International Council of Women's Health; Multidisciplinary Conference - Beyond 2015: What will it take

Dear Colleagues and friends

FUNDISA with SIGMA THETA TAU INTERNATIONAL as diamond partner, is hosting the -

INTERNATIONAL COUNCIL ON WOMEN'S HEALTH ISSUE (ICOWHI) 20th conference

- from 12-14 November 2014 at the ICC in Cape Town. Please note this is a MULTIDISCIPLINARY conference and any discipline working on women's health issues or related topics are invited to submit an abstract. See the call for abstracts.

Please distribute to relevant colleagues in your network.

Kind regards

Hester
Prof Hester C. Klopper (PhD, MBA, FANSA)
President: Sigma Theta Tau International
Chief Executive Officer: FUNDISA
Professor: UWC and NWU
Office tel: +27 (0) 12 333 1415+27 (0) 12 333 1415
Twitter: @klopperhc

The GANM is part of the Johns Hopkins University School of Nursing PAHO/WHO Collaborating Center. The thoughts, opinions and views that are posted on the GANM do not reflect those of either Johns Hopkins University or WHO.

Please visit the GANM webpage at: http://knowledge-gateway.org/ganm/
If you want to reply privately, read below.
You are receiving this message because you are a member of the community GANM (Global Alliance for Nursing and Midwifery).

Call

Send SMS

Add to Skype

You'll need Skype CreditFree via Skype

Author's copy: Humans, Information and Science - now on Academia.edu

Humans, Information and Science

This evening I went through some old directories from two PCs ago and added the two figures missing from a paper published in 1996. This is now available on Academia.edu:

http://www.academia.edu/3555654/Humans_information_and_science

I've mentioned this paper before on W2tQ. I thought I would upload a copy as the basic details seems to have prompted some interest. At some point I would like to return to this subject:

ABSTRACT

The use of information forms the basis of nursing policies, standards and professional codes of conduct. Although used intuitively, nurses must now also grapple empirically with information needs often defined by others, and with the technology used to capture and process it. Even the briefest contemplation of 'information' reveals a truly pervasive concept. Information is ubiquitous. In order to care effectively in the so-called "information age" health care professionals need to understand information. This paper is a small contribution to that effort, attempting to conjoin the disparate fields of health and the information sciences; and the basic sciences upon which they are based.

This paper explores how definitions of 'information' formulated in computing and communication theory relate to health and other aspects of human experience. The strategy adopted to achieve this is threefold. First, there is the vexed question of defining data, information and knowledge. Second, I consider how communication - that essential nursing activity - relates to information, meaning and the messages people seek to convey to each other. Thirdly, clinical situations are described in an information oriented manner, using the concepts of 'redundancy' and 'entropy'. The conclusion provides an historical perspective.

Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, 24(3),591-598.

In the meantime a draft paper on Hodges' model, case formulation (conceptualization) and diagrams is at a reduced 4,000 words ready for a meeting with my co-author later in June.

Early next month I'll post a book review and crack on with other reading for reviews.

Inaugural issue open-access journal: Global Health - Science and Practice

Dear HIFA members,

The inaugural issue of the open-access journal Global Health: Science and Practice, is now available here:
http://www.ghspjournal.org/content/current

Below are extracts from the editorials:

'USAID and the Schools of Public Health at JHU and GWU welcome you to the inaugural issue of GHSP­an open-access, peer-reviewed journal for the global health community, particularly program implementers, to contribute to and benefit from a dialogue based on science and practical programmatic experience...'
'We foresee that public health practitioners, university colleagues, donors, and other development partners will be able to contribute to and benefit from a dialogue based on science and experience of what works for field programs.... GHSP will take a multidisciplinary approach to the science and practice of global health... We look forward to your engagement and feedback.'

Ariel Pablos-Méndez, Michael Klag, Lynn Goldman
Glob Health Sci Pract 2013;1(1):1-2
http://dx.doi.org/10.9745/GHSP-D-13-00012

'Formal research definitely helps. But it is not enough. We also need programmatic know-how, including experience-based knowledge and 'lessons learned.'.

James D Shelton, Ronald J Waldman
Glob Health Sci Pract 2013;1(1):3-4
http://dx.doi.org/10.9745/GHSP-D-13-00001

Best wishes,
Neil

My source: HIFA2015

HealthTap: Invited to add their widget... I asked a question...

No doubt it was a bulk email, but I received an invitation from HealthTap to add their widget here on W2tQ. The widget provides the means to access their service, that of putting questions to medical experts.

I have minimized the side bar content, stripping out buttons and other media paraphernalia and yet suitably intrigued I asked a question - ;-)

Q. Is there a conceptual framework that can help

 assure holistic (physical - mental, social) and integrated care 

that is also person-centered? 

Fourteen hours later news of an answer duly arrived by email:

Holistic Medicine
I believe that Holistic Medicine, when properly practiced, assures all of that. For the principles delineated by the American Holistic Medical Association see http://www.holisticmedicine.org/content.asp?pl=2&sl=22&contentid=22

Also see http://www.abihm.org/general-public


I greatly appreciate Dr. Randy S. Baker's response and the above links. This is helpful in several respects despite not exactly being the answer I was hoping for.

The answer is itself holistic in a sense in wrapping the question up in an organisational wrapper. That's a safe response, with medicine in there for wholistic measure. Who ever said medicine is reductionist! Judging from his profile holistic medicine is Dr Baker's forte.

Also interesting in the answer is the way the hook in the question was deemed to be the reference to 'holistic' and not the conceptual framework element.

Another point in Dr Baker's reply that reflects on Hodges' model and the health news media in England (UK) next week* is the bit about when properly practiced.

The adoption of Hodges' model is no guarantee of 

person-centered, 

integrated, 

holistic care.

Although the term conceptual framework (Hodge's model !) is not given in the answer: assure is.

What ever conceptual framework (care model, care philosophy...) is adopted to deliver health care, they must contribute towards the assurance of high quality care - that which ultimately positively engages the patient, carer, family and communities.

My question still remains and is usefully extended, passed to the above organisations.

So does the AHMA and the American Board of Integrative Holistic Medicine have a conceptual framework that helps support their holistic objectives and assurance of care? I will contact them to see if I can obtain a further response.

Thanks again to Dr Baker and HealthTap.

* The Francis Inquiry Report is anticipated on Wednesday.

SCIE Research briefing 43: Effective supervision in social work and social care

This research briefing provides an overview of the evidence concerning the value of supervision in supporting the practice of social care and social work. It is relevant to both children’s and adult social care services and includes a consideration of supervision in integrated, multi-professional teams. While the focus is on social work and social care, some of the research reviewed includes participants from other professions such as nursing and psychology.

The briefing covers evidence on the use of different models of supervision and outcomes for workers, employers, service users and carers. It considers evidence on the costs of supervision and concludes with implications for policy-makers, practitioners, organisations, service users, carers and researchers.

Download here: 
http://www.scie.org.uk/publications/briefings/briefing43/

My source: Jill Anderson via MHHE list

World Mental Health Day & Hodges' model

Today is World Mental Health Day. Here are some mental health related concepts mapped to Hodges' model that I have encountered over the past few weeks (I could list many more of course).

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

depression, suicidal ideas, motivation, beliefs, agitation, assessment tools, understanding of treatment, communication skills, confusion, aggression, lability of mood, loss, disorientation, orientation, concordance, stress and vulnerability, observation, distress	risk assessment, electroconvulsive therapy benzodiazepines, anti-depresssants, side-effects, gait, pain, care environment,  diagnosis of depression, anxiety, dementia, records - behaviour charts, electronic health record, security
carer under stress, reassurance, counselling skills, respite care, family therapy empathy and rapport with residents (colleagues...), patient and relative engagement, activities, distraction, engagement, life history, touch, care strategies and recommendations, smiles, companionship	commissioning, funding of services, consent, integrated working effectiveness, referral-on, care vouchers, advocacy, service access, compliance, use of Mental Health Act, staff survey, gatekeeping - access to beds, work allocation, health & nursing in the media

See also: Hodges' model - indicative content

Visual means: Patient Status at a Glance (PSAG)

A recent HSJ came with a CHKS supported document on Top Hospitals. Page 14 considers Worldwide comparison and learning from others with three items on Patient Status at a Glance (PSAG) Boards; Developing a safety culture; and Reducing readmissions.

All are related (communication, safety, outcomes, multidisciplinary collaboration), but PSAG stands out to me for obvious reasons as it acknowledges the value of visual management, a quick heads-up overview of status. On PSAG four brief sentences note that South Tees Hospital NHS Foundation Trust in the UK has applied experience from Virginia Mason Medical Center in Seattle to develop PSAG in surgery.

Of course this application is focussed, being quite specific in the value of fewer nursing interruptions and a daily update for bed managers. This now contributes to making many wards more productive.

Hodges' model is a 'PSAG' of sorts, but it is more general, global in scope, summative. Perhaps it could act as a precursor to discharge?

Like the astronomer's blink comparator it could provide a before:after visual cue.

So, I wonder if Hodges' model could provide not only Patient Status upon Reflection, but Care Status upon Collective Reflection. This is vital at a time when we also need the patient and carers to be more productive in terms of supporting and sustaining their own care.

Health Care - drawing lines

Multidisciplinary care

Original image source:
http://www.jointline-group.co.uk/councils.php

Now I am - IST

Since January 9th 2012 I work in IST, that is the Intermediate Support Team.

This means my colleagues and I try to facilitate early discharge, prevent admission, relapse and also have a gate-keeping role for the local in-patient beds.

Working in IST and being a nurse makes me think about all those other –ists that are out there.
Several immediately fall out of Hodges' model:

Human-ist, human biolog-ist, technolog-ist, psycholog-ist, educational-ist, public-ist - for public [mental] health, socio-technolog-ist.

As per the many nodes, edges and dimensions within Hodges’ model being an IST means:

taking the edges off the things that count but 

visiting all the edges

So, yes I am a social-ist too. You have to be working in health and social care:

As you do your bit to deliver safe, lean and yet high quality nursing and social care - engage in discussions about an individual's health care, care placements, care transitions you are also a polic-ist^*. You take the government’s policies, the welfare reforms, the savings, and latest legislation and sell them to the public.

While you do this you try to ensure you are not ageist, sexist, racist, elitist and those many other ists that try to prevail - especially amid chaotic change.


^* Policist is I believe a neologism in English. What I mean is the way that workers on the ground (inevitably) enact health and social care policy, thereby also selling it to the public. There may be a word that fits the Bill, but it's eluding me ...

Musings on Integrated Care: A Visible and Invisible Matter

If measures for clinical outcomes, health literacy, patient satisfaction, benefits and many more present a challenge then a measure for integrated care falls into the category of a very steep peak.

It's a nebulous concept, we know what we mean, we recognize the principles and we even allow for variation in what integration and integrated care means for different people.

The January 2012 integrated care report by The King's Fund and Nuffield Trust (my post on this) had me thinking about some of the ingredients that might contribute to measures of integrated care and our efforts to record it. What instruments and formats do we need - what mix of microscope (individual), telescope (population), strobe (snapshot), time lapse (series), objective - subjective? Some elements  then (in no particular order):

Breadth of the 'episode' (primary-secondary-tertiary-palliative)
The number of systems
  information - e-records
  commissioners
  datasets: total, number of gatherers, submissions
The number of people - individuals involved
The number of 'responsible' organisations
 Primary organisational efficiency - Lean Standing?
The number of teams
The number of policies (policy touches)
 The number of interviews, assessments (paper, electronic, formal), care plans, reviews
Opportunities for communications
  potential
  actual
  media forms
  delivery forms (inc. technologies)
Number of handovers
  weighted according to type
Patient experience - measure
 (that is holistic across physical, mental health, social care?)
 staff attitude
 therapeutic relationship engagement (quality)
 therapeutic modalities (quantity)
 educational content, materials provided / information gains
 number of patient (carer) choice points (potential - exercised)
Incidents of positive risk taking
Increase in health literacy
Co-ordination effectiveness
Self-care - autonomy, decision making
Patient (carer) as budget holder
Patient as record holder and direct data source (telecare - data entrant)
Carer involvement
Health : Social care (main dependency, ratio, index)
The number of disparate care philosophies encountered
Diagnoses
Diagnostic investigations complex (location, time)
Declarative success: agreed plan - success?
The geographic encounter footprint
Duration of engagement
Follow-up - care continuity care
Care Disintegration - safety
 care interrupts^# (falls, errors)
 relapse, readmission
 dependency (deferred discharge)
Influence of public engagement - involvement in local health services^*


While many of the above might qualify as candidates for a measure of integrated care, you have to wonder whether in order to measure integration you must measure everything else. It appears here at least that integration and complexity are closely related. Several of the items above might individually represent - and no doubt do - indices of various kinds that also beg definition (e.g., co-ordination, success, philosophies, episode ...).

Although I've referred to 'numbers' you could no doubt refine the list by consulting the literature and considering the quantitative : qualitative mix.

Perhaps the key indicator of integrated care isolates the primary concepts for the person concerned and then fuses those within the INTERPERSONAL and POLITICAL care domains (policy touches would be one example)?

^*How does a measure of integration incorporate those socially excluded?
^#For want of a better word.

Report - Integrated care for patients and populations: Improving outcomes by working together

I've posted on integrated care previously on W2tQ. The core recommendations of this New Year  report on integrated care are:

• government policy should be founded on a clear, ambitious and measurable goal to improve the experience of patients and service users and to be delivered by a defined date
• patients with complex needs should be guaranteed an entitlement to an agreed care plan, a named case manager responsible for co-ordinating care, and access to telehealth and telecare and a personal health budget where appropriate
• change must be implemented at scale and pace; this will require work across large populations, significant reform and flexibility to take forward different approaches.

Publication prompted Time to integrate words with action by Chris Ham and Jennifer Dixon (HSJ 5 January pp. 16-17 - and my source for this news). The report and mention of measures of integrated care that include patient experience provoked further reflection.

Integration in health and social care should be considered critically over the past 25 years and more (but that's a thesis). Evolution in policy matters, but there is a deep archaeology that illustrates the policy aspiration - practice gap the reports priorities seek to address. A comment in response on the King's Fund's site notes the need for (strategies, methods and) a framework. While no magic wand there is a framework that can at least unify disciplines, public and policy makers. And act as a bridge between words and actions.

Integration needs a shared and agreed origin.

(A point* around which disintegration turns)

Although brief (20 pages) the report is an excellent source for references (3 pages) that includes:

Kodner D, Spreeuwenberg C (2002). ‘Integrated Care: Meaning, logic, applications, and implications – a discussion paper’. International Journal of Integrated Care, vol 2,
Available at: www.ijic.org/index.php/ijic/article/view/67 (accessed 13 December 2011).

Kodner D (2009). ‘All together now: a conceptual exploration of integrated care’. Healthcare Quarterly, vol 13(Sp), pp 6–15.

Leutz W (2005). ‘Reflections on integrating medical and social care: five laws revisited. Journal of Integrated Care, vol 14, no 5, pp 3–12.

As we try to integrate words and actions we need to remember:

how we dice and slice influences the scope of integration.

We'll explore this more soon.
*Points?

Nick Goodwin, Judith Smith, Alisha Davies, Claire Perry, Rebecca Rosen, Anna Dixon, Jennifer Dixon, Chris Ham Integrated care for patients and populations: Improving outcomes by working together. Report to the Department of Health and NHS Future Forum from The King’s Fund and Nuffield Trust

Masquerade in health care but on which level?

There is a Drupal module called Masquerade, the project page explains:

The masquerade module is designed as a tool for site designers and site administrators. It allows a user with the right permissions to switch users. While masquerading, a field is set on the $user object, and a menu item appears allowing the user to switch back. Watchdog entries are made any time a user masquerades or stops masquerading.

Life frequently asks more of us and the same applies for employees in whichever employment sector. For teachers and nurses they know the call. As a nurse you adopt the mask of the uniform and the role. You may not actually carry the lamp, but it's there. Sometimes it helps light the way; for the public, for you. If you are a 'bad' nurse - whether your attitude put the lamp out this morning, yesterday, or several years ago -  the darkness that follows you about speaks volumes.

It prompts Prime Ministers to make announcements:

PM announces new focus on quality and nursing care

06 January 2012 12:54

A new drive to free up nurses to provide the care patients and relatives expect has been announced today by Prime Minister David Cameron and Health Secretary Andrew Lansley.

The push will see nurses spending more time on front line care in wards and other services, a senior ward nurse with whom the buck stops, patients leading on inspections and a new 'friends and family test' to show whether nurses and patients had a good overall experience, or would want loved ones needing care to be treated at each hospital.

Prime Minister David Cameron said:

“We know the vast majority of patients are very happy with the care provided by the NHS. And I’ve seen the NHS at its very best. But we have heard recently that in some hospitals patients are not provided with the level care or respect they deserve and I am absolutely appalled by this.
“If we want dignity and respect, we need to focus on nurses and the care they deliver. The whole approach to caring in this country needs to be reset. And it needs to start with this simple fact. Caring for patients is what nurses do. Everything else comes second."

<->

While we all play masquerade there are many levels. As a 'nurse' it's difficult (but never impossible) to play the caring, skilled, knowledgeable, patient, warm, efficient ... representative AND ensure all records are maintained, letters written, all communications logged, targets achieved, electronic records and data gathering requirements met. ... If you need a steer-clear from the stereotypical image of Angels, then you should see the faces nurses pull behind the mask trying to satisfy the audience.

That audience does not just include managers, patient representatives, inspection agencies but policy makers and politicians. Of course the latter are expert proponents of masquerade (they practice through a 4-5 year cycle).

Closer to home and the Drupal module? Well, I can't see a role for masquerade on a new h2cm website, but the thought crosses my mind of general nurses masquerading as mental health nurses; social workers masquerading as nurses. ... Although I'm playing games :-) it makes you think about what we mean by 'multidisciplinary'. To what extent, for example, is care of people living with dementia being missed because these disciplinary distinctions - silos really do still prevail? Surely the nursing issue isn't just a lack of light?

This announcement is not exactly news given what has gone before in the UK media through 2011.

What is strange is that this policy should emerge in 2012: The Alan Turing Year.

Yes, nurses DO need time to care, but perhaps we also need a test for empathy and rapport and not just intelligence?

Interprofessional Collaborative Care Will Be Key to Meeting Tomorrow’s Health Care Needs

Maryjoan Ladden, Ph.D., R.N., F.A.A.N., Robert Wood Johnson Foundation Senior Program Officer

A little over a year ago, the Institute of Medicine’s landmark Future of Nursing: Leading Change, Advancing Health report put forward a series of recommendations for transforming the nation’s health care system. Among them was a call for a system in which “interprofessional collaboration and coordination are the norm.” That’s no simple assignment in a system that often operates in silos, from schooling through practice. But a number of innovators around the nation are already making headway.

Their work is the subject of a new policy brief from the Robert Wood Johnson Foundation, part of its Charting Nursing’s Future (CNF) series. The brief delves into what the IOM recommendation means for health care systems, offers case studies of several collaborative care models already in place, and examines the implications of the recommendation for how we train nurses and other health care professionals.

According to the brief, Implementing the IOM Future of Nursing Report–Part II: The Potential of Interprofessional Collaborative Care to Improve Safety and Quality, the “silo” approach must soon give way if we are to meet coming health care challenges. For example, chronic conditions are increasingly common—not surprising given an aging population. But the health care system is poorly structured to provide the sort of coordinated care and preventive services needed to give these patients quality care while reducing costs. Some health care institutions are gearing up for the challenge.

• In Boston, where Harvard Vanguard Medical Associates developed its Complex Chronic Care (CCC) program, primary care has become interprofessional, collaborative and noticeably more efficient. Each CCC patient is assigned a nurse practitioner (NP), a registered nurse with advanced education and clinical training. The NP consults with all the patient’s subspecialists and incorporates their guidance in a single plan of care. The NP then manages and coordinates that care, connecting patients to nutritionists, social workers, and other professionals as needed. The model is dynamic, allowing patients to meet more or less frequently with the NPs and their primary care physicians, who remain responsible for the patients’ overall care.
  

• In New Jersey, the Camden Coalition of Health Care Providers is “revolutionizing health care delivery for Camden’s costliest patients,” according to the brief. These individuals, sometimes called super utilizers, typically rely on hospital emergency rooms for care. Not surprisingly, such patients account for an outsized share of local hospital costs, often with diagnoses that would have been more properly handled in a primary care setting. The Coalition developed its Care Management Project to reduce these unnecessary emergency room visits by treating patients where they reside, even when that means treating them on the street. A social worker, NP and bilingual medical assistant work as a team to help patients apply for government assistance, find temporary shelter, enroll in medical day programs and coordinate their primary and specialty care.
  

Training the Next Generation to Collaborate

Of course, the silo effect usually begins in school. In May 2011, six national education associations representing various health care professions formed the Interprofessional Education Collaborative (IPEC) and released a set of core competencies to help professional schools in crafting curricula that will prepare future clinicians to provide more collaborative, team-based care. Such efforts are already under way at a number of institutions.

• Maine’s University of New England has developed a common undergraduate curriculum for its health professions programs in nursing, dental hygiene, athletic training, applied exercise and science, and health, wellness and occupational studies. The curriculum includes shared learning in basic science prerequisites and four new courses aimed specifically at teaching interprofessional competencies.
  

• In Nashville, Vanderbilt University is also pursuing an interprofessional education initiative that unites students from the medical and nursing schools with graduate students pursuing degrees in pharmacy and social work at nearby institutions. Students are assigned to interprofessional working-learning teams at ambulatory care facilities in the area.
  

• The Veterans Health Administration (VHA) is piloting an interprofessional initiative, as well, focused on preparing medical residents and nursing graduate students for collaborative practice. As part of the initiative, five VHA facilities have been designated Centers of Excellence and received five-year grants from the U.S. Department of Veterans Affairs. Each VHA Center of Excellence is developing its own approach to preparing health professionals for patient-centered, team-based primary care.
  

• In Aurora, Colorado, the University of Colorado built its new Anschutz Medical Campus with the explicit objective of creating an environment that promotes collaboration among its medical, nursing, pharmacy, dentistry and public health students. It features shared auditorium and simulation labs, as well as student lounges and other dedicated spaces in which students from different professions can pursue common interests such as geriatrics in a collaborative fashion.
  

Such initiatives are clearly the wave of the future, if only because the pressures of caring for a larger, older and sicker population of patients in the years to come will drive efforts to identify efficiencies. In the words of Mary Wakefield, PhD, RN, head of the Health Resources and Services Administration, “As the health care community is looking for new strategies and new ways of organizing to optimize our efforts—teamwork is fundamental to the conversation.”

Sign up to receive future Charting Nursing’s Future policy briefs by email at
www.rwjf.org/goto/cnf.

My source: Matt Freeman (PRS)

Christmas: Buena Vista Social Club & Multidisciplinary, Interdisciplinary, Interprofessional and Transdisciplinary

A welcome gift for Christmas^# was Wim Wenders' and Producer Ry Cooder's film - Buena Vista Social Club. The music, story, sound and images are a real treat. Several of the artists are sadly no longer with us, what is clear is the role that music can give to people in their senior years. The companionship and musical narrative that was rekindled in the late 90s is brilliantly captured and just in time: for the rest of us. The way these musicians and the technicians fuse, improvise, learn together, complement and contrast, and inspire each other is brilliant.

Whilst watching and listening I've realised that for the intro to the conceptual space notes I need to grasp details about the cussed customers - multidisciplinary, interdisciplinary, interprofessional and transdisciplinary.

Checking on current and forthcoming books I'm seeking a review copy to inform my musings:

The sequence in the title is not accidental but roughly equates to the descending frequency of use in health and social care. The most common (multidisciplinary) and least (transdisciplinary) are not dissimilar in needing to be defined and explored. Talk of multidisciplinary in theory, practice and management – notably policy – is so frequent that the meaning of the concept is diminished. On the other hand transdisciplinary is so infrequently used that the meaning is blurred. This is compounded by the noisy signature produced by the proximity of interdisciplinary and interprofessional.

This quartet are like musical disciplines and genres that can potentially grate on the ear and yet also make possible some amazing productions. Maybe that process is what goes into World Music? What in turn needs to go into global health?

^#Another much appreciated present is the Steve Jobs biog.