Int. Nursing and Nursing Informatics Day: the big 'C' and little 'c' in nursing

12th May is International Nurses Day and International Nursing Informatics Day: so have a great day!

Even though the vast majority of people use information and communication technology in their work - and this includes nurses - there are many within and without the profession who will wonder what has nursing to do with 'IT'?

Surely 'nursing informatics' is being opportunistic in piggy-backing on the day to celebrate nursing; after all nursing is about people NOT technology? Well that is of course true, technology is a means to an end not an end in itself for nursing. Perhaps there is another way of coming at this and it lies right at the heart of -

I.c.T.

AND
nursing

It is of course: COMMUNICATION

As I have described on in several posts on W2tQ communication is the means by which health and social care professions differentiate and so define themselves. Communication practices, processes, purposes and policies also provide the foundation for standards and governance. Communication is also at the heart of I.T. and various informatics disciplines. Informatics has benefited from communication models such as the Open Systems Interconnection Reference Model (OSI Reference Model or OSI Model). Nursing and health curricula also stress communication although of course in markedly different contexts.

So where is the glue that enable nurses and informatics to spend this Day together (the degree of harmony is another post)?

The glue for me is the concept of information and the associated concepts of data and knowledge. To which we add a demographic nod to wisdom.

So to all nurses the world over whether you are in nursing, informatics or hopefully you 'work' in both: have an infoeau riche day!

Primary Health Care Specialist Group (PHCSG) Summer Conference 2009: Patient Safety – who cares?!

Patient Safety – who cares?!

Primary Health Care Specialist Group (PHCSG) Summer Conference 2009

29th June – 1st July at Chesford Grange Warwickshire

The event attracts a wide group of people including GP’s, other practice staff, nurses and allied health professionals, ICT staff, PCT staff, system suppliers and researchers.

UKCHIP Accredited towards Continued Professional Development (CPD)

Programme and online booking available at http://www.phcsg.org/

Programme Topics include:

• Clinical Risk Management
• Clinical Safety Testing of the Care Record, and Information Governance
• The Future of NHS IT: life after NPfIT in primary care
• Patient Confidentiality – the current legal position
• Practice Accreditation
• Data Extraction from Primary Care Systems (GPES)
• Updates on GP2GP and EPS
• NHS Resources Centre – free training for staff
• Care Pathways- peril or profit?
• Use of Clinical Indications
• Medication Safety Alerts
• RCGP Guide – Making IT work for you

Exhibition - As well as the formal programme the conference provides an excellent opportunity for networking and is supported by an exhibition, which features many of the established IT suppliers to primary care alongside suppliers with exciting new products and services. Come and chat to exhibitors and hear how they are developing and promoting their products or services to enable “Patient Safety”.

Interested in Exhibiting or Sponsorship Opportunities, or need further information?
Contact Jill Riley email jill at phcsg.org

Guidance: Breakthrough to real change in local healthcare - a guide for applications to create Health Innovation and Education Clusters (HIECs)

6 May 2009: The Department of Health is investing £10 million in the introduction of Health Innovation and Education Clusters (HIECs) across England. HIECs will be partnerships between NHS, higher education, industry and other public and private sector organisations. They will support the spread and adoption of innovation locally and strengthen professional education and training.
This guide describes the vision for HIECs, the role of HIECs in education and training, how HIECs will support innovation and the application process. This starts a period of informal dialogue with strategic health authorities (SHAs) and prospective HIEC partners, leading to expressions of interest in early September 2009 and a final announcement on the first wave of HIECs in December 2009. SHAs are co-ordinating applications and, as part of the process, they are arranging regional stakeholder events.
Contact details for the SHA in your area are included.
Published by Department of Health, UK

Review: Tackling Health Inequalities - ten years on

A review (Published: 7 May 2009) of developments in tackling health inequalities in England over the last ten years.

This report reviews developments in health inequalities over the last 10 years across government - from the publication of the Acheson report on health inequalities in November 1998 to the announcement of the post-2010 strategic review of health inequalities in November 2008. It covers developments across government on the wider social determinants of health, and the role of the NHS. It provides an assessment of developments against the Acheson report, reviews a range of key data sets covering social, economic, health and environmental indicators, and considers lessons learned and challenges for the future.

Published by Department of Health, UK

c/o Alex Scott-Samuel The Spirit of 1848 list

Nursing Times: Safety ytefaS :semiT gnisruN

This weeks Nursing Times includes an article by Liz Owen 'Improving compliance with the C. difficile root cause analysis tool' (2009). The piece includes a section that highlights* the importance of reflection, which together with action planning underpins the concept of root cause analysis (p.16).

There are three references in particular cited: Murphy (2002) in relation to the infection and prevention team giving leadership to staff committed to reducing health care associated infections (HCAI) rather than accepting sole responsibility for HCAI. This also entails capturing the 'hearts and minds' of staff (Shapiro, 2003) completing the root cause analysis tool (p.16). Amongst many interesting points - it was found that there were unexpected benefits too (Glanfield, 2003) notably - strengthened relationships and improved attitudes.

This reminds me of affordances in human-machine interfaces and the use of technology more generally. As Owen and others show whatever we call these unexpected outcomes they are by definition unexpected, or not readily accessible to our initial perception and reasoning. Owen found that clinical engagement and leadership proved central in this project. Is there a way to foresee more of the 'unexpected' whether barriers or benefits?

Before being able to engage with others we need to be aware and able to -

reflect on our own hearts and minds.

A coherent team with the inevitable chaotic-creative outliers that (just 1 or 2....) personalities bring might just help us see around the corners - an additional key asset to safety...

Murphy, D.M. (2002) From expert data collectors to interventionists: Changing the focus for infection control. American Journal of Infection Control; 30: 120-132.
Shapiro, A. (2003) Creating Contagious Commitment. Hillsborough, NC: Strategy Perspective.
Glanfield, P. (2003) Towards sustainable change and improvement. In: Pickering, S.P. (ed) Clinical Governance and Best Value. London: Churchill Livingstone.
Owen, L. (2009) Improving compliance with the C. difficile root cause analysis tool. Nursing Times; 105: 16, early online publication.
*even if that is just a subtitle?

Drum Beat Network: Development Policy Ideas and Critique

To: Academics and other Researchers in The Drum Beat Network
From: Warren Feek - Executive Director - The Communication Initiative

Development Policy Ideas and Critique

Dear Peter

Many best wishes. Never has consideration, analysis and debate of Development policies been more important. We would welcome your Development policy ideas, analysis and thoughts being shared through The CI's policy process [with and supported by The BBC WST].

There is a coming opportunity to give your Development policy ideas wide circulation. We will be doing a theme issue of The Drum Beat e-magazine [subscriber base of 44,000 in development action and thinking) in mid-May based on the blog submissions to the Policy section on The CI site.

That policy site is receiving increasing access and engagement from amongst the 2,700,000 individual user sessions over past 12 months on The CI portal.

A significant and growing percentage of the CI network and user base are policy makers and funders and their support staff.

It would be excellent if you are able to blog - we encourage a substantive op-ed style (my link) - on an interest to you within the overall theme for this blogging process - namely issues of development policy. There are more details at http://www.comminit.com/en/node/286565/bbc

To participate, simply send me your blog [op-ed] contribution in whatever form you wish and we will consider and process it for possible featuring both on the policy blogging site and in the mid-May Drum Beat.

We would also welcome your comments on the present blogs that have commenced this process and can be seen at http://www.comminit.com/en/development_policy

So, if you want to join this blogging process - in the Op-Ed style we have adopted - on development policy issues and themes as featured through Policy tab at top of all pages on site - www.comminit.com - then please check out the guidance notes at
http://www.comminit.com/en/node/286565/bbc and email me your contributions - wfeek AT comminit.com

It would be great to have your reflections in this policy mix. Please do send your contribution.

(edited for length) ...

Thanks - Warren
--------------------
Hi Warren, Thank you for this news and invitation. A very interesting and worthy project all the more so with the use of op-ed style. I'll see what I can do - perhaps using the h2cm matrix ... Good luck! PJ

GIS a look (and learn)!

Starting work yesterday my colleagues and I had a real surprise.

The boss greeted us as positive, jovial, forward thinking and smiling as ever. Something seemed strange, but as we got to our floor we were handed some note paper and briefed - very briefly - about a "local surprise for you hard-working, dedicated clinicians".

So it was off to the desk and on with the log-in. The surprise came with the provision of a series of maps and questions and exercises. The maps just like google maps, multimaps and other variants provided various views and choices of emphasis; street, satellite and several boundaries: our organization's borders the frontiers of partner PCTs, GP practices, social services. After all these decades GIS had arrived on the clinician's desktop.

There was more to follow though. My mug-shot was there in addition to my colleagues (ah... I'd wondered what that recent (online*) form was for). Drag and dropping this beautiful pic on the map the nursing homes pulsed (as if to confirm that I am alive at least clinically) and changed colour. I know something about drill down, aggregation and such like and there they were: caseload parameters: gender, referral source, diagnosis (if known), drug classes, MMSE. I was getting heady as it was possible to look at clients living at home AND/OR residential care. I nearly flipped when there was more available about the referrers and not just the frequency of referrals but the expected frequencies too. There was going to be quite a compare and contrast exercise there post-2011 Census.

On another map I suddenly thought of 'use the bus Ethel': a carer who when she could went everywhere and also used the trains. Active body : Active mind and there it was - the travel logistics and public transport routes across the patch. This was not just GIS on the clinician's desktop it was GIS for the caseload manager. What proportion of my caseload was within 2, 4, 6, 8 and 10 .... miles of base?

Individual insight aside there was team oversight too, a tool to engage in peer group supervision - with (and get this) tools for the 'integrated health and social care team' to investigate local commissioning and how that factors in geographically. Amazing! Yes there are tools to do all this now, but they are not in the hands of the people they should be. Reports are just for managers? What a waste!!

I was just really getting ready to do that piano-playing-finger-flexing thing that you do when you are about to be extraordinarily creative. I mean I had waited for this, public MENTAL health.... my mouth was dry and here it was - GIS nirvana...

Then it happened....

It was time to wake up and get to work.

I won't stop dreaming though....

*I should have recognised it was a dream at this point.

Additional links:

Welcome to the GIS Files

Free Our Data

ESRI

Mapinfo


Image sources: Ordnance Survey

Crossroads - was c/o http://www.photochart.com/photo_1189_Crossroads.html
and Copyright Olga Dunaeva

Issue 2, 2009 of The Cochrane Library

Issue 2, 2009 of The Cochrane Library is now available. Among the new and updated Cochrane Reviews you will find :

• Homeopathic medicines for adverse effects of cancer treatments
• Music for stress and anxiety reduction in coronary heart disease patients
• Interventions for preventing falls in older people living in the community
• Extraction of primary (baby) teeth for unerupted palatally displaced permanent canine teeth in children
• Psychological therapies for the management of chronic pain
• Topical treatments for chronic plaque psoriasis
• Alcohol and drug screening of occupational drivers for preventing injury
• And many more … www.thecochranelibrary.com

Some of these reviews have been highlighted in Evidence Podcasts and are free to access.

Please see the Release Notes for a summary of the updates in this issue. Users can also access our Highlights PDF to learn more about the findings of new and updated Cochrane Reviews.
The Cochrane Library

The Cochrane Handbook for Systematic Reviews of Interventions is now available in print format. It is published by John Wiley for The Cochrane Collaboration.

Editors: Julian P. T. Higgins MRC Biostatistics Unit, Cambridge, UK Sally Green Australasian Cochrane Centre, Monash University, Melbourne, Australia

There is a 25% discount for Cochrane Review authors and an information page for the book where authors can also order, with a prompt to enter their discount code.

Wiley authors are entitled to a 25% discount not only on their own titles, but on all Wiley books, when ordering either via the site, by phoning customer services or filling in any printed order forms.


Images and my source: John-Wiley mail-list

Cash Transactions : Care Continuity

In programming major applications such as finance there is a need to ensure within the transactions and the database operations that mistakes do not occur.

The classic example is a transfer between two accounts:

def transfer(from, to, amount)
  from.debit(amount)
  to.credit(amount)
end

It is vital that the above method (example provided by Tate and Hibbs) does not fail after the debit. In Rails the transaction method help to prevent 'digital accidents' as follows:

def transfer(from, to, amount)
  Account.transaction do
   from.debit(amount)
   to.credit(amount)
  end
end

transaction is itself a method built into Rail's Active Record that helps to maintain the integrity of transactions. Which brings me to 'care'. ...

There are several blog posts here since you reach a stage in your career when the hard fought lessons of yesteryear have to be faced again but this time like after dinner wind.
There are many possible care transactions that arise.

Many have a specific context and frequently these are conjoined:

• timing
• relationships - trust
• responsibility - transfer
• care environment
• record (paper, electronic)

As to care transaction consider these:

def transfer(from, to, care_plan)
 Care.transaction do
  from.hospital(care_plan)
  to.community(care_plan)
 end
end

def transfer(from, to, day_care)
 Care.transaction do
  from.home(day_care)
  to.day_center(day_care)
 end
end

Wherever, whenever, whatever and whoever your transactions involve, take care of them and remember in health and social care (esp.) outcomes add up.

Don't forget to look after the however: the information, the knowledge, the promises ....

def transfer(from, to, promise_plan_of_action)
 Care.transaction do
  from.nurse(promise_plan_of_action)
  to.carer(promise_plan_of_action)
 end
end

Reference: Bruce Tate, Curt Hibbs (2006) Ruby on Rails: Up and Running, O'Reilly, p.35.