compose, direct, conduct and 'dilute to taste' outcomes

In Drupal musings 12 I mentioned that the classification of nursing practice is not necessarily at the forefront of nursing's mind set against the turbulence and rush of clinical areas.* This is especially so at the moment as nurses on wards, clinics and community try to identify savings.

I am interested in classification in part as this is the raison d'être for the health career model; on a mental (cognitive) level, in practice and potentially in virtual representations of health care activities. For learners it is an extra to hold the bicycle saddle for those first turns of the pedals. Additionally, for those who have completed many rides and races (lifelong learners) they can reflect on how they got there, and plan for the next round.

As a conceptual framework then h2cm is, like classification, in the background. The model can help to compose, direct and conduct (c-d-c) nursing (health and social) care. Classification matters to ALL nurses because we need to know not only the c-d-c of nursing but the outcomes too.

If all the above is in the background, then together with classification the health career model can help differentiate nursing as a discipline and make nursing visible. We can only take heed of the adage "divide and conquer" by being able to differentiate nursing from other disciplinary contributions. Then perhaps we can truly identify and so define the facets of integrated, interprofessional and multidisciplinary care that must also be person-centred. As nurses and the team respond to the individual's trauma (assault, illness, chronic disease ...), they can also assure their combined values, which must be defined and articulated if there is to be a unified philosophy.

If the respective professions have not noticed (I am sure they have) 'professionalism' is itself under assault in terms of unique knowledge and skills, respect, power and status. To a degree this a good thing. It is also called 'progress': countering restrictive practices, improving service access and challenging institutionalised and state paternalism. Professionalism is accorded for reasons of accountability, education, responsibility, integrity and advocacy. Amid the public (mental) health disaster that we face - the professions - are needed more than ever and if the assault is taken too far ... ?

* Should you know of examples where classification IS at the forefront of nursing practice please let me know - h2cmng @ yahoo.co.uk.

Free event 29th September 2010 Promoting the collaboration of Age research

Dear Colleagues,

We are pleased to announce a fantastic free event coming up on the 29th of September 2010 titled - "Promoting the collaboration of Age research"

The event is run by the UK Age Research Forum (UKARF) which is a strategic partnership between government, research councils and charities that aims to make a positive difference to the lives of older people through research.

The aims of the conference are:

• To highlight the best of UK research funded by collaborative working of the UKARF member organisations
• To demonstrate the benefits of collaborative working in age research
• To inform about developments in age research in the UK

Where is it taking place?

Time: 9:30am — 4:00pm
Venue: The Royal College of Physicians
11 St Andrews Place
Regent’s Park, London NW1 4LE

How to register: fill in the form attached or register online at -
http://web.me.com/magic_bean/UKARF/registration.html

KT-EQUAL will have a stand at the conference so please register for the event and drop by and say hello!

If you want to know what we are up to, register for any of our future events, or download our monographs from previous events please visit our website www.equal.ac.uk

Best Wishes
Helen Haigh
KT-EQUAL Co-ordinator
University of Sheffield

My source: Sparc/KT-EQUAL network

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

Paper: Patel et al. (2009) Clinical complexity and medical education

The following item about a paper from last year was posted by Rakesh Biswas on the COMPLEXITY-PRIMARY-CARE list. After Rakesh's comments I have included a quotation.

The paper in question by Patel, et al. will be an important reference for me, even though the definition of domain and discipline remains problematic. (A glossary for the health career model will follow on the new site.)

Suddenly, the passing of time is also clear given that:

Shortcliffe, E.H. (et al.) Ed. (1990) A History of Medical Informatics, Wokingham, Addison-Wesley Publishing Co.

- appeared twenty years ago. Ten years ago I cited Shortcliffe et al..

Twenty years! How long is that in technology / internet terms?

The bold text below is my emphasis:

From: Rakesh Biswas
To: COMPLEXITY-PRIMARY-CARE@JISCMAIL.AC.UK
Sent: Thu, 12 August, 2010 16:41:06
Subject: Clinical complexity and medical education

As our society progresses in the accumulation of knowledge and as the complexity of this knowledge increases, it becomes more important to determine how to structure education to provide individuals with the most comprehensive base of knowledge without sacrificing either depth and complexity or broadness of material.

Human beings have an extraordinary capacity for storing large volumes of organized information in memory. How does one apply such detailed knowledge to practical, real-world problems and situations?

What is the optimal mode of learning that will promote flexibility and transfer of general knowledge across domains during problem-solving?

For more, see the article by Dr Patel whose focus area is Medical Cognition (how doctors think and develop their so called expertise).

Regards,
Rakesh

Here is a quote from the paper:

Much of the early research in the study of reasoning in domains such as medicine was carried out in laboratory or experimental settings. There has been a shift in more recent years toward examining cognitive issues in naturalistic medical settings, such as medical teams in intensive care units [2], anesthesiologists working in surgery[89], nurses providing emergency telephone triage [90], and reasoning with technology by patients [91] in the health care system. This research was informed by work in the area of dynamic decision-making [92], complex problem-solving [93], human factors [94,95], and cognitive engineering [44]. Naturalistic studies reshaped researchers’ views of human thinking, as expressed in ‘‘situativity” theory’s terms (as described in Section 2.1.4) [23–26], by shifting the onus of cognition from being the unique province of the individual to being distributed across social and technological contexts. p.186.

Whilst as Rakesh points out Dr. Patel's focus is medical cognition, then through the health career model it would appear my interest is nursing cognition. As per the legacy of models of nursing - which did recognize the patient through the concept of patiency (Stevens, 1979) - we realise that now all disciplines must demand much more of their respective models in the 21st century.

Patel, V.L., et al. (2009) Cognitive and learning sciences in biomedical and health instructional design: A review with lessons for biomedical informatics education, Journal of Biomedical Informatics, 42, 176–197.
doi:10.1016/j.jbi.2008.12.002

Stevens, B.J. (1979) Nursing Theory: Analysis, Application, Evaluation. Boston: Little, Brown and Company.

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.

Nursing attitudes [towards patients ( and self { and ? } ) ]

In the past half-year there have been two discussions, that concern the nurse's attitude towards patients.

One was held on the nursing philosophy list in February:

https://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=NURSE-PHILOSOPHY

"The patient is always right"

The other in May was on the mental health in higher education list:

https://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=MHHE

"Insufferable' or 'Suffering' - a response"

Both provoked a similar response and debate. I have just reprised my post in February on the MHHE list and have copied it - with some revision - below:

<->

Patients are always a challenge in that they come in lots of 'varieties'.

This is why we recognise the need for individualised, person-centred care. One variety is trauma laden to which the full-complement of the multidisciplinary team must respond. These patients and *their* crises bring out the best in us in terms of the skills and knowledge, team work they force us to exercise.

Among the plethora of other varieties there are those who are viewed as 'problems'. Like the Pepsi ad of decades ago they are variously and pejoratively described as multiple attending, attention seeking, patience sapping, heart-sinking, time wasting, symptom preoccupied .... patients.

If I receive referral information, or heads up information on diagnosis that suggests the above what do I do?

• Brace myself for impact?
• Become task focused?
  
• Share collective anecdotes in the staff room as a way to cope, unstress, inject some humour?

OR -

• Avoid labelling them or use these labels in a re-constructive way?
• Refuse to make gross assumptions
• Look at the individual non-judgmentally, holistically, educationally, behaviourally
  
• Believe I can make a difference (change is always possible [inevitable] )
  
• Side-step being tripped by foibles, behaviours and blatant displays of -ve obstructive ... attitudes that offend 'me'
  
• Enter their space and do my utmost to find room for manoeuvre?
• As a nurse do go and seek out strengths and opportunities in the same way that Capt Kirk et al. go and seek New Life, New Civilizations..?

You may have an impossible lock to pick. In its most severe form this is (pejoratively) known as 'personality disorder', but the nursing challenge is there in all its personal and professional glory.

So. Listen.
Attend to this personal
/ under-the-skin \
slant.
Listen and Learn.

Be aware of the pit that continues to trap many people. The life chances - the health career - that they may have missed, took for granted, spurned and much more you (we) will never know about.

Do your job: nurse.

Call for Proposals to Phase 3 Lifelong Health and Wellbeing (LLHW)

Last month I posted the advanced notice about this call for proposals, which is now fully released and has been publicised on the SPARC / KT-EQUAL network:

Dear All (but especially researchers who are desperate to secure research funding)

The Call for Proposals to Phase 3 of the cross-research council multi-health agency Lifelong Health and Wellbeing (LLHW) initiative was released today.

Details can be found at:

http://www.mrc.ac.uk/Fundingopportunities/Calls/LLHWPhase3/MRC006680

This is a very significant opportunity, well worth close scrutiny and consideration and, hopefully, subsequent action.

If you have any uncertainties about the programme or its requirements then I am sure that the representatives of the research councils will be very pleased for you to make contact with them.

Importantly this is a call for multidisciplinary research, a requirement which must be wholeheartedly embraced for any proposal to stand a chance of being eligible for consideration.

It's time for action!!

Best wishes

Peter Lansley
Professor Peter Lansley, BSc, MSc, PhD, MCIOB, FCOT
Director, KT-EQUAL – Knowledge Transfer for Extending Quality Life
School of Construction Management and Engineering, URS Building,
University of Reading, Whiteknights, PO Box 219, Reading, RG6 6AW, UK
p.r.lansley at reading.ac.uk
http://www.sparc.ac.uk

The health career model, reflection, curriculum development

There are many new insights and remembrances available in the content of -

Occasional Paper No 10 (PDF access)
Connecting Reflective Learning, Teaching and Assessment
October 2009 by Helen Bulpitt and Mary Deane

We tend to speak of reflection as if it is merely a case of being in the right place at the right time:
in front of a mirror or other reflective surface.

Among the issues raised in OP #10 (which I will expand and explore further) are:

• the need to embed reflection in learning, teaching and assessment at the curriculum design level;
• the existence of an optimal curriculum design that can foster effective critical reflection (Clouder, 2009);
• reflection to meet specific learning outcomes can be said to be 'reflection to order' (Dalley, Chap 2, 2009);

As this short list shows reflection is a complex and serious component and activity of learning. A central problem is in the assessment and marking of reflective writing (Deane, Chap 5, 2009; Dalley, Chap 6, 2009). Marking a piece of reflective writing what would we look for:

• Observation
• Structure
• Reasoning
• Critical review
• Argument
• Personal disclosure
  
• Writing?

There really is the basis for a paper here on the health career model, reflection and there on the horizon - curriculum development.

Image source:
http://www.reelcollectibles.co.nz/stargate.htm

HEA Mental Health SIG, h2cm & reflection

The HEA mental health SIG presentation yesterday on Hodges' model was very well received. The other sessions were also very interesting and of direct relevance to my role in the care of older adults and mental health. The other sessions were on national dementia strategy and a study of competencies, plus the use of a book club in student learning. I hope other opportunities will arise to spread word of the health career model at other events. The trip (British Museum and an hour in the National Portrait Gallery inc.), networking and dialogue that ensued was very enjoyable. The next meeting will be later in the year and may be in Glasgow, so check their site and I will see if I can post future details on W2tQ.

In addition to the potential of the model being recognised, I also had to defend some points and assumptions that I have carried for a long time:

• The Care Programme Approach and flexibility of community mental health nurses to employ the model;
• associating 'audiences' to specific care domains (as per the - dated - introductions to the model - click on the images);
• the level of the model - the fact it is 'high level'.
  

I say defend in the sense that I continue to hide behind the slogan: the website and this blog represent a call for research, evidence and verification of the model (I did this yesterday!).

Is my proselytizing virtually, to placement students and at events such as the HEA justified, or the result of over-valued idea? This model definitely has a role to play. It is one of many tools, in a way it is the toolbox.

Browsing the HEA website and other SIGs I found one devoted to reflection. As we wrapped up in the afternoon Charles Kasule (Communications & Resources Officer) brought in an occasional paper produced by the group:

Occasional Paper No 10 (PDF access)
Connecting Reflective Learning, Teaching and Assessment (250KB)
October 2009 by Helen Bulpitt and Mary Deane

This is a brief (pp.76) but very useful introductory reader on reflection. Reflection is central to the creation and application of the health career model being one of the original purposes. My presentation included a 15 minute powerpoint breather when we collectively reflected on dementia care across the model's care (knowledge) domains. I will read OP #10 and share my thoughts here over the coming months. Should anyone be interested in exploring reflection in theory, practice, or both please get in touch. Finally, I am very grateful to Bill Penson the mental health SIG facilitator for the slot and the HEA for making this and other occasional papers freely available. More to follow ...

A call for applications for the 3rd phase of Lifelong Health and Wellbeing (LLHW)

Advanced Notice

A call for applications for the third phase of Lifelong Health and Wellbeing (LLHW) will be announced in early May 2010.

Lifelong Health and Wellbeing is a major cross-council initiative involving AHRC, BBSRC, EPSRC, ESRC and MRC in partnership with the UK health departments. LLHW supports multi-disciplinary research addressing factors across the life course that influence healthy ageing and wellbeing in later life.

The initiative aims to lead to improvements in health and quality of life in later life, inform policy and practice and increase capacity building in ageing related research.

Phase 3 will invite high-quality innovative multidisciplinary applications that focus on major ageing-related challenges faced by the UK in the 21^st century. Proposals will be welcome from multidisciplinary teams in the areas of, but not restricted to the following:

• Mental Health and Wellbeing including quality of life, preserving cognitive function and exploiting mental capital
• Resilience for successful ageing: from cell to society including life course influences, markers for ageing and processes of ageing
• Age-related conditions, including frailty and interventions to promote independence in later life.

Structure of the call
Funds will be available through two modes of support:

LLHW Research Grants - up to £10m will be available for multi-disciplinary research awards from £300k up to £2.5m over three to five years.

LLHW Pilot Studies - a total of £2.5m to fund up to 10 pilot or feasibility studies for a maximum of two years, aimed at informing the development of future cross-disciplinary research proposals.

Selection Criteria
Successful proposals will be of strategic importance, be truly multi-disciplinary, encompassing the remits of more than one Research Council, and have clearly articulated and robust methodology and design.

Further information
Updates and further information about phase 3 can be found on the website:
http://www.mrc.ac.uk/LLHW or by emailing llhw AT headoffice.mrc.ac.uk

My source:
Charlotte Jones
NDA Programme Secretary
The University of Sheffield
Department of Sociological Studies
Elmfield, Northumberland Road
Sheffield, S10 2TU, UK

http://www.newdynamics.group.shef.ac.uk

International Journal of Integrated Care

Dear IJIC reader,

Recently PUBLISHED in the International Journal of Integrated Care

A Research and Theory paper:

An evaluation of SNOMED CT® in the domain of complex chronic conditions,
by Tara Sampalli, Michael Shepherd, Jack Duffy and Roy Fox

… It is the hypothesis of this work that showing the availability of multidisciplinary concepts for one complex condition can generate a similar expectation of available terms for other chronic conditions …

A policy paper:

Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management,
by Nick Goodwin and Simon Lawton-Smith

… the lesson from the CPA experience suggests that there is potential for better care integration to be had in a strategy based on personalised care planning and investment in care co-ordination for people with chronic and sometimes complex needs …

And a book review:

Managing transition. Support for individuals at key point of change, edited
by Alison Petch and reviewed by AnneLoes van Staa

…This book is unique in its broad focus on different transitions in various contexts, and its exploration of the evidence for support given to people who risk getting ‘lost in transition’. This makes this publication highly interesting to readers of the International Journal of Integrated Care …

The IJIC journal is freely available at: http://www.ijic.org/

10th INTERNATIONAL INTEGRATED CARE CONFERENCE

“All together now: Exploring the Many Faces and Facets of Integrated Care”,
Tampere Finland, June 16-18, 2010.

The INIC Conference 2010 will make an effort to look at and evaluate the challenges and status quo of mutual many-faceted collaboration of integrated care from the point of view of benefits to patients, service users and carers. The annual conferences offer an ideal meeting place for the integrated care community to discuss recent developments and future challenges across systems and continents.

On the website you can find more information on the keynote speakers, the pre-conference and site-visits, the program of the conference and the parallel sessions.

Visit the conference website at: http://www.integratedcare.org for more information and registration.

Thanks for the continuing interest in our work.

Erika Manten
Managing editor IJIC
ijic at uu.nl
___________________________________________________
Erika Manten - Managing editor International Journal of Integrated Care,
http://www.ijic.org/ - IJIC Editorial office: Igitur, Utrecht Publishing &
Archiving Services, University Library Utrecht, P.O. Box 80124, 3508 TC
Utrecht, The Netherlands.

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

IMIA monthly news bulletin; no. 8, 08 December 2009

My source: Rita Arafa, BCS Health Northern Specialist Group, Membership Secretary.
Original source - IMIA: International Medical Informatics Assoc. see below.

For more frequent news updates, and subscription options by email, RSS feeds, etc., see the IMIA News site at http://imianews.wordpress.com/

IMIA website: http://www.imia.org
MedInfo2010 website: http://www.medinfo2010.org
For all official IMIA communications, please use imia@imia-services.org

Items:

1. MedInfo2010
a] Early bird registration deadline
b] Submissions feedback dates
2. Forthcoming events
a] IMIA Working Group activities
b] Regional events
c] National/international events
3. Boards (deleted for brevity)
4. Publications
5. Corresponding members - new SOP (deleted for brevity)
6. January 2010 bulletin

1. MedInfo2010

MEDINFO 2010 - 13th World Congress on Medical and Health Informatics;

12 to 15 September 2010 in Cape Town , South Africa.

a] Early bird registration deadline

Early bird registration closes 18 December 2009 - book early to save money. The site for conference registration and accommodation booking payment is open - via the main MedInfo 2010 website (www.medinfo2010.org), or directly at https://events.confco.co.za/ei/cm.esp?id=126&pageid=_2OO0LACU8

(NB BCS Health will be offering funding for those participating in Medinfo 2010 – details to be announced soon).
b] Submissions feedback dates

The SPC and reviewers are currently working hard on the paper submissions and other scientific submissions. Notification on acceptance of papers should be by 28 February, 2010.

2. Forthcoming events

Due to the increasing number of events, we will only here mention those in 2009-10. Notices of events in 2011 and beyond will be added to the IMIA website and IMIA news website when they are announced or when there is significant new information.

a] IMIA Working Group and Special Interest Group activities

The IMIA Health Information Systems Working Group (IMIA HIS WG) will be organising a two day workshop on Health Information Systems – 30 Years of Evolution, that will take place on September 10-12, 2010 in Stellenbosch, South Africa, just before the Medinfo 2010 Conference in Cape Town, South Africa. Further details will be advised in due course.

A number of WG/SIG chairs and vice chairs have changed as of the 2009 GA. This information will be updated on the IMIA website in the next few days, and on http://imianews.wordpress.com/
If WG/SIGs have activities planned, please send in the information so that we can help promote them.

b] Regional events

The 2010 Special Topic Conference (STC) of the European Federation for Medical Informatics (EFMI) will take place in Reykjavík, Iceland on June 2-4, 2010. The event has the theme ‘Seamless care – safe care. The challenges of interoperability and patient safety in health care’. - http://www.sky.is/efmi-stc-2010-.html

c] National/international events

HIMSS10 - March 1-4, 2010. Atlanta, Georgia, USA. http://www.himssconference.org/

BCS HC2010 Health Informatics Congress, April 27-29, 2010. Birmingham, UK. http://www.hcshowcase.org

eHealth2010 - May 6-7, 2010. Vienna, Austria. http://www.ehealth2010.at/index_en.html

e-health 2010 - May 30 - June 2, 2010. Vancouver BC, Canada. http://www.e-healthconference.com/index.htm

HINZ2010 - 2-4 November, 2010. Wellington, New Zealand. http://www.hinz.org.nz

AMIA2010 - 13-17 November, 2010. Washington DC, USA. http://www.amia.org

4. Publications

Applied Clinical Informatics (ACI) is a new official eJournal of the International Medical Informatics Association (IMIA) and the Association of Medical Directors of Information Systems (AMDIS), and will be published by Schattauer. This is Schattauer's first online journal. Full information about this new development, including instructions for authors, can found at the journal website –

http://www.aci-journal.org See also IMIA News website:

http://imianews.wordpress.com/2009/10/13/applied-clinical-informatics-aci-ejournal-launches/

The proceedings of the Post-Congress Workshop of the 10th International Nursing Informatics Congress (NI2009), which was held at Vanajanlinna, Finland on July 1-4, 2009, are titled “Personal Health Information Management – Tools and Strategies for Citizens’ Engagement”. The 215 page book has been edited by Kaija Saranto, Patricia Flatley Brennan and Anne Casey. See IMIA News website:

http://imianews.wordpress.com/2009/12/05/ni2009-post-congress-workshop-proceedings/

6. January 2010 bulletin

The January 2010 bulletin will be published on 04 January. We welcome all feedback (to imia@imia-services.org) and any news items, conferences, etc for the websites.

END OF IMIA News Bulletin, December 2009
- - - - - - - - - - - - - - -
Dr Peter J. Murray
Executive Director
IMIA, International Medical Informatics Association
http://www.imia.org

Medinfo 2010 - Cape Town, South Africa - 12-15 September 2010 - http://www.medinfo2010.org
NI2012 - Montreal, Canada - June 23-27, 2012 - http://www.ni2012.org

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?

Health care and handedness

The word legerdomain featured on Wordsmith's Word.A.Day as listed below:

PRONUNCIATION:
(lej-uhr-duh-MAYN)

MEANING:
noun:
1. Sleight of hand.
2. A display of skill.

ETYMOLOGY:
From French leger de main (light of hand), from leger (light) + de (of) + main (hand). Ultimately the from Indo-European root man- (hand) that's also the source of manage, maintain, maneuver, manufacture, manuscript, and command.

It is a shame and a matter debated at large that specialists - whether medical or of other disciplines - are not held in the high esteem that they once were. And yet when you come across a leader and specialist in their field the way they deploy their knowledge, insight and skills remains something to greatly admire and respect. I mean knowledge and experience that transcends sole reliance on interpersonal skills and blinding people with jargon and 'science'. Such are the outcomes of what the specialist brings to the (operating?) table, that it may even seem like a sleight of hand. Not in the sense that it is a trick, but there is an effortless transparency to not only what they achieve, but how they make people - their patients, clients feel. Not just feel, but how these people react and may find themselves.

If there is a sleight of hand it is in how while a specialist, they can and do cross boundaries. They see and can count the important numbers (evidence) in their discipline, but they know (from some no doubt hard-won lessons) that frequently some of the numbers in the very sequence they need lie outside their comfort zone.

RIGHT-handed (mechanistic)

or

(humanistic) LEFT-handed

- they know there is a

middle

and they cross it, without anyone noticing.

Combining h2cm, Informing Science and informatics on the Rainbow Bridge

As a boy one of my favourite superheroes and subjects of myth was Thor and his retinue - Loki, Odin, The Rainbow Bridge. These remain tantalizing escapes for young minds should a corner shop sell comics.

As I mentioned previously in posting about the informing science journal, a paper currently in preparation makes use of holistic bridges and I have had in mind Thor and his ilk and Rainbow Bridge between worlds. In Hodges' conceptual framework the domains of knowledge that make up the model could almost be disparate worlds. This disciplinary repulsion presents several challenges at a time when disciplinary in-fusion is needed (demanded by our problems):

Integration of health and social care in the form of:

• physical - emotional health;
• applied socio-technical informatics
• personalised and service centred care

Academic cross-disciplinary working, e.g. informatics -

• clinical
• urban
• e-governance

Last summer I posted a suitably colourful mix of holistic bridges that included the image below. These hyphenated cross-disciplines conjoin the four care or knowledge domains of Hodges' model.

My interest in ICT began with the ZX81 in 1981 and ever since I've been intrigued as to how we can integrate the above. Why does this matter? It matters not just because of the complexity of the problems we face in in our work and home lives. The real challenge lies in communication.

To take one problem the application of ICT in health care. Here the technical world, the mechanistic butts up against - clashes with - the humanistic. The paper published in spring focused upon socio-technical structure in nursing informatics.
Structure whether virtual, conceptual framework, mythical rainbow is one thing; but what purposes can arise from structure?

In highlighting communication (critical in health care) our purpose is -

using information technology to help convey
the meaning of information in order to inform.

The two axes (or hammers?) in Hodges' model are:

HUMANISTIC - MECHANISTIC [H-M]
and
INDIVIDUAL - GROUP [i-g]

These axes provide the bridge to link informing science and Hodges' model. In the act of communicating, imparting information we may be concerned with the concept of information from its mathematical formulation, the channel, noise through to the semantics and meaning from a sociocultural perspective. This seems to match with the (horizontal) axis [H-M], while the task of informing is concerned with the agents that is the (vertical) axis [i-g].

So what is the relevance of Thor? Well that role of engaging clients (patients, carers, managers, service users....) in communication sees a group communicate with an individual and vice-versa. The processes involved are not necessarily discrete as might be captured 'on paper'. The axes of Hodges' model labelled 'information' and 'informing' become blurred.

We are constantly reminded of the multi-contextual nature of health care. Now, I don't know if care is suddenly more complex on a Thursday, I just figure that when Thor starts to swing his hammer there is suddenly not one axis, but a great many. We are not just aware of multiple contexts we are forced to consider the multi-dimensional too.

Additional links:

Informing Science Journal

Thor image and interesting discussion:
http://afewshotstoshaman.blogspot.com/search?q=thor

Thor - movie 2011?

Informing Science (with Thor to follow) ...

The problem with the web is you search, find and save stuff and then it virtually disappears on hard drives and folders only to somehow bubble-up back to life hopefully at a time of need. So with the Informing Science Journal.

I know the details are only a click away, but here they are:

The academically peer refereed journal Informing Science endeavors to provide an understanding of the complexities in informing clientele. Fields from information systems, library science, journalism in all its forms to education all contribute to this science. These fields, which developed independently and have been researched in separate disciplines, are evolving to form a new transdiscipline, Informing Science.

Informing Science publishes articles that provide insights into the nature, function and design of systems that inform clients. Authors may use epistemologies from engineering, computer science, education, psychology, business, anthropology, and such. The ideal paper will serve to inform fellow researchers, perhaps from other fields, of contributions to this area.

Ever since reviewing Gary Hall's "Digitize This Book!" the future of academic publishing, the university as an institution and scholarly disciplines has been on my mind. I did have another book on my wish list that predicted I believe the death of the university if things do not change. This is lost somewhere... I am really pleased to rediscover this journal, its contents and look forward to reading more and possibly contributing once existing projects are completed...

In the substance misuse paper draft, in addition to the usual key concepts I am wondering about the use of holistic bridges and so...

More to follow soon on the aims of the Informing Science Journal with reference to Thor, bridges and what informing science means for Hodges' model ....

h2cm: Original purposes and 21st century additions

Listed below are the four reasons that prompted Brian Hodges to create Hodges' model in the early-mid 1980s, these being to support:

1. reflective practice (Moon, 2004; Jasper, 2006) ;
2. holistic care (Brooker and Waugh, 2007);
3. curriculum development;
4. bridging the theory – practice gap. (Doherty, 2009)

Although nursing, health care and society have changed to a revolutionary extent these original purposes are still outstanding some 25 years later as the authors above and many others testify.

Perhaps in the next few years it would be timely for researchers to revisit the original stimuli and consider afresh the role of Hodges' model within nursing theory and practice and beyond. I believe the relevance of the model grows not because of the constant need for the big picture, but the need to represent and consider new dichotomies and challenges. To the original four then we might add:

• To inform the socio-technical application of information and communications technologies in health and social care;
• To conceptually ground (domain relate) and integrate the 4Ps of PROCESS, PURPOSE, PRACTICE, POLICY in theory and practice;
• To provide a universal conceptual framework to conjoin all multidisciplinary teams across the 4Cs of COMMUNICATION, COLLABORATION, CO-ORDINATION, CONTINUITY and COMPLEXITY*;
• To inform research in what may be termed ‘cogeographics’ the fusion of conceptual spaces and visualization in the humanities - social sciences.

The 4Ps and 4Cs provide a further aide memoir for students and practitioners to accurately locate situated care. Finally, nursing and health, social care as a profession is bound to a code of practice, accountability and has an educational – public (mental) health duty to the aims and objectives of the global health community. Cogeographic (or cogneographic) may be a neologism, but seeks to conjoin the cognitive (cognition) involved in defining, representing and using concepts in conceptual spaces; AND the finding that knowledge is invariably situated - that is knowledge has a geography.

References:

Brooker, C., Waugh, A. (2007) Foundations of Nursing Practice: Fundamentals of holistic care, Mosby.
Doherty, C. (2009) A qualitative study of health service reform on nurses’ working lives: Learning from the UK National Health Service (NHS), International Journal of Nursing Studies,46,8,1134-1142.
Jasper, M. (2006) Reflection, Decision-making and Professional Development (Vital Notes for Nurses), Blackwell.
Moon, J.A. (2004) A Handbook of Reflective and Experiential Learning: Theory and Practice, Routledge.

*I can count really ;-)

Chair of Int. Academic Health Science Centre Designation Panel announced [UK]

Dated: Wednesday 15 October 2008 10:20

Department of Health (National)

Health Minister, Ben Bradshaw, today announced the appointment of Sir Alan Langlands as Chair of the international panel that is being established to designate Academic Health Science Centres (AHSCs) in England. The international panel will make a recommendation to the Secretary of State for Health about the partnerships that should be awarded AHSC status. The panel will offer a form of "peer review" and will identify the organisations best placed to compete internationally alongside leading AHSCs elsewhere in the world, such as Harvard, Johns Hopkins and the Karolinska Institute.

The NHS Next Stage Review announced the government's commitment to fostering AHSCs in England. The intention is to identify and work with a small number of health and academic partners, who have come together to focus on world-class research, teaching and patient care. These Centres will take new discoveries and promote their application in the NHS and across the world.

Health Minister Ben Bradshaw said:

"I am pleased to announce that Sir Alan Langlands will chair the international panel that we are establishing to designate Academic Health Science Centres in England. Sir Alan brings a wealth of expertise to this role. His experience in health policy and in education means that he is ideally placed to assess the strength of applicants' proposals for bringing together research, education and patient care functions to improve health outcomes."

Sir Alan Langlands said:

"I am delighted to be appointed chair of the international panel. Academic Health Science Centres in England have the potential to improve healthcare services in the NHS and internationally. Improved collaboration between healthcare organisations and Universities has the potential to enable the rapid adoption of new research into clinical practice."

Additional links:
Manchester Academic Health Science Centre
London Academic Health Science Centre

My source: HSJ then COI:
http://nds.coi.gov.uk/environment/fullDetail.asp?ReleaseID=381342&NewsAreaID=2&NavigatedFromDepartment=True