h2cm: fixed or primary concepts the push and pull of nursing

When commentators, students and others write of the primary or core concepts of nursing what does this mean in terms of Hodges' model [h2cm]?

For quite some time I have been describing Hodges' model as a cognitive - conceptual space. This suggests that there are fixed concepts within the care domains. Yes, they may vary according to the context and over time, but if concepts were arrows and our aim is true then h2cm would provide the ideal target. It on this care matrix that we really could take aim and nail the kernels of knowledge that make up our care activities.

Is it a mistake to venture that for people to talk of basic nursing care, essential care needs, that there must be some fixed ideal out there; an ideal that nurses, society and policy makers can hang discussion and debate upon? And let's face it there is much to debate - mental health stigma, obesity, nutritionism, heart disease, dementia, unplanned pregnancies, funding, access, poverty. ...

Medical sociology has done and continues to do society at large a great service. It forces practitioners to look over their shoulder and take in the social and cultural forces that influence health. As a question for further deliberation within medical / clinical sociology we might ask: How are the concepts in Hodges' model fixed? There are several possible answers:

1. Someone determines that concepts a, b, c, d are in care domains 1, 2, 3, 4. The question of whether Hodges' model (or any other conceptual resource) is classed as evidence based depends on how that determination is made.

2. Alternately, the structure of the model provided by the axes, could act as a skeleton. This might serve as a boot strap breathing life into the empty spaces created by this structure. The first instances of concepts might then arise like some sort of quantum event - self, other, temperature, time, height, mood. ...

3. As (medical) sociology, philosophy and psychology continue to reveal, we also need to accept of course that society, culture and language are all inextricably linked and they pre-empt that empty space, predetermining what will be written (thought and reflected) there.

4. This external influence is a must if those working in the health and social care professions are to communicate with those 'outside' (public involvement can only run so far?). It is not so much a case of common ground, as common space and the freedom and opposition that this affords. this is essential for communication amid what is variously called - multidisciplinary working and integrated care. Here there must be a degree of latitude between different disciplines' usages of terms. This must provide common understanding or some close approximation and yet still be safe.

So rather than empty space the care domains are really full of care concepts all waiting on tenterhooks, to see whether they will get to aggrandise and become 'complex care needs'. Will the assessor / care evaluator pick them - from what is initially a virtual crowd? Go on make their day: care-fully!