This is achieved through guided discovery. The health record captures that state at a certain point in time, knowledge that can prove very useful as a benchmark to monitor change, response, attitudes. The HCM can help to record transition, across the subject disciplines and multidisciplines that make up the knowledge base and health care team. Change occurs however at the micro and macro level. Changes in cells preoccupy the histopathologist, physician, patient and their families.
Systemic infections focus attention on temperature and other homeostatic indicators.
Sudden change in physical environment can alienate and disorientate confused people. Advocacy first, however, rather than contacting the patient's physician to prescribe sedation for an unsettled rest home resident, the community nurse may try to find out why a change in behaviour has occurred. If still unresolved perhaps a change of environment is needed, although staff may not wholly agree. Although the patient may not be able to request a move to more appropriate accommodation others must do so if needed, rather than a resort to a so-called 'chemical fix'. Integrated care pathways anticipate change, charting the planned progression through a care episode which can then be audited.