Assisted Dying Bill - UK

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Choice by dying person of how they die Anticipation of role of AI Where does mental illness 'lie'? Decision needs approval by two doctors Change in relationship between: INDIVIDUAL -	Prognosis of < 6 months Terminal diagnosis Anticipation of role of AI Seek assistance to end their life Decision needs approval by two doctors What of patients who are comatose?^
Profound Societal Change Quality of Life Quality of Death Impact of 'poor' death on others - friends and family Vulnerabiity of certain groups Lest we forget what happened to the nursing and care home sector during COVID*	and the STATE UK - House of Lords Oversight Panel:  Legal figure e.g., King's Counsel; and a Psychiatrist Doctors and care workers not compelled to take part in assisted dying What about the psycho-POLITICS of anorexia, severe depression?

^Brian M. Rosenthal. They woke as doctors prepared to remove their organs. The New York Times International Edition, 11 June 2025, p.6. 
https://www.nytimes.com/2025/06/06/us/kentucky-organ-donations.html

*https://covid19.public-inquiry.uk/hearings/care-sector-module-6-public-hearings/

"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

Intima - Creativity in a Time of Crisis: Rethinking Vulnerability in Response to Care and Social Justice

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HERO?	HERO?
HERO?	© COVID Hero by Brandon Mogrovejo Fall 2020 Intima

 

Welcome to the Fall 2020

Intima: A Journal of Narrative Medicine

We invite you to explore the issue.

 

In much the same way narrative medicine practitioners invite their patients to become storytellers, vulnerably disclosing their illnesses, we invited contributors to engage in their own acts of vulnerability to submit their poetry, art, media, fiction, nonfiction, Field Note, and academic pieces to the Fall 2020 issue of Intima: A Journal of Narrative Medicine.

More specifically, we invited submissions around the theme: Creativity in a Time of Crisis: Rethinking Vulnerability in Response to Care and Social Justice. Pen to paper, brushes to canvas, and strokes to the keyboard produced a wealth of submissions, many of which hearkened the specialized theme, to narrate the challenging public health and racial unrest that marred 2020. Whether the invitation arrived with much anticipation or as a surprise, we were heartened at the warm response we received and the quality of work we accepted for publication.

The pieces comprising the Fall 2020 issue are varied yet many evoke the images of 2020 as you read stanzas in a poem, gaze onto art, or pour over lines of narrated personal experience. Go to theintima.org to dip into the Fall journal today.

 

My source: Intima - mail list.

Book: "Of Human Potential"

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"1. The picture we have painted of human nature is centered on the notion of action as purposive, symbolic, and social - actions both reflective of prior norms and creative of new ones through the instrumentality of choice. ... 3. Their courses are modified by belief and interpretation, fear and hope, recollection and anticipation, symbolism and value.	2. Human lives thus do not ride on fixed rails; they do not follow trajectories already laid down by physics supplemented by biology. ... 4. The newborn child, considered simply as a biological unit, is indeterminate as a human being -
- the texture of its life is still to be filled out largely by human effort, that is to say, by culture, history, education and decision." p.41.	It is politicians' and policy makers' role to help realise human potential and societal progress: human AND now biospheric flourishing. THINK about how YOU vote!*

Of Human Potential
Cover: AbeBooks

*Political freedom permitting.

Scheffler, I. (1985) Of Human Potential. Chapter II POTENTIAL: A CONCEPTUAL FRAMEWORK. London: Routledge & Kegan Paul.

Another book gone to the charity shop...

Book review - "Human Landscapes: Contributions to a pragmatist anthropology"

'After Ethnos', a previous book review was an enjoyable challenge. As a nurse, you are, to a certain extent several disciplines all rolled into one, sociologist, psychologist, diplomat, anthropologist ... but After Ethnos and now Dreon's 'Human Landscapes' bring their own demands.

If it was experiment that attracted me to Tobias Rees's book, Dreon's title works on two levels.

Hodges' model anticipates different 'landscapes'. The model also provides a lesson in pragmatism (another post) with pragmatism identified as a method to research Hodges' model.

On health care education programmes, how often do we write of human nature, cognition, or cognitive processes, qualitative and quantitative, subjective and objective? How quickly do we present ourselves, and the readers of assignments with dichotomies, dualities, and polarities?

Just 40 pages in they are here in expected and welcome abundance. I clearly have some reading to do [ that's why it's a review! :-) ] and from reading, much to critique in my differentiation between phenomena and as concepts presented here on W2tQ.

"... the conceptual framework for my approach to human nature is represented by cultural naturalism— that is, a nonreductive form of naturalism that assumes culture to be continuous with nature, rooted in the very organic and environmental conditions of human life, and yet irreducible to the mere association of preexisting resources." p.23

Human landscapes

"Nonetheless, even if we wish to focus on a theoretical analysis of the concept, the idea of human nature seems to display a tangle of problems, punctuated by distinctions that could be useful when treated as functional and connected to specific contexts, but which are actually turned into dogmatic oppositions. One first form of dualism concerns the opposition between the innate and the acquired, between the allegedly innate equipment existing on the genetic or neural level and the properties and ways of behaving this is assumed to give rise to. To give but one example, based on Chomsky’s influential hypothesis, the idea of a neural program for producing grammar encoded in our genes has been assumed to be an efficient (and sometimes sufficient) cause for specific linguistic practices. From this point of view, nurture, culture, and institutions seem to be something completely different from nature, since they supervene on an already fixed material substratum as an adjunct." pp.17-18.

"Taking this or that snapshot of a human could be a useful intellectual expedient in specific circumstances, but “[b]iologically all growth is modification and all organs have to be treated and understood as developments out of something else and as pointing forward to still something else” (Dewey 1985b, 32–33)." pp.19-20.

"I believe that the conceptual opposition between subjective and objective qualities is like a net with too wide a mesh, unable to catch the complexity of our interactions with the world. The problem, I would argue, is that this opposition often involves the idea that qualitative experience is a private, purely first-person experience, consequently posing problems of public access." pp.33-34.

"The section 2 will focus on the Pragmatists’ conception of experience as something broader and richer than cognition—because, in turn, cognition is understood as a specific phase within experience, responding to the needs and problems emerging from qualitative experience and ultimately returning to it. In this approach, perception through the senses and pure sense data are reframed within the context of inquiry, as features that are pointed out, discriminated, and isolated from a more holistic field of experience according to an
idea, namely, the anticipation of the possible consequences of an action or a certain assumption." pp.37-38.

Not sure why, but at one point, reading prompted consideration of: 'lived experience' and the role of peer support workers?

Starting the book, Dreon is (naturally) laying out the scope and structure of the book. Not just a preface but first chapter, and it looks like - the second. As I get more accustomed to Dreon's style (I'm a nurse remember) there are valuable lessons in laying out arguments, with more reward to follow I trust. I have a sense of a wall, not an impenetrable one, but one that is well argued - the blocks shifting into place - even if I cannot grasp their true significance to specialists in this field.

More to follow.

Dreon R. (2022) Human landscapes. Contributions to a pragmatist anthropology. Suny Press, Albany.

Many thanks to Roberta and Suny Press for my copy (confession to follow).

[Simple] Space medicine ... c/o Chris Hadfield

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	I was seated in the audience front row, and recognised Heide's symptoms. The crew, behind her, couldn't see that she was about to faint, so I jumped onto the stage and luckily caught her in time. Ever since then, astronauts sit during the debriefs immediately post-spaceflight. Don't need anyone falling and getting hurt. — Chris Hadfield (@Cmdr_Hadfield) October 23, 2026

 Previously: 'observation' : 'anticipation' : 'astronautics' : 'space'

Invitation to post to the QUAD & human ecology

I've sent out some invites to people I've either worked with, or had contact with over the years since starting the website in 1997. Invitees will be able to contribute directly to this blog.

It would be great to have other authors on board, but of course I realise everyone is busy so I'm open minded. This move is long overdue and does me good in terms of 'letting go' and releasing H2CM into the wild.

Switching to the latest Blogger I lost haloscan. I've added it again to manage comments: purely in response to a sense of anticipation than demand. In doing so it appears I've lost earlier comments; although the correspondence is saved the loss is still a pain.

Job-wise things are a bit up in the air at present. Clinical - Informatics: both...?

There are plans for another group meeting on human ecology to possibly establish a NW England group. Possible dates are:

• Sat 9th or Sun 10th June
• Sat 30th or Sun 1st July
• Sun 8th July

The venue could be Sedburgh (lots of bookshops apparently!) or Manchester where we met in March. Let me know if you would like more information.

With the Serres-Hodges chapter now out the door (what a relief!) it would be good to write something collaboratively using some of the available e-tools.

More soon...

From local field to global arena: the rough and tumble of conceptual sport

Jo hit the deck. it was a foul tackle, an apt description for a move that Jo did not see coming.

Talk about a change of perspective!! Sheesh! Was it bone crunching, did I hear something?

It could have been worse. At least the ground knows it’s March and not January.

There was no anticipation, no reflex adjustment, no ability to shift, just in time, no poetry in motion this time.

The coach and physio dashed on to the field. Jo looked up and said “OK, tell me straight, what’s the damage?”

Coach looked down. "Well you're talking that's a start." Assessing rapidly though and through gritted teeth he replied:

“It’s not looking good Jo.”
“Wha..?

[Silence]

Oh come on tell me…”

“Well, kid it’s bad, yes, really bad.

You’ve got an academic detachment.”

Jo groaned, "Oh no, not that! What about the future!!"

<->

OK, sorry about that and I do realise that a great many world class athletes are very well educated people.

The tendency of young and promising athletes to relinquish contact with their academic side and really be the best they can be - remains a challenge for some, but this post concerns academic detachment as in - educational institutions and students with the world.

Call it a paradox, a contradiction in this hyper-connected world, what with gap years, travel opportunities.... that there seem so many examples of a lack of awareness of the bigger picture that is the international stage. Not just in students, in education, but the wider citizenry.

Does this matter. Well it does, at least according to the 2012 Conference of The Association of International Education Administrators (AIEA) which included:

Academic detachment is not an option in the 21st Century

on the theme “Building a Secure World through International Education.”

The point I’d like to make is that Hodges’ model is fit to assist in some of the objectives that the AIEA outlines in this context:

Keynote speaker Abiodan Williams, Senior Vice ‐ President of the US Institute for Peace, offered remarks at the opening plenary. Mr. Williams said that his own international education began with post ‐ secondary level study at the Lester B. Pearson College, United World College of the Pacific, in Victoria, BC. To develop graduates committed to peace and security, he urged educational institutions to teach:

• Knowledge – including greater interdisciplinarity and learning about conflict prevention
• International outlook – to shape the attitudes and outlook of a new generation, encourage all students to spend at least six months studying abroad, learn at least one new language and take at least one course about another country
• Sensibility – alluding to Fielding’s definition of ‘good nature’, developing people of benevolent and amiable temper of mind, who sympathize with the problems of others and who enjoy the happiness of others

“Academic detachment from the world is not an option in the 21st Century,” he said. Globalization is here to stay, and international education is playing a key role in contributing positive answers to many of the challenges that it presents.

Many institutions are actively engaged in programs that further environmental and energy sustainability, broader access to health care and education, resolution of conflicts, pursuit of fundamental human rights, economic development, and greater cross‐cultural understanding around the world. Harnessing the collective effort, and lessons learned, from each of these individual initiatives is important in moving internationalization forward. [AIEA conference website]

With thanks to Katy Rosenbaum:

27 March 2014:
Good morning,
Thank you for your email. I will check with my colleagues to see if they have any suggestions for someone who might be able to provide more information on work within this theme, and if they have any insights on this, I will certainly forward these on to you.
In the meantime, all conference session materials that presenters made available to download are available at the link below. The zip files include multiple presentations and handouts; underneath are links to these materials hosted on other websites: http://www.aieaworld.org/2012-conference#Presentations
The article you referred to mentioned Abiodan Williams' keynote address, which is available here: http://www.aieaworld.org/assets/docs/Conference_Materials/2012/abiodunwilliamsspeech2012.pdf
Thank you for your interest; I hope this information is useful. If my colleagues have other suggestions, I will certainly pass them on.

Best,
Katy Rosenbaum
Program Associate - AIEA
Association of International Education Administrators
www.aieaworld.org
kathryn.rosenbaum AT duke.edu

Additional link:
http://www.ruthnestvold.com/tomjones.htm
Thanks Dad.

Being @work2work and out-of-reach innovation

Apparently a web year (not to be confused with Internet time) is compressed in comparison to a calendar year. The rate of change on the web and technology in general is rapid; with health and social care constantly cited as key beneficiaries of technical and informatics developments.

In order to be beneficiaries though
what does this mean in terms of time?

It can be argued that to take full advantage of the 'latest and greatest' informatics (ICT) developments in health and social care means being in the early or late majority of adopters - the mainstream. Whichever way you define benefits (and measure them!) one of the factors and qualities must be time? But given the rate of change of technology just how much benefit can be accrued if you are late to the party?

There are articles and websites that extol the initiatives of Web 2.0 within health and e-Health, to the extent that this trend anticipation is labelled Health 2.0 - for example. You can see how the new Health 2.0 applications and personal health records will be the preserve of the new and nimble.

Back on the 'Trust' shop floor - if you try to access anything connected with social networking any e-mails end up in the corporate spam folder and social networking sites and blogs are blocked.

Well what do you expect?
We are @work2work
and that is not in dispute!

There are various studies that show what people get up to when at work with (free) web access. Maybe the filters are also not up to snuff?

Without some special provision - a secure sandpit for experimentation - there's a major worry that innovation and creativity could be marginalised.

This (vital) digital lockdown could mean that
while health and social care services deliver
outreach services, ...
innovative e-Health / ICT developments remain
out-of-reach.

Definition of e-Health: "Having your cake and eating IcT"

To follow: The four other labels for Hodges' model.

W2tQ shortlisted for Computer Weekly IT Blog Awards!

...

Voting is 'now' closed... :-)

This is a really amazing development.
Thanks to the CW team for the recognition!
And in anticipation of our visitor's votes!
It's great to see that Rod Ward is also listed informaticopia
Nursing & Community Informatics - let's spread the care!

TEMSS - Therapeutically Enhanced Medium Secure Service for Women [II]

Dear Rachel (Ms Magee)

Delighted to help you and well done on picking out Hodges' model. It sounds like an exciting time for you personally being newly qualified and working on a new unit.

Apart from several occasions as a student (late 70s at Winwick Hospital) and more recent liaison through my Trust's NHS Care Record Service Project I have not worked in forensic/secure mental health services. So what follows is a very generic over view. That said Hodges' model is more than an out-liner - brainstormer tool. As your experience grows the model will grow with you and your clients if it is appropriate to share it with them. Anyway, here are some initial thoughts a real mish-mash running through the care (knowledge) domains in turn (with some repetition).

If you wish to develop and elaborate on what follows, casting a distinct TEMSS light on each care domain I'd be happy to place your prioritised version in a graphic (with you duly ack.)

intra-INTERPERSONAL
Screening on admission. Existing psychic 'injuries'.

An·a·gram: 'secure' = 'rescue' .....

Life history, experiences +ve/-ve (including hospital care), skills, strengths, beliefs, mood, expectations, RISK behaviour, personality, psychological reactions to situation (admission, secure environment, diagnosis, prognosis, treatment - psychotropics, locus of control, helplessness, motivation, family contact...), specific, individualised - person-centred care. Thought disorder? Attribution. Risk - self-harm, harm to others, self-neglect. Psychological dependence. Intelligence. Literacies: 3Rs, visual, social, information. Boredom, Mental capacity. Cognitive functioning. Religious beliefs. Personal skills, strengths, interests. Education - access to training. Response to stress - existing coping mechanisms. Sleep. Attitudes. Sexuality. Biopsychosocial influences PMT (sorry don't wish to seem sexist!)? Stress-vulnerability. Biases, prejudices. Orientation time, place, person (not just older adults).
(YOU as a nurse are also in this domain - your skills, control and restraint, anticipation of needs, observation, empathy, self-awareness, non-judgemental, bias etc....) Assessment tools. My care plan. 'personal' time. Quality - therapeutic time if used.

SOCIOLOGY
Family, pressure on existing - new relationships, spouse-boy/girlfriends, socialisation into the 'secure' environment, dependencies - children / pets. Observation. Group activities. Group therapies. Routine. Co-operation. Team work. Leadership. Status, stigma, respect. Communication. Social skills, Assertiveness. Media - papers, radio, TV. Qualitative research - client narratives. Demographic profiles - catchment areas - deprivation indices.

SCIENCES
Screening on admission. Existing injuries. Access to GP, emergency services if needed. Physical characteristics, height, weight - BP, temp, bloods, mobility. Evidence based care? NICE. Drugs, side-effects (+ substance misuse / alcohol), physical effects of addiction, physical environment - lighting (on-off [fade]), noise (acoustic) signature, colour, architecture (sharp corners vs curves), physical health problems, trauma. ADLs. Assessment toolkit - what's in yours? Nursing (care) process. Hygiene, Domestic services. Infection control. Physical space allocation. Multidisciplinary assessments - occupational therapy, physiotherapy, psychology, pharmacist. Unit viewed as a system - ecology. Complexity within TEMSS. Literature review. Site visits / conferences. Learners. Staff course study opportunities. Academic partnerships. Quantitative research. Triangulation. Statistics. Data gathering processes. Geographic profile of referrals.

POLITICAL
Human rights, policies, protocols, GP service provision, right of appeal as relevant, 'disciplinary constraints', compliance-concordance, 'offence' category. Client space - privacy / dignity. Access to therapies, rehabilitation, training opportunity, AUTONOMY, ability to exercise choice, institutional 'rules' make-up, clothing, bathing, kitchen, toilet facilities, dignity and privacy, 'unwritten' rules - bullying - vulnerable adults, abuse, financial, sexual, physical. Inspection - Commissioners - accountability. Referral process-pathway. Thresholds, waiting lists? Travel distance - regional resource. Transport links - visiting times. Cost of fares. Staff establishment. Health & safety rules. Disability. Care transitions. Learning disability. Early onset dementia. Ageism (other '-isms') RECORDS. CPA. Community Team. Qualified-unqualified staffing. Patient-relative groups. Service user representation on management. Academic links. Visiting. SAFETY - patients-staff. Serious untoward incident reporting. Translation. Advocacy - short-long term. Other agencies - Social Services, third sector voluntary partners? Philosophy of care, OUTPUTS vs OUTCOMES? 'contracts', Mental Health Act, appeals, hospital managers. Politics of care. Psychiatry in Dissent. Audit, data collection, IT systems. Access to REPORTS - INTELLIGENCE "How are we doing?" "Where are we going and is that the right way?" Your involvement - engagement - in these processes. Client - carer - public involvement. Finance budgets - (unit budget - resources), staff support / supervision. Energy use. Recycling. Client abilities with finances / debts. Homelessness. Re-housing. Existing tenancy. Opportunity for (regular) TEAM BUILDING ;-) Innovation and creativity. PDP - KSF. Targeted issues: Managed care. Personality disorder....? Professional associations, groups:
http://health.groups.yahoo.com/group/forensic-psychiatric-nursing/
No group for TEMSS for women? Over to you! .....

As you can see the model is high level. It does not DICTATE how your unit is run, what therapy is undertaken. It can help as an aide memoire prompting you and your colleagues to systematically consider all the care domains according to the context-situation and can help ASSURE an holistic assessment and evaluation.

The model can also be used to help explain problems, issues and their solution - or realistic outcomes to clients and their families. So the model doubles as an educational resource - very helpful to engage the INDIVIDUAL or a GROUP (family). You can do this EXPLICITLY using paper or flipchart for example, or implicitly with you using the model mentally as you go along...

By including a POLITICAL domain Hodges' model is ideally suited to your speciality - in fact POLITICALLY and SOCIALLY there are 'nested' issues within your 'secure care' context: gender, ethnicity, equality and equity, public attitudes, institutionalisation, citizenry, public involvement....

This blog includes many labels (on the right hand side) I will also add 'secure services'.

Rachel - I noticed on your organisation's website there are the names of the wards and address - there's a space to fill there...

Good luck, hope this helps and thanks again for your interest.

Best,
Peter

EHR Software Market Share Analysis & UK residential care / nursing home sector musings

Last month (20th May 2010) Chris Thorman, who blogs about EMR systems at Software Advice, e-mailed me (copied below). Could I mention his recent EHR post on my blog?

Well thanks Chris! It is very encouraging to learn that W2tQ is seen by others as an infocare centre and valuable media avenue. It is very difficult for me to comment on this USA based analysis ...

- but here are some thoughts. ... This is a great piece of work-in-progress which acknowledges the problem of being 100% comprehensive and coherent given the task, plus the market's spread and dynamics.

My perspective is UK and my full-time work as a nurse gives me a limited outlook on health IT markets as a whole. Nonetheless I value efforts to capture such data in order to better understand the health informatics industry and grasp the bigger picture. As Chris notes this project is challenging, the post is also an appeal for help. While a great proportion of surveys are commercial in motivation, the e-community and e-media can now add value by pointing out the gaps and other data sources. The comments that conclude Chris's post ably demonstrate this.

I would very much like to read something similar for the UK, including the use of information systems in the residential and nursing home sector (any suggestions welcome). It still amazes me how many care homes - including those that are part of large business groups - do not use a 'resident' information system.

Perhaps the new - post-election - health ICT market in England will see new opportunities?
(See post re. 1 July 2010 NW England BCS - British Computer Society meeting).

In ICT terms the care / nursing home sector to me seems passive; it is content to be waited-upon by primary care and the hospital based systems. If they are not engaged on this level can they (and others, e.g. commissioners) argue that they are integrated? I think not.

Care homes need to realize that a dedicated information system could pay dividends in terms of assessment; continuity of care (transfer of care); quality of care; client, family and staff engagement, reporting to inform commissioning, inspection and marketing. When we talk of a patient's viability, there is also the question of the future viability of this market sector amid competition, economics, standards and costs ... ?

[Previously ..] Buyer sought for Loyd’s Nursing Homes Group’s 64 care homes
Catherine Boyle, Times Online, 21 May 2010.

Chris' focus is the EHR market, very much concentrated upon physician, medical and medical billing coding applications. This is reflected in the search facility on the Software Advice website. The search is constrained and directed, driven of course by the underlying database of companies, their applications and reviews. Markets are, however, defined by their boundaries and the way they change over time. Anticipation of that change is a gift indeed.

The personal health record (PHR) lies outside the scope of this Software Advice post, since as per WikiPedia:

It is important to note that PHRs are not the same as EHRs (electronic health records). The latter are software systems designed for use by health care providers. Like the data recorded in paper-based medical records, the data in EHRs are legally mandated notes on the care provided by clinicians to patients. There is no legal mandate that compels a consumer or patient to store her personal health information in a PHR.

This work by Chris and respondents helps to establish and define the boundaries. The EHRs in question are not purely institutional (e.g. hospital-based), the vendors cater for varying numbers of users, in different care settings as you can see on the site's 3-stage search. So while I cannot add anything as such, I wonder if there could (should) be scope for residential care in there?

Or perhaps the EHR market is not viable when it comes to older adult* residential care?

Heaven forbid that the transatlantic (and global) EHR market is ageist!

Thanks again Chris.

*Residential care is also needed for younger adults too.

From: Chris Thorman
To: " Peter,"
Sent: Thu, 20 May, 2010 18:57:41
Subject: Blog post idea for your blog

Hello Peter,

I hope you've had a good week. I just finished a blog post about market share in the EMR industry and I wanted to give you a heads up about it. Here is the link:
...

In the article, I broke down:

• The size of the outpatient EMR market;
• What EMR vendors have the most physicians using their system; and,
• What EMR vendors have the most practices using their system.

As I'm sure you can imagine, it was a tough project to get accurate numbers on. I was hoping you could mention my article on your blog to get more eyes on it so we can clear up any discrepancies. Sort of a "crowd sourcing" project if you will. I'd also be interested to read your thoughts on our findings.

Would you mind mentioning my post?

------------------------------------------------------------
Chris Thorman
Senior Marketing Manager
Software Advice
www.softwareadvice.com

Relativistic - Thinking checks and balances [V]

Effective nurses aspire to be time travellers.

Why should flash traders have all the adventure?

They also need to think relatively and be relativistic thinkers, the latter as described by Johnson (1994). If this sounds like faster than light travel in a sense it is, or at least it should seem like. Meeting the patient as they or someone reaches for the phone to seek help: is obviously taking the anticipation of care needs to the relativistic extreme - so what is this about?

This page at JHU "Perry’s Scheme – Understanding the Intellectual Development of College-Age Students" lists how Perry's formulation is reduced from nine to four levels of development:

1. Dualism – knowledge is received, not questioned; students feel there is a correct answer to be learned.
2. Multiplicity – there may be more than one solution to a problem, or there may be no solution; students recognize that their opinions matter.
3. Relativism – knowledge is seen as contextual; students evaluate viewpoints based on source and evidence, and even experts are subject to scrutiny.
4. Commitment within relativism – integration of knowledge from other sources with personal experience and reflection; students make commitment to values that matter to them and learn to take responsibility for committed beliefs. There is recognition that the acquisition of knowledge is ongoing activity.

Previous posts from January 2016 - with links supplied below - have reflected on dualistic and multiplistic thinking. I'm still exploring how work in educational psychology might inform my own. Picking up this thread again how does Hodges' model engender and contribute to relativistic thinking? Relativistic thinking as relates to Hodges' model is about a journey and not just one as item #3 above suggests. The student's journey may fly-by in time, but it is long and quite dense. Learners must negotiate lectures, self-study, simulation, patient, carers and public encounters, learning journals, clinical placements, assessed work and assessments, student-mentor sessions and all that the curriculum entails. Within the student's career there are innumerable situations and contexts if we cared to count them.

Responding to #3 Hodges' model can encourage immersion in a given context that presents a learning opportunity. They can also evaluate the situation as the care domains provide an epistemological platform from which to take in viewpoints and in the care domains scrutinize the knowledge that is shared and found through study. This includes the knowledge of experts. Whatever the care domain as a platform and viewport the student finds themselves in they should find a tendency to anticipate the other vistas nearby. Not only that but cognitively if not literally the patient and family when relevant can be with them. For person-centred care isn't just a matter of what is relativistic, but quantum too. 'Where' the patient is: so we are too.

Johnson, D.D. (1994). Dualistic, Multiplistic, and Relativistic Thinking as it Relates to a Psychology Major. Honors Theses. Paper 202.
http://opensiuc.lib.siu.edu/uhp_theses/202/

See also:
William Perry's Scheme of Intellectual and Ethical Development
A journey along the 9 "Perry" positions (as modified by Belenky et al. 1986) by William J. Rapaport

Thinking checks and balances [I]

Dualistic- thinking checks and balances [II]

Dualistic- thinking checks and balances [III] (or: The-hyphen)

Multiplistic - Thinking checks and balances [IV]