Squaring circles: Compressed patient care pathways = rich(er) patient experiences?

The use of Lean and Six-Sigma, their combination and other service improvement approaches has resulted in much more effective patient care pathways. A shining example is that of diagnostic medicine and subsequent out-patient appointments, apparently patients can attend for diagnostic services such as imaging and on the same day also attend for their first out-patient appointment. This saves time for all, with expensive imaging technology also proving its worth and RoI by working from 0700-2200.

Trust Boards are well pleased with such progress, but there is no such thing as a free lunch. Managers and execs know the lunch (diagnostics and imaging) isn't free, but quantitative aspects aside what does does this mean in terms of quality and assurance? Quality in the sense of:

• patient (and carer) experience;
• staff capacity to find and take advantage of patient learning (self-care, patient health career management) opportunities;
• assessment and evaluation of patient (carer) comprehension;

There is a circle to be closed by relating quality to quantitative aspects; such as, re-referral rates, re-admission, medication / treatment concordance, plus the infusion of intelligence from local and national patient related outcome measures [PROMS] to new patient journeys.

In information science there is the concept of information compression, taking out the redundancy - repetitive data in an image or text to save on processing, transmission, and storage. As Lean Six Sigma assists teams to remove tasks, processes that do not 'add value' then the result is a richer experience. The patient journey has in this sense been compressed. The patient has fewer hospital and clinic visits with fewer bus, taxi journeys, or they pay less in car park fees. Health personnel and specialists are primed to help and deliver services that really count.

What does this compressed - 'denser' experience - mean though? Does it mean that:

• patient's are exposed to more information (2-3 significant interviews / leaflets / instructions)?
• there is less time available for education, health promotion, info Px giving?

- or alternately:

• does this 'value packed' patient journey help by providing rapidly successive hooks - experiential threads to integrate patient (carer and staff!) learning?

It will be interesting to see answers to these questions and how extensive the scope of benefits are of these patient experiences across different care contexts.

Is there an optimal number for 'clinical encounters' before things start to go awry?

PROMS are quite specific (as they need to be initially), but amid richer and varied patient journeys there will be a need for other (national and local) measures. What about the extent and level of 'care complexity' and 'holistic care'?

Image source: http://www.navyenterprise.navy.mil

International Journal of User Driven Healthcare (IJUDH) CfP

Dear Mr. Jones

In view of your work in patient-centered care, I’d like to invite you and/or your colleagues to submit a paper to this Special Issue of the new journal described further below and via the web link provided. I think our global readers would be very interested in your thoughts (and projects) on innovative ways to get relevant healthcare information into the hands of ‘users’ (both patients and providers), within the user-driven EBM paradigm, per below.

Please also share this call for papers with your colleagues.

Thanks for your consideration,

Susan Ross, MD

International Journal of User Driven Healthcare (IJUDH) Call for Papers

Editor-in-Chief:
Rakesh Biswas,
Center for Scientific Research and Development (CSRD),
PCMS Campus, India

Published: Quarterly

Call for Papers - Special Issue:

Submission Due Date: July 1, 2010
Special Issue On User Driven Healthcare and Evidence-based Medicine

Guest Editors:
Susan Ross, MD, FRCPC

Introduction

User Driven Healthcare (UDH) is part consumer-driven healthcare, part narrative medicine, and part Health 2.0. It stems from a concept of participatory healthcare whereby all stakeholders, enabled by information, software, and cyber-community, focus on healthcare value. But where does Evidence-based Medicine (EBM) fit into this framework? It is sometimes forgotten that EBM is a three-legged stool, comprised of the triad of evidence +provider expertise + patient preferences. In this EBM framework, provider expertise is needed to bridge the inferential gap between population-based evidence and the individual patient. And each patient's values and preferences should narrow that inferential gap further. But since the introduction of EBM nearly two decades ago, the primary focus of EBM proponents has been on Evidence, at the expense of patient preferences and provider expertise. Perhaps this is why the promise of EBM to foster the most efficient and high quality healthcare has not yet been realized.

Objective of the Special Issue

This Special Issue will focus on the following questions: Is the recent emergence of User Driven Healthcare really a new, post-EBM paradigm for healthcare, or just an overdue consideration of the other two legs of the original EBM stool? How might this trend affect all stakeholders?

Recommended Topics

Topics to be discussed in this special issue include (but are not limited to) the following:

• Developing valid patient-level evidence using the Web
• Evidence generation—clinical research strategies using social media and mobile technologies
• Examples of UDH to a) help formulate the right questions to ask in EBM; b) develop answers to those questions; c) disseminate the answers to patients and providers with a need to know; and d) test the impact of UDH-generated Evidence on patient outcomes
• Helping online patients sift the ‘wheat’ from the ‘chaff’—information management for patients in an EBM world
• How to incorporate patient preferences and values into ambulatory care decision-making (i.e., into the 10 minute visit)
• Measuring the impact of UDH on patient outcomes
• Patient-level decisions vs. population-level evidence (bridging the inferential gap)
• Pharmaceutical communication strategies using social media—impact on healthcare quality and costs in an EBM framework
• Place of social media in EBM—patient and physician online communities
• Practice of UDH vs. EBM around the world
• Regulatory issues of evidence dissemination by industry using social media in healthcare Statistical and other evaluative methods to assess the validity and reliability of evidence developed using social media and mobile technologies
• Trends in N-of-1 studies, and their relevance to EBM and UDH
• Use of collective intelligence to solve healthcare problems for individuals and communities

Submission

...

All submissions and inquiries should be directed to the attention of:
Susan Ross, MD
Guest Editor

Reference [ii] "Practice in forensic psychiatry: A proposed interdisciplinary model"

Practice in forensic psychiatry:
A proposed interdisciplinary model

Expanding on the post about a further reference for Hodges' model:

Holmes, D. Perron, A. Jacob, J.D. Paradis-Gagné, É. & Gratton, S (2018). Pratique en milieu de psychiatrie légale: proposition d’un modèle interdisciplinaire. Recherche en soins infirmiers, (Practice in forensic psychiatry: A proposed interdisciplinary model). 134, 33-43. DOI: 10.3917/rsi.134.0033

Here, and on twitter I have sought to stress the limitations of the biopsychosocial model in healthcare, and I value Holmes et al. recognition of Hodges' model as politico-biopsychosocial. 

The authors also identify the structural nature of the model.

 

In comparing 'models of care' there is the question of whether Hodges' model is a model of care. As a generic conceptual framework Hodges' model can of course be used in the health care (as per its original design and creation) but it can be used to compare models of care.

Below, translated by Google are the models used in the paper.

I have altered the listing bringing the Tidal and Recovery model s together. Some I've 'mapped' in pairs, using formatting to indicate the differences.

Tidal Model

"The Tidal Model is a humanistic nursing model of recovery developed by Barker (12) with the premise that the person with mental disorder has strengths, abilities, personal priorities and a future ahead (13). This model of care, popular in forensic psychiatry circles, recognizes certain deficits of the hospitalized patient but it is especially interested in the meaning that the latter attributes to them. The sick person is the expert in his life and is therefore the one who contributes the most to his own recovery. This nursing perspective is therefore centered on the phenomenological experience (lived experience) of the patient and on the role of the staff, which is to allow healing and restore hope (12,14)."  

Recovery Model

"A popular model in mental health care, the recovery model is increasingly gaining ground in psychiatric care settings (28). The postulates of this humanistic model state that anyone, including those suffering from mental disorders, can aspire to a fulfilling future, participate in rewarding and inspiring activities, self-determination and finally, be able to live in an environment free of stigma and discrimination (29). The peculiarity of this model lies in the fact that recovery is part of a process where the person with mental illness can continue to show symptoms while being able to adapt to their condition (often chronic) and pursue their goals. life (30)."

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

recovery strengths, abilities, personal priorities deficits healing and hope phenomenological - (lived experience) personal responsibility fulfillment - life goals patient as expert personal adaptation living with x,y,z... coping strategies	place as context my future deficits signs - symptoms chronicity Institutional settings clinical - hospital
humanistic - human qualities social expectations social contribution participation - social inclusion free from stigma deficits	Institutional settings politics of recovery free from discrimination forensic deficits

<>

Integrated Practice Model

"This model was developed by Virginia Lynch, a pioneer in forensic psychiatry, and it guides the role of practicing staff in this care setting (15). There are three main theoretical foundations: 1) the fields of expertise involved (nursing, criminal justice and forensic science), 2) the health system (victim and offender, health care and forensic nursing ) and 3) the social impact (social sanction, human behavior, crime and violence) (16). According to this model, patients should be cared for using an interdisciplinary and holistic approach (15)."

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

nursing forensic psychiatry 2. health system interdisciplinary holistic OFFENDER	nursing theoretical foundations forensic science 1. fields of expertise 2. health system interdisciplinary holistic
VICTIM role of practitioners 2. health system 3. social impact (social sanction, human behavior, crime and violence)	criminal justice 2. health system

<>

Model of Nursing Interaction

"This model of care includes six categories of forensic nursing interaction with the goal of establishing a relationship with the patient: establishing and maintaining a relationship (relationship based on honesty, respect and trust), encouraging and support interactions (help the patient to recognize his qualities and use his resources), the learning of social skills (encourage the patient to do social activities and talk to others), reality orientation (help the patient patient to be aware of his way of being and of acting), reflective interactions (the perception of the patient and his problems) and the learning of practical skills (encouraging the patient to develop good lifestyle habits) ( 17,18)."

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

patient qualities, resources reflective interaction self-perception of problems reality orientation awareness of way of being and of acting	practical skills develop lifestyle skills
reality orientation learn social skills develop lifestyle skills encourage social activities talk to others	encourage and support interactions reality orientation perception of patient and problems

<>

Healthy Living Program

"This model was developed in response to metabolic syndrome and physical illnesses that may develop in people with severe mental illness (19). It includes programs related to health promotion activities such as weight reduction, smoking cessation, physical exercise, etc. It is a voluntary approach that not only improves physical health, but also independence and recovery. For the program to work in the institution and to fit into its organizational culture, the approach must be flexible and systematically maintained by the entire interdisciplinary team."

[ PARITY OF ESTEEM ] 

mental health - metabolic syndrome physical illnesses

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

independence recovery voluntary approach	(physical) health promotion activities such as weight reduction, smoking cessation, physical exercise,
independence recovery	voluntary approach for program to work in the institution and to fit into its organizational culture, the approach must be flexible and systematically maintained by the entire interdisciplinary team

<>

Holistic Model

"This model is used in forensic care in the assessment, health care and psychotherapy of patients with personality disorder (22). Holistic care includes the physical (diet and exercise), cultural, spiritual, and psychosocial needs of the patient. This model is based on problem solving, anger management and decision making. Caring is a central concept in the holistic model and is actualized in an emotional, psychosocial, constant and authentic caring response (23). It is for caregivers to be present for the patient, to respect his situation, to understand his experience and to demonstrate a desire to help."

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

holistic care personality disorder [mental] health care psychotherapy assessment emotion problem solving, anger management decision making actualized psycho-	holistic care 'caring' assessment diet, exercise health care 'being present'
-social culture holistic care 'being present' constant and authentic caring understand person's experience respect person's situation desire to help	forensic care holistic care desire to help (also exemplified in the organisation?)

<>

Good Lives Model

"This model focuses on the offense committed by the mentally disordered offender, his recovery, the promotion of personal goals, the reduction of the risk of reoffending, and the treatment of mental illness (24,25, 26). The model favors an approach based on the strengths of the patient. In addition, mechanisms of change are present, that is to say that behaviors judged to be poorly adapted are replaced by adapted behaviors when the patient is equipped with the skills, resources and support provided by the nursing staff. This model contextualizes the offense, focuses on the symptoms of mental illness while conceptualizing both as inappropriate behaviors.This model helps to better understand the relationship between mental illness and crime in order to create an individualized plan of care."

Risk-Need-Responsivity Model

"This model (27) imported from the correctional environment was adapted to the psycho-legal context by the addition of the “mental illness” dimension. It was developed primarily to reduce the risk of recurrence. Care interventions are geared towards the identification and treatment of criminogenic factors. This model is based on three major principles: the risk principle (granting the highest level of resources to the group most at risk of crime), the needs principle (identifying dynamic criminogenic risk factors and targeting them in treatment) and the principle of receptivity (adjusting programs according to the characteristics of the person: learning style, motivation, strengths, etc.) (24,25)."

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

mentally disordered (diagnosis) recovery characteristics of the person learning style (evidence?) motivation, strengths 3. principle of receptivity treatment: skills, resilience personal goals “mental illness” <-> crime recurrence individualized plan of care	1. risk principle -> resource allocation recurrence treatment 2. dynamic criminogenic risk factors  support of nursing staff
treatment [social determinants?] mechanisms of change adapted behaviours inappropriate behaviours recurrence	offense reoffending correctional environment contextualise the offence treatment principles [policy] recurrence

<>

Hodges' Health Career Model

"This model has a politico-biopsychosocial structure which is consistent with contemporary interdisciplinary practice (20); that is, it relies on a multidimensional critical approach, incorporating writings in sociology and politics, in order to understand the person in context. It is based on four objectives: measuring learning, providing holistic care, supporting reflective practice and closing the gap between theory and practice (21). This model is applicable in various clinical situations in a psycho-legal context. When this model is used as a frame of reference, it emphasizes the role of caregivers who must meet the patient's needs and focus on their problems. It also serves as a guide to assess and provide assistance to the patient vis-à-vis their physical, psychological and social needs as well as with the justice system in order to promote their recovery. The theoretical foundations call on four sources of knowledge: interpersonal, scientific, sociological and political (21)."

The PERSON in Context 

(situated)

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

INTRAPERSONAL INTERPERSONAL reflective practice conceptual structure psychological needs measure of learning psycho-	SCIENTIFIC physical needs theory-practice gap
SOCIOLOGICAL reflective practice (develop self-awareness) social needs practice-theory gap	POLITICAL justice system (needs) -legal

[ all embedded within the SPIRITUAL ]

Not just 'problems' Hodges' model can incorporate any desired stance, perspective or philosophical approach - strengths, disease, skills, weaknesses or deficits, psychosocial for example.

I am not sure about explicitly 'measuring learning, but the model can be used by learners and teaching staff / mentors to demonstrate their understanding and justify their output - formulation.

There is an instrumental potential in Hodges' model as a whole. Hodges' model can illustrate the degree of holistic intent - whether this is realised could also be indicated using the model.

Once again I am grateful to the authors for their inclusion of Hodges' model. The reference is listed in the blog's bibliography (please see the sidebar for others) which includes:

Doyle, M., Jones, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. 20, 7, 631-640.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2012.01961.x/abstract

Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311.

See also on W2tQ (with overlap):

https://hodges-model.blogspot.com/search?q=forensic

https://hodges-model.blogspot.com/search?q=justice

https://hodges-model.blogspot.com/search?q=interdisciplinary

Narketpally syndrome: A different approach to medical education and research

From: Marc Jamoulle
MD (UCL 1974), PhD (ULg 2017)
Family physician, Belgium (INAMI 15324119004)
marc.jamoulle AT uliege.be
Associate researcher at HEC-Liège, BAS-SCM, University of Liège, University of Rouen, D2IM & CAMG-UCL, Brussels

hi friends,

in an unknown syndrome, another way to deal with the patient, to learn from the patient, to develop a partnership with the patient, caring while waiting for the cure,

Jamoulle, M., & Soylu, S. (2025). Phenotyping Long COVID in Children in Primary Care: A Case-Based Study Using the Human Phenotype Ontology. ORBi-University of Liège. https://orbi.uliege.be/handle/2268/334447

From: Rakesh Biswas
rakesh7biswas AT gmail.com

This paper illustrates a global patient-centered learning ecosystem, anchored in Narketpally, that adopts a syndromic approach to medical education and research. Rooted in the etymological origins of 'syndrome' ("together we flow"), this approach reframes medical research as a collective, contextual response to individual patient needs.

https://pubmed.ncbi.nlm.nih.gov/40674544/

Methods: The structure of the paper is intentionally modeled as a team-based learning exercise, grounded in our prior Web 2.0-based cognitive tools: CBBLE (Case-Based Blended Learning Ecosystem) https://pmc.ncbi.nlm.nih.gov/articles/PMC6163835/ and PaJR (Patient Journey Record) https://pajr.in/. These are framed against the conceptual scaffolding provided by three key publications: a framework by Sturmberg et al. and two contrasting commentaries by Greenhalgh and Ioannidis.

Results: Through our ongoing CBBLE-PaJR workflow, thematic learning outcomes emerged in response to these frameworks. Sturmberg's stratified realism helped us recognize how individual patient connections, recorded in our daily practice and online learning portfolios, can drive both contextual learning and meaningful changes in patient outcomes. Greenhalgh's commentary inspired our conceptualization of a 'wildebeest river crossing value model,' contrasting population-based efficiency with individual-centered compassion. Ioannidis's critique of methodological rigor highlighted the potential for expanding low-resource, high-impact research through patient-centered designs, particularly in phases 1 and 4 of the clinical trial hierarchy.

Podder, V., Kulkarni, R., Samitinjay, A., Salam, A., Gade, S., Agrawal, M., Surendran, A. K., & Biswas, R. (2025). Narketpally Syndrome and the Embedding of Contextual Values in Real-Life Patient Pathways. Journal of evaluation in clinical practice, 31(5), e70186. https://doi.org/10.1111/jep.70186
[Citation added PJ].
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Workshop - Patient access to medical records: the patient's view

You may be interested in this online meeting/workshop for 3-5pm May 12th 

Patient access to medical records: the patient's view

It is open to all, free of course, and registration is here:

https://www.eventbrite.co.uk/e/patient-access-to-medical-records-the-patients-view-tickets-144456929565

The aim of the meeting is to add another little push towards getting this higher priority in the UK.  The assumption for the session is that most if not all who turn up will already be convinced of the benefits - but nevertheless it is useful to (re)hear some of those benefits from patients, and maybe one or two of the frustrations, and then get discussion from those present as to how it can be given higher priority by CCGs, Trusts, politicians, etc.

The meeting will be on Zoom and the provisional timetable is:

3:00-3.10            Ray Jones - Introduction (aim of the workshop, a little background, and welcome)

Short presentations taking questions and comments by the typed chat room

3:10-3.30            Liz Salmi - US experience of Open Notes

3.30-3.40            Jene Jinatun - experience 1 from Haughton Thornnley Medical Centre

3.40-3.50            Cheryl Ashton - experience 2 from Haughton Thornley Medical Centre

3.50-4.00            Fran Husson - experience of Patient Knows Best (London)

4.00-4.05            Nik Seth - comparing Patient Access in Estonia with the UK

4.05-4.10            Mar Soler-Lopez - comparing Patient Access in Madrid with the UK

4.15-4.45            Break out room discussion: how can patient groups help bring about better availability and uptake of patient access?

4.45-5.00            Feedback- 1 or 2 points from each group.

5pm                    Close

Please do register and come if you can, and please pass on to anyone and everyone. In particular if you have contacts in the media please invite them - given the need for patients to take control of their health information this should be topical and normally the media likes to take a 'personal story' approach.

Thanks

Ray

Ray Jones

Professor of Health Informatics, School of Nursing and Midwifery

Co-Facilitator for Centre for Health Technology

Research Gate

Email: ray.jones AT plymouth.ac.uk

University of Plymouth, Faculty of Health, PL4 8AA

__________

Source:

HIFA: Healthcare Information For All: www.hifa.org

Patient? Client? Consumer? Some thoughts....

Below is an edited version of a response to an item posted on LinkedIn Working Nurses, the issue raised by Genevieve M. Clavreul, RN, Ph.D. is as follows:

One day I came across “The Martha Stewart Show” as it aired a segment dedicated to nurses and Nurses Week. It began with a brief discussion of the history of nursing over the past century or so, and I recognized many of the instruments from my youth and my early career in nursing. But what caught my fancy was how the nursing school representative, a nurse herself, continually referred to the patient as the “client,” and how she seemed to struggle while using the term, as if it was a foreign concept.

The replies thus far have already addressed this question and and its ramifications very well, reflecting the scope of experience and expertise of many working nurses. We have this issue in the UK - NHS also, indeed it is no doubt a global matter.

Mental health has 'client' and 'service user'. Health care IS a business, but a business that must be allied with professionalism. I know that goes without saying, but please bear with me. Use of 'patient' seems to denote dependency and not partnership and collaboration. Being a 'patient' you are compliant with your treatment, rather than concordant with insight into your care plan and the pros and cons of medication (intervention or non-intervention).

As nurses though we have a duty of care. Each nurse represents the profession and the terms we use reflect the values we hold in theory, practice and management (the business again).

On one level perhaps the multiplicity of terms reflects upon the complexity of health and social care and the many contexts 'nursing' takes place. The emphasis on 'recovery models', self-care, the expert patient, relapse prevention, well-being is a sign of the demographic trends and the rise of social media and e-health.

I understand that patiency is a key concept and question in formulating models of nursing: When does a patient become a patient and when does that period end? It is not wholly fashionable for nurses to act as advocates and yet I would argue that being in a 'business' nurses can / should / must advocate not just for the patient but for the health of the general population. Nurses should also look over their shoulder (that's business politics) and take cognizance of the first rule of first-aid. In this case you cannot be an advocate for personal, family, local, regional, national and global health if you become the casualty. By implication the profession - nursing - suffers too.

Will we reach a point were access to and the salience of 'patiency' as a - human currency - has to be enshrined in human rights? What title do we grant to our seniors in whatever environment: their home of twenty years, their hospital bed, their Room 123 of The Nursing Home?

In any business the ethos and strategy for success should be to make the 'business' transparent. I'm in London at the moment at an IT event. One presentation focussed upon the 'user experience' - UX. Customer service in health is essential [ CX - CareX ! ], but this should not be a 'business' add-on. This is crucial to all caring professions. Rather than be thrown from side-to-side by the science OR art of health and its client OR patient equivalent we can embrace the dialogue and make a positive difference as we do so.

The astute student / learner will ask the person concerned how they wish to be addressed. As future nurses and nurse leaders in the 21st century they might also consider those populations around the world who would very much like to hear the utterance of 'patient': not in reference to themselves, but their infants and children ...

Anticipatory Prescribing as part of Anticipatory Care

This post is derived from a selection of the main concepts found within three papers (references listed below) on 'anticipatory prescribing'. Some explanation may assist. I have duplicated 1. What is current practice? across the domains to suggest that the question needs to be answered for each of the care (knowledge) domains. The same principle applies to the repetition of the attitudinal questions at the individual and group (sociological) level. Person-centredness demands that the patient's views are paramount plus the aggregated responses of the group as a whole.

Perhaps there is a 'drug TIME' too, which operates across all the domains once more, and each variously weighted objectively and subjectively? The concept of control and assessment of control is also critical.

I've placed GP decision-making across both 'individual' domains described as it is as a 'process' and for the patient as 'bedside manner', as also reflected in the GP and healthcare professional's communication with the family.

Clinical effectiveness and observations are likewise span the interpersonal and sciences domains. This is to denote the need to achieve and sustain parity of esteem and integrate physical and mental health care - pastoral and spiritual also.

'Cost' is anchored in the political domain, but clearly there are much wider economic ramifications, both in quality of life, quality of death and the way 'cost' is determined, measured, analysed, evaluated and reported.

For me nursing, medicine, healthcare are most effective when they are anticipatory. Observation, reflection and critical thinking are key. In a way for an individual to be health literate is a preparation for self-care. Although clearly in a general sense of health and well-being; not necessarily being literate with respect to a long-term medical condition.

Hodges' model is an idealisation and the detail is obviously described in the papers listed. The intention below is for readers to gain an appreciation of anticipatory prescribing and the application and scope of Hodges' model.

 Taking a larger perspective anticipatory prescribing is part of anticipatory care.

@GeriSoc https://twitter.com/GeriSoc/status/1374716732120645632?s=20

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

Anticipatory Prescribing Reassurance for patient, family &  friends clinical effectiveness subjective TIME observation agitation, distress (mood, anxiety, orientation, communication, identity - self, fear, understanding, mental capacity...) The patient's spiritual well-being needs are met*. 1. What is current practice? 2. What are the attitudes of patients? 3. What are the attitudes of family carers? 4. What are the attitudes of community healthcare professionals? [as individuals] GPs’ discussion with patients (Advanced care planning - choices) 5. What is its impact on patient comfort and symptom control?

Anticipatory Prescribing Physical access to medication and treatment is assured. clinical effectiveness objective TIME observation remote anticipatory prescribing increased 24 hours availability (out-of-hours) The intervention seeks to improve [my] symptom control pain, nausea and vomiting, agitation, and respiratory secretions. The Covid-19 pandemic has accelerated the practice of Anticipatory Prescribing; more terminally ill patients are having end-of-life care at home and in care homes. 1. What is current practice? New routes of administration injection, oral, sublingual, or rectal 5. What is its impact on patient comfort and symptom control? GPs’ decision-making processes Research: Systematic review and narrative synthesis Semi-structured interviews Web-based survey

An important intervention in supporting patients and families who wish to have last days of life care at home. 1. What is current practice? 2. What are the attitudes of patients? 3. What are the attitudes of family carers? 4. What are the attitudes of community healthcare professionals? [collectively] 5. What is its impact on patient comfort and symptom control? Patient and families’ well-being throughout the end-of-life journey *There is concord and respect regards patient's spiritual well-being needs. GPs’ discussion with family family caregiver administration

The Independent Review of the Liverpool Care Pathway found that the use of Anticipatory Prescribing without adequate explanation or justification led to families being concerned about over-sedation and the medication hastening death. 1. What is current practice? 5. What is its impact on patient comfort and symptom control? 6. Is it cost-effective? Revise pharmaceutical regulations to permit repurposing of anticipatory prescribing medications in care homes, wider community drug access, and recycling unused medications returned to pharmacies. Address stock shortages.

Bowers B, Ryan R, Kuhn I, Barclay S (2019) Anticipatory prescribing of injectable medications for adults at the end of life in the community: A systematic literature review and narrative synthesis. Palliative Medicine 33(2): 160-177 https://doi.org/10.1177/0269216318815796

Antunes B, Bowers B, Winterburn I, Kelly MP, Brodrick R, Pollock K, Majumder M, Spathis A, Lawrie I, George R, Ryan R, Barclay S. (2020) Anticipatory prescribing in community end-of-life care in the UK and Ireland during the COVID-19 pandemic: online survey. BMJ Supportive & Palliative Care; http://dx.doi.org/10.1136/bmjspcare-2020-002394

Bowers B, Barclay SS, Pollock K, Barclay S (2020) General Practitioners’ decisions about prescribing end-of-life anticipatory medications: a qualitative study. British Journal of General Practice; 70(699) e731-739 https://doi.org/10.3399/bjgp20X712625 

 

Nursing care of the patient - 1976 and Earth Day . . .

Moidel, H.C., Giblin, E.C., Wagner, B.M. (Eds) (1976) Nursing care of the patient with medical-surgical disorders. New York: McGraw-Hill,  ISBN 10: 0070426554 / ISBN 13: 9780070426559

"The process of nursing assessment is a deliberate and systematic analysis of the patient and his environment with the purpose of gathering data about the patient's health-illness status and resources. A systematic and recorded assessment also provides (1) a baseline measure for identifying change over a period of time; (2) a foundation for the nursing-care plan, giving direction to nursing interventions; (3) a means for evaluating the effectiveness of nursing care." p.8.

"The nurse's major tools for obtaining data regarding a patient's health-illness status and resources include communication (with the patient, his family, health team, and nursing-team members), direct observation and examination (through the use of all sensory channels and technological adjuncts), consultation, and review of the literature. The use of these tools, which is amplified in chap. 7, should be in accordance with some organized, systematic, valid, and reliable framework." p.9.

The need for systematic and deliberative approach remains, despite the passing decades. Whatever 'system' is adopted it needs, as per 1-3 to be dynamic, act as a substrate; that is also neutral - non-prescriptive (apart from); facilitating the flow of assessment, planning, interventions and evaluations, and what used to measure effectiveness, outcomes, quality and safety. As an American text, chapter 7 is also concerned with 'nursing diagnosis' and Orem is referenced.

Nursing care of the patient
with medical-surgical disorders

 

Nursing Management

"Nursing management is based upon and follows assessment. It is the process of determining and initiating goal-directed nursing action in relation to the patient problems diagnosed during assessment. Without assessment, nursing management becomes mechanical, dependent on physician's orders, and detached from the ultimate goal of wholeness for the patient." p.9.

We still need balance in humanistic-mechanistic care delivery. Paying attention and due regard to the interpersonal detail and needs, while also seeing the whole.

"Delong studied the impact of preoperative information on recovery from surgery. In general, individuals who were given specific detailed information regarding the surgery and postoperative care had a less complicated recovery and were discharged earlier than those who received general nonspecific information. When coping styles were considered, it was found that those who exhibited flexible patterns of coping with general stress in their lives recovered well regardless of the type of information they received. Copers, who were defined as individuals who seek out information regarding potential threat, recovered better if they were given specific information before surgery. Avoiders typically showed slow, complicated recoveries, regardless of specific or nonspecific information; however, those who received specific information had more postoperative complications than those who heard only the general information." pp.38-39.

Now in healthcare, we are concerned with Health Information for All, and Health Literacy. I wonder what the informational nuances are in 2023 bio-psycho-socio-politically: and of course spiritually?

"All the disease and illness concepts cited above have reshaped society's thinking and practices about health, maintenance of health, and treatment of disease when it appears. But each emphasizes specific aspects of the totality of interwoven dynamics that constitute disease and illness, leaving us with cumbersome vocabularies and classifications that are partial and imprecise. Theoreticians, endowed as they are with a sense of order and logic, will most assuredly seek to bring the various viewpoints together into new conceptual frameworks." p.51.

Now our 'new' conceptual frameworks must incorporate nursing, patient-nurse relationship, the 'team', society, research and evidence-based care, policy - local, national, and global, plus technical and climate change all amid the politics of health and the informational milieu - or melee?

Also of note (Chap. 1):

Section headings: Care as a Nursing Function, with Cure, and Coordination as Nursing Functions.

Ecologic Orientation, Part 2.

Individual differences in patterns of anxiety arousal, stress-relevant information and recovery from surgery. Delong, R. D., University of California, Los Angeles ProQuest Dissertations Publishing, 1970. 7116307. https://www.proquest.com/openview/0d64def524b9e5845b7e168aa4cc5876

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As I continue to sort through 'old' books and papers, on Earth Day we are (duty) bound to reflect on the future. As my grandson was on the post-school play ground this week, I noticed the infants and those at risk of walking into the merry-go-round. I wondered whether in their senior years, will the ice be returning, the sea-levels stabilise, and will the CO² in the atmosphere be reducing? 

What of - Nursing care in 2076? We need a conceptual framework that can project the care of the past and now, into the future. For those who are not yet here.

Previously:

'Planetary Health'

Gaia

'climate change', 'ecology' . . .

Relatedness and Similarity - in The Health Career Model

How can we demonstrate the basis for the axes, 'found' conceptual structures and conceptual clustering in Hodges' model?

UMLS::Similarity Web Interface (measuring pairwise similarity and relatedness of medical concepts)

Some results and definitions obtained from the above.

Results:

The similarity of person (C0027361 ) and patient (C0030705 ) using Lin (lin) is 0.85.

Using:    SAB :: include MSH
    REL :: include PAR/CHD

The similarity of person (C0027361 ) and patient (C0030705 ) using Conceptual Distance (cdist) is 0.5.

Using:    SAB :: include MSH
    REL :: include PAR/CHD

The similarity of person (C0027361 ) and patient (C0030705 ) using Resnik (res) is 1.6384.

Using:    SAB :: include MSH
    REL :: include PAR/CHD

The similarity of person (C0027361 ) and patient (C0030705 ) using Jiang & Conrath (jcn) is 1.7295.

Using:    SAB :: include MSH
    REL :: include PAR/CHD

The similarity of person (C0027361 ) and patient (C0030705 ) using Path Length (path) is 0.5.

Using:    SAB :: include MSH
    REL :: include PAR/CHD

The similarity of person (C0027361 ) and patient (C0030705 ) using Wu & Palmer (wup) is 0.8.

Using:    SAB :: include MSH
    REL :: include PAR/CHD

The similarity of person (C0027361 ) and patient (C0030705 ) using Nguyen & Al-Mubaid (nam) is 0.2038.

Using:    SAB :: include MSH
    REL :: include PAR/CHD

The similarity of person (C0027361 ) and patient (C0030705 ) using Random Measure (random) is 0.5703.

Using:    SAB :: include MSH
    REL :: include PAR/CHD

The similarity of person (C0027361 ) and patient (C0030705 ) using Leacock & Chodorow (lch) is 2.9957.

Using:    SAB :: include MSH
    REL :: include PAR/CHD

--

The relatedness of individual (C0027361 ) and group (C1257890 ) using Vector Measure (vector) is 0.7869.

Using:    SABDEF :: include UMLS_ALL
    RELDEF :: include CUI/PAR/CHD/RB/RN

The relatedness of individual (C0027361 ) and group (C1257890 ) using Adapted Lesk (lesk) is 9584.

Using:    SABDEF :: include UMLS_ALL
    RELDEF :: include CUI/PAR/CHD/RB/RN

--

The relatedness of self (C0036588 ) and group (C1257890 ) using Adapted Lesk (lesk) is 263.

Using:    SABDEF :: include UMLS_ALL
    RELDEF :: include CUI/PAR/CHD/RB/RN

The relatedness of self (C0036588 ) and group (C1561557 ) using Vector Measure (vector) is 0.4054.

Using:    SABDEF :: include UMLS_ALL
    RELDEF :: include CUI/PAR/CHD/RB/RN

Definitions:

individual (C0027361)

HL7V3.0 : A living subject of the species homo sapiens.

NCI : Human beings in general.

NCI : A human being.

NCI_BRIDG : A human being.

MSH : Persons as individuals (e.g., ABORTION APPLICANTS) or as members of a group (e.g., HISPANIC AMERICANS). It is not used for members of the various professions (e.g., PHYSICIANS) or occupations (e.g., LIBRARIANS) for which OCCUPATIONAL GROUPS is available.

individual (C0237401)

individual (C3245468)

HL7V3.0 : Description:Person as specified by coverage policy or program.

HL7V3.0 : Description:The level of coverage under the policy or program is available to an individual.

HL7V3.0 : Description: A role played by a party covered under a policy as the policy holder. An individual may be either a person or an organization.
Note: The party playing the role of an individual insured is not a claimant in the sense conveyed by the RoleClassCoveredParty CLAIM (claimant). However, a named insured may make a claim under a policy, e.g., a party that is the named insured and policy holder under a comprehensive automobile insurance policy may become the claimant for coverage under that policy if injured in an automobile accident and there is no liable third party. In the case of an individual insured making a claim, a role type code INSCLM (insured claimant) subtypes the class to indicate that an individual insured has filed a claim for a loss.
Example: The individual insured under a comprehensive automobile, disability, or property and casualty policy that is the policy holder.

HL7V3.0 :

self (C0036588)

HL7V3.0 : The "same" roleclass asserts an identity between playing and scoping entities: that they are in fact instances of the same entity and, in the case of discrepancies (e.g different DOB, gender), that one or both are in error.
Usage:
playing and scoping entities must have same classcode, but need not have identical attributes or values.
Example:
a provider registry maintains sets of conflicting demographic data for what is reported to be the same individual.

NCI : The individual as the object of his own reflective consciousness.

HL7V3.0 : The relationship that a person has with his or her self.

self (C1551994)

HL7V3.0 : Covered party is the policy holder. Also known as the subscriber.

See also:

WordNet::Similarity

This is a Perl module that implements a variety of semantic similarity and relatedness measures based on information found in the lexical database WordNet. In particular, it supports the measures of Resnik, Lin, Jiang-Conrath, Leacock-Chodorow, Hirst-St.Onge, Wu-Palmer, Banerjee-Pedersen, and Patwardhan-Pedersen. 

n.b. While Hodges' model was created for application in health and social care contexts it can be applied generally.