Hodges' Model: Welcome to the QUAD: September 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

Monday, September 26, 2011

PJ's project [i]: Hodges' model An aide mémoire, or candidate Gärdenforsian conceptual space?

I'll expand on this over the coming months ... first something a bit off the wall...

Now and again I revisit what started as my 'notes' on conceptual spaces. This could be an embarrassing case of mistaken identity (and an embarrassing series of blog post!).

As with everything what is the cost? Well in words .....

1,300    2,400          5,567                        10,534                                   20,340 ...

I add text. I subtract.
Possibilities are appended. Relevance is questioned.

Where IS the panoptic eye?
Where to find the supervision that can ground me?

(Their flies the constant: Astronautic dreams; Young, Cernan, Aldrin, Armstrong, Yuri, Tereshkova and you too Albert II)

Structure emerges.
Potential strategies form to combine interests and efforts.

Te                  the                    xt 
So how is the nursing stack?

Quality of Care?
Dignity & Respect?
Confidence in Care?
Skills mix?

1st in : last out - OR....?

How to shuffle the decks that are nursing, informatics, cognitive science, and education?

Some text (thoughts) fails to mature -
beyond redundancy -
IT withers.

References are found. Some are metallic - key - sources. Some are virtual.

Some pass un-realised.  Present but lazy, not furthering the case.

Some are never recovered:............................
...............................:from paper scraps; from grey matter.

(Limited Orientation [don't panic] Should b Temporary)

Recovery. Who can recover from: LIFE? No choice in that. But do exercise. Travel past : now :  future : now : past ... forth and back ...

Toys R Us
Yo-YoUR memories are U

For a long time it collected virtual dust. Encoded on the hard disc long since last accessed. A Frozen amalgam of bits. But then, a return -


 The aRc of relief- fresh eyes, fresh thought, further insights ....

The overall structure changes. For a long time this project was h2cm, then additional thoughts a website, a blog, several papers with this - yet another. A possible submission, journal - conference?

Then a text; a project; a song*; possibly a thesis?  (* Only joking)

How many texts start this way?
How many are still born?
No cry, no joy, less holistic care.

I do believe h2cm is an example of a conceptual space.

It could be that there is ONE ' ' or several [Is it lexical, discursive, cognitive, enacted, ....?]

Where are the edges of h2cm?

The h+listic space


That space is idealised across ALL nursing theories. ButT (my head hurts) what sort of space is it? Shuffle the cards again, take one, memorize it.... Have we landed yet? Am I moving, or is that you?

Where is that space in practice now - and where is it post-midnight?

It is there in all care theories, they all count towards local - global health. Rejoice in eclectic care realms; in pre-post training and lifelong learning.

Roots or tendrils: it's all growth.


In books, on lecturer's lips, values carried forward in student's thoughts and deeds.

Friday, September 23, 2011

Books: Bortz's Next Medicine, a summer break and an oath

As the Northern autumnal equinox rolls in I've a book to read and review with thanks to OUP for the copy:

Next Medicine: The Science and Civics of Health
Walter Bortz, MD

Even though the health care systems of the USA and UK differ markedly the book caught my interest on several levels:

First the title: the next & civics aspects stand out. As for next something has to give in health care systems, not just in the USA but globally. Civics to me suggests a public and collective responsibility and level of engagement. The book's description also highlighted issues that I can relate to here in the UK nursing community. In the first chapter Bortz considers medicine's mission:
As I search for the first principle(s) from which to all else derives, I offer as a terse definition: "Medicine's mission is to assert and assure human potential." In a parallel vein, Norman Cousins ventured that "the physician's role is to help mankind make of itself the most of which it is capable (4)". Put yet another way, the physician's job is not only to cure illness or to fix broken bones, but to serve first as a mirror into which the patient peers to see the reflection of the problem, and secondly as a prism showing not just what is, but what might be. The physician's role transcends that of simple mechanical repair. The human body is infinitely more than than a deterministic machine. p.6.
I was delighted to enjoy a vacation in Kos this past week. Early on Walter Bortz refers inevitably to Hippocrates who was born and lived on Kos. By quite a coincidence the BBC Radio 4's In Our Time featured Hippocrates last week. Already, as the quote above shows (and Bortz stressing the need to attend to the big picture!) I'm really pleased to have this copy and look forward to a fascinating read and reflecting more here.

Wednesday, September 14, 2011

After'math' II of... The Difference that Makes a Difference

Continuing in the vein of challenging and stimulating ....

It seems there are several people attributed with the saying "the map is not the territory". The debate around maps and territories came up in discussion and is frequently raised on psychology and therapy discussion lists. At DTMD I referred to h2cm as a cognitive periplus, which I came across in Cunliffe's book The Voyages of Pytheas. Basically, ancient mariners would draw a map, a periplus of the coastlines for navigation and an outline of land masses. During the meeting I came to equate the basic features on the coast as data; buildings or smoke as information; and the conclusions derived as knowledge. Whether to proceed inland well, that is about pioneering, courage and wisdom.

A challenge comes with the DTMD talk of information theories. The DTMD workshop was promoted as a forum to discuss and expand our collective understanding of what we mean by information in our different disciplines.

What would an information theory based on the knowledge domains look like? Given the presence of the SCIENCES domain then the mathematical and logic-based theories are already determined for us, are the specific information theories and models that relate to the physicality, the entropic journey of the body? What information theories can we identify for the other domains:

  • and the spiritual, unknown?
If we categorised the 25 info theories listed by Paolo Rocchi in his session how might they be distributed across the h2cm domains?

Here is part of the listing c/o Prof. Rocchi and with many thanks:
  • The statistical theory of information by Shannon (1949);
  • The algorithmic theory of information by Solomonoff, Kolmogorov (1965), and Chaitin (1977);
  • The economic theory of information by Marschak (1971);
  • The living system information theory by Miller (1978);
  • The autopoietic theory of information by Maturana, Varela (1980);
  • The biological information theory by Jablonka (2002);
  • The cybernetic information theory by Nauta jr. (1970);
  • The dynamic theory of information by Chernavsky (1990);
  • The fisherian theory of information by Fisher (1950);
  • The general information theory by Klir (1991);
  • The general theory of information by Burgin (2009). ...

What is the result? What criteria determines the final domain 'home'? On what basis can we differentiate such theories - quantitatively and qualitatively? As noted at DTMD where are the family resemblances? Perhaps they can be found within the care domains:

Sciences - inclusion of a mathematical - logical underpinning (There be equations in the hold!)?
Social - reference to social and family networks without explicit recourse to mathematics? The use of psycho-social concepts?
Interpersonal - reductionist-wholist rendering that incorporates perception, individual information processing? What can be drawn from the latest research in anxiety and psychoses for example? Is it appropriate to wonder if ontological* approaches have anything to offer?
Political - Theories that cover economics and also explain power relations, decision making, and choice for example? 

Even though when we see / read the word 'unified' you tread carefully, Hodges' model ultimately presupposes a unified view. Recall again the DTMD2011 challenge:

to discuss and expand our collective understanding of what we mean by information in our different disciplines.

So the purpose here on W2tQ and through h2cm is to focus on all the domains simultaneously; at least when information in the context of health is our concern. As I mentioned in my presentation, there are clear exceptions in emergency and crisis situations. Then 'holism' is suspended. Information (re)sources, selection, analysis, synthesis and salience are focussed; specialised individual, team and organisational memory are brought into play with varying degrees of technology in support. The second-by-second, minute-by-minute demand for data, information and knowledge increases, its longevity in terms of significance may decrease, replaced by updated values by turn until 'stability' is restored: by human effort or nature.

To be sustainable (applicable, creditable, relevant ...) for me a unified theory of (health) information must span situations such as the emergency and all the h2cm domains and care contexts. Now that is a challenge!

*What would it mean to create four ontologies that could be merged together?

Tuesday, September 13, 2011

h2cm presentation: Colombia Nursing Theory conference (slides from Feb)

As the slides from Milton Keynes and DTMD 2011 are posted, here below are the slides from February. There are some 'artifacts' in there - the question marks were included then replaced by the text as part of the animations (as with the stick figures). The Colombia slides provided the template for the ten minute talk last Thursday. It was a very useful experience, exercising discipline to cram sufficient explanation in to cover the slides in the brief time available. No time for animations. The Chairs for the sessions did a great job, providing a 3 minute warning.

Colombia remains a real highlight: three of the slides are in Spanish thanks to Luz Stella Saray and Prof. Wilson Canon Montanez for their translation skills. (Any mistakes are mine in data transfer / formatting). 

The next event to prepare for is Dublin in November: a poster. This will really be different and I need to see what production / printing resources I can access, taking portability into account.

Saturday, September 10, 2011

After'math' of... The Difference that Makes a Difference: an interdisciplinary workshop on information and technology

Here's my take on this workshop 7-9th September in Milton Keynes at the Open University. It was a really challenging and stimulating event. How so? Well...

Challenging: The first day's theme - What is information? and Thursday a.m. included presentations on quantum information. Trying to keep up with such ideas, to keep up with the progress of science and its philosophical implications demands effort, as does putting the ideas, concepts and applications in a form the public can understand. Given the academic calibre of the keynote speakers and organisers several books were held aloft and referred to:

Perspectives on Information 
Edited by Magnus Ramage, David Chapman
Decoding Reality
  Vlatko Vedral

Stimulating: Revisiting information theories with one slide c/o Paolo Rocchi, LUISS Univ. / IBM, The Concepts of Signifier and Signified Revisited listing 25 examples. The vast majority were new to me and of course as was also pointed out the list was not comprehensive.

Challenging: The maths on display here were way beyond me. With the talk about hard and soft sciences though I recalled a previous post Bell Jars and Bell Curves and how many mathematical techniques remain off limits to would-be users in the humanities. The maths didn't help my note taking - do I assume that lack of notes is shorthand for befuddled?

Stimulating and Challenging: Exposing Hodges' model and my vision of the model as a conceptual space (whether one ... four, or five) helps me focus on how best to lift a foot, and envisage the next steps. In the workshop I've found a few puzzle pieces for the draft text I have on h2cm as a conceptual space. It's a mix of nursing, informatics, Gärdenfors' definitions, ICT and aspects of education. Next month I'll post a draft content listing - adding to it as it takes shape.

Stimulating: On Wednesday evening there was a screening of a documentary film narrated by Nora Bateson An Ecology of Mind a portrait of her father Gregory. The film was quite a delight - in content and style - covering the central themes of Bateson's life and work with insights from his daughter and recognised commentators and colleagues:
"Gregory Bateson’s theories, such as “the double bind” and “the pattern which connects”, continue to impact the fields of anthropology, psychiatry, information science, cybernetics, urban planning, biology, and ecology, challenging people to think in new ways."
I remember double bind from mental health and reference to Bateson in family therapy circles. The title of the workshop - the difference - stems from Bateson as quoted on the DTMD2011 website:
Kant, in the Critique of Judgment – if I understand him correctly – asserts that the most elementary aesthetic act is the selection of a fact. He argues that in a piece of chalk there are an infinite number of potential facts. ... I suggest that Kant’s statement can be modified to say that there is an infinite number of differences around and within the piece of chalk. There are differences between the chalk and the rest of the universe, between the chalk and the sun or the moon. And within the piece of chalk, there is for every molecule an infinite number of differences between its location and the locations in which it might have been. Of this infinitude, we select a very limited number, which become information. In fact, what we mean by information – the elementary unit of information – is a difference which makes a difference Gregory Bateson (1972).
Not unexpectedly some speakers did challenge the views of Kant and Bateson. I found the recurring discussion on objects, subjects and relationships very enlightening. After the first day and the film I took Shannon's communications model SENDER, RECEIVER, CHANNEL, MESSAGE and NOISE and extended reference to this in my slides. Being situated and encompassing four care - knowledge domains h2cm can represent several contexts.  From a systems perspective we can consider the nurse, patient and carer as sender and receiver. Disease becomes 'noise', or according to Canguilhem life as the background noise with disease as (an inevitable) manifestation? The philosophical talk prompted me to cast health care practitioners as 'existential informaticians' (although the majority see themselves as assistants to a higher power).

Unless speakers have indicated otherwise slides and audio will eventually appear on the DTMD website. I've uploaded my DTMD presentation comprising 13 slides:

The workshop was a great experience, the organisers and  participants were very friendly, a very inclusive community; essential for all events clearly, but critical for one with interdisciplinary aspirations. I was not the only NHS employee there and now have a new NHS contact on Linkedin from finance / information governance. After Drupalcon this is great - as networking is of course a key objective. At Druplcon I was told about another nurse and Drupaller in Manchester and now we plan to meet up next month. You can learn to play the guitar on your own, but it helps to learn with others.

The organisers have applied for funding to support research and three further events tentatively proposed for 2013, 2014 and 2015. Speakers and attendees are also encouraged to submit to a special issue of tripleC - Cognition, Communication, Co-operation The Open Access Journal for a Global Sustainable Information Society.

I will add more in another post (on sessions) as time permits.

Thanks to: the Committee for being able to present and the Open University Department of Communication and Systems (http://cands.open.ac.uk/) and the ESRC Centre for Research on Socio-Cultural Change (http://www.cresc.ac.uk/) who supported the workshop.

Saturday, September 03, 2011

Recast: The NHS Future Forum's four workstreams

This week's Health Service Journal HSJ is in my laptop bag.

In last weeks issue (25 August 2011) was an editorial mention
and news item (p. 6-7) on the NHS Future Forum's four workstreams.
 Apparently, the new addition on a further round of consultation is integration. It may be new for this government and in this context, but the issue of integration has been on the policy table before. 
I've set the four workstreams within Hodges' model:

Education and training
Public (mental) health

There is a lot of overlap, perhaps that is why integration proves so problematic? Yes, integration is SO political; there are budgets, management, teams, leadership... but it's SOCIAL! Professionals are socialised - trained into practice. Maybe that is the place to start - a mash-up?

Education and training are with the individual - the self. The same issue reports the "shocking" finding of staff who have had no professional development through their careers. Staff must be sufficiently motivated, engaged to seek professional development themselves.

Public health is social too, especially when it comes to non-academic transmission. Public health though relies on evidence - science, but let's not forget the inclusion of that mental component.

Information: so many people await the new information strategy. Despite decades of focus on information, information technology, the benefits of information for clinicians, commissioning there is still so much to learn and get right.

It isn't that the three domains of SCIENCES (medicine, nursing), INTERPERSONAL (mental health, learning disability) and SOCIOLOGY (social care, social work) seek to surround and confound the POLITICAL (managers, policy makers). The ongoing challenges highlight the sheer complexity of it all. It also illustrates the immaturity of our knowledge and lack of understanding of this stuff that is information. This next week I am looking forward not only to giving a brief presentation on h2cm and engaging with information, but listening to a very varied interdisciplinary programme:

The Difference that Makes a Difference:
an interdisciplinary workshop on information and technology
The Open University, Milton Keynes, UK

If the strategy groups need a tool to help them find and integrate answers to the big questions might I suggest they adopt a suitably scalable framework.

Additional links:
NHS Future Forum recommendations to Government