Drupal musings 12: Semantic Web, ICNP, Case studies and Care domains

Drupalcon 2010 Copenhagen is over for me. It's been a really useful week: awesome indeed. My head is dizzy with all the options, sources and resources to consider. I will contact the London Drupalcon group for 2011 with some suggestions regards beginners, networking and outreach.

Ever since setting off on the Drupal road, the semantic web has been a constant item of street furniture. In Szeged '08, Paris last year and this past week in Copenhagen the semantic web, RDF and terminologies have had a pivotal presence. I did not attend all the rdf / SW sessions but Wednesday's Semantic Terminologies was sit on the floor popular (even though at that point the program hit a bottleneck from 6 to 3 streams). Whatever the cause - I was there, late and my pivot ached (no padding!).

As a Drupal 7 prelude I'm creating a Drupal 6 site, a basic homepage for someone. The content for the latter is fixed - sorted. Apart from the pages for the archive, the new h2cm content involves me figuring out how to combine:

1. the health career model;
2. nursing - in theory and practice;
3. external sources and resources;
4. and Drupal.

Johannes Wehner's terminology session above did not emphasize RDF, but highlighted Open Linked Data by means of Open Calais as a tool to extend existing content. I've downloaded the Drupal OC module and obtained a key.

As for the list: #1 The health career model is straight forward really. Four care domains - get on with it! From there though it is quite a reach to encompass #2 & #3. My options appear to be:

• free tagging, auto tagging - let the users of the site decide;
• pre-define a data set, a terminology (classification) for the health career model;
• use an existing nursing classification / terminology scheme - perhaps a subset.

Before I decide I need to be aware of what is available. I e-mailed Derek Hoy in Scotland - contact for the International Classification for Nursing Practice® [ICNP]. This is another thing I pick up, put down. ... Now thanks to Derek I'm sorted now with ICNP downloaded (and I will need a module to import .csv files). There are videos on the ICNP website.

I have followed the development of nursing terminologies for quite some time. The most striking thing to me is how removed they are from the day-to-night life on wards and other care encounter situations. With mental health as a Cinderella in terms of the politics and recognition of nursing service provision I am in effect professionally twice removed. For the vast majority of nurses on the ground and from where I work in community mental health the ICNP, SNOMED CT, Omaha and other schemes are rather esoteric things. They are there in the background, part of management and reporting 'function'. This is not to say that the above initiatives have few followers, or lacks experts in this field. Make no mistake nursing has its own geeks, nursing classification its experts!

The scope of ICNP makes it a great candidate (from the website) -

Diagnosis/outcome

Interventions

Individual 7 axes

1. focus
2. action
3. client
4. judgement
5. location
6. means
7. time

Plus:

• it's International;
• it's by nurses, for nurses;
• it has momentum (political and financial support);
• So it is credible, and research based.

Despite this, I must take a critical look at what is available for my needs and time available. All the above provide way too much for a first bash - prototype, proof of concept. I have the luxury of not worrying about safety. My project does not constitute an electronic health record or other variant. Yes, I want to prove the health career model and to this end I must also find or create several nursing case studies to interrogate within Drupal and h2cm.

Perhaps as things improve economically, nursing classification will be revived and will allowed the time to fully mature? I recall in 2006 plans to explore mental health within SNOMED which unfortunately did not materialise. So, when I say mature, I mean like cheese in the holistic senses of the ingredients: nursing care concepts across contexts that also incorporate self-care, recovery, demographic trends ...; and the process across communities of practice (integrated care) through to academic and management applications - research / reporting.

In March 2010 plans were announced of plans to harmonize the efforts of the ICNP and SNOMED CT nursing.

So, with a possible jumpstart - a sprint for my site this autumn in Manchester, UK and work afoot to make nursing classification matter on the 'ground' there is more to follow on several fronts. ... I remember a presentation Derek did in the 1990s about classification and making nursing visible - let's do it!

contact: h2cmng @ yahoo.co.uk

"Registered Nurse RN": What is in a Title?

or, Here is Saturday's Multidisciplinary Team selection;
Registered Nurses on the subs bench;
On the Roll, or Roll with the Times?

While never a union/professional body (formal) representative, I have as a nursing assistant then student nurse been aware of the 'political' in health. Once again perhaps another way in which I was primed to the reality of staff as a key (the) resource and hence the centrality of the workforce. Abbreviations are ever present and I remember RAWP - Resource Allocation Working Party; which also drew attention to geography and scale. Unfortunately, the vitality of the workforce has suffered with workforce planning inconsistently exercised.

Once again, I also recall a presentation by Derek Hoy on the need for information systems (data - information - knowledge . . .) through nurse informatics to help make nursing visible. It seems this is still an issue, for example:

Lyu, XC., Huang, SS., Ye, XM. et al. What influences newly graduated registered nurses’ intention to leave the nursing profession? An integrative review. BMC Nurs 23, 57 (2024). https://doi.org/10.1186/s12912-023-01685-z

Leamy, M., Sims, S., Levenson, R. et al. Intentional rounding: a realist evaluation using case studies in acute and care of older people hospital wards. BMC Health Serv Res 23, 1341 (2023). https://doi.org/10.1186/s12913-023-10358-1

Stadnicka, S.K., Zarzycka, D. Perception of the professional self-image by nurses and midwives. Psychometric adaptation of the Belimage questionnaire. BMC Nurs 22, 412 (2023). https://doi.org/10.1186/s12912-023-01564-7

 
Last month on a trip to Hay-on-Wye I picked up some back-issues of London Review of Books. Needless to say, in light of space and the clearing exercise I was very selective. The pearl of an essay cited below prompted me to wonder on the silence, quietness, lack of noise - invisibility even - of certain wards where registered nurses are present: or not? How and what data is captured and interpreted for reporting purposes and how meaning is gleaned and by whom? Making a difference in terms of patient safety and the quality of care:

LRB 45:18

"Call​ it the Jaap Stam conundrum. The story is told in Rory Smith’s entertaining book about the use of data in football, Expected Goals. Stam was a very talented but ageing central defender who had for three years been crucial to the success of Alex Ferguson’s Manchester United. Stam got into Ferguson’s bad books, and Ferguson decided to get rid of him, backed by data showing that Stam was now making fewer tackles. Stam was sold to Lazio for £16.5 million. Simon Kuper, co-author of Soccernomics (2009), about the use of numbers in football, wrote that this might have been the first deal in football based partly on data. It was, as Ferguson later admitted, a ‘bad decision’. Stam went on to have several productive years at the top of Italian football. The mistake was based on the fact that the data were Delphic. The question Man U wanted to have answered was ‘Should we keep Stam?’ Instead, the oracle answered the question ‘How many tackles is Stam making?’ But, as Smith writes,

'the best defenders do not need to make many tackles. The tackle itself is an act of last resort; great defenders intervene long before anything so tawdry is required. That Stam was making fewer tackles was not a sign that he was getting worse; if anything, it may have been a sign that his anticipation and his positioning and his reading of the game were all improving.'

Football, like Mao’s China, has discovered that getting hold of the data is one thing, interpretation of the data is another. The terms ‘data’ and ‘analytics’ are used interchangeably in sport, Smith points out, but in fact the gathering of data, fuelled by surging interest from sports teams and professional gamblers, has tended significantly to outpace the intelligent analytic use of that data."

("Delphic. It answers the question you ask, but it doesn’t tell you what to do.")

John Lanchester. Get a rabbit. Vol. 45 No. 18 · 21 September 2023.
https://www.lrb.co.uk/the-paper/v45/n18/john-lanchester/get-a-rabbit 

See also:

Gorsky M, Millward G. Resource Allocation for Equity in the British National Health Service, 1948-89: An Advocacy Coalition Analysis of the RAWP. J Health Polit Policy Law. 2018 Feb 1;43(1):69-108. doi: 10.1215/03616878-4249814. PMID: 28972019; PMCID: PMC6312698.

RAWP

https://www.kcl.ac.uk/sspp/assets/icbh-witness/rawp.pdf

Book for review: ii "Philosophy of Care - New Approaches to Vulnerability, Otherness and Therapy"

What I like here is being drawn (rescued then!) from the torrent that is the near reaches of the 

    bit, byte ... data, information, knowledge, wisdom

continuum, to its latter realm. The forever incomplete project of wisdom in 'care':

"Care, which is prior to all curing, identifies a fundamental availableness that has not yet been appropriated in the expert and technical discourses of care specialists." p.9.

This goes back to Pierron's 1st chapter focus upon 'Care: A New Arrival in the History of Philosophy'?

J. Braga & M. Santiago de Carvalho (Eds.), Philosophy of care: New approaches to vulnerability, otherness therapy. Springer.

A real gift for me (Hodges' model) is:

"Narration .. In opposition to the mathematization of the world, which reduces human problems to theoretical questions and to a universalized and rational formulation of moral dilemmas, the philosophies of care present a conflict of interpretations which deconstructs official and stereotyped narratives. Amy (or the voice of care) does not conceive a dilemma as a mathematical problem but rather as a narration of human relations, whose effects extends over time. (Gilligan 2008: 53)." p.13.

In addition to Tronto "Care is <<a species of activity that includes everything we do to maintain, contain, and repair our 'world' so that we can live in it as well as possible. That world includes our bodies, ourselves, and our environment>> (Tronto 2009: 143)." p.15. (see i) - I must add Gilligan to the list. 

In this weekend's FT, there's an item about the sorry state of the UK's statistical infrastructure (a post will follow, and mention of another book). I remember* Derek Hoy (RIP) doing a presentation about using data, and nursing informatics to make nursing visible. I wonder how he would make sense of the contrast between nursing whilst in COVID and post?

"Gilligan puts forward a distinction between a feminine ethics of care, which makes use of the idea of the natural solicitude of women by associating self-sacrifice and concern for others, and a feminist ethic of care, thought of as a critical approach that brings to light the mechanisms which favour the "invisibilisation" of care. The latter makes it possible to analyse the ways in which we lose the capacity to care for the other when relations of mutual caring are damaged." p.14. 

As usual below I've mapped some concepts to the domains of Hodges' model. 

Many thanks again to Springer for my copy.

Please note, also - as usual I am trapped in chapter 1! :-)

Individual

|

      INTERPERSONAL    :     SCIENCES                   

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

"Amy - voice of care" relational situated	data, information, informatics visibility statistical infrastructure
context equity - equality social justice	context feminism data - reporting accountability of government(s)

See also:
body & soul - Book: Philosophy of care: New approaches to vulnerability, otherness therapy

*https://hodges-model.blogspot.com/2010/08/drupal-musings-12-semantic-web-icnp.html