Considering his abstract I have added some observations below that I hope will further highlight the model's potential utility in this and other areas.
To begin George is quite right to describe the model as -
'a relatively simple way to think about and summarise the variety of engagement types.'This explains the model's use as a student resource, a foundational framework on which to superimpose their learning and map placement and professional development experiences. As a learning activity reflection is greatly concerned with the student's accounts of engagement with patients, colleagues, carers and the public at large. This also flags up the belief that the model has some generic educational purposes in health and beyond with patients, carers and the public.
The model should not however be restricted to simple representations and applications. Granted the safety, efficacy and value of the model remain to be proven, but hopefully the directions indicated here on W2tQ and in publications to date are worthy of further exploration? More complex - lifelong learning - uses of the model might include:
- case formulation
- psychological therapy formulation (CBT, family)
- self-directed care planning and budgeting (sign-posting)
- complex systems in health care
- policy and politics in health care
- reflection: students, client life story work
- integrating care recording
- and clearly public engagment in many contexts; research, management and service development.
The first quadrant [SCIENCES] deals with scientific response to individual signs and symptoms: where engagement aims to ensure that people comply with the healthcare intervention: engagement is about informing the patient and their informal carer about their physical needs and responses.People comply when they understand treatments and this understanding needs to be demonstrated. There has been much emphasis on concordance, but this has to be earned as Prof. K. indicates.
The second quadrant [POLITICAL] deals with mechanistic and group activity: for example political interventions to agree rules, policy and systems. Engagement here refers to members of groups working under a specific governance system or approach– activists and unions lobby for change, in this care domain. Arrangements for protection of vulnerable people are set through engagement here. Ethical issues guide the group mechanistic activities.The past couple of years has seen a whole new group of people acting in this domain. The Mental Capacity Act has resulted in various protections for individuals who are assessed as lacking mental capacity. Whilst this is quite specialist and the province of secondary care and social services, the public will increasingly be exposed to vulnerable adults in their community, on their street. (I saw a gent walk past last night - to be collected by a care worker and taken back to the near-by care home. There was some resistance as they reached the corner. Deprivation of liberty and best interest sprang to mind. ...)
There are numerous other examples: membership of the public in Foundation Trusts, consultation processes on service locations, the provision of information resources for the public.
Another critical policy factor here is QUALITY, how this is measured and the public engaged in those measures and their EVALUATION.
A hybrid approach WILL be needed. A single measure is insufficient and within h2cm inevitably skewed.
Thirdly [SOCIOLOGY], there are more humanistic aspects of care: speech, thought, narrative and free text: stories contribute to group actions. Here we have the social and cultural components to remind us that engagement must work in a social context.
I tend to ground speech and thought in the interpersonal domain (related to cognition) as the primary focus of nursing (health and social care) is the individual. Although communication (society) is impossible without thought and speech and there is a special link here in that the individual cannot acquire appropriate thought and speech without being socialised.
Stories have a definite home in this care domain. Stories are the foundation of what people share, who we are, heritage. Stories differentiate familiars and strangers - stories old and new. Narrative medicine is here, right now. Significantly, the rise of science is in diagonal opposition to the domain of stories.
The final domain [INTER-intraPERSONAL] emphasizes the role of the individual in needing tailor-made care, requiring dignity and respect. Here lies a more holistic type of care and is more ‘mind’ than ‘body’ where interpersonal aspects of engagement are more person-centred.This domain and the proximity of the 'individual' axis is the focus of nursing care. The rationale for individualised, personalised, person-centred, client-centred care is found here. We need to cross the individual axis repeatedly in order to achieve holistic care. There is no single destination. This journey is never a 'single' in two senses: neither one-way, nor travelled alone hence George's objective in public engagement.
Across all four care domains, public engagement is a key sustaining action to make the model meaningful but also to provide some reassurance that engagement although complex and varied, can be managed in a logical way to enhance care.I can see what George means by stating that engagement can be managed in a logical way.
Logic's extent varies across the care domains of Hodges' model; from the logical affirmation and assurance that underpins evidence based interventions to the decision algorithms that inform NHS Direct. There is also a need for recourse to several forms of logic as the model is traversed and negotiated. Folk theory, dreams, the chaos of elections and economic uncertainty, and the public's sense of demographic trends also have their place.I understand that Prof. Kernohan's slides will be posted on the event website in due course.
Many thanks to Professor Kernohan for his recognition and publicizing of the health career model.
Image source:
Gogeometry.com - http://www.gogeometry.com/problem/p076_square_circle_area.htm
