Global health: Organ failure and systemic sustainability

... or
Blue Planet :: Blue People

Original image sources:
Northern Europe - http://commons.wikimedia.org/wiki/File:Northern_Europe_10.17239E_63.58242N_center.png

Nursing human rights - dementia care II: fao Sir Gerry Robinson

The 2nd and final edition of BBC Two's TV programs Can Gerry Robinson Fix Dementia Care Homes? was on last night and made for uneasy viewing.

The saving grace for the public's confidence (if there is one) was repetition of the excellent care at one home.

For all the negatives presented on TV, before mapping the key content of this program using Hodges' model it must be acknowledged that the staff and both managers involved are to be congratulated in allowing and facilitating the production of this program. Sir Gerry and the program's producer(s) obviously travelled an especially difficult course in this episode.

Unless qualified or having undergone some training, many staff will behave and eventually modify their norms and expectations according to what they are exposed to within a short period of starting to work in residential care. Perhaps, this explains in part the adage 'start as you mean to go on'? It was apparent that many staff knew they were failing, they recognised the lack of leadership, their inability to sustain the effort for positive change.

This is why (in 1977 at least) the school of nursing I attended was a little more than churlish about students initially working as a nursing assistant. If you were not working on a ward that also trained student nurses then you may adopt the wrong attitudes and with it what we might call 'non-skills'. This includes 'learning' means of avoiding contact and interaction with patients; and possibly interpreting behaviour in a purely negative and non-therapeutic way. This may extend to the point of becoming personally involved - taking things personally - whether the behaviour exhibited is aggression or sexual dis-inhibition, for example.

Here then are some of the points I noted, many are repeated from the first program with some very unfortunate and troubling additions (which I may further review as per the above text):

PURPOSE, CARE PHILOSOPHY (none?), person-centered care, attitude, memory loss, vulnerable individuals, training, risk, assessment, motivation to change, interpersonal skills, motivation, listening, life skills, knowledge and skills, feedback, aggression, agitation, measures, rapport, empathy, +ve care, boredom, personal choice & autonomy, access to personal belongings, dolls, personal focus, anxiety, psychological stress and trauma of physical relocation

physical environment, colour, decor, noise, outside access - physical security, physical restraint - use of furniture, position of furniture, day-to-day items, tasks, PROCESS, measures 'dementia care mapping', routine tasks, time with residents, assessment, care files (paper!), bed occupancy, activities - painting, gardening, sheds, staffing cover : resident ratios, models of care (none?), objective measures

PRACTICE (common minimum standards), the residents, team work, day staff:night staff, collective faith and trust, collaborative objectives, care, shared enthusiasm, social attitudes, dignity and respect, relationships, social values, personal-social history, engaged activities, involvement, 'social' norms, inclusion, community - institution, being valued by others, impact on families and local community of home closure

POLICY (the lines in the sand?), management spot checks, '24 hour care', disciplinary procedures, professionalism in management relationships, duty of care, ratings: tokenistic inspection regime, home closure, consultancy, audit, legislation, sickness, pay, business ethos, staff morale, recruitment and retention, confidentiality, sanctions, management style, qualifications, standards, institutionalised care, re-location, lessons learned (business involved, local authority)?

There are also Open University learning resources associated with the program.

My closing thought: in closing the asylums over the past 40+ years I hope we have not and are not creating a series of micro-institutionalised replacements.

This is an issue for everyone.

The Communication Initiative Network and holistic bandwidth

In 2004 I attended a day at a community informatics conference in Brighton, UK (see the side bar for details). My interest in that event stems from recognising the different schools of informatics and the multidisciplinary potential for Hodges' model that extends beyond health and social care. The model provides a cognitive gymnasium for us to test and exercise our holistic bandwidth.

The notion of 'holistic bandwidth' really comes into its own within global development and communication. In 2004, or soon after I discovered The Communication Initiative Network. They kindly posted the Brighton position paper on their site and were very encouraging regards the model. Now they are developing a new Communication Initiative Social Networking Platform - http://groups.comminit.com/

There are many groups including:

• The Future of ICTs and Development
• Communication and Climate Change Adaptation

In the above group I learned of the following initiative :

There is an interesting initiative in Africa called AfricaAdapt. It is a network that works to facilitate the flow of climate change adaptation knowledge for sustainable livelihoods between researchers, policy makers, civil society organisations, and communities who are vulnerable to climate variability and change across Africa. There is a whole section on their website that allows for communities to upload their own information on how they are adapting to climate change. The initiative also offers an award for best community project which helps elicit contributions.

Africa: never far from the news. Lets hope this next week there is some +ve news from COP15 Copenhagen.

• Students - Communication for Development
• HIV/AIDS Strategy: Future Directions
• Polio Communication Consultation Group

There are diseases lost to the developed nations and with diseases like polio and leprosy communication and education are central to those who are ill and their families. Even as a nurse there is a stark reminder in the need for an International Leprosy Day.

• Gender, Education, and HIV/AIDS

On the teaching psychology list someone asked this past week about alternatives to structure a student's lifespan assignment. I suggested Hodges' model an approach that can also be adapted to educate people about disease ....

SCIENCES: aetiology, prevention, transmission, hygiene, diagnosis, prognosis, evidence, research, physical resources, drugs, nutrition, age, weight...
INTRAPERSONAL: attitudes, beliefs, education, literacy, personal responsibility, mood...
SOCIOLOGY: social networks, cultural beliefs, gender expectations, community, family, friends, trust...
POLITICAL: policy, leadership, funding, activism, infrastructure: housing heating..., access to services, media, employment, governance...

• Ethics in Communication for Development
• Gathering Theories and Models

This group only has 5 members and is of obvious interest to me. I can't recall whether I signed up: must check! Planning and development in this context covers topics and issues I know nothing of and yet I am sure that dressed in its socio-technical guise Hodges' model can contribute to the theoretical development here. It could be that there are other perspectives, models and conceptual frameworks to be found that can inform the global health agenda?

• DRAFT: Technical Update on Social Change Communication and HIV/AIDS
• Human Rights and Technology
• Web Site Directors

So, do visit the Communication Initiative both the new groups above and the general website.

NHS clinical informatics best practice marketplace 25th March 2010 Waterside, Watershed, Bristol

An opportunity to share innovations and experiences in the field of clinical informatics that can make a real difference to patient care.

25th March 2010 - Waterside, Watershed, Bristol

A collaboration between:

UK Faculty of Health Informatics and Bristol Royal Children’s Hospital -

Dear Colleague,

We would like to invite you to participate in an innovative new meeting which aims to bring together clinicians and social care staff from various backgrounds, who are involved with real world informatics solutions.

Many of the themes that we will be covering at our first market place are focusing on sharing informatics solutions that have already made and can make huge differences to patient safety and the overall quality of care.

The 6 main areas that we plan to cover on 25th March we hope are of huge interest, potential and at times frustration for NHS and Social Care staff, patients and carers. These are:

1. E-prescribing with decision support in secondary care

2. Clinical incident reporting systems and clinical audit tools

3. The development and use of community based information systems spanning across mental health, long term conditions and social care

4. Telecare and the use of teleconferencing in patient care

5. Clinical portals, patient portals and the use of clinical dashboards

6. Medical simulation and its use in clinical learning and development

The features of the proposed market place are very distinct from existing conferences and trade exhibitions in that it will be:

• Clinically focused – the issues that we are trying to find solutions to and share lessons learned from are led from a clinical viewpoint rather than a technical or sales perspective. There will be suppliers present but they will all have been invited along by Health or Social Care service provider.
• Focused on real experience of what already works – too often NHS staff have felt frustrated by suppliers promoting technical developments that haven’t actually yet been deployed in UK health and care settings. This market place is designed to share what has already been tried and tested in different parts of the NHS and Social Care from across the UK from a clinical/service perspective.
• Free of charge – the event is funded by the UK Faculty of Health Informatics and has been organised in partnership with Clinicians from Bristol Royal Children’s Hospital and academics from the University of the West of England. The personal details used when registering will not be shared with any other suppliers i.e. no follow-up sales calls or invitations to demonstrations
• Provide access to established Communities of Practice – if you want to progress ideas or issues more you will be able to sign up for free membership of an on-line community based on the Department of Health’s Informatics Directorate’s eSpace platform as well as other groups in order to keep in touch with other people that you have met on the day.

Format and structure:

Although the market place will be open all day from 9.30am until 5pm, unless you are a presenter or exhibitor you only need to attend when you wish to or are free to.

Short presentations on each of the 6 main themes will take place throughout the day from 10am until 4pm in a separate auditorium adjacent to the market place. You can attend as many of these interactive presentations as you wish.

We will have a limited number (around 16) stands for participants and their associated suppliers to demonstrate their solutions

The event is designed for staff working in Medical, Nursing, Pharmacy, AHP, Social Care, Informatics, Senior Management, Communications or Education and Training roles.

Support for back-fill and travel costs will be available to NHS and Social Care staff who exhibit a solution and/or share their experiences at one of the plenary sessions.

Organisation and next steps:

The event has been organised by 5 members of the UK Faculty of Health Informatics, including:

Bruce Elliott – Co-ordinator of the UK Faculty of HI/ Programme Manager – DH Informatics Policy & Planning, ... bruceelliott at nhs.net

If you would like to share your experiences at the event please contact leon.rushworth at nhs.net by Friday 29th January 2010.

You can book your place at the event by registering at ...

We hope that it is of real interest to you.

Kind regards

Bruce Elliott

The UK Faculty of Health Informatics purpose is:
To stimulate the uptake and application of Informatics research and development within UK Health and Social Care services in order to improve the quality of care for all.
This is done through providing opportunities for anyone with a passion for applying their Informatics knowledge and experience in practice to participate in:

• an engaging on-line discussion forum
• vibrant face to face events and meetings
• writing relevant and stimulating reports and papers
• sharing their own research findings

Online Deliberation: Design, Research, and Practice

This is the website for the book Online Deliberation: Design, Research, and Practice, edited by Todd Davies and Seeta Peña Gangadharan (CSLI Publications, November 2009).

All content on ODBook.Stanford.Edu is licensed under a Creative Commons Attribution-Share Alike 3.0 Unported License.

My source: Community Informatics list.

(many) Care Transitions and The Little '-' That Could

Some people looking at Hodges' model may believe that the model perpetuates the dichotomies of old:

Human --- Machine
Individual --- Group
Sick --- Healthy
Supply --- Demand
Home --- Hospital
Self care --- Nursing care

In the 1990s as a community mental health nurse I was involved with a group of general nurses looking at ways of improving:

• discharge planning
• continuity of care

These issues remain and with the dichotomies of care above we can see how Hodges' model can assist our thinking and planning about transition. Not just one transition, but several.

This past week I was fortunate to attend one of a series of workshops -
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, Leeds, UK

Organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group

The event was very good, stimulating and challenging. In the closing debate the appeal of 'socio-technical' and how to market a much needed joined-up approach in health IT came down at one point to the difference between:

'socio-technical' and 'sociotechnical'

In trying to find an alternative title, the hyphen was lost, and whilst it is not a crucial issue - for me that hyphen represents the axes of Hodges' model. Hodges' model acts as a high level aide-mémoire and that little hyphen can perform the same trick. The hyphen reminds us of the differences. The dichotomies that need to be navigated and negotiated in our dialogues about care AND caring. These are most evident in transfers and transitions (after all - "getting out of bed is a risk").

There are mini and macro transitions. Care pathways are not yellow-bricked unbroken splines from cottage to cottage hospital. They should be tortured if they do reflect person-centered experiences and needs.

Some transitions are process laden and repetitive, such as drug administration and must be protected - free from interruption. Although grounded in a social exchange of (correct) identities: a registered nurse, the right patient, right drug, right dose, right duration and right time these can be framed within the SCIENCE domain. That is where (for me) the conventional 'drug round' can be found. Counselling is another transition (if effective it also moves people on). 'Counselling' can be found in the INTRAPERSONAL domain - close to the border with SOCIOLOGY.

Other transitions and transfers are more involved:

• person's home to attend day care (for the first time!)
• person's home to residential home
• hospital ward to home
• home encounter with the crisis team
• telecare consultation
• ...

Care is constantly passed hence the need to write and record. Passed from -

person-to-person
team-to-team
team-to-carer
time-to-time
discipline-to-discipline
self-care

This is the outcome that is sought. Ultimately passing responsibility back to the individual and when applicable their family. Having formal integrated care pathways is one thing, but they are never truly continuous, clear and true. And as they say crossing bridges you may have to break step and surely different disciplines march to different tunes? Today though the most audible tune must be socio-technical. ...

Additional link: The Little Engine That Could
Image source:
Drug round tabard http://internet-workwear.co.uk/acatalog/Drug_Round_Tabard.html

IMIA monthly news bulletin; no. 8, 08 December 2009

My source: Rita Arafa, BCS Health Northern Specialist Group, Membership Secretary.
Original source - IMIA: International Medical Informatics Assoc. see below.

For more frequent news updates, and subscription options by email, RSS feeds, etc., see the IMIA
...

Items:

1. MedInfo2010
a] Early bird registration deadline
b] Submissions feedback dates
2. Forthcoming events
a] IMIA Working Group activities
b] Regional events
c] National/international events
3. Boards (deleted for brevity)
4. Publications
5. Corresponding members - new SOP (deleted for brevity)
6. January 2010 bulletin

1. MedInfo2010

MEDINFO 2010 - 13th World Congress on Medical and Health Informatics;

12 to 15 September 2010 in Cape Town , South Africa.

a] Early bird registration deadline

Early bird registration closes 18 December 2009 - book early to save money. The site for conference registration and accommodation booking payment is open - via the main MedInfo 2010 website.

(NB BCS Health will be offering funding for those participating in Medinfo 2010 – details to be announced soon).
b] Submissions feedback dates

The SPC and reviewers are currently working hard on the paper submissions and other scientific submissions. Notification on acceptance of papers should be by 28 February, 2010.

2. Forthcoming events

Due to the increasing number of events, we will only here mention those in 2009-10. Notices of events in 2011 and beyond will be added to the IMIA website and IMIA news website when they are announced or when there is significant new information.

a] IMIA Working Group and Special Interest Group activities

The IMIA Health Information Systems Working Group (IMIA HIS WG) will be organising a two day workshop on Health Information Systems – 30 Years of Evolution, that will take place on September 10-12, 2010 in Stellenbosch, South Africa, just before the Medinfo 2010 Conference in Cape Town, South Africa. Further details will be advised in due course.

A number of WG/SIG chairs and vice chairs have changed as of the 2009 GA. This information will be updated on the IMIA website in the next few days. ... If WG/SIGs have activities planned, please send in the information so that we can help promote them.

b] Regional events

The 2010 Special Topic Conference (STC) of the European Federation for Medical Informatics (EFMI) will take place in Reykjavík, Iceland on June 2-4, 2010. The event has the theme ‘Seamless care – safe care. The challenges of interoperability and patient safety in health care’. 

c] National/international events

HIMSS10 - March 1-4, 2010. Atlanta, Georgia, USA. http://www.himssconference.org/

eHealth2010 - May 6-7, 2010. Vienna, Austria. ...

e-health 2010 - May 30 - June 2, 2010. Vancouver BC, Canada. http://www.e-healthconference.com

HINZ2010 - 2-4 November, 2010. Wellington, New Zealand. http://www.hinz.org.nz

AMIA2010 - 13-17 November, 2010. Washington DC, USA. http://www.amia.org

4. Publications

Applied Clinical Informatics (ACI) is a new official eJournal of the International Medical Informatics Association (IMIA) and the Association of Medical Directors of Information Systems (AMDIS), and will be published by Schattauer. This is Schattauer's first online journal. Full information about this new development, including instructions for authors, can found at the journal website –

http://www.aci-journal.org

The proceedings of the Post-Congress Workshop of the 10th International Nursing Informatics Congress (NI2009), which was held at Vanajanlinna, Finland on July 1-4, 2009, are titled “Personal Health Information Management – Tools and Strategies for Citizens’ Engagement”. The 215 page book has been edited by Kaija Saranto, Patricia Flatley Brennan and Anne Casey.

6. January 2010 bulletin

The January 2010 bulletin will be published on 04 January. We welcome all feedback (to imia@imia-services.org) and any news items, conferences, etc for the websites.

END OF IMIA News Bulletin, December 2009
- - - - - - - - - - - - - - -
Dr Peter J. Murray
Executive Director
IMIA, International Medical Informatics Association

Nursing human rights and Int. Human Rights Day: fao Sir Gerry Robinson

On last nights BBC Two TV program: Can Gerry Robinson Fix Dementia Care Homes?

- amongst the angst his visits and engagement with several care homes provoked Sir Gerry highlighted the need for a moral compass and compassion. The themes I expected to find were there: the need for person-centered care, knowledge of the clients and their backgrounds, being occupied and having access to a secure environment when the weather permits, staff morale and the level of staff training and competence. Although not necessarily 'enjoyable' viewing the program was very good in raising awareness and included either directly or indirectly:

person-centered care, attitude, memory loss, vulnerable individuals, training, risk, assessment, review, motivation to change, interpersonal skills, motivation, listening, life skills, knowledge and skills, feedback, aggression, agitation, change, measures, rapport, empathy, +ve care, boredom, diurnal variation of mood, personal choice & autonomy	physical environment, colour, decor, noise, outside access, physical security, nutrition, tasks, processes, measures 'dementia care mapping', routine, meal times, time, physical risk - falls, mobility, assessment, care files (paper!), bed occupancy, staffing : resident ratios, models of care
the residents, visitors, family, love, social attitudes, dignity and respect, relationships, social values, personal-social history, engaged activities, involvement, 'social' norms, inclusion, community - institution, being valued by others, distraction	records, freedom, care funding costs / weekly charges, funding, inspection, consultancy, audit, legislation, rules (meals), pay, investment, business, staff morale, recruitment and retention, financial risk, confidentiality, plans and initiatives, management style, qualifications, standards

Today 10 December 2009 is also International Human Rights Day. To many people elderly care issues in a Western democracy may seem a world away from 'human rights' as per:

• false imprisonment
• denial of justice, law and order
• political repression
• freedom of expression
• education and health for all
• discrimination
• ....

- and yet the situations that arise within nursing, health, social care are never far from ethical and human rights concerns:

• Mental capacity
• Consent
• Physical restraint
• Mental health law
• Environmental health law
• Conscientious objection
• Medicine and nursing in the armed forces
• Equity and equality
• Accessibility
• ....

Moral dilemmas can and do arise in any and all of the care domains of Hodges' model and all combined (the spiritual). In addition to a moral compass, it seems we need a compass in nursing in order to be compass-ionate.

Hodges' model can provide a compass.

A compass to help navigate open waters, new coastlines and the uncharted corners and recesses of human nature.


Additional links: Amnesty International

POLITICAL care domain resources


Compass image: http://clipart-for-free.blogspot.com/2008/07/compass-rose-clipart.html