Excuses found: "premature definition of variables"

Currently reading:

MURPHY E., DINGWALL R., GREATBATCH D., PARKER S., WATSON P. (1999). Qualitative research methods in health technology assessment: a review of the literature. Health Technology Assessment. 2(16), p.84.

http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0008/64826/FullReport-hta2160.pdf

Marshall (1985) presented the flexibility of qualitative research as one of its strengths. She argued that, in qualitative research, the researcher does not assume that (s)he knows, at the outset, the exact nature of the research question. Rather, qualitative research offers the opportunity of discovery. In fact, researchers vary considerably in the extent to which they formulate the precise nature of the research question in advance of the study. Most seek to avoid what Silverman (1993) referred to as “premature definition of variables”.

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Ah, so this is what I've doing!

Yes, but for how long with h2cm, with Drupal...?

1997... 2007...  and counting... :-)

Book review: Values-Based Commissioning of Health and Social Care

This book was a welcome change from the last review, being quite brief in comparison at 155 pages including the index. This isn't a criticism, it just helps in clearing the decks for other reading and distance learning.

The text is no lightweight, however; and should be mandatory reading for all health and social care personnel. Well maybe not all; but that is part of the problem. The clinical and social care workforce are trained to care. Commissioning (and clinical coding) is something done in another location, by other personnel.

If there is a recurring criticism of public services it is that they are cossetted, protected, removed from many of the financial realities of the world. The book, published in 2012, was written anticipating the structural and financial change brought in by the Coalition government and the need for austerity. Therefore, the public sector and clinical staff are not  immune from the vagaries of finance as might be assumed. For the past couple of years I've witnessed the regular shakes of the sieve and heard of the same within local authorities.

Christopher Heginbotham's book provides the background and tensions of commissioning and delivers much needed insight on several fronts by conjoining what so often seems remote. The lesson of the book for me is how distinct finance and commissioning are. I can sum this up as: if person-centred clinicians are concerned with sense-making for and with patients and their families, then commissioning is the sense-making of the available finance. Viewed this way you see the importance of commissioning.  Clinicians are concerned with evidence-based care, ethics, the health reforms, outcomes, quality, and of course values. Add to this patient involvement and public engagement and you have a read that opens a field that many clinicians dash by as they manage various clinical priorities.

Chapter 1 and 2 set the scene of values-based commissioning, definitions, the fact-value distinction; and the post-Labour NHS. The health reforms (chapter 3) are central to the text, but despite the date of publication which the author acknowledges there is little loss of significance. The health and social care commissioning landscape is still taking shape, outcomes based commissioning (chapter 9) can make the news as implementation is delayed (Williams, 2013). Chapter 4 describes the seven fat years followed by seven lean years; an excellent overview with the major influences at work, The Wanless Reports and Marmot Review for example. It is salutary in these times to see NPfIT as a footnote, with IT benefits still to be accrued (p.32). The need to respond to the public health challenges are noted (chapter 6), as with the potential mental health impact of climate change.

The book's figures and tables are a great asset, very useful to educate student nurses about commissioning, value and values. There are a couple of references to colour (p.72) in what are black and white - grey illustrations. 'Reading' the diagrams you can follow them. The author's background comes across, as with location and mental health experience. The book is I believe relevant to readers across all sectors. Heginbotham also indicates that the book is one of a series by CUP, and points to Fulford et al. as a sibling. There are a couple of repeated words but otherwise the production is excellent.  I was a little surprised to find a catastrophe in the text - catastrophe theory (p.51). It is well deployed in explaining complexity and values. When I say surprised perhaps I would really like to see more on this theme of complexity and emergence, but Mr Heginbotham stays clearly on track.

My bias - Hodges' model - found the following standout points:

The number of sentences and figures that describe the individual, group, community and population (the structure of Hodges' model). The way that values can act as a counterpoint and essential adjunct to evidence (subjective - objective; qualitative - quantitative).

Some situations are more biological than others - in certain sorts of surgery, for example - and some have a much larger values base - such as in psychiatry (p.40).

 Reference to (Cronje and Fullan, 2003):

The medical literature demonstrates an equivocal attitude which suggests a 'collective need to better integrate scientific quantitative data . . . and the art of human judgement . . . into a common definition of "rational" medical practice (p.40).

Figure 7.8 Filtering the evidence through a values-based matrix (values across four care domains?).

The use of models to test the real world and reference to a values space.

I posted previously about the nhm - new holistic model (p.80).
(back to the review..!)

Technical aspects (a law and index) and ethical issues that beset commissioning are introduced (space is limited), and recur helping to integrate the book as a whole. Chapter 5 deals with public involvement and engagement and how it can be enacted. Chapter 7 on integrative commissioning invariably raises patient and service user care pathways.

Is this the Rorschach test for patient, care professional and commissioner: please draw your care pathway? 

The book admirably deals with the ideal and realised in the space available. As such even when there is a linear care pathway it is how it is experienced that counts (values and outcomes...). (It is sadly the person-affirming life-story pathway that is so often lost.) 

Perhaps, this is what I have in mind above in referring to emergence. Despite the existence of care pathways in practice the route in-through health and social care is probably found in a rather chaotic way (sudden care transitions); with delays, placement changes, ward movement(s)-stasis, choices to be taken into account, lack of attendance, missed appointments. ... This is why trying to define pathways may certainly assist, but it is the granularity of those definitions and their experience that snags at our clothes along the way. As Heginbotham advises - care pathways are not something to use in a slavish way. This excellent and well referenced book should provoke and establish interest in this very important health and social care activity. An activity and process that must be informed by the values of the public and those of patients and be more than a process, but realised in shared purposes and practise.

Many thanks to CUP for the copy.

Williams, D. Trust forces delay in outcomes based commissioning plan, Health Service Journal, 6 December 2013. p. 4-5.

Heginbotham, C. (2012) Values-Based Commissioning of Health and Social Care. Cambridge, Cambridge University Press.

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.

Book review: "Selfhood"

The vertical axis of Hodges' model denotes the individual and hence the self, the person and the group, the populous. As such when I came across Dr Terry Lynch's book Selfhood it was ideal as a book review candidate.

The book declares itself as a self-help book and clearly and quickly qualifies in this through its content. Section two of the book from page 51 through to page 272 (of 281 in total) is devoted to raising an individual's level of selfhood.

At first I wondered if this was going to be a fuzzy read that might also prove repetitious. I'll explain the latter shortly. The former does not apply, even though the 'self' is a very fuzzy concept especially in the hands of philosophers. Some of the content in section two may well overlap, but amongst self-awareness, self-talk, self-care, self-contact – these contributing components to selfhood are clearly explained.  The book utilises diagrams throughout, from page 3; and these support the text and are used to cross reference material.

Section one on basic principles and concepts fosters a sense of self-regulation for the self-help that the intended readership will pursue. The need to take one’s time with recovery of selfhood is stressed initially, the reader reminded of this through the actions, minimising the perception and occurrence of failure. There is no crash program and pacing is vital, small steps, return to some actions if necessary we are told early on. While not stated explicitly section one helps to foster hope. Although this is a self-help book, resort to a good therapist is mentioned on a couple of occasions. The central risk to the self of suicide is also examined and given due regard in terms of safety.

There is little new in a technical sense for a mental health professional, but the way the ideas are explained is very informative. The diagrams and the metaphors that are sometimes employed are very useful as teaching aids. If you are at the latter stages of your career then self-actualisation (p.258), as ever, and  creativity provides hope. I did wonder about the reading-grammar level and how this might exclude some people. Could this be another project? I enjoyed reading of the need to create a life-long solid level of selfhood (p.40), which also emphasizes the general need for life-long learning. Relating selfhood to overall 'health literacy' might be informative. You will not find assessment and methods here, which is liberating. Assessment is integral to the reflective process but not explicit and process bound as it is in mental health services. This may in itself provide a benchmark for the future progress of 'selfhood' and health literacy?

One thing I am still reflecting upon - is distinguishing between being able to have an overview of the route to selfhood and having a ‘big picture’ – holistic - perspective of ones situation (p.42). This concern resurfaced in the risk of being overwhelmed by the ‘big picture’ (p.45) and here am I wondering about the therapeutic uses of the big picture – as a summariser - ready reckoner for health, social care and recovery. 

As a champion for Hodges’ model I can also identify with the call for a flexible balance between the two poles of self and others and the call to reflect carefully. Action as harmony of action (p.54) amid the frequent chaos of our lives and health care systems is a very helpful definition. If you seek another perspective on self-efficacy there's a lead here. I was struck by the first case study about Craig and his initial wish for self-admission to hospital. I smiled somewhat ruefully at this, considering the changes in the number of NHS beds (-1700 HSJ) even in the brief years since Lynch’s book was written and published in 2011. This stresses the need for self-care and supports the advent of the 'recovery' movement in mental health. 

My previous note regards the literacy level of readers, is obviously a factor as users are encouraged to reflect upon each selfhood component and also write a diary/journal. The spatial definitions of selfhood also engaged me, given my preoccupation with cognitive spaces. This discussion of physical space, self, personal space and self-centredness and the notion of polluted environment in the context of emotions and feelings prompted much reflection.

At the end the reader is invited to read through the text again. I can see how a second pass and one that uses the book as a self-help manual could pay dividends. The self-help quality of the book is clear as after each attribute is described several actions are outlined. There are affirmations for the reader to utilise that are also listed in an appendix. The case histories should assist readers, who seeking to improve or recover their level of selfhood, may identify with at least one of several. The thought about repetition is not surprising as this is self-soup so to speak. There are just short of sixty instances of self-'  ' in the very helpful index.

Ultimately, this is not so much a statement about the book but perhaps the mental health challenge that faces the self in dealing with the other and the world at large. Overall the books 281 pages reveal the rich complexity of a vital concept and contributor to mental health and wellbeing. This is a very practical book which is to say it is an excellent self-help book.

Lynch, T. (2011) SELFHOOD, Limerick, Mental Health Publishing.

Immortality, the matrix and Hodges' model

The 5th care - knowledge - domain is the Spiritual

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

floating off as souls	not dying
coming back to life	living on through legacy

group - population

My source: FT Weekend March 31 - April 1 2012, Memento mori, Book review by Julian Baggani of Stephen Cave's Immortality: The Quest to Live Forever and How It Drives Civilization.

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.

Review: Philosophical And Theoretical Perspectives For Advanced Nursing Practice

http://www.jblearning.com/catalog/9780763765705/

If you are a miner for insight, a pearl diver for knowledge or seeking blue sky wisdom this book can deliver and sign-post in plenty through its references. In summary: this book is a history book that nods at futurology.

I had high expectations for the text, also anticipating an exacting read. After all, as a 5th edition this is a well established text. The expectations were not wholly realized, however; many of the papers are quite dated being published originally in the 1990s.

The book is an important collection and can certainly be regarded as essential reading for advanced nursing practitioners and those pursuing post-graduate nursing studies. Several chapters hail from the same journal publisher and perhaps - as a positive - this contributes to the readable and accessible style throughout the book. The text format and size are also easy to read. I found one spelling mistake within the index entry for 'diagnosis' p.387. In addition to the historical development in part 1 the book's division into five parts - 31 chapters in total - acknowledges the reliance on the past and from it appears from a previous edition the arrival of the 21st century. Apart from the current date of issue 2013 I cannot accurately place the most recent additions to the volume. The contents listing and preface are limited in this respect. Judging from the references they are not that recent. 2010 is one of the most recent references I could find, and this, the 75ed of Toby & Mariner.

Many of the papers are seminal and include an overview of particular aspects of nursing thought - analysis and synthesis. Unsurprisingly, there is philosophy and ethics in great abundance, together with ecocentricism, several forms of feminism, aboriginal peoples and their world views, evidence, health, beliefs, art, professionalism, research, patterns, advanced practice, theory and much more. The distinction between evidence based theory and evidence based practice is something of which all nurse students should be aware.

There is specific reference to Advanced Nursing Practitioners. There could obviously be some variation in how this professional group are considered as opposed to Advanced Nursing Practice. Having just returned from Belfast and the University of Ulster there is ongoing currency in McCormack's chapter 17 A Conceptual Framework for Person Centered Practice with Older People. While dated 2003 McCormack's work was emphasized at a recent conference in Ulster I was able to attend (and there are plans for another). I am sure other chapters may be enlivened by such reviewer found co-incidences as this.

I wonder if the scope of the book and acknowledgement of the passing of time seems to shout for a two-volumed approach. As suggested above, the previous acknowledgement of the future seems to have hailed from the 20th century and got lost. We are now after all more than a 1/10 of the way into the 21st century.

Having started my nursing career in the RN, chapter 22 on military metaphor in nursing and the need for another. A researcher contacted me several years ago about using Hodges' model (a conceptual framework) in a study on bullying in nursing. I've never heard anything since, but Hodges' can help in such research in two respects. The inclusion of a political domain and the organization of groups of people, emphasizes process, procedure, protocol, routine, and may proceed to regimentation, discipline, hierarchy so to a degree language games will follow. As this chapter notes, several professions, including nursing are said to eat their young. A commentary after the chapter provides a useful balance and makes this point. The chapter is nonetheless a reminder of the role of language and how professionalism arises and is sustained (disciplines too?). The proposal of frontier as a new metaphor is fitting as Hodges' model identifies five conceptual fronts - frontiers that must be integrated. 

As a frontier - Chapter 21 on rapture and suffering with technology in nursing holds many lessons and insights. Heidegger's "standing reserve", the human-technology interface, what it means to live like a human being and the distinction of being a human being. Mobile technology, m-health, e-health are making a huge contribution to global health and need a place here. I found Macurdy's four principles 326-327 on what patients need to assume power and control over their care very illuminating, especially in highlighting information access and the importance of health literacy.

In the text and the index I could not find specific reference to capacity, as in mental capacity, informatics, global health, information (access), justice, law, legal, management, human rights, literacy, mental, political, psych-, long-term medical conditions and recovery. While the book would become incoherent if a disease/diagnosis-based approach was adopted, we might ask: does dementia deserve specific inclusion? This is an interesting (and potentially vociferous) debate in itself - to what extent should such a book record change through several decades? Of course the book is not an encyclopedia and it is easy to critique according to omission. These are pressing times demographically, however; while there is a population focus: global communities and aboriginal communities in chapter 23 and 24, this merely scratches the surface of very large world.

This book is a valuable asset and has stimulated many ideas here (and potential blog posts). I am very pleased to have read it and would recommend it to students and practitioners alike. I am grateful to the publishers for the review copy.

Book review: Nursing Knowledge: Science, Practice, and Philosophy

Searching for an up-to-date nursing theory book I wanted something different from the usual fare. The usual fare being a description of the various nursing theories, models and frameworks to date. I needed a text that would help me in two ways: firstly, deal with and critique the foundations of nursing theory; secondly, to provide some insights that would inform my own study into Hodges' model. I quickly found a book with a bonus: it is written by a philosopher.

Mark Risjord's - Nursing Knowledge: Science, Practice, and Philosophy (Wiley-Blackwell, 2010).

This is not a large book considering the literature within its potential purview at just 246 pages in total. The text is very readable both visually and in style. Even if points need to be re-read this isn't a chore. Evidence of structure and discipline runs from paragraphs to the overall division into seven parts, with the usual reference listing and index. As a nursing student of the late 70s and early 80s this book needed to reframe this subject for lifelong learning student of the 2010s. Risjord starts by examining the history - prehistory no less - of the problem. 

Key questions that have arisen in nursing and directed thought are discussed. The influence of what was happening simultaneously in the philosophy of science and culture is also related. The writing is succinct (as already suggested) on page 18 we have an explanation for the appearance of the relevance gap, how this gap endures and how it might be closed.

Central to the demographic, media and political challenges that nursing faces part II covers values. This brings in nursing's standpoint and more direct reference to cultural influences on nursing knowledge in particular feminism. This discussion is again brief, standpoints are very relevant for me. The combination of depth of analysis, brevity with a clear focus are a great achievement. A lesson in how to write, how to argue, how to communicate. You can only do this if you know your subject.

If I missed anything it is technology and information, but the book is probably all the better for this whether considered an omission or diversion. Seeing specific reference to multidisciplinary in the index and a discussion of nursing knowledge in relation to other disciplines would be helpful. Risjord's purpose for this book is however, clear from start to finish. It's there in the title. The book is no glossary, or dictionary, and yet the treatment of many concepts here, such as; axioms, borrowed theory, coherence, context, grand theory, and paradigm (a chapter)... will help reader's appreciate their definition and use. Seminal papers from the literature are identified and re-examined. Much of the book is devoted to research and methods with illustrative examples.

There is much to inform my studies, in particular chapter 15: Conceptual models and the fate of grand theory. Here I can conclude from Risjord that Hodges' model creates an orientation picture rather than an abstraction picture:

On this understanding, nursing models are expressions of the philosophical background to nursing research. Conceptual models orient research and practice by guiding the selection of problems or making phenomena salient. They make no theoretical pronouncements. A conceptual model can guide research and practice only in the light of some values and goals. Nursing values and goals are thus crucial components of the conceptual model on the orientation picture. They set the agenda for nursing research by articulating what is important. p.173.  

I've long considered Hodges' model to be a map. Initially, a blank map - a space within which values can be deliberated. In pedalling this particular bike since 1998 I know how tired nursing theory is. Now students don't need to get on the bike, they stand on one pedal and freewheel the short distance that represents the curricula space devoted to nursing theory (and philosophy). A packed curriculum provides the momentum for the (values) by-pass. Mark Risjord concludes with new questions about nursing theory, new maps and new directions. I've outlined other points from the text for future reference. This book will remain a companion for quite some time: a great compass.

Acknowledgement: Many thanks to Wiley-Blackwell for the review copy.

Tied to the mast: achieving anonymity

It isn't just me - is it?
Other people must have this problem.
No?

It isn't that it's an embarrassing body problem -
although time will tell on that
- it's just Frustrating.

If you venture to write a paper for publication then the submission process usually asks you to render the paper Anon. This makes good sense: right and proper. While some scholars can spend decades on a specific problem, or project the majority of academics must be fleet of foot. Usually, they have to  chase funding, publish, publish and shift from flower to flower garnering citations and increasing aplomb. There must be exceptions I suppose, were researchers become a 'known' quantity, associated not just with particular research subject, but with a set of peers and establishments. Of course I'm Generalizing.

Here though I can't help wishing it was different - that's what this mission is all about. Trying to get other people on board, to recognize the potential value of Hodges' model in health, social care and beyond.

Speaking
of
beyond
it is

marvellous 

to note that the past two days have seen over 100 

visitors 

to 

W2tQ. 

Thanks

everyone.

As to the anonymity bit, well I've climbed the pole, I've balanced on the beam and yet sadly this new gymnastic element the anonistic-maneuver is beyond me.

I don't want to moan, but in this case models offer no anonymity.

If I could hide I would: the long and short of it is I'm stuck ....

If it is not Brian Hodges himself writing about the model, then who is?

Now clearly I'm no Odysseus, but it seems I'm tied to this thing. This conceptual contraption. This mast.

Jokes aside though, it makes you wonder how many other innovations, worthy projects, ideas of merit, struggle against what appears to be a figure ground illusion?

You see with h2cm even when duly anonymised -  one moment we have an unknown - a personally, politically neutral entity. The next moment - ah! hold on. Now I can see who it is and hear this 4-track song.

Oh wondrous enchanted music ....


There is a way around this...!

Additional link:
http://hodges-model.blogspot.co.uk/2007/01/hodges-model-what-is-it-1-house-of.html

Figure ground labelled image:
http://psylux.psych.tu-dresden.de/i1/kaw/diverses%20Material/www.illusionworks.com/html/figure_ground.html
Odysseus image source:
http://www.prospectmagazine.co.uk/tag/social-structures/