Hodges' Model: Welcome to the QUAD: April 2016

- 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, April 30, 2016

Buses, Students, Tech and Models of Care

I continue to be surprised, informed and stimulated by the many contrasts and similarities between nursing and information technology. A constant encounter as a mentor is hearing accounts about student nurses and their learning experience. After 12-18 months since beginning their student career what are student's learning, being taught? And yes: nursing theory and models of care still seem twee, out-of-date, out-of fashion.

Change is inevitable of course; in tech if you are not on-board (as in the web), there is a progression of buses and you can get on at any time. At least I hope that's the case. As Web Design magazine asks: "How will CSS be styling the web in 2017, 2018 or 2019?" So for students there are many university blocks, lectures, clinical placements, mentors...: so many buses. Hopefully they really do get on-board sooner rather than later.

The snapshot of evidence as I have it re. models of care, nursing theory and reflection suggests there is quite a vacuum at a time when there is both a need for a tool like Hodges' model and an opportunity.

There are valuable lessons in the history of models of care while we relish the challenges of the future. Those lessons are still relevant as the nursing community and its practitioners constantly travel between the mechanistic and humanistic forms of knowledge that nursing demands.

Technology changes all the time and with it, the buses, the roads and even the bus stops. Clearly, we need our students to be as well equipped as possible. Not to deal with change, then it is too late. We need future practitioners to be able to critique potential change. This is crucial when future change involves nursing itself and nursing's values.

Friday, April 29, 2016

"Index Case": Do we need a new form..? ( cas index, Indexfall, caso índice, 指數情況, الحالة الدالة, सूचकांक के मामले ... )

index case
noun: index case; plural noun: index cases
  1. the first identified case in a group of related cases of a particular communicable or heritable disease.

Source: Google (and translations)

Hodges' model can map the first identified case of any disease, but just as medicine can turn a crisis around - we need a new form of 'index case'.

In healthcare we spend a lot of time managing 'caseness' and for a population casenesses. While triage is concerned quite rightly with prioritization, safety, efficiency, it also seeks to deny people caseness through gate-keeping. Alternately, for those diagnosed and meeting criteria, services then seek to assess when they are better - on the other side...

A new index case is required to respond to demographic, socioeconomic and environmental pressures. Talk, action and outcomes must be about well-being, sustainable health, strengths, health literacy self-care and recovery.

Hodges' model can facilitate this change in care philosophy, perspective and the concurrent focus of disease AND health.


For how long how we espoused person-centered care?

Health is where the person resides*.

So often disease fragments identity, memory, the person, relationships, even the whole community...

Disease is a matter for our humanity.

Hodges' model can be the index case for a person's health and well-being and how they maintain, maximize this status. This might even help us define person-centeredness. A care indices.

Being person-centered should be a index-phenomena that takes cognizance of history where this is available.
This should - must be the index case?


Wednesday, April 27, 2016

what3words = addressing the globe : Hodges' model = mapping the world of care

humanistic ---------------------------------------  mechanistic

think feeling happy

soma tech pressure

gender celebration peers

Bureacracy Hegemony Subsidiarity 

My source: 
Hurley, J. (2016) It pays to know exactly where you are going. The Times, 27 April, p.49.

Saturday, April 23, 2016

Shakespeare - Holistic Practitioner

humanistic ---------------------------------------  mechanistic

Love looks not with the eyes,
but with the mind,
And therefore is winged Cupid painted blind."
A Midsummer Night’s Dream
Act 1, Scene 1

"In poison there is physic; and these news,
Having been well, that would
have made me sick"
Henry IV Part II

"Love is a smoke
made with the fume of sighs"
Romeo and Juliet (1595–96), Act 1, Scene 1


"Why, that's my dainty Ariel!
I shall miss thee;
But yet thou shalt have freedom.
So, so, so"
The Tempest (V, i, 95-96)

Tuesday, April 19, 2016

Pigeonholes and a Matrix 4 Care

The structure of Hodges' model is 
not an invitation to pigeonhole. 
It is an equation: a matrix for care. 
What is done in one quadrant, 
needs to be counter-balanced 
in the other care domains. 
The operations here are not mathematical,
 but reflective, reflexive and ideally communicative.

Sunday, April 17, 2016

Book: Skills for Communicating with Patients

Skills for Communicating with Patients

Part 1 of my studies at Lancaster has been a busy two years. Picking up this book which I used in a research paper, the delivery note was a surprise. The book arrived c/o Radcliffe Health in April 2014. Since then Radcliffe is no more, but the title is available through CRC Press.

An established text given a 3rd edition it is accessible, thorough and well organised. The content presents the Calgary - Cambridge Guides as described on the back cover (PB).

Initiating the session. Gathering information. 
Providing structure to the interview. Building the relationship. Explanation and planning. Closing the session.

(As a non-medic) what I like about this CPD certified book is the clear path through the chapters that explain the Calgary - Cambridge Guides. Other models, frameworks and approaches are described. The Calgary - Cambridge Guides is process-centric as is evident in 'gathering information', but the complexity that arises in achieving competence is included and fully referenced (pp. 263-293) throughout the book. Framing questions in open and closed form is covered, with example dialogue between patient and doctor on many practical points. Person-centredness, uncertainty, motivational interviewing, mental health - psychosis, risk (suicide) are also explained. While person-centredness is not the main focus, 'patient' ... is very well served in the index. There is much here about shared understandings and planning and how to make suggestions and raise options rather directives (concordance, p.193). Although it might be viewed as 'cold', I liked the emphasis on information and inclusion of health literacy.

In a very brief break from my proposal I've brushed off two draft papers I've mentioned before on W2tQ at some point. They relate Hodges' model respectively to:
  • threshold concepts 5,000 words 
  • case formulation 4,000 words
In a way the Calgary - Cambridge Guides is a means to a formulation, but a formulation that is consultation (appointment, session) specific. Perhaps in future we will see developments that are more integrative and consider continuity as a vital part of this critical activity. This is the challenge in communication getting the scalability of communication and communication skills right. Clearly beyond the scope of this book but how much of that communication gets passed-along (communicated!)?

This is however a very complete, readable and informative read. Without expanding the book further: but more on technology-mediated communication (beyond computers in the consultation) must be essential in a 4th edition? I am biased but in dusting off the above papers, more on the challenges within mental health, especially self-harm, body-image, mental capacity, and forensic might highlight troublesome (threshold) concepts. Understandably, the disease-illness model is highlighted (p.65). Living well through self-care, living with chronicity, strengths and recovery perspectives may also deserve mention? Working towards a 'meeting of experts' (p.184) helpfully begins to address such developments. With my project in mind I also looked for 'evaluation'. If "research" had its own place in the index - what would the content be?

It proved helpful having a break from the draft papers I wished I'd picked this text up sooner and that I can look at my research proposal similarly refreshed...

Silverman, J., Kurtz, S., & Draper, J. (2013). Skills for Communicating with Patients, 3rd Edition, CRC Press.

Below I have mapped some of the elements of the Calgary - Cambridge Guides to Hodges' model (disrupting the original).

humanistic ---------------------------------------  mechanistic
1. Initiating the session:
Exploration of the patient's problems
patients's perspective
background information - context
Aiding accurate recall and understanding
Identifying the reasons for the consultation

Providing STRUCTURE:

2. Gathering information:

biomedical perspective

3. Physical examination:

Providing the correct type and amount of information

Building the RELATIONSHIP:
Approp. non-verbal behaviour
Developing rapport
Involving the patient
Achieving a shared understanding: incorporating the patient's illness framework
4. Explanation and planning:

Making organisation overt
Planning: shared decision making
5. Closing the session:
Ensuring appropriate point of closure
Forward planning 

Image source:
CRC Press

Thursday, April 14, 2016


Announcing the release of:


Edited by:
Sue Gregory, University of New England, Australia,
Mark J.W. Lee, Charles Sturt University, Australia,
Barney Dalgarno, Charles Sturt University, Australia, and
Belinda Tynan, The Open University, UK

With a Foreword by Chris Dede, Harvard University, USA

Part of the "Issues in Distance Education" series
(Series Editor: Terry Anderson, Athabasca University, Canada)

Published by Athabasca University Press as an open-access publication—
Free PDF download available at: http://www.aupress.ca/index.php/books/120254
Also available for purchase in Paperback and ePub formats

*** Description ***

Three-dimensional (3D) immersive virtual worlds have been touted as being capable of facilitating highly interactive, engaging, multimodal learning experiences. Much of the evidence gathered to support these claims has been anecdotal but the potential that these environments hold to solve traditional problems in online and technology-mediated education—primarily learner isolation and student disengagement—has resulted in considerable investments in virtual world platforms like Second Life, OpenSimulator, and Open Wonderland by both professors and institutions. To justify this ongoing and sustained investment, institutions and proponents of simulated learning environments must assemble a robust body of evidence that illustrates the most effective use of this powerful learning tool.

In this authoritative collection, a team of international experts outline the emerging trends and developments in the use of 3D virtual worlds for teaching and learning. They explore aspects of learner interaction with virtual worlds, such as user wayfinding in Second Life, communication modes and perceived presence, and accessibility issues for elderly or disabled learners. They also examine advanced technologies that hold potential for the enhancement of learner immersion and discuss best practices in the design and implementation of virtual world-based learning interventions and tasks. By evaluating and documenting different methods, approaches, and strategies, the contributors to Learning in Virtual Worlds offer important information and insight to both scholars and practitioners in the field.

*** For More Information ***

A flyer containing further details about the book, including a copy of the Table of Contents, is attached. The full text of the entire book and of individual chapters can be downloaded for free in PDF format at http://www.aupress.ca/index.php/books/120254 . The PDF and ePub versions can also be purchased from this site.
My source:
open-education mailing list [closed?]

Wednesday, April 13, 2016

Planetary Health (ii) (and the need for a global conceptual framework)

I have 5,000 words drafted on Hodges' model and threshold concepts, for which I've yet to find a home. Staying with the previous post's theme of planetary health the paper includes the following: 

A decade ago Groffman, et al., (2006) stated that ecological thresholds can be 'troublesome' in being important but in having no practical application. Threshold concepts are not, however alone; there are also threshold questions (Halldén and Lundholm, 2009). The answers to these questions are critical to global sustainability and planetary boundaries (thresholds) - an ongoing research effort (Rockström et al., 2009).

Groffman, P., Baron, J., Blett, T., et al. (2006). Ecological Thresholds: The Key to Successful Environmental Management or an Important Concept with No Practical Application? Ecosystems, 9(1), 1-13.

Halldén, O. & Lundholm C. (2009). 25-30 August. Conceptual Change and the Complexity of Learning. Threshold Questions, Meaning making and Contextuality. Paper presented at the 13th conference European Association for Research on Learning and Instruction, Amsterdam, Holland.

Rockström, J., W. Steffen, K. Noone, Å. et al. (2009). Planetary boundaries: exploring the safe operating space for humanity. Ecology and Society. 14(2): 32. [online] URL: http://www.ecologyandsociety.org/vol14/iss2/art32/

See also:
Jones, P. (2008). Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

Tuesday, April 12, 2016

Planetary Health (i) (and the need for a global conceptual framework)

(with thanks to Global Health Now)

In a pointed challenge, Lancet editor-in-chief Richard Horton warned Consortium of Universities for Global Health conference attendees Saturday that an exclusive focus on improving health will fail.

Horton argued instead for planetary health.

“We have to cross outside of health and think about the relationship between health and other dimensions being defined as sustainability,”
Horton said, in a keynote address at the annual CUGH conference, which opened Saturday in San Francisco and attracted more than 1,800 attendees from around the world.

Citing the work of a Lancet Commission that published a 2014 manifesto, Horton argued that the global health community and others need to embrace planetary health. “Our vision is for a planet that nourishes and sustains the diversity of life with which we coexist and on which we depend,” Horton and others wrote in the manifesto.

Brian W. Simpson, Global Health NOW

Full text:

[ See below: PJ ]

Best wishes, Neil

Let's build a future where people are no longer dying for lack of healthcare knowledge - Join HIFA: www.hifa2015.org


Previously on W2tQ:

One mind, many minds - ONE PLANET. One need, many needs - ONE PLANET: what price stability?

Exoplanets, exobiology, exocortex, exocare ...?

Notes (ii) from Paipa Conference: Q & A

Blog Action Day: h2cm around the water whole

TED: Nic Marks - The Happy Planet Index

Saturday, April 09, 2016

tear Here - Build There: c/o Brandt (Denver & Taylor)

humanistic ---------------------------------------  mechanistic
He was born in the summer 
of his 27th year...

Nick Brandt: Inherit the Dust

...coming home to a 
place he'd never been 
before. He left 
yesterday behind him, 
you might say he was 
born again, you might
say he found 
key for every door...

... Now his life is full of wonder,
but his heart still knows some fear,
of a simple thing he can not comprehend.
Why they try to tear the mountains down
to bring in a couple more,
more people, more scars upon the land... 

Quality of Life = Quality of All Life?


Words: Denver, J. Rocky Mountain High (video)

My source:
Kenya's Lost Eden, The Sunday Times Magazine, April 3 2016, pp.26-29.

Tuesday, April 05, 2016

ERCIM News No. 105 Special theme: "Logistics and Planning"

Dear ERCIM News Reader,

ERCIM News No. 105 has just been published at http://ercim-news.ercim.eu/en105

This issue features a special theme on "Logistics and Planning"
coordinated by the guest editors Rob van der Mei (CWI) and Ariona Shashaj (SICS).
Keynote "Trends and Challenges in Logistics and Supply Chain Management"
by Henk Zijm, Professor of Production and Supply Chain Management, University of Twente.

This issue is also available for download in pdf and EPUB.

Thank you for your interest in ERCIM News. 

Feel free to forward this message to others who might be interested.

Next issue: No. 106, July 2016 - Special Theme: "Cybersecurity" (see Call for contributions)

Best regards,
Peter Kunz
ERCIM News central editor

An Industrial Take on Breast Cancer Treatment
d2V – Understanding the dynamics of Evolving data: A Case Study in the Life Sciences

Monday, April 04, 2016

Sunday, April 03, 2016

Place-based systems of care: The King's Fund

humanistic ---------------------------------------  mechanistic

individual workers




'place': physical & virtual?

estates, buildings

technology, e-health?

travel - efficiency

Local need - availability




Social Care : Health

Recovery, Rehabilitation, Reablement
King's Fund Place-based systems of care

organisations, budgets,
integration, populations,
strategic budgets, 

My source:
Ham, C., & Alderwick, H. (2015) Take a place-based approach to care, Health Service Journal. 125:6469, 16-17.