Hodges' Model: Welcome to the QUAD: March 2019

- 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

Sunday, March 31, 2019

Distinction: Phenomenal - Psychological and Scientific interpretations

"In order to separate different uses of quality dimensions it is important to introduce a distinction between a phenomenal (or psychological) and a scientific interpretation. The phenomenal interpretation concerns the cognitive structures (perceptions, memories, etc.) of humans or other organisms. The scientific interpretation, on the other hand, treats dimensions as a part of a scientific theory." Gärdenfors (2004).
SELF - individual
humanistic ----------------------------------------------- mechanistic

Phenomenal (or psychological)



Gärdenfors, P. (2014) Conceptual Spaces as a Framework for Knowledge Representation, Mind and Matter, Vol. 2(2), p. 14. 

Friday, March 29, 2019

Talk @PHPNW Manchester 2nd April 7pm

Responding to a couple of tweets by @phpnw I am now (happily) tasked with giving a talk on Tuesday evening:

Concepts, Spaces and Thresholds and why they matter

Northern Quarter
M4 1NA

Within the Drupal community and online I've heard frequent mention of imposter syndrome as reflected here. I'm no 'programmer', as much as I might wish and after stepping in to help with a quick editorial I'm also conscious of the risks of self-plagiarism - repeating myself yet again.

On Tuesday I'm pulling together threshold concepts, conceptual spaces and #h2cm in that order. I still believe there is a very worthy project here. Even if only having a sense that all the jig-saw pieces are present even if not quite 'correct'?

Recognising the expertise and professionalism of the audience I'm trying to make it relevant with an exercise too. I'm very grateful for the faith of the organisers as I fill a gap of sorts.

Thank goodness the talk is not a day earlier- which might be quite apt in respect of the 'new' site.

With changes in my full-time work status there will be more time.

Always good to see an excuse bite the dust...

Wednesday, March 27, 2019

Nursing's Golden Ratio: Safe-Staffing:Law

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

Care Philosophy:
Task orientation Vs Person-centred
(Reality: Hybrid that assures person-centredness?)

Individual Patient's, Friend's and Family impression

Individual Patient's, Friend's and Family experience (AND memory)

Confidence in Care
(Confidence as a Learning Environment)
 Individual Nurse's Values
Individual Patient Outcomes

Numbers - count
"40,000 missing Nursing" [RCN]
Ratios: x :: y
Staffing Research (Falls, Quality...)
Operational Research; Measures
Dependency; Chronicity; Nursing hours / day; Skill-mix; Care undone
Productive Nursing Care
Demographics: Local, National, Int.
tasks, events, priorities, shifts
The E's: Efficiency, Effectiveness, Equity, Equality


Duty of Care
Public awareness / sensibilities
History of Research into Staffing
(Time and Motion studies)

Direct Nursing Care
High Quality Nursing Care = The Golden Ratio


Recruitment, Retention, Attrition
Workforce Planning
Professional Accountability
Commensurate: Policy - Law
NMC Code of Conduct
Contract of Employment
Employment T&C
Emigration Policy, Overseas Workers
Professional Bodies inc RCN, Unions ...
Nurse Administration Support
Information System - Synergy?

My prompt with thanks: https://twitter.com/DannGooding/status/1110929934262898689

Additional sources [ c/o @DannGooding ]

A critical moment: NHS staffing trends, retention and attrition
Health Foundation, ISBN: 978-1-911615-25-5


American Nurses Association, Nurse Staffing Literature Review

Tuesday, March 26, 2019

Word use & implications for research - 'Population health' by Canales, Drevdahl & Kneipp (2019)

humanistic ----------------------------------------------- mechanistic
individual health

a. INTERVENTION in Individual behaviour

My word use -
(contribution to and affected by
a community of practice)
Begin: Planetary Health End:

  Length and quality of life
 academia - evidence-base
b. INTERVENTION in a healthcare sector
Public Health as a discipline - word use
 health promotion and disease prevention
FROM: individual
CLINICAL - sub-groups
TO: group - population
 A data dictionary?
language use - 'pop. health' meaning?

Social and Society

Does the community have a role in local health population management?

a. and b. insufficient to address -
social determinants and health inequities
root - societal and structural levels


Community activists for Social Determinants of Health

TOTAL POP. [health systems Pop.]

population health management

political & economic systems
LARGE-scale: community initiatives that attempt to reduce inequities by challenging
poverty and racism

SDOH - inc:
food supply, housing, economic and social
relationships, transportation,
education, and health care


Canales, M.K., Drevdahl, D.J., Kneipp, S.M., (2019) Moving Words, Moving Meanings: The Discourse of Population Health, Journal of Professional Nursing, 35, 2, 71-73, ISSN 8755-7223,

Tuesday, March 19, 2019

c/o R Layard "Enact policies to boost emotional health"

humanistic ----------------------------------------------- mechanistic
individual well-being


"overarching criterion for measurement"


Social values
Social cohesion


"schools, mental health, family support,
child support, addiction, social work,
 loneliness, methods of management
and town planning."

"Fortunately more and more governments are beginning to think along these lines."

Prof. Richard Layard* (2019) FT Weekend, 9-10 March. "Enact policies to boost emotional health"
Author of: Happiness - Lessons from a new Science

*Co-director, Well-Being Programme, Centre for Economic Performance, London School of Economics, UK

Saturday, March 16, 2019

"Calculated Risk" (2018) Ciara Phillips

Calculated Risk (2018) Ciara Phillips
Relief print and screen-print on paper on paper
Copyright - Courtesy of the artist.

Ciara Phillips

While far from a printmaker (or 'webmaker') Printmaking Today is a real treat. It gets read page-by-page - cover-to-cover and the challenge - finding this image on the cover - is not to be enthused and inspired by several contributions in an issue. I was disappointed there were no back-issues for sale at the recent Print Symposium.

My source: Cover - Printmaking Today, Volume 28, Spring 2019, Issue 109

Friday, March 15, 2019

Under the SSKIN

Since W2tQ started almost 15 years ago a collection of 250 draft posts have gathered (virtual dust). Many are probably empty - half-baked ideas - with no clear title (reminder - of the contents).

In nursing there are (thankfully) constant reminders, one being: the need to strike a balance between the person, being least restrictive, assumed mental capacity, best interests and high quality care delivery.

Revisiting the threshold concepts, h2cm and deprivation of liberty safeguarding draft paper brings recollection of a draft post and the lesson:

In many nursing situations you cannot assess what you cannot see.

In Nursing Times 29.11.11 a Nursing Practice comment item was titled:

“Compulsory training would help every HCA spot moisture lesions” 

Denise Elson, points to the SKIN (Surface, Keep moving, Incontinence and Nutrition) bundle as a set of very useful principles, and further refined to SSKIN:

SSKIN - Surface: Skin inspection: Keep moving: Incontinence: Nutrition

The Tissue Viability use the principle of SSKIN:
  • Surface: make sure you're on a supportive surface 
  • Skin inspection: check it isn't discoloured or sore 
  • Keep moving: change your position often 
  • Incontinence: keep clean and dry 
  • Nutrition: eat healthily and drink frequently ( https://www.plymouthhospitals.nhs.uk/tv-sskin )

As a reflective exercise, if needed, think about SSKIN within h2cm - Hodges' model. Not just the physical (SCIENCES) focus but how these relate to the INTRA-INTERPERSONAL, SOCIAL, POLITICAL and the SPIRITUAL. We will revisit this using h2cm.

On the blog's 15th anniversary 20th April, I'll also try and put some numbers together.

Whitlock, J., et al. (2011) Using the skin bundle to prevent pressure ulcers. Nursing Times; 107: 35, 20-23.

See also:
Tissue Viability Society

Wednesday, March 13, 2019

Knife crime: treat as a 'disease'.. (in Hodges' model!)

humanistic ----------------------------------------------- mechanistic
Individual Human Rights
Vulnerability - Influence of others?
 Motivation, Anger, Impulsivity
Schools - bag searches

public MENTAL health
Character; Values
Self-esteem, responsibility, resilience
'Kids with attitude' (great)?
'Kids with attitude' (problem)?

 D   disease models
 T                    Public Health
 A             Violence: stabbing, slashing

 T        Access to weapons inc. kitchen knives
 R            Weapon concealment on person
 A                            Metal detectors
 C    of individuals
peer GANGS groups
social cohesion - social integration
Family structures
'Friends and Family'
'Friends as Family'
Social services: housing, education,
community centers, community workers
'Moral Panics'?
Victim's family - aftermath
 K    and groups
 I                   Youth Services - Funding
 N               'Global' action - All Together
 G                          Chicago - Glasgow
          Public Health approach to policing violence
School (exclusion, impact of)
Knife crime: Policy, Home Secretary
Strategy - Early Intervention
 POLICING           legal advocates

See also:

BBC Radio 4 - Moral Maze 13 March 'Moral Panics'

My source:

Various including: @rydermc "Not a sticking plaster" on https://www.tortoisemedia.com/


David Gillanders

Sunday, March 10, 2019

'Surgical Procedure' by Hilary Paynter

Social History - Sterile Field

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


Surgical Procedure by Hilary Paynter

"Road works to widen the airport road near  
Sumburgh Head uncovered a large and 
complex archeological site that had previously
been considered fairly insignificant." p.160-161.
Full Circle (2010)

With thanks to Hilary Paynter for permission and original tif file.
And to the Print Symposium events in Wrexham.

Saturday, March 09, 2019

ii) A map as well as an app...? - c/o John Kulvicki

"Maps are picture-language hybrids." p.149.

"The features covering maps are like lexemes of a language that play a predicative role." p.149.

"Maps are pictorial in their use of space." p.149.

"Maps, pictures, and diagrams differ from language not in whether
they make use of predication, but in the way they organize predicates.
In maps, predicates are introduced holistically, in groups, as degrees of
freedom to which any location on a map must commit.
This proposal constitutes a different way of understanding the
coarse-grained distinction between maps, pictures, and diagrams
on the one hand, and linguistic representations on the other." p.150.

"In maps, failing to indicate the presence of something—a town, a river, a road, or an island—is tantamount to indicating its absence." p.150.

Kulvicki, John, Maps, Pictures, and Predication, Ergo, Volume 2, No. 07, 2015

Friday, March 08, 2019

"Invisible Women" on International Women's Day

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

Voice recognition
Crash victims - statistics
Toilet space allocation 
Fumes from cooking stoves
Women - HIV
Drug development studies

"This is a book about the absence of women, but it is also a book about the reign of the default male - the able-bodied, usually white, 70kg man for whom society is built to work." 

Speed, B. (2019) This is a man's world, (The) 'i', p.43.

Invisible Women - Data Bias

Friday, March 01, 2019

i) A map as well as an app: A De Facto Map of Health

A consulting - interview room 

This all seems quite complicated!

:Healthcare Practitioner
Yes, I can understand that. It is complex and complicated. You're having to take a lot of information in. And.., crucially make a decision that is right for you, as well informed as can be.

Has the app helped?

Yes, sure. The app has helped - being in touch with other people - with similar experiences and yet different experiences and stages.

:Healthcare Practitioner
You don't sound fully convinced there..?

Well, someone with a relative - you know...? A health practitioner, erm.. Jo! Well, Jo argued that while the app is useful, for both the community and auto upload of tests... Jo made a joke too: "we need a map as well as an app".

:Healthcare Practitioner
A map - like on your phone? 

Well no, not exactly. Jo said in medicine and healthcare there's long been talk and work on 'maps of medicine', atlases of various kinds and maps of where disease outbreaks are - I suppose.

:Healthcare Practitioner
Ah, yes of course. Maps are central in public [ mental ;-) ] health.
I'm not sure how a map can help here - beyond the app?

When I said it's complicated - and yes complex too - we discussed how bizarre it is that with something so perplexing on so many levels there's no map! Not even a compass to get your bearings. 

:Healthcare Practitioner
A compass? How on Earth would that help?
To center things. The whole cussed situation. To weigh up what needs to be thought about, discussed, given up and even grieved for.

:Healthcare Practitioner
I see.
Yes, and that's an important point too - as a compass can help orientate us both. And ... are we focussed on your clinical priorities or my domestic and social circumstances. A compass and a map might help capture the context and 'my' health career insofar as what is happening to my life chances at present? ... Yes, I've been reading a bit...

:Healthcare Practitioner
This sounds quite an idea but I'm not sure where we'd begin. Perhaps we can pull some people together to discuss this? When you mentioned centering things in a way that would also help 'ground' things too. The small matters of money and politics that are sat with us already! 
What do you think?

Well actually, I think we've got a starting point!