[ Exclusive* preview ] Wrinkles

individual, dignity, person, memories, identity, security, communication, perception, meaning, friends, belonging, mood, orientation ...	demographics, evidence based care, medication, treatments, physical environment ....
	policy, standards, inspection, training, organisation, safety, governance, management culture, leadership ...

Link:
http://www.arrugaslapelicula.com/

*Person centered?

A *prospective* journal issue devoted to the "Health Career - Care Domains - Model"

Last month I was contacted regards the possibility of acting as associate editor for a journal issue devoted to Hodges' model, or a related theme.

At present with part-time studies having started in January and a residential week to following at the end of March I have rather got my hands full. I hope to post in the near future on how these studies are helping to shape my ideas.

One clear 'result' is the prompt to engage with residential and nursing homes in preparation for a 'small research study' I have to complete this northern Spring. I've two meetings organised thus far with home managers.

A journal issue is a great prospect however, a giant step in fact - for the conceptual framework and myself (I'd also contribute an editorial). Perhaps I could share this project with someone similarly minded regards the potential of Hodges' model in health and social care and without in education and informatics? It seems that this invitation will stand even if I can only pick it up in the future, end of 2015-2016...

In the sidebar, below the bibliography I've listed a publications to-do list that could be extended:

• Hodges' model, structure, content and applications 
• taking the 'career' out of Hodges' model and putting it back;
• curriculum development;
• reflective practice;
• case formulation;
• holistic care (and related perspectives, but in informatics, SOCIO-TECHNICAL);
• the theory - practice gap;
• threshold concepts;
• and conceptual spaces;
• integrated care; 
• Nursing theory: future history - why they still matter;
• quality assurance and care values;
• multidisciplinary care and interprofessional education;
• diagrams that care;
• student contribution;
• patient, service user contribution;
• .... ?

The distance learning Technology Enhanced Learning course is stimulating many other insights. The learning is very collaborative and a great demonstrator in so many ways. The recent trip to London and meeting at London South Bank University also stressed the need for publishing in the 'popular' nursing press. Recent writing (recovery, recovery model) and studies also points to not being tied to original purposes of Hodges' model - but going beyond this ... far beyond: global health integration, health literacy, self-care, methodological approaches to critique and investigate Hodges' model. ...

So many gardens: Press Release [ now ]

It had to happen. Twice over.

The irony that just as so many homes with older people living in them have gardens that are in a state of neglect, so too do many nursing and care homes.

Of course this is a sign in those domestics homes of reduced abilities.

In the residential care and nursing homes, garden neglect is reassuring.

A $ure sign that the love and spending is on the blooms inside?

Reading and writing the minutia of locked doors and windows (still a draught)

Couples, married or not, partners are the cards that frequently, if not by definition, lean on each other beyond the pale, to the n-th degree. Witness so many lessons of what love really is.

They bend and flex. Tested by history, timelines entwined, ties-that-bind, trying to persist in the hear and how.

Their psychological union is challenged as memories become eroded and physically frailty takes hold. Usually; mostly, on the one.

Eventually things, established relationships break and one or the other - should we say: finds themselves in - residential care.

Courtship enables us to become socialised to and with each other and respective families and in some instances other cultures and beliefs.

In this crucial transition sometimes there is learning through experience as respite care is sought.

In other cases health services wonder how this relationship has survived for so long. A crisis is a precipice for change. A chaotic invitation. Radical.

A sudden shift from what was home to a new world of corridors, r, ro, roo, room, rooms; my room? New noises and smells and altered routines and jumbled faces, touches, days and nights

The dolls of childhood are left behind, but may be picked up again literally as an emotional comforter. If not this then perhaps a ‘paper clad dol’ that is bound to be - ‘deprivation of liberty’.

In this new home, this person walks the corridor and inspects the minutia of the doors and windows. Staff pass by(e) waving by their walk - "so-busy-look-no-hands" while trying to be butterflies.

Butterflies that cannot say which way is ‘out’.

They are they. Difficult to follow with eye, head and a hand to catch. The individual recognises the whole of the comings and goings, the main thoroughfare. The strategic point, the nexus of comings and goings.

Something's not right though! I need to be somewhere else.

Sadly (or Usually), there is no going back.

Is there a pattern to this confused-coming-to-terms-with?

From asking repeatedly about being elsewhere, especially with the setting of the sun is there a shift in attempted reasoning? So correct, so responsible all those decades ago. Perhaps even months ago...

If no one will listen to me then perhaps if I have my wife/husband with me then they will see the importance of my cause, my mission.

See look - I have my wife, husband, partner with me now: we really need to go!

Can the residential care home support this person? Can they meet their care needs? They say they are ‘struggling’. Will they need to move – again?

How do they work through this transition? What do we know of how individuals negotiate this transition in their lives? How can we try to understand?

How do they make sense of what has happened, and where they now find themselves? Will their level of distress, agitation gradually extinguish as with their efforts to leave?

As they look to the windows, seek to traverse the doorway, cross the foreign threshold and venture to that somewhere that is not here, we know one thing.

Person centredness lies in the minutia of the life once lived through those locked doors and windows.

We can ‘open’ the doors and windows by travelling with them, together, sharing that journey, the sense of those times and upon returning help them adjust to this new listen and how. Clearly, deprivation of liberty is not a punishment here, yet it demands compensation by provision of high quality personalised care.

'Pictures to Share' book titles for people with later stage dementia

Hi

I am contacting you as one of our LinkedIn colleagues working in the field of dementia. One of our 'Pictures to Share' book titles for people with later stage dementia has been shortlisted for the UK 'People's Book Prize'

By winning this award we can help to to raise awareness of the needs of people with dementia, so it would be great if you could take a look at the People's Book Prize website, and consider voting for our book 'Proverbs and Sayings'.

The link is below:

http://www.peoplesbookprize.com/book.php?id=982

Many thanks for your help

Helen Bate and Michelle Forster
http://www.picturestoshare.co.uk/

[I will register and vote Michelle - good luck PJ ]

The Hundred-Year-Old Man Who Climbed Out the Window and Disappeared

 It all starts on the one-hundredth birthday of Allan Karlsson. Sitting quietly in his room in an old people's home, he is waiting for the party he-never-wanted-anyway to begin. The mayor is going to be there. The press is going to be there. But, as it turns out, Allan is not...Slowly but surely Allan climbs out of his bedroom window, into the flowerbed (in his slippers) and makes his getaway. And so begins his picaresque and unlikely journey involving criminals, several murders, a suitcase full of cash, and incompetent police.
 

As his escapades unfold, we learn something of Allan's earlier life in which - remarkably - he helped to make the atom bomb, became friends with American presidents, Russian tyrants, and Chinese leaders, and was a participant behind the scenes in many key events of the twentieth century. Already a huge bestseller across Europe, The Hundred-Year-Old Man Who Climbed Out of the Window and Disappeared is a fun, feel-good book for all ages.

Image: Sincerely, Anna
Text: Waterstones

Walking the line of signs of movement in fresh air ...

P Being mobile and active is one
H of the most important
Y factors in longevity
S and quality of life.
I  A model of activity in residential
C and nursing home care should be a right.
O I often enquire about
-
P the possibility of residents who
O tend to become
L agitated at a certain time of
I of the day, to be taken, or assisted to
T have a walk, or at least
I  feel the fresh
C air on their faces.
A This can make a real
L difference, as Nature's natural sedative.

Prompted by a question posed by Jackie Pool on LinkedIn:
Supporting individuals through activity - a positive role for carers?

Jackie's description of an everyday indoor activity being used to promote movement and mobility flags a real issue. Access to the outdoors is still very difficult for many residents on units that are located upstairs.

Residential homes should (must) have sufficient staff to facilitate a full range of activities. This month in the Northern hemisphere it is summer: outside.

In terms of taking people out, staff often look at me and I them, as together we acknowledge the constraints that frequently operate. I've walked outside with residents myself a great opportunity to assess and engage. Staff know the benefits of movement and activity. This helps us all to get out-side of our-selves. The gift it that this diversion of sun and air (and rain) can reach through confusion and agitation, even if only for a short period of time. Hence it can be acutely frustrating when this basic need can not be fulfilled. Holding on to life's essential repertoire is vital.

North West Health Hack 15/16 June 2013

Dear Health 2.0 Manchester member,

Please see an update on opportunities that might be of your interest:

Follow us on Twitter!
@H20MCR for latest updates and digital health insights & opportunities

North West Health Hack 15/16 June 2013
This is a free event where clinicians can work with some very talented developers/coders and designers to develop their ideas into working prototypes. There will also be an opportunity to get some early concept validation and feedback from investment/ technology and NHS mentors.  The event is not only open to new concepts but also to ones that are already in development so that teams that are already formed are also invited! Who is organising it: Barclays, ECH Alliance, University of Manchester, Health 2.0 Manchester Chapter, TechHubManchester. Dr Ranjit Gill (Chief Clinical Officer, NHS Stockport) & Dr Mike Burrows (Area Director, NHS Greater Manchester) will attend the event.

Check it out  & REGISTER at http://nwhealthhack.com & follow on Twitter @NWHealthHack

Blueprint Health accelerator is currently accepting applications for their summer program
We have been approached by Blueprint Health to share this opportunity with our community: Blueprint Health, the premier healthcare accelerator program, located in the heart of New York City. Blueprint is currently accepting applications and our team is seeking talented entrepreneurs to join us for the Summer 2013 Program. A number of incredible entrepreneurs have traveled from as far as Shanghai, Dubai, and London to partake in our program. You may have seen some recent press coverage of four surgeons who founded Touch Surgery, a company that graduated with our Winter 2013 Class. http://www.guardian.co.uk/artanddesign/architecture-design-blog/2013/feb/27/touch-surgery-ipad-app-surgeons-learn

We look forward to meeting the talent from Manchester.

Michael Maggio
Associate

Blueprint Health
483 Broadway, 2nd Floor
New York, NY 10013
cell: 781.864.6283
office: 646.627.7627 ext 703
mmaggio@blueprinthealth.org | blueprinthealth.org | @bphealth

Next  H 2.0 Manchester Meetup Thursday the 23rd of May: Care Homes and Assisted Living: in what ways technology can help?
Another great opportunity to discover new opportunities, be inspired and meet like minded people in a relaxed atmosphere.  Please see more details and update your RSVP HERE

Thank you and best regards
Idalia, Daniel, Mariano and Preeti

Health 2.0 Manchester - Leadership Team

IPONS 2012 Leeds: Dementia and Robots - SF and Isaac Asimov ruined me, what about you?

Just before I disappear for 11 days holiday...

In the 1970s I could go into (the old) Smiths in Wigan with £1 and buy three paperbacks. I built quite an SF library that includes Heinlin, Clarke, Smith, Aldiss, Van Vogt, and Asimov, all a bit musty now and boxed.

Robots featured in many of those old books and Issac Asimov in particular with his Three Laws of Robotics. As a result I've tended to take robots for granted, not just in fiction and film but health care too. Big mistake!

It's almost as if every decade we should watch Blade Runner again and reflect. Take our bearings, triangulating them with these other things-beings. ...

The demographic time bomb is proving quite an incentive for developments in leading edge robotics. 

One of the IPONS keynotes with Dr Susan Barnes and Dr Theodore Metzler presented Three Dialogues Concerning Robots in Elder Care.

We were introduced to general developments including Asimo, which I remember seeing on QI:



- and a specific nursing example:


Through their three dialogues ranging through the developments of artificial intelligence and consciousness, Drs Barnes and Metzler also introduced Paro a Therapeutic Robot, which is modeled after a baby harp seal. For many years dolls of various sorts have been used in residential and nursing homes to provide comfort for selected residents. This is an example of personalised care. I know because there are times when it has seemed not quite right. The paradox is that this arises not necessarily from the client's response to the doll, but sometimes that of the other residents. The response of relatives and visitors can also vary, especially when efforts are ongoing to find ways to help someone settle. Seeing - and hearing someone who is agitated is distressing for all.

Needless to say the keynote prompted many robot related questions. Are we deceiving people who are cognitively impaired? Is this a variation of covert administration of medicine? It was later afternoon 1500 hours or thereabouts, which had me thinking about the phenomena of sundowning. A time of day when some residents can feel they need to be elsewhere. Former responsibilities and roles come back to the fore with what can be chaotic results.

This excellent keynote also made me think about how care needs are matched to technologies. What is the ethical spectrum of telecare, of remote care, of robotics (surgical, locomotion, dementia care)?

A person living with dementia at home may benefit from have a robotic carer / assistant who can respond to the repetitive questions that often follow. A robot is not going to get frustrated, angry (Asimov's Laws?) by such behaviour, unless it were conscious?

On the other hand don't we need the frustration of a family member, a carer, a human to alert society at large to this local crisis - situation? What are the reporting capabilities of the robot system?

I realised many years ago the notion of windows of opportunity in terms of supporting independence - delivering care. There may be an optimum period in a person's health career to introduce day care, respite care, care at home, a robot ...?

Nursing (like me) needs to wake up.

The next twenty - thirty years are going to be a real challenge in all sorts of ways and for many reasons. Throughout that time and beyond a good dose of philosophical thought will be the order of the day. IPONS got me thinking anew: perhaps you too? The society are planning changes to the website, membership and journal options.

Back at month end.
P.S. ICN abstract submitted. Prospect of a public health presentation next month.

Hodges' model in Murphy & Welford (2012) Agenda for the future: enhancing autonomy for older people in residential care. Int. J. of Older People Nursing

ABSTRACT: This is the concluding paper of a three paper publications. Paper 1 focused on specifically understanding what autonomy for older people in residential care means. Paper 2 discussed the various factors that either facilitate or hinder residents autonomy and directed readers to reflect upon their practice. This final paper outlines the findings from the action research phase of a study aimed at enhancing resident autonomy. It describes just one way in which residential care units can work on enhancing residents autonomy and enables the reader to reflect upon nursing practices, which with the right approach can be resident-centred.

Murphy and Welford write:

Hodges (1997) model is essentially concerned with the person (resident) in a social context. The notion of it derives from the intervention of the nurse being future orientated, increasing the health choices, health chances or health prospects of individuals or groups (including families) taking cognisance of the biography of the person or persons being helped. The person already has a biography that has been influenced by their physical and psychological make-up, the kinds of families and social networks they have experienced and the culture or geographical location in which they live. The nurse then is also influenced by personal factors of their individual physical or psychological origin and factors relating to their social world and the policies that govern their daily life. The nurse (assessor) must take cognisance of the attributes the person (resident) brings with them in their current presentation (problem) and how this affects their future choices both in terms of ability to make them and the range of choices available. Thus, this approach to care planning recognises the importance of negotiating care.  (online source - see doi link below)

I am not just very grateful to Murphy and Welford for their adopting Hodges' model in their study, but this supports my own use of the model in teaching staff about person-centred care and communication skills in residential and nursing care homes. The inclusion of a political domain and individual and group (populations) dimensions is a great asset in this context. Their conclusion also identifies the limitations of individually directed change, something that seems apparent from my own experience in nursing home liaison.
 
Murphy, K., Welford C. (2012) Agenda for the future: enhancing autonomy for older people in residential care. International Journal of Older People Nursing. 7, 75–80. doi: 10.1111/j.1748-3743.2012.00309.x

Alcohol: Messages in bottles, domains and anagrams

The perennial health news item that is alcohol has bubbled and overflowed this week. In 1987-88 I visited several nearby alcohol services in Blackburn, Preston and Salford with a questionnaire to compare and contrast with Chorley which at the time had no dedicated alcohol services. There was Alcoholics Anonymous AA and Al-Anon, but nothing specific through health beyond community psychiatric nurses. The project was for the CPN(Cert.).

Back then I remember a Consultant Psychiatrist saying that the level of alcohol consumption is directly related to cost. The literature I read also drew attention to historical comparisons. I think it was Alcohol Concern who supported this view and called for urgent action. Of course all that was some 24 years ago. Incredible that there is some movement in 2012. In 2007 the taxi driver from Elounda to Heraklion airport described the movement and horizontal stasis that adorns the pavements (and spills onto the roads) of Malia as we zipped by. The Brits do have a problem. A Consultant physician highlighted this from a hospital ward on BBC Radio 4 news today.

Don't get me wrong: I like an occasional drink but my enjoyment of alcohol has been tempered over the years by several experiences:

• An early party aged 15 (and at a church social club) preloading was already in vogue. No sooner were a group of us sat at a table than someone threw up on the table. It was alcohol.
• Biology and human biology lessons helped instil the impacts of alcohol.
• Having to say 'goodbye' to clients with a drink problem, duly referred by their GP. I cannot support them in their drinking after several attempts to effect change.
• Appreciating the link between drink and risk behaviours.
• Working with people whose 'ill-health career' has seen them having to live with, but not themselves recognise Korsakoff's syndrome.
• Seeing people over three decades who cannot be supported in the community with their family, relatively young for residential care, but given a lack of specialised facilities - there they frequently are.

Hopefully the policy turn will have a positive impact extending beyond news headlines:

Minimum alcohol price planned for England and Wales
http://www.bbc.co.uk/news/uk-17482035

Alcohol pricing: politics under the influence 
http://www.guardian.co.uk/commentisfree/2012/mar/23/alcohol-pricing-politics-under-influence?newsfeed=true

With the prospect of an alcohol and a new NHS information strategy in England you hope that some dots can be joined. Here are a few:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

Motivation    Psychological effects Attitudes to risk         Predisposition Personality     Education    Vulnerability	Data     Evidence      Public health Physical effects    Dual diagnosis Research       Violence - statistics
Social contradictons and attitudes - 'image' Upbringing       Cultural attitudes  Marketing          Media	Cost per unit      Services        Funding   Cost to health budget      Reporting Policy   Lobbying   Taxes   Commissioning

Beer label c/o http://www.beerlabelizer.com/

'Real Stout' = 'Sale Tutor'

Locating the Spiritual in Care: (very big) Plantpots vs Green Windows

Last summer, July 13 2011 to be precise, the cover of RCN bulletin #278 declared 'Prioritise spirituality'.

I am not a religious person, but quite a spiritual one (I think). This RCN news item reported Professor in Dignity of Care for Older People at Staffordshire University, Wilf McSherry's views on spirituality. It is central across health and social care, (it is also vital in terms of cultural and spiritual literacy):

The practice of spiritual and religious care is about meeting people at the point of deepest need,' Professor McSherry said. 'It's not just about religious practices but preserving dignity'.

Also in that month, the 30th in The Times (page 19):
'Sacred forests bear witness to religion's unsung role in fostering a rich variety of life'.

This news concerned the extent of religious forests, with a project by scientists in Oxford to create a global map of forests under religious ownership and control. Now under the guardianship (whether intended or not) such forests have assumed importance as examples of biodiversity. Ruth Gledhill writes: From the Garden of Eden to Avatar, sacred groves have been central to religion and myth ... between 8 and 15 per cent of the world's land is regarded as sacred or religious.

With many remaining exceptions places of care have changed remarkably over the past 30-40 years. There remain many residential and nursing homes that prove challenging for health care professionals (I know they have told me over several years), never mind the residents and their carers. Challenging in the spiritual sense of the surroundings. I posted in 2010 about the wail of call systems. Visually though we must ask: how green is that care home?

Count - plants real [3]* : artificial [13]^#
  
This isn't just the colour of walls and use of curves to soften the environment, but access to outside, to grass, to trees and flowers. The benefits of real plants in the office environment are well established.  Being able to see a green vista greatly improves employee productivity and well-being. For those people in care what is the view outside their window, the lounge(s), the dining room? How can it be improved? For those essentially bed-bound can the furniture and bed be moved around periodically to achieve a new perspective?

It is still upsetting to see that those physically less capable of reaching the outdoors are elevated to first and second floors. Even with positive spiritual acuity of staff (the outdoors matters to all) readiness to hand and soul - a sideways glance through a window, the sound of rustling leaves through an open window - can make a huge difference:

Spirituality, dignity and respect. ...

*And in need of water. ^#Five over-watered.

Image source:
http://www.fanpop.com/spots/avatar/images/9492947/title/avatar_promo-screenshot-screencap