In Browder, 'care' is mentioned over 150 times!

OK - so now you're teasing ...

'Surgery theory investigates the homotopy types of manifolds, using a combination of algebra and topology. It is the aim of these notes to provide an introduction to the more algebraic aspects of the theory, without losing sight of the geometric motivation.' Ranicki, 2001. 

'IV. Surgery and the Fundamental Theorem

In this chapter we develop the techniques of surgery for constructing normal cobordisms and use them to prove the Fundamental Theorem. The ideas of surgery have their origins in the theory of 2-manifolds, in the process of "cutting off handles", and in general, in the theory of Marston Morse of non-degenerate critical points of differentiable functions.' Browder, 1972.

In Browder, care is mentioned over 150 times!

'Poincaré' that is.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

	'The Classifying Spaces for Surgery and Cobordism of Manifolds'
Try to - follow the language* ...	"Follow the money!"

Ranicki, A. (2001) An introduction to algebraic surgery. Surveys on Surgery Theory, Volume 2, edited by Sylvain Cappell, Andrew Ranicki and Jonathan Rosenberg, Princeton: Princeton University Press, 2001, pp. 81-164. https://doi.org/10.1515/9781400865215-005

Browder, W. (1972) Surgery and the Fundamental Theorem. In: Surgery on Simply-Connected Manifolds. Ergebnisse der Mathematik und ihrer Grenzgebiete, vol 65. Springer, Berlin, Heidelberg.

https://doi.org/10.1007/978-3-642-50020-6_4

Madsen, I. H., and Milgram, R.J., (1979) The Classifying Spaces for Surgery and Cobordism of Manifolds. Princeton University Press.

Image: https://m.media-amazon.com/images/I/41THEeVvpdL.jpg

*concepts!

Take II: Awaiting an appt with Nd:YAG

Two years ago in 2010 and post-cataract surgery I was literally full of the light and colour of a new year:

"2010" definitely not - future vision is 20:20!

Working in health you know not to take anything for granted, to live for today and what side effects and outcomes can follow clinical interventions. So, over the past six months I've noticed reduced vision in my left eye. Now I've no focus at all. Here's the situation across the four care domains:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

It is frustrating to have difficulties again, but always sobering to be reminded of what being 'sighted' means. As I drive and also convey others I constantly consider the safety question. The extent of the deterioration is scary. My vision is still brighter than before the intraocular catarct surgery. Being a 'bloke', or plain stupid (what does medical sociology have to say about that?) I've put off addressing this, but time now to act mechanistically and get this fixed.

For some 6-9 months I have experienced blurred vision in my left eye. Now I cannot see distance or read with glasses. Flaring is starting in the right with headlights at night when driving. Problem: posterior capsular opacification. Solution: treatment using a Nd:YAG laser - neodymium-doped yttrium aluminium garnet; Nd:Y3Al5O12. Future side effect includes increased floaters, but my vision should be markedly improved and balanced once more.

It will be very good to have both eyes 'online' again. I've 3-4 days of leave left, and will head to the Lakes next month. Time to walk, run and pick up Drupal again. It is a reminder of the past going back to Wigan, the hospital where I did my general nursing.

Recognising I had a problem and the likely cause, I by-passed the opticians and went straight to my family doctor and asked to be referred to the hospital - Wigan RAEI where the initial surgery took place. The 'systems' including Choose and Book ran smoothly apart from instructions on telephone numbers to contact me.

Whether or not my vision will be '20:20' or better, I will just be grateful to be able to see as well as I possibly can.

Image source:
Rakesh Ahuja, MD

GP launches YouTube health films

Bob Pyke posted the following today:
--------------
I wrote about this about a year ago and they recently updated it, but it is still pretty cool.
http://www.builthsurgery.co.uk/

A GPs' surgery in mid Wales has launched a series of health education films on YouTube, better known as a website featuring home videos.

Advice about flu vaccination and cervical screening are two of the topics covered by Builth and Llanwrtyd Medical Practice in Powys.

Doctors said they wanted to help educate their 7,700 patients and a wider global audience.

Last year, the surgery launched a series of podcasts to advise patients.

YouTube allows users to upload their home videos and other clips online.

Dr Richard Walters, who helped to develop the practice's project, said surgeries normally printed leaflets to advise patients, but added that things were changing.

He told the Western Mail newspaper: "There are a lot of things that we do in a GP practice that have to be conveyed to patients, some of which are not easy to demonstrate within the surgery.

"Sometimes getting patients to watch a quick video on the computer screen is a lot easier."

He added: "We are a practice in rural mid Wales, shops in Hereford and Aberystwyth are an hour away, Cardiff an hour-and-a-half, so although broadband access is not ideal, people tend to use the internet for all sorts of things."

The practice, which covers more than 500 square miles (1,295 sq kms), hopes its advice online will avoid unnecessary travelling to a see a doctor. The videos include tips about asthma inhalers, smear testing, blood sugar testing and the winter flu vaccine, and are made by two practice nurses.

New topics are planned to be added every month. As well as being available on YouTube, the videos are posted on the practice's own website and can be downloaded onto an MP3 player. The surgery is no stranger to using modern technology to get across its health messages to patients. Last year, it launched podcasts demonstrating, among other topics, how to use an asthma inhaler properly.

Story from BBC NEWS:
http://news.bbc.co.uk/1/hi/wales/mid/6234141.stm

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

<>

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' . . .

Robots, surgery, resources and policy

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL
|

group

	"A proliferation of centres offering robotic surgery should be avoided ...
	until a national policy can be developed." p.14.

da Vinci Surgery

Clinical Commissioning Policy: Robotic-Assisted Surgical Procedures for Prostate Cancer, Draft for Public Consultation: NHS England.

The Robot Report

Dunhill, L. (2015) Robot wars over specialist site, Health Service Journal, 8 July. 125: 6453, p.14.

'Maths Without Numbers' by Milo Beckman

'Before you go tell your loved ones that you read a book about math and learned that a square is a circle, keep in mind: Context matters. A square is a circle, in topology. A square is most certainly not a circle in art or architecture, or in everyday conversation, or even in geometry, and if you try to ride a bike with square tires you won't get far.' pp.7-8.

'Like a line:

(Illustration - pen drawing of a line, a 'C' and an almost closed circle.)

A line can be bent almost into a circle, but to finish the job we'd need to click the ends together--not allowed. No matter how you manipulate a line, you'll always have those two special points on either end, where the shape just stops. You can't get rid of end-points. You can move them around and stretch them apart, but the two end-points are an unchanging feature of the shape.

For a similar reason, a figure-eight is a different shape too. There aren't any end-points, but there's still a special point in the middle where the lines cross, where there are four arms reaching out instead of the usual two at any other point. Stretch and squeeze all you want, you can't get rid of a crossing-point either. p.9.

Math Without Numbers

'The circle (aka S-one) and the infinite line (named R-one) are the only manifolds in the first dimension. To avoid end-points, you either have to loop back around or just go on and on forever. And don't forget: Because all the shapes in topology are stretchy, this also covers any closed-loop shape and any goes-on-forever shape. It doesn't have to be literally a circle or a straight line.' p.16.

The third dimension, dough-type manifolds, is pretty well understood at this point, though it took a hundred years and a million-dollar prize to get there, and we still don't have a totally neat and clean classification like the lower dimension. In dimensions five and up, topologists use a set of techniques called "surgery theory" to operate on manifolds and construct new ones.

That just leaves dimension four.

I wish I could tell you what's going on in dimension four. I'm not sure there's anyone who really knows. It's a weird boundary case: too many dimensions to do visually, but not enough to use sophisticated surgery tools. There are entire textbooks dedicated to what little we know about four-manifolds, and I couldn't make sense of anything past the opening pages. A professional topologist once told me she'd wanted to work on four-manifolds as an undergraduate but was advised to steer clear.' pp.23-24.

"Like a line" ... Yes. Take two that cross. Then the universes open up. 

Milo Beckman (2021) Math Without Numbers. London, Penguin Books. Illustrated by M. Erazo.

Previously: 'surgery'

Medical sociology ... "food for thought" c/o POHG

I replied to the message copied below by Alex Scott-Samuel on the Politics of Health Group Mail List. Following up with respondents, I have copied Alex's reply and others:

----- Forwarded message -----

From: Alex Scott-Samuel <alexscottsamuel AT gmail.com>

To: "pohg AT jiscmail.ac.uk" <pohg AT jiscmail.ac.uk>

Sent: Saturday, 26 November 2022 at 13:05:25 GMT

Subject: [POHG] Illich

Just came across this from 19 years ago: still offers food for thought

 

[The graphic file downloaded should be legible. PJ]
 

*************************************

Politics of Health Group Mail List Messages

*************************************

Visit the PoHG website for lots of interesting links and publications: http://www.pohg.org.uk/

PoHG on Facebook: https://www.facebook.com/282761111845400

Follow us on Twitter: @pohguk

You can subscribe to / unsubscribe from the PoHG mail list here: http://www.jiscmail.ac.uk/POHG

====================

On 26 Nov 2022, at 17:46, peter jones <h2cmng AT yahoo.co.uk> wrote:

Thanks Alex,

This is very useful - short but very sweet and as you say food for thought - especially in our (ongoing) consumptogenic age.

You've prompted a draft blog-post I will add an acknowledgement and link to POHG.

I've no evidence, that is reading, so what follows are thoughts ... musings ... but I keep wondering: what has happened to 'medical sociology'?

Is medical (health) sociology - history as a discipline?

Is there ongoing development - has the discipline morphed into others?

Is there a case to stress not only public health, but public MENTAL health? As I often do. Am I over-reacting?

In information technology there is talk of functionality being placed in wrappers. Has sociology been subsumed - it's there - but underneath - policy rhetoric (integrated, person-centred, holistic care)?

Who are the leading current figures - and recent equivalents of -

"Aaron Antonovsky (19 December 1923 – 7 July 1994) was an Israeli American sociologist and academic whose work concerned the relationship between stress, health and well-being (salutogenesis)."

Canguilhem

Virchow ...?

https://en.wikipedia.org/wiki/Medical_sociology

Should I take heart by the arrival of the SDGs, and the recognition of not only the social determinants of health, but political and commercial too and others..?

I keep writing regarding the potential and utility of Hodges' model:

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

Thanks again,

Peter
====

----- Forwarded message -----

From: Alex Scott-Samuel <alexscottsamuel AT gmail.com>

Cc: "pohg AT jiscmail.ac.uk" <pohg AT jiscmail.ac.uk>

Sent: Saturday, 26 November 2022 at 18:41:10 GMT

Subject: Re: [POHG] Illich - wither et al. ?

Interesting questions Peter. I sense that the answers are out there but not necessarily concentrated in this list. Although I retired from academic public health almost 7 years ago, I have no reason to think that what is now called the sociology of health and illness is not as strong as ever. The kind of places I would look are on the one hand journals such as Sociology of Health and Illness, Social Science & Medicine and Critical Public Health and on the other, popular outlets such as Laurie Taylor's Radio 4 programme Thinking Allowed. 

As far as I know the Medical Sociology Group of the British Sociological Association still exists and holds regular conferences. There has for many years been a Journal of Public Mental Health though it's a while since I've looked at it

Antonovsky's ideas were popular in the health promotion field as well as in academic social science. I remember that a number of people in the WHO Healthy Cities movement were interested in salutogenesis. I've not thought about it for many years but I was on a research group with Antonovsky in the mid 80s when he was developing his Sense of Coherence construct. I  I have to say that despite the attractiveness of problematising health rather than sickness, I never thought the sense of coherence was adequately or well theorised. I do recall seeing quite a few papers from people who rushed out to measure the coherence of people in various situations using the tool which Antonovsky produced. I don't know whether this kind of work continues nor whether it developed

All the best, Alex

=============

----- Forwarded message -----

From: Alderson, Priscilla <p.alderson AT ucl.ac.uk>

Sent: Saturday, 26 November 2022 at 18:55:08 GMT

Subject: Re: [POHG] Illich - wither et al. ?

Dear Peter,

My book Critical Realism for Health and Illness Research: A Practical Introduction (Policy Press 2021) reviews the main traditions in medical sociology and critically updates sociology research that is relevant to the COVID-19 pandemic and beyond. The medical sociologists are the largest subgroup among all UK sociologists.

best wishes

Priscilla

Priscilla Alderson PhD,  Professor Emerita,  

Social Research Institute, University College London,
18 Woburn Square, London WC1H ONR p.alderson AT ucl.ac.uk     

http://iris.ucl.ac.uk/iris/browse/profile?upi=DPALD60  

   

Alderson P. 2021 Critical Realism for Health and Illness Research. Policy Press. 

Winner of the IACR Cheryl Frank award 2022.

Children’s consent to heart surgery research website:  

https://www.ucl.ac.uk/ioe/departments-and-centres/centres/social-science-research-unit/consent-and-shared-decision-making-healthcare/heart-surgery

Alderson, P. and Morgan, J. 2022 Realist by inclination, childhood studies, dialectic and bodily concerns: an interview. Journal of Critical Realism, 10.1080/14767430.2022.2068261
Alderson P, Morrow V. 2020 The Ethics of Research with Children and Young People: A Practical Handbook. SAGE.

=============

 

----- Forwarded message -----

From: Eileen O'Keefe <e.okeefe57 AT gmail.com>

To: Alex Scott-samuel <alexscottsamuel AT gmail.com>;

Cc: Professor Lesley Doyal <l.doyal AT bristol.ac.uk>

Sent: Sunday, 27 November 2022 at 19:52:16 GMT

Subject: Lesley Doyal

Dear Peter and Alex

 

Lesley Doyal set the agenda simultaneously with Illich with her Political Economy of Health. She continues to lead the pack re socially produced global inequities in health, eg her Living with HIV and Dying with AID: diversity, inequality and human rights in the global pandemic. Routledge Global Health Series. 2013.

Cheers

Eileen O’Keefe

===========

<->

By way of background:

I've always been impressed (in awe of) and reassured by 'medical sociology', the pioneers (as above), as a discipline, and in terms of sociology's explanatory potential.

Another - not so much an 'explanation' but an avenue to explore, has long been the continuum of care (yes, just one initially?). This spans the need for compassion, empathy, rapport, allied with the importance of hands - in nursing, medicine, surgery ... their being steady, vision true with rapid, safe, reliable, effective judgement and decision-making. In short, the need for humanistic and mechanistic synergy. Finding, and taking up Hodges' model perhaps this can account for the idea of holistic bandwidth(?).

It is an exaggeration surely, but it feels like I made two simultaneous connections in first reading psychology and philosophy. These are mind - body, and the way that many in society are 'remote' from science (knowledge), for a variety of reasons. Sociology can help account for those reasons.

Seeing (literally) the potential of visualization (as posted on W2tQ and in papers) in the 1970s, in 1990s research programs were dedicated to facilitate the development and application of visualization in the humanities. Visualization should not just be the preserve of high energy physics, bio-science and proteomics ... (although the attraction to what is 'quantifiable' is understandable). This is the question that drives this effort (I think!).

So the 'humanities' still have a requirement in information systems, informatics and literacy terms, and Hodges' model can, I believe, offer a way forward.

The replies above are much appreciated and I will follow them up.

c/o GPonline: "Social prescribing patients curate art exhibition at leading Cornish gallery"

"The ‘What Lies Behind’ exhibition, a recent display in Newlyn Art Gallery, saw 10 patients from Morrab Surgery in Penzance select works of art from Arts Council national collection of more than 8,000 pieces.

The group were asked to choose pieces that reflected their personal response to the pandemic. The works on display included textiles, sculpture, prints and paintings by artists including Pablo Picasso, Henry Moore and Chila Burman.

The project came about during lockdown after Morrab Surgery’s social prescribing link worker Ellie Moseley realised that many of the patients in the practice that she was working with had an interest in the arts." [ On GPonline ].

 

  Self - Individual - Person
|

 INTERPERSONAL    :     SCIENCES               

HUMANITIES - ARTS ----------------------------------  SCIENCES

SOCIOLOGY  :   POLITICAL 

|

Community - Group - Population

Personal expectations (care, medicine...) Emotional wellbeing Person-centred care Social prescribing as a care intervention	'What lies behind' exhibition, Newlyn Art Gallery
	Social prescribing as a care policy needs community resources (to match). Amid health policy calls for innovation and  sustainable healthcare systems and services; the community remains the sustainable resource (if not neglected). Funding - ... ££ $$ €€ ¥¥ ฿฿ ₫₫ ₴₴ ₪₪ ₽₽ ₹₹ ₩₩ ... local :: global health.

 

My source: @ActivateEurope

https://twitter.com/ActivateEurope/status/1491751271539351562?s=20&t=ZQHyHs2a9--xJpmJDzrdHQ

@GPonlinenews

North West Health Hack 15/16 June 2013

Dear Health 2.0 Manchester member,

Please see an update on opportunities that might be of your interest:

Follow us on Twitter!
@H20MCR for latest updates and digital health insights & opportunities

North West Health Hack 15/16 June 2013
This is a free event where clinicians can work with some very talented developers/coders and designers to develop their ideas into working prototypes. There will also be an opportunity to get some early concept validation and feedback from investment/ technology and NHS mentors.  The event is not only open to new concepts but also to ones that are already in development so that teams that are already formed are also invited! Who is organising it: Barclays, ECH Alliance, University of Manchester, Health 2.0 Manchester Chapter, TechHubManchester. Dr Ranjit Gill (Chief Clinical Officer, NHS Stockport) & Dr Mike Burrows (Area Director, NHS Greater Manchester) will attend the event.

Check it out  & REGISTER at ...

Blueprint Health accelerator is currently accepting applications for their summer program
We have been approached by Blueprint Health to share this opportunity with our community: Blueprint Health, the premier healthcare accelerator program, located in the heart of New York City. Blueprint is currently accepting applications and our team is seeking talented entrepreneurs to join us for the Summer 2013 Program. A number of incredible entrepreneurs have traveled from as far as Shanghai, Dubai, and London to partake in our program. You may have seen some recent press coverage of four surgeons who founded Touch Surgery, a company that graduated with our Winter 2013 Class. http://www.guardian.co.uk/artanddesign/architecture-design-blog/2013/feb/27/touch-surgery-ipad-app-surgeons-learn

We look forward to meeting the talent from Manchester.

Michael Maggio
Associate

Blueprint Health
483 Broadway, 2nd Floor
New York, NY 10013
cell: 781.864.6283
office: 646.627.7627 ext 703
mmaggio@blueprinthealth.org | blueprinthealth.org | @bphealth

Next  H 2.0 Manchester Meetup Thursday the 23rd of May: Care Homes and Assisted Living: in what ways technology can help?
Another great opportunity to discover new opportunities, be inspired and meet like minded people in a relaxed atmosphere.  ...

Thank you and best regards
Idalia, Daniel, Mariano and Preeti

Health 2.0 Manchester - Leadership Team

Navigating Health and Social Care: We are on a mission - aren't we ...?*

"Before the introduction of instrument navigation, an aircraft pilot had to give up his mission whenever weather conditions worsened to a degree where visual orientation did not allow for secure landing at his destination airfield. This is situation of today's surgery." p.43.

Adams L, Krybus W, Meyer-Ebrecht D, Rüger D, Gilsbach JM, Mösges R, Schlöndorff G (1990)
Computer assisted surgery. IEEE Computer Graphics and Applications. 10:43–51.

*All together.

Thoughts re. 2026 Lancaster Philosophy of Psychiatry Work in Progress Workshop

After posting on the 19th February about the 2026 Lancaster Philosophy of Psychiatry Work in Progress Workshop last Thursday, 1100 through to 1530 on Friday - was well worth attending. I am also grateful for the opportunity to present Hodges' model, share current challenges and questions. Running through the programme what helped here:

While seemingly open in title the first presentation with Hane Maung, was (as with all) specific, but related to aspects of psychiatry and philosophy applicable here; classification, what is a 'disease'?, concepts, Millikan also appears in a reference: https://philpapers.org/go.pl?aid=MAUTDO-6.

As 2nd speaker, there were several questions after my presentation. Fourteen slides went to time: 20 minutes with 10 for Q&A. I'm not the best judge, but I believe I answered them. As my 'subject' is always the same in Hodges' model, I do make an effort to try (at least) to say something new. Listening, I soon realised this is an established Lancaster-grounded group, and welcoming too. If there is ever another opportunity, something new would definitely have to follow.

I can see scope for this in Matthew Williams's - The failure of the harm-minimisation argument for BID Surgery and the necessity of therapeutic justification. 'BIDS' is 'Body integrity dysphoria surgery' a challenging and ethics-bound situation, that while still rare, has made the news for (as ever) the wrong reasons. The relations to be considered cross all the domains and dimensions of health, care and more.

It is possible to become complacent regards our conceptual currency. Without taking care, we grow to take them for granted. I'm grateful to Clive Duddy for a refresh were autonomy is concerned.

'Difference' is a recurring trope in healthcare, informatics and other fields. George Turner's 'difference denied' and subsequent discussions was extra insightful therefore, addressing ongoing (legacy?) issues for service users, carers, patient and public involvement and engagement (PIE).

Presenting, 'Different ways of medical knowing in Walzer's different spheres of justice?', Dieneke Hubbeling drew my attention to Walzer's book: Spheres Of Justice: A Defense Of Pluralism And Equality. In addition capacity and capacities (to achieve an outcome), plus difference (again), especially when it comes to knowledge and knowing. I remember thinking about rather than putting the person at the centre of Hodges' model, place 'equality' and reflect upon that.

I note that we overlap with a journal too, and another topic - overtreatment - that was something of an elephant in the room (perhaps?): a further theme to follow - https://openaccess.sgul.ac.uk/id/eprint/113806/1/jep.13632.pdf

Ali Walker's Forget Fictionalism: Psychiatric Disorders are Quasi-Real,with a topological - cartographic themed slide perked me up later afternoon. The subject of Borderline Personality Disorder also reminded me of the extent of change in adult community mental health services, in practice through 1985-1995 and that encountered in 2019. Much to digest here. A 3 minute video of Ali's thesis BPD Disorder - Trauma is available from last year: https://www.youtube.com/watch?v=5tMSyt71hvs

I will review/add more details here, or a new post.

Medical (local) history II

It is quite surprising (or maybe not) the things we fail to notice in our everyday lives. Making a slight alteration to my path through the cemetery on the way down to Ashton - my home town in WN4 - I came across the gravestone photographed below.

Of course, 'surgery' in 1822 would have been radically different to that of today. In Jameson's lifetime progress was nonetheless being made on several fronts within medicine:

1796	Edward Jenner develops a method to protect people from smallpox by exposing them to the cowpox virus. In his famous experiment, he rubs pus from a dairymaid's cowpox postule into scratches on the arm of his gardener's 8-year-old son, and then exposes him to smallpox six weeks later (which he does not develop). The process becomes known as vaccination from the Latin vacca for cow. Vaccination with cowpox is made compulsory in Britain in 1853. Jenner is sometimes called the founding father of immunology.
1800	Sir Humphry Davy announces the anesthetic properties of nitrous oxide, although dentists do not begin using the gas as an anesthetic for almost 45 years.
1816	René Laënnec invents the stethoscope.
1818	British obstetrician James Blundell performs the first successful transfusion of human blood.
1842	American surgeon Crawford W. Long uses ether as a general anesthetic during surgery but does not publish his results. Credit goes to dentist William Morton.

Infoplease: Medical Advances Timeline

Posting the photo and reading this gravestone I am minded about the need for respect and given to wonder about this man and his contemporaries? Is the family still local in Ashton, are they listed in parish records? Are there other records to follow...? What specific deeds gifted him this epitaph?

"Year of his Age": is thought provoking as we carry our Age literally, individually, around us, a bubble of time. Then we try to distil this into the life story of those whose living memory's fail them, but not their families and carers.

It is remarkable to see, in stark relief, the impact of a practitioner's attitude and aptitude. A lesson from the past for all healthcare professionals. This was the case thousands, hundreds of years ago, it is the case today and must be tomorrow.

As you read this slightly weathered stone there is another lesson.
Reading each word, with aged grammar and worn clarity even the past begs us to 'listen actively': the greatest lesson of all.

Bless you Mr Jameson.


Related post:

• Medical history - I

Jarvis's book 'public parts' [i]: The sanctity of clinical data, INFORMATION, knowledge ....

In New Scientist last week another book, a brief review caught my eye. This one concerns a topic of great sociological, clinical and political interest to me. To be clear this is not a review; consider it raised eyebrows at the book's arrival and some speculations. Here is the intro from New Scientist's website:

WHEN writer Jeff Jarvis decided to tell the world about his prostate cancer he didn't spare the gory details: he happily blogged about his "malfunctioning penis" after surgery, and the adult diaper he had to wear.

Too much information, some may say. Not for Jarvis. He is an outspoken advocate for living one's digital life in the open and his latest book, Public Parts, is one of the first to analyse the shift towards more transparency thanks to Facebook, Twitter and the other big names of this new digital age.

(Niall Firth, CultureLab, New Scientist)

For quite a while I've been wondering about the informational form of 'climate' change. The existence of the NHS's HealthSpace, Google Health, and Microsoft HealthVault had me watching for erosion of the public's attitudes towards clinical confidentiality. Jarvis refers to this as publicness. Like a coast line this particular form of erosion occurs on many levels, given the vagaries of starting conditions (the patient-doctor relationship, the medical establishment), geography, tides, weather and local policies. Would the temperatures change within health care itself - professional values, disciplinary outcomes, The Royal Colleges?

Even if HealthSpace et al. are provided on the basis of being secure, encrypted, meeting the local requirements of data protection and information governance...; is this tantamount to making confidentiality soluble AND throwing it into the water? How big a step is it to the public's posting their personal health information in public online arenas: open and closed? Suddenly the patient becomes the data entry administrator, if that information can be shared and accessed by the health establishment. From a business model and policy perspective this also saves money in an Ikea flat-pack-transport-and-assemble-it-yourself kind of way.

Jarvis's book is evidence, that demonstrates the ability of social media like Facebook, LinkedIn and Twitter to alter attitudes towards disclosure of personal data. Medical details are usually restricted to the medical consulting room and centrally held clinical record. Google Health is closing down though; it has failed to have the broad impact they hoped for (see Google's blogpost). I wonder if this is reflected upon in the text? With the NHS behind HealthSpace perhaps these three 'solutions' are far from equivalent examples?

If we take information as the concept around which this debate revolves with an individual, a person also at the center ('data subject') then several dimensions can be found. Usually, I am increasingly transparent to a greater degree from my work colleagues, friends, family to my partner. This is one of the many ways that relationships are defined and differentiated. Certain things are opaque to the public and commercial world at large, because they are considered private. Clinically, such a class of information is vested in a professional relationship. This does not mean I have signed a contract to only divulge my medical history to my doctor. Even there - a need to know assumption usually pertains.

As Firth notes it is good that Jarvis is stimulating a debate about what is privacy. How has the concept changed, since the 1950s, 1980s in the media (old and new) and in health care?

Apparently Jarvis makes an analogy with Gutenberg's original printing press and its social and political effects. There may be other subtle aspects though that any such revolution must either work around or overthrow. In the first instance though I consider - without reading the book I have to add - some of the main points which are illustrated below.

Information exchange (disclosure) is always within some context or other: interpersonal, political, social; scientific (clinical) and spiritual hence the inclusion of the clinical - social axis. Tied with this is 'space'. Although the spaces defined by virtual and mobile have assumed primacy physical spaces still count: surgery consulting room, clinic, community health center, hospital ward, patient's home, nursing home. ... I've added transparent - opaque to contrast with public - private these are related yes, but analysis may reveal they are distinct in their application?

Although society has changed markedly in terms of technology and the communications it affords - the modes, tools, languages, access, networks, distribution; there is surely still a notion of what is personal and what might become social - (public)?

Technology, technological means and the arrival of social media does not itself constitute universal attitudinal change in health as Google have found (perhaps the pace of change in attitudes was not quick enough for Google Health so they moved on). Amid the hectic pace of life we should be pleased if some things - like public health disclosure - prove to be laggards in terms of change.

I'll expand on this soon with a few more axes - continua to flare.

Axes image original source from: https://den.dev/

"How to Avoid Mistakes in Surgery" BBC TV Horizon 21/03/2013 2100 UT

On 03/18/13 9:45 AM, Martin Bromiley wrote:
--------------------
About two years ago I approached Dr Kevin Fong with an idea for a BBC scientific programme, and at last it’s happened. Since September I’ve been working with Kevin and the BBC Horizon team to pull together a programme about human factors in healthcare. It looks at how learning about the human in the system and the system itself can bring about enormous improvements in safety and outcomes that technology and medical science can only aspire to.

Kevin and the Horizon team have produced something inspirational yet scientific, and - just as importantly - is by a clinician, for clinicians. It's written in a way that will appeal to both those in healthcare and the public. It uses a tragic death to highlight human factors that all of us are prone to, and looks at how we can learn from others both in and outside healthcare to make a real difference in the future.

Although the BBC Management chose a surgery based title for the programme to gain mass public appeal the lessons of this programme are for everyone in healthcare.

It would wonderful if you could pass on details of the programme to anyone you know who works in healthcare. My goal is that by the end of this week, every one of the 1 million or so people who work in healthcare in the UK will be able to watch it (whether on Thursday or on iPlayer). BBC 2 Thursday 21 March 2100 UK

Cheers

Martin Bromiley

My source: Joy Whitlock via LinkedIn

Fallacies of Work as Imagined: c/o Steven Shorrock - HSJ Patient Safety

I came across the following image on twitter. The tweet is also copied below.

This post is prompted by one from 'The Varieties of Human Work' on the Humanistic Systems blog 05/12/16 by Steven Shorrock. The focus is understanding and improving work, and in his opening there is a sense of very large net having to be deployed to capture all the disciplines and dimensions that are invariably involved in work.

"One of these is the simple observation that how people think that work is done and how work is actually done are two different things. This observation is very old, decades old in human factors and ergonomics, where it dates back to the 1950s in French ergonomics (le travail prescrit et le travail réalisé; Ombredanne & Faverge, 1955) and arguably the 1940s in analysis of aircraft accidents in terms of cockpit design (imagination vs operation). Early ergonomists realised that the analysis of work could not be limited to work as prescribed in procedures etc (le travail prescrit), nor to the observation of work actually done (le travail réalisé). Both have to be considered. But these are not the only varieties of work. Four basic varieties can be considered: work-as-imagined; work-as-prescribed; work-as-disclosed; and work-as-done. These are illustrated in the figure below, which shows that the varieties of human work do usually overlap, but not completely, leaving areas of commonality, and areas of difference."

The varieties of human work.

It immediately struck me how well the diagram can be translated and transposed on to Hodges' model on several levels and as per Steven Shorrock's excellent post. I acknowledge I am playing with language, but initial thoughts included:

1. As per Shorrock: the difference between how people think about work and how work is actually done.
2. Shorrock explains how for example 'work-as-imagined' draws on the other forms of work.The level of overlap in between the forms of 'work-as-' is as diverse as the contexts that arise and constantly change.
3. There are many 'gaps' identified in Steven's post [not in the sense of a fault with his post]. A subset of these may relate to the theory-practice gap which was one original purpose of Hodges' model, to help close this gap.
4. Orders of scale: from a single action to a whole job and its specification.
5. The way the 4Ps process, policy, purpose and practice can be used (I identified the 4Ps within Hodges' model, one per care domain, many years ago).

As has been pointed out to me (on twitter) the context here is 'work' and not healthcare, but as Steven notes there are many disciplines, with commonalities and differences. I am really grateful to Steven for his post, in which he also stresses the overlap. 'Work-as' is a flux. Hodges' model can be viewed through time as series of frames. Below are some rather unstructured notes [musings] relating and extending the context of Shorrock's image and post to Hodges' model:

individual - self

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group- population

'Work-as-Imagined': Of the four P's I have placed 'PURPOSE' here, since the individual's purpose must (ideally) achieve synergy with colleagues and the organisational objectives and goals. 'Work-as-Imagined' involves thought (and so is infinite in variety) whether use of imagination is day-dreaming, or radically innovative. Until AI does take over, this is the 'meta' - cognitive domain. Amid many, Shorrock makes an important point in how we imagine the work other disciplines do. Often so many stereotypes follow that are often revealed in referrals and expectations. Shorrock highlights this at the macro level of policy makers [lower right in #h2cm] having to imagine the operational aspects of work; and the simplified accounts of surgery for a patient by anaesthetist and surgeon (while meeting the requirements of informed consent). This domain may be 'work-preserving' in humanistic terms as it is the realm of tacit knowledge, creativity and innovation. Although the artifacts of simulation are ultimately produced in the SCIENCES domain, they are 'imagined' in case studies and scenarios. Shorrock helps make it clear how much of work is theorised and practised virtually, but with recourse to imagination not technology. Mental illness and the systemic - organisational response is mediated diametrically in Hodges' model. Ongoing critique of psychiatry and mental health services in some quarters appears to suggest that being unable to work-as-imagined here, means loss of self and identity that is then outsourced and effected by proxies and advocates. [Discuss?]	'Work-as-Prescribed': Reading 'prescribed' literally then drugs and other physical treatments arise here in the SCIENCES domain. The 4'P is PROCESS suggestive of procedures, specifications, instructions and formal rules. Process is important allied with PURPOSE in that if (your) can be described formally, by a set of rules then you may be vulnerable to your job being taken by a robot through 'robotic process automation'. When I started in the NHS in the 1970s there was a shift taking place from being task-oriented (mechanistic) to individual/patient-centred (humanistic). Shorrock notes how there are relatively fewer examples of work-as-prescribed. Developed nations are waiting to see how many existing jobs are lost to AI and robots, but how many new ones emerge. (Can the developing nations 'skip' several prescriptions?) Here, we also apply time to work. The past, current work and the future. Will we still work the same hours? Is there a lesson in '0' hour contracts? An obvious aspect of work is day vs. night shifts. 'Work-as-Prescribed' also reinforces the presence and context of the SOCIOLOGICAL domain. Now, conferences are devoted to 'social prescribing'. By its nature this is more often than not 'public' and therefore 'disclosed'. Citizen science and patient involvement provide a further angle on work-as-prescribed. As does what is prescribed (especially in what is used) must to some degree influence what is proscribed in what is not used.
'Work-as-Disclosed' Sharrock writes concerns how work is explained and communicated. This will also involve teaching formally and health professional to patient, carer and public.  The challenge is that thinking about work and actually doing work is a SOCIO-POLITICAL act - transaction (as the literature demonstrates). Socially, whether or not someone is working is also disclosed in their domestic  comings and going to work. The socio-political dimension is evident in the assumptions that follow homeless peopleand their apparent 'staying' (many do work?)? There are those who opt not to disclose at all and live off-the-net. SOCIO-ECONOMICALLY there are constant references to 'pay-gaps' especially by those groups and their representatives most affected by low pay and austerity. While the social care workforce toil in the community, social care funding, provision and integration is pushed into the long grass that is green papers. Despite the social value and importance of this work, the status of this sector is signalled - disclosed as poor. Nurses globally are campaigning to establish in law the requirement for safe-staffing levels. Sharrock alludes to the challenge of nursing as PRACTISED on the 'shop-floor' and ongoing studies on staffing - establishments and skill-mix. In the 1980-90s expert systems specialists interviewed workers  in an attempt to understand the knowledge acquisition and elicitation associated were their profession - community of practice. These humanistic care (knowledge) domains reflect the qualitative approach to research. Work-as-disclosed also communicates to would-be future recruits. How are the aspirations of teenagers and mature entrants first experienced, discussed and carried forward socially?	'Work-as-Done' simultaneously speaks of power, employment, accountability and regulation.  As four conceptual spaces #h2cm indicates the 'distance' between concepts that shifts according to context. The space that work takes place within and how people are managed, organised, controlled for efficiency with reminders, queues, appointments, and waiting areas are signs of the institution. The person was a long way from the creators of the Victorian asylum, even as they sought to establish (stamp?) a 'standard' level of care. What difference does it make when work-as-done is bound to an individual and collective sense of duty? The counterpoint is precisely [mechanistic] work-as-done. Work-as in shift completed and recorded - clocked as such. Work-as-done: the 12 hour shift or as already mentioned work-as-NOT-done due to the flexibility afforded by zero hour contracts. Work-as-done also denotes [scientifically] the concepts of power, energy and effort. So, work-as-done must result in personnel actually feeling 'done': burnt-out when safe-staffing is not assured. The old saying: "If it is not documented it was not done.", springs to mind. Shorrock refers to surgery and loss of life. What was 'done' and what does an inquiry reveal? What is actually done and the way it is done if varies - contravenes 'norms' rules then there is a issue of whistle blowing. The question then becomes was the work done as it should - must - be? The 4P in this domain is POLICY.  Perhaps a box-tick here also accounts for 'work-as-' elsewhere?

#HSJpatientsafety Fallacies of work as imagined. More info on Steve’s great blog https://t.co/i5TCs6CLvJ @StevenShorrock

— Iain Moppett (@IainMoppett) July 3, 2019

Pre-Publication Discount: Nursing and Clinical Informatics - Socio-Technical Approaches

Take Advantage of the Pre-Publication Discount by Ordering this Book Today!


Nursing and Clinical Informatics: Socio-Technical Approaches

Edited By: Bettina Staudinger, University for Health Sciences, Medical Informatics and Technology, Austria; Victoria Höß, University for Health Sciences, Medical Informatics and Technology, Austria; Herwig Ostermann, University for Health Sciences, Medical Informatics and Technology, Austria


Description:
The field of nursing informatics is one of the fastest growing areas of medical informatics. As the industry grows, so does the need for obtaining the most recent, up-to-date research in this significant field of study.

Nursing and Clinical Informatics: Socio-Technical Approaches gives a general overview of the current state of nursing informatics paying particular attention to its social, socio-technical, and political aspects to further research and development projects. A unique international comparative work, this book covers the core areas of nursing informatics with a technical and functional respect and portrays them in their proper context.

Table of Contents:

Chapter I: A Treatise on Rural Public Health Nursing

Wanda Sneed, Tarleton State University, USA The objective of this chapter is to promote public health nursing and community health nursing’s role in the new care delivery patterns, with predictive and preventative care models for populations. This entry will broaden the range of information available for informaticists, as their role expands in the new healthcare arena. Articulation with nursing informatics and the “quality chasm” crossings in U. S. healthcare will assist the informaticists with search and retrieval activities. All players in the healthcare arena will continue to be involved, but probably with a more rational policy-making role.

Chapter II: Assessment in a Computer-Based Nursing Documentation

Elfriede Fitz, University for Health Sciences, Austria
Daniela Deufert, University for Health Sciences, Austria
Johannes, Hilbe, University for Health Sciences, Austria
Christa Them, University for Health Sciences, Austria Experience in nursing practice shows that there are still problems with assessment in computer-based nursing documentation. In addition to nursing documentation, an assessment instrument that captures the needs for care must also be integrated. This chapter describes different Nursing Assessment Instruments and the advantages of Computer-Based Nursing Process Documentation by using quality criteria for assessment instruments such as validity, sensitivity, specificity, reliability, practicability, and the appropriateness of the instrument. Quality criteria for computer-based systems are basically software ergonomic aspects and therefore not part of this study. Each country should choose for itself those specific assessment instruments that capture the needs for care of their clients. The data presented make it possible that facilities are compared (also in regard of reliable cost estimates).

Chapter III: Clinical Decision Support Systems in Nursing

Dawn Dowding, University of York, UK
Rebecca Randell, City University, UK
Natasha Mitchell, University of York, UK
Rebecca Foster, School of Health Sciences at the University of Southampton, UK
Valerie Lattimer, School of Health Sciences at the University of Southampton, UK
Carl Thompson, University of York, UK Increasingly, new and extended roles and responsibilities for nurses are being supported through the introduction of clinical decision support systems (CDSS). This chapter provides an overview of research on nurses’ use of CDSS, considers the impact of CDSS on nurse decision making and patient outcomes, and explores the socio-technical factors that impact the use of CDSS. The chapter presents the results of a multi-site case study that explored how CDSS are used by nurses in practice in a range of contexts. The study reveals that how a system is used and may vary considerably from the original intentions of the system designer.

Chapter IV: Culturally Sensitive Healthcare for Newcomer Immigrants

Jerono Rotich, North Carolina Agricultural & Technical State University, USA This chapter will give an overview of the healthcare-related challenges that most newcomer immigrants and refugees encounter as they acculturate into their new environments in Western countries. It will highlight practical tips that can: a) enhance the caregiver and patient relationships across cultures and across continents; b) enhance culturally sensitive healthcare services; and c) help to create culturally inviting healthcare environments. It is also evident that, although these newcomers enrich their new nations with their diverse backgrounds, language, and cultural differences, each continues to pose formidable obstacles to their health, healthcare providers, and the health system in general. While the patients and providers realize the effects of immigration on the quality and access to healthcare, they seem to be overwhelmed by the barriers.

Chapter V: Mobile Technology in a Developing Context: Impacts and Directions for Nursing

Pammla Petrucka, University of Saskatchewan, Canada
Sandra Bassendowski, University of Saskatchewan, Canada
Thomas F. James, Apogia Networks, Ltd. , Canada
Hazel Roberts, Government of St. Kitts-Nevis, Ministry of Health, Canada
June Anonson, University of Saskatchewan, Canada This chapter presents the imperatives of mobile technologies in the healthcare. It presents the contextual overview in development of the diffusion, penetration, and uptake of health-related mobile technologies. A consideration of the roles and responsibilities of the diaspora in the embracing of information and communication technologies is emphasized. Key examples of mobile technologies in development to increase understanding and demonstrate promising practices in this emergent field are given.

Chapter VI: Nursing Documentation in a Mature EHR System

Kenric W. Hammond, VA Puget Sound Health Care System, USA
Charlene R. Weir, University of Utah, USA
Efthimis Efthimiadis, University of Washington Information School, USA Computerized patient care documentation (CPD) is a vital part of a Patient Care Information System (PCIS). Studying CPD in a well-established PCIS is useful because problems of system adoption and start-up do not interfere with observations. Factors interfering with optimal nursing use of CPD are particularly challenging and of great concern, given today’s shortage of nursing manpower. The chapter describes problems and advantages of CPD usage identified by nurses in a series of research interviews. It is shown that explicit consideration of nursing workflow constraints and communication processes is necessary for development of effective nursing documentation systems. Some findings point to a PCIS reconfiguration strategy that is feasible in the short term. Other findings suggest the value of considering mobile and team-oriented technologies in future versions of the PCIS.

Chapter VII: Nurses and Telehealth: Current Practice and Future Trends

Sisira Edirippulige, University of Queensland, Australia
Anthony C. Smith, University of Queensland, Australia
Mark Bensink, University of Queensland, Australia
Nigel Armfield, University of Queensland, Australia
Richard Wootton, University of Queensland, Australia Home telehealth, the use of information and communication technologies to deliver and support healthcare directly to the home, is emerging as an important application for nurses. This chapter provides an overview of home telehealth and how it may be applied to the practical challenges nurses face everyday. We provide a summary of the evidence available to support its use in specific areas and a guide for those thinking of implementing telehealth in their own practice. The future of home telehealth lies in carefully considered and designed research, ongoing education, and training and a multidisciplinary approach.

Chapter VIII: Successful Online Teaching and Learning Strategies

Mary D. Oriol, Loyola University New Orleans, USA
Gail Tumulty, Loyola University New Orleans, USA This chapter presents a theoretical framework and research base for the successful transition of an established Master of Science in Nursing program from that of traditional classroom delivery to one that is Web-based with no geographic limitations to students. The application of socio-technical systems theory to facilitate creation of a positive learning environment for future nurse leaders is described. Use of social processes and application of technology to optimize learning is explained and the latest research on content presentation and student engagement in an e-learning environment are presented. The chapter gives an understanding of the competencies necessary for students and faculty to be successful in online education.

Chapter IX: Shaping Funding Policy for Nursing Services

Virginia Plummer, Monash University, Australia Concerning nursing resource allocation health service executives have different views about whether systems based on ratios or those based on patient dependency are more accurate. This chapter reports on a statistical analysis of almost 2 million hours of nursing data provided by 22 acute care public and private hospitals in Australia, New Zealand and Thailand. To evaluate both ways an informatics system was used which has the capacity to simultaneously measure nurse patient ratios and nursing workloads by a dependency method of nursing hours per patient day. The results showed that it predicts actual direct nursing care requirements with greater accuracy than ratios for all hospital and patient types, facilitating better allocation of nursing resources and demonstrating that the cost of nursing care would be less for hospitals using that system than for ratios.

Chapter X: Simulations to Assess Medication Administration Systems

Elizabeth M. Borycki, University of Victoria, Canada
Andre W. Kushniruk, University of Victoria, Canada
Shigeki Kuwata, Tottori University Hospital, Japan
Hiromi Watanabe, Tottori University Hospital, Japan A range of new technologies/information systems are being implemented in clinical settings in order to reduce errors associated with the medication administration process. Simulation methods can be used to assess the impact of integrating new technology/information systems into the nurses’ work environment prior to full-scale implementation of a health technology/information system. Simulations as an evaluative tool emerged from a direct need to assess unintended and intended consequences of health information systems upon nurses’ work before systems are fully implemented. Nurse information use of simulations to assess and test health technologies/information systems will allow nurses to determine the impact of a new software and/or hardware upon aspects of nurses’ work before its implementation to allow for appropriate system modifications.

Chapter XI: Socio-Technical Structures, 4Ps and Hodges' model

Peter Jones, NHS Community Mental Health Nursing Older Adults, UK This chapter explores the potential of a conceptual framework – Hodges’ model – both as a socio-technical structure and means to explore such structures of relevance to nursing informatics theory and practice. The model can be applied universally by virtue of its structure and the content which it can encompass. In apprehending this chapter, readers will be able to draw, describe, and explain the scope of Hodges’ model within contemporary healthcare contexts and the wider global issues presented by the 21st century that influence and shape nursing informatics. Critically, the reader will also gain insight into how socio-technical structures can facilitate cross fertilization of clinical and informatics theory and practice; drawing attention to information as a concept that provides a bridge between socio-technical, clinical, and informatics disciplines. The paper will review the socio-technical literature and venture definitions of socio-technical structures related to Hodges’ model and advocate the need for sociopolitical-technical structures. This chapter also proposes the 4Ps as a tool to facilitate reflection upon and the construction of socio-technical structures. The adoption and significance of the hyphenated form as per “socio-technical” will also be explained.

Chapter XII: Strategies for Creating Virtual Learning Communities

Beth Perry Mahler, Athabasca University, Canada
Margaret Edwards, Athabasca University, Canada Teaching nursing online requires teachers to purposefully use strategies that facilitate the development of virtual learning communities. This chapter proposes answers to the question, “How can educators effectively teach the very social discipline of nursing in virtual classrooms?” Specific online teaching strategies including Photovoice, Virtual Reflective Centers, and Conceptual Quilting are explored. The social and socio-technical implications of teaching nursing online are considered. A final section in the chapter describes how these developments in online nursing education are changing the social and pedagogical perspectives of distance learning. Research questions that arise from this exploration are presented.

Chapter XIII: The Impact of Technology in Organizational Communication

Roberta Cuel, University of Trento, Italy
Roberta Ferrario, Laboratory for Applied Ontology (ISTC-CNR), Italy In this chapter a case study is presented, in which the ethnomethodological approach is used to analyze the impact of the implementation of an information system, called Sispes, on organizational communication processes in the residence for elderly Giovanelli (Italy). Sispes is a Web-based platform which sustains communication processes and knowledge management according to a customized workflow management system. Adopting structuration theories in the analysis of the case study, and taking inspiration from the philosophical tradition, especially in epistemology and in the analytic philosophy of law, an innovative perspective is adopted, which specifically acknowledges the role played by the communication processes in shaping both the attitudes of the involved actors and the social reality in which they are immersed. According to this perspective, three types of communication processes are presented, namely the normative, descriptive and constructive approach. These latter are then applied to a concrete case study.

Chapter XIV: The Roles of a Nurse in Telemedical Consultations

Boris A. Kobrinsky, Moscow Research Institute for Paediatrics and Children’s Surgery, Russia
Nikolay V. Matveev, Moscow Research Institute for Paediatrics and Children’s Surgery, Russia Telemedicine, or distant medical consultations using communication via electronic networks, is gradually becoming a standard of medical care delivery in distant areas worldwide, including both the most developed and the developing countries. For instance, in 2007 telemedical centres existed in 55% of the Russian regions (on average, about 4 centres in each region). In most of the cases, nurses are actively involved into organization of various types of distant consultation. Main types of telemedical services include: (1) emergency consultations of patients by telephone (2) telemedical consultations using videoconferences or store-and-forward systems and (3) home telecare systems. Possible roles of nurses in different types of telemedical consultations are discussed.

Chapter XV: The Role of EBM and Nursing Informatics in Rural Australia

Daniel Carbone, University of Melbourne, Australia The purpose of this chapter is to discuss broadly the need for enhanced evidence-based medicine (EBM) by nurses in the context of rural Australia and the role that nursing informatics and an informed strategy could facilitate in making such need a feasible reality. First, the introduction highlights current time gaps between health discoveries and eventual practice and the potential for information technology to positively affect this gap. Then, the need for nurses to take an active role in evidence-based medicine in rural settings is argued. The link between information literacy and evidence medicine is consequently presented and gaps in knowledge regarding nursing informatics training are highlighted. Concluding with the argument that to achieve evidence-based research and eventual use, there needs to be a purposeful health informatics learning strategy that recognises the role of computer and information literacy.

Chapter XVI: Use of Handheld Computers in Nursing Education

Maureen Farrell, University of Ballarat, and RMIT University, Australia The use of mobile technologies in nursing education is rapidly increasing. Handheld computers are the most frequently used of these technologies as they can provide students with information for point of care clinical reference, such as diagnostics, medical terminology, and drug references. Integrating the management and processing of information into clinical practice is an effective learning approach for students and reflects a changing paradigm in nursing education. Traditionally, nursing programs have the tendency to separate the acquisition of academic knowledge from clinical practice, and the process of integrating academic information into the decision-making processes in the clinical area has been difficult for student nurses. This chapter will provide an overview of the use of handheld computers in nursing and medical education, including a brief synopsis of current use in clinical practice. It will discuss the advantages and disadvantages of their use, barriers to implementation and future directions.

Chapter XVII: Using Information Technology in Nursing Education

Elizabeth Rogerson,University of Dundee, UK
Linda Martindale, University of Maryland School of Nursing, USA
Carolyn Waltz, University of Maryland School of Nursing, USA This chapter addresses issues relating to nursing informatics as used and applied in nursing education. This includes the use of information technology (IT) in delivering nursing education, as well as the teaching of IT and informatics skills to prepare nurses for practice. Drivers associated with the development and use of IT in nursing education are discussed, as well as current use of IT in nursing education and practice, including both mainstream and emerging technologies. Lastly some key issues for the future are identified. Internationalism is regarded as a consistent theme in IT development and occurs as a recurring thread throughout this chapter.