Why 'Integrated Care' remains a Legacy Issue

Define 'integrated care'?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

Protect myself [You Government] Protect me* The individual need to  'do' something with this model,  not just think about it.  The personal sense (illusion) of doing, with yet another install of Wamp, Drupal ...	Complexity Systems Uncertainty Legacy - issues Evidence-Based Care?
*(I have a duty of care to protect my family and community and not become the next casualty.) Protect my loved ones and community	Evidence-Based Policy? The National Risk Register 2017 Is a tabletop exercise in pandemic  planning and response sufficient? The Political sense of thinking as 'doing'. (This is where the lamp is always on.) Tick here

See also:

'Desk-topping' i [ c/o BBC Radio 4 today 5 Feb. ]

Image source:
https://www.trident-crisis-solutions.co.uk/ (risk register)
https://www.bumc.bu.edu/ (tick box)

The International Health Protection Initiative (IHPI) - Resolution Sign-up

The International Health Protection Initiative believes that health care MUST be protected during armed conflict.

The International Health Protection Initiative (IHPI) is a collective movement of individuals, organisations, institutions and charities (including non-Governmental Organisations-NGOs) who have agreed to help to lobby the United Nations to act to uphold the Geneva Conventions, especially as regards safe-guarding health facilities/equipment/transport, and workers.  The Resolution was agreed following a meeting of the International Child Health Group held in November 2010.

Your support is urgently needed for an international resolution to protect healthcare during armed conflict

The resolution will ultimately be submitted to the United Nations (General Assembly, Security Council, and World Health Organization).

In order to achieve the objectives outlined in the resolution, we need the majority of the world’s healthcare organisations, institutions, NGOs and civil society, especially those in conflict afflicted countries to sign up to this important resolution.

We know that you are aware of the urgent need to protect healthcare during armed conflict, that is, to uphold the Geneva Conventions and we would be most grateful for your support.

Once you have read the resolution we respectfully urge you to sign up to it online, as an individual, or preferably, on behalf of your government, institution, or medical organisation. We also encourage you to state your reasons for supporting this resolution in the appropriate box.

So please Sign up now!

Many thanks for your time and attention and we look forward to working with you to help make this life-saving resolution a reality

The IHPI Team
info AT ihpi.org

"War... is when some adults who don't know what good is and what love is, are throwing dangerous war toys which injure innocent people" 

Tamara aged 10 years during the war in Bosnia and Herzegovena.

My source: Prof. David Southall via HIFA2015

My thoughts upon signing up:

This resolution saddens me: that we should need it in the 21st century after millennia of human conflict.

The resolution is an essential course of action that I will help to publicize. Resources by way of legal enforcement, financial and personnel as declared in the resolution to protect basic human rights and health care provision must be assured and enforced globally. As per #5 the trend of pursuing those who commit crimes against humanity should be escalated as the means to record and furnish evidence also increases. This is imperative as a deterrent to those who supposedly 'lead' and those who invariably follow. In this sense 'education for all' is also crucial to help prevent indoctrination - with the additional health dividend that education affords.

RCN Congress 2026 & RCN North West Multicultural Group (NWMG)

England's North West is certainly in the news at present, on two counts:

1. The current Labour party machinations in the Makerfield ward;
2. and RCN Congress in Liverpool.

 As I attend Congress a key focus is the debates and how I can relate these to Hodges'model - (with some links to previous posts):

1. Nursing as a STEM profession
Matter for discussion submitted by the Eastern Board
That this meeting of RCN Congress discusses the recognition of nursing as a STEM (Science, Technology, Engineering, and Mathematics) profession, valuing the scientific, technical and analytical expertise of nurses.

STEM - science : technology : engineering : mathematics

2. Safe, ethical, person‑centred nursing
Resolution submitted by the Cheshire Branch
That this meeting of RCN Congress calls on RCN Council to urgently develop and implement a UK‑wide framework for realistic person‑centred care, ensuring that nursing practice is safe and ethical.

safe : ethics : person-centred 

3. Regular redeployment
Matter for discussion submitted by the Wiltshire Branch
That this meeting of RCN Congress discusses the impact of the daily redeployment of nursing staff on morale, team work and patient safety.

re- deployment

4. Unpaid hours
Matter for discussion submitted by the North East London Inner Branch
That this meeting of RCN Congress discusses the culture of nursing staff missing breaks and working beyond their contracted hours.

work

5. National safety standards for lone working
Resolution submitted by the Health and Safety Reps Committee
That this meeting of RCN Congress calls on RCN Council to lobby for the implementation of national safety standards for lone working, ensuring access to appropriate safety equipment, technology and protocols to protect staff across all care settings.

lone working

6. Accountable, compassionate and psychologically safe leadership
Matter for discussion submitted by the Cheshire Branch
That this meeting of RCN Congress discusses how the RCN can help create a culture where accountability, compassion, and psychological safety coexist, enabling managers to lead effectively while ensuring all staff feel respected and protected.

accountability : compassion : leadership 

7. Misinformation in health care
Matter for discussion submitted by the Women's Health Forum
That this meeting of RCN Congress discusses misinformation in health care and the impact this has on the nursing workforce.

misinformation : information disorder

8. Confidence to address racism
Matter for discussion submitted by the South West London Outer Branch
That this meeting of RCN Congress discusses how to build the confidence of nursing staff in addressing racism.

confidence : racism

Once again the North West Multicultural Group will have a stand:

The RCN North West Multicultural Group (NWMG) creates a community for members across the region from multicultural ethnic backgrounds to connect with each other, share their lived experience, knowledge and diverse ideas that help drive change around racism to ensure that their various organisations is the best place to work.

Membership is open to RCN members of Royal College of Nursing from multicultural backgrounds and their allies.

Mission statement: 

The aim of the North West Multicultural Group is to stand against racism and discrimination by using members lived experiences, encouraging organisations to be anti-racist and with the support of allies.  

Aims and objectives: 

• To raise the issues around race, discrimination and equality in the workplace and to find potential solutions. 
• To challenge misconceptions about people from different ethnic backgrounds.
• To recognise the skills and contribution to care for people from all backgrounds make.
• To acknowledge that racism is a social construct that needs to be eradicated together.  Together we are stronger.
• To be a platform for black, Asian and minority ethnic staff and allies to work collaboratively to address racism in practice.
• To help amplify the voice black, Asian and minority ethnic staff.
• To be role models, set examples as allies and develop confidence.
• To provide training and support about anti-racist practice.
• To work with the RCN to support campaigns to make sure communication is fit for purpose and acknowledges any cultural differences. 

Your executive team:

Chair: Olanike Babalola
Vice Chair: Susan Owen-Naz
Communications Officer: Mark Anthony

9. Advanced nursing practice
Resolution submitted by RCN Council
That this meeting of RCN Congress agrees that the RCN will act upon attempts to undermine advanced nursing practice.

advanced : practice : theory

10. Protecting nurse education
Resolution submitted by the Education Forum
That this meeting of RCN Congress asks RCN Council to lobby UK governments to protect nurse education from university sector economic pressures.

protect

11. Quality of clinical placements
Matter for discussion submitted by the Students Committee
That this meeting of RCN Congress discusses ways in which the quality of clinical placements can be ensured and consistent across all 4 countries.

quality : placement

12. Bank rates
Resolution submitted by the South Yorkshire Branch
That this meeting of RCN Congress demands that employers pay nursing staff bank shifts at their substantive rate.

pay

13. Are external reviews meaningful?
Matter for discussion submitted by the Midwifery Forum
That this meeting of RCN Congress discusses whether external reviews and inquiries are genuinely driving meaningful improvements in safety across health and social care.

inquiry : review

14. Improving acute mental health crisis services for children and young people
Resolution submitted by the London Board
That this meeting of RCN Congress calls on RCN Council to lobby UK governments to improve the provision of services to children and young people presenting in acute mental health crisis.

children : mental health

15. Access to specialist pain services
Matter for discussion submitted by the Pain and Palliative Care Forum
That this meeting of RCN Congress discusses access to specialist pain services and the role of the registered nurse in caring for those in pain.

pain

16. Palliative and end-of-life care
Resolution submitted by the Pain and Palliative Care Forum
That this meeting of RCN Congress calls on RCN Council to lobby UK governments to ensure everyone living across all 4 nations has access to specialist palliative and end-of-life care.

palliative

17. Accessible and affordable travel
Matter for discussion submitted by the North Central London Inner Branch
That this meeting of RCN Congress discusses what accessible and affordable travel means for the nursing workforce.

18. Uptake of physical health checks
Resolution submitted by the Public Health Forum
That this meeting of RCN Congress requests RCN Council to lobby UK governments to improve the uptake of physical health checks for people with learning disabilities and serious mental illnesses (SMI).

serious mental illness (SMI)

19. Eye donation
Matter for discussion submitted by the Greater Glasgow Branch
That this meeting of RCN Congress discusses the role nursing has in eye donation in end-of-life care planning.

eye : vision

20. 35-hour week
Resolution submitted by the Lothian and Borders Branch
That this meeting of RCN Congress calls on RCN Council to instigate a campaign for a maximum 35 hour working week for the nursing workforce.

21. Inappropriate delegation
Matter for discussion submitted by the Berkshire Branch
That this meeting of RCN Congress discusses the delegation of health care tasks to school staff and non-health care professionals.

22. Access to medicinal cannabis
Matter for discussion submitted by the Cheshire Branch
That this meeting of RCN Congress discusses the impact of current NHS prescribing practice on access to medicinal cannabis.

medicinal cannabis

23. SPA time
Resolution submitted by the Wiltshire Branch
That this meeting of RCN Congress calls on RCN Council to lobby for the inclusion of Supporting Professional Activities (SPA) time in all nursing job-plans.

See: https://www.rcn.org.uk/Congress/Agenda 

Are there any lessons from this exercise? Well, I have no posts tagged 'donor', or 'medicinal cannabis' - to make an important distinction. Something to correct and try to follow this week. 

See you there ...?

(I may need to reduce the link-count here.) 

The number of pages count (in a medical MOT)

Received in the post: an invitation.

For a medical MOT that would cost me £129 - which is a saving of £141.

I am informed that a competitor charges £564 for a "360" Health Assessment and £424 for an "Essential" Health Assessment.

Recently I spoke to someone who had major surgery and they remarked on the lack of assessment not on the medical side, but the social, especially in relation to discharge and the circumstances they would be returning to.

This example of apparent disinterest in a social assessment contrasts with practice in the past - several decades ago.

Apart from an awareness of  'silver clouds' and rose-tinted glasses what struck me was securing a sale by a manifest of paper:

The various blood tests that would be completed are detailed using medical terminology across four A4 pages. Depending on age there is a free respiratory screening too.

The following quotations (Alber, et al., 2017) state clearly the risks:

"There is a growing awareness among clinicians and health care scientists, that medical overuse comprises unnecessary health care lacking benefit for patients [3] or putting them at risk of harm outweighing a potential benefit [4]. Moreover, unnecessary medicine adds to rising health care expenditures [5] and a misallocation of scarce resources [6]. Asymptomatic individuals are at risk of being labelled as patients, causing anxiety and affecting their quality of life [7]." ...

"Moreover, in secondary prevention, risk factors are increasingly treated as diseases [8]. There is a tendency to screen asymptomatic populations at low risk and to label pre-diseases as manifest diseases [1]. Serum cholesterol levels are a good example of threshold lowering by shifting the boundary between health and disease [9]."

Over-treatment is also a problem in two critical and concurrent senses, as follows:

Developed health systems Need to transform to health promoting, educational, preventive, self-caring systems.

Developing health systems Need to prevent the inheritance of commodified health care and over-treatment.*

Alber et al. also provide a useful diagram preceded with more background:

"In primary care, the “quaternary prevention concept” [11] was introduced (see Fig. 1 ) in order to protect individuals from unnecessary investigations and treatment. Quaternary prevention is a “new term for an old concept: first, do not harm” [12]. It refers to actions “taken to identify [a] patient at risk of overmedicalisation [= in the sense of medical overuse, author’s note], to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable” [13]."

Fig 1

The concept of quaternary prevention. Source: [11] Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoulle M. Quaternary prevention: a task of the general practitioner. PrimaryCare. 2010;10:350–4, and [12] Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. Int J Health Policy Manag. 2015;4:61–4

Without being dismissive of screening and its relation to health and well-being, I have removed myself from this particular mailing list.

At some point I must really apply Hodges' model to this discussion. The model is ideally suited to navigating and arguing this debate; from self-care, primary care, prevention, population and global health. I have posted previously about the damaging ideal of the comprehensive health record and the way that records seem oriented to assessment and risk reduction with outcomes and relapse prevention an after-thought. This defensiveness is critical for public safety, professionalism and accountability, but as a thread on twitter shows it can have a negative impact too.


*There is an additional confounding factor at work in developing nations, the incursion of digital technologies from outside.


Alber, K., Kuehlein, T., Schedlbauer, A., & Schaffer, S. (2017). Medical overuse and quaternary prevention in primary care - A qualitative study with general practitioners. BMC family practice, 18(1), 99. doi:10.1186/s12875-017-0667-4

Tsoi, G.W.W. (2014). Update On Prevention - An Introduction to Quaternary Prevention, Medical Bulletin 19, 11, NOVEMBER 2014.

Ack.
I am subscribed to a mail list that is an invaluable resource on the status of medicine and health care, with contributors including, Mohammad Zakaria Pezeshki, Juan Gérvas, Karenleigh A. Overmann, Gene Tsoi and others.

MOT: Ministry of Transport test

Privacy: Open Data, Individual and Group

The vertical axis of Hodges' model is the individual - group, or self through to collective. Health and social care constantly negotiates this from the ideals and delivery of person-centred care to public mental health. So often for health professionals the emphasis is on the individual, the person's care needs, their strengths, their rights, outcomes and feedback on care received. The same individual focus is also ascribed to records and information. Protection of data, maintaining confidentiality is an essential duty of health care  professionals.  

Earlier this year the government's care.data scheme was placed on hold. 'Open' is the way of the world: open access, open source, open data and open government. Increasingly the group as an entity needs to considered in what may be a new way, as Floridi writes:

The idea that groups may have a right to privacy is not new, and it is open to debate, but it has not yet received all the attention it deserves, although it is becoming increasingly important.

 ...

Open data is more likely to treat types (of customers, users, citizens, demographics population, etc.) rather than tokens (you, Alice, me), and hence groups rather than individuals. But re-identifiable groups are ipso facto targetable groups.It is therefore a very dangerous fallacy to think that, if we protect personal data that identify individuals, the protection of the groups will take care of itself. p.23.

Luciano Floridi. Group Privacy. The Philosophers' Magazine. Issue 65, 2nd Quarter 2014. pp. 22-23.

Here is a related book (on my list) a BMJ award winner:

The Private Life, Josh Cohen:
https://granta.com/products/the-private-life/

The war over private life spreads inexorably. Some seek to expose, invade and steal it, others to protect, conceal and withhold it. Either way, the assumption is that privacy is a possession to be won or lost.

But what if what we call private life is the one element in us that we can't possess? Could it be that we're so intent on taking hold of the privacy of others, or keeping hold of our own only because we're powerless to do either? ...

Project: Partners against Stigma and Mortality in Epilepsy (PASME) Cameroon

Boyo Association for Rural Development (BARUDEV - Cameroon) has launched a project on epilepsy called Partners against Stigma and Mortality in Epilepsy (PASME).

We are calling for partnerships and support for our project on epilepsy which will focus on mental health and psychosocial support, treatment, knowledge and skills exchange,raising awareness, rights protection amongst patients affected and or bereaved by epilepsy, health care providers. Also reduce seizures and consequences particularly in children and adolescents living with epilepsy and HIV/AIDS. 

• ADVOCACY AND AWARENESS. Promoting awareness and supporting initiatives that prevent epilepsy. Prioritize epilepsy at national and international levels, while lobbying and advocating support for partners and governments to prioritize epilepsy into their health programs and policies.
• TREATMENT AND SUPPORT. Provide access to treatment and support initiatives that improve access to effective treatment including medications and their therapies. 
• PROVIDE BEST-PRACTICE MODELS. Develop and share models for effective management of epilepsy in diverse settings including conflicts and disasters where people are forced to displace.
• BUILD CAPACITIES THROUGH TRAINING. Advance training and information sharing for healthcare givers, CHWs and family care givers involved in epilepsy care. 
• PROMOTE HUMAN RIGHTS AND DIGNITY. Advocate for the accessibility of services, protection of human rights and preservation of dignity for all with epilepsy including children and adolescents living with epilepsy and HIV/AIDS. 
• EMPOWERMENT AND RIGHTS: Lobby and advocate for the rights of people with epilepsy through their associations and to enable them participate in decision making processes. 
• RESEARCH AND COLLABORATION: Foster research through encouragement and support in epilepsy including causes, prevention, treatment and social impact. Strengthen their associations, develop and support them through mental health and psychosocial support projects and ensuring and protecting their well-being and their families.

BARUDEV is currently building a website (which I will add upon news - PJ).

Please contact me if you need further information

HIFA (my source) profile: Chiabi Bernard Ful is Director of Boyo Association for Rural Development (BARUDEV--Cameroon). This is a local NGO found in Boyo district of North Western Cameroon. Our activities are to empower women, protect the sexual and reproductive health for women and girls, and protect the rights of children. We have been training community health workers to follow up patients, pregnant women, sick children and refer them to the hospital.
barudev AT yahoo.co.uk

HSJ: Human centred systems - the case for [disintegrated] integration

individual
|

 INTERPERSONAL : SCIENCES 

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

SOCIOLOGY : POLITICAL 

|

group

Listening, communication slip ups YOU! are a - “bed blocker” “frequent flyer” My purpose Valuable or Vulnerable person? “PROTECT the Person”	Services, Teams, Silos Repeated doubling up, duplication Threshold raising simplify the steps 1940s style factory production line model ? 5-year cycle, interventions, (budget) ? Place-based
Neighbourhoods Anthropology of Communities PUBLIC - 'shared purpose' lived experience - develop a more flexible multidisciplinary workforce coproduction :: purchaser provider led model of commissioning social scaffolding in neighbourhoods -	initiatives Organisation 'INTEGRATE' Sovereignty, governance structures, pooled budgets “PROTECT the NHS” Public Service reform:  local government, dept of work and pensions,  police, housing and community and voluntary organisations.  - joint investment models

 

Human centred systems - the case for integration, By Donna Hall, 15 February 2021. HSJ. https://www.hsj.co.uk/service-design/human-centred-systems-the-case-for-integration/7029472.article 

 

My source: https://twitter.com/antlerboy/status/1392547724201971716?s=20

Historic Climate Ruling: States Must Step up Climate Action to Protect Human Rights

From: Center for International Environmental Law (CIEL) PRESS ROOM ...

STRASBOURG, FRANCE – Today, the European Court of Human Rights issued a groundbreaking ruling in the Verein Klimaseniorinnen Schweiz and Others v. Switzerland climate case. The Court found Switzerland in violation of the European Convention on Human Rights for failing to implement sufficient measures to combat climate change. 

Center for International Environmental Law (CIEL) Senior Attorney Joie Chowdhury issued the following statement in Strasbourg, France:

“We expect this ruling to influence climate action and climate litigation across Europe and far beyond. Today’s historic judgment in Verein Klimaseniorinnen Schweiz and Others v. Switzerland – the first ruling by an international human rights court on the inadequacy of States’ climate action – leaves no doubt: the climate crisis is a human rights crisis, and States have human rights obligations to act urgently and effectively and in line with the best available science to prevent further devastation and harm to people and the environment. The ruling reinforces the vital role of courts – both international and domestic – in holding governments to their legal obligations to protect human rights from environmental harm. It also affirms the power and courage of those who speak out and dare to demand a livable future for all.”

https://www.ciel.org/news/historic-climate-ruling-on-climate-justice/

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

Personal ethics Envisioning of future lives Anxiety in the here & now

Switzerland - Europe - The World Yesterday - Now - Tomorrow a LIFE TIME :: DEEP TIME

Public action Vulnerable groups Public activism

"In a landmark decision on one of three major climate cases, the first such rulings by an international court, the ECHR raised judicial pressure on governments to stop filling the atmosphere with gases that make extreme weather more violent. The court’s top bench ruled that Switzerland had violated the rights of a group of older Swiss women to family life, but threw out a French mayor’s case against France and that of a group of young Portuguese people against 32 European countries." The Guardian

Frontline First campaign: cost-saving innovations whilst improving patient care

Dear Peter,

Innovations are the key to saving the NHS money. Every day, nursing staff on the frontline are finding new and better ways to deliver patient care.

As one nurse recently wrote to us:

"Without a working knowledge of clinical care provision how can ideas be practical and ensure quality of care is maintained? Nurses are in a prime position to look at care provision to identify better ways of working and therefore identify cost savings without sacrificing patient care and experience."

As part of our Frontline First campaign, the RCN is collecting examples of cost-saving innovations at NHS services across the UK. What nursing solutions have you seen in your workplace that could achieve savings without sacrificing patient care?

http://generalelection.rcn.org.uk/innovation

There are two ways the NHS can find billions of pounds in efficiencies:

discover innovative ways to save money
or
make cuts to staff and services

Every day, UK nurses are helping to devise and implement cost-effective solutions saving their employers money and helping to protect jobs. We've already heard from dozens of nursing staff who told us about innovations in their workplace, from changes to day-to-day practices to
whole new ways of working.

Please take a moment to report any cost-saving innovations you've seen at the workplace:

http://generalelection.rcn.org.uk/innovation

Thanks for speaking up and helping to protect patient care.

Yours sincerely,

Janet Davies
Director of Nursing and Service Delivery

My source:
Subject: Improving patient care
From: "Janet Davies, Royal College of Nursing"
Date: 04 August 2010 16:53:30

Boxing 'II'

As young children we may encounter 'boxing' quite early on. This first experience, which we may or may not wholly remember is undoubtedly critical to our personality and subsequent psyche. Such early experiences influence our ability to 'look after ourselves', how we deal with bullies, anxiety, the potential for conflict and develop assertiveness skills. When a 'scrap' happens it can be quite sudden, that total impact of everything out of control, sheer danger and literal impacts. The environment might be nursery, playground, cloak room and the presence of peers as onlookers can be another key factor.

In the late 1960s early 70s I found some old boxing gloves under the stairs at my nan's. I had a handful of uncles on mum's side (just two now - Uncles Tom and Ken!) and the gloves had clearly been swung and jabbed down the line. I don't count myself as a fighter, unless someone tries to push their beliefs - without invitation - down my throat. Then it will be more a case of a reflex action. The 'arc' being comprised of vomit. In the school playground I learned to talk my way out of trouble, resorting to humour at times; as you learn to deploy whatever intellect you might have judiciously. Legs are essential to a boxer:

“First your legs go. Then you lose your reflexes. Then you lose your friends”

Willie Pep

My legs helped me a time or two.

Not too many years ago, so a new generation is in the frame and a nephew had boxing gloves of his very own. He trained with a local club and had some fights. I didn't go watching, but didn't make too big a big fuss either. He doesn't box now as it happens; he's married with family and busy earning a living. Over four decades I've cared for several gentleman, former boxers who developed dementia. Hence, my lack of enthusiasm. (Although the selective literature listed below does not reflect it, women's boxing is of course also well established.) The extent to which boxing caused their dementia is not the point here. It's trying to acknowledge the ongoing debate: the risks, the history (Ancient Greece 688BC), the discipline, sense of belonging and self-respect it can instill. Of course a great many sports can do this. Of course, I listened very attentively as one gent could still relate how perhaps he had been 'used' in terms of the fights and purses back in the 50s-60s. Vulnerable adults of today and yesteryear. Today American Football is concerned about head injuries, in football heading the ball repeatedly is in the news. Technology should be able to reduce the risks even more and protect individuals from injury that is obvious and more insidious in nature.

Some of these points I've considered in Hodges' model as follows:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

SELF self-awareness Identity self-belief way-finding dementia - cognitive damage personality change aggression tactics  strategy motivation training attitude self-discipline ethics mental health - mental capacity emotions mood Personal safety	boxing technique reflexes speed movement balance punching fitness weight, reach, statistics THE RING stamina nutrition hydration concussion sub-concussive exposure models unconscious knockout Head - Brain injuries physics: force time (duration) momentum technology - sensor equipped gloves Sports Medicine Research Headgear Safety - Evidence Medical risks
OTHER Ethnographics Coaches <-> Boxers Mentors Support network THE STREET personal history-family History sports history trainer friends club Sporting behaviour family friends Socio-	Rules (changes) Conflict Power promotion media finance codification rules Amateur Professional Refereeing Regulating bodies Governance Law Contracts Economics

Selective reading:

Sacha, J. (2017). Fighting Feelings. Sociological Perspectives, 60(1), 77-94.

Erlanger, D. (2015). Exposure to sub-concussive head injury in boxing and other sports. Brain Injury, 29(2), 171-4.

Falvey, &., & Mccrory, P. (2015). Because not all blows to the head are the same. British Journal of Sports Medicine, 49(17), 1091.

Mcintosh, A., & Patton, D. (2015). Boxing headguard performance in punch machine tests. British Journal of Sports Medicine, British Journal of Sports Medicine, 14 July 2015.

http://www.welshboxers.com/quotes/

See related post 2016: 'Boxing' I

"No safety without emotional safety" by Veale, et al. (2022)

 INDIVIDUAL
|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

psychological needs (risk) inc. threat processing - treatment of interpersonal violence 'therapeutic emotional safety (re-traumatisation) control behaviour severe panic with flashbacks, dissociation, and visual hallucinations	physical needs (RISK) 'low intensity touch' environment' ... tepee - in room my safe space physical safety (safe room) to increase physical safety privacy, lighting, doors, window
lived experience family - relationship experience (touch) 'atmosphere'? change in culture, positive risk-taking person-centredness, family orientation in 'team' Leadership 'therapeutic community' Open Dialogue	CONTROL: 'take away' - autonomy, responsibility policies - abuse risk, 'protect' patients and staff regulatory reform in-patient care, pets - policy parity of esteem Access (still) to therapies, CBT Institutional risk Alternative protocols

David Veale, Eleanor Robins, Alex B Thomson, Paul Gilbert, No safety without emotional safety, The Lancet Psychiatry, 2022, ISSN 2215-0366, https://doi.org/10.1016/S2215-0366(22)00373-X. (https://www.sciencedirect.com/science/article/pii/S221503662200373X)

My source:
https://twitter.com/tadhg50/status/1596901626765529091?s=20&t=FJe9qpYUrxHN2yxWEWLUdQ

The purposes of Hodges' model is to identify the concepts that have salience clinically, to the person, be they - patient, carer, student ... and then to integrate care, to draw the care domains together into a 'whole'.

Four original purposes of Hodges' model: 

1. Reflection, reflective practice, critical thinking
2. Person-centred care
3. Holistic - integrated care
4. Bridge the Theory - Practice gap

Think Tank Invitation [2]: Environment, Citizenry, Ecosystem & Health

My response? No major surprises...

In order to integrate - we first need to dis-integrate. Within these four 'issues of the Century' - Environment, Citizenry, Ecosystem & Health there is IMHO a distinct 1 x 4 hierarchy with which to grapple. As ever everything depends on the foundations.

So, a first step is to separate out and protect the flora and fauna. That is, differentiate all that is wild from the spaces that humankind inhabits. The extent of our influence makes this distinction a case of trying to put the genie back in the bottle. We pose an ongoing threat to the wild, ecologically pristine places, such is the invasive nature of human habitation across the planet. For example, lead pollution from Roman times and the more recent industrial age covered the planet as captured within Arctic and Antarctic ice cores. So the FIRST starting point is the natural environment or general biosphere.

This is followed by the artificial environments created as we peopled the world over some 160,000 years. Our modern concrete footprints alter the climate and conditions that would normally prevail. Our cities, farming and use of the soil, sky, oceans and seas all have a wider impact. In 2006 a key phrase was 'climate canary', so of course this natural-artificial distinction already exists. The state of the natural environment speaks volumes, as per one of the first warnings Silent Spring and more recent concerns regards increasing hormone and chemical levels in the oceans. We use light to show the way and lights certainly chart our accelerated progress in the past century.

The THIRD level must - in order to effect change - be not about place but agency. Commentators have highlighted that from now on it is the day-to-day decisions that citizens make that will ultimately make a difference.

So to recap: we have the wilderness as a FIRST level, then SECONDLY our constructed 'biospheres' - cities, towns, networks of various sorts - transport, power - what is often described as infrastructure and finally waste. (I suppose definition of biosphere must entail sustainability. Clearly, this is not yet an appropriate descriptor for our cities.) And THIRDLY citizens; the agency that once politically activated can (must) help bring about change.

Health (and social care) is the FOURTH and key point, crucial in that health links citizens, our environment and the environment with quality of life.

Contemporary (Western) health and social care systems focus on the health of individuals and groups, the latter also at the family and population level. Now we realise the health of the planet has a direct bearing on our health. How hot and dry will it be next summer? How wet and windy will it be next winter? Why is the sun not as bright? When is the next solar maximum?

We tie ourselves in knots, the individual before us. Save some of those sutures (and staples), another casualty demands our attention and needs our care. It is also time to remember our roots, feel the sand beneath our feet and witness once more the stars in the night sky.

Health - Quality of Life
Citizenry - Individual & Group Politic
Artificial or Human 'Biosphere' Footprint [eco-City?]
Global Biosphere - 'Natural' Fauna & Flora Environment

And yes, Hodges' model can help map and represent these four essential ingredients for lively debate.

Truth & Democracy: '300 grammes' - The Daphne Foundation

I remember seeing a documentary, hearing on the radio and reading in the FT about the murder of Daphne Caruana Galizia, who was a journalist in Malta. I was shocked that this could happen in Malta. The British, naval - colonial connections, its being in Europe and the EU. The lesson being of course, that we must take nothing for granted and exercise constant vigilence to protect law and justice. 

'Courage' is often described as a personal and professional quality for nurses.

For journalists as the news  reveals each and every day - it is the first.

Individual

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      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

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Group

Daphne	'The bomb was packed into a steel container, placed beneath my mother's car seat, and detonated remotely just down the road from our home in Bidnija. It contained around 300 grammes of military-grade explosive. I didn't know the weight until this trial. But I already knew what it destroyed.'
Caruana Galizia daughter sister wife mother grandmother friend neighbour colleague citizen ...	'There was something else I didn't know before this trial. The two medics who conducted my mother's autopsy said they found her heart was, incredibly, "intact" - and that it weighed 300 grammes. The same weight used to kill her was the weight of what endured.'

Paul Caruana Galizia. Opinion: Corruption - What Malta owes my murdered mother, FTWeekend. 14-15 June 2025, p.10.

https://www.ft.com/content/3f5012a6-a358-48a9-a72f-9d2ae530878b

See also: The Daphne Caruana Galizia Foundation

Acknowledgement and thanks to Paul Caruna Galizia.