Hodges' Model: Welcome to the QUAD: March 2011

- 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

Saturday, March 26, 2011

Google's "Think Quarterly" (I am and so can you!)

Google has launched a new venture in e-media with a short book, the first issue is on data - from their  website:

Like most companies, Google regularly communicates with our business customers via email newsletters, updates on our official blogs, and printed materials.

On this occasion, we've sent a short book about data, called Think Quarterly, to a small number of our UK partners and advertisers. You're now on the companion website, thinkquarterly.co.uk (also available at m.thinkquarterly.co.uk, if you're on the move).

We're flattered by the positive reaction but have no plans to start selling copies! Although Think Quarterly remains firmly aimed at Google's partners and advertisers, if you're interested in the subject of data then please feel free to read on...
There is much of interest and to admire here with some key commercial and academic contributors.

Using the health care domains model provides a different spin on 'quarters' but getting a handle on e-publishing is essential and Think Quarterly both describes mobile access in an article and provides a demonstration as they cater for readers on the move as per the link above. Enjoy!

On the train Wigan - Euston amongst other stuff I've been reading Web Designer Issue 181 on the jQuery mobile framework.

London does not seem any darker 8.30pm ... but there must be lights off here too ...

Image source: http://thinkquarterly.co.uk/

Friday, March 25, 2011

Drupal musings 20: Keswick and that basic site....

OK hands-up! While up in Keswick (Sun - Weds), yes I wasted time trying to get a parallax effect to work. A layered graphic effect that as was pointed out on Wednesday evening's standards>next: event at MadLab you can only see when you re-size the window.

Anyway on Tuesday I saw sense and adopted the theme - Danland. I looked at Framework as a starter theme. The large banner images included were unnecessary, reading the theme's handbook I noticed there is a subtheme without the pretty pictures. In the end I returned with the required "DJ" content (as in music) accessed via a four option menu that includes an enquiry form created using webform. So the first basic steps have been taken. I've been here before and must carry on. Some users need to be added, styling, test, backup and migrate, test, and to figure out hosting.

The sessions I attended at MadLab were really useful for this and the future h2cm project with talks on CSS3, web fonts, and adaptive layout.

In addition to some walking, on Tuesday I had a run by the river Greta - lovely. That shook out a few cobwebs. I also met the team at M&K Update who are based in Keswick. Over a coffee I was able to confirm in person the travel arrangements for May's event and a further presentation.

Now there are also just 30 pages left of From A to <A> Keywords of Markup, Bradley Dilger and Jeff Rice (editors) University of Minnesota Press so I can complete the book review. There are a couple of posts there too.

Off to London this weekend for the HEA Reflective Practice SIG meeting: Assessment, Evidence, and Critical Reflection : What are the issues? Are portfolios a panacea? 28/03/2011:
which includes Using Hodges Health Domains as a Portfolio Structure.

Monday, March 21, 2011

Bob Newhart, a phone, distance, dementia and communication

BBC Radio 4 have a series For One Night Only which looks back at classic concerts. These are not only music related as last Saturday attested featuring The Button-Down Mind of Bob Newhart. This is the title of Bob Newhart's award winning comedy album that topped the charts in 1960. When Bob Newhart first appeared his act was radically different from the usual comedy fare. In this edition presenter Paul Gambaccini interviews the now 81-year-old Newhart about the album, his success and approach: an individual on stage with a telephone.

In the discussion I was struck by the point that although it was just one man with a phone the audience acted as a proxy for the other party. Being socialised as we are the audience became the other party in Newhart's comical one-to-one conversations. We fill-in the missing details; what has most likely been said, what must have happened and what may happen next. Our humanity, experiences and imaginations fill the space making use of the redundancy that resides in context, language and the comedic.

As noted previously my colleagues and I have started giving some talks on communication to residential and nursing home staff. The focus in these sessions being person centered care and the challenges that residents living with dementia face together with their carers and families.

I don't want to worry senior managers - but in my sessions I try to convey to staff how everyone, whatever their experience, position and grade has a role to play in assuring high quality person centered care. Listening to For One Night Only you see the challenge writ large. Now a sense of humour in medicine and nursing is a great help, but this isn't the staff room and it's no comedy either.

Care staff must realise how important it is that they pick up and use the 'phone'. Their individual observations, patience and interpersonal efforts are vital. Even with some training in dementia care  staff may be surprised how the person with cognitive problems can fill in the spaces. Even if a resident cannot understand the words spoken to them, the tenor, tone, intent and attitude behind the words can be communicated and contribute greatly to supporting the care that follows. Especially when there is a need to deliver personal care.

In providing much needed personal care the technological marvel that is telephony may have its limits (even as telecare), but it can still teach us much about information and communication.

Most obviously when 'distance' remains.

Image source: http://www.pbs.org/weta/onstage/twain2002/bios/

Thursday, March 17, 2011

Hodges' model and three slides in Spanish: Paipa, Colombia Feb 24-25 2011

From the presentation of the Health Care Domains Model in Paipa last month here are three of the slides in Spanish - with many thanks to Luz Stella Saray and Prof. Wilson Canon Montanez for the translation. (Any mistakes below are mine in data transfer / formatting).

These slides were produced to illustrate how the model's care domains relate to some indicative health concepts, supporting the overall presentation.

The presentation was uploaded to Slideshare but I have deleted it as the formatting was slightly disrupted. I will revise and upload it again soon posting it here and no doubt in another post.

creencias     estado de ánimo
motivación       personalidad
                         buenas relaciones
neuropsiquiatría                          tecnología
SOCIOLOGÍA comunidad        relaciones
crianza de los hijos
semántica       cultura, arte, danza
    Familia,     lenguajes
historia socia
derechos humanos     autonomía
presentación de informes
Financiación $£€


priority, care plan, choice
[prioridad, plan de cuidados, selección]
events, time, cause – effect
[eventos, tiempo, causa - efecto

Counselling, team work, carers
[asesoramiento, trabajo en equipo, cuidadores]
professionalism, deprivation of liberty
[profesionalismo, privación de la libertad]

PROPÓSITOS estado de ánimo
Los pensamientos, las creencias
proceso cognitivo
salud mental, estrés, ansiedad

educación, aprendizaje
Modelos y Teorías
Inyecciones intravenosas e intramusculares, salud física
anatomía, fisiología
mediciones, distancia
tiempo, peso
Estadísticas, lógica
Farmacología, medicinas

Compromiso público
Comunidades de PRÁCTICA
redes sociales
amistades privacidad
Cert Internacional de vacunación
Administración y gestión
Liderazgo, poder, registros
Legislacion en salud mental, pobreza
Normas - CIE 10 interoperabilidad consenso

Wednesday, March 16, 2011

Person centred care, wormholes, pesterers, care domains (iii)

Person centred care, wormholes, pesterers, care domains (i)

Person centred care, wormholes, pesterers, care domains (ii)

Mentor: Shall we re-turn to your question?

Student: OK. Good idea.

Mentor: So to recap how we can define and represent person centered care? Where does person centered care fit in h2cm (Hodges' health career model)?

The INDIVIDUAL-GROUP vertical axis places the person, the individual - at the top of the model. That could be a positive if we are thinking hierarchically, but shouldn't a model that is situated AND person centred be explicit and put the person at the center? Is that the nub of it?

Student: Yes.

Mentor: So can you suggest an avenue to pursue?

Student: No... but I was struck by the talk of movement.

Mentor: And that was your suggestion if I recall correctly. In a similar way you also mentioned ensuring that the individual is taken into account across all the domains of care. So it sounds like there is a theme there?

Student: Yes, but this may as well be a foreign language - ironically I am stuck - conceptually and physically.

Mentor: Mmm.. What do you do?
Student: Exactly!

Mentor: No sorry, really - what do you do?

Student: I study obviously. Mentor: And...? Student: Well I study and work as a nurse - a student nurse...

Mentor: So you should know the answer? I do not practise clinically as much as I used to, so you have an advantage over me in terms of finding the answer.

Student: If the answer lies in practice?

Mentor: For matters 'person centered' is there a better place to look?

Student: True. OK. So - movement... reasoning... 

Mentor: Is your job easy in practice?

Student: It varies of course, but in general - no it's not easy: it takes effort.

Mentor: Ah, now you may have something there!

Student: Oh well that's heartening [with a smile]. In terms of effort then - nursing - health and social care takes concentration and attention as per active listening. You finish a shift and you know you're spent - and there's that assignment and self-directed study to complete.

Mentor: So it sounds like nursing requires - demands even several forms of effort.

Student: Yes in thought and action.

Mentor: And the model - h2cm - can support you in your reasoning and action?

Student: Yes it can because the model encourages you to consider each of the care domains back and forth - and in so doing you move the individual from the top of the I-G axis to the center of the model. Right at the heart, the nexus!

Mentor: So if the model says something about person centered care what does it say?

Student: Well, it says that person centered care is not a given it has to earned. And there - clearly [smiling] is the effort!

Mentor: Well found. Yes, it takes a lot of effort on the part of individual practitioners to put the patient, carer, member of the public - the person - at the center and keep them there. Socio-political factors and lest we forget sometimes the individual themselves will sweep the center clear. What we find and place there are the constraints which are always many and can always be found, such as; location, finance, beliefs, politics... Nursing, health and social care is a constant struggle not necessarily against nature, but with nature and many other factors.

Student: You said something about the INDIVIDUAL-GROUP continuum being irregular and I'm sure there must be more to that?

It's almost as if there are the four pages - the care domains - through which we consider and write our care assessments, plans, evaluations and outcomes. And yet I'm intrigued regards the movement between these pages and the knowledge domains they give rise to.

 Mentor: That is another very worthwhile question and in the same way that we remember the fifth care domain - the spiritual; I am sure you will find a way with that question also in good time ...


"Riemann's cut, with two sheets are connected together along a line. If we walk around the cut, we stay within the same space. But if we walk through the cut, we pass from one sheet to the next. This is a multiply connected surface."

Kaku, Michio (1994). Hyperspace: A Scientific Odyssey Through Parallel Universes, Time Warps, and the Tenth Dimension. Oxford: Oxford University Press. Fig. 2.4, p. 42.

Tuesday, March 15, 2011

Colombia: Two Nursing Journals AQUICHAN & CUIDARTE

Two nursing journals were brought to my attention in Colombia with two possible avenues to engage.

There is scope for English speakers with abstracts provided in English and for me the editorial of Aquichan is quite pertinent to h2cm - Visibility of Nursing Knowledge.

I can not locate a cover image for Cuidarte hence the photo of some flowers.

Universidad de Santander - UDeS
revistaenfermeria at udes.edu.co
Bucaramanga, Colombia

mariae.moreno at unisabana.edu.co
Universidad de La Sabana
Facultad de Enfermería y Rehabilitación
Campus Universitario del Puente del Común, Km. 7, 
Autopista Norte de Bogotá D.C.

Saturday, March 12, 2011

Reading: From A to <A> Keywords of Markup

On the way to Colombia I started to read this book in order to review it - more on that to follow. I've only read four chapters so far and it is a fascinating read. A collection of essays each deals with a particular HTML tag and each so far provides new insights for me and resources.

When I came across the invitation for reviewers I read through the index. HTML 5 was not there so I thought the book might suffer from the rate of change in the interval from original conception to publication. Well HTML 5 is not in the index (just HTML), but it is in the text. Drupal and Ruby on Rails also get a mention.

Of particular interest is chapter 4 'alt' by Colleen A. Reilly which combines accessibility and definitions of disability.

I'll start writing the review soon for the Journal of Community Informatics trying to be more concise than previous efforts (I volunteered to learn too). As for W2tQ I've already found several interesting quotes too, such as the example below. This struck me because it's possible to describe h2cm as a keyword collage ...

Book cover
<A> evokes collagist writings, "interesting networks that open up a conceptual map" McLuhan (258).
Indeed, collage often is the focus of this type of educational/digital education or writing that asks students to merge texts and ideas. <A>, as a social space, though, is not a collage. As a network, <A> builds relationships while also becoming relationships. To enact a pedagogy of <A>, I have to imagine a social software logic as opposed to connection or merging among things. That logic is not bound to a specific platform, such as the Web, but instead informs institutional practices through the generation of large-scale spaces.p.61.

Thursday, March 10, 2011

Person centred care, wormholes, pesterers and care domains (ii)

Person centred care, wormholes, pesterers and care domains (i)

Mentor: Sorry my friend where were we up to?

Student: I am still puzzled as to how we can define and represent person centered care? Where does person centered care fit in h2cm (Hodges' health career model)?

The INDIVIDUAL-GROUP vertical axis places the person, the individual - at the top of the model. That could be a positive if we are thinking hierarchically, but shouldn't a model that is situated AND person centred be explicit and put the person at the center?

Mentor: This is a good question and you are right to ask it. As our previous discussions have illustrated our models are idealised and yet they should reflect the real world and experiences they seek to model and re-present for us:

Student: but in this case....?

Mentor: Well, not so quick...

As we noted the World's governments get the citizenry they deserve and vice-versa. If peace, political engagement, legitimate government and contentment are not a given but have to be earned then is person centred care any different?

Student: So, you are saying that peace, being a citizen, and mm... well-being I suppose are in a sense similar to person centered care?

Mentor: Perhaps?

Student: That seems quite a leap.

Mentor: Well your question prompts exercise - a certain gymnastics even - and with that a daily requirement we'll save this point for another time.

For now though... I know we don't necessarily need a precise definition of person centered care at the moment, but humour me and see what you can come up with in terms of this model of care. As you have mentioned it includes the INDIVIDUAL, the GROUP. And with the interpersonal and science domains the person's mind and body are literally in the frame.

Student: Well unless we are talking medical emergency then person centered care is about ensuring the individual is taken into account across all the domains of care.

That is - intra-interpersonal, physically - through the sciences, socially and politically. 
Oh - and spiritually too of course.

Mentor: So person centered or being person centered concerns domains of care?

Student: No. It's the content that matters. Take the interpersonal and myself as an example - what are my beliefs, previous experiences, writing skills and interests, my mood, disposition and attitude towards others. That only scratches the surface.

Mentor: I see. Can you go on from there...?

Student: Well I suppose each domain is visited according to various cues - and this is where context and situation come in. These supply the cues. They determine what is significant, what counts as information. For experienced nurses and health care practitioners this travel within and across the care domains comes as second nature.

Mm... I suspect that even if someone was not using h2cm explicitly their cognitive - conceptual movement could still be traced through the model, like passes on a football pitch.

Mentor: Very poetic! So if these care domains are being reflected upon does that mean person centered care is a consequence?

Student: Well I suppose it could if you take your mention of 'reflection' literally. Yes, picture the patient - the person - in the center of the h2cm matrix. We might even argue that our reflections place them there? Within the model what is the position of the person? If our deliberations could be measured - and practically that would be quite a task given patient engagement and dialogue - then is there an average across the domains? And is that the center - hence person centered?

Mentor: An interesting idea. And yet as you questioned initially the INDIVIDUAL in the model is at the top, at the top of an irregular continuum, so...?

Tuesday, March 08, 2011

Students at Paipa Nursing Theory Conference 24 - 25 Feb 2011

I will post a few more photos as I sort and (hope to) receive them.
Still pinching myself here - a great experience!

I've emailed a few nursing lists that I subscribe to as GICS - the three universities who organised this conference and are planning another - are keen to reach out to the academics and students of other nations.
If anyone would like more details / contacts please get in touch with me: h2cmng at yahoo.co.uk.

On the Friday it was quite sunny and being asked for photos I struggled myself in the sun it was really bright (lovely!):

Happy International Women's Day also - and great to see some guy's and at a nursing theory conference too! Best wishes to all!

Monday, March 07, 2011

Person centered care, wormholes, pesterers and care domains (i)

Student: I am puzzled as to how we can achieve and represent person centered care? Where does person centered care fit in Hodges' health career model?

Mentor: Can you recall the questions posed to formulate the model?

Student: Yes, I think so ... In h2cm there are two axes. The first is the vertical with the INDIVIDUAL - GROUP. The INDIVIDUAL is the primary recipient of nursing, medical and other disciplinary care. [Pauses] That's right, in the question posed in creating the model, the individual is identified first. Followed by the GROUP. It is the individual that I must learn to assess, plan care for, intervene and then evaluate that care. It is the individual who provides consent and then ... whose observations I record. It is this one person I am learning to observe, understand, reassure, and nurse back to health, or a peaceful, dignified and comfortable end.

Mentor: And in these times of the demographics, economic pressures 
and ongoing organisational change is that all?

Student: Mmm... No. The individual can also self-care and be taught to manage their condition and whenever possible to find their own (unique) way to recovery.

Mentor: That is right and will be very important in this century.

Student: What I do not understand is that in the model the INDIVIDUAL is hardly at the center, but at the top. This can very quickly become a word game played by the policy makers and the authors of care philosophies. It seems to me this model is merely playing games too. After all there are only so many letters in 'person centered' however we spell it!

Mentor: Enough ... to spell ... 'conned pesterer'?

Student: [Pauses, scribbles...] Hah! Goodness me! Hardly an appropriate term, even if my path crosses that of someone the 'team' regards as an 'unpopular patient'. That certainly highlights the true state of affairs. The public, and not just the public is repeatedly duped into believing person-centred care is a reality. Patients who are ill, not taking advice and especially those with long-term medical conditions and so a potential 'pesterer' [looks aside...]...

Mentor: Yes [wry smile] - do go on....

Student: Well your words not mine... These people, plus those who recover - are also citizens and they are the - supposed - stock in trade of the politicians. In that sense you are quite right - they are 'conned'. There aren't always the resources to deliver person centered care. Even then there is no definition of what person-centered should mean now - is there?

Mentor: Well I thought I was being clever with the anagram, but that is an excellent response.
Well done. I don't believe we are done here yet though...

Saturday, March 05, 2011

Most typical face in the world revealed (amid deep irony)

National Geographic Magazine has revealed what the most typical human on the planet looks like.…

There is a deep irony here (since we are talking about 'skin') in that as the global demographics flow across the decades to alter this typical face, there is a growing proportion of the population who hope that health and social care delivery is not typical and a 'composite'.

They hope that health, nursing and social care is truly personal and individual - taking in their preferences, needs and priorities.

Having said that though - would it be progress if everyone could expect at least to receive what is deemed a 'standard' level of basic nursing care that is in a way 'typical'?

more to follow - more will follow - are we ready?

Friday, March 04, 2011

Notes (ii) from Paipa Conference: Q & A

Q. What is the appeal and relevance of Michel Serres to the Health Care Domains Model [h2cm]?
c/o Fred Manrique / UPTC 

(As per the paper - Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons. 2008)

A. I cannot remember how I came across this French philosopher (Bruno Latour?), but in 2004 I started to read some of his translated texts. Serres' work is not easy to read, but rewards perseverance. Thus enthused I wrote (in my spare time) and eventually submitted a paper to a prestigious nursing journal. This was rejected - twice. Using the feedback I was able to produce the paper that found publication in the informatics field. This is listed in the W2tQ bibliography. Serres' ideas were remarkable in how they spoke to me and reflected in many ways the conceptual framework of h2cm. I need to read more of Michel Serres' work. Ideas of particular appeal include his use of several tropes:
  • Harlequin: the uninvited guest (disease, illness?), mischief (health taken-for-grantedness), chaos (the unpredictable);
  • blanc: in my presentation I included a blank slide. There it represents every new person, new page - no judgements, positive regard. A page for lifelong learners and being able to self-reflect.
  • Hermes: the Greek God, the messenger - information and Serres' early study of information science. The 'underworld' - nursing and medicine - are not for everyone. The importance of ports as a means of information and cultural exchange - today economies see themselves as information ports and the rise of information portals.
  • Serres states (as do other commentators) that the Internet will provide opportunities for new scholars, outside of established academic institutions.
  • borders, boundaries - the middle: in life we often have to ask do we continue and cross the middle?
  • The Planet: Serres is concerned for how we treat the planet. The health care domains can also be utilised to explore the physical and psychological impacts of climate change and the need to attend to human ecology. We are rocking the boat - Earth is our boat.
  • ... plus many others - fluid, dynamics, life - rivers - choices, narratives, Home, Angels, statues.
Finally, within "... S E R R E S ..." you will also find H2CM!  

Please see the bibliography for the paper.

Additional links:

Michel Serres on this blog.


More Q and A to follow plus photos and slides. Photo source (PJ, Copenhagen shop window, 2010).

Wednesday, March 02, 2011

Notes (i) from Paipa Conference: Q & A and sessions

Questions from the delegates (once more interpreted by Andrea Ramirez) at the plenary session on Friday 25th February included  - with my response (extended here):

Q. Could you please give some specific examples of the model's application and its achievements?

A. The model was created by Brian Hodges to facilitate reflective practice and encourage holistic care - especially balancing physical and mental health - psychological - care. In the mid-1980s the model was used in several locations in England and the Isle of Man. The model was taught and learning assessed through case studies in community mental health nursing, learning disability and health visiting.

As highlighted in the presentation unlike other models of care h2cm has not had the benefit of specific research. The models of care we use must be evidenced based. The website and blog represent a call for research in the health care domains model. This is why I appreciate so much this invitation to Colombia and being able to present what I believe is a very useful and increasingly relevant care resource.

In terms of achievement there are an as yet limited number of papers published and listed on the blog in a bibliography.

A couple of individuals have contacted me for advice on using the model in academic work, which has also been posted on the blog.

In my presentation and the plenary I did not mention the planned workshop in the afternoon!

Q. What has been the experience of applying the model in the practice (clinical area) and in the community?

A. The model is used in two centers for forensic psychiatry (low and medium secure) where the inclusion of the interpersonal and political care domains are pivotal in the tensions between the custodial context and need for person-centred nursing care that arise.

In forensic nursing the model informs care philosophy and is also represented in care documentation. A paper is in production describing the model and this application.

The model is I understand being used in a research project investigating bullying within midwifery. I will post more details on this when I have them. The researchers approached me seeking permission to use the model, I indicated the model's origin - as in "It is not 'mine'", and furnished a letter indicating the model's status. I understand the appeal of the model in this instance may be in scoping the research project.

Currently the model is helping me in my role (as a Nursing Home Liaison Specialist) to plan and deliver education sessions to residential care staff on communicating with people who are coping with dementia.

Being simple in structure and basic content once learned the model is accessible as an aide memoire, while you are assessing, planning and evaluating.

I have also used the model when working on informatics projects, as the model can help integrate the SOCIAL and TECHNICAL aspects of ICT.

More Q and A to follow plus photos.

Tuesday, March 01, 2011

'Health coaching': One application for the Health Care Domains Model?

The following message from Helen Erickson (Univ. of Texas) was received through the Modeling and Role Modeling mail list MRM-L at LISTS.UFL.EDU. It is the patient education aspect of the post that is of interest to me as it highlights why I continue to champion Hodges' model near and far.

'Coaching' (in its various forms) is a potential application for h2cm which can be used explicitly by explaining the model to the (potential!) patient / carer, or implicitly used by the health care professional as an aide memoire - a conceptual framework.

More to follow as I referred to the matter of health care delivery vs. health education in my presentation and the delegates raised the question of applications of Hodges' came up in Paipa last week.


Good afternoon,

Some of you know that the healthcare bill signed last year (HR3590) includes a section aimed at revamping the healthcare system from a disease model to a health promotion, disease prevention. Section 4001 particularly addresses care for those on Medicaid and Medicare. A national advisory committee is being named to study this, make recommendations, etc (see Section 4001). Among the representatives of specific groups (orientation to health care) being named to the advisory group is the "health coach".

STTI and ICN put out a manual on coaching a year or so ago, coupled with a short CE test. When I read the manual and took the test (it took about 10 minutes total), I discounted the movement, thinking that it was just another way to define what we call MRM. The only difference is that it requires some specific strategies and skills, most of which I've discussed with you through the years, e.g. contracting, The other difference will be determined by what happens at the national scene. It is possible that "coaching" will be reimbursed. Many think that it will, thus the national group out of Harvard, the University of MN, and others are meeting, talking, defining the construct, etc.

As Chair of American Holistic Nurses' Certification Corporation, I have been drawn back to the topic repeatedly. Most recently, AHNCC has decided to actively explore certifying nurses who practice holistic health coaching, i.e.certifying a holistic health nurse coach. I have added a poll to the ahncc website, eager to learn if nurses are interested in the movement, etc. if you are interested in the website or want to express your position on health coaching, please visit ahncc.org.

Hope to hear from you,

Best to all,