Nursing (Health) Art or Science...?

Is nursing an art or science?
It is simply and complexly both ...

"Warp. Weft. Woof! are terms from weaving: the threads or yarns that run lengthwise on the loom are called the warp; the crosswise threads or yarns are called the woof or weft. The web is the name given the completed woven fabric, and it also has wide figurative use: What a tangled web* of circumstance you've woven.
All these are Standard."
(http://warpweftwoof.com/)

*Also known as the care plan!

Original image source:
http://www.wovenwire.co.uk/plainweave.htm

Additional links:
http://www.africancrafts.com/

h2cm: Original purposes and 21st century additions

Listed below are the four reasons that prompted Brian Hodges to create Hodges' model in the early-mid 1980s, these being to support:

1. reflective practice (Moon, 2004; Jasper, 2006) ;
2. holistic care (Brooker and Waugh, 2007);
3. curriculum development;
4. bridging the theory – practice gap. (Doherty, 2009)

Although nursing, health care and society have changed to a revolutionary extent these original purposes are still outstanding some 25 years later as the authors above and many others testify.

Perhaps in the next few years it would be timely for researchers to revisit the original stimuli and consider afresh the role of Hodges' model within nursing theory and practice and beyond. I believe the relevance of the model grows not because of the constant need for the big picture, but the need to represent and consider new dichotomies and challenges. To the original four then we might add:

• To inform the socio-technical application of information and communications technologies in health and social care;
• To conceptually ground (domain relate) and integrate the 4Ps of PROCESS, PURPOSE, PRACTICE, POLICY in theory and practice;
• To provide a universal conceptual framework to conjoin all multidisciplinary teams across the 4Cs of COMMUNICATION, COLLABORATION, CO-ORDINATION, CONTINUITY and COMPLEXITY*;
• To inform research in what may be termed ‘cogeographics’ the fusion of conceptual spaces and visualization in the humanities - social sciences.

The 4Ps and 4Cs provide a further aide memoir for students and practitioners to accurately locate situated care. Finally, nursing and health, social care as a profession is bound to a code of practice, accountability and has an educational – public (mental) health duty to the aims and objectives of the global health community. Cogeographic (or cogneographic) may be a neologism, but seeks to conjoin the cognitive (cognition) involved in defining, representing and using concepts in conceptual spaces; AND the finding that knowledge is invariably situated - that is knowledge has a geography.

References:

Brooker, C., Waugh, A. (2007) Foundations of Nursing Practice: Fundamentals of holistic care, Mosby.
Doherty, C. (2009) A qualitative study of health service reform on nurses’ working lives: Learning from the UK National Health Service (NHS), International Journal of Nursing Studies,46,8,1134-1142.
Jasper, M. (2006) Reflection, Decision-making and Professional Development (Vital Notes for Nurses), Blackwell.
Moon, J.A. (2004) A Handbook of Reflective and Experiential Learning: Theory and Practice, Routledge.

*I can count really ;-)

Workshop - Delivering High Quality Health Care for All: Bringing the social and technical together...

My SOURCE: SOCIOTECH at JISCMAIL.AC.UK

Dear Colleague,

Please find details attached of a Think Tank focused on developing socio-technical approaches to the provision of healthcare (in the context of the National Programme for IT in the NHS).
Please note that attendance is restricted to around 30 people and that anyone wishing to contribute will need to apply (as specified in the attachment) - which follows below PJ.

Thanks and best wishes

Chris
P.S. please feel free to circulate these details to colleagues who you think may be interested. Thank you.

Professor Chris W Clegg
Centre for Socio-Technical Systems Design
Leeds University Business School
University of Leeds
Leeds
LS2 9JT
c.w.clegg at leeds.ac.uk

Delivering High Quality Health Care for All:
Bringing the social and technical together for a joined-up approach to deliver supporting systems and technologies
10th/11th December 2009

Call for contributions to an event organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group

Core idea
This 2-day Think-Tank event has been set up to discuss and report on how Health and Social Care employers and other key stakeholders in the Informatics field might bring about a joined-up approach to the implementation of electronic health records, one that brings together changes both in technology and in the social practices around it.

Rationale
The National Audit Office’s report on “Delivering successful IT-enabled business change” see: www.nao.org.uk/publications/nao_reports/06-07/060733es.pdf and the University College London Evaluation report on the Early Adopters of the Summary Care Records project (see: https://discovery.ucl.ac.uk/id/eprint/6602/1/6602.pdf) both highlight the challenges of implementing technology-based projects within a fixed time line and how this can reduce the opportunities to get a more “user-centred” approach to change.

In many sectors of the UK economy the drive to get the technology ‘on desk, on time, and on budget’ can mitigate against developing a full understanding and consideration of how the changes may be of real practical value to users and customers.

It is increasingly recognised that ‘technology-push’ will not be enough in its own right to achieve the full benefits and efficiencies that are being sought in service delivery. Rather, we need to bring about innovations both in the technical systems, and in the working practices, work roles and processes that surround them. Put bluntly we need a more joined-up approach to change. This has been variously called ‘user-centred’ or ‘socio-technical’ or ‘holistic’.

Objectives
The objectives of this event are to discuss and subsequently report on –
• What does such a joined-up approach mean in practice?
• What examples exist from across the UK Health and Social care sector where such approaches have been used?
• Who has to do what, to make it happen consistently across the NHS and Social Care services?
• How will we know if it is succeeding?

Organisers
The event has been organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group.

The event will be chaired jointly by Professor Chris Clegg, Chair of the British Computer Society’s Socio-Technical Group the and Doctor Beverley Ellis, Joint Vice-Chair of the UK Faculty of Health Informatics.

Getting involved as a contributor or delegate at the event
If you wish to attend the Think Tank, please submit an Expression of Interest (EOI) to Bruce Elliott, Co-ordinator of the UK Faculty of Health Informatics at bruceelliott@nhs.net by 28th September 2009.

Your EOI should include brief summary (of up to 200 words) of your role, experience and expertise in this context.

Please note we are seeking people from a range of stakeholder groups including:

• Acute Hospitals
• Suppliers
• Health and Care Commissioning organisations
• Primary and Community Care Providers
• End users of nationally-led systems, e.g., CMS, SCR, ECR
• Connecting for Health, Informing Healthcare and the Scottish Government’s E-Health Programme
• Academics
• Patient Leads

In the event that we are over-subscribed, we will select people so as to provide an appropriate balance of experience and expertise, to ensure the Think Tank can meet its objectives.

Please make it clear in your EOI if you would also like to present a short paper at the event. In such a case please also add a brief abstract of your proposed paper (of up to 200 words).

If you have been allocated a place you will receive written confirmation along with a copy of the final programme by 16th October 2009.

Associated papers
In November 2009, a Position paper capturing some of the Key Challenges in adopting Socio-Technical approaches will be shared with the participants to identify some of the key issues that will be addressed at the event.

Following the event, up to 5 contributors to the event will be commissioned to write papers on the topics and issues emerging, with the aim of informing key stakeholders in how Socio-Technical approaches can be utilised effectively across the NHS and Social Care. These papers will be completed by the end of January 2010, for inclusion in an overall Briefing report. We will also be actively exploring avenues for wider publication in order that the good ideas can be spread and acted on.

Location
Weetwood Hotel and Conference Centre, Leeds

NHS data breaches: the 'cogeography' of who and where?

Computing this past week featured an item (extract below with link) -

Five more NHS trusts involved in serious data breaches
Written by Tom Young
Computing, 17 Jul 2009

Privacy watchdog the Information Commissioner's Office (ICO) has found five more NHS organisations in breach of the Data Protection Act.
The Royal Free Hampstead NHS Trust reported the loss of an unencrypted CD initially thought to contain medical treatment details of 20,000 patients from the hospital’s cardiology department.
Chelsea and Westminster Hospital Foundation Trust reported the theft of an unencrypted memory stick containing 143 patient details including sensitive medical information.
And Epsom and St Helier University Hospital NHS Foundation Trust has been storing hospital records insecurely for nearly two years following data being transferred between hospitals. ...

Straight away reading this I thought of my previous post about cogeography and commented accordingly (which registered twice - oops!). In light of the previous post here's that comment with some additions....
Such events merely (without trivializing) highlight the human capacity to ERR big(gish) time. Is it not possible for tech to help? If info systems through to mobile devices had a sense of where they are and their status as carrying sensitive data recognised through digital IDs - plus additional meta-dynamic data, then 'cogeographic awareness' might result?

I blogged about this with ref to conceptual spaces.

This would be an artificial example and would make it possible for data previously designated as confidential, sensitive, - HOT data if you will - to self-destruct, 'e-vaporate' if it found itself beyond a given combined virtual or physical environment be that hospital, Trust boundary, SHA, or National border...? This capability already exists no doubt in the security services (although sometimes you wonder) or as suggested in the realms of 'MI' and '007'.

Cogeographic or (cogneographic) may be a neologism and seeks to conjoin the cognitive (cognition) involved in defining, representing and using concepts in conceptual spaces; AND the finding that knowledge is invariably situated - that is knowledge has a geography.

Copies of NHS and social care
data could - should - MUST
have a geography too...?

Another comment rightly questioned the ability to put personal data on
CDs and other media in the first place. Amid the emergence
of renewed debate about the future of e-health
records, clinicians may have a professional
duty to demand cogeographic
properties no
less ...?

Image source: http://www.tapintoquality.com/facts/glossary-d.html

Happy Anniversary 20th July!

Holistic care and 'where' it means....

Delivering holistic care does not mean being -

here	here
here	- or here

Holistic care is not even
about being in all these
places at the same time.

It means you have already
been to these places and you
will be going back again.

Holistic care also means
none of the participants travel alone ...

Well-being, Teddy Bears and the NYC Fresh Air Half-Marathon

These days 'well-being' crops up everywhere it seems. Literally in the crops and technology used to grow our food, in response to the rise of obesity and its personal and social impact. Diabetes, bullying, the need for exercise, personal space and quality time the well-being list and its associations is as long as the number of journals and magazine issues and covers it features in.

For Hodges' model though where can well-being be found?

I believe there is a risk that 'well-being', whilst it undoubtedly has a role to play in health and social care, education, media, policy (oh and lifestyle), runs the risk of diluting the critical health messages. Not in the sense of not dealing with critical health problems but not as bad as putting your health at risk. If you do not do X, or Y and put your well-being at risk this is not as bad as putting your health at risk...? Do people really make the right connection? One response to my initial question is as follows:

Emotional Well-being	Physical Well-being
Social Well-being	Political Well-being

Since well-being is a rather nebulous concept the risk is that -

'Well-being' may become* a sort of Teddy Bear comforter.

Well-being is very helpful in opening doors to walk-in centres, well man and women clinics and in damaging the stigma that surrounds mental health. For me though well-being is not to be found in the h2cm matrix, Well-being is the totality. It is how well we are in all the care domains. How well are they integrated? Well-being brings a whole new meaning to global health. Collectively this also includes that spiritual yearning found within humanity. Miss one domain out and like a pack of cards... ...

So next time you drag Teddy up the stairs easy
as you go....

Speaking of well-being: running while you can - is a great mantra because the ability to run is a great gift for those of us who can; whether 100s of meters or marathons. Here is news of what looks a truly great event across the Pond:



Hi again Peter

I sent you an email last week and didn't hear back so I thought I would try again. The Fresh Air Fund is still looking for runners and sponsors to join our Fresh Air Fund-Racers team for the NYC Half-Marathon on August 16th. It would be a huge help if you could post a mention of this exciting news on Hodges Model: Welcome to the QUAD. This is a great way to participate in NYC's premier summer road race while helping Fresh Air Fund children. Please feel free to use anything from our site...

Last summer's NYC Half-Marathon was a huge success and the Fresh Air Fund-Racers raised more than $125,000. We are also still in need of Friendly Town hosts for next month. Host families open their hearts and home to a NYC child who would not otherwise have the opportunity to escape the hot, crowded city streets. Please let me know if you are able to post or have any questions, and if you could send me the link that would be fantastic.

Thank you so much, (A pleasure Sara - all the best for next month!)

Sara
-----
Sara Wilson,
The Fresh Air Fund
sara AT freshair.org
www.freshair.org

Additional link:

Runners Web: Run for Charity

* may already be...?

Distorted care

Some musical performances are so polished, clear and (p)honed that we readily attribute them to the classical genre. There are experimental pieces that 'buck this quality trend' but the musicianship, melody and composition stand the test of time grabbing audiences by the ear, throat and heart. On the popular music front some bands - The Eagles spring to mind - are not universally appreciated for their sound, (sales), shine and harmonies.

Whatever the music though if you ramp up the volume enough - distortion happens. This disturbs and disrupts the artist's, composer's and producer's original intent.

The worry is that care can be similarly distorted, not only by those who can shout the loudest creating noise, but the political clamour that creates its own form of cultural background radiation. It becomes hard for everyone to listen and reflect on the track we've heard so many times since our teen years:
you know the one - 'Quality Care' by 'Informed Debate, Health & Social Lookyafters'.

Image my source: Sodahead.com

Additional link - BBC: Compulsory social care bill plan

Workshop: Making the most of the Potential of Assistive Technology

Dear KT-EQUAL/SPARC supporters

I am pleased to confirm that the next KT-EQUAL workshop, in this case organised jointly with and hosted by the Brunel Institute for Ageing Studies (BIAS), will take place on 17th September at Brunel University, Uxbridge. It is now possible to register for this workshop by going to the SPARC website (www.sparc.ac.uk). There is no charge for attendance just an enthusiasm and interest in extending the quality of life of older people through informed user-focused research and its application.

Making the most of the Potential of Assistive Technology will provide a round-up of recent developments in AT and the underlying research aimed at enhancing independence in the home, improving safety and security, extending the use of the car, managing continence, maintaining the body and stimulating the brain. It will also look at new models for the delivery of care through employing AT and how current research is supporting industry and government in the design, development and adoption of new technologies.

Several speakers have confirmed their participation:

Ms Keren Down MBE, Director of FAST, New Service Quality to Support Self-Care
Professor Rachel McCrindle, University of Reading, Safety and Security in Later Life
Mrs Eleanor van den Heuvel and Ms Felicity Jowitt, Brunel Institute for Bioengineering, Tackling Ageing Continence - and several other speakers are in the process of confirming/reorganising other commitments so that hopefully they will be able to take part:

Professor Heinz Wolff or colleague, Brunel Institute for Bioengineering, "The Companion" - Independence, choice and self-sufficiency for the housebound.
Dr Arlene Astell, St Andrews University, Nourishing the body and saving the soul
Dr Ruth Mayagoitia-Hill, Applied Medical Research Group, King's College London, From chairs to stairs
tbc, Middlesex University, Older drivers and technology
tbc, Centre for Information Systems Research, Brunel University, Supporting industry and Government in the design, development and adoption of medical devices.
The programme is being constructed and more details will be available in late July. We expect to start at 10.30am with registration opening at 10.00am and to finish before 4.30pm, with several presentations as well as lunch and refreshment breaks in between!

The workshop will be of interest to a wide range of practitioners and policy makers, health and social care practitioners, industry, charitable and government bodies concerned with the needs of older people, as well as researchers and academics from engineering, biological, social science, medical and health care disciplines.

Older people are especially welcome.

Please make certain to register sooner rather than later, especially if you are about to go on holiday as you might forget to register when you return!!!

We are delighted to be running this event with BIAS, a new and exciting grouping of researchers drawn from within and outside Brunel University.

Kind regards and best wishes for a relaxing summer

Peter Lansley
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
Professor Peter Lansley, BSc, MSc, PhD, MCIOB, FCOT
Director, KT-EQUAL – Knowledge Transfer for Extending Quality Life
School of Construction Management and Engineering, URS Building,
University of Reading, Whiteknights, PO Box 219, Reading, RG6 6AW, UK
p.r.lansley at reading.ac.uk www.sparc.ac.uk
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

My source: The KT-EQUAL/SPARC list
(I have registered and hope to attend this workshop)