Hodges' Model: Welcome to the QUAD: August 2009

- 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

Friday, August 28, 2009

Medinfo 2010 South Africa 12-15th September

medinfo2010 logoCape Town, South Africa will host the 13th International Congress on Medical Informatics from the 12 - 15 of September 2010.

This will be the first time MEDINFO is held in Africa. It promises to boost exposure to grassroots healthcare delivery and the underpinning health information systems. This will open the door to new academic partnerships into the future and help to nurture a new breed of health informaticians.*

Conference Theme

Partnerships for effective e-Health solutions

Innovative collaborations promote solutions to health challenges

The theme for the International Medical Informatics Association’s 13th World Congress on Medical Informatics, Medinfo 2010 is Partnerships for effective e-Health solutions with a particular focus on how innovative collaborations can promote sustainable solutions to health challenges. It is well recognised that information and communication technologies have enormous potential for improving the health and lives of individuals. Innovative and effective change using such technologies is reliant upon people working together in partnerships to create innovative and effective solutions to problems with particular regard to contextual and environmental factors.

As Medinfo 2010 brings together the health informatics community from across the globe we are seeking to focus on how we can work together and share our experiences and knowledge to promote sustainable solutions to the challenges presenting to us all. This will be an historical event as Medinfo 2010 is hosted in Africa for the first time.

My sources:

Implementing Best Practices (IBP) Knowledge Gateway GANM
& The Conference Company and the Medinfo2010 website.

Africa! While I have linked to many, I have never attended an International informatics event. This one sounds really special being in Africa.
*I would love to pass over the baton that is Hodges' model and also discover what other conceptual frameworks may be out there...?

Thursday, August 27, 2009

Basic Nursing Care @ the X-roads?

Basic nursing care:

It sounds straight forward enough doesn't it?

And yet according to news today here in the UK (The Independent) some nurses it seems fail to deliver safe, effective and efficient care of the required standard. This sorry news was reported by The Patients Association. The cases cited are upsetting and represent the care and behaviour of a minority of nurses, although there was a debate as to the 'true' numbers the report findings may represent.

The worrying point here though is this highlights not just a lack of basic nursing skills and knowledge, but a blatant disregard for the needs of vulnerable individuals and a sense of humanity. Even with NVQ's in the UK and equivalent programmes elsewhere when it comes to high standards of care we can take nothing for granted.

A commentator on the radio asked if the nursing profession is at a crossroads?
It is.
This crossroads is also a target that nursing must hit -
not most of the time -
but every time and for every person.

In truth of course, all professionals should constantly find themselves at the crossroads.

So, where next for nursing and who has the map?

Original image source:

Tuesday, August 25, 2009

'X', 'Y', 'Z'... Based Learning

As a student or lifelong learner starting a course you expect that you will and are being exposed to the latest learning and educational methods and techniques*. The non-exhaustive list that follows is ... what shall we call it? ... non-trivial in its extent:

case-based learning
person-based learning
self-directed learning
work-based learning
enquiry-based learning
game-based learning
project-based learning
resource-based learning
movement-based learning
classroom-based learning
action-based learning
team-based learning, ...

Hodges' model
is person-centered, situated and capable of taking in multiple contexts.

So perhaps the most important word above is based ...?

*One of the original roles for Hodges' model was curriculum development, posts to follow on this topic....

Friday, August 21, 2009

'Relative' poverty (4) - sociology

[The introduction is repeated across these posts: intrapersonal, political, sciences]
There are many paradoxes in life and many of these are concentrated in the realm of health and medicine (a major sub-division of life and death).

For decades the link between poverty and standards and quality of health has been recognized and politicized in the media and policy. In June there was news of a Bill to make the eradication of child poverty a legal obligation not something that can be the political objective at the start of a Government and then cast aside.

Many things are relative and poverty is often described in this way applying to individuals, social classes, communities, regions and whole nations. Using the domains of Hodges' model what reflections does this prompt? Let us see:

SOCIOLOGY: A key resource we all ordinarily rely upon is that of family, friends and community. While a source of stress at times as in you can choose your friends, but you can't choose your family..., and then there's the history of psychosocial intervention; the family is nonetheless usually seen as the asset.
Social poverty - having no (immediate, accessible) next of kin, friends or social network has been identified as a key deficit that may result in negative outcomes and problems in rehabilitation, recovery and staying well. There is an expanding literature on the role of social networks. Despite the current emphasis on e-social networks the interpersonal form of social network remains pivotal as a key strength for people to deal with major challenges to their health, social care and well-being.

The socio-economic contribution of informal carers is well recognized (Carers UK) and vital in the management of long term medical conditions ('self-care by proxy'?). 'Caring' and carers predates what we today call 'nursing'. Carers shoulder a care burden saving the State an enormous sum of money. Within Hodges' model this domain - the SOCIOLOGICAL - may be a remote cousin, far from the sciences, but the fuzzy logic here is predicated on families and relationships.

In the social domain the whole community can act as a pool of kinetic and potential energy, a resource - locking up wealth in knowledge and skills that can counter social poverty and periods of self-neglect should this occur. The future health and social care agenda depends upon the workforce being able not only to create this social wealth, but ensuring people are able to release this knowledge. Physics, energy, time - there is no escape. Perhaps assumptions as per this quote* also have a role to play -

‘‘Of all the self-fulfilling prophecies in our culture, the assumption that ageing means
decline and poor health is probably the deadliest.’’
Marilyn Ferguson,
The Aquarian Conspiracy, 1980

Additional links:

Relative poverty, absolute poverty and Social exclusion - poverty.org.uk

World Poverty - Social Poverty

'Poverty' on W2tQ

Sociology care (knowledge) domain links resource


*Sirven, N., Debrand, T. (2008) Social participation and healthy ageing: An international comparison using SHARE data, Social Science & Medicine, 67, 12, 2017-2026.

Mitchinson, A.R., Kim, H.M., Geisser, M., Rosenberg, J.M., Hinshaw, D.B. (2008) Social Connectedness and Patient Recovery after Major Operations, Journal of the American College of Surgeons, 206, 2, 292-300.

Monday, August 17, 2009

Combining h2cm, Informing Science and informatics on the Rainbow Bridge

As a boy one of my favourite superheroes and subjects of myth was Thor and his retinue - Loki, Odin, The Rainbow Bridge. These remain tantalizing escapes for young minds should a corner shop sell comics.

As I mentioned previously in posting about the informing science journal, a paper currently in preparation makes use of holistic bridges and I have had in mind Thor and his ilk and Rainbow Bridge between worlds. In Hodges' conceptual framework the domains of knowledge that make up the model could almost be disparate worlds. This disciplinary repulsion presents several challenges at a time when disciplinary in-fusion is needed (demanded by our problems):

Integration of health and social care in the form of:
  • physical - emotional health;
  • applied socio-technical informatics
  • personalised and service centred care
Academic cross-disciplinary working, e.g. informatics -
  • clinical
  • urban
  • e-governance
Last summer I posted a suitably colourful mix of holistic bridges that included the image below. These hyphenated cross-disciplines conjoin the four care or knowledge domains of Hodges' model.

My interest in ICT began with the ZX81 in 1981 and ever since I've been intrigued as to how we can integrate the above. Why does this matter? It matters not just because of the complexity of the problems we face in in our work and home lives. The real challenge lies in communication.

To take one problem the application of ICT in health care. Here the technical world, the mechanistic butts up against - clashes with - the humanistic. The paper published in spring focused upon socio-technical structure in nursing informatics.
Structure whether virtual, conceptual framework, mythical rainbow is one thing; but what purposes can arise from structure?

In highlighting communication (critical in health care) our purpose is -

using information technology to help convey
the meaning of information in order to inform.

The two axes (or hammers?) in Hodges' model are:


These axes provide the bridge to link informing science and Hodges' model. In the act of communicating, imparting information we may be concerned with the concept of information from its mathematical formulation, the channel, noise through to the semantics and meaning from a sociocultural perspective. This seems to match with the (horizontal) axis [H-M], while the task of informing is concerned with the agents that is the (vertical) axis [i-g].

So what is the relevance of Thor? Well that role of engaging clients (patients, carers, managers, service users....) in communication sees a group communicate with an individual and vice-versa. The processes involved are not necessarily discrete as might be captured 'on paper'. The axes of Hodges' model labelled 'information' and 'informing' become blurred.

We are constantly reminded of the multi-contextual nature of healthcare. Now, I don't know if care is suddenly more complex on a Thursday, I just figure that when Thor starts to swing his hammer there is suddenly not one axis, but a great many. We are not just aware of multiple contexts we are forced to consider the multi-dimensional too.

Additional links:

Informing Science Journal

Thor image and interesting discussion:

Thor - movie 2011?

Sunday, August 16, 2009

Informing Science (with Thor to follow) ...

The problem with the web is you search, find and save stuff and then it virtually disappears on hard drives and folders only to somehow bubble-up back to life hopefully at a time of need. So with the Informing Science Journal.

I know the details are only a click away, but here they are:

The academically peer refereed journal Informing Science endeavors to provide an understanding of the complexities in informing clientele. Fields from information systems, library science, journalism in all its forms to education all contribute to this science. These fields, which developed independently and have been researched in separate disciplines, are evolving to form a new transdiscipline, Informing Science.
Informing Science publishes articles that provide insights into the nature, function and design of systems that inform clients. Authors may use epistemologies from engineering, computer science, education, psychology, business, anthropology, and such. The ideal paper will serve to inform fellow researchers, perhaps from other fields, of contributions to this area.
Ever since reviewing Gary Hall's "Digitize This Book!" the future of academic publishing, the university as an institution and scholarly disciplines has been on my mind. I did have another book on my wish list that predicted I believe the death of the university if things do not change. This is lost somewhere... I am really pleased to rediscover this journal, its contents and look forward to reading more and possibly contributing once existing projects are completed...

In the substance misuse paper draft, in addition to the usual key concepts I am wondering about the use of holistic bridges and so...

More to follow soon on the aims of the Informing Science Journal with reference to Thor, bridges and what informing science means for Hodges' model ....

Thursday, August 13, 2009

Memo to America's Right

Please do not treat the UK's NHS as a
political football and yes I mean 'football'
(there's enough of that o'er here without
you sticking your ten cents worth in!).

Do not underestimate the -
knowledge, skills, creativity and dedication -
of NHS staff, or how it is perceived, valued and loved by the People.

Yes, the NHS is not without its faults (it is also true we are not all Angels), but amid the signs of wear, the aged splinters -

we do not forget the middle,
the constant called change,
or the challenges that beckon in the 21st century.

Image source: Allproducts.com
Additional links:

BBC News Bloggers debate British healthcare

New York Times 2008 Paying Patients Test British Health Care System

Friday, August 07, 2009

Birds in paper cages: Cognitive spaces with a little isotropy

In Consciousness Explained, Dennett (1991) provides further support for my belief in the significance of Hodges’ model:

Any of the things you have learned can contribute to any of the things you are currently confronting. That at least is the ideal. This feature is called isotropy by Fodor (1983), the power, as Plato would say, of getting the relevant birds to come, or at least to sing out, whenever they are needed. p.279.
Dennett highlights the fact that we are not isotropic. There are many often comedic instances in which people are slow or fail to fully appraise the significance of new data. This point reinforces the need and role for Hodges’ model providing not just one of Plato’s metaphorical aviaries (with knowledge in the form of the birds), but at least four (five - with spiritual claims to know-ledge).

Next spring I will return to the conceptual spaces paper I started and last saved in September 2008, how time flies! (I do finish stuff eventually - it's not easy this 'part-time' lark). As already posted on W2tQ there is more inspiration if needed. Drawing upon the cognitive science and computing literature the objectives of Peter Gardenfors’ book Conceptual Spaces are made clear from the outset:
'... is to show that a conceptual mode based on geometrical and topological representations deserves at least as much attention in cognitive science as the symbolic and associationistic approaches’. p.2 ....

'This is a book about the geometry of thought. A theory of conceptual spaces will be developed as a particular framework for representing information on the conceptual level.’ p.2.

Further reading:

Jerry A. Fodor (2000) The modularity of mind.

The Frame Problem Stanford Encyclopedia of Philosophy.

Wednesday, August 05, 2009

NHS fundamentals: a conference + some fundamental thoughts...

I received notice from the Health Service Journal of the following conference:

HSJ conference logoFundamentals of the NHS

Get up to date with the latest changes in NHS structure, policy and reform

25th November 2009

Does the rapidly changing world of the NHS leave you feeling overwhelmed? Do you need a solid introduction or an up-to-the-minute refresher to firmly underpin your understanding of all the recent policy changes, reforms and agendas?

Whether new to the world of the NHS or simply in need of clarification over recent advancements - this essential Health Service Journal learning forum provides a whistle-stop tour of where the NHS is now and where it is heading in the future. ...


The HSJ's NHS focus is clear just from the snippet above.

As to the 'fundamental' in health care, well, I still wonder how (since August 1977*) with all this talk of:
  • multidisciplinary care
  • integrated care
  • continuity of care
  • holistic care
  • individualised care
- there is still NO fundamental model, NO universal conceptual framework applicable for the whole of health and social care. Yes, there is the nursing process, CPA (Care Programme Approach), SAP (Single Assessment Process), CAF (Common Assessment Framework). ... We have and benefit from - it must be said - the NHS Core Values, Patient Charters. ...

But where is the conceptual primer, the underlying substrate that can be applied implicitly or explicitly, whatever a person's age, discipline, ethnicity, beliefs, employment, financial means, legal status, location. ...?

More than ever we need a model that is not just the preserve of nurses and their colleagues, we need a conceptual tool that is part of education programs world wide: helping to preserve individual, family and community in health and well-being.

Conceptual models are so abstract. Strange then that a model - simple, basic, underlying, fundamental - is needed that is much more substantial than a chapter in a book, or paper in a journal.

This conference is in Manchester.

Manchester - where Hodges' model was first taught.

For the sake of future health - a universal model should be one of the fundamentals:
our tools
and values
should indeed deliver
right on the doorstep.

* As a Nursing Assistant awaiting entry to Warrington School of Nursing, Winwick Hospital.

Please note: This blog post is not sponsored nor
endorsed by HSJ, its publishers, or the event sponsors.

Sunday, August 02, 2009

Can YOU add to the H2CM bibliography (now listed on W2tQ)...?

Peter Jones June 2009
For readers not already aware, yesterday I started adding a bibliography to the blog. It is listed in the side-bar.

Links are included if applicable and these have been checked. I can supply electronic copies of most of these papers if you wish.

There are two publishing projects in process that are closely related to each other, covering substance misuse and forensic nursing.

On the forensic nursing front just over a week ago I met and greatly enjoyed speaking with -

Dr Michael Doyle
Nurse Consultant, Professional Lead & Honorary Research Fellow
Greater Manchester West Mental Health NHS Foundation Trust
Edenfield Centre
M25 3BL

Apparently, Hodges' model is used and has quite a history at the Edenfield Centre. So Mike and I are working on a paper we will submit to a journal before the end of the year. More on this to follow.

In the hope that Erdos-Bacon Numbers might work for me, if anyone reading this has contact with community mental health nurses in the Isle of Man please get in touch. I understand they have used the model in the past.

Finally, should you be interested in applying Hodges' model in your nursing, social care, education or informatics theory / practice, do let me know h2cmuk @ yahoo.co.uk. I would be pleased to provide some paper - electronic resources and advice as needed.

August! Great Drupalcon soon!

Best regards everyone,

Peter J. (and yes that is me up there)

Saturday, August 01, 2009

Nursing - a model with 'glocal' aspirations

Reading through Dan Pink's book again I came across this ....

The rise of Empathy has even begun to color parental advice. In a recent survey of of Australian information technology managers, 90 percent said they would not recommend that their own children pursue careers in the L(ogic)-Directed field of software engineering. What would they recommend their children do instead? "I'd rather my kids opt for nursing as a profession," said Joseph Michaels, who works for a telecommunications company in Sydney. "It has both global and local demand." p.165.
And wherever nurses travel so too must the reflective tools they employ.

In the paper on Hodges' model and Michel Serres I wrote the following:
The scholastic 3Rs alone are no longer sufficient to equip youngsters for current and future challenges. Wither health literacy without digital, information and visual literacy (accessibility issues acknowledged)? Carroll and Rosson (2007) recognise the moral imperative of participative design. If technology has the capacity to change, people must be involved in that change. Are governments granted the electorate they deserve? The ability to appreciate what lies between analysis and synthesis is the 21st century touchstone. In being educated to care for others, self, and the planet there is a need for a generic model that can be taught globally, across curricula, cultures, and ethnic divides. Janus-like we must combine the local and global, achieving glocal perspectives (Erikson, 2001, chap.19).

Daniel H. Pink (2006) A whole new mind, How to thrive in the new conceptual age, Cyan, p. 165.

Eriksen, T.H. (2001). Small Places, Large Issues, Pluto Press.

Michel Serres on W2tQ

Michel Serres: A blog