Musings... axes in hand and mind

...

Axes in hand and mind
[Accounting for the I-G (individual-group) axis and the need for the H-M axis]

Clearly there is a need for a basic scaffold. One that reflects the real world and the real time to which we are all exposed and are a part; and one that can also represent the model(s) we wish to create - the products of our health care, nursing activities. The scaffold we build must be one on which we can hang concepts and for simplicities sake human (care) concerns. Specifically a conceptual scaffold and a human scaffold. The latter can be represented simply as a continuum from INDIVIDUAL to GROUP, hereafter referred to as I-G.

The other, the conceptual scaffold, calls for what might be termed conceptual inflation. If we imagine the I-G as the vertical challenge (remember the health & safety issue!) and draw with the 'individual' at the top, then there is much we can model based on this basic dichotomy. This is too simple however. We cannot capture the part of the rich tapestry that is life - well-being, health - and death. For this another axis is needed.

(Which begs me to ask myself:

is there a law that suggests that one axis however oriented invites another?)

With this further partition and heralding of a further dichotomy what is lost? What is gained, if anything? In scribing this first line we explicitly separate the 'one' - the self from the other. The addition of another axis is where and how we define a center. With this center and from it we can find the energy to fuel our conceptual inflation. We literally draw out the foundation by considering what these persons do? ...

Conceptual inflation: Four-fold nursing agnostics
...
PJ Dec 2010

Musings... building models, health & safety, group and individual

....

Basic foundations and minimal defaults
[Accounting for the I-G (individual-group) axis]

Since nurses and technologists are concerned with communication then the foundation from which they begin to (build and model their) work is of fundamental importance. The foundation needs to be generic in the first instance. Generic in the sense of the commonality that language instills, enables and facilitates within and between communities. Not only that, but if we take the property of 'generic' to its extreme then the foundation must be stripped down to the barest of defaults: there are no 'types'.

To use the safety analogy we need to risk assess the extent of our model building activities.

We can do this by asking: is this a one, or at most two dimensional venture; such that we can rest secure on terra firma? Or are we above 'ground' floor and immediately required to address health and safety legislation?

Since medicine and nursing are concerned with - must be evidence based - there is an immediate  vertical challenge in the hierarchies inherent in the sciences and the structure of knowledge.

Science is not the only influence here. The foundation of what we are modelling and building must reflect the ultimate subjects (the person - patients, carers, communities, whole populations) of our activities. So, the individual (whose very safety is our concern!) must be factored in and with this concept the notion of human rights. While a dialogue of no trivial nature in itself, suffice here to suggest that individual and applied human rights emerges out of and is dependent upon the collective (group). This in turn is a measure of the level of social coherence, coherence through a level of social and political organisation that allows leaders to effect positive change and betterment. The person, the individual is built not upon the shoulders of giants, but ordinary people - our ancestors and peers. ...

Axes in hand and mind
...
PJ Dec 2010

Buller and Butterworth: Skilled nursing practice - four domains?

The health care domains model identifies four domains within health and social care and medicine. What evidence is there to support the model's inclusion of:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

- plus the spiritual within and without? Steve Buller and Tony Butterworth undertook a ethnographic study in 2001 'Skilled nursing practice - a qualitative study of the elements of nursing'. With skilled nursing practice at the center (Fig. 5.) they identified:

relating and communicating	doing the job
being professional	managing and facilitating

There is some overlap, reflection arises in relating and communicating and doing the job. Overall however there is a definite correspondence between these domains and those within h2cm - the health care domains conceptual framework. I have equated being professional with the SOCIOLOGY domain as for the authors this includes being with patients, conveying confidence, handling situations, being informed. Managing and facilitating is undoubtedly POLITICAL with supervising, auditing, making sure things get done. Doing the job - is based upon planning, informing, assessing, intervening, and being confident (with equipment, procedures, manual dexterity..?).

Having been thinking and writing about h2cm for many years it is a shame that other models have benefitted from funding and gain "ward and community (research) cred" while here evidence is retrofitted. Looking at the paper just in the decade since submission and publication I wonder which elements remain local, and where other elements of the skills base (care concepts) have migrated to ethnographically?

Steve Buller, Tony Butterworth (2001) Skilled nursing practice — a qualitative study of the elements of nursing. Int. J. of Nursing Studies. 38, 4, 405-417.

h2cm: Globalization, Accommodation theory and Relativism (Grayling, 2010)

From A.C. Grayling's Ideas that Matter, 2010, Phoenix.

Globalization: p. 235-236.

A more neutral account of globalization describes it as the process of making things known, done, available or possessed worldwide - such as Internet access, telecommunications, medical knowledge and benefits such as vaccines, transport technologies, political ideas, art and music, books and much besides.

Grayling also explains how the increased distribution associated with globalization is unequal, hence the sense of injustice that is felt resulting in protest.

The health care domains model is concerned with making things known - helping to make knowledge available on a personal, group and family level. This is no Mercator projection, not even Peter's projection but it is a global map.

Accommodation theory: p. 3-5.

Accommodation theory states that when people talk to each, they adjust their behaviour and manner of speech to take account of (to accommodate themselves to) the topic, the circumstances, and the other people engaged with them in conversation.

There are many theories to explain how we communicate and thereby model(?) ourselves, others and the world. Imagine a doctor's surgery and the morning's clinical consultations, it is easy to envisage the role that accommodation routinely plays. The one-to-one conversation (dialogue, argumentation, debate) can be extended, and viewed as the combined chatter, the whole series of multidisciplinary Q&A with the breaks (the silences when we are listening!). Accommodation theory has proved of value in multiculturalism, especially on policy concerning immigration and integration. p.5

The care domains provide an ethnoculturally neutral space (it could be argued) for the accommodations that are demanded in the 21st Century. 

Relativism: p.433.

There is a distinction to be drawn between moral or cultural relativism, on the one hand, and cognitive relativism on the other. The former concerns the difference between cultures, or between different historical phases of the same culture, with respect to religious, social, and moral values and practices, that is, with respect to what might be called the 'superstructure' of the culture's conceptual scheme. Cognitive relativism concerns the 'infrastructure', the level of basic beliefs about the world, such as that there are perception-independent, re-identifiable and individually discriminable objects or events, occupying space and time, interacting causally, and bearing properties of various kinds.

Much is said of the games that people play. Whether the care domains model provides a game board that can accommodate both the super- and infrastructural conceptual levels is open to question. In the health career model the infrastructure level concepts are light - as we find that they reside in the upper part of the model: perceived, individually discriminable (INTRApersonal) objects occupying space and time (SCIENCES) with mass, weight, inertia. ... The political domain prompts access to values and how these shape the total conceptual landscape(s), the conversations and silences that go on there ...

Naivety [I] ever unfolding : ever present - SCIENCES

naivety [naɪˈiːvtɪ], naiveté, naïveté [ˌnɑːiːvˈteɪ]n pl -ties, -tés

1. the state or quality of being naive; ingenuousness; simplicity

2. a naive act or statement

My source:
http://www.thefreedictionary.com/naivety

There are times when we are all naive. It can be so embarrassing! When you realise, or more severely are made aware by others the abrupt learning is suddenly resolved. Within the bounds of the health career model, naivety can be found and is expressed in so many ways.

Hodges' model may appear naive in its simplicity, but behind that simplicity there are several assumptions. When you act as scribe, reader or doer you exercise the model's structure. You potentially demonstrate several levels of literacy.

If the health career model can represent most 'everything', then naivety should be no problem. So, if we visit each of the care domains in turn what can we find?

SCIENCES

I came across a post: 'We are all naive scientists' on The Financial Philosopher blog which includes this quote:

"It is clear, then, that the idea of a fixed method, or a fixed theory of rationality, rests on too naive a view of man and his social surroundings." ~ Paul Feyerabend

Regularly, I ask myself if I am naive in this particular domain. Am I right to assume that there are questions in nursing that can be answered (or at least reflected upon) using Hodges' model? Furthermore, can this use, this application be demonstrated in a scientific (evidenced) way?

Does experience of programming in BBC Basic as an enthusiast really help equip me now to get to grips with PHP, using Drupal and even Ruby?

Is information (and informatics) really the all encompassing Swiss army knife of a concept I take it to be?

The most extreme naivety here is not mine, however; it is as Feyerabend suggests the one that is in diagonal opposition. It is the scientific naivety of the masses in the social domain. Is this ignorance? In some cases, yes. But the tabloid (gutter) press shouts aloud when science gets it wrong; or, more accurately industrial porcesses based on science totally mess up.

The masses are not divorced from science. True, there was (still is?) a promised intimate relationship borne of equality and egalitarian ideals (education), but this naivety matures in real (social) time also known as life-chances. Its cost is not just red-faced, but illiteracy and exclusion at a time when literacy, inclusion and engagement are paramount.

Global health: Care logistics in-deed

Although the previous post -

Care Logistics: have model will travel ...

- differentiated between what we might term mechanistic and humanistic logistics, there is a great deal of overlap:

communications, time, priorities, purposes, service, quality, processes ....

Global health has featured on W2tQ and it is here that the true dimensions of logistics can be defined. I may be confusing logistics and scale, but if I am then the challenge of logistics presents itself by virtue of scale and in global health the focus upon populations, nations, medical conditions and physical environments, climates and topography.

While the Wikipedia page on global health does not explicitly refer to logistics it is there in the shadows: it contributes to inequality, illiteracy, poverty, public ill-health (and mental too), pandemics ...

Logistics is there in the light too; the torch of disaster relief, the many development organisations, the ethos and values of the Millennium Development Goals. ...

Frontline or tightrope?

As the various media outlets and commentators discuss health care, nursing, medicine and social care they often refer to the frontline -

Where exactly is the frontline these days (and nights)?

Who is on the frontline?

Is the frontline always visible?

Is there a 2nd, 3rd or 4th line?

Are there any gaps in the frontline?

Is it twisted at any point?

When health care economics is squeezed
how does this affect the frontline?

Does the frontline have an optimal tension?

If the frontline is Lean, in lean times
does it have a harmonic?

How has the frontline changed over
the past 20 years?

How is our frontline forecasting?

Is there space on that (front-) line for
partners, information technology,holistic
bandwidth, values, policy, safety ..., ....?

All doodles welcome.

Reading the signs - Idealised Care

With the axes of the health career model labelled and the care domains - that fall between - identified, what can we read into and from the health career - care domains - model?

What basics of care and caring can we find there, what assumptions can we jump upon?

Here is a list ... (which also illustrates how the model grows with the learner) :)

• Health, well-being and social care are not declared in the face of the model, this suggests the model is high-level - generic.
  
• Health care (here) has at least seven disciplinary degrees of freedom:


• Sciences (biology, physics, chemistry)
  
• Politics
• Psychology
• Sociology
• Spirituality

• Health and social care theory and practices are reductive.
• Health care involves the traversal of space - distance.
  
• Health and social care has the potential to be depersonalising and alienating.
• Health and social care is simple and complex.
• The environment is inherent within the model in its varied forms.
• There is a moment of imbalance within the INDIVIDUAL - GROUP.
  
• Context is essential as a means to situate care (co-ordinate in an 'x','y' sense).
• The means is provided to situate the care context in a person-centred way.
• This model provides a template for personal and group reflection (shallow or deep).
  
• The model is open in terms of the final content, the content as expressed in care approach, philosophy, discipline, description (concepts, problems, priorities, strengths, a 'mash-up') is not dictated.
  
• In acknowledging the existence and primacy of the individual (located at the top so - must be important), the model provides a (potential) focus and vehicle for individualised, personalised, person-centred care.
• Whilst individualised care is at the center of care theory, practice and management, it cannot be defined purely by virtue of the INDIVIDUAL-group axis and the claim of an associated INTRA-INTERPERSONAL care domain.
• The individual must also be considered as a POLITICAL entity, a citizen, a legal entity that falls under the auspices of human rights. As such the individual is someone who can (or has previously) expressed their choices, wishes as to their health, care, well-being, best interests.
• Being an INDIVIDUAL within the family of humankind - 1 of some 6.x or > 7 billion - this person is unique and deserving of highest quality care, dignity and respect that should be accorded to all people.
• Health and social care whilst organisationally distinct (POLITICAL - POLICY) are to the INDIVIDUAL and carers (GROUP) concurrent, transparent and ideally integrated activities.
• Physical care (SCIENCES) can be, and is, defined in mechanistic terms; for example, time (objective), events, place, outcomes, observations / data (discrete, quantitative).
  
• Physical care is hence primarily objective.
• Emotional INTERPERSONAL care can be, and is defined in humanistic terms; for example, time (subjective), communication, responses to events (behaviour), feelings, beliefs, relationships (SOCIAL), expectations, fears, observations / data (subjective, qualitative).
• Physical care, emotional care is often mediated through the SOCIAL domain and the group - the family unit.
• Since this model indicates an initial structure and content the model is of potential use as a reflective resource for novice through to expert.
• The model is generic and as such not limited to health and social care.
• Such is the generic nature of the model it can support all learners in lifelong learning.
  
• The Spiritual is not there: it is ineffable. It is everywhere, everything, every'I' and everynow.
• Time is inherent in several forms within health and social care.
  
• The economics of health care is infused to all the domains, notably in the first instance to the SCIENCES and SOCIAL domains.
• The economic effects upon the individual in a humanistic sense, may be remote, but is inverse in terms of its impact.
• The model reinforces dualism: mind - body (but cognitively innoculates also).
  
• In highlighting boundaries, dichotomy, limits the model can stress the need for integration.
• The model suggests an antipodean fracture in relationships*: the patient and clinician (across physical care and mental health) inhabit the Northern hemisphere; while the carer (public), manager and policy maker the Southern.
• Health and social care is grounded in human communication (and that which is mediated).
• 'Sense making' must be a key issue in health and social care.
• Given the scope of the model, technology must be making a major impact across all fields of health and social care.
• The model can simultaneously represent the SOCIO- and the -TECHNICAL.
• A great many (potentially - all) values and standards are inherent in the model.
• This model can be represented using many media.
• This model is open to the Management Consultant's delicacy alphabet soup, i.e. using letters to represent approaches / methods, e.g. 4P's, 4C's.
• Health and social care can also be described holistically.
  

*Clearly, given the relationships and issues that arise this bears further examination and discussion.

This list is subject to revision - addition.

Image source:
http://en.wikipedia.org/wiki/File:Antipodes_LAEA.png

Notes (IV) for a 2010 introduction to the Health Career Model

... Influences past, present and future

The above [development, definitions] can be explained more coherently by reflecting on events and influences at the time when Brian Hodges first created the model commuting between Manchester and his home in Sheffield in the NW England. We can compare and contrast the situation from 1983-84 and so highlight:

• models of nursing
• the nursing process
• individualised care (through the nursing process)
• mind mapping

Models of nursing and nursing theory are still there on nursing curricula. Students still write the essays in their first year (as I learned this week), but their importance on many nursing courses - be that foundation, the adult, paediatric, learning disability or mental health branches; or post-graduate is diminished. This does not mean to the extent that they are no longer worthy of Masters dissertations and Doctorates, but the academic agenda and theoretical emphasi*, found in the curricula, practice and management have however moved on. The nursing process is now transparent, it is embedded into theory and practice in the form of paper (the nursing Kardex) and electronic record formats. What is interesting is that individualised, or personalised care remains a challenge to achieve and measure. The final item listed above - mind mapping - is in many respects coincidental, but was concurrent and of great importance for Hodges' model, informatics and the social sciences. For decades before Hodges' model was created the potential of diagrammatic forms and representation as an educational and learning tool was recognised and championed in several quarters notably in the 1970s by Buzan and others.

So, in 2010 we can identify needs - both old and new - to account for #:

• person-centred care
• public engagement
• preventive health programs (NHS = 'ill NHS')
• public health and public mental health (in which mental health is still 'lost')
• global health and nursing's role in achieving the aspirations of health for all (bridging other divides - local - global: glocal)
  
• information technology - various schools of informatics
• self-care
• demographic trends
• economics and care delivery / commissioning models
• information and visual literacy

In addition to knowledge, in light of the above, we can also add information as a key concept to help explain Hodges' model. The website in updates after 1998 attempted to introduce information as a concept that can conjoin Hodges' model, health and social care (nursing) and informatics (in particular the socio-technical). Of the original purposes the statement concerning bridging the theory - practice gap is too general to inform this introduction. ...

* emphasi = neologism: it just sounds right?
# At the same time - is that possible?

(Notes V to follow)

[These are notes. If you have any thoughts, views on a new introduction to the model please get in touch:
h2cmng @ yahoo.co.uk What do you feel needs to be explained? Which audience should be addressed in the first instance? What assumptions can be made? ....? Many thanks PJ ]

Notes I intro for 2010

Notes II intro for 2010

Notes III intro for 2010

Notes (III) for a 2010 introduction to the Health Career Model

Definition through purpose

The original purposes for the model's creation are as relevant today as they were in 1983-84:

1. To produce a curriculum development tool;
2. Help ensure holistic assessment and evaluation;
3. To support reflective practice;
4. To reduce the theory-practice gap.

Items 1-4 plus safety are all dependent in one way or another upon knowledge. Admittedly, this is a case of stating the obvious and something of a non-statement in that everything comes down to being knowledge (or nonsense). Resort to some global notion of 'knowledge' amounts to non-differentiation and this tells us nothing. On the contrary: this is how the simplicity of Hodges' model can cultivate and give rise to global complexity. This can help explain the model's potential and utility as a cognitive tool, an aide memoire, a mental prompt and structured conceptual checklist to frame:

• thought
• knowledge (ontology)
  
• perspectives
• dialogue
• problems
• strengths - weaknesses
• plans and actions
• outcomes
• and much more ...

Whether student or specialist practitioner various conceptual elements and (care) threads can be acquired, constructed, integrated and mapped from the dual (in-situ) worlds of theory and practice to the cognitive (personal - reflective) and virtual [cogeographic?]. This means the model can be used as a mental prompt helping to inform theory as in a lecture and subsequent essay; or practically during an interview or care assessment. Beyond this cognitive application, the model's produced can then also be captured and represented on paper, or as an electronic record - by various user communities. ... (Notes IV to follow)

[These are notes. If you have any thoughts, views on a new introduction to the model please get in touch:
h2cmng @ yahoo.co.uk What do you feel needs to be explained? Which audience should be addressed in the first instance? What assumptions can be made? ....? Many thanks PJ ]

Notes I intro for 2010

Notes II intro for 2010

Notes (II) for a 2010 introduction to the Health Career Model

... Where to start?

By its very nature as already suggested Hodges' model is difficult to explain. There are so many elements that demand our attention and so many avenues to run. Despite revealing one heading to be followed, Murphy (2002) describes how a theory of concepts is still elusive. From this we might focus purely on nursing and take a professional stance. We should be able after all to assume solid grounds for the system that supports nursing: namely nurse education. There is no need to do this as existing theories of concepts can provide a vehicle for explanation and research of Hodges' model.

Frequently acknowledged as a science AND an art, the individual-group axis in Hodges' model and the accent on communication makes individual and group psychology as much a pivotal source of knowledge as human anatomy and physiology. There are differences in the methods of verification, but the dependency is there and evident in the core nursing curriculum. Even though psychology remains a young science, resort to psychology is advantageous in other respects as the development of cognitive science and computer science can also inform our thought and research on Hodges' model. Fundamental to this is the basic form of the model construct the 2 x 2 matrix.

There are a great multitude of models that take this 2 x 2 matrix form. Apart from mathematics examples one the most commonly cited and influential is the so-called Johari window model of Harry Ingham and Joseph Luft which dates from 1955. Luft and Ingham were psychologists who created their model at the University of California, Los Angeles, while researching group dynamics. The Johari model has found a home in soft systems problems and can now be found in many other variations and one-off examples. There are whole books devoted to the subject of '2 x 2', an acknowledgment indeed of their utility and ubiquity (Lowy and Hood, 2004). From the OHP transparencies of old to the latest data projection forms, the 2 x 2 matrix is the tool of choice in the management consultant's armamentarium. This special cognitive device can also serve the (global) health and social care community and do so right across the board*. ...

Ref:
http://www.amazon.com/Power-Matrix-Thinking-Decisions-Management/dp/0787972924

Additional links:

http://hodges-model.blogspot.com/2008/02/big-book-of-concepts.html

http://hodges-model.blogspot.com/2010/02/notes-for-2010-introduction-to-health.html

*I would not include that last sentence in a new introduction, but it completes the post.

Notes (I) for a 2010 introduction to the Health Career Model

.... The structure and composition of Hodges' model can be viewed as a sketch, a back-of-the-envelope idea expressed as a diagram as per (insert figure 1 and 2) and in combination (figure 3). While this is a perfectly valid interpretation it invites the view that Hodges' model is simplistic. In its basic unpopulated form the model is simplistic, in the same way that a blank canvas, computing device display, or piece of paper is simplistic. There is however, much more going on here, consideration of which can lead us to new ways to justify and explain the model.

"Make everything as simple as possible, but not simpler"
Albert Einstein

Einstein is helpful because while simple - the model provides the foundation for global conceptual scope (complexity) should this be needed. Hodges' model demonstrates the complexity of health and social care without making it simpler.

"Simplicity means the achievement of maximum effect with minimum means."
Dr. Koichi Kawana, Architect

If Hodges' model is simple, a way to represent the tip of the health and social care iceberg, then why should we then wish for global conceptual scope? The reasons are manifold, but revolve around one factor:

safety.

...

Quotes source: http://www.petefreitag.com/item/496.cfm

HoNOS, checklists and semi-structured interviews

Mental health services not routinely (and formally) using HoNOS (Health of the Nation Outcome Scales) are gearing up with a push to implement the scale across services by April. HoNOS has been around for a long time almost 20 years so it is time it earned its keep. Perhaps high quality tools take time to emerge from the noise and chatter of the care marketplace? ;-)

Although they are available, I've been putting a presentation together to help get to grips with HoNOS in the role of a trainer. The evidence for the validity and benefits of using HoNOS is well established, with the HoNOS family of scales boasting global usage and development:

• HoNOS for working age adults
• HoNOS65+ for older people
• HoNOSCA for children and adolescents
• HoNOS-Secure for use in health and social care settings secure psychiatric, prison health care and related forensic services, including those based in the community)
• HoNOS-LD for learning disabilities
• HoNOS-ABI for acquired brain injury (ref.)
  

The number of assessment, intervention and evaluation tools available to clinicians AND managers begs the question (ironically): is there 'space' in the toolkit for yet another tool? If HoNOS can help establish a coherent currency for mental health commissioning beyond the block contract then this is most welcome. Mental health services need to move forward on several fronts. There is a timeline running with completion of this difficult task in its sights.

One set of guidance for HoNOS points out that:

The scales are not used as a checklist or semi-structured interview, but form a brief record of severity.

There is some succor there then, since Hodges' model is a checklist and a quad-structured interview there is still a role for a global conceptual framework.

There's nothing like a full and tidy set of tools!

Ref. http://www.gpsa.org.au/media/docs/mentalhealth/honos_information.pdf

DoH: Honos health of the nation outcome scales report on research and development July 1993 - December 1995

Additional links:

The UK Routine Clinical Outcomes in Mental Health Group

The NHS Information Centre: Mental Health Minimum Dataset

RCP references

Currencies and travel in health and social care

Before the advent of the euro, holidays in Europe were that bit more exotic. Having to buy and adjust to another currency - and not just one - was part of the novelty and fascination of travel.

Health and social care have their own currencies (and yes, read that as there being integration here too!). Most of the currencies are national given the efforts to standardise, with examples such as, length of stay, referral to treatment and more recently in residential care and elsewhere continuing care and its occasionally truculent neighbour 1-to-1. Unfortunately, like land masses, these currencies can also suffer from continental drift.

Dissemination (use in the wild) lack of review and ongoing attention to standards, benchmarks and definitions can see a currency drift in its application and subsequent reporting (affecting perceived utility, value and impact). The value of a currency can be diminished over time as it no longer acts as a unit of difference.

So enjoy your travels, but beware the risks while you vive la difference, especially in your work!

Image source: http://www.artlebedev.com/mandership/77/

'situated' in Hodges' model #2

So, Hodges' model is person-centred and situated
- a conceptual springboard for all.

In the 1970-80s the nursing process challenged task-based care.

Ever since we have stressed individualised, personalised care and now today self-care.

Interpersonal and communication skills are central to nursing theory,
practice, management and informatics.

In Hodges' model the individual is the primary focus*.

The science and art of nursing
is predicated upon the
nurse - patient
relationship.

Situated = 'Its a duet' (anagram)

*Inclusion of the 'group' in the model also facilitates
consideration of relatives, parent-child, family, community and populations.

'situated' in Hodges' model #1

I'm not exactly sure how many times I've cut and pasted the paragraphs that introduce Hodges' model as person-centered and situated. Quite a few!

Thanks to the HIFA-2015 list I realised last week that there is no tag for 'situated' on W2tQ. Well, this post corrects that omission, but what does situated mean in Hodges' model?

Here is a definition c/o Google:

• situated/s'ɪtʃueɪtɪd/
  Synonyms:

  • adjective: located
  • If something is situated in a particular place or position, it is in that place or position. ADJ adv ADJ v-link ADJ prep
    ...
    

Related phrases

• situate
  If you situate something such as an idea or fact in a particular context, you relate it to that context, especially in order to understand it better.
  ...

Hodges' model is based on the belief that health and social care are multicontextual. Without wishing to substitute one term for another context and situation are inter-related and bear closer examination here on W2tQ.

Hodges' model prompts the user to consider that the person (-at-the-center) of care is simultaneously residing within four primary situations or contexts (five - if we include the spiritual aspects). Veterans and new recruits appreciate from the dizzy heights of the model, how quickly we find complexity in the multiple contexts that exist in health and social care. The many perspectives and views that must be taken into account to achieve safe, integrated and holistic care. Together with the above there are other definitions of relevance to scholars, champions and users of Hodges' model:

located: situated in a particular spot or position; "valuable centrally located urban land"; "strategically placed artillery"; "a house set on a ...
wordnetweb.princeton.edu/perl/webwn

In artificial intelligence and cognitive science, the term situated refers to an agent which is embedded in an environment. ...
en.wikipedia.org/wiki/Situated

Located in a specific place; Supplied with money or means
en.wiktionary.org/wiki/situated

The first definition about location is important as Hodges' model puts the person at the center. It is from there that the care domains are considered in turn and revisited as required. Hodges' model provides a locus around which care activities can be placed. Usually we view self-centeredness in a pejorative way. When you think about it though this is precisely what is needed to achieve person-centered care. In this case we need something that constantly re-centers - reorientates the subject(s) and agent(s) of care.

The second definition which looks to A.I. for inspiration is relevant as the concept of embodiment, embeddedness already has academic form* as a means to explore self-centeredness. Not only is the individual embedded in a (the) situation, but the carer (formal - informal) must also reside there and share to an extent the experience, if empathy, rapport and communication are to arise.

That final definition can be utilised due to the inclusion of means. People have skills, strengths and coping strategies and this sense of situated rings very true at present, with the emphasis on recovery, staying well, relapse prevention and adjusting to what may be permanent change. People also need knowledge as a means to maximise their health and well-being, which takes me back where I started with Health Information for All by 2015.

So, amid all the complexity, over-arching infrastructures, policies,
debate (and definitions!) it is refreshing that as I revel in the
scope of Hodges' model - two axes, four domains,
its holistic bandwidth... I can find the
word 'situated' planted
firmly
at the model's
center.

* Ref:
Paley, J. (2004) Clinical cognition and embodiment, International Journal of Nursing Studies, Volume 41, Issue 1, Pages 1-13.

Image source - with thanks: Ariel Bravy - http://www.arielbravy.com/photoblog/
http://www.arielbravy.com/photoblog/images/20060719214447_glenn%20x%20millenium%20park.jpg

Nurses as modellers and informaticians: surely not!

Nursing is still trying to escape and evade the sexual 'Carry On' stereotypes that have plagued the profession in the popular imagination. For the majority of people talk of nursing and models more readily conjures up visions of catwalks than an academic pursuit.

You can still see and hear the response of bright-eyed girls and boys (aged 9-10...) to the age-old question: "What do you want to be when you grow up?" The answer: "I want to be a nurse and help people get better!" Even though youngsters are more sophisticated these days (the reference to girls and boys is not just me being politically correct), they are still most likely primarily motivated by humanistic leanings as opposed to wanting to pursue the necessary studies in the sciences.

Despite efforts worldwide practicing nurses do not all see themselves as data modellers enthralled by IcT. IT isn't usually why they came to nursing, although many mature students may have started their career in the IT sector. Chapter 1 of Programming the Semantic Web highlights how a basic table is a model (p.6-7). So of course gifted with natural language we are all data modellers. Hodges model then is the ubiquitous high-level data model - a two-by-two table and a whole lot more.

An invitation to mine data, gather information and deliver nuggets of knowledge.

Ref:
Programming the Semantic Web: Build Flexible Applications with Graph Data
By Toby Segaran, Colin Evans, Jamie Taylor
Publisher: O'Reilly Media
Released: July 2009

Health care and handedness

The word legerdomain featured on Wordsmith's Word.A.Day as listed below:

PRONUNCIATION:
(lej-uhr-duh-MAYN)

MEANING:
noun:
1. Sleight of hand.
2. A display of skill.

ETYMOLOGY:
From French leger de main (light of hand), from leger (light) + de (of) + main (hand). Ultimately the from Indo-European root man- (hand) that's also the source of manage, maintain, maneuver, manufacture, manuscript, and command.

It is a shame and a matter debated at large that specialists - whether medical or of other disciplines - are not held in the high esteem that they once were. And yet when you come across a leader and specialist in their field the way they deploy their knowledge, insight and skills remains something to greatly admire and respect. I mean knowledge and experience that transcends sole reliance on interpersonal skills and blinding people with jargon and 'science'. Such are the outcomes of what the specialist brings to the (operating?) table, that it may even seem like a sleight of hand. Not in the sense that it is a trick, but there is an effortless transparency to not only what they achieve, but how they make people - their patients, clients feel. Not just feel, but how these people react and may find themselves.

If there is a sleight of hand it is in how while a specialist, they can and do cross boundaries. They see and can count the important numbers (evidence) in their discipline, but they know (from some no doubt hard-won lessons) that frequently some of the numbers in the very sequence they need lie outside their comfort zone.

RIGHT-handed (mechanistic)

or

(humanistic) LEFT-handed

- they know there is a

middle

and they cross it, without anyone noticing.

h2cm: Original purposes and 21st century additions

Listed below are the four reasons that prompted Brian Hodges to create Hodges' model in the early-mid 1980s, these being to support:

1. reflective practice (Moon, 2004; Jasper, 2006) ;
2. holistic care (Brooker and Waugh, 2007);
3. curriculum development;
4. bridging the theory – practice gap. (Doherty, 2009)

Although nursing, health care and society have changed to a revolutionary extent these original purposes are still outstanding some 25 years later as the authors above and many others testify.

Perhaps in the next few years it would be timely for researchers to revisit the original stimuli and consider afresh the role of Hodges' model within nursing theory and practice and beyond. I believe the relevance of the model grows not because of the constant need for the big picture, but the need to represent and consider new dichotomies and challenges. To the original four then we might add:

• To inform the socio-technical application of information and communications technologies in health and social care;
• To conceptually ground (domain relate) and integrate the 4Ps of PROCESS, PURPOSE, PRACTICE, POLICY in theory and practice;
• To provide a universal conceptual framework to conjoin all multidisciplinary teams across the 4Cs of COMMUNICATION, COLLABORATION, CO-ORDINATION, CONTINUITY and COMPLEXITY*;
• To inform research in what may be termed ‘cogeographics’ the fusion of conceptual spaces and visualization in the humanities - social sciences.

The 4Ps and 4Cs provide a further aide memoir for students and practitioners to accurately locate situated care. Finally, nursing and health, social care as a profession is bound to a code of practice, accountability and has an educational – public (mental) health duty to the aims and objectives of the global health community. Cogeographic (or cogneographic) may be a neologism, but seeks to conjoin the cognitive (cognition) involved in defining, representing and using concepts in conceptual spaces; AND the finding that knowledge is invariably situated - that is knowledge has a geography.

References:

Brooker, C., Waugh, A. (2007) Foundations of Nursing Practice: Fundamentals of holistic care, Mosby.
Doherty, C. (2009) A qualitative study of health service reform on nurses’ working lives: Learning from the UK National Health Service (NHS), International Journal of Nursing Studies,46,8,1134-1142.
Jasper, M. (2006) Reflection, Decision-making and Professional Development (Vital Notes for Nurses), Blackwell.
Moon, J.A. (2004) A Handbook of Reflective and Experiential Learning: Theory and Practice, Routledge.

*I can count really ;-)

'Information' a definition

Exactly what information is (at least one very useful technical definition of it) is answered by the mathematical theory of information. A rich field with many applications to biology, linguistics, and electronics, the theory is couched in the language of bits, each bit of information conveying one binary choice. [Hence 5 bits, for example, convey 5 such choices and are sufficient to distinguish from among 32 (or 2⁵) alternatives, there being 32 (2⁵) possible yes-no sequences of length 5.] Bits serve too as units in the numerical measure of such notions as the entropy of information sources, the capacity of communication channels, and the redundancy of messages.

Source: Paulos, J.A., (1991) Binary numbers and codes, Beyond Innumeracy, p.26.

Additional links:

W2tQ 'information'

W2tQ 'Ye Olde paper: 1996 "Humans, information and science'