Notes (ii) from Paipa Conference: Q & A

Q. What is the appeal and relevance of Michel Serres to the Health Care Domains Model [h2cm]?
c/o Fred Manrique / UPTC 

(As per the paper - Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons. 2008)

A. I cannot remember how I came across this French philosopher (Bruno Latour?), but in 2004 I started to read some of his translated texts. Serres' work is not easy to read, but rewards perseverance. Thus enthused I wrote (in my spare time) and eventually submitted a paper to a prestigious nursing journal. This was rejected - twice. Using the feedback I was able to produce the paper that found publication in the informatics field. This is listed in the W2tQ bibliography. Serres' ideas were remarkable in how they spoke to me and reflected in many ways the conceptual framework of h2cm. I need to revisit Serres, but ideas of particular appeal include his use of several tropes:

• Harlequin: the uninvited guest (disease, illness?), mischief (health taken-for-grantedness), chaos (the unpredictable);
• blanc: in my presentation I included a blank slide. There it represents every new person, new page - no judgements, positive regard. A page for lifelong learners and being able to self-reflect.
• Hermes: the Greek God, the messenger - information and Serres' early study of information science. The 'underworld' - nursing and medicine - are not for everyone. The importance of ports as a means of information and cultural exchange - today economies see themselves as information ports and the rise of information portals.
• Serres states (as do other commentators) that the Internet will provide opportunities for new scholars, outside of established academic institutions.
• borders, boundaries - the middle: in life we often have to ask do we continue and cross the middle?
• The Planet: Serres is concerned for how we treat the planet. The health care domains can also be utilised to explore the physical and psychological impacts of climate change and the need to attend to human ecology. We are rocking the boat - Earth is our boat.
• ... plus many others - fluid, dynamics, life - rivers - choices, narratives, Home, Angels, statues.

Finally, within "... S E R R E S ..." you will also find H2CM!  

Please see the bibliography for the paper and contact me for a copy if you wish.

Additional links:
Serres on this blog.
http://michelserres.blogspot.com/

More Q and A to follow plus photos and slides. Photo source (PJ, Copenhagen shop window, 2010)

Notes (i) from Paipa Conference: Q & A and sessions

Questions from the delegates (once more interpreted by Andrea Ramirez) at the plenary session on Friday 25th February included  - with my response (extended here):

Q. Could you please give some specific examples of the model's application and its achievements?

A. The model was created by Brian Hodges to facilitate reflective practice and encourage holistic care - especially balancing physical and mental health - psychological - care. In the mid-1980s the model was used in several locations in England and the Isle of Man. The model was taught and learning assessed through case studies in community mental health nursing, learning disability and health visiting.

As highlighted in the presentation unlike other models of care h2cm has not had the benefit of specific research. The models of care we use must be evidenced based. The website and blog represent a call for research in the health care domains model. This is why I appreciate so much this invitation to Colombia and being able to present what I believe is a very useful and increasingly relevant care resource.

In terms of achievement there are an as yet limited number of papers published and listed on the blog in a bibliography.

A couple of individuals have contacted me for advice on using the model in academic work, which has also been posted on the blog (see application).

In my presentation and the plenary I did not mention the planned workshop in the afternoon!

Q. What has been the experience of applying the model in the practice (clinical area) and in the community?

A. The model is used in two centers for forensic psychiatry (low and medium secure) where the inclusion of the interpersonal and political care domains are pivotal in the tensions between the custodial context and need for person-centred nursing care that arise.

In forensic nursing the model informs care philosophy and is also represented in care documentation. A paper is in production describing the model and this application.

The model is I understand being used in a research project investigating bullying within midwifery. I will post more details on this when I have them. The researchers approached me seeking permission to use the model, I indicated the model's origin - as in "It is not 'mine'", and furnished a letter indicating the model's status. I understand the appeal of the model in this instance may be in scoping the research project.

Currently the model is helping me in my role (as a Nursing Home Liaison Specialist) to plan and deliver education sessions to residential care staff on communicating with people who are coping with dementia.

Being simple in structure and basic content once learned the model is accessible as an aide memoire, while you are assessing, planning and evaluating.

I have also used the model when working on informatics projects, as the model can help integrate the SOCIAL and TECHNICAL aspects of ICT.

More Q and A to follow plus photos.

Presentation(s) at 1st Int. Congress of Nursing Models and Theories in Colombia

I will revise this post over the coming week and add more, including one of the Spanish slides.

Many thanks to Danny Eduardo Rodriguez for meeting me at the airport (and to everyone who waited  with Eduardo). Hearing my name and seeing the university transport proved instantly reassuring. Thanks also Eduardo for the in-session translation - a great help and for your efforts to ensure I felt at home and a part of things: I certainly did. ... 

Well I am due to leave Paipa soon for Bogota El Dorado airport and the trip home via Paris. It is a beautiful day in Paipa. Very warm, bright sun, from my room I can see people water skiing on the lake.


Yesterday's presentation, workshop and Q and A session were very well received through a lecture and workshop. These would not have been as successful with the brilliant work* of Interpreter Andrea Ramirez on both occasions.
I had started to add some Spanish translations to my slides and these were checked and extended by Luz Stella Saray and Prof. Wilson Canon Montanez, (UDeS) to whom I extend sincere thanks (a good photographer too!).


In the morning session Andrea related each slide in Spanish after my account. For the workshop I had emailed the case study in English with a Spanish version c/o Google translate. This had been checked and improved and the format we followed was for students to read the case study and then individually draw out the aspects of Alice's case (fictitious yet based on 20+ years of experience) which they feel significant across the care domains. During this exercise for 20-25 minutes Andrea assisted again with some questions from individual students. Then in groups of 4-5 they collectively reflected on their 'results'. Finally each group in turn offered one item for each of the four domains. Astute questions from the floor and discussions followed. Not having done this before, with the addition of translation I was surprised at how well it worked: instant teamwork!

At 5.30 Luz had arranged to meet to discuss nursing in England. A little jet-lagged, I thought she meant with 2-3 colleagues, but in the end the room was filled as we were joined by 60-70 students in a circle. I can't believe that 90 minutes passed. The students and faculty are so very enthusiastic, charming, friendly and knowledgeable. Two days is not long to learn and make judgements, but from the student's questions they seem acutely aware of the specific health challenges and issues they face in Colombia. Their professor's approach in pursuing this meeting reflected an awareness of 'nursing as it is learned and practiced elsewhere'. I advised I was not able to speak generally, outlining my specific role and location. I let them know I was drawing from matters I do know (as highlighted on W2tQ) and personal experience. The notion of 'basic nursing care' is clearly and unsurprisingly universal given this encounter.

You do need to consider such travel very carefully: your health, security, travelling alone... The organisers took care of this assuring a personal meeting at the airport, transport and accommodation. The journey was hard for me from the UK. A short hop Manchester to Paris 1.15-30 was followed by an 11 hr and 10 hr flight back home passing through Bogota. Travel is difficult due to the condition of the roads, driving laws and the traffic situation that the populous of Bogota faces; but where there are 'gaps' (pot holes!) there is a way through.

I never would have believed I would set foot in South America. To stand under Orion and see Canopus was another dream come true. As Space Shuttle Discovery set off on her last flight I was making discoveries of my own in helping others do the same.

I am very grateful to GICS - the three Universities UPTC, UdeS and Unillanos who invited me and supported my attendance; plus my employer Lancashire Care NHS Foundation Trust and colleagues covering duty for new referrals at the Beechurst Unit, Chorley, Lancashire. This has been a marvellous experience, with many contacts made that I hope will grow in the future.

*Presenting in Spanish at the conference (Teoría “Marco de la Organización Sistémica” con enfoque en Familia), Dr Marie Luise Friedemann - RN, PHD and her husband informed me of Andrea's effectiveness and memory feat. Dr Friedemann, Profesora de la Universidad Internacional de la Florida, in Miami and I also hope to compare our respective interests.

Presentation London May 2011: The Future Role of Support Workers & Assistant Practitioners in Mental Health and Social Care

2011 looks like it will be busy:

In May I have been invited to present the Health Care Domains Model at a conference organised by M&K Update.

The Future Role of

Support Workers & Assistant Practitioners in

Mental Health and Social Care

My presentation will include:

Why does ‘having’ a framework matter?

• Explaining the health care domains model, its structure, knowledge domains and applications.
• How the model can support HCSWs to address personalised, integrated and holistic care. 
• The model in theory, practice and management – an illustration.

 There will be 10 minutes for Q&A too.

This is a great prospect as with Colombia this coming week.

1st Int. Congress of Nursing Models and Theories: Colombia 24th-25th Feb. 2011

I am delighted to report the news that the

Health Care Domains Model

will feature at this International conference.

In November I received an invitation to be one of the main speakers from the Grupo Gics Investigacion Team; and so next month I will be heading south to Paipa, Boyacá, Colombia.

This prospect would not be possible without the support of the conference organisers - GICS and Prof. Wilson Canon Montanez, Nursing Faculty of the University of Santander UDES (Bucaramanga-Colombia) and my employer Lancashire Care NHS Foundation Trust.

Recently a group of Nursing Faculties of three major Universities in Colombia (Universidad de Santander UDES, Universidad Pedagogica y Tecnologica de Colombia UPTC y Universidad de los Llanos UNILLANOS) have come together to organize the First International Congress of Nursing Models and Theories.

This congress will be held in the city of Paipa-Colombia 24 and 25 of February, 2011:
http://www.uptc.edu.co/eventos/cong_enfermeria/index.html

I very much look forward to this trip for several reasons:

• New people to meet and things to learn.
• This invitation literally puts h2cm on the map (so I must deliver)!
• It is marvellous to see faculty and nurses in Colombia re-invigorating thought about models of nursing.
• I have never travelled this far south - how will Orion look?

This will be a great adventure, but before then - where's my checklist: presentation(s), jab, tabs, passport...

Buller and Butterworth: Skilled nursing practice - four domains?

The health care domains model identifies four domains within health and social care and medicine. What evidence is there to support the model's inclusion of:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

- plus the spiritual within and without? Steve Buller and Tony Butterworth undertook a ethnographic study in 2001 'Skilled nursing practice - a qualitative study of the elements of nursing'. With skilled nursing practice at the center (Fig. 5.) they identified:

relating and communicating	doing the job
being professional	managing and facilitating

There is some overlap, reflection arises in relating and communicating and doing the job. Overall however there is a definite correspondence between these domains and those within h2cm - the health care domains conceptual framework. I have equated being professional with the SOCIOLOGY domain as for the authors this includes being with patients, conveying confidence, handling situations, being informed. Managing and facilitating is undoubtedly POLITICAL with supervising, auditing, making sure things get done. Doing the job - is based upon planning, informing, assessing, intervening, and being confident (with equipment, procedures, manual dexterity..?).

Having been thinking and writing about h2cm for many years it is a shame that other models have benefitted from funding and gain "ward and community (research) cred" while here evidence is retrofitted. Looking at the paper just in the decade since submission and publication I wonder which elements remain local, and where other elements of the skills base (care concepts) have migrated to ethnographically?

Steve Buller, Tony Butterworth (2001) Skilled nursing practice — a qualitative study of the elements of nursing. Int. J. of Nursing Studies. 38, 4, 405-417.

Fran Biley's video: Students on nursing theory

I came across this great video created by Francis Biley Bournemouth University through the Martha Rogers list:

Quite some time ago I wondered about having dummy - animated heads to carry out a dialogue. It is great to see how e-media forms and tools have developed now.

I have my own thoughts and ideas on nursing, perhaps over time I am drafting them in the bibliography and here on W2tQ?

Additional links:

Nursing theory resources SCIENCES links

Virtual Reality in Nursing: A dialogue from 1991

Nursing Telemachus and Computers: A dialogue from 1995

New to nursing? after Jules (just scratchin the skin)

If you are new to nursing (social care, learning disability, forensic nursing... ) we have some amazing guests on this weeks show, appearing especially for you, because of you: because you care - on four stages ....
[with apologies: Jules Holland, BBC 2]

Interpersonal : Sciences

Sociology : Political

Self Awareness orientation communication rapport, empathy anxiety values, beliefs mood, risk knowledge & skills aptitude and attitude	anatomy and physiology (The) Make the Beds  TPR [BP] hygiene birth...........................................death drugs journals, books nutrition assess, plan, actions, evaluate tech & equipment
community family relationships culture traditional medicine social networks public involvement	HUMAN RIGHTS Consent, Choice, Capacity health economics Law DoH, NLM, WHO health social care services professionalism policy

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

FROM: A community mental health context TO: Acute EMR/EHR and other ...

or: Will 21st Century health and social care informatics truly begin on Sunday 10 10 10 ?

I've been a nurse AND info tech / informatics enthusiast since 1981. As an advocate of info-tech as a means to improve the quality, effectiveness and safety of health care - I must confess; I feel I have let down those colleagues purely there to 'nurse'. (Don't worry, I am also a realist and post-therapy!).

After 20+ plus years the nearest we (the team and I) got to a system that answered our questions was a small PICK database and a later MS Access database. These focused on referrals and data capture - demographics, problems, interventions (WHO and what) and outcomes. Although the number of data items was not great, no more than 30 the insights we could glean from queries was surprising. People versed with databases, datasets and research readily appreciate how even small datasets, carefully thought out and planned, can answer a diverse range of questions (and generate countless new ones too!).

I noticed in the mid-1980s to mid-1990s the development of customer management software and recognised that clinicians have a need: caseload management.

Even now the requirement of 'X' visits per day, the number of information systems and lack of integration (health - social care) mean that in many instances there is still no readily accessible caseload manager for the individual practitioner. This is an outcome and amid all the talk around 'engagement' (with a 'E').

Perversely, ironically, paradoxically (take your pick) at a time when Lean is (presented and) needed, there are scarce resources to do the things that should now be embedded (routinised) into the life history of the professional. This includes what the professionals do WITH the patients, carers, data, information ...

I speak to student nurses (and other disciplines) regularly as a nurse mentor and sign-off mentor. Their exposure to health care informatics to me is minimal, adhoc, and when it has happened it has signally failed to strike a cord. A very small (and so non-significant*?) sample admittedly.

Informatics remains an academic 'must do'.

Perhaps 21st century informatics only begins on Sunday -

101010

Whatever:
as it stands informatics is a management pursuit.

Slippage is a fact of project management, but words present their own challenge when target driven 'secondary' uses become 'primary'.

*surely not.

[A version of this post first appeared on the Healthcare Information and Management Systems Society HIMSS group on LinkedIn.]

Caution! spanning the Theory - Practice Gap

As a new academic year begins and we endeavour to bridge the theory - practice gap we need to be cautious:


While we may not burn our bridges we need to be aware of which bridge spans are redundant and which are still active and serving their purpose.

As ever - standards, inspection, audit and governance are critical.

So in our efforts to bridge the theory - practice gap do we also maintain it?

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

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

Drupal musings 6: Content types - Reflection!

Does anyone have any experience in using established models of reflection in:

• education (nursing, public health, information technology)
  
• practice
• therapy
• supervision
  
• carer support
• eHealth
  
• ... ?

If so please get in touch [h2cmng at yahoo.co.uk].

In its initial downloaded state Drupal has two content types:

1. story
2. and page.

The option then is to use these which would be rather limiting. Add to these two by enabling other core modules. Drupal administrators can extend the core functionality by adding other modules which provide new content types.

You can also roll your own. A key content type for the new site is one that uses the health career model to facilitate - reflection - one of the original purposes for the model.

This also provides an opportunity to adopt a model of reflection that is itself supported by research. This may be Gibbs:

• Stage 1: Description of the event
• Stage 2: Feelings and Thoughts (Self awareness)
• Stage 3: Evaluation
• Stage 4: Analysis
• Stage 5: Conclusion (Synthesis)
• Stage 6: Action Plan

John's Model of Structured Reflection

• Aesthetics – the art of what we do, our own experiences
• Personal – self awareness
• Ethics – moral knowledge
• Empirics – scientific
• with its Cue Questions

Smyth’s Framework for Reflection on Action

• Activity
• Inform (Analysis)
• Confront (Self awareness)
• Reconstruct (Evaluation and Synthesis)

There are many others. ...

Once the hedgehog-headlights glare has passed, this is going to be a really interesting project. There must be a way to link one (or more) of the above with each of h2cm's care (knowledge) domains. There must be a way to create a first version that can be extended and support other content types. The possibilities are really exciting - hence the glare (reflected of course!).

Some reflection sources:

http://www.practicebasedlearning.org/resources/materials/docs/reflectiononpractice.pdf

http://www.communityhealthcarebolton.co.uk/SHA/LLL/resources/reflective/Framework%20for%20Reflection.doc

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.

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 ...

Update - King's College London mental health SIG 17 May

With the title of my talk sorted here is the programme for the Mental Health SIG meeting:

Health Sciences and Practice Subject Centre
Room: 1.17 Franklin Wilkins Building (1st floor)
Franklin-Wilkins buildings, King's College London,
150 Stamford Street, London SE1 9NH

Monday 17th May
10- 4pm
King’s College London, Waterloo

Programme

10:00 Arrivals and Refreshments

10.30 Welcome and introductions
Bill Penson
Teacher Fellow/Senior lecturer in Mental Health,
Faculty of Health, Leeds Metropolitan University

11.00 ‘The Darzi Dementia care pathway- competencies’
Professor Paul Kingston
Faculty Director for Research and Scholarship
Staffordshire University

12.00 Lunch and Networking

13.00 ‘Hodges' model: a conceptual framework’
Peter Jones
Community Mental Health Nurse NHS,
Independent Scholar & Informatics Specialist

1400 Refreshments

14.30 ‘e-PsychNurse’ an EU funded project
Professor Mary Chambers
Director of Nursing
South West London and St George’s Mental Health NHS Trust

15.30 Future meetings and summing up
Bill Penson

16.00 Close

I can expand on my plans - broadly three 20 minute sections:

• Re-introduce the model, history, background;
• Explain h2cm's relevance, scope and applications - possibly with a brief exercise;
  
• Discuss publications to date, future publication plans to include the website and use of Drupal, with time for questions.
  

Presentation: King's College London 17 May Mental Health SIG

Can you join us at the Higher Education Academy Health Sciences & Practice Subject Centre - Mental Health SIG in London
17th May 1000 - 1600?

I am really looking forward to presenting at the Mental Health Special Interest Group next month. It looks a great prospect as I have an hour on the programme. The draft title does not really represent what I intend, paradoxically I will re-introduce Hodges' model and explain why the model is so relevant in theory and practice.

I will outline my presentation here in a future post and the programme overall. For my sins I am now also a sign-off nursing mentor, so being able to network is another great plus. More to follow ....

Here are some details about the SIG from their website:

Welcome

To date, there has been no UK wide, cross disciplinary special interest group providing a regular opportunity for educators to meet face to face - with a view to exploring common issues and challenges, sharing resources and influencing policy and practice in the field of mental health. Arguably, this has hampered educators’ capacity to shape and respond to new developments.

In February 2005 the ‘Common Ground’ event organised by the Mental Health in Higher Education project in partnership with the Health Sciences and Practice subject centre met to identify key issues facing mental health educators in nursing and the Allied Health Professions. Subsequently, the special interest group has broadened out to encompass all colleagues with an interest in sharing approaches and engaging in debate about educational practice and the implications of policy developments for learning and teaching about mental health.

Who is the Mental Health SIG for?

Anyone involved in higher education with an interest in mental health.

We are keen to bring together people from across all disciplines and perspectives (including lecturers, practice educators and user educators and carers with involvement in education) – those who are mental health specialists and those for whom mental health may be one aspect of a broader subject area.

Health Sciences and Practice Subject Centre
Room: 1.17 Franklin Wilkins Building (1st floor)
Franklin-Wilkins buildings,
King's College London,
150 Stamford Street,
London SE1 9NH

Reading the signs - Idealised Care

With the axes of the health career model labelled and the care domains - that fall between - identified, what can we read into and from the health career - care domains - model?

What basics of care and caring can we find there, what assumptions can we jump upon?

Here is a list ... (which also illustrates how the model grows with the learner) :)

• Health, well-being and social care are not declared in the face of the model, this suggests the model is high-level - generic.
  
• Health care (here) has at least seven disciplinary degrees of freedom:


• Sciences (biology, physics, chemistry)
  
• Politics
• Psychology
• Sociology
• Spirituality

• Health and social care theory and practices are reductive.
• Health care involves the traversal of space - distance.
  
• Health and social care has the potential to be depersonalising and alienating.
• Health and social care is simple and complex.
• The environment is inherent within the model in its varied forms.
• There is a moment of imbalance within the INDIVIDUAL - GROUP.
  
• Context is essential as a means to situate care (co-ordinate in an 'x','y' sense).
• The means is provided to situate the care context in a person-centred way.
• This model provides a template for personal and group reflection (shallow or deep).
  
• The model is open in terms of the final content, the content as expressed in care approach, philosophy, discipline, description (concepts, problems, priorities, strengths, a 'mash-up') is not dictated.
  
• In acknowledging the existence and primacy of the individual (located at the top so - must be important), the model provides a (potential) focus and vehicle for individualised, personalised, person-centred care.
• Whilst individualised care is at the center of care theory, practice and management, it cannot be defined purely by virtue of the INDIVIDUAL-group axis and the claim of an associated INTRA-INTERPERSONAL care domain.
• The individual must also be considered as a POLITICAL entity, a citizen, a legal entity that falls under the auspices of human rights. As such the individual is someone who can (or has previously) expressed their choices, wishes as to their health, care, well-being, best interests.
• Being an INDIVIDUAL within the family of humankind - 1 of some 6.x or > 7 billion - this person is unique and deserving of highest quality care, dignity and respect that should be accorded to all people.
• Health and social care whilst organisationally distinct (POLITICAL - POLICY) are to the INDIVIDUAL and carers (GROUP) concurrent, transparent and ideally integrated activities.
• Physical care (SCIENCES) can be, and is, defined in mechanistic terms; for example, time (objective), events, place, outcomes, observations / data (discrete, quantitative).
  
• Physical care is hence primarily objective.
• Emotional INTERPERSONAL care can be, and is defined in humanistic terms; for example, time (subjective), communication, responses to events (behaviour), feelings, beliefs, relationships (SOCIAL), expectations, fears, observations / data (subjective, qualitative).
• Physical care, emotional care is often mediated through the SOCIAL domain and the group - the family unit.
• Since this model indicates an initial structure and content the model is of potential use as a reflective resource for novice through to expert.
• The model is generic and as such not limited to health and social care.
• Such is the generic nature of the model it can support all learners in lifelong learning.
  
• The Spiritual is not there: it is ineffable. It is everywhere, everything, every'I' and everynow.
• Time is inherent in several forms within health and social care.
  
• The economics of health care is infused to all the domains, notably in the first instance to the SCIENCES and SOCIAL domains.
• The economic effects upon the individual in a humanistic sense, may be remote, but is inverse in terms of its impact.
• The model reinforces dualism: mind - body (but cognitively innoculates also).
  
• In highlighting boundaries, dichotomy, limits the model can stress the need for integration.
• The model suggests an antipodean fracture in relationships*: the patient and clinician (across physical care and mental health) inhabit the Northern hemisphere; while the carer (public), manager and policy maker the Southern.
• Health and social care is grounded in human communication (and that which is mediated).
• 'Sense making' must be a key issue in health and social care.
• Given the scope of the model, technology must be making a major impact across all fields of health and social care.
• The model can simultaneously represent the SOCIO- and the -TECHNICAL.
• A great many (potentially - all) values and standards are inherent in the model.
• This model can be represented using many media.
• This model is open to the Management Consultant's delicacy alphabet soup, i.e. using letters to represent approaches / methods, e.g. 4P's, 4C's.
• Health and social care can also be described holistically.
  

*Clearly, given the relationships and issues that arise this bears further examination and discussion.

This list is subject to revision - addition.

Image source:
http://en.wikipedia.org/wiki/File:Antipodes_LAEA.png