!RFC: Extreme distress prevention --- agk's phlog 5 September 2021 @ 21:05 --- written on Pinebook Pro while Cassie gets ready for bed --- 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 ------------------------------ 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 --------------------- 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. --- agk@sdf.org Questions/strong disagreement/strong words always ok.