Serres - Hodges Paper

Amid the festive yuletide I am completing the Michel Serres-Hodges paper for possible publication next year as a book chapter. (The web version is now rather out-of-date, but highlights the direction of travel.) Almost finished @ 6,999 words - although it's scary the things you (still - argh!) keep finding to revise, delete and add, plus some last minute and yet much appreciated comments that highlight the things authors miss completely. So, when is a paper 'finished'?

Well finished this one will be, as the deadline is the 31st December. Plus I must move on... I plan to e-mail the text tomorrow and then fingers x'd! If the paper is accepted it would be a great start to 2007.

My return to clinical practice one day per week has been postponed until March, but more on that another time. Speaking of which - I feel another post coming on as everyone's out buying boxes...

All the best for the Season and the New Year!

Beware Reflex Moves and the Triple Whammy

In the past working as a community mental health nurse, I had several referrals in which a house move proved a key contributing factor to mental health problems. I'm surprised that moving residence is not ranked higher in terms of most stressful life events. For older people though an often initial trigger to ensuing chaos is bereavement and the degree of stress this causes is obvious and well documented. It was Simmel the sociologist who highlighted the vulnerability of the dyad - the couple:

"for its life, the dyad depends on both its members; but for its death, the dyad depends upon only one"

Whether marital partners or not, we often take this relationship for granted. Key really is the word of choice here, because listening to the 'patient' tell their story you really wonder what prompts such a vulnerable person to put their keys on the market and re-locate? Often still in grief and depressed they are certainly not able to think clearly and make effective decisions.

If you work in health and social care this scenario will not be news to you. Whatever your employment status though you may (sadly) have personal experience when a parent has died leaving your mother or father alone. For many decades now families are tending to live further and further apart, fifty miles or more - transcontinental even.

Following bereavement the cry goes up “come and live near us, we’ll look after you!” Usually for reasons of longevity that call is to 'mum'. Statutory services don’t hear about the instances when this move is the best thing since sliced-bread, but they certainly do when it goes wrong. We can describe it in many ways, but the importance of place, space, geography, community, in short - home has repeatedly been stressed.

Helping pick up the pieces on many occasions three features stood out:

1. The changing demographic – ageing population
2. The highly personal, subjective, narrative, and qualitative content that arose in session
3. The special circumstances of the older person and their capacity to negotiate this critical conjunction

Plus: my need in 1997 to learn HTML.

Given population trends surely this problem will become more common? What do we know about this dislocation? How frequent does it happen, what are the time-scales, personal and family outcomes, what are the socioeconomic consequences?

Surely it is nothing other than pure sentimentality to say:

"I miss the squeaky garden gate, the GP (family doctor) I knew for twenty years, the people who stopped and chatted on the front, even that nuisance-dog-next-door-but-one?"

Is there a double whammy effect? 1. People previously very well medically for their age suffer acute anxiety and depression. Suddenly pathological age = chronological age; and the negative impacts this can bring. 2. While people who may have had stable longer-term chronic conditions develop additional emotional problems, possibly resulting in hospital admission?

Could there be a triple whammy? [Surely not. Enough already!]

Well, that re-location also means of course that it is a new health and social care team who must help this person and their family make sense of the situation and find their feet again. This 3rd whammy will have its own subtleties. The former doctor-patient relationship may not previously have been tested to this extent. The situation can also impact the health of other relatives. The case for electronic health records also comes to the fore.

All this resulted in the [former] website ‘Beware Reflex Moves'. The title announced itself and captures the situation precisely. Creating the site helped me learn HTML and check out the use of frames. It is not maintained, although I really would like to follow this up!

Being able to air this pet research question at the Ideas Factory in October, other people were certainly interested. Their research questions concerned the quality of care and support that follows 'sudden' versus 'anticipated' deaths in palliative, primary care and related care environments.

I must do a Hodges' matrix. One aspect to highlight would be INTERPERSONAL: counselling, psychotherapy POLITICAL: access to counselling services for >65s. Can anyone help out? Any tutors with a class of students who could take the existing website content and do an update - re-design?

At this time of year loved ones and the rest of humanity are always in our thoughts. Take care and beware those reflex moves ....

Hodges Model: Need for a glossary and a comment!

Claire's use of Hodges model in residential care highlighted that terminology is an issue for some staff. This reminds me that a glossary is underway, but who knows when it will be completed. Some of the terms listed at present include:

• Career
• Conceptual framework
• (Care) Domain
• (Knowledge) Domain
• Model
• Situated
• Syndetic

Claire's application also flags the need to think practically about the model and not to get carried away with jargon. As the Health Care Assistants are engaged in care delivery what terms are being used? Are there any terms also common to Hodges model that staff already used? What are the core terms within Hodges model? These might be terms that Brian used in his course notes, plus some additions. Definitions would certainly help people adopt and use the model in a consistent way.

If you have any suggestions about definitions that would help, or specific terms you would like to see in a Hodges model glossary let me know and at least they can be added to the 'to do' list.

Before I close - thanks to Dan Bassill, Tutor/Mentor Connection, Chicago for his comment (our first through Blogger) to last month's post There Are Four P's in "Hodges model

Dan is also using graphics to create a simple, visual understanding of complex community and health ideas and provides an example link.

Hodges Model in Residential Care, Ireland

Claire Welford, Clinical Link Facilitator – Gerontology: a joint appointment between the National University of Ireland, Galway & The Nursing & Midwifery Planning Development Unit, HSE West - e-mailed me to say she is using Hodges' model.

It was great to hear this news. I put some questions to Claire as follows:

Q. What attracted you to Hodges model?

A. Its ability to address social needs.

Q. What are your objectives?

A. To prompt staff to address older people's social participation needs in long-stay residential care. To include all team members in care planning, including Health Care Assistants.

Q. How are you finding using the model - pros and cons (any surprises)?

A. No major problems yet. Some staff are struggling with new terminology. So many staff are used to Roper, Logan & Tierney, which I believe is not suitable for older person care.

Q. What feedback are you receiving from staff and students?

A. Staff as above. Students are interested and their Clinical Placement Co-ordinators have attended the educational sessions.

Q. Any comments from your colleagues?

A. User-Friendly. Succinct.

Q. Did you use any resources from the website, Brian's notes for example?

A. I didn't really use the notes, just used the general theory and went from there myself.

Q. Have you created any tools to help you, or do you feel there is something missing?

A. I have included assessment tools for nutrition, pressure sores, continence, manual handling and falls risk assessment.

Q. Would you be interested in doing a podcast interview, (if I can fully master the technical aspects)?

A. Happy to do a podcast. It would be great to see Hodges' model used more.

Q. Can you tell me about your role and work Claire?

A. For my role please see above, while my research interests include:

* Promoting quality care for older people.
* PhD work looking at autonomy in long-stay care of older people.
* Person-Centred Care.
* Action research/Qualitative methodologies.
* Currently a member of the Departments research cluster for older person research.

Claire also forwarded a publication on care planning in relation to the introduction of this model.

It sounds like Claire's use of Hodges model is at quite a high level, which supports the idea that the model is not prescriptive in terms of care philosophy or approach (note also the range of assessment tools). The way the model has been adopted also suggests it is quite accessible. Hodges' model is helping to extend the thinking and reflection of staff as they assess, plan and evaluate care in the residential setting.

For some people there may be a problem with Claire picking up the model and applying it in this way. Where is the evidence that the model is being used consistently? What about quality assurance? This brief Q&A sesssion prompts many more questions, that I hope we will have an opportunity to explore in the future.

On the other hand information literacy and knowledge management allied with the Web, are supposed to encourage the dissemination AND use of tools and resources. Given Claire's role and skills she has made a professional judgement, evaluated and appraised Hodges' model and found it of potential use and has set about testing her assumption. She is not doing this alone, but has Clinical Placement Co-ordinators on board. Quality assurance and detailed research do need to follow (this is why I created the website), but lack of this should not hamper progress.

Claire asked about keeping in touch - definitely - and thanks++ for sharing your work.

[For an introduction to Hodges model there is a 30 minute podcast.]

What are you - mathematician, book-reader or book-reading clock-watcher?

Sometimes you don't realise you are on a long-term cherry-picking escapade. I say escapade because this captures the rather haphazard, accidental and part-time nature of my fruit gathering.

In 1992 in the Engineering Computing Newsletter [SERC] Science and Engineering Research Council's EASE programme #38 p.4-5 Michael McCabe asked readers - "How would you label the quadrants of this diagram?"

I cannot find the brief article "Human Factors Aspects of User Interfaces Design" on the web, but I kept the original. It obviously meant something to me, McCabe shows why...

As a mathematician you might choose -

A clock-watcher -

- for a book-reader.

And a book-reading clockwatcher -

So, how would you label Hodges' model and does this say anything about how you would populate and read the model?

Advocacy No. 2

Where was I..? Oh yes - if we have largely withdrawn from the role of advocate, than what is left politically (no pun intended)? The nursing pioneers set an agenda that in many respects we have still not addressed. They made a difference - have we?

So what was the agenda set by the nursing pioneers and why does this matter now? Amongst many other things their efforts highlighted:

* the elements of basic nursing care
* importance of data - information - knowledge
* the diverse scope of nursing (health care)

They helped to define nursing and what constitutes nursing's standing agenda items. This post is not a denial of progress, because of course giant strides have been made, but where are we now? And, more crucially where do we need to be in the next 10, 20, fifty years...?

I cannot speak first-hand, because I am no longer at the sharp-end of general nursing care. From what the media says though what frequently passes as 'nursing care' these days fails to meet basic care needs. Especially, it seems when older people are the focus care delivery. Lobbying and action to protect the tenets of high quality basic nursing care is ongoing. This, however, is were our language changes and we shift from advocacy at that nurse-patient level to activism. What can nursing do as the population pyramid changes? And this is just the start as the issues in-tray is overflowing:

* ecosystem health - global warming
* global health: Aids, diarrhoea, TB...
* migration - refugee status
* public mental health
* health promotion
* public literacy, engagement, expectations
* ...

In order to wave a banner (never a shroud) effectively, you need hard and soft data. A banner is insufficient. Yes, true - it might get you noticed, but attention span is all with this issue set. That data needs to be transformed into information, knowledge - in short intelligence. All too frequently the facts we need are incomplete, inaccurate, or too late. Two circumstances are guaranteed:

1. There are facts critical to furthering the cause and
2. they are totally absent
(and not expected to arrive within the interval of a pregnant pause)

So much of what NU S NG does remains invisible. This must change.

We noted previously what the students may ask, I wonder what the pioneers would say? One thing for sure - they would not balk at the challenge and neither should we. Nurses as advocates begins with patients and their care, but it should not and must not end there.

There Are Four P's in "Hodges model"

People are not very good at multitasking (surprise, surprise!).

In conversation people discuss one topic or thing at a time. If the subject alters, the change of context is indicated through a verbal redirect "There's something else...", or a gesture. When writing, paragraphs help structure our prose. If there are several tasks to perform, then it really is a case of "one at a time thank you!". Although, as the saying goes though - where there's a will, there's a way - hence the constant emphasis on EFFECTIVE team working.

Reality is of course rarely presented to us in discrete contextualised packets. Experience is not always filtered to the extent that only information relating to one context is delivered to our senses. Can you imagine the informational equivalent of the IV drip? (Virtual reality?) And yet this is what our brains are tasked with, to select, sort and prioritise....

There are exceptions:- the arrival of news about an impending birth or sudden illness or accident. Then informationally speaking the world is ordered and yet a personal chaos ensues. We move like the wind...

So usually several contexts are knotted and presented together. Predicatable consequences may follow; confusion, a task may be left incomplete, risk becomes a dance partner, although at first this passes unnoticed as we are still going with the flow. A key message becomes garbled, the meaning fails to get through.

The amount of information needed by a team is erm... well - a big number! The demand for data and information on just process and policy is monumental. Project management tools are no guarantee against satisficing. The volume of information and human fallibility can fracture discipline and has us saying "that’s far enough", or "that will do for now".

So without untying the contexts, unwrapping the complexity - key parts of the picture may be missing. Sometimes even when the picture is complete, we forget about the frame and picture hook? Just which way is 'up' if that matters a[r]t all?

In the same way that items of data can have meta-data (that is data about data), could it be that Hodges’ care domains have their own meta-terms of reference? These terms characterise each of the care domains and their respective contents. In the same way that process is integral to project management, perhaps there are terms that can contribute to the overall effectiveness and scope of Hodges’ model? What I have in mind is the following:

Purpose Process
Practice Policy

Surely this rather complicates matters? For an artist this would actually prove a very limited palette. And yet this is a common strategy – reduce the palette to four colours. This greatly affects the 'masterpiece' assuring discipline and influencing style before the paint is even amb(r)ushed.

For project managers armed with their PM tools the 4Ps really are a handful, but well worth getting to grips with.

Advocacy No. 1

What’s your view on nurses as advocates?

For nurses advocacy is seen as a constant facet of the role. It may not be as pronounced these days, but it is always present. If a person (patient or carer) needs an advocate in that 'non-legal' sense, then as nurses we are ready and willing to assist and present the patient's views. Quite a few years ago there was much navel-gazing that questioned the appropriateness of nurses as advocates. Where are the boundaries and how do you define non-legal? How independent can nurses be?

This no doubt presaged the advent of formal and dedicated advocacy worker schemes, a development reinforced by the emphasis on human rights over the past decade. Rather than travelling along the care pathway WITH the patient, carer(s) and health care team, advocacy workers are ready to get involved - independently - as the care situation reaches a crossroads (and pauses momentarily). In my experience though it is not easy to find longer-term independent advocacy input. Sometimes it is the very need to call 'time' - to seek space to reflect and weigh pros and cons - that is an issue.

Unless their role is radically changed, nurses will always be an initial advocate. Nurses are in the midst of care, their privileged relationship and proximity to the patient, their knowledge of the issues, diagnosis, interventions and prognosis makes advocacy a natural (caring!) response. I raise this because if advocacy is a political concept and the nurse’s role as advocate is less than it used to be, then what is left - beyond the political essentials of pay & pensions?

This blog is in danger of becoming a litany of examples by which I reveal my age. ... Back in the late 1970s and 1980s nursing was far more political and in the UK those were certainly employee-employer troubled times. They had quite an effect did those Union badges! Metallic drops of red, blue and green that adorned so many lapels, instant decoration for the grey suit with waistcoat that I used to wear (my mum thought I looked smart for once). Mental health always seemed more, shall we say union-attuned, than general nursing and yes the power of the unions had a lot to answer for in the UK; but where are we today?

Acting as an advocate you really can make a difference. Individual needs are nursing's bread & butter; but why stop at one person, when the needs of the many...?

Perhaps my view on this is a personal illusion, brought on by the purchase of Jane Salvage's ‘Politics in Nursing’ (1985)? Did this book, like most, merely reflect the times? I must confess the book did not 'activate' me. (Although, as the website may demonstrate, my head was lost above the clouds.)

In my student and early years the advice was keep your nose clean; deposit your assignments on time into the school of nursing's coffers and get through the current placement. There were exceptions as might be expected in a huge aged asylum, though thankfully when necessary action did not fall upon the conscience of one individual (that takes real conviction, courage & dedication). The issue was 'public' witnessed by several colleagues, all dedicated to high quality care. A case of a problem shared…...

The point of all this: If nursing has largely withdrawn from the role of advocate, than what is left politically? Maybe for you nursing is still there, the sparks flying as the activists sharpen advocacy's edge? The nursing pioneers Nightingale, Seacole, Makiwane, Breckinridge, Walking Bear Yellowtail, Peplau; and many others set an agenda. To what extent have we (nurses) addressed this? What remains to be done and what new challenges do we face?

The pioneers made a real difference. Not only did they build the ship, they set us on a course. If I were a student I'd be shouting "Are we there yet!" Has nursing arrived? If not, why not, how can we correct course and where - in the time of constant re-invention - is the new horizon?

Multi-touch interface demo 10mins TED2006

If you have not already seen it - check out this video demo of a hands-on interface from TED2006 - Technology, Entertainment, Design conference in February featuring:

Jeff Han

I came across it c/o the Instructional Technology Forum. Enjoy.

TED2007 watch that space!

Podcast part 1: available at last....!

I've an audio file that I feel passes for muster. I've tried to inject some animation and enthusiasm, which is not easy at 0000 hours. Anyway - thanks to ccPublisher and the Internet Archive you can now download it if you wish.

In the podcast I mention that it will run for just under 30 minutes. In the end it's actually 31:33.4 - not too far out. There are no bells and whistles (thank goodness), no fancy opening music.

There are three files provided (a learning package?):

1. The podcast itself in mp3 at 30MB 128bit.
2. The podcast notes including my responses to the two questions posed.
3. A powerpoint summary of 10 slides.

At 30MB it is a large file, but it will I trust reward your patience. As I'm writing this I've just noticed that ccPublisher has also created a 64bit version 15MB, plus Ogg Vorbis 22.2MB (Open Source).

I've checked the files (except for the XML & OV) and they download fine.

If you find the podcast of help please let me know, especially if it proves useful within education. Wherever you are working, if Hodges model appears to offer something to you get in touch.

Part 2 will follow in due course, after I complete that other project...

Podcast part 1: delayed but ... this weekend!?

Well it's November and no podcast. Yes, mention was made of October, but I did say don't hold your breath. There are two test audio files at 27 mins and 25,000k that I can point to, so very nearly there except that the microphone stand (hey this guy's serious!) got in the way of my foot. Should be fully cooked and served this weekend, if the walking windmill can stand still...

I have to get part 1 through the door sharpish because I need to finally nail the Serres-Hodges paper. I've to reduce the current version from 8k words to between 5-7k when completed, which MUST be at the end of the month. To support this effort I'm reading 'Small Places, Large Issues' by Thomas Hylland Eriksen, excellent introduction to social and cultural anthropology.

Before I go (and gargle) the Idea Factory did the job in terms of my getting on board with Skype. I now have a working internet phone - at least the test call worked. It was easy to install too.

The event also rekindled a potential research question I've wondered about for many years. A question that like Hodges' model grows in relevance each year - more to follow ...

Who are you going to be Jo(e)?

Are all nurses, psychologists, health and social care professionals in general frustrated would-be Joe 90s?

If you recall: courtesy of an incredible device called BIG RAT - Brain Impulse Galvanoscope Record And Transfer - Joe could benefit from the transferred knowledge and experience of experts in disparate fields. The literature is full to this day with commentaries on the transition from novice-to-expert practitioner. Enter Joe: our fictional character who could take a short-cut.

Fact may be catching up, not that nurse training departments will notice next year, but major strides are being made in understanding the relation of stimuli and neural activities across the cortex.

What I'm interested in though is Joe's briefcase. Bizarrely equipped for a nine-year old: packing gun and silencer. We readily take Joe and the entertaining premise of the show in our stride, but we trip-up when it comes to real child-soldiers. Of course, it is just fiction vs fact; a question of worlds-apart - North-South and East-West?

Joe's briefcase held the tools that he needed by virtue of the transferred knowledge and skills (for UK NHS readers you can imagine the Knowledge and Skills appraisal interview). Just think when the BIGRAT's job is done and Joe is spin-dizzy, the repertoire of tools will change. Some are generic, but others need to be specific to the new mission. Health professionals are dizzy with constant change and the world's citizenry struggle to keep up locally and globally.

So as your foot taps in time to Barry Gray's excellent theme music - what's in your briefcase today? What will you need tomorrow? What choice do our children have? What do they need in their briefcase to cope with the 21st Century?

Student Query: Paediatric Burns Unit - Change from Hodges to Casey's Model

Rachael Baron contacted me from Salford University about her assignment on:

Change management relating to a problem identified in practise.

Mine is about changing from Hodges' model to Casey's in a paediatric burns setting (one of the reasons being that there is little evidence supporting Hodges) to achieve family centred care and better partnership with parents. Before my placement on the burns unit I had never come across Hodges' model so it has been interesting reading about it.

In response I acknowledged Rachael's observation about the evidence base and provided the reference bundle.

I also explained how Hodges can co-exist with another model (although the proof is in the testing). Brian Hodges has never been prescriptive in terms of a particular approach to how care is delivered, the model is higher level - an aide memoire. Noting Rachael's objective I wonder if Hodges' model could provide a test of the extent and quality of parent-guardian/care professional partnerships?

In addition Rachael informed me that they use the Health Career Model on the Burns Unit at Booth Hall Children's Hospital. I must follow this up and think Rachael was happy with the reply...

Once again, many thanks for your rapid response and suggestions for reading - it was a huge help!!

Cheers Rachael and best of luck with 6 months of your course remaining!

Ideas Factory: Research Theory and Practice - Bridging the Divide

As mentioned last week, I was in Bath from 16-20 October and when in Bath like the Romans I managed to visit the (new) spa complex. The hot pool and steam room were a really welcome free-time treat and at £9.50 - because the rooftop pool was closed - lead the way or should that be "beam us up Scotty!"

After three days getting to know 26 new colleagues and wrestling with health care issues and the creation of worthy and novel research projects it was definitely time for a break.

The Ideas Factory Taking care to the patient: new thinking in mobile healthcare delivery was very hard work, intensive, challenging and exciting all at the same time. It was marvellous to take part, to share and work together.

At the end there were clearly some sound and winning research proposals: - seedlings - if you like. Those that did not get through were still winners, but as mere 'seeds' they had not yet germinated. All they need is more work and an appropriate funding stream.

I really do hope to stay in touch with people, the range of backgrounds, expertise and experience was startling. Thanks to the organisers, after the first day we all more or less knew each other recognising faces and names. A great way to cross the divide.

And there was I ... thinking it's just a website and blog that has you working into the early hours ...

Home page with a difference?

It's hardly rocket science, but I wonder of the people who do visit the h2cm site, how many think about the home page layout?

If you haven't noticed - I've tried to use Hodges' model to locate the menus and drop-down options...

Are there any items that you would place elsewhere?

Hodges Model References Bundle

I've finally put the primary references in a bundle [Oct 2006] and used ccPublisher to publish the document on the Internet Archive. I missed a few details off the JAN reference (Volume, Issue) which are included below. It would be great to see this list grow through your contributions....

As the first podcast script is also complete I've no excuse to delay much longer. I am leaving for Bath this evening a workshop, so will tackle this next weekend... Bye for now. PJ

Primary references as of October 2006 (if you know of others please get in touch):

Adams, T. (1987) Dementia is a family affair. Community Outlook, Feb, 7-8.

Hinchcliffe, S.M. (et al.) (1989) Nursing Practice and Health Care, 1st Edition only, London, Edward Arnold.

Jones, P. (2004) Viewpoint: Can informatics and holistic multidisciplinary care be harmonised? British Journal of Healthcare Computing & Information Management, 21, 6, 17-18.

Jones, P. (2004) The Four Care Domains: Situations Worthy of Research, Conference: Building & Bridging Community Networks: Knowledge, Innovation & Diversity through Communication, Brighton, UK. March 2004.
[http://www.comminit.com/healthecomm/planning.php?showdetails=318] Accessed: Oct 07 2006.
(If you visit the above link you can download this position paper - look at the bottom of the page.)

All the above are about the model – Hinchliffe is one chapter by Brian Hodges.

---------------------------------------------------
Hughes, E. (1958) Men and their work. New York: Free Press.

Hughes is used by Brian Hodges to define health career the idea of life chances.
---------------------------------------------------
You can also of course reference webpages:
[ no longer available:
web archive: https://web.archive.org/web/20121230101851/http://www.p-jones.demon.co.uk/ ]

Jones, P. (1998-2006). Hodges' Health Career Care Domains Model, [http://www.p-jones.demon.co.uk] Accessed: Oct 07 2006.
Jones, P. (2000) Hodges' Health Career Care Domains Model, Structural Assumptions;
[http://www.p-jones.demon.co.uk/theory.html] Accessed: Oct 07 2006.
Jones, P. (2000) Hodges' Health Career Care Domains Model, Theoretical Assumptions;
[http://www.p-jones.demon.co.uk/struct.html] Accessed: Oct 07 2006.

The Journal of Advanced Nursing paper below is prior to the website, but hints at the way I have since stressed the role of information within Hodges model as the unifying concept.

Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, Vol. 24,3, September, 591-598.

Hodges' model - it's all pants really!

It's no use - I have a confession to make.

After all these years of trying to publicise Hodges’ model, in practice, on paper, through the website. I’ve realised it really is a load of pants. Absolutely, definitely, no counter argument it is:

Utter pants.

Let me explain….

On the site you will find Brian’s notes and various additions that state what h2cm is, including a conceptual framework, holistic model, cognitive space and so on…

Beyond this though what is Hodges' model trying to say? Cruising down the centre of a one-way street if it were a street sign what would it stand for? There is this word ‘essence’ and in philosophy like many words it metamorphoses and starts to play trick or treat. So what is the essence of h2cm?

Whether you loosen your belt or tighten it at this point is of course entirely up to you, but here is my two cents worth.

Firstly, h2cm signifies the debate about parts and wholes.

Secondly, it represents pants – well ok - pantology to be specific.

Here's a definition:

Pan`tol´o`gy
n. 1.
A systematic view of all branches of human knowledge; a work of universal information.

Is there another beyond - beyond the beyond? Because the corpus of knowledge is so extensive and growing by the second if measured by published media could it be that h2cm provides a space where several pantologies can exist and co-exist? This must be the case because if pantologists exist then they must produce pantologies? What do you think? Is that what the internet is, or will become - a conglomeration of integrated pantologies?

So you see Hodges' model really is pants. Would you like to be a pantologist? Living in the 21st century and being a life-long learner by default it looks like there is no choice….

Meanwhile if you happen to live in a galaxy far, far away....

Kandinsky, Bento Boxes and the Art of Hodges' Model

Last month I had an opportunity to visit Tate Modern in London, the meeting that took me South finished at 4pm and TM was 10 minutes away a colleague told me - "you must go!" (Thanks Dee - you were spot on!)

It proved quite an experience walking around TM both from an artistic and mental health perspective. Both challenging 'relaxation' and work: a study day. When you are faced with Dali's Metamorphosis of Narcissus, Bacon, Magritte, Tanguy and others what can you expect? Like you I've seen images of these pictures for years, but seeing the real thing was disorientating, a thing to fall into.


I didn't have time to explore Kandinsky a paid exhibition, wish I had planned a little more - but I really was there for work and this was a bonus. The TM shop(s) were packed with Kandinsky books, postcards and posters.

I've tried to find some guidelines on the question of copyright and posting the Dali and Kandinsky images above. If any one can direct me to anything. I hope as presented this is classed as 'fair use'?

So what effect did this cultural exposure have on me? Well - on the train between London Euston and Wigan (the St Ives of the North) another podcast started to take shape, also fueled in part by the Serres-Hodges paper. How it will be received is another matter.

A few days later I came across Bento Boxes: - weird. Are these associations - connections a sign that I'm just walking through a Forest with a leaf in my hand? Or should that be a Forest of giant leaves and I have a tree in my hand. I'm really lost now, "Frodo!" - anyone ...

Study on Student's Interest in Nursing (Grades 6th-12th)

The effects of demographic change over the next few decades are a regular topic of debate in the developed nations. The comparison of the workforce with those retired means that the health and social care sector face an increasingly competitive arena to find the staff with the 'right stuff'. Before that point though students need to be interested in health related disciplines. How well do we understand this...?

Asst. Prof. Shannon Frodge [Maysville Community & Technical College, KY] contacted me about using an image of Hodges' Career Model (HCM) in her project:

My study will be to survey 60 children in each grade from grades 6th-12th and students that are currently enrolled in our ADN nursing program. It touches on the four major quadrants of the HCM. I’d like to know what kids think about nursing, and how I can recruit them to our program, and if not our program, a nursing program somewhere else.

No problem Shannon and happy to assist. [Thanks for your OK to post this.] I look forward to hearing more and the possibility that you yourself may share details here as your study progresses. I wonder if anything affects whether students will enroll in traditional nursing programs or online nursing programs. One other thought don't forget the 'fifth' domain - the spiritual - Hodges' four in combination.

Shannon's query is also a useful prompt for me to check and update the quality of some of the images on the site and bundle the existing references.

Podcast hosting options - promising

Over the past few days I've checked out podcast hosting possibilities. I knew there were hosting services out there - otherwise I wouldn't have picked up the mic. Two options stand out:

CcPublisher

and -

liberated syndication

- which costs from $5 per month, with 100mb of storage per month with unmetered bandwidth usage. This level of service is recommended for once-a-week podcasters.

It looks promising! Liberated syndication is very slick, with room to grow, CcPublisher is free and combines Creative Commons and Archive.org.

Creative Commons and CcPublisher allow you to address the licensing of your podcast, attach tags (metadata) and upload your files to Archive.org, which plays host.

I think the spirit of Hodges' model and my personal finances will win out. Looking at the time taken with this first podcast, I don't think I'll get to one a month, let alone once-a-week.

I've joined Yahoo! podcasters group to check what's buzzin and make a final decision...

Podcast: update - Powerpoint-OPML & Barry White

The draft for the first cast is now complete and finished @ 2,800 words. The stock market should take note of this, because the drug companies are in for a hiding. Hypnotics they don't know the first thing!

Well I hope it isn't gong to be that bad. There's no way I can do this without a script - and some tools. Realising I'll have more content than just the audio file made me wonder about being able to produce a package of sorts:

1. Outline of cast - Powerpoint slides
2. The audio file
3. The full podcast notes

I came across a 5 minute video by Laura Bergelis that may be worth a look for you too? You provide the Powerpoint presentation and it shows how to convert this to OPML (Outline Processor Markup Language) an outline format. The OPML code has the audio file included, although when I tried this is missing.

In the 'studio' practising I turned the treble down to get rid of the background hiss, at first I thought it was an advance audience with pre-cognition. Problem then though I sound like Barry White. Hey, I know that's no bad thing and yes I luuuvvvv nursing, but this is serious and fun... On a slightly critical note (which figures) I still don't know where on Earth to host this - I'm sure I haven't got the bandwidth - any ideas anyone?

Paper on Serres & Hodges' model - great news progress!

Earlier this month I mentioned a project that has proved something of a saga starting in 2003 - the paper on Michel Serres and Hodges' model. Well yesterday I received an e-mail bearing great news: provisional acceptance for a publication due in 2007. And not just a paper, but a chapter no less of between 5000-7000 words. This has really made my month. I've still work to do of course, but it just goes to show: don't give up!

Michel Serres

Modelling Belief, Leadership & Group Cognitive Therapy Older People

For the past two years come this Nov I have been occupied purely with health informatics. The clinical knowledge and experience of my colleagues and I have proved very beneficial in supporting the enormous changes taking place in our organisation and throughout the NHS. As 'Clinical Specialists' though, we are acutely aware of how quickly you can lose touch, how quickly your credibility with peers can start to wane. Of course, there's a whole debate around this which includes academic staff...

That debate aside - added factors for me are belief, leadership closely allied with Hodges' model. So some great news to report, a new job description means 25% of my time will be a return to clinical work (can you hear running feet?). The plan is to devote this time to establishing and running group therapy.

It's a really exciting prospect: finding a co-worker, planning, preparation, therapy manual / protocols, tools, materials, measures, records, supervision, engaging referrers AND clients!

Connecting with people - that's what IT's about. Having the time to focus on a therapy would be great. I've wanted to do this for so long. How many of us undertake specific therapy training, but are not able to practice? Now without a caseload of 25-30 and Team Leader responsibilities...

I don't know my co-worker as yet. Have they heard of Hodges' model? They will have their own cognitive and practical tools and views on others... They need not worry (I don't like pate), but if there's an opportunity to incorporate Hodges' model then my belief, leadership need be at the fore. It's early days - but fingers are x'd...

Mental Health Nursing - Lessons Learnt

On the Psychiatric Nursing list a new student posted saying 'hello' and seeking pointers. Given my 21+ years experience I pondered and sent what I hope will be a few pearls of wisdom:

* Learn to listen
* Learn from your clients - they are the experts
* Be yourself
* Look after yourself (1st lesson of 1st aid!)
* Do not prejudge
* Visiting people in their home - you are a guest - and not always welcome.
* Always remember you were a learner once
* You are also a learner today and tomorrow...
* With therapies always check the 'use by date'
* What aptitude~ is to engineering, so attitude is to health and social care
* Make 100% use of your placements - golden opportunities
* Always be ready to think on your feet
* So - keep an effective yet accessible toolkit in your head
* Take nothing personal - except constructive criticism
* Seek supervision - never be afraid to ask
* That's quite a gift: the talking mirror use wisely

Do some students squander their placements, like teenagers always thinking about the next year? It's the great opportunity to learn about in-patient, community - outreach services and the various therapuetic approaches. That's the problem though - if I knew then ....

~Aptitude does help when wielding injections...

Podcast - ok let's get the show on the road....

Wherever you look, or should that be - look and listen? - podcasts abound.

I've just downloaded the latest copy of Audacity and managed, using my son's audio kit to create an mp3 test file. Playing back though Audacity it's a bit low in amplitude, but sounds quiet good. Thirty years ago aping around with electric guitars my old Akai mic is still sound. No great shakes in creating an mp3 file I know, but it's a start. All I need to figure out is what to say.... Mmmm... Maybe something like this ....

Part 1 Welcome to the Quad Part 1 Introduction
Part 2 Part 2
Part 3 Application[s] or App. 1,2,3,4
Part X The Art of Hodges Model
Part X Why Hodges Model Matters ...

At the same time, I must finish the Hodges-Serres paper. This started in 2003. Most of an older version is on the site - with some images not suited to the standard journals. I've had some excellent support and feedback thus far, so the delay/struggle rests with me. Can't connect with the right journal and that speaks volumes (no pun intended) for the quality. In a way that isn't surprising [que rationalisation]. Serres is apparently very difficult for academics to summarise (let alone me) and in addition the paper echoes something of Serres' random flight with I hope the more recent addition of a little order. Podcast now I wonder ....?

Photos & Google Analytics

Now three months since last post! Like they say things get worse, before they get better...

Good excuse of course with summer holidays, lounge and dining room decorated, still more jobs to do especially with the nights getting longer.

I posted on Flickr quite a while ago, finally uploaded some photos inc. some holiday snaps:

This shot was taken at the theme park Puy Du Fou, just SE of Nantes. The night spectacular was indeed superb and a nice contrast to the usual theme park fare, running through the history of the people of the Vendee. Over a thousand actors contributed to the show, the stage huge, the night 28 July star-lit clear from the start 10.30pm to 00.30am.

On the site - AddfreeStats has been really useful for many years, but I've taken the plunge with Google Analytics. Short on details about the pages that people are visiting, look forward to reading the reports.

In 2003 I started reading some of the translated books by Michel Serres, a French philosopher. It's a concentrated read, constantly going back and re-reading, but the way Serres' approach marries with Hodges model is amazing. I had to write and now what a saga. You see, the paper sort of wrote itself, so there was no audience in mind and it shows. After several rejections more to follow on this.

Bye for now...

Thanks Google ... Wiki ... oh for more time ....

Over a month since that first post ...

One thing I did not mention last time, was the existence of a blog set up using the h2cm title. This blog was not concerned with the model, merely hitching a ride.

They say all sorts about imitation and flattery, which is nice, but that needs to set alongside the impressions the Net creates. Being a part-time webslinger with h2cm online since 1998, as you seek to publicise your project this inevitably attracts link spam. Over eight years it appears that enthusiasm can be transformed into over-zealousness. Of course this gets noticed, hence the virtual monkeys on the back. So in addition to the reasons posted in April, that's why I started this blog.

I sent an e-mail to the company concerned and an Exec at Google. Searching for that blog last night the link was listed, but was not found. So if it has gone - many thanks to whoever and Blogger crew.

Does it matter? It does when that 'enthusiasm' has you post an article on Wikipedia that is deemed as ripe for deletion. In fact - hold on - yes its gone! At the time it seemed a good idea; well, we all need a lift sometime and when a bus comes along that's headed downtown - who am I to walk? The Wiki-police-team wondered about evidence as to the model's importance. The link spam was also duly noted. They concluded the site is limited to hits on Google and links that merely circle back to the home page. To be fair the links to h2cm are more credible than the Wikipedia editors stated, with some very reputable organisations and repositories providing introductory and link details.

Their comment that the site has no dedicated url was helpful. A point that was being addressed as I read their comments. I agreed the submission should be deleted - another time. They have enough (brilliant work) to do at WikiPedia without me muddying the waters. They have also merged pages connected with nursing theory/models and deleted the h2cm external link at the same time, flagged as 'did not survive'.

Well enough of me - I have to check the bus timetable, waiting for a number 4 ...

Welcome to the Hodges Health Career - Care Domains Blog

Hello everyone.

Welcome. As with most things your arrival here has a history. So I'll begin with what is now our shared history.

The website devoted to Hodges' model has been online since 1998 (- until 2015). From the beginning the site has comprised three parts:

1. Brian' original course notes;
2. my contributions on Brian's model and informatics;
3. and four unique link pages - one per care domain.

In the time it takes a bubble to burst the web has not stood still. Unfortunately, considering that the website is supposedly devoted to Hodges' model, the result is far from a rich internet application. The latest additions to the site include an invitation (appeal!) for you good people to get involved, to submit your work. So if you have an idea about how you might apply Hodges' model please get in touch.

The other addition is a project to try to find a philosophical home for Hodges' model. A foundation that might underpin further development theoretically and practically. Advancing work to date is not a big ask, as there is little to show when compared with other health and social care models. I can hide behind the excuse that the site is a spare-time pursuit, and the site's links are pretty up-to-date. Speaking of which - if you explore the links pages:

Interpersonal : Sciences

Sociology : Political

- you will I hope appreciate how they have become a runaway monster. You see once upon a time there was one monster on a train, then he found a mate and now (thank goodness for that tunnel!) there are four of the blighters each with a train of their own....

Now to 2006 and all that.

Seeing the amazing blogs that adorn the cyberfirmament and the future prospect of Web 2.0, it really is time to get back on track. So this blog is one step into tomorrow....