principles and practices of integral care: the future of hiv nursing 22 nd annual anac conference...
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Principles and Practices of Integral Care: The Future of HIV
Nursing
22nd Annual ANAC Conference“Reaching Beyond: Collaborating to Build Capacity”
Jacksonville, FloridaNovember 19-22, 2009
Foresight
“Images of the future are the blue prints that we use in constructing our lives”
Cornish, E. (1977). The study of the future. Bethesda, MD: World Future Society.
Wonder
If a time traveler from 50 years in the future could give you the answer to
one question, what would it be?
Pride
If you were looking back 10 years from now and telling the tale of the
organization’s greatest success, what would the story be and why?
Shame
If you were looking back 10 years from now and telling the tale of the
organization’s greatest failure, what would the story be and why?
Memory
What does the organization need to forget?
What must it always remember?
Imperatives
What are the most important strategic decisions we will have to make as an
organization?
Obstacles and Dangers
What will prevent us from succeeding?
What are the greatest risks and dangers?
Priorities
If you had the power to do one thing for the organization, what would it be, and
why?
Future Pacing
• What concepts, tools, techniques are most useful?
• How can information be used?
• Why is information important?
• Why care about the information?
Outcomes
• Identify and apply futures research methods to support advances in the field of HIV nursing
• Describe and discuss and integral care model for HIV Nursing.
Foresight ~ Future Blind
Knowledge ~ Research
Learning ~ Education
Service ~ Practice
Kelso, Scott & Engstrom, D. (2006) The complementary nature. Bradford Books, MIT Press, Boston, MA.
Future Blind
• Lost and trapped in yesterday’s decisions, choices and consequences –become risk aversive
• Betrayed by expectations -must negotiate the expectations of youth with the experience of life
Hudson, Frederic (1999). The Adult Years: Mastering the art of self-renewal. Jossey-Bass: San Francisco.
Future Blind
• Social systems once protective are destabilizing
• Overwhelmed with information and decisions• Bewildered by change, complexity and
discontinuities• Develop discourse of regret versus hope
Hudson, Frederic (1999). The Adult Years: Mastering the art of self-renewal. Jossey-Bass: San Francisco.
Crossing the Quality Chasm
A New Health System for the 21st Century- The Century of
Complexity
http://newton.nap.edu/books/0309072808/html/
Health Care PerformanceCharacteristics
• Safe
• Effective
• Patient- centered
• Timely
• Efficient
• Equitable
A 21st Century Health Care System
• Evidenced based, planned care
• Reorganization of practices
• Systematic attention to patient information needs and behavioral change
• Ready access to clinical expertise
• Supportive information systems
Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st century. Institute of Medicine, National Academy Press, Washington, D.C.
Redesign Challenges
• Redesign care processes
• Effective use of information technologies
• Manage clinical knowledge and skills
• Develop effective teams
• Coordinate across conditions, services, settings, time
• Use of outcome measures for improvement and accountability
Four Futures
• Possible
• Plausible
• Probable
• Preferred
“What the future holds for us depends on what we hold for the
future.”
Mikela and Philip Tarlow
Navigating the Future
Future Studies
The purpose of future studies is not to predict the future, but to envision desirable futures and avoid or prevent catastrophic ones.
Becoming A Futurist
• Pay attention to time and time-spirits.
• Learn about the future.
• Understand people’s reactions to learning about the future.
• Actively monitor industry trends and forecasts.
Becoming a Futurist
• Discern logical consequences of trends using futures thinking tools and techniques.
• Use emotional intelligence in change efforts.
• Create vision-based scenarios.
• Stimulate strategic conversations about espoused visions.
• Consider the value of an integrally informed future.
Time and Time Spirits
Domains of Work
SharedMeaning
Creating valuein the present
Adding valuefor the future
Sustainingvalues
Quality indaily work
Processmanagement &
improvement
Process/systemdesign
Innovation & transformingwork
Strategicdevelopmentof physical &
intellectual capital
Strategic intent asdirection
Strategic intent asviability
Corporate citizenship& stewardship
Meeting present needswithout compromising
future generations
Keith McCandless, 1998Adapted from Hoebecke &
BIOSS
Time Span Responsibilities
Creating valuein the present
Adding valuefor the future
Sustainingvalues
Quality indaily work
Processmanagement &
improvement
Process/systemdesign
Innovation & transformingwork
Strategicdevelopmentof physical &
intellectual capital
Strategic intent asdirection
Strategic intent asviability
Corporate citizenship& stewardship
Meeting present needswithout compromising
future generations
Keith McCandless, 1998Adapted from Hoebecke &
BIOSS
20-50 Years
10-20 Years
5-10 Years
2-5 Years
1-2 Years
3 Months-1 Year
1 Day-3 MonthsMastering the directtouch & feel of worktasks & patient care
Improving step-by-stepdiscrete processes
Connecting & finetuning parts of a system
Modeling & mappingalternative ideas/
practices
Imagining & creatingnew rules & fields of
knowledge
Weaving social, political,economic, global
intelligence
Sensing/perceiving theinterconnectedness of
all things & envisioningnew forms oforganization
50+ Years
Core Work Capabilities
Engaging Stakeholders in Each Domain
Learning About the Future
Future Forces Affecting Education 2006-2016
http://www.kwfdn.org/map/background.aspx
Reactions to Learning About the Future
• Patterns of Mind
• Patterns of Heart
• Patterns of Soul
Actively Monitor Trends and Forecasts
Scanning
Scanning involves searching information resources, consciously (active) or not (passive), for a particular kind (directed) of information which is then subjected to special attention.
Trends and Consequences
• Personal
• Professional
• Organizational
ANAC Future Scan
• Funding and Resources
• Health Care Reform Policy and Politics
• Health Care Provider Person Power
• Patient, Family, Community Response to Treatment
• Medical Advancements in Treatment
• Technology: Electronic Medical Records
• Education, Training, and Research
Discern Consequences of Trends
Trend
• What does this really mean?
• What does this really mean?
• What does this really mean?
• What does this really mean?
• What does this really mean?
Futures Wheel
A futures research method that draws out the consequences and expands the impact of an identified trend or event.
Futures Wheel
The search for consequences continues until three unanimously agreed-upon consequences have been developed.
Cross-Impact Analysis• A futures method
technique used to make judgments about relationships among identified trend consequences.
• A matrix is developed with the identified trends.
• Judgments are made about the positive and negative impact of the trends in relation to one another.
Future Health Scan
• Globalization• Cost containment and outcomes• Advanced personalized therapies• Information infrastructure advances• Human genome project• Predict-and-manage paradigm
Old ParadigmChronic Disease Management
Life ThreatLife Threat
Symptoms EmergeSymptoms Emerge
0
DiagnosisDiagnosis
SalvageSalvage
TreatmentTreatment
AgeAge
Inte
ns
ity
Inte
ns
ity
Source: Health Futures
Diabetes - The Harvest Scenario
Life ThreatLife Threat
Symptoms EmergeSymptoms Emerge
0
InsulinInsulindependencedependence
DialysisDialysis
DiagnosisDiagnosis
TimeTime
Ac
uit
yA
cu
ity
CataractCataractremoval/removal/new lensesnew lenses
AmputationAmputationof limbsof limbs
CardiacCardiacSurgerySurgery
Source: Health Futures
Diabetes - The Prediction & Management Scenario
Life ThreatLife Threat
Symptoms EmergeSymptoms Emerge
0 TimeTime
Ac
uit
yA
cu
ity
Biosensors/regulationBiosensors/regulationArtificial pancreasArtificial pancreasIslet cell transplantationIslet cell transplantationImmunotherapyImmunotherapySerum marker testingSerum marker testing
GeneticGeneticscreeningscreening
Source: Health Futures
• The future happens at the intersection of knowledge and services……
Influence Change With Emotional Intelligence
Emotional Intelligence
• “The ability to sense, understand and effectively apply the power and acumen of emotions as a source of human energy, information, connection and influence”
Cooper, Robert & Sawaf, Ayman. (1997). Executive EQ: Emotional intelligence in leadership & organizations: Grosset/Putnam: New York.
Integral Theory: A Meta Theory and Framework for EvolutionWilber, K. (2007). What is integral theory?
http://in.integralinstitute.org/integral.aspx
"Integral" means comprehensive, inclusive, balanced, not leaving anything out.
Integrative Principles"Integral" means comprehensive, inclusive, balanced,
not leaving anything out.
Nonexclusion : acceptance of truth claims that pass the validity tests for their own paradigms in respective fields
Ennfoldment: sets of practices that are more inclusive, holistic and comprehensive than others
Enactment: various types of inquiry disclose different phenomena depending on the quadrants, levels, lines, states and types of the inquirer.
Wilber, K. (2002d). "Excerpt D” The look of a feeling: The importance of post-structuralism, unpublished manuscript
Kosmic Address: Altitude and Perspective
– Magenta/Red Magic egocentric, the world of magical powers, sacrifices and miracles
– Amber Mythic ethnocentric, the stage of absolute traditional truths, tribal/ethnic beliefs’ myth
– Orange Rational world centric, the level of universal regard, reason and tolerance
– Green Pluralistic –multi world centric, the stage of divinity within all beings, all paths are equal
– Teal/Turquoise Integral –Kosmo centric can shift between all previous levels and see relative truths there
Four QuadrantsSelf and Consciousness
Interior-Individual
Experiences
Subjective
Truthfulness
I
Brain and organism
Exterior-Individual
Behaviors
Objective
Truth
IT
weJustness
Intersubjective
Cultures
Interior-Collective
Culture and Worldview
ITSFunctional-Fit
Interobjective
Systems
Exterior-Collective
Social Systems and Environment
Esbjorn-Hargens, S. (2006). Integral research: A multi-method approach to investigating phenomena.
Constructivism in the Human Sciences,11(2), 79-107.
Integral Methodological Pluralism
Esbjorn-Hargens, S. (2006). Integral research: A multi-method approach to investigating phenomena. Constructivism in the Human
Sciences,11(2), 79-107.
Eight Zones and Methodologies
Esbjorn-Hargens, S. (2006). Integral research: A multi-method approach to investigating phenomena. Constructivism in the Human Sciences,11(2), 79-107.
Phenomenological Inquiry
• Self-Inquiry
• Phenomenology
• Reflection
• Prayer
• Journaling
• Shadow work
• Mindfulness practices
• Truthfulness
• Honesty
• Authentic Expression
• Sincerity
• Integrity
• Identify assumptions, acknowledge bias
• TransformativeEsbjorn-Hargens, S. (2006). Integral research: A multi-method approach to investigating phenomena. Constructivism in the Human Sciences,11(2), 79-107.
Structural Assessment
• Psychometric measures
• Developmental tests
• Video tapes
• Notice speech and behavioral patterns
• Interviews
• Use of established developmental models
• Psychological tests
• Descriptions with analysis
• Triangulation
Esbjorn-Hargens, S. (2006). Integral research: A multi-method approach to investigating phenomena. Constructivism in the Human Sciences,11(2), 79-107.
Hermeneutical - Interpretive
• Interviews, role playing, small group work
• Story telling
• Interpretive analysis, textual analysis
• Collective reflection
• Focus groups
• Gives voice to other
• Serves community
• Mutual understanding
• Resonance
• Meaningful
• Emancipatory
• Symbolic
Esbjorn-Hargens, S. (2006). Integral research: A multi-method approach to investigating phenomena. Constructivism in the Human Sciences,11(2), 79-107.
Ethnomethodology
• Participant Observer
• Appreciative inquiry
• Cultural anthropological techniques
• Coaching
• Mentoring
• Forms of structural analysis
• Cross cultural
• Observation of group dynamics
• Symbolic coherence
• Well documented observations
• Member checks
• Acceptance by group
Esbjorn-Hargens, S. (2006). Integral research: A multi-method approach to investigating phenomena. Constructivism in the Human Sciences,11(2), 79-107.
Empirical Observation
• Surveys, documentation, exams
• Fieldwork observations
• 3rd person description, charts, statistics
• Case studies, gap analysis,
• Capacity development
• Repeatable,
• Controlled conditions
• Empirical, logical
• Measurable
• Use of multiple senses
• Representative samples
Esbjorn-Hargens, S. (2006). Integral research: A multi-method approach to investigating phenomena. Constructivism in the Human Sciences,11(2), 79-107.
Systems Analysis• Statistical analysis
• Mapping
• Scientific studies
• Library research of previous studies
• Monitoring and evaluation
• Functional fit
• Repeatable
• Controlled conditions
• Empirical
• Logical
• Reputable and multiple sources
• Direct experience with the system
Esbjorn-Hargens, S. (2006). Integral research: A multi-method approach to investigating phenomena. Constructivism in the Human Sciences,11(2), 79-107.
Create Vision Based Scenarios
A scenario is a method for telling a story about the future. It can be based on reliable or speculative data.
Scenarios: The Back Side of Vision
Scenario Planning Resources:http://www.well.com/~mb/scenario_planning/
Strategic Conversations
• How plausible does the scenario seem?
• What thoughts does it bring to mind?
• What feelings does it generate?
Strategic Conversations
• What are the implications for society, healthcare and nursing?
• If parts of the scenario are desirable what actions need to be taken to increase the chances of it happening?
• If parts are undesirable what actions need to be taken to prevent them form happening?
Being and Becoming a Futurist
• Pay attention to time and time-spirits.
• Learn about the future.
• Understand people’s reactions to learning about the future.
• Actively monitor industry trends and forecasts.
Being and Becoming a Futurist
• Discern logical consequences of trends using futures thinking tools and techniques.
• Use emotional intelligence in change efforts.
• Create vision-based scenarios.
• Stimulate strategic conversations about espoused visions.
• Consider the value of an integrally informed future.
Future Pacing
• What concepts, tools, techniques are most useful?
• How can information be used?
• Why is information important?
• Why care about the information?
Contact Information
Daniel J. Pesut PhD RN, PMH- BC, FAAN
Professor and Associate Dean for Graduate
Programs, Indiana University School of Nursing
1111 Middle Drive NU 136 Indianapolis, IN 46202, USA
317-274-3115