Cognitive Therapy & Community MH Nurses - anyone for tennis?

Last week there was quite an announcement about psychological therapies - specifically cognitive behavioural therapy, with a £170 million boost to help treat the millions of people affected by anxiety and depression. Stuck with their condition many are also stuck on waiting lists.

On the media the inevitable debate followed about research, the evidence base and the possibility that perhaps nurses could undertake some of this work. You guessed it - the 'but' followed in the form of 'training'. True, training will be needed, as the conveyor belt that is the workforce takes on-board the new kids in town and seeks to squeeze the best out of its more senior clinicians. With mention of training though someone had better watch that £170 million, to ensure it really does deliver quality therapy with the required supervision. There's also an invitation here for the various schools of therapy to take up arms - and this could be a further distraction.

A stock-take of EXISTING skills would be in order. Many people have already been trained in CBT as part of a skills set to deliver psychosocial intervention. Personnel information systems that are breathing (alive!) are critical, since there are many nurses (one hand raised here) and other disciplines who have the skills to maximise the effectiveness of that investment. Polish those rusty skills and there's a regular Genie there. So where are they?

Well many are playing tennis and it sure is not pretty...

If you listen carefully you can hear the grunts; the thud-after-thud as the players seek the sweet-spot. Any applause was lost a long time ago. You see, primary and secondary care are locked in a tie-break. Primary care refer; secondary care continue to hone their return of service, trying to spot the attempted ace down the centre. Screening tools are perfected, referral thresholds revised - the net gets dizzy; meanwhile, who is doing the therapy, the carer support, the public mental health education? Of course, this word therapy also comes with economic and status baggage.

You have to feel sorry for both these players and their coaches, now they can't just run to return the ball, the rules say that between shots they have to include a gymnastic element too.

Wimbledon 2008 should be fascinating: there's bound to be a break soon - I bet your demographic dollar$

Image source http://www.tennisserver.com/set/set_03_09.html

Baseball: One of the games people play ... Fisher (2001) ii

Critical Thinking 
2nd Ed. Cover

Returning to Fisher's excellent book I mentioned an analogy from basket ball in discussion about Richard Paul's definition of critical thinking and 'thinking about your thinking'.

'Critical thinking is that mode of thinking - about any subject, content or problem - in which the thinker improves the quality of his or her thinking by skilfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them. (Paul, Fisher and Nosich,1993, p. 4).' pp.4-5.

Fisher's daughter aged eleven wanted to learn how to play basket ball and attended coaching sessions. At the first the raw recruits were divided into two teams and with simplified rules set to play. Initially, getting the ball and in a position to score: shoot.

After the chaos, the coach had them practice shooting after he demonstrated how they had been playing. He explained and pointed out the basics of technique and 'drew attention to how he held the ball, where he looked, how he stood and so on.' p.5. Acknowledging their efforts, they subsequently moved on to passing, then guarding, or marking - practising each skill. 

This is a great analogy and can be applied to health, social care, medicine, nursing and other novices. Hodges' model is the basket ball, tennis, squash court, football, hockey pitch. You might move to a position to obtain an advantageous point of view. In reflective, critical thinking terms, additional data to support or negate a line of thought.

The axes of Hodges' model, serve as a scaffold to help structure our 'game player', and possibly better co-ordinate a group or team's efforts. The domains of Hodges' model cover the knowledge or subject bases that will relate to any context. Hodges' model is situated. If there is need to consider spiritual matters - experiences, then a conceptual journey ... at least, as befits an individual's or group's beliefs and purpose can be made. So forms if intelligence (emotional, cultural, spiritual ...) can also be factored in, as necessary.

 

Are there relational, logical, even mathematical standards that can be applied (formally, in theory) to our thinking? Does 'subject, content or problem' equate with 'situated'? Another book to pass on.

Fisher, A. (2001) Critical Thinking: An Introduction. Cambridge University Press, Cambridge, England. PB. 

Previously: LANDscape : ground : line-of-sight : role-model : structure

Post: ... 'anyone for tennis'.

Entry to the Theatre of Nursing & Space

I do understand that reading theatre related texts, joining a theatre group, my writing a play is still pi in the sky. It's the journey, that's all. In Hodges' model I've differentiated between structure and content. This is the center of the stage about which Hodges' model turns. In the guided discovery by which students and audiences can discover the model,  these are the bases to touch in turn.

Sir Alan's focus on construction in writing: is narrative, time, location, characters (p.12). The overall message for me is, the frequently uttered - less is more. I must take heed and listen. During Ayckbourn's career, he has encountered the full retinue of writers and directors young and 'experienced'. Reading this, it is nice to be both 'new old-er' -

'Then there is the new old playwright. Far more difficult to deal with. They have probably nursed this script for twenty-five years and they're damned if you're going to mess it up for them when they've waited so long. Especially someone your age who wasn't even born when their harrowing play about World War Two was still raging, dammit.' p.110. (My emphasis in bold.)

Thinking about 1959 and the start of Sir Alan's career, his reference to WWII, made me recall nursing assistant and student nurse studies and placements at Winwick Hospital in 1977. On the geriatric wards for entertainment it was WWI songs were often sung, or records played. Long players, indeed.

In health we are usually accustomed to stopping before the 'true' end, with the exception of palliative care, although even then the ending should be 'better' than what it would otherwise have been.

If I am nursing Hodges' model, I've been doing so ever since 1987-88. As Sir Alan also observes of writers, while passionate about the utility of the model - my project - not my model; I am filled with self-doubt. Is this an over-valued idea - in my hands (and mind!)?

In other reading - Stagecraft. The Complete Guide To Theatrical Practice, by Griffiths Trevor R. 1982, I came across the word 'proscenium'.

'Incidentally, when we came to stage [the play in question is 'Woman in Mind' PJ] the London proscenium version this was far more difficult to achieve. Proscenium theatres generally make scenic statements whether they want to or not; the round makes none unless called upon to do so.' p.32. 

There are many insights into sets, design, and the various pros and cons. In May and earlier this month, with three other cast members I performed a role 8-9mins in a Living Newspaper (40-50 mins in total). It was fascinating to watch the various aspects developing from the initial reading in January. With Hodges' model an idea, the question of set design is not straight forward. But as with over-valued ideas, I am probably over-thinking (as usual) making things more complicated than necessary.

One golden nugget of advice, is if you are the writer and write well, well you don't have to think the set design. That is a problem for someone else to solve. Hopefully you will be impressed by the interpretation and realisation (often in film credits) of your work.

That is, unless you're unlucky and find yourself on the receiving end of Obvious Rule No. 13:

Beware of competitive set designers, particularly those with a 'concept'.

The name Ayckbourn is synonomous with The Stephen Joseph Theatre, which is in the round:

'The Round provides a truly unique experience as the audience is seated all around the stage. Not only does the audience see the performance from every angle, it also brings the actor into the same space as the audience.'

"Let’s have the actors in the same room as the audience, let’s have four front rows, let’s get really excited about this acting business!"

Stephen Joseph, 1959 - https://sjt.uk.com/about-us

From the mid-1980s and 90s I used to visit Bolton's Octagon quite regularly. Performances were frequently in the round. Last month, Abigail's Party was too (the last night).

Whatever, the staging, set, I'd be interested to see the 'concept'. On directing:

'As regards interpretation. you may need to tread more warily. As I said earlier, many playwrights are not naturally theatre creatures - certainly they are rarely visual theatre creatures, I have seen them sit there and watch their play physically anfold with a look of total amazement. pordering sometimes on delight, sometimes on dismay. What was in their head has been made three-dimensional flesh.' p.111.

Space has been and remains fundamental to my thinking about Hodges' model. Even pushing the envelope to topology, this is well beyond my ken. But not other gifted researchers. Hodges' model provides inter- multi- transdisciplinary bridges: we need to Before the time of schools becoming fenced and patrolled sites, we used to play cricket, tennis and football. There was a large wall at front of a former school, great for tennis, but not return of serve. Now a projection shared in the round - so everyone sees the same thing (yes, another rule!) might hold potential. There's acknowledgement that technology moves on too (p.123). And room for comedy, Ayckbourn's starting point. 

'Designers, it has been said, even the best of them, sometimes get hold of the wrong end of the stick. ... Always get to look at drawings, ground plans and, most helpfully, scale models of what they intend.' p.120.

The Crafty Art of Playmaking by Alan Ayckbourn. Faber, 2004, softcover, ISBN 0571215106.

https://www.concordtheatricals.co.uk/s/45898/the-crafty-art-of-playmaking

Individual and shared mental models c/o Proctor, & Vu, (2023).

The first day of the conference on 'Ecologies of Care' 4th-5th June is complete. It was helpful to contribute early and then focus on the programme. The questions and acknowledgement have made the (personal) effort worthwhile. Tomorrow also looks promising. There was an emphasis on attention which I tried to reflect and featured in a fascinating keynote by Professor Yves Citton. I will check the sources highlighted; and tomorrow, inquire about a point made re. use of socio in contrast to social.

Regards ongoing reading, perhaps, the evidence to support Hodges' model in practice is already out there? There might be a caveat, that the literature may suggest (if does not yet confirm) that if taught cross-curricula and professional groups then Hodges' model can function as a meta-model? 

What do you think of the following from a chapter on 'Social attention and team performance' (with my emphasis)? :

'... Other two-person team examples include doubles tennis partners and pairings of an airline pilot and copilot. Larger teams can be found in the numerous team sports surgical teams, busineses, and research teams of many scientific laboratories. For teams, coordinated performance is crucial, which becomes more difficult when teams extend to three or more people. As such, teams need to have shared mental models representing the team knowledge (Gardner et al., 2017), which support team situation awareness (Demir et al. 2017).

 

The concept of individual mental model refers to understanding a particular event on the basis of the activation of relevant schemas from long-term memory and, sometimes, simulation of possible scenarios (see also Chapter 10). Bower and Morrow (1990) pointed out that a crucial role in mental models is to shift and focus attention. ...

 

Shared mental models refer to collective understanding among team members of the task to be performed and how it can be accomplished. This understanding includes the responsibilities of the individual team members and dependencies between teammates on other members progress. The term team mental models is sometimes used when the context is teamwork that needs to be coordinated and executed (Jonker et al., 2010). The idea is that teams will perform better if they share mental models. ...

 

The surgery intern study illustrates that shared mental models are learned, leading to the question of how this learning can be facilitated.' p.368. ...

 

'Team leadership can be effective at getting members to be engaged in activities that will promote shared mental models. Boies and Fiset (2018) found evidence that leaders can facilitate the development of shared mental models by involving team members in the consideration of the to-be-accomplished task and their roles in its accomplishment. This involvement, again, likely directs members' attention to information relevant for achieving team goals and enables more domain-specific group discussion, which then furthers the emergence of a shared mental model. ...

 

Situation awareness is a broader concept than mental models, focusing on an explicit understanding of events and contexts. Shared situation awareness differs from individual situation awareness discussed in Chapter 9, in the information required for operators to have effective coordination (Chiappe et al., 2016). For example, paramedics delivering a patient to an emergency room need to coordinate with the hospital and its staff members to ensure that the hospital has the capacity and that the doctors receiving the patient have the vital information they need to treat the patient. Once the patient is in the emergency room, nurses, doctors and technicians need to coordinate with each other to make sure that the patient is being properly cared for.' p.369. 

Proctor, R. W., & Vu, K.-P. L. (2023). Social attention and team performance. In R. W. Proctor & K.-P. L. Vu, Attention: Selection and control in human information processing (pp. 343–374). American Psychological Association. https://doi.org/10.1037/0000317-012

Drupal, Northern England CHE group

It's been a busy week...

On Wednesday night the turnout for the 1st NW England Drupal user group was excellent. A great springboard for next month. I've ordered another book! The title reflects an aspirational air. Although search inside helps, there's nothing like having chance to open the book for real and scan. Especially, when you've also been shown (thanks Chris!) some basics of installation and must-have modules. So, if this blog suffers through the Solstice well you know why ;-).

Today, the Yorkshire Sculpture Park proved a great find for me; with Criggy and Andy there were just three of us for the Northern England CHE group meet. It was overcast and drizzled occasionally, but the conversation and exhibits ensured it was really warm and sunny. Walking and bike riding in the 90s around Grizedale Forest I remember Andy Goldsworthy's work: brilliant! Hope to go back before this exhibition ends in January. Strange how I'd seen it featured on the Culture Show - BBC 2 and the programme returned for a new series tonight.

Back very soon... CBT and CMHNs: - Anyone for tennis?

FROM: Personal Forms, Paper Forms and e-Forms TO: Forms of Transparent and Opaque Support

It is hard to outrun paperwork.

Even though the promise of a great E-scape has been around for so long that the original pronouncement has become an eerie technology-enhanced echo.

Even before we arrive at the paper forms that are the bureaucrat's delight, there is in our mind's eye a personal idealised version.

This is in turn a product of the professional training and experience to which we are subjected. The quality of this personal idealised version is also affected by individual traits (aptitude and attitude) that are further shaped by the situation and the unique individual(s) who becomes the focus of our undivided attention.

This personal form, its gestation and sustenance is important because it affects the other forms:

• paper forms - policy, legacy (we've always done it this way);
• theoretical (academic-the idealised standard) form(s);
• electronic forms:
• the computer based record
• scanned - archived forms (electronic document management systems)
• and other variations (e-mails)

- and how they are received, adopted, owned and used. ....

Very frequently we need to listen. No. I mean really listen. Not just to one person, but two and more people verbally (with yet others non-verbally). People like to play tennis and when they start slugging it out they often seek a referee. There you are, having to 'write' things down, but you are still learning the(ir) rules. And anyway, writing things down on paper or e-form is a distraction for all. This IS NOT a problem (the problem's the grunting you can hear in the background). It is just a natural interface. As with any communication hand-over or transition point we need to take care, to be safe, efficient and effective.

Another personal form has of course arrived in the very humanoid (person-centred!) shape of self-assessment and the personal health record. There are new challenges in how these hybrid, composite record forms are defined, interoperate, cooperate, and how they will be governed and are seen to accrue measurable (holistic) benefits.

If these different forms prove seamless in use and achieve transparency, well that is quite a trick. If alternately the forms are opaque then the misfit will quickly become apparent. So, have you got the forms? Or is that just the way you walk?