Hodges' Model: Welcome to the QUAD: December 2013

- 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, December 26, 2013

To-do list and challenges ... 2014

...in no particular order of priority or level of challenge presented...

Graduate study - distance learning, assignments, supervision, residential week
Research question
Role of simulations - games?

E-mail address (beyond yahoo and demon)

Video and Audio skills
 Drupal 8 (stable Windows install - Linux)
the Drupal stack (still)
Abandon/transition from this blogging platform to other

Complete and format recovery, recovery model and Hodges' model paper for submission to journal
Prioritise and relate conference attendance and presentations/workshops to post-grad studies
Complete remaining three books for review

focus, focus, focus...

Happy holidays a Healthy and Prosperous New Year to All!

Monday, December 23, 2013

SCNTST - Self Therapy

Self Therapy

"... Self Therapy 
is designed for the headphones
 not the dance floor, ..."

Hunter-Tilney, L., Life&Arts, FT Weekend November 16-17 2013, p.19.

group - population

Image source: http://renownedforsound.com/index.php/album-review-scntst-self-therapy/

Sunday, December 22, 2013

mEDucator 3.0 | Open Linked Education - Melina+ (Drupal)


Checking through links yesterday I came across the mEDucator initiative and Melina+ [no longer available] which is part and noticed it is built using Drupal.

There is a thread on Drupal.org on science applications:


I posted in 2009 about the Science Collaboration Framework - SCF (for creating biomedical resources).

The link to SCF no longer works; there is an archive of this and other work that was part of Harvard's Initiative in Innovative Computing (IIC).

So it's important to consider these initiatives at least in terms of their longevity, their scale and number of participants, as examples of funded research and as Drupal projects.

Wednesday, December 18, 2013

Papers, *actual* post-grad studies and a visit to Brian Hodges

Early last month I posted about planned trips to Sheffield and Lancaster Universities.

On the 4th I visited Paula Procter at Sheffield Hallam University, spending two hours there. Paula and I have known each other through informatics conferences since the late 1980s or early 90s and the British Computer Society Nursing Specialist Group. (Sadly this group and its publications are not as active as they used to be.) I really appreciate Paula's time and her key conclusion that rather than thinking about Hodges' model I need to apply my knowledge and experience with the model and DO something with it. In doing something with the model in a certain community - most likely residential care and nursing homes - I would also have a potential community of users for the new website. This was quite something to hear as I'm at that stage of my career when, shall we say - other possibilities beckon.

In the afternoon I travelled the short distance to meet Brian Hodges at his home. It was great to meet with Brian again and his wife. It was a lovely sunny afternoon as per the welcome and some cake! We reflected on the respective changes over the past five years and current events. Hot-off-the-press of course was my sharing the discussion with Paula and the planned visit to Lancaster University.

We agreed to meet again and not leave it so long next time. Brian has a desire to write again and and a prospective topic in dependence - independence. I hope this is something Brian can do and forward a photo for the (still) promised site. Brian now has copies of the most recent papers and the latest draft on recovery in mental health and the model.

On the Wednesday, after work I drove to Lancaster to discuss their PhD E-Research and Technology Enhanced Learning (thesis and coursework) distance learning.

At the start of last week a reserve place - for January 2015 became an offer of a place next month.

So, as of next month I will make a start. There is a residential week to look forward to at the end of March. Three second hand books from the reading list are ordered. There is a recommended video link too that invites repeat viewing, Etienne Wenger on Communities of Practice:


- and in the Nursing Informatics book I'm reading for review, on page 189 box 11.1 is on the same topic and referenced source Wenger, E..

I predicted quite some time ago about the post count decreasing here ... now I have an excuse and I plan on this including Drupal.

Tuesday, December 17, 2013

Cognitive Informatics and other forms?

Over the past couple of months I've posted on topics that include an example of Hodges' model related to the post's particular theme. In McGonigle and Mastrian's Nursing Informatics and the Foundation of Knowledge, Second Edition (2012) on page 63 the editors cite Wang (2003):

Cognitive informatics attempts to solve problems in two connected areas in a bidirectional and multidisciplinary approach. In one direction, CI uses informatics and computing techniques to investigate cognitive science problems, such as memory, learning and reasoning; in the other direction, CI uses cognitive theories to investigate problems in informatics, computing and software engineering (p.120). 

I will leave it to you to consider the INTRA-INTERPERSONAL and SCIENCES domains, and not (just) how Wang's cognitive informatics 'fits' within Hodges' model, but what of the many other informatics fields. Here they seem like stepping stones, but taken together where do they lead to, from, ... about ...?

Wang, Y. (2003), Cognitive Informatics: A New Transdisciplinary Research Field, Brain and Mind: A Transdisciplinary Journal of Neuroscience and Neurophilosophy, Vol.4, No.2. pp.115-127.  

Saturday, December 14, 2013

H2cm - Beauchamp and Childress (1994) four principles of healthcare ethics

I'm clearing the decks of books at the moment, one of which is McGonigle and Mastrian's Nursing Informatics and the Foundation of Knowledge, Second Edition (2012). I notice a 3rd edition is in preparation.

A review will follow, but in chapter 5 on Ethical Applications of Informatics on page 73 (pb.) the four principles healthcare ethics of Beauchamp and Childress (1994) are mentioned in a very concise, informative discussion.

Although the exercise that follows involves 'putting concepts in boxes', doing so helps us to see beyond the boxes, to see the links between.

Although harm takes several forms it is physical harm (for nonmaleficence) that is most commonly thought of. This is the ethics concerning an individual so why have I placed beneficence in the sociology domain? Justice should be straight forward, but only if reinforced by law, and then only if that law is exercised. Autonomy should be straight forward. I must have the mental capacity, the insight to have choices. In the eyes of others these choices may be rationale or irrational. Although justice is place in the political (group / population) domain, rights are ascribed to individuals. This is useful property of Hodges' model the way that the individual and their mental life are diametrically placed (opposed?) and linked. It is others who are having determine the ethics of a given case, evaluating what is in the person's best interests; also having to take into account any advanced directives, or living wills.

What do you think? If you have some comments, can improve this or feel there is a correspondence here please let me know.


autonomy nonmaleficence
group - population

  • Respect for autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
  • Beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
  • Non-maleficence - "first, do no harm" (primum non nocere).
  • Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
Above text:

Thursday, December 12, 2013

Critical Thinking - Gaining knowledge: Beginners + Experts = audience?

Clearing through books last month with several bound for the charity shops I came across Critical Thinking in Nursing: An Interactive Approach, by Rubenfeld & Sheffer, with the following table (p.30):

Ways of:

Gaining Knowledge Assigned readings and asking authoritiesMultiple written and verbal sources, and experience
Thinking DualisticRelativistic
Using rules Context freeSituation dependent
Looking at situations NarrowBroad

The table is not remarkable in its theme, but it is a useful prompt for Hodges' model and future studies. The concepts listed might help illustrate how Hodges' model can support learning. In addition to having an individual focus the model can consider any situation, hence the claim that the model is 'situated'. As stated previously person centeredness is not a given. It does not follow, nor is it achieved just because 'person centered' features several times in care philosophies and policies. The person must be put at the center of the model and then each of the domains considered together with the spiritual dimensions.

I'm also reading a nursing informatics book (posts and review to follow) that discusses casuistic ethics, that is case-based reasoning. While the utility of casuistry is debated in nursing, the need to consider the individual is always paramount. A prime example of the focus on the individual is the programme Inside the Ethics Committee on BBC Radio 4. Central to ethics are the frequent dilemmas that arise in health and social care, the difficult moral choices and dichotomies that must be faced. The model can be used in a context free way, that is considering rules in general; and also employed in specific contexts, such as a best interest meeting for a person recently moved into a residential care facility and distressed by the experience.

There are many dichotomies that can be identified in the basic model, and to a certain extent they reflect the dualistic thinking of the beginner as they build an understanding of particular fields of health care. As learners progress they integrate the concepts they encounter and are then able to associate these and relate them to prior learning, the current case and generate hypotheses that may also be predictive. Hodges’ model can frame and help represent student encounters be they narrow or broadening (recognising patterns). Gaining knowledge may need particular attention by the student (mentor and lecturer) in terms of the student's strategies for creating and protecting opportunities as a beginner and competent practitioner.

As a sign-off mentor I’ve become acutely aware – as required - of a learner’s level of skills and knowledge. What is their level of competence? What is their level of situational awareness? How are they progressing through their learning according to previous mentors and their own goals, learning objectives and evaluation? The concept of emotional intelligence is not new and still has the attention of researchers. Perhaps this could also inform questions for research into Hodges’ model as students elaborate their initial representations of nursing care, skills and knowledge through their course and ongoing as experts. Is emotional intelligence central to compassion in nursing? Encompassing all of these ‘ways’ in the table is reflection. This is not just for reflective practice but an ability to critique one's own practice and that of others.

The table is also helpful at this time considering future content and content types and the potential audience of a new website. The challenge is to emulate the table above in the way it reduces, simplifies very complex educational matters. Yesterday afternoon I was able to attend a very helpful two hour research clinic in Lancaster, following this I must (still) reduce the above questions and also recognise my own biases.

Rubenfeld & Sheffer (1994) Critical Thinking in Nursing: An Interactive Approach. 1st Edition, Lippincott Williams and Wilkins.

Sunday, December 08, 2013

Join the Revolution: For the Lady in the Corner (c/o ST4Health)


personal experience
one disease -
malaria, smallpox, leprosy, TB,

 emergency treatment, hospitals,
systems, capacity
society, community, village

gender, interactions,
humanitarian works,

policy, organisations,
population health improvement, global health, poverty,
economics, outcomes

group - population

My source:  HIFA2015 list

Saturday, December 07, 2013

Reading and writing the minutia of locked doors and windows (still a draught)

Couples, married or not, partners are the cards that frequently, if not by definition, lean on each other beyond the pale, to the n-th degree. Witness so many lessons of what love really is.

They bend and flex. Tested by history, timelines entwined, ties-that-bind, trying to persist in the hear and how.

Their psychological union is challenged as memories become eroded and physically frailty takes hold. Usually; mostly, on the one.

Eventually things, established relationships break and one or the other - should we say: finds themselves in - residential care.

Courtship enables us to become socialised to and with each other and respective families and in some instances other cultures and beliefs.

In this crucial transition sometimes there is learning through experience as respite care is sought.

In other cases health services wonder how this relationship has survived for so long. A crisis is a precipice for change. A chaotic invitation. Radical.

A sudden shift from what was home to a new world of corridors, r, ro, roo, room, rooms; my room? New noises and smells and altered routines and jumbled faces, touches, days and nights

The dolls of childhood are left behind, but may be picked up again literally as an emotional comforter. If not this then perhaps a ‘paper clad dol’ that is bound to be - ‘deprivation of liberty’.

In this new home, this person walks the corridor and inspects the minutia of the doors and windows. Staff pass by(e) waving by their walk - "so-busy-look-no-hands" while trying to be butterflies.

Butterflies that cannot say which way is ‘out’.

They are they. Difficult to follow with eye, head and a hand to catch. The individual recognises the whole of the comings and goings, the main thoroughfare. The strategic point, the nexus of comings and goings.

Something's not right though! I need to be somewhere else.

Sadly (or Usually), there is no going back.

Is there a pattern to this confused-coming-to-terms-with?

From asking repeatedly about being elsewhere, especially with the setting of the sun is there a shift in attempted reasoning? So correct, so responsible all those decades ago. Perhaps even months ago...

If no one will listen to me then perhaps if I have my wife/husband with me then they will see the importance of my cause, my mission.

See look - I have my wife, husband, partner with me now: we really need to go!

Can the residential care home support this person? Can they meet their care needs? They say they are ‘struggling’. Will they need to move – again?

How do they work through this transition? What do we know of how individuals negotiate this transition in their lives? How can we try to understand?

How do they make sense of what has happened, and where they now find themselves? Will their level of distress, agitation gradually extinguish as with their efforts to leave?

As they look to the windows, seek to traverse the doorway, cross the foreign threshold and venture to that somewhere that is not here, we know one thing.

Person centredness lies in the minutia of the life once lived through those locked doors and windows.

We can ‘open’ the doors and windows by travelling with them, together, sharing that journey, the sense of those times and upon returning help them adjust to this new listen and how. Clearly, deprivation of liberty is not a punishment here, yet it demands compensation by provision of high quality personalised care.

Wednesday, December 04, 2013

The EQUATOR Network: Support for “Declaration of transparency”


Following publication in the BMJ, in October 2013, of a proposed declaration of transparency a number of journals have now expressed their support for the transparency declaration and now ask lead authors to sign a declaration affirming that:
"this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained".

The following journals have now expressed their support:

BMJ Open
BJOG: An International Journal of Obstetrics and Gynaecology
Canadian Journal of Anesthesia
NIHR Journals Library

Reference: Altman DG, Moher D. Declaration of transparency for each research article. BMJ 2013;347:f4796 [free full text].

My source: equator network - newsletter December 2013