Hodges' Model: Welcome to the QUAD: December 2018

- 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, December 29, 2018

The Art & Science of Health: [conceptual scraps i]

The role that both art and science have to play in health, medicine and nursing is recognised by all. The distinction can be made in a great many ways using Hodges' model. Now: there is an exercise for a new group of student nurses ... ?

As I hope is evident in numerous blog posts and subjects of relevance to h2cm, notably, conceptual spaces and threshold concepts, concepts are a basic element in nursing scholarship and debate within art.
In the FT Weekend June 9-10, 2012, p.11 I read: "Conceptual: only worth the paper it's written on" (Georgina Adam). From a healthcare perspective, Adam's opening question seems fairly innocuous:

"How do you prove that you own a work of conceptual art?"
Amid the ongoing revelations involving user's personal data and the governance and values of social media companies lies the question of ownership. First though, back to Adams:
"This is an interesting issue in today’s art market, with the trend towards the dematerialisation of art, and the primacy of the idea over its physical presence.
For example, the late US artist Félix González-Torres’s works include “Candy Spills”, in which wrapped sweets are piled on the floor or in a corner, to be taken and eaten by viewers. When the pile has gone, the owner of the work replenishes it. So what stops anyone making and selling their own “Candy Spill”?

The answer is the certificate of authenticity issued by the artist or their estate. This scrap of paper is, in fact, the only proof that the work of art genuinely belongs to you, and this is actually what you buy and sell.

So losing it is a disaster."
The contrast of this within health care and its 'record' is quite stark. There are at least two ways to  distinguish between the scraps of paper we use ...:

to be continued...

Thursday, December 27, 2018

The WEF Nexus: Water - Energy - Food

“Due to the flexibility of the nexus concept, its application in empirical studies has best served to expand, rather than direct, study scope. Insights tend to be high-level, while identified actionable management and policy proscriptions are not broadly applicable. We found no clear methodology uniting nexus studies, and a lack of improvement of resource management and governance outcomes.” p.5.
"The great breadth of the WEF nexus provides an intellectual home for an expansive array of research objectives, methods, and conclusions. This has produced some valuable scholarship but simultaneously limits overall insights and lessons that can be drawn from empirical nexus work. Our review identified some high-level insights and commonalities related to the definition of the WEF nexus (centring on linkages between WEF systems), the motivations for empirical nexus study, the importance of economics and governance in the nexus and nexus analyses, and the role of social and physical factors in constructing nexus interdependencies. Beyond these, however, the findings and specific technical and policy solutions proposed in the reviewed studies are difficult to synthesize as they lack coherence." p.14.
Galaitsi, S., Veysey, J. and Huber-Lee, A. (2018). Where is the added value? A review of the water-energy-food nexus literature. SEI working paper. Stockholm Environment Institute, Stockholm.

"In this light, the ‘nexus’ has gained significant interest as a potentially effective approach for considering the interdependencies between WEF security and climate change at various scales. Put simply, a nexus is defined as one or more connections linking two or more things. The term is widely used (e.g. the environment — development nexus, the population —migration nexus, etc.)." p.445-446.
"Analytical eclecticism* is characterised by the following: (i) a pragmatic ethos that targets the world of policy and practice; (ii) interest in wide-scoped problems (in contrast to narrowly defined theoretical dilemmas) that ‘incorporate more of the complexity and messiness of particular real-world situations’, and (iii) the aim of providing complex causal stories that account for multiple causal mechanisms predominantly explored in isolation within particular research traditions (Sil and Katzenstein 2010, 412). Notwithstanding the potential of transdisciplinary approaches and analytical eclecticism, some still argue that more research and criticaltheoretical engagement is required to advance the nexus (Harris and Lyon 2014)" p. 452.

Leck, H, Conway, D, Bradshaw, M, and Rees, J (2015), Tracing the Water–Energy–Food Nexus: Description, Theory and Practice. Geography Compass, 9, 445–460. doi: 10.1111/gec3.12222.

*My emphasis and with some reformatting '-' breaks.

 Hodges' model and reference to 'nexus'

With thanks to Stockholm Environment Institute

Wednesday, December 26, 2018

i A new Health Index for England: the Chief Medical Officer's 2018 annual report


My comments are italicised below ...

humanistic ----------------------------------------------- mechanistic
health of

"... explores emerging technologies and their potential impact on health promotion, protection and treatment. This section concludes by discussing the ethics of big data, emerging technologies and the fundamental role of mutual trust between the public and health institutions."

Some individual users of social media platforms are learning the hard way, that they are the product. The effectiveness of technology depends upon user-testing and attending to the user-interface and ultimately deploying a socio-technical approach.

"The first section identifies health as one of England’s primary assets through analysing the links between health and the economy, the local health environment, social health and how the maintenance and treatment of health could be experienced in 2040."

Tangible assets are by definition readily identified. Much data gathering is focussed here: events, contacts, referrals and sessions ... Healthcare systems and health systems can be described, economics studied and quantified. Additional perspectives can and must be integrated from the experience of individuals and society as a whole (more subjective considerations). 'Here' things are described objectively as far as possible (until disproven). On this future policy can be based ...
"... identifies the potential health gains and reduction in health inequalities that could be possible with a ‘prevention first’ approach."

The effects of a 'prevention first' approach may be small initially, but it is here in society as a whole where inequalities are experienced and witnessed that the benefits will be felt.

nation as
"... explores current and future uncertainties in health and identifying the potential of futures thinking methods to inform and ‘future-proof’ health policy." Chap 1, p.2.

There are problems that demand cross-party and long-term political sustained approaches to policy if progress is to be assured.

a whole

Davies, S.C. Annual Report of the Chief Medical Officer, 2018, Health 2040 Better Health Within Reach. London: Department of Health and Social Care, 2018.

My source: twitter

Image: https://www.imperial.ac.uk/news/189627/diversity-champ-producing-plastic-news-from/

Sunday, December 23, 2018

Butt up against the Boxes...?

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



Hodges' model may seem to suggest (as above) that its purpose is to help categorise and put things - concepts - into boxes. While this is true, the model's primary purpose is to support users (and especially learners) to 'see' and reflect upon the (disciplinary) scope of what is being paid attention to and what is not. Ultimately, as we organise our thinking, we can collapse this series of boxes into what will hopefully be a meaningful whole. If this scoping is also conceptual, then the model's two axes also serve to denote implicitly the many oppositions - dichotomies that must also be negotiated (one way or another). This does not represent an appeal to, or for conceptual or information overload. Quite the contrary. We may acknowledge that uncertainties remain, information is missing. It is meaning that counts. What is salient. Meaningful as pertains to the specific context or situation at the time and the sharing of this meaning.

Image: Sisifo rassegnato/Sisyphus Resigned (1983) Copper engraving, 109 x 161 mm

My source: Cuttings, Obituary Jürgen Czaschka (1943-2018), Printmaking Today, Autumn 2018, p.19.

Tuesday, December 18, 2018

c/o BBC Radio 4: Inherited Fear

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

Inherited Fear

"Scared - but not named."

 The ghost of a ghost or
the memory of a

Germ cells
PAG or periaqueductal gray -
the primary control centre for pain modulation

Know your surroundings
Facial recognition


Transmission of trauma across generations

Who is Who

All around the World
War, Perpetual Conflict
Ethnic cleansing
Climate migrants ...

The Past
The Present
The Future

My source: BBC Radio 4: Inherited Fear

Monday, December 17, 2018

India: Health needs of manual scavengers: Does our health system care?

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

“In India, a man is not a scavenger
 because of his work.
He is a scavenger because
of his birth irrespective
 of the question whether
 he does scavenging or not.”

– Dr. B.R. Ambedkar

WORLD other

Three forms of manual scavenging:
1. removal of human excrement from public streets and dry latrines;
2. cleaning septic tanks;
3. cleaning gutters and sewers.
Health risks & risk of death 
Reported: 1 death every 5 days
Infectious diseases
Respiratory diseases
Carbon monoxide and methane poisoning
Safety, Protective equipment?


"Dalits of specific sub-caste and
is an archetype of the
oppressive legacy of the
Hindu varna system"
WORLD others

International Labour Organisation

The Employment of Manual Scavengers and Construction of Dry Latrines (Prohibition) Act (1993)
Prohibition of Employment as Manual Scavengers and their Rehabilitation Act (2013)

International Dalit Solidarity Network
National Safai Karmachari Commission Rashtriya Garima Abhiyan
Ministry of Health and Family Welfare

Original source: twitter

Friday, December 14, 2018

Study: Measuring Different Types of Relationship Styles in Psychosis

Division of Psychology and Mental Health
2nd Floor, Zochonis Building
The University of Manchester
Brunswick Street
M13 9PL

Participant Information Sheet

Measuring Different Types of Relationship Styles in Psychosis

You are being invited to take part in a research study developing a questionnaire to measure different types of relationship styles in psychosis. Before you decide whether or not you would like to take part in the study, please read the following information carefully so that you can understand what taking part would involve for you. Then click the button at the bottom of the page to continue. If you have any questions or queries about taking part in the study, please contact the principal investigator, Catherine Pollard (catherine.pollard AT postgrad.manchester.ac.uk). You do not have to make a decision straight away, so if you have any doubts or feel unsure please take some time to think it over.

What is the study about?

Our early relationships have been linked to the development of psychosis, a mental health problem that means people interpret things differently from those around them. Psychosis involves experiences such as hallucinations, where a person hears, sees and in some cases feels, smells or tastes things that are not there; or delusions, where a person has strong beliefs that are not shared by others.

When people are young, they develop a sense of how they relate to themselves, others and the world. This includes how others relate to them. Some people grow up seeing their parent/guardian as fearful. Research suggests that when these young people grow up they are more likely to report hearing voices and feel paranoid. However, it is not clear how this happens.

At the moment, it is difficult to understand why these people are more likely to hear voices and feel paranoid. Therefore, more research needs to be done. We aim to develop a questionnaire that measures whether people have grown up feeling scared of their parent/guardian so that we can use this in research to help us understand the link between feeling fearful in early relationships and the development of psychosis.

This study will not directly offer you any benefit, but the study addresses a gap in psychosis research. Our work will help to understand the development of unusual experiences and help us develop more treatments for distressing experiences.


humanistic ----------------------------------------------- mechanistic
early relationships 
lived experiences
sensory experiences -
hear, see, feel, smell, taste ...
hallucinations, delusions
psychosis, distress, trauma

Confident with

Involved in major accident
antipsychotic medication

English language

social environment
parent(s), guardian, significant others
fear, traumatic loss of other
 Therapeutic input: CBT, Psychologist


Treatment in a Mental Health
Unit / Hospital
Input from Community Mental Health Team or Early Intervention Service

subjective ------------------------------------------------------------------------------------- OBJECTIVE
qualitative -------------------------------------------------------------- QUANTITATIVE

My source:
@HearingVoicesUK & @RSInPsychosis

Thursday, December 13, 2018

Care Haiku

care this race for you
and I on this planet all
domain by domain

humanistic ----------------------------|--------------------------- mechanistic

intra- interpersonal




Monday, December 10, 2018

Book: Nine Pints

humanistic ----------------------------------------------- mechanistic
group - population

Source: Marriot, J. (2018) History lesson that will get your blood up, Saturday Review, The Times, November, p.20.

Sunday, December 09, 2018

BREXIT: On the Border

humanistic ----------------------------------------------- mechanistic
group - population

Medicines, Medical products
Time - Logistics

"Border Delivery Group"

import - export

(crunch) Commons Vote (deferred)

Source: Hughes, L. (2018) NHS faces risk of reduced drug access for six months, FT Weekend, 8-9 December, p.2.

Thursday, December 06, 2018

Patient Education: Stable - Unstable Plaques c/o twitter ...

humanistic ----------------------------------------------- mechanistic
group - population
'The patient'
Insight, Awareness, Understanding
Attention, Engagement, Recall

Health Literacy

Stable-Unstable Plaques
Post Myocardial Infarction
Evidence-Based Care

Post MI Intervention
Pre MI?
Clinics ('Real time'?)

Public Health Funding

Art & Science: The need 4 Care Notation

McQueen - 'Picnic'

If you can make the core notation 
fit for purpose 
(assess, plan, intervention, evaluation)
then annotations can be added 
according to the context 
(illness, strengths, recovery, end of life)
for a unique performance
(person centredness, integrated, holistic care)

My source: Battle, L. (2013) Scores unsettled, FT Arts, Sept 28-29, p.13.

Image: https://www.classicfm.com/discover-music/latest/graphic-scores-art-music-pictures/mcqueen-picnic/
8. McQueen - Picnic

Graphic scores serve a dual purpose: as well as looking beautiful, they explain abstract ideas about how the music should be played. In this piece, written in 2006, each line represents a different instrument, with the colours and shapes informing how the music might sound.

Monday, December 03, 2018

A vision for population health: Towards a healthier future - c/o The King's Fund

I have taken the four pillars above and mapped these to Hodges' model, essentially a horizontal flip -

humanistic ----------------------------------------------- mechanistic
group - population

Health behaviours
 and lifestyles

Wider determinants 
of health

The places and communities
 we live in, and with

Integrated health 
and care system