ࡱ> #%"y5@ bjbj22 2XXe3HHHH48h<8(,,,R x,|,,,HHvvv,Hv,v v6 pt9dSd0d88HHHHDv,,,88v88BOOKLET INTRODUCTION The example within this booklet outlines the community care of a confused, (fictional) older person - Mrs Richards - who likes to be addressed as 'Flo'. Although two professionals may acknowledge and agree with a patient's clinical diagnosis, their own individual HCM assessments will differ in subtle ways. This is part of the HCM's appeal. The HCM can help ensure practitioners adopt a truly holistic approach. Research is required, however, as freedom - lack of constraints - can be a dangerous thing. The format of the HCM also lends itself to peer-group supervision, multidisciplinary work and collaborative care via engagement of carers and families (and possibly communities). In many situations there is no 'correct' formulation, but of course in risk management users will seek to ensure that critical elements of assessment, care planning, and evaluation are included. This requirement - comprehensiveness - and the need for an aide memoir provided the initial stimulus for Brian's creation of the HCM. SHARED RESOURCES We are keen to add further clinical examples to the HCM site, with full acknowledgement to authors. Another objective would be agreement of an XML standard for HCM documents, and translation from assessment to care planning. The HCM web site offers more details: http://www.p-jones.demon.co.uk/ The site includes Brian's original notes - used with permission. HCM INTRODUCTION Hodges Health Career Model (HCM) provides a map upon which health care professionals can record various aspects of a patients care problems. The HCM is also of use to patients and their carers, in achieving collaborative care. Brian E Hodges of Manchester Met. University, U.K. created the HCM to facilitate assessment, initially in Health Visiting with emphasis upon childcare, and learning disability. The HCM was then applied to Community Psychiatric Nursing, its potential extends to all aspects of health care both clinical and management. The HCM comprises two axes, which create four quadrants or 'problem spaces' as per the illustrations below: EMBED Word.Picture.8EMBED Word.Picture.8 Users of the HCM place the desired aspects of care they wish to record onto this framework. Users may also have a HCM template, which can act as an aide mmoire, ensuring all relevant factors are considered. INTERPERSONAL Maintaining safety. Oriented for place when at home, and person Often confused about the time, especially in winter. Flo disturbed in early hours, believes someone is trying to get in her flat. EMPIRICAL (SCIENTIFIC) Flo is susceptible to UTI, which has exacerbated her confusion previously. CT scan shows evidence of multi-infarct dementia. Hypertensive.SOCIOLOGICAL Flo's lives alone. Her husband died five years ago. She has two children and a long-term neighbour friend. Daughter interested in attending group cognitive behavioural therapy for carers. Daughter stays some w/e. Son often away at work. Vulnerability. Risk living alone. POLITICAL (AUTONOMY) Independence - able to make decisions appropriately. Community Support Worker calling weekly. Community Psychiatric Nurse supervising. Carers call 0900 and at night 2130. Family call twice daily. Meals on Wheels at dinner - five days a week. Son or daughter visits at dinner to help Flo prepare her meal, check she eats it, and provide company. 2. Attendance Allowance Request for the same 2-3 carers to visit.  A RATIONALE FOR THIS FORMAT - NOT ITS CONTENT Clinical examples of the HCM readily display its potential utility. Above the use of several forms of notation are apparent: NARRATIVE KEYWORD MULTIDISCIPLINARY MULTIFUNCTION - MULTICONTEXTUAL (Recording, Problem Solving) CURRENT PRIORITY POTENTIAL Free text descriptions of problems may be recorded, [NARRATIVE] or main points outlined [KEYWORDS], boxed [MULTICONTEXTUAL] items above denote problems that extend beyond one HCM quadrant. A number may denote the most current and urgent [PRIORITY]. Problems not recorded are [POTENTIAL] problem areas. In a computer-assisted version, data items could reside in that quadrant, ready to be activated if needed. (The notion expressed in the HCM web site that "space is empty, but not of information" - could then be taken quite literally.) + CARE OF CONFUSED OLDER PERSON IN THE COMMUNITY HCM PRACTICE GUIDE HCM PRACTICE GUIDE DRAFT: PJ-JAN 2003 Px drugs change in policy - 'memory' drugs now more widely available. Mini Mental State Exam = 13 CAPE assessment completed by Occupational Therapist. 1. 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