universal health coveage

Dear All,

As we all know that eHealth plays a vital role in promoting universal health coverage in a variety of ways. For example, it helps provide services to remote populations and underserved communities through telehealth or mHealth. It facilitates the training of the health workforce through the use of eLearning, and makes education more widely accessible especially for those who are isolated. It enhances diagnosis and treatment by providing accurate and timely patient information through electronic health records. And through the strategic use of ICT, it improves the operations and financial efficiency of health care systems.

The third global survey on eHealth conducted by the WHO Global Observatory for eHealth (GOe) has a special focus -the use of eHealth in support of universal health coverage.

To read the Global Observatory for eHealth, World Health Organization, 2016
http://apps.who.int/iris/bitstream/10665/204523/1/9789241565219_eng.pdf

Hope you find it interesting.

Ghassan Shahrour

HIFA profile: Ghassan Shahrour is Chair of the Syrian Medical Informatics Association (Syrmia). His professional interests include Health for All, Health Promotion, and Equity in Health. syrmia AT gmail.com


My source: HIFA  Healthcare Information For All: www.hifa2015.org

Wednesday, April 29, 2015

IxD&A Interaction Design and Architecture(s) Journal: TEL + 'Designing Self-Care For Everyday Life'


Special issue on:

The Design of TeL with Evidence and Users

- which includes:

Focus Section on 'Designing Self-Care For Everyday Life'

Ivo Maathuis, Valerie M Jones, Nelly Oudshoorn
Telecare and self-management: a guideline for anticipating future care in scenario-based design, pp. 142-159

Koen van Turnhout, Jasper Jeurens, Martin Verhey, Pascal Wientjes, René Bakker
The Healthy Elderly: Case Studies in Persuasive Design, pp. 160-172

Juan Jimenez Garcia, Natalia Romero, David Keyson, Paul Havinga, Reflective Healthcare Systems: micro-Cycle of Self-Reflection to empower users, pp. 173-190.



Saturday, November 29, 2014

Reflexive strategy realised in policy: from hokey cokey to hocus pocus

Strategy is usually about the longer term, as such it needs to be reviewed, but it is hardly a matter of reflex. Crisis management within a strategy should be an operational contingency, the implementation of contingency plans.

As posted several years ago, I've been fascinated by the need for vulnerable people to 'beware of reflex moves'. The example I have comes across repeatedly is due to the people community mental health services encounter. Older adults who are newly bereaved (and suddenly become vulnerable) and for whom it is (also) suddenly judged by well-meaning family members that they should move their home to be nearer the family. This decision is often made quickly, when the grieving if it is ongoing, has only just started and decision-making is impaired to say the least.

It is a bit of stretch, but we can relate this to health, social care and policy. Let's see ...

As an evidence-based activity health care is far removed from "hokey cokey". To be precise its Levenshtein distance (or edit distance) is 8 :-)

Unfortunately, a recent HSJ/Serco Commission on Hospital Care for Frail Older People concluded that health and social care integrated care is a "myth" in terms of being the "silver bullet" for the NHS's financial difficulties (Barnes, 2014).

I'd been wondering about the problems that have been solved and those still ongoing since I began my nursing career in the late 70s. You could call the latter personal legacy career issues. The commission's report describes the current flagship project the better care fund, as having been planned in a "hokey cokey" fashion.

Of course, integration is as many-splendored in its transformational promise, as it is many tentacled in its complexity. What is being integrated? To what extent does this include disciplines, finances (budgets), philosophy, location, record systems, management, policy, accounting, reporting and accountability ...? How do we measure and recognise success?

On a positive side the Levenshtein distance for "hocus pocus" from "health care" is 10, so that maybe reassuring?

The worry is that there is form elsewhere, also highlighted in HSJ (Illman, 2014).

The 3 Million Lives telehealth programme has been scrapped. If it is a measure at the time of this post, the last tweet was 18 March 2013.

Given the major upheaval that the NHS has been through this is hardly the ideal environment for policy making that must engage staff and the public.

Engagement - crucial!

Barnes, S. (2014) Landmark report criticises integration policy. Health Service Journal, 21 November, 124: 6424; pp. 4-5.
Illman, J. (2014) NHS England outlines telehealth successor, Health Service Journal, 26 September, 124: 6416; p.13.


Sunday, February 23, 2014

18th Annual International Philosophy of Nursing Conference

in association with the International Philosophy of Nursing Society
(IPONS)

September 8th, 9th and 10th, 2014

Hosted by the School of Health Sciences, University of Nottingham, England, UK

Brave new world?
Health, technology and evidence based practice

Nurses have seen some fundamental changes in the way that healthcare is delivered. Body care is at the centre of nursing practice but the nature of that care has been extended beyond the personal, human-to-human contact, and is increasingly refracted through the medium of technological/scientific interventions. The way that these technologies interact with the human dimension does, and should, require critical analysis.This is particularly the case for nurses who are increasingly expected to adopt methods and approaches that change the nature of the nurse patient relationship.  Added to this is the way that clinicians/academics/researchers interact with health care issues, locally as well as globally.

There is an established debate and tension within the evidence based practice literature that illustrates a deep ambivalence about how a holistic approach to clinical practice relates to, enhances, or is undermined by the new health technologies. These include care pathways, systematic reviews of knowledge, the enabling/disabling effects of technology and the putative implication that there is an empiricist and dehumanising process involved in these developments. For example, what happens to the complexity of ethical debates when they are shaped in the form of arguments based on literature reviews? These may wittingly or unwittingly serve as a means of translating complex moral issues into usable clinical regimes that partially mimic meta-analyses. Furthermore we may ask what place narrative knowledge and qualitative experiences may have in this new world of implementation technologies? And how do the new interventions of telemedicine and other policy drivers that emphasise the “hospital-at-home” impact on the ways that nurses carry out health care?

This conference intends to examine these and other issues related to ‘Health, technology, and evidence-based practice’.

CONFERENCE DETAILS

Details of the Conference can now be found at the following link: ...

These details include the list of Keynote speakers; the venue; a Call for Abstracts; conference registration and accommodation, and transportation. Abstracts of the Keynote speakers and the full Conference Programme will be available soon on the above link.

Any specific queries should be addressed to Dr Stuart Nairn ...


other IPONS posts on W2tQ

Saturday, September 21, 2013

Health 2.0 Europe 2013: Nurses, registration and £££

This year I've really enjoyed the Health 2.0 Manchester chapter meetings and there's some great evening sessions to follow this northern autumn. In June as I posted on W2tQ I also spent a weekend at the NW Health Hack in Knutsford. 

For several months European Health 2.0 conference has been publicized at the Manchester meetings. I was keen to attend until I saw the registration fee even with a 15% reduction. The fee increased yesterday too as I was reminded by Pascal Lardier on twitter.

I retweeted and replied to Pascal and Health2eu, with the thought that few nurses would be able to afford the registration fee.

NW Health Hack was a success for me (in addition to our group coming 3rd) because it was free, apart that is from driving there over the weekend on my days off (thanks again to all the sponsors). As the NHS is trying to save money I've also taken some unpaid leave this year.

NHS nurses, like many public sector groups have effectively had a pay cut these past few years. There are other general challenges:

  • Are those nurses who might attend already 'onboard'?
  • Does nursing engagement itself need a health check (what is 'clinical engagement' now)?
  • Much was made of achieving clinical engagement in previous NHS IT projects. How can clinical engagement that reaches nurses be assured now?
  • If (technical) innovation is to be a constant stream, please don't leave the nurses on an island: they can set sail too.
  • Are nurses, like the one writing this, tainted, having been sat on the fence (health care || ICT) for too long?
  • Once projects are established how can nurses, patients and carers stay the course and keep in touch and engaged?
  • As 'NHS clinicians' can nurses participate in initiatives such as the forthcoming Code4Health, or will operational constraints limit their involvement?
  • How are the socio-technical aspects and outcomes measured (hospital vs. home personal use vs. self-care...) ?
  • Is there a golden ratio for the mix of delegates?
  • If there's a strategic partner involved where's the strategy?
Pascal sliced through my query and many of the points above:

Pascal Lardier ‏@pascal_lardier 19 Sep
- then they should reach out to me!

So if the World Wide Health 2.0 conferences are of interest to you, do as Pascal suggests. New communities can provide new opportunities. Don't just help make your day, help make tomorrow too.

In 2012 the NHS employed 146,075 doctors, 369,868 qualified nursing staff, and 37,314 managers. 
http://www.nhsconfed.org/priorities/political-engagement/Pages/NHS-statistics.aspx#staff

Additional notes 29 Sept:

Health 2.0 MCR ‏@H20MCR
@h2cm patients are also asking how can @Health2eu Health 2.0 Europe conference be made more accessible for them @pascal_lardier?

Pascal Lardier ‏@pascal_lardier
@H20MCR @h2cm @Health2eu @pascal_lardier they should email me pascal AT health2con.com there is a FREE reg code for them.

Saturday, May 18, 2013

North West Health Hack 15/16 June 2013

Dear Health 2.0 Manchester member,

Please see an update on opportunities that might be of your interest:

Follow us on Twitter!
@H20MCR for latest updates and digital health insights & opportunities

North West Health Hack 15/16 June 2013
This is a free event where clinicians can work with some very talented developers/coders and designers to develop their ideas into working prototypes. There will also be an opportunity to get some early concept validation and feedback from investment/ technology and NHS mentors.  The event is not only open to new concepts but also to ones that are already in development so that teams that are already formed are also invited! Who is organising it: Barclays, ECH Alliance, University of Manchester, Health 2.0 Manchester Chapter, TechHubManchester. Dr Ranjit Gill (Chief Clinical Officer, NHS Stockport) & Dr Mike Burrows (Area Director, NHS Greater Manchester) will attend the event.


Check it out  & REGISTER at ...


Blueprint Health accelerator is currently accepting applications for their summer program
We have been approached by Blueprint Health to share this opportunity with our community: Blueprint Health, the premier healthcare accelerator program, located in the heart of New York City. Blueprint is currently accepting applications and our team is seeking talented entrepreneurs to join us for the Summer 2013 Program. A number of incredible entrepreneurs have traveled from as far as Shanghai, Dubai, and London to partake in our program. You may have seen some recent press coverage of four surgeons who founded Touch Surgery, a company that graduated with our Winter 2013 Class. http://www.guardian.co.uk/artanddesign/architecture-design-blog/2013/feb/27/touch-surgery-ipad-app-surgeons-learn
We look forward to meeting the talent from Manchester.

Michael Maggio
Associate

Blueprint Health
483 Broadway, 2nd Floor
New York, NY 10013
cell: 781.864.6283
office: 646.627.7627 ext 703
mmaggio@blueprinthealth.org | blueprinthealth.org | @bphealth

Next  H 2.0 Manchester Meetup Thursday the 23rd of May: Care Homes and Assisted Living: in what ways technology can help?
Another great opportunity to discover new opportunities, be inspired and meet like minded people in a relaxed atmosphere.  ...

Thank you and best regards
Idalia, Daniel, Mariano and Preeti
Health 2.0 Manchester - Leadership Team

Tuesday, March 27, 2012

Dementia - The size of the challenge

The image and link below is the first of a set on Flickr produced from the Prime Minister's presentation and meeting with the Alzheimer's Society on March 26 2012. A transcript and video are also available:

Transcript - Prime Minister's speech to the Dementia 2012 conference

As the image below suggests there are many stats including the startling variation in services nationwide, for example:

In Belfast diagnosis is at almost 70 per cent.
Here in England we’ve got neighbouring areas with massively different rates…
… in Sheffield 57 per cent; in East Riding – less than 80 miles away – it’s 29 per cent.

Dementia - The size of the challenge

Friday, October 14, 2011

ERCIM News No. 87: Special theme "Ambient Assisted Living"

Dear ERCIM News Reader,

https://ercim-news.ercim.eu/en87
ERCIM News No. 87 has just been published at
 http://ercim-news.ercim.eu/

Special Theme: "Ambient Assisted Living"

Guest editors: Michael Pieper (Fraunhofer FIT, Germany), Margherita Antona (ICS-FORTH), Greece) and Ulyses Cortes (UPC, Spain)
http://ercim-news.ercim.eu/en87/special

Keynote by Constantine Stephanidis, Director, ICS-FORTH
http://ercim-news.ercim.eu/en87/keynote/

This issue also features a section on FET Flagships, introduced by Mario Campolargo, European Commission Director, Directorate F: Emerging Technologies and Infrastructures, Information Society and Media Directorate General.

The six FET Flagship Pilots - "Graphene", "Guardian Angels for a Smarter Life", "FuturICT", "IT Future of Medicine", "The Human Brain Project" and "Robot Companions for Citizens" present their vision and what they would like to achieve in the next ten years.
http://ercim-news.ercim.eu/en87/es

Next issue: January 2012 - Special Theme: "Evolving Software"
(see call at http://ercim-news.ercim.eu/call)

Thank you for your interest in ERCIM News.
Feel free to forward this message to others who might be interested.

Best regards,
Peter Kunz
ERCIM News central editor

Tuesday, June 28, 2011

International Conf. "Ageing Globally – Ageing Locally" Dublin Nov. 2011 & h2cm Poster

Today I'm really pleased to report news that h2cm will be presented as a poster at
"Ageing Globally – Ageing Locally".


I will use Hodges' model to explore the dimensions of the conference themes. More to follow ...

Acknowledgement: Thanks to Prof. George Kernohan, Ulster.ac.uk for bringing this event to my attention.
Related post:
Musings... on 'local', 'global' and 'glocal'

Monday, March 21, 2011

Bob Newhart, a phone, distance, dementia and communication

BBC Radio 4 have a series For One Night Only which looks back at classic concerts. These are not only music related as last Saturday attested featuring The Button-Down Mind of Bob Newhart. This is the title of Bob Newhart's award winning comedy album that topped the charts in 1960. When Bob Newhart first appeared his act was radically different from the usual comedy fare. In this edition presenter Paul Gambaccini interviews the now 81-year-old Newhart about the album, his success and approach: an individual on stage with a telephone.

In the discussion I was struck by the point that although it was just one man with a phone the audience acted as a proxy for the other party. Being socialised as we are the audience became the other party in Newhart's comical one-to-one conversations. We fill-in the missing details; what has most likely been said, what must have happened and what may happen next. Our humanity, experiences and imaginations fill the space making use of the redundancy that resides in context, language and the comedic.

As noted previously my colleagues and I have started giving some talks on communication to residential and nursing home staff. The focus in these sessions being person centered care and the challenges that residents living with dementia face together with their carers and families.

I don't want to worry senior managers - but in my sessions I try to convey to staff how everyone, whatever their experience, position and grade has a role to play in assuring high quality person centered care. Listening to For One Night Only you see the challenge writ large. Now a sense of humour in medicine and nursing is a great help, but this isn't the staff room and it's no comedy either.

Care staff must realise how important it is that they pick up and use the 'phone'. Their individual observations, patience and interpersonal efforts are vital. Even with some training in dementia care  staff may be surprised how the person with cognitive problems can fill in the spaces. Even if a resident cannot understand the words spoken to them, the tenor, tone, intent and attitude behind the words can be communicated and contribute greatly to supporting the care that follows. Especially when there is a need to deliver personal care.

In providing much needed personal care the technological marvel that is telephony may have its limits (even as telecare), but it can still teach us much about information and communication.

Most obviously when 'distance' remains.

Image source: http://www.pbs.org/weta/onstage/twain2002/bios/

Friday, January 28, 2011

Proximity: Relationships, Records, e-Health - Person-centredness near and far

When data protection and confidentiality is debated "the need to know" is often wheeled out as a rationale for access to personal identifiable data.

See the following:
NHS Confidentiality Consultation - FIPR Response (esp. #18).
DoH, Confidentiality, UK

In addition, if I need to access the record of patient held at hospital 'x' from hospital 'y' what is the health care relationship that prompts and justifies this need?

At present visiting nursing and care homes, you go knowing that data capture and recording (care assessment) is a fundamental requirement. Having a secure laptop for community has long been promised. While tech solutions are available and implemented elsewhere, my lack of such technology prompts me to imagine a future visit. ...

Pulling up at the nursing home I walk up the drive, ring the bell. While I wait the new tablet device in its bag has already introduced itself to the home. As I am allowed in - my identity assured - the tablet continues its dialogue, it:

  1. Downloads and updates existing active client data.
  2. Downloads additional data as per the agreed dataset on the new referral.
  3. Checks on items 1-2 with a review of recent prescribing for key psychotropic medicines.
  4. It checks the most recent NICE, Cochrane evidence and reconciling the local care knowledge. (This may seem excessive at present, but come personalised medicine this will be crucial).
  5. Will check on most recent clinical reviews and due dates.
  6. The h2cm template is there ;-) ready to present the care domain summary for the general physician ... and possibly (roles?) the next care professional to visit this home and this resident.
The significance of relationships is usually denoted by distance. Personal space is rather obviously spatial. This is how we recognise (well one of the ways!) the meaning and significance of an intimate relationship. In care situations with individuals who are confused and potentially aggressive we are conscious of the need to have due regard and respect for that person's personal space. Spaces and boundaries have to be negotiated in a variety of ways and means. 

Health information technology has already made effective use of role-based access to systems. If we take person-centred care to the nth degree, proximity can also count as it does in mobile health (m-health). Whilst to effect a role is to be in a certain location and context (sat at the office PC in the hospital) roles are organisationally and politically defined. Proximity is also contextual and situated in other ways, my proximity to:
  • the nursing home;
  • the individual's room;
  • the individual themselves.
  • (and their relatives)
While telecare / informatics can deliver a dividend in remote care, it is essential that it can also demonstrably support person-centred care. The best way (clinically assured) to do that for many activities is person-to-person contact. Just because one-side of the relationship may not recall the encounter as little as five minutes after, does not mean that there is no value in sustaining the ring of the bell, the exchange of s-miles, the record that results and other background conversations.

Image source:
Gestalt - proximity
http://graphicdesign.spokanefalls.edu/tutorials/process/gestaltprinciples/gestaltprinc.htm

Friday, December 04, 2009

Sheltered housing, care domains, ADLs, telecare and wardens

Shelter is a basic human need, one rendered acute when people are forced to flee their homeland. On a rather different level in the UK there is currently quite a debate about sheltered housing and the withdrawal of live-in wardens. This 'debate' has even progressed to judicial review.

I've visited many clients when the warden has appeared at the window or door to check that things are aok? Such has been the time keeping and client's faith in their clock that on occasion it could have been Kant walking by. It is often helpful to invest some time and get to know the warden, too see what they know not just about 'care of older adults', but about their residents many of whom become friends. We need to remember what a difference an individual can make in these situations. The clue is in the title 'sheltered housing' which in Hodges' model spans the interpersonal and sociology care domains. I've illustrated this below:

Suddenly, the advent of telecare, video and mobile comms and resulting benefits raise the possibility of service 'duplication' at a time when cost savings are sought in social care. Alternately, we might ask if some overlaps in service provision are good insurance? For the people in sheltered housing and their relatives what did sheltered mean to them when they first viewed the facility, what does it mean now? As is the case with day care centre managers, the more dynamic wardens really do make a difference to these communities of individuals. As Peter Sellers showed us sometimes for a gardener - or a warden - just Being There is reassurance enough.

Hodges' model can be used as a reflective device for this real-world bricks and mortar example of a clash between the humanistic and mechanistic care domains.

Additional link: International Human Rights Day 2009

Original dwelling image from: http://www.cherokeemedicineman.com/dwelling.html

Film image source IMDb

Friday, May 18, 2007

New Scientist: Application of RFID technology in Alzheimer's disease

Up to November 2004 I had worked in the community for some ten years with older people (and some well-under '65 years old') who were coping, usually supported by their families; sometimes struggling alone with "Oh, I'm fine!" dementia.


As an ICT enthusiast I've attended presentations that highlight the role that telecare and telematics is playing in extending independence and maintaining quality of life for people with chronic medical conditions. Of course people and families who are robbed of so much, deserve all the help that can be provided.

Having just completed 7,000 words on Hodges' model, selected works of philosopher Michel Serres and informatics, it has struck me the way that just as health and medicine has its many disciplines, so informatics has its various schools. There is community, social, health, e-government, biomedical and many others...

There are two key characteristics of the (western) population pyramid: form and implications. It's getting top heavy as older people far out-number the young. At that top heavy blunt-end there will be increased call on social and mental health care services. Meanwhile, at the sharp-end the younger generation will be (already are!) the 'new generation carers'. Optimist that I am - I'm on that cusp, you know that one where you are looking back and looking forward in equal measure. As a nurse you have to worry these days what passes as 'care' never mind 'nursing care'.

The 'youngsters' will rise to the challenge, won't they? Otherwise, the State will help...

If not, what other solutions are available? And hold on, whose 'solutions' will they be? Will those at the sharp end call for blunt solutions or sharp ones?

Informatics values are out there, but where is the value system that provides ethical assurance across informatics disciplines, health and social policy?

Whatever your age and state of health this New Scientist item begs reading and reflection - 'Plan to 'chip' Alzheimer's patients causes protest'.

I hope you don't have to say "best read the manufacturer's blurb now"!