!RFC: Extreme distress prevention
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agk's phlog
5 September 2021 @ 21:05
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written on Pinebook Pro
while Cassie gets ready for bed
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The topic of my paper is "A nursing health promotion
approach to reduce extreme distress in people with
disabilities." I haven't written it yet. Just poked
around the lit and put together ideas.
I found a framework and a screening I think together
could identify causes of extreme distress without
medicalizing the sufferer. The Power Threat Meaning
framework (PTMF) could structure nursing care, which
could in turn be quantified with capability screening
from health economics: OCAP-18, ICECAP, or a deriv-
ative. I'll try to explain.
Power Threat Meaning framework
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Everybody's lives are structured by power relations.
If you have personal care assistants you might have
power and be the boss or lack power and feel at their
mercy. This might affect, for example, whether you can
have a sex life.
Power saturates interactions with speech and occupat-
ional therapists, guardians and representative payees,
teachers and school systems, friends, prescribers,
caregivers, and police. It structures the transport-
ation system, how appointments are made and broken,
whether books or room numbers are readable, etc.
When power triggers a threat response, you interpret
your perception of threat through whatever system of
meaning you've learned and assembled.
The bus might be late so I'm going to miss my med
refill appointment. My online boyfriend might have told
me he doesn't actually ever want to see or touch my
body. I might be getting evicted. I integrate the
threat situation into a story so I know what to do.
What I do is my response to the whole power-threat-
meaning situation.
The PTMF analytical framework preserves complexity and
suggests interventions. Maybe I can change the story I
tell myself. Maybe things which trigger my threat
response were once bad but should be okay now. Maybe I
need new skills for responding. The framework fits
traditional interventions---but clarifies that I am
explicitly not the whole problem. Many problems make
up the chain. One of many solutions may break it.
I think the Power Threat Meaning framework is a solid
theoretical basis for nursing assessment and health
promotion. It isn't enough by itself, though, because
institutions want numbers that can be quantified and
plotted on trendlines.
Capability assessment
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OCAP-18 and ICECAP assign numeric scores to multidomain
capability questionnaires. Instead of the PHQ-9 nine
question depression screening, I'd like to see ICECAP.
Instead of the 12 question PHQ-12, I want OCAP-18.
The PHQs ask if I feel sad, but prohibit me from prov-
iding context. Capability screenings ask if my housing
meets my needs, I have enough love and support, feel
safe where I live, and can do stuff I enjoy. A facility
could report we have an x% 30-day readmission rate and
OCAP-18 scores improve 5 points on average between
admission and first follow-up.
The framework guides interventions. The screening tracks
wellbeing holistically enough to capture many paths to
decreased extreme distress. Numbers reward the facility
so management stays off nursing's backs and, in theory,
lets us do stuff that works. Numbers can also support
activism and changes in policy.
I've read enough phlogs to be familiar with fellow
phloggers with hard-won expertise at the intersection of
disability and extreme distress. I want to know what you
think about where I'm going with these ideas.
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[email protected]
Questions/strong disagreement/strong words always ok.
