UK: Health Insights - how innovations support in health and care communities

Hi Peter We are delighted to introduce our new series of Health Insights. These free to attend events for healthcare professionals feature interactive round table activities, news on how the latest innovations support the health and care community, and best practice experiences from NHS Trust colleagues. CLICK HERE TO SEE NEW DATES AND LOCATIONS Starting in Leeds and Newbury this October and held in association with NHS England, each one day conference will feature: Digital Discovery Sessions - facilitated round tables exploring procurement issues An update from NHS England on Tech Funds and Open Source Programme Host Roy Lilley, popular Healthcare Broadcaster, with lively panel debates Speakers will include Rob Webster, CEO of NHS Confederation, Tim Straughan, Director of Health and Innovation at Leeds and Partners, and Clive Kay, Chief Executive of Bradford Teaching Hospitals. REGISTER FREE TODAY We hope to see you at your local Health Insights. Kind regards Samantha Phillips HIMSS UK

ICN and IHTSDO extend collaboration to advance harmonisation of health terminology

Press Information   .   Communiqué de presse   .   Comunicado de prensa

Geneva, Switzerland & Copenhagen, Denmark, 1 September 2014

The International Council of Nurses (ICN) and the International Health Terminology Standards Development Organisation (IHTSDO) today announced an updated collaboration agreement to advance terminology harmonisation and foster interoperability in health information systems.  The new collaboration agreement signed today will be reviewed on completion of the work or in April 2016, whichever is earliest.

The overarching goals of this collaboration are to ensure that nurses worldwide have the tools they need to carry out their jobs effectively, that they are not disenfranchised from the global informatics infrastructure, and that they remain active in the collection of meaningful and useful health information.

As part of the collaboration agreement, ICN, owner of the International Classification for Nursing Practice (ICNP), and IHTSDO, owner of SNOMED CT, have agreed to undertake further work that defines the relations between SNOMED CT and ICNP to enable their interoperability in health information systems globally. It builds on work already undertaken to produce an equivalence table for nursing diagnoses.

In the coming years IHTSDO and ICN will focus on two key areas of work: joint publication of a completed equivalence table between SNOMED CT and ICNP for Nursing Diagnoses, and joint publication of a completed equivalence table between SNOMED CT and ICNP for nursing interventions.

“ICN is delighted to extend our collaboration with IHTSDO,” said David Benton, ICN’s Chief Executive Officer.  “This agreement will be of mutual benefit to both organisations as well as to patients and will improve the description and comparison of nursing practice locally, regionally, nationally and internationally.

“IHTSDO is pleased to be continuing its collaboration with the ICN”, said Jane Millar, Head of Collaboration at IHTSDO. “Our joint work in linking SNOMED CT and ICNP will be of benefit to the nursing profession worldwide to ensure a common understanding and interoperability, and also to support sharing with other members of the healthcare team.”

The first collaborative agreement between the two organisations was signed in 2010, and in January 2014 the cooperation was further advanced by the announcement of an equivalence table between ICNP concepts and SNOMED CT concepts.

Notes to the Editor:

ICN and IHTSDO are the developers of the International Classification for Nursing Practice (ICNP) and SNOMED Clinical Terms (CT), respectively. The ICNP terminology serves a critical role for ICN in representing the domain of nursing practice worldwide, thus providing nurses at all levels with data-based information used for practice, administration, education and research. SNOMED CT is a multidisciplinary healthcare terminology designed to support the entry and retrieval of clinical concepts in electronic record systems and the safe, accurate, and effective exchange of health information.

About ICN:
The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations representing the millions of nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality care for all and sound health policies globally. (www.icn.ch).

About IHTSDO:
IHTSDO determines global standards for health terms, an essential part of improving the health of humankind. Its experts work collaboratively with diverse stakeholders to ensure that SNOMED CT, its world-leading terminology product, is accepted around the world as the common language for health (www.ihtsdo.org).

My source: Amy L Amherdt

Global Research Nurses competition: win attendance to UK research nursing conference

The Global Research Nurses’ network is pleased to announce the second competition for nurses working in clinical research …

THE WINNER WILL BE INVITED TO ATTEND THE ROYAL COLLEGE OF NURSING INTERNATIONAL NURSING RESEARCH CONFERENCE IN NOTTINGHAM, UK, 20th – 22nd APRIL 2015, ALL EXPENSES PAID.

SECOND PRIZE – ONE YEAR’S SUBSCRIPTION TO 2 ONLINE JOURNALS:

THE JOURNAL OF ADVANCED NURSING & THE JOURNAL OF CLINICAL NURSING

To enter, research nurses should write a 1,000-1,500 word article to discuss the role of the research nurse: “Using examples from research projects that you have worked on discuss what skills nurses contribute to a clinical research team.”

Full information and criteria, as well as information on how to upload your entry, can be found at https://globalresearchnurses.tghn.org/extra/competition-2015/

Entries must be received by 31st October 2014. Please share this opportunity widely!

Thanks and kind regards
Tamzin

Tamzin Furtado
Project Manager
The Global Health Network

HIFA profile (and source): Tamzin Furtado is Project Manager of Global Health Trials, UK. Professional interests: Global health, clinical trials. tamzin.furtado AT ndm.ox.ac.uk

Paper: Low-cost strategies to improve dementia care

An interest in health and science invites some thought about chaos, complexity and catastrophe theory. These suggest quite a cold - mechanistic - perspective of reality. So trying to think of clinical and nursing examples beyond fluid dynamics, the heart muscle... to more socially oriented applications demands some creative thinking.

In my work within intermediate support in the community for decades my colleagues and I come across cases were husband, wife, partner have looked their significant other to the nth degree. That degree can include hiding the extent of a person's cognitive problems from other family members. Suddenly there is a real catastrophe as the carer is taken acutely ill and hospitalised.

Left at home soon the dependency is revealed. Trying to negotiate care at home can then be a real challenge.

Alternately, when people living with dementia are hospitalised for physical reasons another host of challenges arise.

I've a relative who works over at Warrington General Hospital and it's great to be able to help highlight a paper written by Michelle Beavan their dementia champion and published in Nursing Times:

Beavan M (2014) Low-cost strategies to improve dementia care. Nursing Times; 110: online issue.

Gender models role models and cognitive models... Discuss?

As a male nurse I have been aware of gender throughout my career ever since my student days (late 1970s-early 80s) - mental health - and then as a student again for two years general nurse training. The cultural, professional and global changes over the past three decades and more have been quite profound all influencing the perspectives and realities of gender in nursing today.

Since 1987-88, when I discovered Hodges' model I was also bound to wonder about gender in terms of:

• the number of male nurse theorists and their contribution (should this matter!)?; 
• other male nurse theorists globally and the influence of other cultural perspectives;
• the need to consider gender of course in terms of 'standpoint' within research;
• Is Hodges' model gender biased as its structure and basis comprised of categories of care concepts is a very masculine activity? (Even though the intention in identifying the boxes is to transcend and integrate them.) Please see below (and no pun intended).
• Therefore nursing (still primarily a female profession) may ignore/discredit the potential of the model?

Possibly, the stand-out feature of Hodges' model is its invitation to categorise and typify. There could be gender-based consequences in how the model is perceived and received, which in turn could affect interest and participation in research on this subject? In designing studies of the model the feminist standpoint might be useful?:

“What, then, about the further charge that making clear-cut classifications of this kind is a very masculine thing to do? … It reaches its peak in empirical science as we know it, itself a very male affair, and it embodies the desire to have control of things and to know what is likely to happen. It issues in the kind of binary opposites we have found feminists, especially postmodernist feminists, decrying so vigorously-antimonies such as thought/language, nature/culture, reason/emotion, theory/practice, white/black, and especially men/women.” Crotty, (1998) p.171.

Crotty, M. (1998) The Foundations of Social Research: Meaning and Perspective in the Research Process. SAGE Publications Ltd.

This post was prompted by an item on GANM (Global Alliance for Nursing and Midwifery)

ICN International Conference 19-23 June 2015 Seoul, Republic of Korea - Global Citizen, Global Nursing

The International Council of Nurses is pleased to send you the link to the Call for Abstracts for the ICN Conference to be held in Seoul, Republic of Korea, 19-23 June 2015.  With the theme “Global Citizen, Global Nursing”, the ICN 2015 Conference will provide a global platform for the dissemination of nursing knowledge and leadership across specialities, cultures and countries.

The extensive ICN 2015 Conference scientific programme will feature keynote and main session invited speakers as well as a wide range of concurrent sessions including dynamic papers accepted through our highly competitive abstract selection process.

To share your ideas, research and expertise on how to provide quality care, improve populations’ equity and access to health care or contribute to further advance nursing knowledge and practice, you are invited to submit an abstract.

The Call for Abstracts provides you with all necessary information to enable you to actively contribute to the scientific and educational content of the ICN 2013 Congress by submitting an abstract on-line at www.icn2015.com

CALL FOR ABSTRACTS NOW AVAILABLE AT www.icn2015.com

Key dates

15 April 2014:	Online submission of abstracts opens
7 October 2014:	Online submission of abstracts closes (midnight GMT)
7 October 2014:	Registration opens
9 December 2014:	Applicants notified of abstract acceptance
11 February 2015:	Deadline for registration of abstract presenters

My source: PAHO

Interested in writing? [ II ] Hodges' Health Career - Care Domains - Model

In the side bar beneath the bibliography (on a desktop) I've listed a few topics worthy of critical attention. The real need is to link practical application of Hodges' model and further some theoretical underpinnings for the model. This is now happening and it's quite a challenge as I chase questionnaires and write up a draft report for next week. This report is set out as a paper using an author's template from a nursing journal.

Trying to get the message out on writing about this free, holistic bandwidth defining, holistic wrangling, (self-) caring info-portal I blogged an appeal of sorts in 2010. Here we are again. The existing topics in that list relate to the original purposes of the model, plus a few 'extras':

• reflection;
• curriculum development;
• case formulation;
• holistic care;
• conceptual spaces

I'll revise the above as a result of this post and ongoing studies at Lancaster University. I will also add the journal to the most recent recovery paper. Expanding on the above for the benefit of anyone interested in using Hodges' model, reflection (as in 2010) is for me the primary purpose of the model.

Reflection: I'm sure that Hodges' model can complement existing and established approaches to reflection. It would be interesting to compare the use of Hodges' model with a control in clinical reflection, reflective practice with a patient/client, and in clinical or managerial supervision. (You see why this is a challenge, and I appreciate it is easy to generate suggestions!)

Curriculum development: If you need a map that incorporates an academic compass (sat-nav even) look no further. Where are the curricula hot-spots and how are they distributed?

Case formulation: There is an existing draft that needs to be revisited at some point, but the scope here is huge in terms of disciplines and applications. As mentioned above it is coming up with questions and research methods.

Holistic care: Is it time to revisit this phrase? Break it apart and put it back together if it still fits?

Is it a damaged good(s)?

Is this a broken currency as it originally did not include the patient as an active participant? Is it one of several linguistic tropes, said in earnest yet what does it mean? How do we measure it? Could there be a role for Hodges' model in defining or measuring it in theory (through the health record) in practice through outcomes that are demonstrably holistic? Does this make sense...? What is this holistic bandwidth that PJ witters on about? Is an informatics metaphor too far, or this a means to a definition?

To conceptual spaces I need to add threshold concepts and there is a literature here for health and social care, something to build upon and post here....

Interested in writing?

Two items can be readily brought together here: 

----- Forwarded Message -----
From: JS Drummond
To: NURSE-PHILOSOPHY AT JISCMAIL.AC.UK
Sent: Tuesday, 22 April 2014, 18:00
Nursing Philosophy (Post)-Graduate Student Essay Prize

Hi Folks,

To interested parties, there is still time to submit an entry for the (Post)-Graduate Student Essay Prize to the Journal, Nursing Philosophy.

Details are on the IPONS website. http://www.ipons.co.uk

Best Wishes,
John Drummond (IPONS)
Sent on behalf of Derek Sellman, Editor, Nursing Philosophy

The latest paper on Hodges' model -

Exploring the Dimensions of Recovery and User Experience

- has progressed to the point were I am awaiting contact from the production office of the International Journal of Person Centered Medicine.

In addition to the (Post)-Graduate appeal with IPONS there may be an opportunity through h2cm. If there are any student nurses and other health care learners interested in models of care and the future, I would be pleased to offer some support on a paper. Perhaps there are personal tutors out there who could also engage? I can't offer a prize, but there is surely a prospect with the journal Advances in Nursing Sciences:

Models of Care for the Future
Vol 38:1 - June 2015
Manuscript Due Date: October 15, 2014
As nations worldwide seek to establish models of care that provide quality and efficiency, nurse leaders are emerging to play a significant role in the development of these models. For this issue of ANS we are seeking manuscripts that provide theoretical underpinnings of creative models of care, as well as evidence that supports their implementation. Manuscripts should be clearly grounded in a nursing perspective; the content can include philosophic, theoretic, empirical or ethical aspects related to the model.

I do have form here - two submissions without success - but the very helpful feedback did result in a publication elsewhere.

With studies of my own I can't write another paper alone, but perhaps I can help others. It's time for me to not just think about the model, but do something with it too. It feels strange finally having questions out there in the field - a small study.

Earlier this week a colleague referred to the model's elegant parsimony. This is definitely a quality of Hodges' model and one that merits exploration with new explorers.

Blog birthdays, a missing model and history

Eight years ago today this blog was born. Last month I came across a backup of some old emails and discovered one of my first related to Hodges' model. This was while attending Bolton College for the Post Graduate Certificate in Education in 1997. I had a project to complete and in researching nursing theory came across a resource by Judy Norris then at the University of Alberta in Edmonton. There was one a model of nursing missing. I'd also visited Alberta (ALTA) twice in 1979 and 1989: wonderful holidays.

19 ‎March ‎1997, ‏‎09:28:38

Hello there.

I'm fairly new to the net and E-mail, but fairly conversant with other aspects of I.T.. I would be very interested in being involved. My E-mail is read once a week, when attending college.

Both nursing informatics and nursing theory have been keen interests for some time. Over Easter I'll have more time to explore and learn.
There is one 'model', which I don't think you have listed, although it is debatable whether it qualifies as a model - the health career model.

Perhaps I could write something up with references, and key questions?
(And also consider the list of work for volunteers.)

Bye for now

Peter
P.S. I hope ALTA is still as beautiful as I remember it.

So, h2cm became the preoccupation and now there is a small research project to complete these next six weeks, Hodges' model within the residential care sector.

Nursing theory links: H2cm Links II (any updates?)

Acknowledgement: Judy Norris
Thanks Judy for your encouragement all those years ago and with this post.

[ganm] International Journal of Africa Nursing Sciences - submit today to this exciting new journal!

Dear colleague,

The International Journal of Africa Nursing Sciences (IJANS) is a new, open access, international scientific journal published by Elsevier. The broad-based journal is founded on two key tenets, i.e. to publish the most exciting research with respect to the subjects of nursing and midwifery in Africa, and secondly, to advance the international understanding and development of nursing and midwifery in Africa, both as a profession and as an academic discipline.

The fully refereed journal will provide a forum for all aspects of nursing and midwifery sciences, especially new trends and advances. The journal calls for original research papers, systematic and scholarly review articles, and critical papers which will stimulate debate on research, policy, theory or philosophy of nursing as related to nursing and midwifery in Africa and technical reports, and short communications, all of which will meet the journal's high academic and ethical standards. Manuscripts of nursing practice, education, management, and research are encouraged. The journal values critical scholarly debate on issues that have strategic significance for educators, practitioners, leaders and policy-makers of nursing and midwifery in Africa.

The journal will seek to publish the highest quality scholarly contributions reflecting the diversity of nursing. It is also inviting international scholars who are engaged with nursing and midwifery in Africa to contribute to the journal.

The IJANS is an open access journal and in 2014 there will be no publication charges for any author.

The Editor, Dr Hester Klopper (CEO, FUNDISA and President, STTI), welcomes submissions at  http://ees.elsevier.com/ijans/

With kind regards,

Tewodros Seyoum Nigussie
Lecturer, Msc in Clinical Midwifery
University of Gondar
Department of Midwifery
PO.Box 196
Email Address : tedysha AT gmail.com

University website @ Gondar: http://www.uog.edu.et/

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/

Call

Send SMS

Add to Skype

You'll need Skype CreditFree via Skype

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. ...

Is it a Ship, Mars Mission I, a Biscuit, IPO, or Cyber Attack ...?

No!

It's a 3rd year student nurse, 

several in fact

launched 

on their careers.

It is quite a poignant life changing and affirming moment for everyone involved. Of course, there are instances were qualification is problematic, but this is about the +ve.

For the student of course, this represents a great achievement and the realisation of the responsibilities that suddenly apply. This is tempered by preceptorship as mentor and sign-off mentors remind and reassure.

Our students have jobs and this is heartening to hear. They really are off and up-and-running.

There are graduation celebrations and parties to follow for them, but this past week I wondered about another way to signify this literally professional defining event. A way that accompanies and yet transcends the final page 'sign-off' that clearly does carry volumes of meaning and learning.

There was a fleeting thought that I shared: should I form an arch with the student's mentor for the student to pass through? A laugh.

Heaven forbid that this week and day should be for any student an anticlimax. Speaking of heaven there are of course pledges out there. Which also includes:

Nursing is an art;

and if it is to be made an art,

it requires as exclusive a devotion,

as hard a preparation,

as any painter's or sculptor's work;

for what is the having to do with

dead canvas or cold marble,

compared with having to do with the

living body - the temple of God's spirit?

It is one of the Fine Arts;

I had almost said

the finest of the Fine Arts

- Florence Nightingale, 1868.

http://www.florencenightingaleexhibit.com/

As I would like to pass on the (twinned-)baton that is Hodges' model, could there be a form of words that can reflect the entry of a new nurse into our midst; an exchange of words that captures the moment for the student, the mentors, nursing and the public we care for and with?

This may seem twee, archaic, a nod to times of formality, the sense of duty, vocation and hierarchy. This wouldn't be about hierarchy, experience yes. It would be reflexive, a dialogue between these 'professionals' that acknowledges the student's rite of passage, the present moment and the collective future of nursing, of caring and their position in time and the professions' values.

18th Annual International Philosophy of Nursing Conference

in association with the International Philosophy of Nursing Society
(IPONS)
September 8th, 9th and 10th, 2014

Hosted by the School of Health Sciences, University of Nottingham, England, UK

Brave new world?
Health, technology and evidence based practice

Nurses have seen some fundamental changes in the way that healthcare is delivered. Body care is at the centre of nursing practice but the nature of that care has been extended beyond the personal, human-to-human contact, and is increasingly refracted through the medium of technological/scientific interventions. The way that these technologies interact with the human dimension does, and should, require critical analysis.This is particularly the case for nurses who are increasingly expected to adopt methods and approaches that change the nature of the nurse patient relationship.  Added to this is the way that clinicians/academics/researchers interact with health care issues, locally as well as globally.

There is an established debate and tension within the evidence based practice literature that illustrates a deep ambivalence about how a holistic approach to clinical practice relates to, enhances, or is undermined by the new health technologies. These include care pathways, systematic reviews of knowledge, the enabling/disabling effects of technology and the putative implication that there is an empiricist and dehumanising process involved in these developments. For example, what happens to the complexity of ethical debates when they are shaped in the form of arguments based on literature reviews? These may wittingly or unwittingly serve as a means of translating complex moral issues into usable clinical regimes that partially mimic meta-analyses. Furthermore we may ask what place narrative knowledge and qualitative experiences may have in this new world of implementation technologies? And how do the new interventions of telemedicine and other policy drivers that emphasise the “hospital-at-home” impact on the ways that nurses carry out health care?

This conference intends to examine these and other issues related to ‘Health, technology, and evidence-based practice’.

CONFERENCE DETAILS

Details of the Conference can now be found at the following link:
http://www.nottingham.ac.uk/conference/fac-mhs/healthsciences/aipnursingconference/index.aspx

These details include the list of Keynote speakers; the venue; a Call for Abstracts; conference registration and accommodation, and transportation. Abstracts of the Keynote speakers and the full Conference Programme will be available soon on the above link.

Any specific queries should be addressed to Dr Stuart Nairn
stuart.nairn AT nottingham.ac.uk

other IPONS posts on W2tQ

ICN and IHTSDO partner to provide a new Informatics Resources for nurses

International Council of Nurses (ICN) and International Health Terminology Standards Development Organization (IHTSDO)
partner to provide a new Informatics Resources for nurses

Geneva, Switzerland, Copenhagen, Denmark, 20 January 2014 - The International Council of Nurses (ICN) and the International Health Terminology Standards Development Organisation (IHTSDO) are pleased to announce an equivalency table between the International Classification for Nursing Practice (ICNP) concepts and SNOMED CT concepts. The table contains ICNP Diagnosis and Outcomes Statements that have semantic equivalencies with SNOMED CT concepts.

ICNP is an international standard that facilitates the description and comparison of nursing practice locally, regionally, nationally and internationally. The ICNP terminology serves a critical role for ICN in facilitating representation of the domain of nursing practice worldwide to promote evidenced based quality care. ICNP provides nurses with content solutions for electronic health records (EHRs) at all levels to support data-based information for use in practice, administration, education and research. SNOMED CT, a multidisciplinary international healthcare terminology, is designed to support the entry and retrieval of clinical concepts in electronic record systems and the safe, accurate, and effective exchange of health information.

“This equivalency table between ICNP and SNOMED CT is a tangible demonstration of how collaboration among standards development organisations can contribute to improved and standardized documentation of healthcare delivery,” noted ICN CEO David Benton. “Greater standardization supports the larger goal of interoperability of systems as well as better understanding of the contributions that each discipline makes to health outcomes and the effective and efficient use of health resources.“

“The IHTSDO is pleased to see this work being made available to users internationally and hopes that there will be feedback on its usage over time in supporting the care of individuals on a multidisciplinary basis. Continued collaboration with ICN is important to the IHTSDO going forward, providing a key link to the nursing profession internationally” said Jane Millar, Head of Collaboration at IHTSDO.

This new product advances the collaboration on terminology development agreed between ICN and IHTSDO in their 2010 harmonization agreement by allowing ICN to make the equivalency table available through its website at the ICNP Download page ( http://www.icn.ch/pillarsprograms/icnp-download/ ). Although this table is not formally endorsed by IHTSDO, persons interested in using it should review the terms of the SNOMED CT Affiliate License before downloading ( www.ihtsdo.org/licence.pdf ).

The product can be a useful resource to nurses and healthcare facilities interested in using SNOMED CT for documentation in EHRs and using ICNP to help identify clinically relevant content for use in documentation of nursing care.

An additional product from ICN, the ICNP Technical Implementation Guide, was also recently released with the intent of supporting ICNP users, from vendors to nurses in care delivery settings. When used alongside documentation available on the IHTSDO website ( http://ihtsdo.org/fileadmin/user_upload/doc/ ), the Implementation Guide will be of particular use to those who choose to access and use the ICNP-SNOMED CT Equivalency Table in that it gives details about applications that use ICNP, approaches to implementation, structure and content of ICNP, and technical overview. The ICNP Implementation Guide is available on the ICN website ( www.icn.ch/pillarsprograms/implementing-icnpr/ ).

My source: Amy L Amherdt, icn-ehealth

Book review: "Nursing Informatics and the Foundation of Knowledge" (long book - long review)

Happy New Year to everyone!

Last spring I requested a book for review and received three c/o and with thanks to Jones & Bartlett Learning Nursing. Finally, I've picked up the second - and about time it seems - as on this first day of 2014 the publishers are planning the 3rd edition. This book provided a break from virtual matters being a door-stop of a book; 538 pages, excluding abbreviations, glossary and index. In addition to this physical rendering the publishers emphasize an online presence for this and other books. Inside the cover there is a card with an access code to unlock the companion website for online resources for readers, students and lecturers. The account setup is straightforward and there are additional student exercises beyond those in the book.

Informatics is by definition a challenge for authors and publishers. Even though published in 2011 - 2012 time is at work. From the outset then the team involved in this text are to be congratulated on what is a monumental task in scale and time.

The foundation of knowledge in the title refers to the adopted conceptual framework - the foundation of knowledge model, which is illustrated at the start of the book's sections and especially section I on the building blocks of nursing informatics.

The foundation of knowledge model was itself quite a hook for me.

The model includes bits, bytes, data and information and from this arise:

• knowledge acquisition
• knowledge processing
• knowledge generation
• and knowledge dissemination

- with all of these influenced by and influencing feedback (there is an illustration in the sample chapter). The model describes people as information systems. Although the diagram presents a structure for the model, and it fits this informatics context very well and provides a link throughout the book it is not convincing in terms of subjects, agents, and knowledge disciplines. Admittedly the foundation of knowledge model is high level like Hodges’ model. Similarly, it is not prescriptive in terms of how events, phenomena are characterised. Data, information, knowledge and wisdom are however, the most fuzzy of concepts and subject to ongoing philosophical debate. I'll reflect a little more on this later. As already noted the model works here and I see online that a couple of students (and no doubt a great many more) have utilised the model in e-portfolios.

Each chapter has a listing of key terms, which are highlighted in the text. There are reflective questions at the end of each chapters. Chapters are concise, well referenced across various media and are all accessible and evident of a great editorship. There are a couple of longer treatments of certain and well chosen topics. Within chapters there are brief diversions in boxes on a related theme, for example in chapter 3, box 3.2 on ‘storage capacities’. I’d almost forgotten about EPROM and RAM, even though I used to purchase computer programs on EPROMS and ROMS in the 90s. Although abbreviations still abound, these abbreviations have become rather transparent now - and may say more about the generational scope of the authors - including this one? If these are going to be included then where is ‘GPU’, ‘SSD’ …? This is a difficult balance to strike, but mention of these struck me as antiquated and date the text. ('GPU' is hardly new - 1998 c/o Nvidia)

With two major companies referred to early on, open source is explained on page 43 and in the examples of software programs that are listed. The book is courageous in several respects introducing the model, listing software and specific technology examples, some of which can be brief in terms of market longevity. The emergence of the cloud is discussed and provides a current flavour, as with usability (‘UX’). Although the authors are clearly leaders and advocates for nursing informatics and the technologic, the enthusiasm is tempered.

The limits and complexity of AI artificial intelligence are raised in addition to the revolutionary progress. Chapter 4 on cognitive informatics I found personally fascinating, as it reassures me about my interest in the potential of combining conceptual spaces, threshold concepts with Hodges’ model. As a result I previously posted items from the book about cognitive informatics and another relating Beauchamp and Childress’s four principles of health care ethics to Hodges’ model.

Chapter 5 continues the consideration of the limits and challenges posed by technology in exploring the theoretical approaches to health care ethics. The standards for e-health ethics will now be tested with the fate of the .health domain (deliberated online at HIFA2015 to follow...). I wonder if this debate will figure in the 3rd edition? Clearly there are implications for the governance of such a domain. As the chapter points out many ethical e-health standards are voluntary.

As an individual and a reviewer of book with international scope and a discipline with international global aspirations you are acutely aware of your parochial situation. When I look at the UK (Northwest England!) and nursing informatics it seems, with some exceptions to have failed to make a mark in nursing. Yes, colleagues and I use an electronic health record, but there is so much more that could be provided in terms of purposes, functionality and reports. The majority of student nurses I speak to do not seem to be primed let alone tutored for the wider informatics world they will enter as practitioners. So much more that could be done with mobile technology, caseload management tools, research tools. Perhaps this is why as I read of - the use of decision support systems and expert systems (p.77) – I thought “Get real!”. How accessible are such tools to the majority of nurses? Speaking from Wigan Pier at least, if it is 'nursing informatics' you seek then you must be westward bound. It appears there is quite a difference in the esteem of nursing informatics in the USA and UK? - and my review reflects this. Jocularity aside there are two serious points here.

1. The book is clearly USA centric, but it really is relevant to readers elsewhere (I thought there might be a problem registering on the website, but there was no .
2. The other point concerns activism.

When there is an opportunity should we advocate for nursing? Is there scope for this within a nursing informatics text? Even in ‘developed’ nations we should take nothing for granted be that the UK - rickets, TB, sexually transmitted diseases in older adults, obesity; or the United States with the potential impact of climate change and health inequality (MacKenzie, 2013, America's hidden epidemic of tropical diseases). The complexity of nursing and health is also apparent while reading that informatics can serve to check compliance with antibiotic regimes, you simultaneously reflect on the need to reduce the general prescribing of antibiotics and the correct administration and management when they are utilized.

My interest in and exposure to informatics and the humanistic-mechanistic axis within Hodges’ model brought me to the socio-technical literature. Even though socio-technical aspects of nursing and nursing informatics abound implicitly in the book (chapter 6, page 100 and elsewhere – chapter 16) ‘sociotechnical’ or ‘socio-technical’ does not have a place in the index. Although they rarely come across it – hence my thoughts above – I explain something of classification and coding to the student nurses who visit our team. Chapter 7 is a very informative contribution on this subject by one of several international contributors (all listed at the book’s start). How can nursing informatics make an impact if nursing students are not aware of the existence of nursing terminologies and approaches – enumerative and ontological - to the same? Nurses should be aware of the international standards associated with their profession - nursing terminologies included. Chapter 8 on nursing roles, competencies and skills prompted me to wonder about other forms of informatics and to what extent there can (should) be dialogue between these other disciplines?

In, Information and Knowledge needs of nurses in the 21st century (chapter 9), as an individual practitioner you are always situated (p.531) in a local nursing experience. I think this is where the model needs to be extended to facilitate the incorporation of local, global and glocal perspectives. Surely informatic's role as the latest technical means to communicate across a diaspora and it seems create a reverse diaspora through online communities and virtual worlds is worthy of a political stance? Global initiatives such as Health Information for All 2015 (what year is it next and still so much to do...) and other groups (maternal and infant care) need nursing's support and this extended information-informatics awareness (wisdom!) might also pay local and national dividends?

Chapter 10 is lengthy as befits legislative matters which nevertheless maintain the readable tone, clearly there is an ongoing evaluation by systems suppliers and users on the potential of the Cloud (Chapter 17). Chapter 11 was a nice surprise and the impact of which I have already referred to in e-portfolios. Individuals act as their own portal – p.187. This is a subject that (I hope) will occupy me for the next couple of years. The use of e-media by nurses for reflective commentary using web publishing tools is addressed very well. Having just ordered a second hand copy of Etienne Wenger’s book on communities of practice I find this discussed here:

In the future it is hoped that the use of communities of practice in nursing will grow beyond knowledge sharing and promote more knowledge discovery and sense making. p.189.

I’m not sure if e-portfolios have affected the EU populace with the rapidity and extent expected (by 2010), but there is a series of ongoing conferences dedicated to the cause. In the 1990s and early 2000s you could not miss the emphasis on benefits realization. If this concept has had its day what exactly happened? (There is no longer a need to prove the worth, potential of the computer at the bedside, nurses station.) We should still focus on outcomes as noted in several  chapters.

The sections also take on a practical – application focus across administration and nursing functions. Open source is further examined p.212. If SQL is mentioned would it help to acknowledge the development of noSQL approaches? Memory and processing power (for indexing) are less of a constraint on systems now. There is another challenge presented to editors: is 2004 really a ‘recent’ study? ‘Recent’ and its synonyms ‘currently’ need to be checked throughout the book and revised accordingly. The same applies to references to demographics and changes in nursing numbers (p.320-321). The trends in the numbers are established and remain, but perhaps there are more up-to-date sources? Throughout the book there are also case studies and pointers to research that provide practical and personal insights to the subject at hand.

While the context is nursing and informatics I think the discussion on ‘health literacy’ requires a critical review. It seems that health literacy may be being construed as synonymous with health technology literacy, computer and information literacy which are also noted in the text. There is admittedly a great deal of overlap.

‘Health literacy’ needs to be considered before a specific health problem arises – it is too late then. Health literacy does not mean, should not be equated with the deployment and use of e-tech applied to people with diabetes, coronary heart disease. Is this specific health education aimed at self-care, relapse prevention, staying well? Is health literacy concerned with positive health?

http://www.healthliteracy.org.uk/why-it-is-important

I’m sure the authors – editors are only too aware of this but this understanding of the wider context of ‘health literacy’ as a field of research and practice is not conveyed at present. I also don't necessarily see a wiki as a search tool, yes you can search a wiki but it is a type of repository and as such the effectiveness of a search must depend on the contributions made and the preceding searches. Perhaps a dedicated wiki could become a form e-grey literature?

A highpoint for this reviewer was to read: Learning is a multispatial function, … (p.406). It certainly is. The discussion on creating learning resources is an excellent introduction, especially on using the electronic health record as the learning resource.

In considering the future chapter 29 does not explicitly utilize the framework of knowledge. This may provide an opportunity to extend the framework to more readily integrate bio-psychosocial-political and spiritual perspectives through time. The framework of knowledge within informatics is a great resource. As mentioned this drew my interest to the book, in 1996 I sought to relate informatics concepts to nursing and mental health (redundancy, entropy.... see bibliography). Whatever the differences between the USA and UK nursing informatics the framework might benefit from a way to integrate context, specific concepts and practices, self-care, interprofessional education and wisdom.

This is a great book, one that is also courageous in its scope and execution. The third edition will be very well worth not just purchasing, but applying. Thanks again to Jones & Bartlett Learning for this copy.

MacKenzie, D. (2013). America's hidden epidemic of tropical diseases, New Scientist. 11 December 2013, 2947.
http://www.newscientist.com/article/mg22029473.200-americas-hidden-epidemic-of-tropical-diseases.html?full=true

 

McGonigle, D., Mastrian, K.G. (2012) Nursing Informatics and the Foundation of Knowledge, Second Edition. Jones & Bartlett Learning, Burlington, MA.

Cognitive Informatics and other forms?

Over the past couple of months I've posted on topics that include an example of Hodges' model related to the post's particular theme. In McGonigle and Mastrian's Nursing Informatics and the Foundation of Knowledge, Second Edition (2012) on page 63 the editors cite Wang (2003):

Cognitive informatics attempts to solve problems in two connected areas in a bidirectional and multidisciplinary approach. In one direction, CI uses informatics and computing techniques to investigate cognitive science problems, such as memory, learning and reasoning; in the other direction, CI uses cognitive theories to investigate problems in informatics, computing and software engineering (p.120). 

I will leave it to you to consider the INTRA-INTERPERSONAL and SCIENCES domains, and not (just) how Wang's cognitive informatics 'fits' within Hodges' model, but what of the many other informatics fields. Here they seem like stepping stones, but taken together where do they lead to, from, ... about ...?


Wang, Y. (2003), Cognitive Informatics: A New Transdisciplinary Research Field, Brain and Mind: A Transdisciplinary Journal of Neuroscience and Neurophilosophy, Vol.4, No.2. pp.115-127.  

H2cm - Beauchamp and Childress (1994) four principles of healthcare ethics

I'm clearing the decks of books at the moment, one of which is McGonigle and Mastrian's Nursing Informatics and the Foundation of Knowledge, Second Edition (2012). I notice a 3rd edition is in preparation.

A review will follow, but in chapter 5 on Ethical Applications of Informatics on page 73 (pb.) the four principles healthcare ethics of Beauchamp and Childress (1994) are mentioned in a very concise, informative discussion.

Although the exercise that follows involves 'putting concepts in boxes', doing so helps us to see beyond the boxes, to see the links between.

Although harm takes several forms it is physical harm (for nonmaleficence) that is most commonly thought of. This is the ethics concerning an individual so why have I placed beneficence in the sociology domain? Justice should be straight forward, but only if reinforced by law, and then only if that law is exercised. Autonomy should be straight forward. I must have the mental capacity, the insight to have choices. In the eyes of others these choices may be rationale or irrational. Although justice is place in the political (group / population) domain, rights are ascribed to individuals. This is useful property of Hodges' model the way that the individual and their mental life are diametrically placed (opposed?) and linked. It is others who are having determine the ethics of a given case, evaluating what is in the person's best interests; also having to take into account any advanced directives, or living wills.

What do you think? If you have some comments, can improve this or feel there is a correspondence here please let me know.

INTERPERSONAL : SCIENCES
SOCIOLOGY : POLITICAL

individual

autonomy	nonmaleficence
beneficence	justice

group - population

• Respect for autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
• Beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
• Non-maleficence - "first, do no harm" (primum non nocere).
• Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).

Above text:

http://en.wikipedia.org/wiki/Medical_ethics

Critical Thinking - Gaining knowledge: Beginners + Experts = audience?

Clearing through books last month with several bound for the charity shops I came across Critical Thinking in Nursing: An Interactive Approach, by Rubenfeld & Sheffer, with the following table (p.30):

	BEGINNERS	EXPERTS
Ways of:
Gaining Knowledge	Assigned readings and asking authorities	Multiple written and verbal sources, and experience
Thinking	Dualistic	Relativistic
Using rules	Context free	Situation dependent
Looking at situations	Narrow	Broad

The table is not remarkable in its theme, but it is a useful prompt for Hodges' model and future studies. The concepts listed might help illustrate how Hodges' model can support learning. In addition to having an individual focus the model can consider any situation, hence the claim that the model is 'situated'. As stated previously person centeredness is not a given. It does not follow, nor is it achieved just because 'person centered' features several times in care philosophies and policies. The person must be put at the center of the model and then each of the domains considered together with the spiritual dimensions.

I'm also reading a nursing informatics book (posts and review to follow) that discusses casuistic ethics, that is case-based reasoning. While the utility of casuistry is debated in nursing, the need to consider the individual is always paramount. A prime example of the focus on the individual is the programme Inside the Ethics Committee on BBC Radio 4. Central to ethics are the frequent dilemmas that arise in health and social care, the difficult moral choices and dichotomies that must be faced. The model can be used in a context free way, that is considering rules in general; and also employed in specific contexts, such as a best interest meeting for a person recently moved into a residential care facility and distressed by the experience.

There are many dichotomies that can be identified in the basic model, and to a certain extent they reflect the dualistic thinking of the beginner as they build an understanding of particular fields of health care. As learners progress they integrate the concepts they encounter and are then able to associate these and relate them to prior learning, the current case and generate hypotheses that may also be predictive. Hodges’ model can frame and help represent student encounters be they narrow or broadening (recognising patterns). Gaining knowledge may need particular attention by the student (mentor and lecturer) in terms of the student's strategies for creating and protecting opportunities as a beginner and competent practitioner.

As a sign-off mentor I’ve become acutely aware – as required - of a learner’s level of skills and knowledge. What is their level of competence? What is their level of situational awareness? How are they progressing through their learning according to previous mentors and their own goals, learning objectives and evaluation? The concept of emotional intelligence is not new and still has the attention of researchers. Perhaps this could also inform questions for research into Hodges’ model as students elaborate their initial representations of nursing care, skills and knowledge through their course and ongoing as experts. Is emotional intelligence central to compassion in nursing? Encompassing all of these ‘ways’ in the table is reflection. This is not just for reflective practice but an ability to critique one's own practice and that of others.

The table is also helpful at this time considering future content and content types and the potential audience of a new website. The challenge is to emulate the table above in the way it reduces, simplifies very complex educational matters. Yesterday afternoon I was able to attend a very helpful two hour research clinic in Lancaster, following this I must (still) reduce the above questions and also recognise my own biases.

Rubenfeld & Sheffer (1994) Critical Thinking in Nursing: An Interactive Approach. 1st Edition, Lippincott Williams and Wilkins.

Surveys, Nursing Education, Drupal and Webform

Just before heading to Drupalcon Prague I learned of a new paper by Gill et al.:

Using a web-based survey tool to undertake a Delphi study: Application for nurse education research

Background: The Internet is increasingly being used as a data collection medium to access research participants. This paper reports on the experience and value of using web-survey software to conduct an eDelphi study to develop Australian critical care course graduate practice standards.
Methods: The eDelphi technique used involved the iterative process of administering three rounds of surveys to a national expert panel. The survey was developed online using SurveyMonkey. Panel members responded to statements using one rating scale for round one and two scales for rounds two and three. Text boxes for panel comments were provided.
Collecting data and providing feedback: For each round, the SurveyMonkey's email tool was used to distribute an individualized email invitation containing the survey web link. The distribution of panel responses, individual responses and a summary of comments were emailed to panel members. Stacked bar charts representing the distribution of responses were generated using the SurveyMonkey software. Panel response rates remained greater than 85% over all rounds.
(in press)

The paper is interesting in combining surveys and an e-variant of the Delphi research method. Conclusions highlight the improved accessibility to experts and how ethics needs to keep pace with technical change and affordances.

Yesterday at Drupalcon there was a presentation on Webform:

Webform 4.0: Surveys in Drupal Improved

I've mocked up a enquiry form using Webform, but this session pointed to how the module can be extended for polls and contact forms. Based on Gill et al. and the eDelphi technique they explain this could be a really powerful combination.


Gill, F.J., et al., Using a web-based survey tool to undertake a Delphi study: Application for nurse education research, Nurse Education Today (2013), http://dx.doi.org/10.1016/j.nedt.2013.02.016

Health 2.0 Europe 2013: Nurses, registration and £££

This year I've really enjoyed the Health 2.0 Manchester chapter meetings and there's some great evening sessions to follow this northern autumn. In June as I posted on W2tQ I also spent a weekend at the NW Health Hack in Knutsford. 

For several months European Health 2.0 conference has been publicized at the Manchester meetings. I was keen to attend until I saw the registration fee even with a 15% reduction. The fee increased yesterday too as I was reminded by Pascal Lardier on twitter:

@pascal_lardier 19 Sep
Today is the last day to pay less for your ticket to @Health2eu Register here: http://www.health2con.com/events/health-2-0-europe-2013-registration/ … #health2con #nhssm #hcsmeu

I retweeted the above and replied to Pascal and Health2eu, telling them what they already know - Health 2.0 rocks! but adding that I thought few nurses would be able to afford the registration fee.

NW Health Hack was a success for me (in addition to our group coming 3rd) because it was free, apart that is from driving there over the weekend on my days off (thanks again to all the sponsors). As the NHS is trying to save money I've also taken some unpaid leave this year.

NHS nurses, like many public sector groups have effectively had a pay cut these past few years. There are other general challenges:

• Are those nurses who might attend already 'onboard'?
• Does nursing engagement itself need a health check (what is 'clinical engagement' now)?
• Much was made of achieving clinical engagement in previous NHS IT projects. How can clinical engagement that reaches nurses be assured now?
• If (technical) innovation is to be a constant stream, please don't leave the nurses on an island: they can set sail too.
• Are nurses, like the one writing this, tainted, having been sat on the fence (health care || ICT) for too long?
• Once projects are established how can nurses, patients and carers stay the course and keep in touch and engaged?
• As 'NHS clinicians' can nurses participate in initiatives such as the forthcoming Code4Health, or will operational constraints limit their involvement?
• How are the socio-technical aspects and outcomes measured (hospital vs. home personal use vs. self-care...) ?
• Is there a golden ratio for the mix of delegates?
• If there's a strategic partner involved where's the strategy?

Pascal sliced through my query and many of the points above:

Pascal Lardier ‏@pascal_lardier 19 Sep
- then they should reach out to me!

So if the World Wide Health 2.0 conferences are of interest to you, do as Pascal suggests. New communities can provide new opportunities. Don't just help make your day, help make tomorrow too.

In 2012 the NHS employed 146,075 doctors, 369,868 qualified nursing staff, and 37,314 managers. 
http://www.nhsconfed.org/priorities/political-engagement/Pages/NHS-statistics.aspx#staff

Additional notes 29 Sept:

Health 2.0 MCR ‏@H20MCR

@h2cm patients are also asking how can @Health2eu Health 2.0 Europe conference be made more accessible for them @pascal_lardier?

Pascal Lardier ‏@pascal_lardier

@H20MCR @h2cm @Health2eu @pascal_lardier they should email me pascal AT health2con.com there is a FREE reg code for them.