Hodges' Model: Welcome to the QUAD: May 2007

- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Thursday, May 31, 2007

Ecotherapy: Hey Surf's Up - Better grab your sunbed

Having an eye for 'therapy-this' and 'that-therapy', a report on ecotherapy has appeared on the MIND website, blogs and other media. It's not new really, although the researched approach is very welcome. The mental health benefits of volunteering and the great outdoors have been recognised for countless years.

This summer - August in fact, there's an opportunity to do something different that also has an outdoor theme. It means putting that surf board down and getting the sun bed out: after midnight. Now is the time to do some networking and planning - at that time of night of course you must be safe and this is an experience to share with people you know and trust.

This is 'astrotherapy' which is connected to ecotherapy because venturing out you realise how light it is at night - where is the night sky!

Why go out and find dark skies? It's the PERSEID meteor shower and this summer with maximum the 12-13 August there is no full moon.

You can also check on whether the International Space Station (AND Space Shuttle on this occasion!) will pass within sight for your location.

When you can and do look at the stars it's quite a trip. If you are feeling depressed or lacking in self-esteem, if you let the view work its magic - it sure can make you feel insignificant and yet so very special. Gifted: to look the infinite in the eye...

Mind - Go green to beat the blues - Executive Summary
Some obvious tips: If travelling somewhere even with others check the site during the day. If needed: get permission - tell someone; take extra clothes and a hat - midges, mozzies. If you've a torch cover it with a transparent red film (red hanky even) so it doesn't mess your (and others!) night vision as much. Support your neck properly, you can't stand and crane your neck for hours - besides you'll look daft the next day walking into work - hey I know. If you are in the back garden and see a meteor don't shout out. The buckets of water will fly. Give yourself a good 10-15 minutes to light-dark adapt. Don't forget the flask! Be patient and I'm sure you'll be rewarded...

Monday, May 28, 2007

Four knowledge domains = four audiences?

I don't know if there is any sense in this, but people look for 'signs' all the time - don't we? With the last front-end revision of the website (early 2005) I had twigged that there are at least four audiences that an introduction to Hodges' model needs to address.

Looking at the care domains the following seemed to fall just right:

Patients and Carers : Students - Lifelong Learners

Public [Citizens] : Policy makers, Managers

These may be lost to many visitors (but not you!) given the surfing attention span. If people do access and digest the first page above, which acts as a general introduction, they may not reach the second audience specific page.

Should I swap these around?

What is provided on the first page of each, is a basic h2cm graphic showing some relevant concepts for that particular domain. (It's this representation that trivialises h2cm).

The introductions do need revising and updating. I found some typos on the student - sciences piece, so not the best effort.

I think overall though this approach works - and highlights the need for collaboration and engagement on so many levels.

What do you think, any suggestions?

Ecotherapy to follow...

Sunday, May 27, 2007

Invitation to post to the QUAD & human ecology

I've sent out some invites to people I've either worked with, or had contact with over the years since starting the website in 1997. Invitees will be able to contribute directly to this blog.

It would be great to have other authors on board, but of course I realise everyone is busy so I'm open minded. This move is long overdue and does me good in terms of 'letting go' and releasing H2CM into the wild.

Switching to the latest Blogger I lost haloscan. I've added it again to manage comments: purely in response to a sense of anticipation than demand. In doing so it appears I've lost earlier comments; although the correspondence is saved the loss is still a pain.

Job-wise things are a bit up in the air at present. Clinical - Informatics: both...?

There are plans for another group meeting on human ecology to possibly establish a NW England group. Possible dates are:

  • Sat 9th or Sun 10th June
  • Sat 30th or Sun 1st July
  • Sun 8th July
The venue could be Sedburgh (lots of bookshops apparently!) or Manchester where we met in March. Let me know if you would like more information.

With the Serres-Hodges chapter now out the door (what a relief!) it would be good to write something collaboratively using some of the available e-tools.

More soon...

Thursday, May 24, 2007

Holistic Bandwidth: All or Nothing

Quite a few years ago (Jones, 2004), I took the term bandwidth from the information and communication technology (ICT) world and applied it to health and social care. We seem to have been trying to achieve holistic and integrated care for decades. When care assessment, planning, intervention and evaluation is limited in scope this creates a narrowing of perspective, a bottleneck. Just as bandwidth problems used to affect the quality of on-line experience, so the bandwidth in health and social services ultimately affects the quality of care.

There's nothing wrong with perspective.

It's essential to making sense of the world. And after all, that railway line travels all the way to the vanishing point and it doesn't stop there. Road or railway - there's enough space reading between the lines to launch a whole film and literary genre.

I've said it before – but it really is ironic that many of the constraints in ICT have been overcome through broadband, memory costs/capacity and multi-core processors; while health services still struggle, still need to change:


Single-track thinking is no longer sufficient, even if it is reassuring being able to see where you came from.

There’s an interesting non-trivial aside that follows from this bandwidth notion. The old conundrum of quality versus quantity.

Quality and quantity are the ties that bind, the Gordian knot. Cut this one at your peril!

Failure to focus on priorities, to take in that single, that utmost life-threatening perspective could result in disaster. Intensive care is the obvious example. Failure to attend to the physical priorities because of what seem new-age, airy-fairy ideas will quickly get you noticed.

There’s probably a paper out there on quality, quantity and appeals to holistic care. Returning to bandwidth I have wondered about how to measure this? Integrated care pathways and variance might be one approach, serious incident reports may be another revelatory approach? If it’s a care concept and moves ((uses energy) has currency) measure it!

There are a raft of measures for all sorts of things including, mood, behaviour, nursing care related, quality, risk and dependency. If you know of any that might measure holistic bandwidth, please let me know and add a comment here.

In the meantime I’ll ramble on - travelling h2cm's tracks…

Jones, P. (2004). Viewpoint: Can Informatics And Holistic Multidisciplinary Care Be Harmonised? British Journal of Healthcare Computing & Information Management, 21, 6, 17-18.

Gordian knot image c/o Bernice Steinbaum Gallery.

Saturday, May 19, 2007

"Where are we?" Take Two, Three, F.... (witheringcare?)

In Five Senses, Serres does not overtly discuss mortality, loss, depletion and omission (Connor, 1999). Management consultants advise that to succeed ‘think outside the box’, but the population pyramid is casting an ever larger shadow, highlighting an ageing population and the box is frequently found full and yet empty? Plaques disconnect, disable the memory; the critical biological box no longer registers and connects. The noise that counts, the background bioelectrical hum is disrupted or absent. Memories once ready to roll downhill, surfing the wave of potential are inaccessible, if marshalled at all. Wither the neural crossroads; the informatique mote in Hermes’ eye?

Our older people, those not yet ephemeral have become peripheral, their personal space an adjunct to furniture. New quantities in life, beg questions of quality, especially quality of care and what it means to care. The concept of self, person-hood is a prime distinguishing factor in terms of describing the attitudes of cultures and communities to older adults and memory loss. In the developed nations the debate continues: is this the price of a long life, or a way of life? In a search for the locus of informatics: the sign on this door reads deep informatics. Listen carefully, as inside the seniors are cared for at home (touched*) remotely courtesy of telecare solutions. The values here of course extend from inappropriate use of informatics to lack of access to such services (Barlow et al., 2006). ...


*For Serres touch is the interface.

We must ensure remote care is not a total substitute for face-to-face interaction.

Barlow, J., Bayer, S., Curry, R.
(2006). Implementing Complex Innovations in Fluid Multi-Stakeholder Environments: Experiences of ‘Telecare’, Technovation, 26, 3, pp.396-406.

Connor, S. (1999). Michel Serres’ Five Senses.
Retrieved May 19, 2007, from http://stevenconnor.com/5senses.html

From submitted chapter: Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons - forthcoming...

P.S. Sorry about the two posts today - trying to figure some things out...

Friday, May 18, 2007

New Scientist: Application of RFID technology in Alzheimer's disease

Up to November 2004 I had worked in the community for some ten years with older people (and some well-under '65 years old') who were coping, usually supported by their families; sometimes struggling alone with "Oh, I'm fine!" dementia.

As an ICT enthusiast I've attended presentations that highlight the role that telecare and telematics is playing in extending independence and maintaining quality of life for people with chronic medical conditions. Of course people and families who are robbed of so much, deserve all the help that can be provided.

Having just completed 7,000 words on Hodges' model, selected works of philosopher Michel Serres and informatics, it has struck me the way that just as health and medicine has its many disciplines, so informatics has its various schools. There is community, social, health, e-government, biomedical and many others...

There are two key characteristics of the (western) population pyramid: form and implications. It's getting top heavy as older people far out-number the young. At that top heavy blunt-end there will be increased call on social and mental health care services. Meanwhile, at the sharp-end the younger generation will be (already are!) the 'new generation carers'. Optimist that I am - I'm on that cusp, you know that one where you are looking back and looking forward in equal measure. As a nurse you have to worry these days what passes as 'care' never mind 'nursing care'.

The 'youngsters' will rise to the challenge, won't they? Otherwise, the State will help...

If not, what other solutions are available? And hold on, whose 'solutions' will they be? Will those at the sharp end call for blunt solutions or sharp ones?

Informatics values are out there, but where is the value system that provides ethical assurance across informatics disciplines, health and social policy?

Whatever your age and state of health this New Scientist item begs reading and reflection - 'Plan to 'chip' Alzheimer's patients causes protest'.

I hope you don't have to say "best read the manufacturer's blurb now"!

Wednesday, May 16, 2007

News exclusive: Mind mapper is visited by guardian angel of Hodges' model

On the web I found an interesting comment item from the Educational Guardian 2006 by Philip Beadle "Mind maps: rubbish in theory, but handy in practice". Being an educational piece Mr Beadle is concerned with mind mapping in the context of children, although that's quite an age range in reality. As the title suggests, the piece as a whole does not rubbish mind mapping completely, but the start got my goat.... You see I thought of the first impressions and assumptions that people may form coming to Hodges' cognitive x-roads. Do they turn back or cross the divide?

Beadle apparently mind mapped the article and asks the reader if they notice a rise in quantity. I don't know if it's a typo, but quality should be the factor here. He made several points:

  • Mind-mapping is easy
  • Send people to search for coloured pencils
  • Sharpen them - and again - and again
  • DO NOT use a felt pen
These instructions are c/o the books by Tony Buzan the mind mapping guru. Beadle declares them wrong - and continues:
  • Draw something in the middle (right dead bang, no less) of the paper
  • Stay away from the sides - radiant thinkers need space
  • Draw six multicoloured lines from the centre and a picture at the end of each
  • Lines should be curly - no room for rulers in this realm
  • Write key words in UPPER and lower case and voilà! A basic mind map is born
I realise you can read, but suffice to add that Beadle explains the claims that are made for mind mapping and the issue of 'bad science'.

Hodges' model has a problem here. It is not scientific - not evidence based. Not for the last time I'll say that the website and this blog are a (faltering?) call for research.

In many subjects the concepts of locus and control is important, in psychology and therapy for example. In mind mapping what determines that initial centre-stage drawing? True it could be person-centred, situated and problem centred.

As described above, though the space (page) in mind mapping is blanc*, virginal, neutral and crucially - unstructured.

Actually, there's some grief and annoyance in store for the mind mapper coming to Hodges' model.

There they are coloured pencils in hand, tongue protruding seeking airborne creative inspiration...

And then, it happens "Sh-t! Who the hell has graffitied on my page!"

Then suddenly, a voice booms out from overhead:
"Greetings, mild-mannered mind-mapper. Here is an announcement: the centre of this page has been rendered a no-go-zone. It is now a hyper-dimensional nexus, the point of fusion between four disciplines, five even (how could I forget). It is Complexity and Chaos. You can venture as near as you wish. Now please do not fret; I have it on good authority that aesthetically many things look better slightly off-centre."
The point I want to make - is the central importance of:
  • Hodges' axes and knowledge domains - just where is the 'map'?
  • How these influence the locus of control and association
  • The concepts are already 'on' the page implicitly
  • The user makes them explicit (in mind-mapping the space is aconceptual)
There are other critical dependencies:
  • The knowledge, skills, attitudes and aptitudes of the user (are they a novice or expert#?)
  • Whether they are novice or expert, Hodges' model provides a common conceptual substrate
  • Finally (though I could go on!) quality in health and social care - and without - is the real issue. There are times when silence is golden...
There are many visualization (with apologies to those with voluminous datasets to swing) and mind mapping tools out there, but with the semantic web and Web 2.0-3.0... then Hodges' model will come of age....

Ack: *Michel Serres; #Benner, et al..

Monday, May 14, 2007

What is a 'domain'? II

Last week I referred to a definition of domain that included mention of:

1. A territory over which rule or control is exercised.
2. A sphere of activity, concern, or function; a field: the domain of history. See synonyms at field.
3. Physics. Any of numerous contiguous regions in a ferromagnetic material in which the direction of spontaneous magnetization is uniform and different from that in neighboring regions.
4. Law.
a) The land of one with paramount title and absolute ownership.
b) Public domain.
The remaining definitions -

5. Mathematics.
a) The set of all possible values of an independent variable of a function.
b) An open connected set that contains at least one point.
6. Biology. Any of three primary divisions of living systems, consisting of the eukaryotes, bacteria, and archaea, that rank above a kingdom in taxonomic systems that are based on similarities of DNA sequences.
7. Computer Science. A group of networked computers that share a common communications address.

[Source: Answers.com]

- I suggested were connected by language....

There are some very formal definitions of domain from the world of 5. maths. Pulling other words out of the hat isn't the answer, but the idea of mapping between 'domains' is (I think) very important in Hodges' model; even though any mapping is subjective and - in this instance - not evidence based. Is it possible to be presented by an insurmountable edifice - something that terrifies you and yet fascinates at the same time? Well that's maths for me. I'll return to this another time.

Maths, 6. biology and computer science (to follow) are as noted in the first post domains of study. In health care and especially within medicine 'formal languages' has been and remain a major preoccupation in the form of coding and classification schemes. If you follow the links above you'll see they are listed in the SCIENCES page - since they are formal and structured. In order to report on activity locally and epidemiology at a global level, classification and coding is essential.

The links also include examples of languages of nursing. Nurses spend quite some time writing and computers still choke when it come to analysing and reporting on reams of narrative text. Computers still love codes. Although they are becoming ever more versatile, they still crunch numbers or 'data'.

As for computer science 7: in the 1980s I remember seeing graphs depicting 'languages' from microcode and assembler language at the heart of the machine, through to the fuzzy world of written and spoken language. In between there's quite a spectrum covering logic and a huge range of computer programming languages.

Searching the web I suppose I was bound to come across domain specific languages (DSL). There's a couple of videos and Ruby's in the frame. Funny that, I had noticed in Starbucks how some people like to show off their DSL expertise.
One things for sure this really focuses the mind in terms of defining a domain.

Thursday, May 10, 2007

What is a 'domain'?

With visitors to the website confusing the title Hodges' Health Career Model for job careers; the addition of 'Care Domains' was intended to reduce confusion.

I think this has helped, but because the future beckons and this blog plus the website appear to have a multidisciplinary readership more clarity may be of help, especially the use of this word 'domain'.

The dictionary is a good place to start:


1. A territory over which rule or control is exercised.
2. A sphere of activity, concern, or function; a field: the domain of history. See synonyms at field.
3. Physics. Any of numerous contiguous regions in a ferromagnetic material in which the direction of spontaneous magnetization is uniform and different from that in neighboring regions.
4. Law.
a) The land of one with paramount title and absolute ownership.
b) Public domain.
5. Mathematics.
a) The set of all possible values of an independent variable of a function.
b) An open connected set that contains at least one point.
6. Biology. Any of three primary divisions of living systems, consisting of the eukaryotes, bacteria, and archaea, that rank above a kingdom in taxonomic systems that are based on similarities of DNA sequences.
7. Computer Science. A group of networked computers that share a common communications address.

[Source: Answers.com]

1. A territory over which rule or control is exercised: can apply in Hodges' model from a theoretic perspective by a curriculum, a scheme of work, and consequently in practice. We refer to the clinical domain, medical domain or social domain. This latter usage overlaps with 2. we often speak of fields of study and practice.

Place (territory) is the vital ingredient here; specific wards, clinics, treatment centres and even community may be described as a domain of care. The way 'domain' is used in day-to-day language may vary markedly. On some occasions the domain in question may be at an even higher level: clinical domain versus management domain.

3. Is interesting because although they are not exactly magnetic, there are several polarities* at work in Hodges' model.

On the borders between Hodges' domains, what is the 'switch' (context, situation, person focus ...) that determines the placement and direction of care concepts: for example - humanistic or mechanistic?

Sticking with physics there are undoubtedly several chaotic attractors within the bounds of Hodges' model. From the behaviour of the heart to the role of psychosocial stress in risk of relapse. If several variables are linked chaotically, what risks are run if one or more domains (however defined) are deemed non-relevant or out of scope?

4. This legalistic definition of 'domain' also applies. Hodges' model is person-centred, but although focused on the individual the model acknowledges the need to reconcile the diametric opposition that is the law that prevails for the one [INTERPERSONAL] and the law, justice and systems of the many [SOCIAL] and [POLITICAL].

Hodges' model is also in the public 'domain' all that is needed is an acknowledgement.

The remaining definitions 5, 6 and 7 - maths, biology and computer science - are all connected.

The connection?


More to follow.... Hope to return over the weekend...
*Will post about polarities, when I take a certain photo over in Manchester.
Just hope they don't pull it down before I get there! Bye for now...

Monday, May 07, 2007

ERCIM news latest issue "The Digital Patient"

Hello everyone

This research publication c/o European Research Consortium for Informatics and Mathematics is excellent - especially the latest issue:

Introduction to the Special Theme: The Digital Patient

View online.

Enjoy - a marvellous publication.

Sunday, May 06, 2007

Bits and Pieces II: Better put the kettle on...

Well my tickets booked for Charleston, SC and the Society for Philosophy and Technology Conference in July. Still to sort the accommodation and conference fee. I've applied for funding from two organisations and hopefully the response will be positive on both counts, great news that I've £200 as a start.

I'm on the final stretch too for the book chapter, which combines Hodges' model, Serres and informatics - fingers x'd and just a day or two until I need to send it off! Can't wait to have this (successfully) done and dusted. Must move on...

The past month and evening I've really enjoyed the 50th birthday TV celebrations for the Sky at Night and Patrick Moore's contribution to astronomy. Absolutely - MEGA. April's Episode - Time Lord must be a TV prize winner - informative, funny and great entertainment. Looking forward to the next 50 years!

I've read through David Mercer's - Drupal and yep I'm still keen. Home for over 2/52 and not even managed to log-in to Drupal.

Getting to grips with this particular content management system is good, because I'll have to pick up some Apache, MySQL and PHP.

If you're familiar with the website on Hodges' model, you'll recognise that the links pages need checking regularly. If you are new or have never scrolled down:

psychology, human computer interface, accessibility, mental health, therapies, philosophy, theology, artificial intelligence and knowledge management, ideas...

anthropology, qualitative research, sociology, health protection & promotion &
change theory, patients, carers and advocates, health, social & pastoral care practitioners, art, media, culture, & tech., collaborative computer supported working...

nursing theory, astronomy, science, maths and logic, quantitative research, info sources, evidence based practice, governance & complexity, informatics, diagrams, visualization, virtual reality, markup languages, environment, ecology & eco-system health...
human rights, citizenry, employment, standards, policy, democracy & law, activism, development & poverty, economics, community informatics, commercial, info. assurance & governance, organisations, open source & trade principles...

Once the chapter's submitted I'll get the links check done. Then I can focus on other things. This is my take on the links for Hodges domains. Would you move, add or delete any?

What could I do with these links pages and Drupal I wonder?

I notice that MEDINFO 2010 is to be held in Cape Town. Alpha Centauri! Sure would love to see the Southern night sky. That would be quite a project (offsetting the CO2).