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.

Reflections on publicising The 1st Int. Congress of Nursing Models and Theories in Colombia

Inevitably I have posted news of this conference and presentation to several mail lists. I received a reply pointing out that this news was short notice and getting to Colombia in the time remaining would be quite a feat. I replied saying that I had only just sorted medications and my yellow fever jab was only just 'active'.

I realise you can read all sorts into such short notice, but apart from being truly flattered and cock-a-hoop about this invitation my post was intended to raise a question...

In October 2009 I posted a fictional quote apparently cited from a conference in 2015 by:

Ms. Florence Seacole Mashaba*. 3rd Year Student Nurse
Keynote address 2nd February 1000hrs
Global Conceptual Frameworks for Health & Education:
1st International Conference on Visualization in Care Models, Assessment and Evaluation.
St Francis Bay, South Africa. Monday 2nd - Thursday 5th, February, 2015.

Future Conceptual Frameworks for Global Health: a quote

Nursing models and theories are still a feature on nurse curricula. As a mentor I check when student nurses are on placement with us - the community mental health team. What models have they come across? What are their thoughts about them? Many models of nursing still have an active following and conferences. The oomph factor is definitely lacking though. As a feature models and theories are but a frame or two in a busy learning schedule. Where does informatics figure? Does geography begin and end in school or maybe the hospital site map? ...

Then here, suddenly in Colombia is the 1st International Congress. I do hope this is the first of several and an awakening. An awakening not of a fashion item (perish the thought), but an emergent attentiveness to theory that is mature and ongoing. A thread that is worthy of the communities and populations we serve, the students we must inspire to one day be leaders themselves, the disciplines with whom we form 'the team', the people - patients and carers - we must also educate and empower.

We need models (yes plural) of care that extend beyond nursing across the four care domains and several divides. That is where the pearls of enlightenment lie.

<->

I opted for St Francis Bay as the 2015 venue recalling the film The Endless Summer. This will be the closest I have ever been to the equator.

* Personal communication from a future fictitious individual. ;-)

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...

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

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?

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 art and science of Serresian spin

To Michel Serres:
- the middle is a point of reflection, a point at which questions - the question - must be asked. In fulfilling the purposes of the health career model:

• bridging the theory - practice gap;
• facilitating holistic practice;
• supporting (personal and group) reflection;
• enabling curriculum development;

- the model's four domains are constantly (re-)visited in turn. Motion is constant. Conception - birth provides that initial impetus. Health status. Life - momentum. Centered on the person the movement is usually self-correcting, seeking balance. Health care. Questions and answers whether whole or in part follow, leaving a trail of care delivered and care planned. A record.

There is definite synergy between our use of the health career model, the dynamic quality and quantity of health and social care and Serres' description of the spinning top:

"The behaviour of the cone or the top is worth analysing. Throw this toy and describe, as Plato did, what happens. It is in movement, this is certain, yet it is stable. It even rests on its point or its pole, the more so as its movement is rapid. All children know this. But its rest is still more paradoxical. The top may move about, by translation, without ever losing its stability. To repeat, it can do so as long as it turns very quickly.


Even better, its axis may lean, take on an inclination, without putting the movement of the whole in too much danger. It may again rock, by nutation, oscillating around a mean location. This very ancient and quite childish machine is marvellously instructive.

First of all, it combines and the movements known and thinkable at the time: rotation, translation, fall, leaning and swaying. An integral model, additive, overcharged, yet simple. Second, and above all, it conjoins in a simple one-off experiment phenomena judged or presumed to be contradictory. It is in movement and rest, it turns and yet does not move, it rocks and is stable. The simplicity of a complexity, first and foremost, an additive machine; a synthesis of contradictions, beyond anything else. Now it may serve as a little model of the world, for a naive simple and local orrery. It quivers, at rest, it moves forward, turning, like the heavens, like the stars." p.28-29.

Michel Serres, (2000) The Birth of Physics, Return of the Model, Turba, turbo. Clinamen Press.


Image source: http://industry.bnet.com/technology/10002785/spinvox-or-someone-like-it-keeps-spinning/

earth, wind, fire, water AND the birth of physics

To begin - the health career model is concerned with space, structures and knowledge (care domains) built around two axes, plus the 'subjects' and 'activities' of health.

How we define and (so) divide space and accord that space salience amid changing contexts is critical to theory, practice and management and the models we subsequently derive:

... The dichotomy does not cut, it defines, it surrounds the closure of a limit, it delineates a boundary. Within the space thus enclosed like meets like. Or rather, conversely, the specific convergance [convenance] or identity, the assembly of the analogous, delimits zones in the disorder which are distinguished from each other. The earth is separated from the waters, air divides from fire. ... p.28.

Michel Serres, (2000) The Birth of Physics, Return of the Model, Turba, turbo. Clinamen Press.

water	earth
air	fire

Philosophy of information empowers philosophy of care

The moral and ethical dimensions of nursing quickly become apparent to individual practitioners and professional associations. Philosophy in nursing boasts specific courses, journals and groups, for example:

International Philosophy of Nursing Society (IPONS)

Nursing Philosophy (journal)

International Centre for Nursing Ethics

Here on W2tQ, in papers and on the website I have stressed the importance of the health career model as a framework that can utilise information as a fundamental and potentially unifying concept.

Expanding on the post last week about the philosophers' magazine [tpm50] let's look at Floridi's piece on the philosophy of information (PI). The 50 ideas featured are each only granted two pages, but this has a definite philosophical equivalent twitter-styled appeal. On page 42 (- 43) Floridi notes that:

... PI possesses one of the most powerful conceptual vocabularies ever devised in philosophy. This is because one can rely on informational concepts whenever a complete understanding of some series of events is unavailable or unnecessary for providing an explanation. Virtually any issue can be rephrased informationally. Such semantic power is a great advantage of PI, understood as a methodology. ...

It shows that we a dealing with an influential paradigm. But it may also be a disadvantage, because a metaphorically pan informational approach can lead to a dangerous equivocation, namely, thinking that since any x can be described in (more or less metaphorically) informational terms, then the nature of any x is genuinely informational. (Luciano Floridi, 2010).

Admittedly Floridi's context is the position and status of PI as an emerging discipline within philosophy. As he notes the vocabulary while powerful lies in the discipline of philosophy.

Given my preoccupation with information, Floridi's observation above is a timely warning for me and the many nurses who in the past saw a concomitant risk that in adopting the nursing process, patients (and carers) would be processed. Ironically, this processing concerned information. The workflow - form and layout of the documentation - was prescribed. This is an old tale, with the nursing process being subsumed within the routine work of nursing. Perhaps though this also demonstrates a need for a new debate?

My interest in information is as a trope to explain the significance of the care (knowledge) domains that underpin Hodges' model. Crucially, though these can stand on their own as nursing philosophy issues. Joining the efforts of the nursing philosophers above, this can bring information and philosophy out of the academic realm to include a more practical and grounded variety of topics:

FROM: personal identity,
definitions and ownership of computer based records,
utility versus security of information (summary care record ...),
definitions of information (data, knowledge) - through
TO: patient information and patient informatics, ...
where is collective informatics^# heading?

Taking Floridi's lead - which of the above .... are core nursing (health) information concepts (and not just freeloading info-masqueraders along for the ride)? Well, that is a question for a new community of scholars to decide?

Philosophy resources: Interpersonal care domain

^#Collective informatics = all the claimed informatics disciplines combined?

Musings in the nursing domain (specific language)

It is one giant leap from the humanistic world of nursing, health and social care to the m(a-e)chismo of information technology. It is no Earth-bound chasm that greets us in considering the vaguest possibility that nursing could ever be captured, distilled and represented in a domain specific language (DSL). Given the full title of Hodges' model my attraction to DSLs should be obvious, but how realistic is this fascination?

Here are some links to definitions / resources on DSLs:

• Michael Fowler
• DSL Bibliography
• WikiPedia

I am not advocating DSLs as a real time clinical software application, there is neither time here, nor on the wards. Since the sky above is clear blue with not a contrail in sight I am indulging in a little blue sky thinking, a reverie...

Nursing already has its concept analysis, but taken at face value this says nothing about domains as per h2cm (other than the context / application is nursing). To avoid confusion with career in the job-work sense, I have emphasized the notion of domains. By this I mean a partition of specific knowledge about a discipline or subject. This disciplinary focus or subject is often the province of expert practitioners. My forte then in Hodges' model are the INTERPERSONAL and SOCIAL care domains. This is my rationale for the musings here, as all experts were learners once upon a time, and are still as lifelong learners. It is an educational application that I have in mind.

I have come across a paper by Reinhartz-Berger, who describes the movement - Towards automatization of domain modeling. The author refers to domains artifacts and domain analysis:
(I have removed the reference numbers and inserted from prev para*)

A domain in this context [Domain engineering, also known as software product line engineering]* can be defined as a set of applications that use common concepts to describe requirements, problems, capabilities, and solutions. Domain artifacts are built and reused through domain analysis, which identifies the domains and captures their ontology to assist and guide system developers with particular applications in those domains. Despite the rapid growth of technologies and technical solutions, domain analysis models usually remain valid longer than domain designs and implementations, potentially justifying the cost and effort required for their development. Domain analysis artifacts may also serve as the basis for defining Domain-Specific Languages (DSL). Reinhartz-Berger (2010), p.491.

As the previous post - Reading the signs... Idealised Care - amongst several revealed, the domains within the health career model are broad to say the least. So broad that from the INDIVIDUAL-GROUP axis the left-hand margin of the INTRAPERSONAL-SOCIOLOGY^# care domains are but distant horizons (with no curvature in-sight). It's no surprise that I keep wondering about how to get a grasp on that 'space', for reasons of a website, a potential community of explorers, educational objectives and sheer enthusiasm for trying to mix IT up. Reinhartz-Berger continues:

Several domain analysis methods have been proposed over the years. However, they all can be criticized as making the domain engineer alone responsible for developing correct, complete, and consistent domain analysis artifacts. Since domains may cover broad areas and are usually understood only during the development process, creating domain models can be a very demanding task. It requires expertise in the domain, reaching a very high level of abstraction, and providing flexible, yet formal, artifacts. Reinhartz-Berger (2010), p.491.

Also in the literature Chavarriaga and Macías (2009) highlight two approaches that are the focus more generally to help get a grip and the big wide world of knowledge: The Semantic Web and Web 2.0.:

... However, in spite of its semantic power, one of the main underlying problems with this [semantic] paradigm is the explicit representation and visualization of information, mainly focused on ontologies and the complex relationships that these code. This has made the Semantic Web inaccessible and unmanageable by most designers that are not expert on ontological representations and languages, but on domain specific applications and creative design.
On the contrary, the Web 2.0 paradigm provides a rather pragmatic vision. It is based on the use of wikis, folksonomies and protocols like SOAP, mainly intended to the automatic management of services and the collaborative maintenance of (mainly) syntactic knowledge-based information. Moreover, Web 2.0 can be considered an end-user paradigm. ... Chavarriaga and Macías (2009), p.1329.

The Semantic Web, Web 2.0 will (at some point) figure in the new site. A folksonomy can be quite broad by definition, as there is no strict control on the definition of terms. As to DSLs in Hodges' model, there we have four VERY broad domains. Exactly how domain analysis proceeds and what domain artifacts might emerge from this model would no doubt depend on reducing each of the domains, sub-dividing, being more specific.

If nothing else at present the health career model is a hybrid cognitive domain specific language.

References: (my source: Science Direct)

Iris Reinhartz-Berger (2010) Towards automatization of domain modeling, Data & Knowledge Engineering, Volume 69, Issue 5, May 2010, Pages 491-515. doi:10.1016/j.datak.2010.01.002

Enrique Chavarriaga, José A. Macías (2009) A model-driven approach to building modern Semantic Web-Based User Interfaces, Advances in Engineering Software, Volume 40, Issue 12, December 2009, Pages 1329-1334. doi:10.1016/j.advengsoft.2009.01.016

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

Have workspace, workbench - let chaos ensue

Whether trying to write computer programs, engage in woodwork, artwork or needlecraft the workspace that you need is critical to what follows.

Having a dedicated workspace is the sign of a professional.

If these activities are purely a hobby you may need to create the space on the fly. Getting the easel and paints out, protecting the carpet and then after all those creative juices are spent you have to organise the clean-up.

The Health Career Model can provide a workspace: a dedicated one. So if like many researchers your focus is (global) health, nursing, social care and social policy ... Hodges' model can provide an assurity space. Whatever your approach here is a great way to explore the scope and boundaries of your plans, objectives and final outcomes.

I noticed a letter by Fawcett et al. (2008):

We congratulate Chaffee and McNeill on the publication of their article, “A Model of Nursing as a Complex Adaptive System” (Nursing Outlook 2007; 55:232-241). The development of a new conceptual model of nursing always is a cause for celebration of the advancement of our knowledge. We are, however, concerned that Chaffee and McNeill did not place their conceptual model within the context of or show an evolution from relevant existing nursing conceptual models. We refer readers to Holden’s¹ concept analysis of complex adaptive systems. She explained the relevance to nursing of the concept, complex adaptive systems, by tracing the “rich tradition” of systems thinking in nursing and pointed out that nurse theorists, including Dorothy Johnson, Imogene King, Martha Rogers, and Callista Roy, have developed conceptual models of nursing that reflect systems thinking. Holden concluded, “This rich tradition in nursing that has emphasized connections and interactions within a systems paradigm continues today. Complexity science merely represents the next stage in understanding how systems operate.”¹

Jacqueline Fawcett, RN, PhD, FAAN
Professor, College of Nursing and Health Sciences, University of Massachusetts, Boston.
Jacqueline Fawcett, Elizabeth Ann Manhart Barrett, Barbara W. Wright, Letter to Editor, Nursing Outlook, Volume 56, Issue 2, March-April 2008, 49.

REFERENCE
1. Holden LM. Complex adaptive systems: Concept analysis. J Adv Nurs 2005;52: 651-7. Nurs Outlook 2008;56:49. doi:10.1016/j.outlook.2008.01.003

Whilst explanations of systems have an essential place in understanding nursing, for me the concept of primary interest within (and without) systems is information. This is not just symptomatic of the paradigm of our times, but a fundamental facet of not only engaging leading edge (quantum) sciences, but relating nursing, complexity, systems, art and science to patients, carers, citizenry and global (eco-) health.

If this appears a recipe,
which when executed on the workbench will result in indigestion,
- have faith -
the problems of our times demands a framework with a massive conceptual maw.

So, in turn I would request that future nurse and complex systems researchers look further afield and factor in the need for and use of a high-level global (ethnoculturally agnostic), universal (multidisciplinary, objective, subjective) workspace:

One with sufficient bandwidth.

Having a dedicated workspace that can be shared across disciplines
- that is multidisciplinary -
denotes a mature profession
and a 21st century professional.

Image source: With thanks to Chunx.com 'Chaos Field'

Additional links:

Nursing Theory Link Page

W2tQ: chaos

W2tQ: complexity

'assurity space'

Information: See bibliography.

Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, 24(3), 591-598.
Jones, P. (1996) An overarching theory of health communication? Health Informatics Journal, 2,1,28-34.

'situated' in Hodges' model #2

So, Hodges' model is person-centred and situated
- a conceptual springboard for all.

In the 1970-80s the nursing process challenged task-based care.

Ever since we have stressed individualised, personalised care and now today self-care.

Interpersonal and communication skills are central to nursing theory,
practice, management and informatics.

In Hodges' model the individual is the primary focus*.

The science and art of nursing
is predicated upon the
nurse - patient
relationship.

Situated = 'Its a duet' (anagram)

*Inclusion of the 'group' in the model also facilitates
consideration of relatives, parent-child, family, community and populations.

Activities of Daily Living ADLs and Hodges' model [1]

The Hodges' model matrix below lists some basic Activities of Daily Living. The intention is to read the table as per the numbers. In 1. - the sciences domain - is a list of basic ADLs, this represents my classification of 'where' these ADLs live within Hodges' model. This is followed by a qualification in the intra-interpersonal domain 2.:

2. While basic ADLs are typically designated as 'functional', that is related to physical abilities they are of course also very dependent upon mental health status. Including: mood, motivation, memory, orientation, confusion. Many ADLs are closely associated with disease and illness, which affects people's independence.	1. personal hygiene dressing - undressing eating and drinking toilet: (urinary and faecal) elimination (often taken for granted) transfers: e.g. bed to chair and back degree of mobility (sitting - standing balance)
4. We can appreciate the impact of the carer's burden by arriving here finally. The sciences, interpersonal and political domains weigh heaviest here, as the carer assumes responsbility for the care of another, themselves and often other dependents.	3. Assessment of ADLs covers aspects of safety and risk to SELF, OTHERS and risk of SELF-NEGLECT. Increasingly, however the emphasis is on self-care, independent living and strengths in the above ADL skills.

In further blog posts I will present a similar treatment of other ADLs with references.

Link:
"Activities of Daily Living Evaluation." Encyclopedia of Nursing & Allied Health. Ed. Kristine Krapp. Gale Cengage, 2002. eNotes.com. 2006. 30 Nov, 2009 http://www.enotes.com/nursing-encyclopedia/activities-daily-living-evaluation

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 Variables and Constant Values

From the ancient days of BBC BASIC I am today still trying to pick up some PHP to help me grasp Drupal (and Ruby).

In declaring variables - a key element of computer programs - I thought about the following both as a VARIABLE -

$nursing_care = "variable"

- and as a CONSTANT.

Which made me wonder: when do we want nursing to be a 'variable' and when a 'constant'?

The answer is of course obvious.

Nursing care must be a VARIABLE when it reflects the care plans and objectives that relate to a person - a unique individual.

Alternately, what must be declared as CONSTANT are -

safety, values and good-high quality nursing care.

You may wish to consider what other aspects of nursing and your practice are either variable or constant in nature?

Additional link:

Hodges' model care domains suggested content: http://www.p-jones.demon.co.uk/quads.htm 
I am updating the single page above and must add hygiene;
should you have any additional suggestions please get in touch - 
h2cmng at yahoo.co.uk