World Mental Health 'Day' - what about the night shift?

For convenience sake our lives usually follow the sun's traverse. The majority of events associated with World Mental Health Day will take place during office hours and early evening.


I am looking forward to a local event in Leyland, Lancashire on Monday, which includes speed dating. This will provide that 10-15 minute opportunity to share and obtain information about other services and people involved in local mental health care. The agenda looks excellent and includes the active participation of carers and service users.

So, what of World Mental Health 'Day'?

Mental health - like all health and social care is a 24 hour affair. How often do we forget this? Of all the care (knowledge) domains I write about here, mental health remains the 'silent one'. If you have had worries, anxiety and much more besides you know full well there are actually 24 hours in a day and the silence is not because 'mental health' sleeps. So 'Day' is quite apposite in shedding light on what remains a poorly understood and  stigmatised aspect of health care and our lives. 

Comprising all four declared domains and uncertainty - the spiritual domain is not referred to in Hodges' model explicitly and yet in our day-to-day existence spiritual matters figure in lives just begun, journeys ongoing and lives at an end and people remembered. Whether we practice a religion, follow a belief there is no escape from news that relates to religion. Strange then: not listed in Hodges' model and yet more evident and prevalent than mental health it seems. In my career I have noticed how religion and mental health can be very uncomfortable companions for some individuals. One exacerbating or being the cause of problems in the other. By the same, or maybe a different token, religion is also a great source of comfort, solace, affirmation, peace and reconciliation for many and a crucial resource through the many people who work under the auspices of the World's religions.

I have tried to catch this 'relationship' in my categorization of links in the INTER - INTRAPERSONAL domain which includes:

Psychology, Mental Health, Therapies, with Philosophy, Ethics, Ideas, Context, Creativity, Theology and Inter-Transdisciplinary resources.

So wherever you are, I hope you find peace especially through this day and night, whether or however you illuminate your mind, heart and soul.

Image source: http://www.daily-tangents.com/ImageCat/ErthMoon/
and NHS various.

Health care and handedness

The word legerdomain featured on Wordsmith's Word.A.Day as listed below:

PRONUNCIATION:
(lej-uhr-duh-MAYN)

MEANING:
noun:
1. Sleight of hand.
2. A display of skill.

ETYMOLOGY:
From French leger de main (light of hand), from leger (light) + de (of) + main (hand). Ultimately the from Indo-European root man- (hand) that's also the source of manage, maintain, maneuver, manufacture, manuscript, and command.

It is a shame and a matter debated at large that specialists - whether medical or of other disciplines - are not held in the high esteem that they once were. And yet when you come across a leader and specialist in their field the way they deploy their knowledge, insight and skills remains something to greatly admire and respect. I mean knowledge and experience that transcends sole reliance on interpersonal skills and blinding people with jargon and 'science'. Such are the outcomes of what the specialist brings to the (operating?) table, that it may even seem like a sleight of hand. Not in the sense that it is a trick, but there is an effortless transparency to not only what they achieve, but how they make people - their patients, clients feel. Not just feel, but how these people react and may find themselves.

If there is a sleight of hand it is in how while a specialist, they can and do cross boundaries. They see and can count the important numbers (evidence) in their discipline, but they know (from some no doubt hard-won lessons) that frequently some of the numbers in the very sequence they need lie outside their comfort zone.

RIGHT-handed (mechanistic)

or

(humanistic) LEFT-handed

- they know there is a

middle

and they cross it, without anyone noticing.

Forensic Nursing: bio-psycho-social (political) steps

I've been searching for a definition of forensic nursing and came across this by The International Association of Forensic Nurses (IAFN)…

“the application of nursing science to public or legal proceedings; the application of the forensic aspects of health care combined with the bio-psycho-social education of the registered nurse in the scientific investigation and treatment of trauma and/or death of victims and perpetrators of abuse, violence, criminal activity and traumatic accidents.”
IAFN 2002

While seeing bio-psycho-social in the definition comes as no surprise - the list of areas, situations and contexts that forensic nurses may work in is enlightening:

• Interpersonal Violence
• Forensic Mental Health
• Correctional Nursing
• Legal Nurse Consulting
• Emergency/Trauma Services
• Patient Care Facility Issues
• Public Health and Safety
• Death Investigation

In writing about the relevance of Hodges' model in this field there is the assumption that forensic nursing is specialized, but built - of course - upon fundamental nursing principles and values. These are carried forward in forensic nursing theory and practice - Beyond Tradition, Advancing Humanity -  as the IAFN slogan ably puts it. Being reminded yesterday of mental health law (always a good thing!) in training on Mental Health Act 2007, I can see just how well Hodges' model can support the early bio-psycho-social steps of the nurse learner.  Then if students go on to specialize in forensic care, the model's political care (knowledge) domain will continue to serve them well.

Hodges' model: publications

The book chapter for Radcliffe Publishing is now in the hands of the editor. This is great step forward for Hodges' model (and me) in that the text considers the model within substance misuse care and services. To my knowledge the only other book chapter is that of Brian Hodges' in Hinchcliffe (1989) [please see the bibliography lower right].

The next project entails me completing my half of a paper on the application of Hodges' model in forensic nursing. My contribution introduces the model (with new text) to a forensic nursing audience and highlights why h2cm is of relevance to this very challenging specialised field of nursing. This is also a significant development being yet another clinical example and a co-authored effort. Collaboration with other people interested in and actually applying Hodges' model is definitely the way forward.

There are other topics that in championing h2cm would hit the sweet spot:

• Continuing the current vein - papers on clinical applications for the model in mental health, learning disability and health visiting. These are areas in which the model was first taught and originally applied. 

• The four original purposes for the model also compete for attention:

1. supporting holistic theory and practice;
2. reflective practice;
3. bridging the theory - practice gap;
4. curriculum development.

On that last theme, I need to type up a review of a book on curriculum development in nursing that will be featured here shortly. In the meantime if you have an essay, case study to complete, please bear h2cm in mind (and paper). ...

Foundations, projects, corners and cornerstones

Ok, so you have a new project - that's great!

Yes, we are going to build something - outstanding!

Sounds marvellous!

We are going to use up-to-the-nanosecond project management tools.

And you're going to do it by the book, charts and real-time tags.

Yes, with a dash of intuition plus - you know - gut instinct!

Well sure, pleased to hear that too.

We will take account of history, learn the lessons -
we've a researcher onboard you know?
Building a world-class team that's all fleet of foot and mind.

We'll tick all the boxes, check all the corners and leave no stone un-turned.

Truly admirable, but how many boxes and corners have you got and how many cornerstones* will you need?

Eh?

Hey listen up. Corners are for losers,

naughty children

and people lost in the dark.

Nobody is going to be stuck standing in the corner on this one!

Oh - right.

Well good luck....

Image sources:
'Cornerstone office': Cornerstone Corp. Center
Dan Flavin: at Artnet.

Inspired by the word 'cornerstone' and Untitled (Corner Piece) 1969 on visit to Tate Liverpool, 25 September 2009 (not the piece illustrated above):

Flavin made a number of works intended to be shown in corners, engaging directly with the architecture of the gallery. His use of commonly available fluorescent tubes enabled him to explore light as a non-physical material, animating gallery walls. The size of the work was determined so that the units could be fastened in the centre only, without having to be anchored to the floor. The artist rejected any symbolic significance of the object, insisting that it was simply a form that made good use of a corner.

Question: How many corners are there in Hodges' model?

*Cornerstones: here referring to stakeholders, sponsors, owners, partners, investors, builders, architects, designers...?

KT-EQUAL event Ageing Research 17 September

I was really pleased to be able to attend this event last Thursday (do check the site as there is an ongoing programme of workshops):

Making the most of the potential of Assistive Technology

This workshop organised in conjunction with BIAS (Brunel Institute for Ageing Studies) 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.

 

Hosted by: Brunel Institute for Ageing Studies
Sponsored by: BIAS and KT-EQUAL

10:20 Welcome and Introduction, The world of  BIB and older people, Chair for the morning, Professor Emeritus Heinz Wolff, Founding Director, Brunel Institute for Bioengineering (BIB), Brunel University 
10:30 New Service Quality to Support Self-Care, Keren Down MBE, Director of FAST
10:55  Tackling Ageing Continence, Felicity Jowitt, Brunel Institute for Bioengineering
11:20 Refreshments
11:40 From chairs to stairs, Dr Ruth Mayagoitia, Applied Medical Research Group, King's College London,
12:05 "The Companion" - Independence, choice and self-sufficiency, Edward Varney, Brunel Institute for Bioengineering
12:30 Discussion
12:45 Lunch
13:45 Introduction to the afternoon, The world of BIAS and older people, Chair for the afternoon, Professor Mary Gilhooly, Professor of Gerontology, School of Health Sciences and Social Care, Brunel University 
13:50 KT-EQUAL: its mission for older people, Professor Peter Lansley, Director KT-EQUAL, University of Reading
14:00 Older drivers & older IT users: designing new technology, Suzette Keith, Middlesex University
14:25 Safety and Security in Later Life, Professor Rachel McCrindle, KT-EQUAL Consortium, University of Reading
14:50 Tea
15:10 Nourishing the body and saving the soul, Dr Arlene Astell, St Andrews University
15.35 Technology for people with dementia, Eleanor van den Heuvel, Brunel Institute for Bioengineering
16:00 Discussion
16:30 End

As noted above Prof. Heinz Wolff duly and delightfully introduced proceedings and chaired the morning. As a community mental health nurse for older adults and informatics / ICT enthusiast the day certainly proved worthwhile for me. Here are some reflections on two sessions:

While clinical and information standards have and remain a preoccupation for me, Keren Downs' session raised the chicken and the egg problem of standards and quality in the development of self-care and assistive technologies. Keren's presentation highlighted the stasis in design in the older adults sector and the question of how to energise future vision and models for innovation. There was reference to Shaping the future of care together and Common Core Principals to Support Self Care 2008, Department of Health.

Funding inevitably featured - the green paper listing three options:

Partnership - government pays for between a quarter and a third of care costs ...
Insurance - government pays for between a quarter and a third of care costs ...
Comprehensive - everyone pays into a state insurance scheme, whether or not they need care, and everyone gets free care when they need it.

The next slide reminded me of the tilting, table fitted geriatric chairs of old as Keren Downes highlighted the relative stasis in design and need for change for this population group.

While form follows function - can it also stifle innovation? When you consider change in materials, people's homes, care environments, attitudes ... there must be opportunities for innovation?

I also recalled similarities between this market of assistive technology and that of benefits realization within nursing (health) informatics. Especially as barriers were considered such as:

• poor design (usability)
• information provision
• workforce competency
• procurement
• (To which I would add 'value added services' - maintenance, life-cycle management.)

As the speaker and work of FASTUK made clear, older adults represent a growing and emerging market, for whom standards and design will be critical if self-care and assisted living are to be fully realised *.

The final slide listed some reports and a web link as follows:

FAST reports: www.fastuk.org

• Assistive Technology supporting self care, July 2006
• Assistive Technology –Workforce Development, June 2007
• Annual Report to Parliament on Research and Development in Assistive Technology, July 2009

Felicity Jowitt in another session:

TACT3: Tackling Ageing Continence through Tools, Theory and Technology

- provided a concise non-medicalized definition:

Urinary Incontinence 'is a condition in which involuntary urine loss 
is a social or hygienic problem and is objectively demonstrable'.

International Continence Society definition of incontinence

The talk included explanations of the problems and how they arise, prevalence, management, available AT options and the anatomically - stigma driven challenges that male and female continence presents. To close new assistive devices were discussed. The creation and production of discrete, well-designed person- (in a social context) friendly aides, special pads and devices to detect the odour that signifies the need to change a continence pad before the human nose is alerted.

The sessions featured a Q&A session and amongst the many questions raised, I wondered about the ideal of continence aids that also help nurses and carers maintain high quality standards of care and professional values. ... Perhaps from the late 1970s I have antiquated notions of basic nursing care? It is shocking to hear stories of people being told to "do it anyway - you've got a pad on!". Does it not occur to these people that if the person is asking they obviously have insight and are distressed by their urgent situation. As to people who are confused and asking as a result of agitation - the mind boggles and the heart aches at the standards of care evident in such an attitude.

So, this was a really thought provoking and - despite the subjects - enjoyable event and I have only of course scratched the surface.

A related reference I am following up:

Duarte, L.R., Marquié, L., Marquié, J-C. et al. (2009) Analyzing feature distinctiveness in the processing of living and non-living concepts in Alzheimer’s disease, Brain and Cognition, Volume 71, Issue 2, November 2009, Pages 108-11.

Hodges model: indicative concepts in Substance Misuse Care

Hodges' model
in substance misuse services

psychological dependence vulnerable individuals, education, risk, assessment, review, motivation to change, harm reduction,  motivational interviewing, appreciative inquiry, life skills, education, advice, feedback withdrawal, aggression, hallucinations, change, drug use history, measures, care pathways, contract, rapport, empathy	substance profiles, abuse, signs physical dependence, health status, pregnancy, research methods, evidence, diagnosis, co-diagnosis, staff awareness, statistics, drug-treatments, triage, screening, scientific advice, dissemination models: stepped care, training, forensic science - mental health, classification, interventions, physical access, stepped care models
dependents, family, social network social attitudes, vulnerable communities, community projects, self-help, e.g. A.A., socio-economic depreviation, systemic - family, group therapies Advertising, housing, casual drug use, work, employment, benefit incentives, re-integration, inclusion, community, neighbourhood policing, drug culture, media	supply, cost of drugs - alcohol health & social care policy, service interfaces, statistics Drugs strategy, funding, X-agency working, funding, GP contract, commissioning, "client contract-plans", National Treatment Agency, NICE, Home Office, legislation, crime, offending, re-hab. / specialist teams / treatment facilities, Government data, community prescribing, employers

Sour grapes and 'holistic' academic publishing

Having been a student on several occasions, an independent scholar and online for the past decade (I was a late arrival) something is really getting on my pips.

When I see an Editorial entitled -

Theoretical Frameworks 

and Concept Development

in an established publication -

Journal of Holistic Nursing

That states - 

There is a commitment within holistic nursing to explore and refine terminology and frameworks that will enhance the care of patients and provide understanding about the healing process. To accomplish this directive, manuscripts will be published that provide an in-depth analysis of existing, alternatives, or extensions of concepts, frameworks, or theories associated with holism and holistic health and nursing. Holistic nursing involves a complex view of the individual, family, and environment that is constantly being challenged by new and emerging paradigms and information that furthers the ability to understand humans as multidimensional and pandimensional beings.

I do wish someone else would recognize the
holistic value inherent in Hodges' model.

That value is not there by default it has to be found, learned and earned, but there are few frameworks that can simultaneously encompass holistic nursing, healing, touch, global health, informatics disciplines, the green agenda and human ecology. ....

So come on just a whisper - who Dares...?

 

Ref:

Diane Wind Wardell, Editorial, Theoretical Frameworks and Concept Development, Journal of Holistic Nursing, American Holistic Nurses Association, Volume 27, Number 3, September 2009 158.

Additional links:

How many interfaces are there? 
http://hodges-model.blogspot.com/2007/04/hodges-model-how-many-interfaces-are.html

Hodges model: What is it? [2] It’s an interface...

http://hodges-model.blogspot.com/2007/01/hodges-model-what-is-it-2-its-interface.html

Lonely model seeks ...
http://hodges-model.blogspot.com/2007/12/lonely-model-seeks.html