Lean machine(s): chasing the contexts

There is a perennial game in health and social care called assessment and evaluation: the game could also be called 'CTC' - 'chasing the context'.

Relativity lies not only in the realm of physics and philosophy.

When I say relativity I am referring of course to the influence and impact of a health and social care situation from the constantly changing perspective of each of several different players:

• the patient;
• carer;
• nurse;
• doctor;
• manager;
• medical ward;
• community mental health team;
• commissioner.

Usually, the context collapses to a specific problem (a situation) and the players set to solve a care problem presented by an individual -

• a client, resident or patient;

and their -

• relatives;
• residential care home manager;
• residential care home staff nurse and team;
• community mental health nurse;
• medical personnel.

Context directs, dictates, and shapes health and social care theory, practice, management and policy.

This relativism can also subvert, sublime, confuse and stymie plans, common sense notions, creativity, innovation and management directives.

Like a tide this relativity picks us up and re-figures, re-paints and shifts the location of everything - including measures and how they are used.

Context is all! - so the saying goes. But context never wholly reveals itself. For that is another situation, another context, another side, another coin.

For context there are key defining parameters (location, diagnoses, risk, need, physical, mental, holistic ...) all of these are couched or spring from time.

So, the game calls for us and the tide teases us to measure and evaluate. This coast is never clear, but how long is it now? Where are the pathways now? Where will they be again?

As we travel (and travail) to and from this context to that - thresholds are also altered: up and down and always around; the way of life and ..... .

Image source:
http://www.esd112.org/edtech/no_limit/rs_archive.cfm

Music Gym - flexes its muscles

Hi,

My name's Matt, and I'm the Roadshow Coordinator for Decoda with some information which I hope will be of interest to those of you in or around the area of Lancaster and Preston.

Decoda have been successfully running a Music Gym down in Hastings for the past five years, continually developing and refining their techniques and technologies, whilst building a rapport with those who attend week after week. Using an innovative combination of music, images, space and fun the Music Gym provides an effective, flexible platform to engage and entertain people with a variety of complex needs. It’s also a great opportunity for parents, carers and those they care for to meet others from the local area and socialise. Others have described us as:

'fantastic use of colour and music, very interactive and inviting.'

'A really intriguing and dynamic approach'

'An excellent resource – we need more like this.'

'A great range of innovative, creative equipment... lots and lots of fun.'

'... a wonderful innovative idea.'

We have been invited to bring the Music Gym to Lancashire this month, and so we’ll be at the Salt Ayre Sports Center in Lancaster on the 16th and 17th of August, and at the Caritas Deafway home in Preston on the 18th [Deafway, Brockholes Brow, Preston, Lancashire, PR2 5AL].

If you would like to see the gym in action prior to making a decision (Or just see it in action without attending), I see no reason why you would not be allowed to observe any of the sessions we’re holding at the Salt Ayre. I appreciate that it is very difficult to form an opinion of what we do without seeing it in action, and this is a really good chance to do so. The 16th has been set aside for children under 16 years of age, whilst the 17th is for adults. Preston is undecided to be totally honest, we were contacted towards the end of last month, and are in the process of ironing out the final details. One benefit of this is that it’s an ideal date for those individuals who require a less busy venue, as we have not that long to publicise it. It is however a smaller venue than the Salt Ayre, so we may not be able to have our full facilities on offer on that date.

The days have been divided into 5 slots each as follows: 10.00-10.45 11.00-11.45 12.00-12.45 13.00-13.45 14.00-14.45

From our experience in Hastings, I would predict that the 11.00 slot will be the quietest, whilst the 14.00 slot will be the busiest, should that have any bearing in your decision.

In our continuing efforts to bring this to as many people as possible we are offering these places at £7.50 each if booked in advance £10 at the door (carers come free), additionally where this may be helpful, siblings can attend the session for £2.50. This is a great opportunity for people in the local area to get together, try out the facilities and enjoy the real benefits of the Music Gym.

Places can be booked online http://www.decoda.org/node/50 by phone or by post (contact details below).

If you require any more details, or have any questions at all please do not hesitate to contact me roadshow@decoda.org

Many thanks, Matthew Saunders, Roadshow Coordinator

Decoda - a social enterprise benefiting the local community South East Coast Regional winners of the Innovative Health and Social Care Technology Award at the NHS Health & Social Care Awards June 2009

Theaklen House Theaklen Drive St. Leonards on Sea TN38 9AZ Tel: 0845 2938354 websites: www.decoda.org www.musicgym.org www.myspace.com/decodamusicgym www.soundtherapy.org.uk BBC's South East Today film about the Music Gym is at http://www.youtube.com/watch?v=8j7v7pQ9kYQ

My source:
Foundation for People with Learning Disabilities

h2cm - Being at the center of things [I]

The center of Hodges' model can represent many things:

an epistemological nexus for the transdisciplinary dependencies of our times
multidisciplinary coffee shop
self-care engagement stage
the chaos of all things
holistic harmony
integrated idyll*

More down to Earth and acknowledging this cruciform '+' structure as a mythic device, in addition to searching for the mysteries of the universe at the center we can also place the 'well' person there.

As the previous post on ADLs suggests the 'well' person can function on a basic level and has negotiated the four axes and the four and five fold knowledge domains. They can therefore be considered (sufficiently) wholly integrated. We are all travellers, constantly traversing these domains of experience consciously, unconsciously, expertly or with the awkwardness that denotes the novice.

Conversely and reflecting the model's utility: it is also possible to locate the unwell individual in the center too. In this instance the placement suggests impoverishment of experience, ongoing personal and social stasis and in the case of substance misuse the presence of specific disruptive focus and preoccupations. The person becomes lost to their potential, stuck in a 4:5-fold minima. They continue to travel chronologically, but the journey is spiral, self-iterative and diminishing by return.


However: what you can see you can change, or come to terms with.

*from Greek eidyllion, little picture (h2cm as a snapshot).

Image source: http://www1.lsbu.ac.uk/water/protein2.html

Bee in my bonnet and a place to call home

For some years (over a decade) I've had a bee in my bonnet about the impact of relative-ly sudden house moves that older adults often make following sudden bereavement.

This prompted a first and no longer maintained website 'Beware Reflex Moves'.

This rather silent issue still stands and is arguably growing in volume.

There are surely a series of studies to be made here. Like most forms of life, the patient-nurse encounters of all those years ago have evolved: the ability of Jo(e) Public and their families to independently visit, select and move their relative into residential care is a new factor.

Self-funding frees up valuable resources as people can essentially circumvent the formal assessment processes of social services (and health), negotiating directly with the home of their choice for a place. This place may be many, many miles away from what was home. Amid increasing demand this arrangement works well much of the time. When it fails though, the impact is a personal and social catastrophe that can also reverberate across two health and social care economies. The person's original social services and their new location - that of their family.

Here the 'diagnosis' may not just be bereavement reaction / depression, but dementia too.

So, the advice remains beware of reflex moves.

Wish those bees had stayed in that bonnet - they might be safe now.....

Image source with thanks: http://www.flickr.com/photos/lelonopo/2378726643/

1st Contact: ET and care on the front line

ET as in 'extraterrestrial' may seem remote from nursing and health care, but where there's a will....

Health and social care appears to become ever more specialised with each turn of the policy machine. People's lives are experienced as being ever more complex. Health care is filled with uncertainty and the public present with multi-diagnostic, person-centred, choice bearing, (usually) recovery directed problems, needs and strengths.

Pity then the care workers on the front line, at the point of 1st contact. Like the baseball catcher it helps if they can field the knowledge and skills required to cover physical, mental health and possibly learning disabled clients. You have to hope that coaches recognise that Hodges' model can help the team be aware and fully prepared to cope with 1st contact supporting and facilitating what follows. So, how does your team get to grips with complex care?

Additional links:

Baileff, A. (2004) Developing high quality first contact nursing in Southampton NHS Walk-in Centres. At, Innovations in Partnership, Practice and Education, 3rd Annual Scholarship Conference, Portsmouth UK, 2 Jul 2004. Southampton, UK, University of Southampton. http://eprints.soton.ac.uk/9197/

Declaration of Principles Concerning Activities Following the Detection of Extraterrestrial Intelligence http://www.setileague.org/general/protocol.htm

Image and source: Louisville Slugger OXFB Omaha Pro Series 13 Inch First Base Baseball Mitt from http://www.anacondasports.com/

Transcultural health & Hodges model

Text by Larson et al. (2001) is presented below with a suggested placement of
Bradshaw's (1972) typology of social need on to the four care domains of Hodges' model:

INTERPERSONAL : SCIENCES
SOCIOLOGY : POLITICAL

Felt need: The needs as perceived by members of the group.	Normative need: The group fails to meet an objective, universalistic standard. Technical definitions of need such as the Australian National Mental Health Standards are examples of normative need.
Expressed need: Through their behaviour, group members have demonstrated a need, often by lengthy queues for services or failure to attend a service.	Comparative need: The group is demonstratively worse off than another group. Comparative need is usually demonstrated through routinely collected statistics, which is problematic for small ethnic groups whose identities are rarely recorded (p.336).

Bradshaw’s framework is still widely used. The important distinction is one between the ‘top-down’, professional-derived definitions of normative and comparative needs, on the one hand, and the felt and expressed needs, interpreted as the ‘bottom-up’ expression of experiences and attitudes, on the other (p.336).

See also Larson et al. discussion of 'thin' and 'thick' needs.

(The fact that this typology can be described in terms of 'top-down' - 'bottom-up' also highlights the socio-technical potential of Hodges' model.)

References:
Bradshaw, J. (1972). The concept of social need. New Society, 19(496), 640–643.
Larson, A., Frkovic, I., van Kooten-Prasad, M., Manderson, L. (2001). Mental Health Needs Assessment in Australia’s Culturally Diverse Society, Transcultural Psychiatry, 33(3), 333-347. Abstract.

The INTRAPERSONAL links page includes Psychology I & II, Mental health, Therapies...

The SOCIOLOGICAL links page includes Patients, Carers, Sociology I & II...

Holistic care: What is 'holistic bandwidth'?

The old website with its pages is static. In thinking about how to mix the old and create new dynamic content for a Drupal based site, I came across a possible way to define and explore our notions of holistic care. Here are some very initial musings....

First to focus on quantity. In completing an assessment whichever care domain I start in (let's say the intrapersonal domain) then as that domain is populated can it be argued that within the other domains the same number of placeholders for our assessment data are created? If my patient has eight problems (and two strengths) then according to one definition of holistic bandwidth the remaining domains should have the same number of problems (and strengths). Balance in all things - including holistic care?

One thing that the ADLs teach us is that (holistic) care as represented in Hodges' model is asymmetrical (see previous post).

This does not mean that the ideal of holistic care is lost.

It might mean that strident efforts to assure holistic bandwidth can interfere with our attaining person-centred, integrated and multidisciplinary care.

It is essential that we recognise holistic care as an ideal, as a constraint and the primacy of functional considerations in:

• assessment;
• planning;
• care interventions;
• evaluation;
• and governance.
  

It comes as no surprise then that there are several versions of holistic bandwidth:

1. If we want to be inclusive then version #1 is epistemological. This anticipates the total number of semantically associated concepts that can potentially arise in a given care episode. This is what might be termed the 'semantic web of care'.
   
2. The sum total of concepts across all the care domains (inc. spiritual) that are actually activated in the course of a care episode.
   
3. The concepts that are deemed relevant by the patient, carer, family and guardians.... These add holistic value to and may well (must!) overlap with the care concepts recorded by the clinical team and reflected in the health record(s).
4. The degree of expressiveness of the care recording system - its capacity to represent holistic care and capture (measure) holistic bandwidth pre- or post- care episode completion.
5. The (idealised and learner generated) collections of care concepts identified and enacted within education.
   
6. The idealised and actual collections of holistic arrays applied and recorded by the combined clinical and social care disciplines* involved (there are two sets in practise and theory). As per #3 these (should) overlap with the patient and carer's....
   
7. The final combined lexis of written, electronic and other record(ed) media that constitutes the final:
• personal health record;
• summary health record;
• historical health record;
• clinical record;
• ....
  
• all the above combined;
• an individual and group's (family) health career!
  
8. In addition there are the anonymised and aggregated data items that form part of clinical / management reports, local, central government statistics and returns that inform national health and social care policy and global health intelligence at the WHO.
9. Throughout 1-8 holistic bandwidth must also incorporate education, engagement and informatics.
   

It is reasonable to speak of personal and impersonal forms of holistic bandwidth.

Students - if this is helpful or confusing please let me know h2cmuk @ yahoo.co.uk