h2cm: philosophy of science - analytical AND dialectical Refinetti, R. (1989).

"For centuries, philosophers have discussed whether knowledge progresses analytically or dialectically. In the Cartesian tradition of starting with simple concepts and then building up more complex concepts [4], the idea of science as a gradual accumulation of small pieces of knowledge was put forward by Auguste Comte [5]. This constitutes an analytical view of the progress of knowledge. On the other hand, Hegel proposed that knowledge grows as a whole, so that contradictions between opposing ideas are solved (and disperse pieces of knowledge are integrated) at each stage of the dialectical progress of knowledge [6]. This constitutes a dialectical view of the progress of knowledge.

The partial correctness of both the analytical view of Comte and the dialectical view of Hegel have been acknowledged for many years. Wisdom from both views can be found in the writings of many contemporary philosophers of science." Refinetti, R. (1989) p.583.

.... and can also be found within the structure and potential content of the Health Care Domains Model. Goethe in his own way(s) of seeing recognised the same...


Refinetti, R. (1989). Information processing as a central issue in philosophy of science, Information Processing & Management, 25, 5, 583-584.

Recipe II: Holistic care - Care pebble overhere!

...

WouldBeUser: Well there's no shortage of pebbles, the referrals come thick and fast.

ActualUser: That's why reflecting on that particular pebble is important, turning it - them, their situation over. Asking yourself is there anything I and the team have missed?

WouldBeUser: OK, the beach is still full of them!

ActualUser: Is it the pebble you are trying to see?

WouldBeUser: Ah, of course! Individualised care?

ActualUser: That's right. Nursing, health, social care and in fact good governance everywhere is about seeing the person. Sometimes it isn't easy; but if you pick that person out then you can count the rewards as you would the pebbles on the beach ...

Original image sources - see Recipe I

Recipe: Holistic care - Care pebble turnover*

WouldBeUser: How can you sum up use of the health career - care domains - model?

ActualUser: Well it's a bit like you are picking and throwing some pebbles on the care plan or game board.

WouldBeUser: What - as simple as that!

ActualUser: Yes, but - NEVER underestimate the value of turning each of those pebbles over and reflecting, sharing...

*Also great for a game of nudge - nudge.

Original image sources:

http://imagecache.artistrising.com/artwork/lrg//4/417/7CV9000A.jpg
http://www.crglass.ca/images/dark%20green%20pebbles.jpg
http://www.crglass.ca/images/dark%20blue%20pebbles.jpg
http://www.crglass.ca/images/red%20pebbles.jpg

Comets, holistic care and peripheral vision

Comet Hartley 2 is still bright and yet throughout its visit by Earth quite diffuse, so I have yet to try to find it with my binoculars. To effectively use binoculars, a telescope (or even a microscope) and enjoy the astronomical delights (especially as Councils save money and switch off street lights) it helps to develop your peripheral vision.

Nursing, medicine and social care calls for its own kind of peripheral vision. Peripheral vision that nonetheless enables us to really see. It is ironic that in order to see the big picture that includes the person, that allows us to coherently assess, plan, deliver and evaluate person-centred care we must look off-center.



Comet image source: http://maineastro.com/2010/10/binocular-comet-now-high-in-the-sky/

h2cm: Globalization, Accommodation theory and Relativism (Grayling, 2010)

From A.C. Grayling's Ideas that Matter, 2010, Phoenix.

Globalization: p. 235-236.

A more neutral account of globalization describes it as the process of making things known, done, available or possessed worldwide - such as Internet access, telecommunications, medical knowledge and benefits such as vaccines, transport technologies, political ideas, art and music, books and much besides.

Grayling also explains how the increased distribution associated with globalization is unequal, hence the sense of injustice that is felt resulting in protest.

The health care domains model is concerned with making things known - helping to make knowledge available on a personal, group and family level. This is no Mercator projection, not even Peter's projection but it is a global map.

Accommodation theory: p. 3-5.

Accommodation theory states that when people talk to each, they adjust their behaviour and manner of speech to take account of (to accommodate themselves to) the topic, the circumstances, and the other people engaged with them in conversation.

There are many theories to explain how we communicate and thereby model(?) ourselves, others and the world. Imagine a doctor's surgery and the morning's clinical consultations, it is easy to envisage the role that accommodation routinely plays. The one-to-one conversation (dialogue, argumentation, debate) can be extended, and viewed as the combined chatter, the whole series of multidisciplinary Q&A with the breaks (the silences when we are listening!). Accommodation theory has proved of value in multiculturalism, especially on policy concerning immigration and integration. p.5

The care domains provide an ethnoculturally neutral space (it could be argued) for the accommodations that are demanded in the 21st Century. 

Relativism: p.433.

There is a distinction to be drawn between moral or cultural relativism, on the one hand, and cognitive relativism on the other. The former concerns the difference between cultures, or between different historical phases of the same culture, with respect to religious, social, and moral values and practices, that is, with respect to what might be called the 'superstructure' of the culture's conceptual scheme. Cognitive relativism concerns the 'infrastructure', the level of basic beliefs about the world, such as that there are perception-independent, re-identifiable and individually discriminable objects or events, occupying space and time, interacting causally, and bearing properties of various kinds.

Much is said of the games that people play. Whether the care domains model provides a game board that can accommodate both the super- and infrastructural conceptual levels is open to question. In the health career model the infrastructure level concepts are light - as we find that they reside in the upper part of the model: perceived, individually discriminable (INTRApersonal) objects occupying space and time (SCIENCES) with mass, weight, inertia. ... The political domain prompts access to values and how these shape the total conceptual landscape(s), the conversations and silences that go on there ...

Balanced Care: Safe Landings and Recovery

In health and social care patient, family and the health care team are united in what is constantly described as a journey. Sometimes there are several, care pathways into territories unknown.

Unknown?

Well yes, if care delivery is personalised (who are we to assume ...?); and yes again even if the patient - the individual concerned is an 'expert' in their condition.

Apart from the metaphysics of life's journey our physical environment can present dangers and yet fewer and fewer corners are truly  unknown. We leave it to astronauts (and oceanographers) to adventure on our behalf. Prior to the Apollo missions it was essential to confirm the nature, solidity of the lunar surface. Would a spacecraft sink and possibly tilt to the extent that return to lunar orbit and Home was impossible?

The Apollo Lunar Module's four legs provided support for a safe landing and take off. A base in every sense.

In health and social care the health career model can provide a base and re-assurance too. Each of the four care domains allied with knowledge and skills - holistic competence - can bring about a successful mission: however the crew and 'success' are defined.

Image source and original text below from:
http://www.robertaonthearts.com/id763.html
Cartier Replica of a Lunar Module
Three individual 18-karat-gold models of the American lunar module were made in 1969 by the jeweler Cartier of Paris on behalf of the French newspaper Le Figaro and presented to the three Apollo 11 astronauts during their post-flight tour in Paris. This model was presented to astronaut Michael Collins.
Image ©Nick Welsh/Cartier Collection 2006

Gardner's 5 Minds for the Future (and the Question)

In order to pursue post graduate study you need a project, which demands a question. Formulating a research question is central. I wonder however whether there remains a bias - hard sciences vs humanities (and triangulation) - towards a class of questions that are closed and so can be answered in X-words : Y-time : with Z-funding? Thereby passing through the necessary academic hoops. Of course I realise that if there are no constraints then chaos would ensue. I just wonder if the journey (creativity, discovery ...) might be lost for the sake of assuring the end product?

My questions (apart from 'beware reflex moves') tend to be framed in broad terms. You could say that as yet I am not disciplined (specific) enough to come up with a question that passes "GO!"

In Howard Gardner's Five Minds for the Future the issue of educational programmes is raised and I read the following:

The second antidote entails the creation of educational programs directed specifically at certain individuals of promise - for example, leaders of tomorrow. Chief executives and general managers are expected to be able to see the big picture - to look beyond their own background and specialization; to understand the various components in their organization or constituency; to think systematically about what is working, what is not working, and how goals can be more effectively achieved. ...

Other individuals - for example, those exhibiting a "searchlight" or "bricoleur" intelligence - might be attracted to such programs as well. They would make use of their enhanced skills even if they do not occupy explicit leadership roles. Perhaps, as educator Vartan Gregorian has suggested, we need a specialization in becoming a generalist. p.75.

Gardner, H. (2008) Five Minds for the Future, Harvard University Press.

Interprofessional education, philosophy and conceptual frameworks

I received a copy of the following - Interprofessional Education in Wales: case studies in health and social care - July 2010, Editors: Clare Kell and Marion Helme (Health Sciences and Practice). Published by the HEA.


As per other HEA publications there are many papers here of great interest. One stood out at a first reading as in addition to the quote below Mark Edward's also refers to the need for an holistic approach, and this particular MSc. course providing a critical space.

UK Professionals are trained and educated in their own disciplines, learning their own unique and specialist knowledge for their chosen profession. Therefore, although each profession is well equipped for its singular contribution, they find their 'educational preparation a total mismatch for the complex, interactive world into which they graduate and practice' (Sullivan, 1998: 428). Sullivan's view reinforces the WLGA's concerns, that professional boundaries *demarcate* social professions (and others) from each other and that resistance to collaboration and co-operation on any meaningful level has been compounded by the historical development of the uni-professional training model. We need therefore to agree a uniting philosophy and *conceptual framework* that facilitates a dialogue between these professional disciplines and gives reasons for these discrete services to work together in providing effective inter-professional solutions to shared social problems. p.53. Edwards, M.L. (2010). * -- * My emphasis.

I do not merely want to hang word associations here on the blog line. But, I have wondered about how we demarcate the disciplines. This is a major question. In the rather incomplete, ill-formatted glossary I cite Resnik (2002) - A pragmatic approach to the Demarcation Problem. I would love to have the opportunity to explore this philosophical, scientific and disciplinary conundrum within the context of pantology in the 21st century (h2cm?).

On the new site a living glossary is a must - the terms we use often vary from context to context, professional to professional. Clearly (or opaquely) I cannot provide all the answers hence the need for a community and a (Drupal) module. ...

Mark L. Edwards, Case Study 7: Issues in collaboration between undergraduate professional qualifying programmes of youth work and social work. pp.47-55.

HEA, Health Sciences and Practice Subject Centre: Room 3.12 Waterloo Bridge Wing, Franklin-Wilkins buildings, King's College London, 150 Stamford Street, London SE1 9NH.

Resnik, D.B. (2002) A pragmatic approach to the Demarcation Problem, Stud. Hist. Phil. Sci., 31:2,249-267.

Related posts:

http://hodges-model.blogspot.com/2010/05/hea-mental-health-sig-h2cm-reflection.html

http://hodges-model.blogspot.com/2010/05/update-kings-college-london-mental.html

Cost savings: 4-fold literacy = care literacy

The RCN's campaign I posted yesterday highlights the belief in and potential of nurses to 'think out of the box'.

There are many people, in many walks of life who are currently racking their brains and flipcharts to come up with ideas for cutting costs. In addition to the RCN, the government has its on-line campaign with the 'Spending Challenge'.

As for nurses there is an extra rabbit to pull from the hat: improving patient care.

Media discussion about the cloned beef - food supply story this week brought a point regarding the relative scientific literacy of the general population of USA and UK. This prompted me to consider discipline based literacy, what usually passes for 'basic grounding in ...' or competency. ('Literacy' has already been corrupted, now for another kick.)

For nurses with their subject disciplines, which can be represented in the health career model - what current public sector health (and social) care requires (demands!) is care literacy.

It is the ability of nurses (and other professionals) to be aware of what happens in the two adjoining boxes, or that one remote enclosure that can simultaneously engender and deliver:

• new insights - creativity and innovation;
  
• holistic integrated care;
• care literacy;
• and - cost savings that can still improve patient care.

See also:
http://hodges-model.blogspot.com/search/label/literacy

Editorial JRN. Coalition in leadership: Politics - the big picture and the big game

In the Journal of Research in Nursing, Veronica Bishop's editorial -

Coalition in leadership.
Politics - the big picture and the big game

- explores the state of the body politic in nursing. Bishop's focus is research, but the implications extend beyond the UK, to nursing globally. The body is indeed immersed in politics, but it seems the feet are dry and there is no one at home.

Considering that The Politics of Nursing by Jane Salvage was published c. 1991 political maturity is long overdue?

While the sexual politics of nursing have been campaigned for in the nursing media and vigilance is needed, it seems that a political birth for nursing needs to be induced. There is a political mentality there, there has to be. The future is too challenging, too fraught, too close to be mollified by appeals of "Anything for an easy life (and death)!."

Bishop begins with a quote:

The very essence of leadership is that you have to have a vision. It’s got to be a vision you articulate clearly and forcefully on every occasion. You can’t blow an uncertain trumpet.
Theodore Hesburgh (1917–)

If you are familiar with the health career model then you know what is coming. ... In quantitative terms 25% of our deliberations using Hodges' model can be POLITICAL. This is not just the political dimensions of the patient, carer and the health and social care enterprise. The model includes the practitioner, but back to Bishop:

Having ‘power’ is a concept that sits uncomfortably with many nurses – it does not fit with the ideal of caring and many clinical nurses are quite open in their lack of regard for those in management, seeing them as power-seekers rather than power-movers. Clearly nurse leaders have in many cases failed to take their clinical colleagues with them in the drive to put nursing where it belongs, at the decision-making point that drives the agenda for health services, a point borne out by Stanley (2009).

How ironic that 'comfort' itself has been the subject of concept analysis and theorising in the nursing literature. If student nurses are exposed to the POLITICAL from the outset of their careers, then surely at the very least they will be more comfortable dealing with the guises and disguises of power?

Bishop refers to leadership and ownership and the two are frequently conjoined. The question of politics in nursing - in thought, practice, management and policy (research!) - makes me wonder ownership of what?

If the political domain is so frequently a vacant lot as far as nurses are concerned, then perhaps when we do put in an appearance we are not taken seriously. It really is a case of: what are you doing here?! As Bishop points out through -

Nurses are scientific. When they want to get to the core of a problem they always try to drill down. Yet politics are about the big picture. Nurses are agriculturalists in that they grow and nurture things but politicians are hunters – they’re always after the big game. It’s these kinds of differences nurses need to start to understand. (Cumberlege, 2007).

Nurses are there in the POLITICAL domain: they are constantly trying to complete the big picture.

... we were considering the best way for her [Baroness Cumberlege] to approach an interview the following day, and eventually, after we had viewed the uppermost issue of the day from every angle she said ‘Oh, nursing is so big!’. How right she was – there is hardly any aspect of life that it does not overlap or impinge on, so considering the big picture is a mammoth task! And again, she was right, we need leaders who have clarity and energy, and can cut through the detail and focus on the professional entity.

Yes, the big 'P'-icture is a mammoth task, hence the need to uncover, compose and frame it early. POLITICS is not just a matter of whistle blowing, industrial relations, policy, the system, us-and-them, banner headlines. ...

Politics is much more and crucial to research as Bishop attests. So, if our students do not reflect upon and articulate the politics of health: ill-health, well-being, equality and inequality, wealth and poverty ... then that professional entity will be a political ghost. A ghost playing a little game in an alien and alienating domain.

Veronica Bishop (2010) Coalition in leadership. Politics - the big picture and the big game, Journal of Research in Nursing; 15; 291.
DOI: 10.1177/1744987110374692

The cost of anholistic care

Being 'holistic' in care delivery can seem anachronistic, paying homage to new age thinking and practices. Paradoxically, being holistic in nursing can also mimic an admin exercise that amounts to ticking the boxes. So for Hodges' model - have you visited all the care domains?

• INTERPERSONAL care ✓
• POLITICAL care ✓
• PHYSICAL care ✓
• SOCIAL care ✓

Advanced discharge planning is many things:

• idealised care;
• standardised care;
  
• evidence of policy, targets;
• sign posting for the care pathway;
• an essential care aspiration that emphasizes the individual's strengths and resources.

As Wimbledon once again reaches its climax we observe that a fast serve needs to be prepared for a fast return of serve.

Last month 23 June, 2010 The Guardian, Society Guardian featured The high cost of return:

Hospitals could lose up to £1.5bn of NHS funding a year because of the government's decision to penalise those where patients return within 30 days of being treated. That is the conclusion of research conducted by health analysts Dr Foster into the potential impact of the tough new policy. It warns that NHS trusts face large potential losses, the biggest could reach £28.7m, as a result of the new approach. In all, 146 acute, specialist and mental health trusts could lose out. Denis Campbell, p.3.

Apparently -

Andrew Lansley wants to force the NHS to provide better care in hospitals and mental health establishments, to keep treating patients there until they are fit to leave and to work more closely with community-based healthcare professionals, such as GPs and district nurses, to ensure sick people receive more help with their convalescence after discharge and so are less likely to return to hospital. "Making hospitals responsible for a patient's ongoing care after discharge will create more joined-up working between hospitals and community services and may be supported by the developments in re-ablement and post-discharge support," he says.

I hope in reading the above you have a sense of my frustration in that the health career model can encourage and support timely reflection that can help achieve holistic, integrated - coherent care.

If the model was shared
- a common resource -
across disciplines and available to patients and carers
then the potential benefits (and savings?) are even greater.

Knowledge Management & E-Learning: An International Journal (KM&EL)

As Editors-in-Chief of Knowledge Management & E-Learning: An International Journal (KM&EL), we are very pleased to announce the release of the special issue "E-Health: Accessing Knowledge for Global Health". Please see below for a detailed description of the contents.

A FREE copy of this Issue can be downloaded at Knowledge Management & E-Learning: An Int. Journal (KM&EL)

http://www.kmel-journal.org/ojs/index.php/online-publication

KM&EL Lab
http://kmel-lab.org/website/index.html

******************************
The contents of the special issue
******************************

Editorial: E-Health: Accessing Knowledge for Global Health
By Patricia Abbott

The Relevance of Telehealth across the Digital Divide: The transfer of knowledge over distance
By Ton AM Spil, Roel W Schuring, Margreet B Michel-Verkerke, Reuben Mugisha, Peter JB Lagendijk

Knowledge Networking for Family Planning: The Potential for Virtual Communities of Practice to Move Forward the Global Reproductive Health Agenda
By Megan O'Brien, Catherine Richey

Developing Nursing and Midwifery Communities of Practice for Making Pregnancy Safer
By Jody Rae Lori, Debbie Diaz Ortiz, Sandra Oyarzo, Patricia Abbott, Sandra Land

Managing knowledge across boundaries in healthcare when innovation is desired
By Mats Edenius, Christina Keller, Staffan Lindblad

The use of synchronous video-conference teaching to increase access to specialist nurse education in rural KwaZulu-Natal, South Africa
By Jennifer Chipps

Learning AIDS in Singapore: Examining the effectiveness of HIV/AIDS efficacy messages for adolescents using ICTs
By Arul Indrasen Chib, May O. Lwin, Zhuomin Lee, Victoria W. Ng, Priscilla H. P. Wong

Development of an online sleep diary for physician and patient use
By Jacqueline Blake, Don Kerr

************************************
Forthcoming Issue Vol.2, No.3, Sep 2010
Special Issue on "Advanced Learning and Performance Technologies, Open Contents, and Standards" - Best Papers Selected from the Conference ICCE C3 2009

Table of Contents

Editoral: Advanced Learning and Performance Technologies, Open Contents, and Standards
By Kiyoshi Nakabayashi, Fanny Klett (IEEE Fellow), Stephen J.H. Yang

Automatic Generation System of Multiple-choice Cloze Questions and its Evaluation
By Takuya GOTO, Tomoko KOJIRI, Toyohide WATANABE, Tomoharu IWATA, Takeshi YAMADA

The Effects of Blended Instruction on Oral Reading Performance and their Relationships to Five-Factor Model of Personality
By Noritake Fujishiro, Isao Miyaji

Design and Implementation of Extensible Learner-adaptive Environment
By Kiyoshi Nakabayashi, Yosuke Morimoto, Yoshiaki Hada

Specifying Cases for TEL in an SME
By Vladan Devedžić, Sonja Radenković, Jelena Jovanović, Viktor Pocajt

The Design of a Sustainable Competency-Based Human Resources Management : A Holistic Approach
By Fanny Klett (IEEE Fellow)

Building Virtual Collaborative Research Community Using Knowledge Management Approach
By Ju-Ling Shih, Jussi Nuutinen, Gwo-Jen Hwang, Nian-Shing Chen

Situational Language Teaching in Ubiquitous Learning Environments
By Angus F.M. Huang, Stephen J.H. Yang, Gwo-Jen Hwang, Chin-Chung Tsai

Understanding Retailers' Acceptance of Virtual Stores
By Irene Y.L. Chen

*******************************
Call for Papers:
http://www.kmel-journal.org/ojs/index.php/online-publication/announcement
*******************************

Editors-in-Chief
Maggie M. Wang (magwang at hku.hk)
Stephen Yang (jhyang at csie.ncu.edu.tw)

Knowledge Management & E-Learning: An International Journal (KM&EL)
http://www.kmel-journal.org/ojs/index.php/online-publication

My source: GANM (Global Alliance for Nursing and Midwifery) list

CARE: Whether NHS or Social Care ...

C	A
R	E

Whether -
NHS or Social Care^*
what
C.A.R.E.
is crying out for is a
universal, shared, holistic and wholly integral conceptual framework.
Then and only then will the currencies^# of care be
transferable, translatable and transforming!

* Private, 3rd sector, religious order, or social enterprise ...
# Currencies does not just refer to finance.

Walls, Lines, Dykes and Health Care

We are accustomed to defensive care and medicine.


Costs aside it seems the driving mantra (always served with a smile) is avoid risk at all cost; but we also recognise the need to balance risk in its negative and positive forms.



When it comes to thinking about care though we need to be open to new ideas, territories and opportunities and what being defensive means in practice and theory in the 21st century.



Additional links:

http://en.wikipedia.org/wiki/Offa%27s_Dyke

It is unlikely that the Dyke was constructed as a defensive earthwork. No army of the period could defend a 120 plus mile long earthwork. It is more likely that the Dyke was constructed as a political statement of power and intent.

http://en.wikipedia.org/wiki/Great_Wall_of_China

Health & holistic care in the 21st and 22nd Century

With the technical means at our disposal it is relatively easy to provide information to the masses. Facebook, Google and advertisers are increasingly better versed to target information not just our way, but your way.

Health education and preventive medicine programs depend on the dissemination of health and well-being information, that in turn also relies on access to an expanding digital infrastructure. Equality of access to information communications technologies is now the province of human rights and not just manifestos whether ambitious or binned.

There is much talk of trying to categorise the stage (and hence maturity) of our civilization: hence we talk about being in the information age.

In health care terms this is clearly the case. The provision of information is a key operation and goal of the UN and WHO as per the Millennium Development Goals. Amid the MDG and multiple other related initiatives we need to take care that the habits of many thousands of years do not dilute our efforts.

There is a danger that just as we have broadcast seeds to grow crops,
we will repeat the exercise with technology's reach and
so many seeds will fall on stony ground and
so not take root and
grow.

As people working in the development field know only too well, initiatives like Health Information for All by 2015 and national efforts are not just about the provision of information. In some respects that is not as big a problem as it once was (though is still presents a huge challenge) with community, urban and developmental informatics. Mobile phones and various technologies can get information to people. Increasingly though the problem is one of sufficient or extended literacy. This extends the conventional educational literacy and notion of the 3R's - Reading, wRiting and aRithmetic.

What knowledge do I need about my health and that of the 'other' gender and ethnic groups with whom I share this 'home'. What knowledge do I need in order to live long and then be able to prosper and do so sustainably?

Allied with the problem of literacy is seeking the attention of individuals. This perhaps is why infant, primary and secondary schooling are so important - learning to attend is the most important lesson of all. Especially as health and well-being messages must compete in the multi-spectral communications channels polluted with so much dross.

The MDG make clear the above requirement in Goal 2: Achieve universal primary education:

2.1. Net enrollment and retention in primary education
2.2. Proportion of pupils starting Grade 1 who also reach the last grade of primary education
2.3. Literacy rate of 15-24 year old #

With the requisite baseline - personalised literacies and the information that HIFA2015 and others can provide then individuals can achieve a level of health and well-being knowledge commensurate with living (and dying well) in the 21st century:

and 2nd-by-2nd the

growing proportion of the global population that will know the
22nd century. ...

# Thanks to Remi Akinmade and HIFA-2015 list
http://mdgs.un.org/unsd/mdg/Host.aspx?Content=Indicators/OfficialList.htm

Literacy on W2tQ
http://hodges-model.blogspot.com/search/label/literacy

Ageism: Four year old ideas and big pictures

Models of nursing are still alive and kicking on nurse education curricula. One day ;-) I will do that literature search and look at the numbers and dates of publication. It seems reasonable to assume that there are now fewer newborn and infant examples compared with the 70-90s. While internet time may be compressed there must be strange goings on in nursing academia if some students (apparently) only refer to sources within the past four years. The field is going to be very furrowed with so many wheels being brought to bear on theory and practice and then suddenly cast aside to rust (if mechanistic) or go rotten (if humanistic) or perhaps both (holistic). Wither a space for creativity and innovation that also supports sustainability, continuity, stability, integrity...? Are they mutually exclusive?

If there is an over-four-year-can't-go-there! rule then logic suggests that a newly realised evidence-based method or tool has a limited life span for some students. This constant, iterative, critique of theory and practice IS crucial, but in terms of doing those things that depend on nurses weaving between subject disciplines and other professions where is the big picture? How old are your stories: the ones that really count?

Nursing and the care 'event horizon'

The axes of Hodges' model as illustrated:

HUMANISTIC - MECHANISTIC
and
INDIVIDUAL - GROUP

- are quite straight forward to understand, hence the ready utility of the model.

Nursing care is often described in terms of care that is 'visible' and that which is 'invisible'.

Hodges' model then makes explicit the division between physical - task-based care (upper-right SCIENCES domain) and that which concerns mental health and emotional care (upper-left INTRA-INTERPERSONAL domain. Within Hodges' model what is considered the individual axis can be likened to the astrophysicist's 'event horizon'. An irrevocable barrier and division between two fundamental areas (quadrants) of care that we are still working to conjoin and integrate.

Drupalcon Paris 2009 "big picture..." x 5 "holistic..." x 6

Today at Drupalcon my keyword count by the speakers of day 3 sessions I was privy to (assuming I was awake throughout) is something like:

"big picture" = 5
"holistic (+ or - thinking)" = 6

These were stressed repeatedly especially by keynote speaker Chris Heuer. Like last year in Hungary I have looked at the BOF (birds of a feather) board and wondered about sticking Hodges 'framework' up there. Why 'framework' and not 'model'? Well framework, product and service are amongst the other keywords at Drupalcons past, present and future no doubt.

Hodges' model is a framework to carry, represent and disseminate big pictures.

While it is very encouraging to me to hear these terms I get the impression this is window dressing. At the end of the day the 'big picture' is the paper around the fish and chips. Its value is quickly spent - especially in this most apparent recycled mode. Chris Heuer alluded to this in his very interesting talk.

There is more to see in the big picture than what seems to be there.


This is why Hodges' model is so readily passed over for its simplicity.

When we gather the constituent parts of the big picture they are invariably 'recycled materials'.

The converted can see the re-purposed value, the need to re-visit the frame and tinker with the contrast, horizon(s), sky and colour; but critically do those who really need to create, see and utilise the resource?

The thing about 'big pictures' is
they are not enough in themselves,
it depends not only on how you fold them,
but on how hard you can throw them.

Image sources:

Fish and chips in paper: http://www.roadfood.com/Restaurants/SearchResults.aspx?st=photos&ob=RestaurantName&ps=1&s=XX
Paper plane: http://www.clker.com/clipart-4601.html

Holistic care and 'where' it means....

Delivering holistic care does not mean being -

here	here
here	- or here

Holistic care is not even
about being in all these
places at the same time.

It means you have already
been to these places and you
will be going back again.

Holistic care also means
none of the participants travel alone ...

The Conceptual Age needs tools to catch, match and patch ...

I have finally read some of Dan Pink's book A Whole New Mind: Moving from the Information Age to the Conceptual Age.

The graphic copied here from the book is interesting for this blog and its readers by both what is included - the conceptual age and what is omitted.

Pink's graphic supports and reinforces what I have felt for many years. Namely, that in Hodges' model we have a conceptual framework fit for our time and purposes. Looking at the figure developmentally then of course we think conceptually from a very early age in order to make sense of self, other, world and future.

Pink's graphic is interesting in that as depicted here we have not reached the knowledge age as yet. While these ages are discrete when conducting health and social care and other activities the boundaries are of course unclear and fuzzy.

Being in the conceptual age we need tools that can catch our care and related concepts. A stage that makes them accessible for reflection and association.

Moving further towards the knowledge age we then need tools that can recognise patterns in our concepts and begin to match them.

For safety's sake we then need to recognise the important concepts missed in our assessments, problem solving, project management and service improvement processes ... These tools will be able to suggest and patch the gaps in our framework and hence our understanding.

Image original source: http://elearningtech.pbworks.com/f/daniel-pink-conceptual-age.png

Additional links:

Dan Pink - A Whole New Mind

'conceptual spaces' on W2tQ

'concepts' on W2tQ

Reflecting on this it is a shame that there is no Innocent Age any longer or what there is often cut short.
The least we can do is to try to preserve it for as long as possible ...