Hodges' Model: Welcome to the QUAD: October 2008

- 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, October 30, 2008

Help for NHS.jobs and job hunters with standard file names

NHS.jobs is a marvellous web resource. Once you have entered your personal and career details you can save time and focus on what matters....

One thing I've noticed is that should you download assorted 'job descriptions', 'person specifications' and other essential guidance the files become meaningless when listed.

Browsers and operating systems do behave differently, but on my PC extra characters are appended to differentiate one 'jobdescription.doc (or pdf)' file from another.

There must be a way to define a standard across the NHS (and dare we suggest the social care sector)? Then prospective job-hunters can see from the file name the organisation, the job title, closing date or other combination of details? Given the redundancy in our language(s), the need for equality (in access) it would not take much to achieve this?

There are some points of note: what's the shelf (directory!) life of these files? "If you have not heard from us within four weeks of the closing date then please assume your application has been unsuccessful on this occasion."... Plus, the semantic web and an intelligent file system may overtake this problem and perceived requirement, but until then...?

Even if only gifted a recommended convention, then perhaps this could quickly emerge as a standard, because it makes a difference, affords an early advantage in the 'market place' and assists everyone.

Surreal door handle
As the demographic squeeze tightens its grip this might even help HR departments, students, returnees, and the middle-aged-mid-career-crises-smitten.

Until then NHS.jobs and job hunters can only handle the files they 'receive'.

NHS.jobs does very well in helping to open doors... in the meantime I'll keep knocking ... and anyway what date did I save that person spec?

Image source - previously at: http://www.ectomo.com

Wednesday, October 29, 2008

Transcultural health & Hodges model

Text by Larson et al. (2001) is presented below with a suggested placement of
Bradshaw's (1972) typology of social need on to the four care domains of Hodges' model:
Felt need:
The needs as perceived by members of the group.
Normative need:
The group fails to meet an objective, universalistic standard. Technical definitions of need such as the Australian National Mental Health Standards are examples of normative need.
Expressed need:
Through their behaviour, group members have demonstrated a need, often by lengthy queues for services or failure to attend a service.

Comparative need:

The group is demonstratively worse off than another group. Comparative need is usually demonstrated through routinely collected statistics, which is problematic for small ethnic groups whose identities are rarely recorded (p.336).
Bradshaw’s framework is still widely used. The important distinction is one between the ‘top-down’, professional-derived definitions of normative and comparative needs, on the one hand, and the felt and expressed needs, interpreted as the ‘bottom-up’ expression of experiences and attitudes, on the other (p.336).
See also Larson et al. discussion of 'thin' and 'thick' needs.

(The fact that this typology can be described in terms of 'top-down' - 'bottom-up' also highlights the socio-technical potential of Hodges' model.)

Bradshaw, J. (1972). The concept of social need. New Society, 19(496), 640–643.
Larson, A., Frkovic, I., van Kooten-Prasad, M., Manderson, L. (2001). Mental Health Needs Assessment in Australia’s Culturally Diverse Society, Transcultural Psychiatry, 33(3), 333-347. Abstract

Cognitive tools and fashion: no accounting for taste!

As a child of the rose tinted 60s and 70s I've seen all sorts of fashions come and go. Likewise with the tools used in nurse education. At least with cognitive tools, such as Hodges' model we don't have to wear them on our sleeve. ...

Thank goodness for that!

Image source with many thanks: John Eric Hughes

Sunday, October 26, 2008

Working with the mind in dementia, not against it

The following (edited) item was posted to the NURSE PHILOSOPHY list by Phil Benjamin;
Sandwell Third Age Art's DVD: ‘Fountain's Jolly Inn’ (no longer available?).

You may be interested in a novel and sophisticated model for aged care in Tasmania. This model is based on a sophisticated psychological interventions based on an understanding of the intact affective life and needs of patients, even with the most severe cognitive disabilities - useful links below:

Dementia can produce challenging and erratic behaviours. The disease itself is one cause, but so is the world outside. Which psychosocial interventions really make a difference? And, a tour through an orthodox nursing home for the most extreme cases -- there's a bus stop with no bus, a car that won't go -- and it really works.

This film was about the making of a pub themed area inside a residential home for older people with mental health needs.
It was made by Paul Nocher.
The DVD shows how a little imagination can go a long way in creating an interesting and stimulating environment in a residential home and how the transformation of a space can enrich the lives of the people who live in it.

Saturday, October 25, 2008

The Public, Patients and Carers in Hodges' model

The table below indicates some of the main concepts and concerns that
surround the PUBLIC, PATIENTS and CARERS agenda presented using the four care domains of Hodges' model:

mental (subjective) health, mood,
hope, human spirit.
Knowledge and understanding of condition. Literacies: 3Rs, ICT, social, visual, spiritual, health.... Diagnosis - prognosis. Psychological impact. Aware of info sources

tolerance, personal choices & autonomy. Response to trauma, threat, loss. Belief systems. Coping strategies. Emotional memory
Perception. 'Individual pain'
Motivation. Responsibility
Ability to work,
disability, gender

Individual engagement,
personhood, dignity.

Self-care, Purpose

Personal Health Record

Attitudes, beliefs
Physical (objective) health.
Chronological - Pathological Age (of care subject, carers).
'Fitness'. Activity. Systems.
PROCESSES, structural flexibility.
Pain thresholds. Measures (Pain genetics, scorecards).
Systems, feedback, redesign, improvement.
Complexity. Change. Research: Evidence-based care. NICE. Quantitative, Quality of Life, assessment, screening.
Process redundancy.
Decision making

Referral, care pathways, plans, time.
Self-admin drugs. Expert patient.
Health, care, eng. model(s)
Ill-health - Health promotion
Time for data collection.
Curricula design, Courses, qualification.
Standards vs Innovation
Computer supported engagement*
Carer - family understanding of condition, diagnosis-prognosis. Genetic implications (if any). Familial genetics pain.
Sense making. Meaning.
Social articulation of individual +ve & -ve experiences.
Generational (role) inversion.
Engagement and Social inclusion: work, social mobility, homelessness, stigma, poverty.
Access to info and comms technology

Medical Sociology. Sick-role. PRACTICE
Effects of culture 'meanings'. Dependency.
Religion, fatalism.
Leisure. Volunteering.
Social capital / capacity.
Collaborative care, concordance.
Socio-cultural reach.
Communications. Media. Dialogue.
Qualitiative research.
Social change attitudes.
Shared definitions and meanings: 'engagement', 'health', 'wellness'...
POLICY, Nat. - U.N., FUNDING, GLOBAL ECONOMICS. Legislation: Section 11 of the Health and Social Care Act 2001. Nat. programs: Health For All. Health & Local Social Service Auths, 3rd & Independent sectors.
Choice, Equity, Equality, Access, Advocacy Services. Consultation, engagement. Patient Advice and Liaison Service (PALS). Definitions: engagement continua, datasets, intelligence / reporting. Service planning and development. 'Localisation' - Center.
NHS Constitution
Scalability of concept: Grp - Ind.
Organisational empathy
('x.org' <-> public, patient 'rapport, involvement').
Economic cost of prolonged 'patiency'. 'Patient Lead'. Compliance. Political priorities, strategy, continuity. Policy half-life. Consolidation. Governance. Expenses. Specificity of roles, social exclusion. Wellness. Disability. Human Rights. Invalidity. Re-training. Health outcomes, assessment. (Lay) Representation. Champions. Black, Minority, Ethinic groups. 'Citizen-Patient'?
Retirees. NHS: 'Open All Hours'
Dedicated centres

The focus above is UK, but can be readily revised to reflect other countries.

1. INVOLVE: Promoting public involvement in NHS, public health and social care research.
2. Involve: Promoting public and patient involvement in policy making and service design.

*Several informatics schools: community, urban, social, health, nursing, gender, e-gov...

Tuesday, October 21, 2008

Periodic Table of Visualization Methods [Net-Gold]

Plenty here to think about... (source ack. Terri Willingham & Net-Gold):

Date: Tue, 21 Oct 2008 14:50:54 -0000
Subject: [Net-Gold] E-LEARNING: Visual Literacy

Visual Literacy

See, especially, the Periodic Table of Visualization Methods:
http://www.visual- literacy. org/periodic_ table/periodic_ table.html

This e-learning site focuses on a critical, but often neglected skill for business, communication, and engineering students, namely visual literacy, or the ability to evaluate, apply, or create conceptual visual representations. After this tutorial, students should be able to evaluate advantages and disadvantages of visual representations, to improve their shortcomings, to use them to create and communicate knowledge, or to devise new ways of representing insights.

The didactic approach consists of rooting visualization in its application contexts, i.e. giving students the necessary critical attitude, principles, tools and feedback to develop their own high-quality visualization formats for specific problems (problem-based learning). The students thus learn about the commonalities of good visualization in diverse areas, but also explore the specificities of visualization in their field of specialization (through real-life case studies). They will not only learn by doing, but in doing so contribute new training material for their peers to evaluate (peer learning).

Terri Willingham

Monday, October 20, 2008

Introducing Visual (Research) Methods: Review Paper

ESRC National Centre for Research Methods Review Paper
Introducing Visual Methods (65 pages)
Jon Prosser, University of Leeds, UK
Andrew Loxley, Trinity College, University of Dublin, Eire
October 2008
National Centre for Research Methods
NCRM Review Papers


Over the last two decades there has been a global surge in interest in visual research methods. Word and number-based researchers are coming to realise there is considerable potential for gaining knowledge if image-based methodologies are adopted. This paper provides and overview of approaches and perspectives broken down into five easily digested sections to be consumed wholly or in part: early visual research; researcher created data; respondent created data; research design; and visual ethics. The paper will be of particular interest to qualitative social scientists new to visual methods or those with little experience of their application. A wide range of carefully selected references and resources are included to provide the reader with further in-depth insights.

My source: IVSA Digest - 17 Oct 2008 to 18 Oct 2008 (#2008-153)

Sunday, October 19, 2008

ERCIM News No. 75 Special theme: "Safety-Critical Software"

ERCIM News no. 75 has just been published:

Special Theme: "Safety-Critical Software"

Featuring a keynote by Gérard Berry, Chief Scientist, Esterel Technologies; Member of the ERCIM Advisory Board; Member Académie des sciences, Académie des technologies, and Academia Europaea.

Next issue: January 2009 - Special Theme: "Sensor Web"

Thank you for your interest in ERCIM News.
Feel free to forward this message to others who might be interested.

Source: Peter Kunz; ercim.org

Thursday, October 16, 2008

Chair of Int. Academic Health Science Centre Designation Panel announced [UK]

Dept of Health [UK] logoDated: Wednesday 15 October 2008 10:20

Department of Health (National)

Health Minister, Ben Bradshaw, today announced the appointment of Sir Alan Langlands as Chair of the international panel that is being established to designate Academic Health Science Centres (AHSCs) in England. The international panel will make a recommendation to the Secretary of State for Health about the partnerships that should be awarded AHSC status. The panel will offer a form of "peer review" and will identify the organisations best placed to compete internationally alongside leading AHSCs elsewhere in the world, such as Harvard, Johns Hopkins and the Karolinska Institute.

The NHS Next Stage Review announced the government's commitment to fostering AHSCs in England. The intention is to identify and work with a small number of health and academic partners, who have come together to focus on world-class research, teaching and patient care. These Centres will take new discoveries and promote their application in the NHS and across the world.

Health Minister Ben Bradshaw said:

"I am pleased to announce that Sir Alan Langlands will chair the international panel that we are establishing to designate Academic Health Science Centres in England. Sir Alan brings a wealth of expertise to this role. His experience in health policy and in education means that he is ideally placed to assess the strength of applicants' proposals for bringing together research, education and patient care functions to improve health outcomes."

Sir Alan Langlands said:

"I am delighted to be appointed chair of the international panel. Academic Health Science Centres in England have the potential to improve healthcare services in the NHS and internationally. Improved collaboration between healthcare organisations and Universities has the potential to enable the rapid adoption of new research into clinical practice."

Additional links:
Manchester Academic Health Science Centre

Wednesday, October 15, 2008

Blog Action Day 15 October: Poverty - Hodges' model

The table below indicates some of the main concepts and concerns that
surround poverty presented using the four care domains of Hodges' model:


mental health, mood,
hope, human spirit.
Education - literacies: 3Rs, ICT, social, visual, spiritual, health....
human potential, premature death, personal choices & autonomy.

ability to work,
philanthropy, disability, gender, LEARNING - UNLEARNING,

adversity, personal development, making a difference - Giving. Awareness of poverty.

Attitudes, beliefs, sustainability.

Physical health, nutrition, DIAGNOSES: infectious diseases - diarrhoeal illness, malaria, tuberculosis, HIV/AIDS. Infant / maternal mortality. Water. Natural resources, fuel, crops, disasters. Geography, global warming, climate change, gender, age. WHO regional-global reporting, ICD. Complexity. Research:
Dimensions of Poverty - "The human development index (HDI) includes income, longevity and education. This paper contends that poverty extends beyond these domains. It explores dimensions of poverty that poor people value, but for which little or no data is available."

Shelter, housing, schools, local environment, social inclusion,

work, social mobility, homelessness, stigma (poverty as a disease?), media, major - national & global fund-raising events. Access to information and communications technology.

Dependency. Social justice.

Social Impact Analysis (PSIA)
Religion, humanitarianism, fatalism, leisure. http://www.poverty.com/

HUMAN RIGHTS, LAW, POLICY, U.N., FUNDING, GLOBAL ECONOMICS, MDG 2015. Governance. DEFINITIONS: Relative poverty, absolute poverty, exclusion. effects of globalisation, industrialisation, urbanisation, conflict, refugees, migration, loss of statehood, immigration, professional migration, corruption, economic costs, welfare, benefits, income thresholds, min. wage, inflation, poverty indicators, GDP, major philanthropic programmes, charities, NGOs. social exclusion, unemployment, 'knowledge' economy - learning disability, pension economics, micro lending. International Aid: Official Development Assistance 0.7% national targets.

The POLITICAL links page includes Development, Human Rights, Activism, Policy...

Friday, October 10, 2008

World Mental Health Day

Posted on the Mental Health in Higher Education (mhhe) list by Jill Anderson:

Making Mental Health a
Global Priority

This year’s theme is ‘Advocacy for global mental health: scaling up services through citizen advocacy and action'.

It's an opportunity to think about how our teaching addresses these issues and concerns.

How might you involve learners in World Mental Health Day 2009?

Now is the time to get planning for next year!

Additional link:

WHO report shows mental health services in England leading the way in Europe

Wednesday, October 08, 2008

20/20 vision minus 1, 2, or 4 blind spots....

blind spot experimentBasic science classes very quickly introduce students to 'the eye' and vision.

This includes the simple experiment that can be done which reveals the blind spot.

Here's an example from (what was) Service Works Consulting:

Consulting companies pride themselves on knowledge, foresight and expertise. This is fine if there is only one blind spot to deal with, but of course we each have two. From the perspective of project management there are many more blind spots.

Hodges' model suggests there are potentially four;
five even if we include the spiritual domain.

A benefit of using Hodges' model* is that just as in normal vision our two eyes overlap and compensate for the blind spots; so attention paid to just one additional care domain may diminish the impact of care domain blindness.

3 out of 4 domains - is better (more holistic) than - 2 out of 4.

The problem in health and social care, is that any one of four blind spots (ironically the site of the optic nerve bundle) can become a fuse for trouble or disaster.

If you have the gift of vision - best to use it.#
*cognitively or deliberately on paper or computer

Image source with many thanks: John Eric Hughes

Additional links:
Visual acuity: http://en.wikipedia.org/wiki/Visual_acuity

#Wish I had and could do that!

Monday, October 06, 2008

Identification and Hodges' model

In health and social care the importance of correctly identifying people in your care is drummed into you from the outset. Even before staff are on the payroll or in the lecture theatre everyone knows that common sense shouts "pay attention!"

Drug administration and various other clinical interventions are safety critical:

Right patient - Wrong drug
Wrong patient - Right drug

If in additional to acute clinical scenarios we add information giving and 'social care' then once again identity is key:

Right person(s) - Wrong information
Wrong person(s) - Right information

Information unsurprisingly lies at the
heart of identification
and consequently

There are four key identifiers that we rely on and they map to Hodges' model beautifully - use them wisely....

personal, first name

NHS number

Four key identifiers

Death in Birth By Vivienne Walt/Freetown Thursday, Sep. 18, 2008

An excerpt from an article in TIME magazine is posted below by Patti Abbott, Co-Director of the PAHO/WHO Collaborating Center for Nursing Knowledge, Information Management and Sharing (KIMS), Johns Hopkins University School of Nursing.

The entire article can be found at: http://content.time.com/time/magazine/article/0,9171,1842278,00.html

“In a hospital ward in Freetown, the capital of Sierra Leone, Fatmata Conteh, 26, lay on a bed, having just given birth to her second child. She had started bleeding from a tear in her cervix, the blood forming a pool on the floor below. Two doctors ran in and stitched her up, relatives found blood supplies, and nurses struggled to connect a generator to the oxygen tank. One nurse jammed an intravenous needle into Conteh's arm, while another hooked a bag of blood to a rusted stand, and a third slapped an oxygen mask over her face. In the corner of the room, a tiny baby--3 hours old--lay on a bed, wailing, swaddled in bright-colored African fabric. "Listen! You must feel happy to hear your baby cry," said a nurse, pleading with Conteh to find strength. Three visiting members of a neighborhood church began chanting over Conteh: "Jesus, put blood into this woman! Thank you, Lord!" But as their chants grew louder, the nurses stepped back from the bed. Conteh was dead.
Some version of that scene is repeated around the world about once a minute. Death in childbirth is not just something you find in a Victorian novel. Every year, about 536,000 women die giving birth. In some poor nations, dying in childbirth is so common that almost everyone has known a victim. Take Sierra Leone, a West African nation with just 6.3 million people: women there have a 1 in 8 chance of dying in childbirth during their lifetime. The same miserable odds apply in Afghanistan. In the U.S., by contrast, the lifetime chance that a woman will die in childbirth is about 1 in 4,800; in Britain, 1 in 8,200; and in Sweden, 1 in 17,400. Deaths are heavily weighted to the poorest and most isolated in each country, which means that many politicians remain largely ignorant of the scale of the tragedy. "Often the people in the cities do not know what is happening in their own rural areas," says Sarah Brown, wife of British Prime Minister Gordon Brown and patron of the White Ribbon Alliance, a global advocacy organization that works with governments to lower maternal mortality rates. Brown--who lost a baby 10 days after giving birth in 2001--says that when she tells heads of state and their spouses how many women die in childbirth, "they are aghast."

The Gains Not Made
They have reason to be. For here is the truly ghastly reality of maternal mortality: in 20 years--two decades that have seen spectacular medical breakthroughs--the ratio of maternal deaths to babies born has barely budged in poor countries. To be sure, maternal health has seen advances, with new drugs to treat deadly postpartum bleeding and pregnancy-related anemia. But in many places, such gains are dwarfed by a multitude of problems: scattershot care, low pay for health workers and a scarcity of midwives and doctors. In Mozambique, where women have a 1 in 45 lifetime chance of dying in childbirth, there are just 3 doctors per 100,000 people; in all of Sierra Leone, there are 64 government doctors, only five of whom are gynecologists. Millions of families have never seen a doctor or nurse and give birth at home with traditional birthing helpers, while those who make it to a clinic--some being carried on bicycles or in hammocks--often find patchy electricity, dirty water and few drugs or nurses. Explaining the task of reducing maternal deaths, Sierra Leone's Minister of Health, Saccoh Alex Kabia, who returned home last year after decades of working as a surgeon in Atlanta, says, "The whole health sector is in a shambles."

The article goes on to say:
“When world leaders gather in New York City this month to take stock of the MDGS, their speeches are likely to tout the many achievements since 2000: millions more African children now attend school and sleep under mosquito nets; thousands of new water wells have been dug. Yet though maternal health care underpins many other development goals (healthy mothers are more likely to ensure that their children are well fed and educated), the total number of women dying in childbirth has remained virtually unchanged in eight years. Why? Health officials are clear in their answers. Aside from lack of money and political will, they also face entrenched traditions and fatalistic attitudes to maternal mortality, especially in very poor communities. "People think that dying in childbirth is not preventable," says Nadira Hayat, Afghanistan's Deputy Minister of Health. "They say it is up to God."

I think they need knowledge, a nurse, a midwife.

Patricia A. Abbott, PhD, RN, FAAN
Co-Director of the PAHO/WHO Collaborating Center for Nursing Knowledge, Information Management and Sharing (KIMS), Johns Hopkins University School of Nursing
Visit web site:

My source: posted by Jody Lori: [Nursing and Midwifery for Making Pregnancy Safer: Discussion] link to article in Time Magazine.

Additional links:



Wednesday, October 01, 2008

Reflection: programming and caring II

Reflection: (Ruby Pocket Reference, O'Reilly, 2007, p. 147.)

The ability of a language such as Ruby
to examine and manipulate itself.
For example, the reflection method class from Object
returns an object's class ("hello".class # => String).

Reflection within health and social care - is there a further definition ...?

Well yes, there are several, but there may be another ...?

The ability of a health and social care model such as Hodges' model
to examine and manipulate itself *
in response to an individual's (and family's)
care situation and context.
For example, the reflection method class from Object
returns an object's class (Intrapersonal.class # => Domain)#.

*This would require of course that Hodges' model is represented as a programming language or formalised conceptual space of some sort....
#Or something like this....