1 in 3 will be older adults by 2025 in Japan

In June Dr Mayumi Hayashi described Japan's vision of 'total care' for its older population in HSJ. The article that prompts this post follows another with lessons for England.

Referring to a "2025 vision" this forward thinking has its roots in established systems of healthcare set up in 1961 and social care established in 2000 (p.25).

Care integration is not new as a fundamental issue in health and social care. It is for me a career legacy issue. As a student nurse it was discussed and debated, closely allied with multidisciplinary and holistic (joined up physical and mental health) care. Even now 37 years later it will drive many arguments and policy deliberations in the run up to the next election here.

Many nations are faced with stark demographics. As the population ages and works its way through wooden blocks, Rubik cubes, it is the population pyramid that takes on increasing significance.


Dr Hayashi lists the need for inclusion, integration and continuation of four components that are essential to the realisation of this vision:

• maximising the integration of healthcare and social care;
• promoting policies for prevention and outreach together with safeguarding;
• embedding supported living programmes and dementia friendly community initiatives; and
• addressing “late life specific” housing needs.

I have mapped these to Hodges' model below:

individual
INTERPERSONAL : SCIENCES

humanistic ------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

group

embedding supported living programmes and dementia friendly community initiatives	integration of health and social care
"late life specific" housing needs (integration of health and social care)	promoting policies for prevention and outreach, together with safeguarding

It becomes clear to see in Japan, China and other nations how telecare and smart homes have a role to play. Getting the basics of integrated care resolved firstly is the prerequisite whatever the culture.

Where achieved the integration of health and social care can act as a diagonal brace as it straddles two care domains. Perhaps the model also reflects the ongoing challenges of parity in esteem in mental health care and physical care; and the funding ambiguity for people living with dementia as opposed to other medical conditions?

In January 2014 the FT Weekend magazine also featured an article on ageing in Japan.

Hayashi, M. (2014) Japan's vision of a 'total care' future looks bright, Health Service Journal, 124, 6404, 25-27. 

FT magazine cover image:
https://www.facebook.com/financialtimes/photos/a.10150157857040750.297340.8860325749/10152119294570750/?type=1

Bleeding holism

Holistic, integrated and 

person centered care

 is what happens when 

 respect and empathy 

bleed.

Sense making? miss-il-es civil-ians te-ears

individual

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

group

tears	tears
civilians to defend m i s s i l e s	m i s s i l e s to defend civilians

Source: Various news media over several days - current and past...
 

Two-day symposium ‘Concerning Relations: Sociologies of Conduct, Care and Affect’ 28-29 Nov. 2014

We are pleased to announce a two-day symposium ‘Concerning Relations: Sociologies of Conduct, Care and Affect’, 28/29 Nov. 2014, University of Exeter. The aim of this exciting international workshop is to bring together leading researchers, practitioners and scholars from care studies, sociology of health and illness, science and technology studies, humanities and philosophy to rethink care. We also plan to publish the results of the workshop.

This interdisciplinary symposium, funded by Foundation for the Sociology of Health and Illness (FSHI) and Exeter University, aims to interrogate the implications of shifting the focus of health care away from ‘delivery’ towards care as an ongoing everyday accomplishment. The situatedness of care relations and how situated care relations are practiced and experienced are vital to understanding the impacts care has upon patients, families and healthcare staff. This shift represents a contrasting view on care, from one that is predicated upon a discourse of absence (of care) or lack (of dignity) to the affective interactional relations between social actors. Such shifts of focus are of prime concern as care may be viewed less as a commodity which can be lost, saved, traded or withheld, but as a relation that is deeply embedded within institutional contexts, of individuals and the social worlds they inhabit.

This symposium examines spaces of collisions, elisions or alignments of social worlds, within which the affective dimension of social life in healthcare may be fruitfully examined. Drawing upon relational concerns as a distinct and distinctive mode of sociological inquiry, the symposium seeks to develop an understanding of care and its consequences that help us get beyond the economics of care as a commodified and managed form of engagement with the ‘other’. Making this shift has huge potential for addressing long-standing, global concerns around ‘cultures of poor care’ or ‘care as absence’, the seemingly intractable problems that are not readily amenable to a quick or even a slow fix.

The symposium examines how the fix, the cure, remains an issue of perspective. Central questions include:

• What if the ‘problem’ of caring in health care settings was viewed differently, how would the issues be seen through an affective, situated relational perspective, how would an affective orientation resolve or heighten long standing and seemingly intractable problems of institutional care?
• Is the demand for a cure (the fix) a manifestation of a broader political economy at work, is it a question of the mundane interaction order where contemporary modes of conduct reinforces distance, or is the organisational ‘cure’ simply a manifestation of organisational disease?
• Can materials, economies, institutional practices and modes of accounting contribute to poor clinical and managerial conduct and do such devices legitimate a focus away from the patient?

Rather than provide a critique with no visible solution, or provide a simplification of institutional mores, a more cogent question may be what or who is now being cared for. Once such questions of central importance to a relational sociology have been attended to, the case for re-imagining the organization of care as a situated accomplishment can be made, a case based upon sound sociological reasoning. This symposium challenges what it means to care.

The organizers would appreciate general information about your possible participation before 15.07.2014. Please reply to: m.schillmeier AT exeter.ac.uk

Kind regards

Michael Schillmeier (Exeter)
Joanna Latimer (Cardiff)
Paul White (Swansea)
Alexandra Hillman (Cardiff)
----------------------
Professor Michael Schillmeier
Schumpeter Fellow / VolkswagenStiftung
Department of Sociology, Philosophy and Anthropology
Centre for the Studies of Life Sciences
Byrne House
University of Exeter
Exeter EX4 4PJ

New Nuevo Neu
Eventful Bodies: The Cosmopolitics of Illness. Ashgate (forthcoming)

http://www.nanomedizin.soziologie.uni-muenchen.de

Genetic disorder: belief's a-gender

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

group

Y I tell you what you will believe and IF you can have an education!	X Wither women in science and engineering?
X Whose place is this? 'Who' is the community? #BringOurGirlsBack	Y Human Rights for Girls and Boys

[ 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?

International Women's Day 2014 “Equality for women is progress for all” He for She

8 March is International Women’s Day, #IWD2014! 

This year, the theme is “Equality for women is progress for all”.

In order to achieve gender equality, we have to change what it means to be a man. For International
Women’s Day [@UN Women] highlights in its #HeforShe initiative men leaders who stand up for gender equality.

“Women’s empowerment works for men, too. Where men and women have equal rights and opportunities, societies prosper. I am a He for She.”
-Ban Ki-moon, UN Secretary-General. 

See what other prominent men from around the world have to say:
http://owl.li/ucuvz #IWD2014

End of Life Care: Gold Standards Framework (Heaven's door)

INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

PRIMARY CARE	ACUTE CARE
CARE HOMES	DEMENTIA (CARE)

group - population

Looking at a table 'GOLD STANDARDS SET BY BENCHMARK PROGRAMME' (p.23) in Prof. Thomas's HSJ article, I could see an instant fit between the four listed care contexts and the domains of Hodges' model.

There are also many overlaps and of course Hodges' model is an idealised resource. For example,  governance applies across all the above and in that way all can be placed in the POLITICAL domain.

Further points explaining the above includes:

• The GP and primary care seeing the person first not the diagnosis. Again in this sense - respect and dignity we can place all these care specialisms in the INTERPERSONAL. You would hope that primary care 'know' the patient as a person, an individual; or at least through recourse to the primary care record.
• If a care home 'works' it will be able to deliver care almost transparently, it is not a process but a social gathering. It is not the person's home (their home is not something to be forgotten, replaced like their past), but it seeks to emulate this as far as possible. Care is a routine that is also personalised and even at the end of life there is peace, calm and dignity.
• Dementia care is a political challenge, a priority and challenge across all the domains. As in the previous post - what training is provided to Health Care Assistants and other staff? How is the strategy for dementia progressing across all these care environments?

The National Gold Standards Framework Centre in End of Life Care

Thomas, K. (2014) 'End of life care is a litmus test for the whole of the NHS'.  HSJ, 31 January, 124, 6384, 21-23.

a reflection on relaxation or ...?

INTERPERSONAL : SCIENCES
humanistic ------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

group - population

Quotation Search:
http://www.quotationspage.com/search.php3?homesearch=lying+down&startsearch=Search

Zero, One, Fifteen, (Thirty, Sixty...?)

SOCIETY

care-S S-cares

context: UK news media 15 minute carer visits to elderly clients

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

Reflecting on Social Care with Hodges' model

The one, self, me, a person. Carers: ethics (and common sense? when is 15 minutes of 'fame' enough?), demonstration of rapport, empathy, dignity, loneliness, independence. Carer stress. Job satisfaction. Staff knowledge and skills. Observation. Mental state. Mood. Choices - personal preferences. Personal - carer's values. Cognition - Re-cognition. Case review. Individualized care? Expressed concerns (wither...?)

theory: task vs. person-centered care mechanistic aspects of care, travel, geography, arrival, tasks, plan, recording, constraints - esp. time, practical problems encountered. Number of carers involved. Safety. Protective clothing. Seasonal factors. Evidence base? Best practice? Relapse rates? Telecare role? Physical mobility - movement. Systems, processes, logistics and scheduling. Degrees of freedom - flexibility. Data, information, datasets. Admissions - depth of data?

practice: task vs. person-centered care Caring relationship building, trust - very personal - intimate care, subjective: time with someone I like / don't like? Relatives experience. Social care infrastructure - community centers. Ability to go out shopping with a carer. Media: BBC 2 Newsnight 7/10/13; The Times; C4 News. Social contact. Social mores (time?)

Policy, professionalism, recording, outcome measures. Agreement - care plan. Care reviews. Ban on 15 minute visits? Management. Standards. Supervision. Zero hour contracts. Pay and conditions. Staff turnover. Vulnerable adults. Personal development, training. Risk of organization's reputations being damaged. Corporate responsibility, values. 'Value for money'. New commissioning systems. Advocacy (position significant). Whistleblowing. 'Francis effect' increase in nursing posts. HSJ, 25 Oct 2013, p.6. 'Funded establishment'.

group - population

Discount the contract, you can then 'discount' the individual worker and the client.

Care Relationship = Care Transaction

Wikipedia: "15 minutes of fame"

Book review "Clinical Intuition in Psychotherapy: The Neurobiology of Embodied Response"

Clinical intuition is something that in formal learning terms is intangible, but in practice is earned and relied upon as a gift of experience. When I first received this book from the author Terry Marks-Tarlow, leafing through I thought the emphasis was on the neurobiology presaging a rather technical read. The references to brain structures, neocortex, brain waves ... seemed to suggest a reductive approach, remote from my conception of intuition in clinical practice. I need not have worried, the initial discussion on the brain and evolutionary development is not just a foundation for what follows but as the title suggests underpins and integrates the whole text. Despite the title and as the foreward advises you do not have to be a psychotherapist to read and appreciate this book. The stall is set from the outset in the introduction which explains that chapter one defines clinical intuition:

Clinical intuition is defined from a neurobiological perspective as a right-brain, fully embodied mode of perceiving, relating, and responding to the ongoing flows and changing dynamics of psychotherapy. (p.3)

The introductory material here is essential foundation reading for people starting a career in psychology and mental health related disciplines. The evolutionary development of the brain from reptile through to the mammalian brain is invaluable. Tying this to specific brain functions and circuits - care, fear, panic, play, lust, rage and seeking - helps integrate brain anatomy, perception, emotion, and behaviour. The advances in neurobiology to follow will no doubt demand that we all extend our understanding of this interdisciplinary fusion.

The book itself (hardback edition) is very well produced, the type face easy to read and the book well structured and with a well balanced mix of illustrations and photographs. The reference listing at the end runs over thirteen pages and is well grounded historically and in having regard to ongoing research. The index is comprehensive (fourteen pages) and a resource itself providing a look-up approach. The book's use of case studies, thirteen in total informs the text and provides some continuity through the book. Dialogue between therapist and client is easy to follow and illustrations are provided with ample explanation in situ. The references also utilize web-based resources.

I recall intuition coming up as a thread on several occasions on the psychiatric-nursing list especially between 1998 and 2004. Intuition is a central quality for all personnel working in health and social care. We must also recognise intuition as a human trait as when non-health professionals exercise the judgement that: "Wait a minute, we need a clinical opinion here." Self-care is also discussed. I had a Pythonesque moment - "Is this the right room for an argument?" - considering psychotherapy as a therapeutic modality within therapies as a whole. Here in the UK (and no doubt elsewhere) self, brief and solution based therapies rule economically. Even though the shortage of psychological intervention is recognised in the UK through IAPT improving access to psychological therapies, we need to ask: how does psychotherapy fare in the current (austerity) climate? To what extent can clinicians exercise intuition? Therapy relies on caseness, relationships and narrative, but to what extent can these be acknowledged and delivered within the economical time frames that frequently operate? 

Although there's no specific chapter on training for clinical intuition, Marks-Tarlow provides a list of how researchers have characterized clinical intuition (more recently in the 1980-1990s); five characteristics are proposed:

• Sudden recognition;
• Immediate knowledge;
• Emergent awareness;
• Non-verbal insight; and 
• Holistic integrative sensibilities. (pp.42-43).

 Of the first two sudden recognition and immediate knowledge, I thought of the intuitive sense that is applied upon receiving a referral. That is the assumptions (not always helpful) that arise from the information provided (and missing) and where this leads you? But of course, is this clinical intuition? Intuition as the author makes clear (p.3 and) throughout the book is in psychotherapy. Intuition here (and for me) depends on interpersonal - therapeutic - interaction. What precedes is something else (data integration, hypothesizing, reasoning...?). I can however still see explanatory avenues in the above that can help us travel from the conceptual (reduced) to a holistic whole. I did wonder about the role of intuition in suicidal ideation and risk management, but this is also a question of referral criteria and caseness.

I would very much like to write myself about information and complexity and these themes recur in the text, especially the latter. Several 'spaces' are discussed too: social, physical and spatial schemas. The work of Buzsáki on the hippocampus, navigation and maps - landmark navigation - is fascinating in chapter 7 Navigating the Seas. I have likened Hodges' model to a cognitive periplus - an ancient maritime map. Over the next few months I'll post some quotes from the book.

This is an excellent book that I heartily recommend. The discussion of what is implicit in the brain and so in therapy, what is embodied and wisdom in mentoring invites re-reading. Finally but vitally there is much humour and humanity here too.

Many thanks to Terry Marks-Tarlow for the review copy.

A New Dynamic of Ageing: The NDA Programme & Age UK research showcase of the decade

London, The Business Design Centre, 52 Upper Street, Greater London N1 0QH

You’ll know that the UK population is ageing. You’ll know that there is significant work to be done to be better prepared for ageing in our society. So it’s crucial that all of us who work in and for later life use latest evidence on ageing to support those preparations. The New Dynamics of Ageing (NDA) Programme and Age UK are proud to provide a unique opportunity to present that evidence at our joint event, held on Monday 21 October, at the stylish Business Design Centre, Islington, London.

This is the ageing research showcase of the decade, presenting the most comprehensive selection of state-of-the-art ageing research ever seen in the UK. This includes active ageing, quality of life, independence, dignity, money, work, environments, participation and connectivity to name a few. Throughout the day, you can hear from high profile speakers, pick up latest knowledge through our themed sessions, interact with exhibits in our innovative marketplace and meet the researchers. It will also be your chance to network with a wide range of colleagues from the public, private and charity sectors.

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

Hope to see you there! PJ

6Cs Live! Story of the Month - Competition

Dear Peter,

We wanted to let you know about our new and exciting Story of the Month competition, in partnership with Nursing Times online.

This is your chance to really shout about the great work that you or your team is doing that underpins the values of the 6Cs – and what’s more, if you win you will be featured in Nursing Times online and 6Cs Live! Communications Hub.

So please take the time to fill in the short entry form on the 6Cs! Live Communication Hub – it’s not too long and time consuming we promise. 

Click here to find out more and access all the information you need.

Each month the entries will be reviewed by four judges, Matthew Hodson (COPD Nurse Consultant at the Homerton University Hospital, London), Sam Sherrington (Head of Nursing and Midwifery Strategy at NHS England), Jenni Middleton (editor of Nursing Times) and Matt King who is a lawyer, professional speaker, charity campaigner and 6Cs Live! Patient Champion.

The deadline for August entries is Friday 2^nd August so you’ve still got a chance to be our first winner of ‘Story of the Month’.

We look forward to hearing from you and good luck!

If you have any questions please email us.

6Cs Live! Team

Don't forget to make your 6Cs Live! pledge: www.6cs.england.nhs.uk

Manet & the art of nursing - never unresolved: (and The Francis report)

Yesterday I travelled to London for a nurse related meeting and used the opportunity from 8pm - 11pm to take in the Manet exhibition at the Royal Academy of Arts. Brilliant! It is a great event. There really is no comparison apart from the very high resolution close examination that our technology makes possible; but then that is a difference experience, a different purpose.

Manet's work at the RA includes paintings that do appear unfinished. Areas of the canvas being unresolved brings home the relationship and dependency of the artist with the subject, and the artist's approach to portraiture. Manet was quite demanding on his subjects apparently and while not completely averse, he did not routinely rely on the new opportunities that photography afforded. Here are some thoughts from the Art Fund website:

'Summer' or 'The Amazon', by Edouard Manet

Manet was a great risk-taker and critics of day rallied against his inconsistent approach, as you will see many of the works seem 'unresolved' or 'unfinished' but one of Manet's great skills was this ability to stop painting at the right moment, and it is this technique which gives the works a sense of movement and life.

Manet once said to his friend Antonin Proust, 'I must be seen whole. Don't let me go piecemeal into the public collections; I would not be fairly judged.' This exhibition, which brings together the largest selection of works by the artist to be exhibited together in a UK museum, is a great opportunity to judge Manet's extraordinary talent as a 'whole'.

In nursing we are accustomed to impatient patients. Many though have no choice but to 'sit' and 'lie'. They are static, not able to walk or run away.

Unconscious patients - we speak to them: redrawing the outlines. Searching verbally where we cannot go, reaching for the centers of personhood. We sculpt them back to their optimal health. Sometimes the brush strokes are urgent, sometimes we improvise with touch.

All the time an ideal: a portrait of care. No matter how busy we are basic nursing care should never remain unresolved.

That part of the canvas is always completed. The outline is integrated. The horizon, foreground, middle and background may be sketchy in the extreme cases, but the real mission critical bases are covered.

What we should never countenance, collude, or indirectly sanction are the cutting of those bases.

If we do the work of art is not just unfinished: it is corrupt.

The Francis Report

Anagram graphic c/o Wordsmith

Manet's 'The Amazon' from: Reproarte.com

Extrasolar planets, x-phi and The Francis report

I'm sure there is a planet out there - extrasolar - with the physical make-up such that be it an incredible water fall, tidal surge, or rolling polished mega-rocks - the noise, could we hear it, would do far more than make your ears bleed.

Today, here in England there is a legal, health and political media event of very serious import. The ruckus in health and political circles might also make for more than bleeding noses and definitely thousands of continuing broken hearts.

The Francis report will be published today. Further insights and findings will be revealed c/o the Public Inquiry with recommendations on the Mid Staffordshire NHS Foundation Trust health care debacle.

In Philosophy Now Jan/Feb 2013 Tibor Fischer's editorial mentions the need for marketing within philosophy and literature, with the suggestion of placing x-phi on a T-shirt.

'X-phi' of course reads as experimental philosophy.

In health care, nursing and social care evidence counts for everything (and for h2cm too). Evidence based practice that is founded upon research is essential. Experiments are needed that can be reproduced, extended, validated. ...

Today is a profoundly sad day for everyone in the NHS, as many commentators have already predicted. The future constantly beckons, but today reflect we must that in the clamour for evidence based care, does this mean we must don T-shirts?:

x-care

Have we forgotten the principles of what it is to care: compassion - our duty of care?

No, but amid the cacophony of technology, technical care, the targets, statistics, budget cuts, the challenges to morale and nursing's values we need to be ever more vigilant.

We must learn how to x-listen and x-shout in the 21st century health care environment(s).

But experiments in how to listen, how to blow a whistle? Surely not.

Well yes: as clearly here basic care systems did not work they failed terribly: individually, organisationally and across the FIVE care domains of h2cm.

The Willis Commission on Nursing Education: Recommendations

Here are the recommendations from this commission (the full report is also available):

• Patient centred care should be at the heart of all pre-registration nursing education and continuing professional development.
• There were no shortcomings found in nursing education that could be directly responsible for poor standards of care or a decline in care standards.
• Nurses and their organisations must stand up to be counted on the challenge of poor care and loss of public confidence in order to restore professional pride.
• Nursing education needs to imbed patient safety and dignity as a top priority.
• Better evaluation of and research into nursing education programmes is necessary to ensure a programme that is fit for purpose.
• The future nursing workforce requires nurses to work in a variety of settings.
• Recruitment campaigns need to widen their diversity in order to encourage the widest, best possible range of applicants.
• Health care service providers must fully support nursing education.
• Universities need to recognise nursing as a practice and research discipline.
• Attention needs to be paid to developing a strategic understanding of the nursing workforce as a whole and as a UK-wide resource.

My source: RCN and others

Hodges' model 'Always Waiting' with Michael Kiwanuka

Seeing and listening with Hodges' model:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

	Safety, 'Illness', ...?
LIFE HISTORY, several selves, ...?	LIBERTY ...?

End of Life Care (Pathways), Nursing and Thresholds

There is a controversy (Telegraph) that has been growing for some time, concerning the Liverpool Care Pathway for end of life care. This is a very demanding and yet rewarding aspect of nursing. I have experience of end of life nursing care in a non-specialist capacity, having worked on wards for older adults and being involved with people who have mental health and life-threatening physical health problems.

It pains me greatly not just as a scouser that something with 'Liverpool' in it should become a cause of distress, a center for debate and review. Is the pathway green and shady? Is it comprised of stepping stones, with room for two, and with time granted for your next step? Or is there a danger in some instances the path can become tarmac clad, without the succor of a services stop for basic sustenance? Can a pathway become a motorway? What does that sign say? "DON'T HOG THE MIDDLE LANE!"

What pains me seriously is that what can be a invaluable, evidenced based palliative care resource can be undermined due to the complexity of the generic and palliative care situation.

If we truly practice person-centered care then there are no care pathways.

Or, to put it another way: there are as many care pathways as there are patients and carers.

Whether you believe in social medicine, or private; whether you are laissez-faire, or leave such matters to a higher power there is no escaping the need for organisation - for order.

The mix and concentration of people, knowledge, resources and time dictates that tasks, roles and processes be delineated and assigned. We need to assure a given level of quality, and to predict things, not everything is as difficult as the weather: or death. Pathways can assist in specific contexts.

Is there scope for personalisation on a pathway? ...

Steps and pace can vary and to the left and right of center. There are many pathways though: some valid - evidenced, award winning; while others might be broad, narrow, twisted - to become a disorientating ethical loop...

Being placed on a pathway denotes a decision point, a threshold. We need to remember in all fields of health and social care practice that there are multiple thresholds to be taken into account, communicated effectively and revisited:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

'me' - existence, resilience, assets, personhood, ethics, personal values, mood, personalised care, understanding of treatment, communication skills, self-expression, loss, orientation, observation, distress, psychological assessment, sedation, beliefs, choices, :theology PURPOSE	'me' - existence, feeding, nutrition, fluids,  evidence base, Liverpool care pathway, quality of life measures, referral thresholds, prediction, resilience, reductive - holistic assessment, medication, distance, where: home-hospital-hospice? pain management, decision locale, specialism, basic nursing care, resilience PROCESS
memories, good-byes, love, compassion, carer under stress, reassurance, counselling skills, meetings with family, empathy and rapport, patient and relative engagement, life history, relative's recognition that loved one is dying, care strategies,  patient experts, patient - carer experience, communities of PRACTICE	consent, advocacy, mental capacity,  integrated working, effectiveness, independent autonomy, service access, bed availability, health & nursing in the media, scope of nursing, scope of medicine, law, medicolegal issues, whistleblowing, complaints, formal review, appeals, organisation, argumentation, professionalism, ageism, POLICY (re-PURPOSED)

The relative position of concepts above does not indicate priority.

"The LCP is not the answer to all our needs for care of the dying but is a step in the right direction."

Marie Curie Palliative Care Institute
Liverpool Care Pathway for the Dying Patient (LCP)

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.

IPONS 2012 Leeds - presentation completed and 2013...

As planned I am in Leeds at the moment attending the International Philosophy of Nursing Society (IPONS). The keynotes and other sessions so far have proved really thought provoking, as with talking to other people in the evening.

My presentation was well received and well attended given the total attendees and three concurrent streams.

Two interesting points were raised in questions:

1. the value of a practical example of h2cm in use even in this forum.
2. the most interesting aspect of my 30 minute presentation was the potential research directions I have identified and am trying to pursue. These may extend beyond the model in terms of finalizing a research question. Would Hodges' model need to feature in the question? A very interesting point.

This is a small community, very welcoming and supportive. The conference next year is in Atlanta. There is plenty more to follow at 0900 on the main conference day, so I will add to this post shortly, or post another.

With the IPONS talk 'sorted', one thing that has me preoccupied is the closing date for abstract submissions for the ICN Congress: the 14th! It looks like it will be an individual effort, which I knew was likely.