Hodges' Model: Welcome to the QUAD: January 2021

- 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

Friday, January 29, 2021

Illustration of Hodges' Health Career - Care Domains - Model

Hodges' Health Career - Care Domains - Model
Hodges' Health Career - Care Domains - Model


This image is available as a .tiff file 300ppi. Please get in touch if needed h2cmng AT yahoo.co.uk

It is figure one of four within the (previously mentioned) co-authored paper mapping the SDGs to Hodges' model. 

Wednesday, January 27, 2021

Capabilities for advanced clinical practice in England: The Four Pillars

humanistic ----------------------------------------------- mechanistic
Clinical Practice
Leadership and Management

England HE. Multi-professional framework for advanced clinical practice in England. London: Health Education England, 2017.

Evans C, Poku B, Pearce R, et al. Characterising the evidence base for advanced clinical practice in the UK: a scoping review protocol. BMJ Open2020;10:e036192. doi:10.1136/bmjopen-2019-036192

Lawler, J., Maclaine, K. & Leary, A. Workforce experience of the implementation of an advanced clinical practice framework in England: a mixed methods evaluation. Hum Resour Health 18, 96 (2020). https://doi.org/10.1186/s12960-020-00539-y


Tuesday, January 26, 2021

Hodges' model and trial by vampires ...

Hodges' model was created in the mid-1980s.
Since then models of nursing, models of care and nursing theory are no longer fashionable.
Hodges' model was produced in Manchester, NW England, so as far as the rest of the World is concerned: it was 'not invented here'. 

The eponymous title, means many people may defer: this model is clearly not mine, or ours. Why should we use this one, let alone consider it?

In addition ...
"Academics are novelty vampires. They crave new stuff ..."


Thursday, January 21, 2021

Book review: iii "Leave No One Behind" #LNOB

Arriving at chapter 4 "No Smallholder Farmer Left Behind" by Jane Nelson,I was acutely aware of the news from India in the (N) autumn. Smallholders and family farmers protested about newly enacted farm laws. The government claimed the changes would protect the farmers from bullying middlemen, while the farmers were afraid of price instability and the rise of corporations*. Even in today's news I note this issue is ongoing. Very quickly any romantic notions of smallholder farmers are challenged reading this book and must be set aside. How can being a farmer (and agricultural laborers) equate with being among the world's poorest and most vulnerable and yet they number an estimated 500 million? There are 200 million smallholders producing food as part of formal supply chains and yet they are in extreme poverty and were circumstances are improved, there is a risk of relapse. 

Leave No One Behind
The talk of public-private partnerships, even if 'new' is disconcerting. This is the 21st C. though as  'inclusive business models' are defined. I was (slightly) shocked at the proximity of businesses and corporations, what choices do 'small-players' have? This is the value of the book, correcting parochial notions from Wigan Pier.

With an eye on the Green agenda though, and reading of the role for technology it still unsettles me thinking about bio-genetics, digital colonialisation when reading of the role of digital technology. With low and high Earth orbits filling up, there should be improved broadband access in remote locations, but I do wonder about choice. This is were the authors and organisations will no doubt push an advocacy role (p.68).

  As I mention orbits and digital technology, mapping is key and to smallholder farmers too:

It is good to hear of development work that is also climate-smart. Leapfrogging is a important idea in the book (to follow) but I hope that as mobile technology has jumped the communications infrastructure of some developed nations that small-holders here can also leapfrog. The book's footnotes do not leapfrog, they are fairly constant and a very rich thread of learning and sources. A key and literal platform for leapfrog is big data and AI (p.70) [ https://www.brookings.edu/research/using-big-data-and-artificial-intelligence-to-accelerate-global-development/ ]. Hopefully, this blog demonstrates my enthusiasm and interest in STEM, again with these influences I can't help recalling my review of Friel's LITTLE-big book on climate change and the people's health in which attention to the nutritional value of food is stressed. When Nelson asks of the poorest farmers "What are they eating?" (p.76) yes, you do have to ask. 

Give me a page of text and certain words standout a kilometer. 'Holistic' is one. So, holistic investment in infrastructure is needed (p.77) and a holistic approach to on- and off-farm interventions. The expertise, experience and political awareness of the development community is evident here in accounts of measures and evaluation. Rurbanomics (p.77) concerns the linkages between rural and urban economies and in policy terms there could be specific mention of the rural phenomena of 'empty villages' (in the EU too?) and the need to better manage the movement of people from rural to urban environments.

The chapter organisation is almost logical moving to refugees and migrants [Chap. 5]. I've posted before on geopsychiatry and it will be interesting to see in coming years if non-refoulement (p.79) routinely enters the news lexicon. At this time, how the majority of us wish we could travel, and p.82 had me wondering about ancient history before 'countries': no nations. Discussion of the definition and its limitations of 'refugee' 1951 is very informative, especially as it relates to the SDGs, which includes migrants. You can see how much crossover there is (and must be - sustainable determinants of health ...) between the SDGs and hence the need for all governments to address this in policy and law. 

Working in healthcare and c/o Brexit and the COVID crisis you are aware of the global nursing and social care workforce.  This is described here in terms of training (p.96) To state the obvious, politically, refugees and migration remain a charged matter. Quite rightly the gains from international refugee and migration flows have a section of their own. Since the 1990s you become ever more aware of remittances sent abroad (and until recently the cost of the same). Talk of seasonal work has an analogue in the seasonal routes that people at great risk whatever their reasons, make from Africa and Asia. I've mapped some content from chapter 5 to Hodges' model:

humanistic ----------------------------------------------- mechanistic
mental health
post-traumatic stress
knowledge diffusion

access to shelter, water,
health care and sanitation
rural - urban
border regions
social media
social attitudes in receiving nations
sexual and gender-based violence
formal labor market access
informal camp employment?
remittance flows
'mechanism design theory' p.93
land registration
having an 'address'

I learned of What3Words quite a while ago** and the addition of 'having an address' in the POLITICAL domain is an addition. I knew an article in May (FT Magazine, 16-17 May 2020, pp.32-35.) would come in handy:

"Where the streets have no name" by Deirdre Mask - The Address Book. 

An illustration by Andy Robert Davies says it all:

Mask's book points out the obvious that if you are Stateless you are address-less too. The health - political implications here are serious and this problem is not restricted to 'developing' nations. So much is tied to this: track and trace, having a bank account, being able to vote all can depend on this specific information. Without an address, a default - whether acknowledged or not - of 'data missing' in census data gathering follows. For many nations the 'census year' has been disrupted by the pandemic. 

Referring back to migrants, refugees and the recent politicization and nationalistic rhetoric, reading made me wonder about government's ability to envision the positive potential of migration flows and refugees. The statistics are revealing in the impressions provided by social media and news reporting. The problem for (some) policy makers and resident populations given the bias and misinformation of reporting seems to me, extracting individual and family narratives from the collective.

The reader is very well served with the index, if needed, while reading and my writing here. Unless I've missed it, there is a missing reference to 'tax' on page 312, which we'll reach next time. It is an important one.

Homi Kharas, John W. McArthur and Izumi Ohno, (Eds.) 2020. Leave No One Behind: Time for Specifics on the Sustainable Development Goals, Washington D.C.: Brookings Institution Press.  



Wednesday, January 20, 2021

Extraordinary People (2020)


the connor brothers

Extraordinary People, 2020



giclee print with silkscreen varnish 

41.5 x 29 cm unframed 

Edition of 300, signed and numbered 

Extraordinary People is an edition of 300 signed and numbered giclee prints measuring 41.5 cm x 29 cm and is sold unframed. All profits from the sale of this edition will be donated to the NHS Covid- 19 Urgent Appeal which supports NHS staff and volunteers caring for COVID-19 patients . The print is priced at £120 plus shipping and is available now. Due to the current pandemic we do not expect to be able to deliver this print until September 2020.

Like everyone else we are extremely grateful for the tireless work being done by our extraordinary NHS staff in near impossible circumstances. We owe them a collective debt we will never fully be able to repay. We'd like to offer our deepest thanks to each and every one of you.

giclee print with silkscreen varnish 

41.5 x 29 cm unframed 

Edition of 300, signed and numbered


See also:

Pay "Nurse Kathy" ?

"Blind to the Big Picture" and Parity of Esteem 

My source:

The art world is back in business, MoneyWeek, 15 May 2020. Issue 999, p.35.

Spaceship Earth

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

Azuma Makoto  Photo source: https://www.pinterest.co.uk/pin/374643262755074853/

Azuma Makoto

Photo source:

My source:
Quick, H. Forces of NATURE, FT Weekend, September 8 2020.


Tuesday, January 19, 2021

Do you have the intell? ... [Sure?]

humanistic ----------------------------------------------- mechanistic
emotional intelligence
physical intelligence
Social & Cultural
[What the State provides ...]

My reminder: Book Reviews, "Physical Intelligence", What Investment, October 2020, p.51.

If you have 'reflective literacy' what is its scope?

Monday, January 18, 2021

Moral injury: Individual - Collective: 'Global'

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


Several news sources.

Patient Safety Learning

Sunday, January 17, 2021

"Supernova" squared* ...?

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


*or rectangled?


Thursday, January 14, 2021

Book review: "Leave No One Behind" ii #LNOB

Leave No One Behind

Ordinarily, the word 'ultra' I'd associate with science, closely followed by branding-speak and then the realm of super heroes. Sad then that for ultra-poverty, neither science nor commerce has the answer and there's no super hero to call upon. Science and commerce are part of the answer to ultra-poverty, as the book also highlights but there is no time to wait: 2030 ...

Ultra-poverty is defined (p.43):

"A useful lens through which to view ultra-poverty is economist Amartya Sens definition of poverty as a "deprivation of basic capabilities," including the freedoms and choices that most of us take for granted, specifically "the substantive freedoms [a person] enjoys to lead the kind of life he or she has reason to value. In this perspective, poverty must be seen as the deprivation of basic capabilities rather than merely as lowness of incomes, which is the standard criterion of identification of poverty."

 In mental illness - health nursing you recognise early on the significance of hopelessness and helplessness (p.44). From the news over successive decades you hear the trials and debate of those on 'benefit' stuck in a 'poverty' trap. Is poverty relative, absolute or both? I was really struck with the connection to psychological therapy, literacy overall and 'health literacy' specifically, when a person cannot imagine that a better world is possible (p.45) for them. They cannot envision. I've stressed here the importance of 'information' as a concept and Coates and MacMillan literally bring information theory home. This when the choice is: do you walk seven miles to have a child vaccinated, or work? Everyday, brings multiple choices, that we can 'dodge' (usually) in the developed nations. 

The 'science of hope' lives through information. On this blog, in a quest for holistic, integrated (physical, mental, social, political, pastoral) care I have written of the need to attend to 'holistic bandwidth'. In our assessments and evaluations do we consider all the factors? Coates and MacMillan provide a gift:

"Mullainathan and Shafir call this the 'present-day cognitive load of making ends meet,' and it is especially acute for those living in ultra-poverty" (p.45). 

I like also the way 'cognitive load' is utilised here as in technology enhanced learning, human-computer interfaces and web design. There is a connection too - with studies on parenting and when norms are stressed and the impact on children.

The key of this chapter is "graduation" or "productive inclusion" and breaking out of the poverty trap.

Online and irony intended coaches appear to be two-a-penny. Here a set of interventions includes coaching and the issue of what is the best approach:

  • Livelihood training
  • Cash
  • Productive assets
  • Savings

It struck me here a synergy with the timed early intervention in psychosis of two-years.

How to prevent relapse and for the ultra-poor how they are post-intervention still poor (p.47).

Studies (inc. London School of Economics - RCT) are explained to compare graduation with unconditional cash transfer. Reading of DIBS - Development Impact Bonds, I thought of Care Impact Bonds, even Social Care? While I make such comparisons, the message is clear that ultra-poverty is qualitatively different from other forms of poverty. Likewise with the use of 'cognitive load' elsewhere - in education: for the ultra-poor this:

"... bears down like a weight too great to lift. Poverty is, at heart, a deprivation of one's capacity to be fully human - to dream, to plan, to arrange one's imagination to see a better future. The graduation approach offers a way out." (p.55).

I note the science of hope is still emerging.

humanistic ----------------------------------------------- mechanistic
My choices of the day ...
cognitive load ...


social infrastructure
social capital
What the State provides ...


Homi Kharas, John W. McArthur and Izumi Ohno, (Eds.) 2020. Leave No One Behind: Time for Specifics on the Sustainable Development Goals, Washington D.C.: Brookings Institution Press.  

Tuesday, January 12, 2021

Book: The Fourfold Remedy

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


My source:

O'Grady, J. (2021) Think yourself better, Reviews. The Daily Telegraph, 9 January. pp.12-13.

Sellars, J. The Fourfold Remedy, London: Allen Lane / Penguin.

Saturday, January 09, 2021

Book review: "Leave No One Behind" i #LNOB

Leave No One Behind

This book is like a favourite CD or LP [that's vinyl ;-) ], every track - chapter - is an ace - no duds. I wanted to start this review with the final chapter, but I'll pick that up in due course (iv?).

The book is structured in three parts:

  1. People
  2. Problems
  3. Places

I don't read horror specifically, so it is not often a book scares me from the get-go; but this one did. 

Chapter 1 gets specific on the statistics of LNOB and sustainable development. The numbers make for grim reading and had me wondering how much sense I could make of the book overall from the albeit COVID tainted comfort of Wigan Pier. What stood out was the way the intro chapter set out the stall. Obviously, that's the purpose and while depressed at what was follow from the initial graphs, the structure and cogency provided its own impetus to read. The text is clear and very readable, the data, graphs, notes all have bite. While the SDGs are Sisyphean in nature, the intro is like a snowball that starts from the upper peaks and grows chapter by chapter in  meaning and significance.

Obviously, Agenda 2030 looms large, but if you think in first reading of poverty, or to be more specific ultra-poor, income, education, Africa, development and finance you know the agenda to follow then for this community mental health nurse there are insights aplenty.

Chapter 2 combines two central issues in gender equality (by 2030) with 'Women on the Move'. The book draws significance to decade long issues that now constitute a specific SDG - #5 in this case. The book is up-to-date - oozing contemporaneity with #MeToo and background on the cussedness of the root causes of gender inequality. There's common sense too in the need for 'adaptable solutions that are fit for the complexity of the problem'. On first reading about the progress of feminist movements, but more recently experiencing resistance in access to and being able to inhabit civil spaces, this is more 'scary' than a horror story. Reflecting on the 'other' challenges and climate change especially and the role that feminism can play, this retrograde motion could be the stuff of nightmares. The chapter and book, as I will explain, drew my attention to the fact that while I tweet and post here on feminist issues: I am no feminist. The notes provide references and pointers to specific books on feminism. From this book I can see I should read one.

Organizations, such as, BRAC, Camfed, CARE Int. and Oxfam with authors clearly experts from academia and such key players in the field. The balances are not just financial, but a community program on women and girls can potentially prompt a backlash if men and boys and not engaged. I can see further relevance of being able to traverse individual-group, as Matthews and Nunn debate the merits and limitations of individual-based and need for social-based interventions. Yes, I can see how individual-based interventions can be apolitical (and how an axis can invoke several thresholds). To a text on feminism, I must add formal reading on intersectionality too, as the analysis called upon here (box 2.2) to make sense of social and income-based factors. 

Several chapters raise the problem of scale, the lack of data, especially what is and can be measured. Without due care, false proxies can be used for measures and more simple interventions may be pursued because they are more easily quantified. This may be insufficient to fully understand the complexity of gender equality. The book is 'dynamic' throughout; with project and service-based action for the individual progressing then to movement-based at the social change level (CARE, 2017, p.31. Gender Equality Framework -- through Individual, Group, Communities to deliver Social Change).

Although in this first review-post I refer to feminism, the treatment in the book is balanced and also essential. I usually equate 'hope' with the intra- interpersonal domain. Of the many sources in this to follow-up, is evidence on the "science of hope" with Coates and MacMillan in chapter 3.

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



Homi Kharas, John W. McArthur and Izumi Ohno, (Eds.) 2020. Leave No One Behind: Time for Specifics on the Sustainable Development Goals, Washington D.C.: Brookings Institution Press.  

Friday, January 08, 2021

Textbook of Patient Safety and Clinical Risk Management

Textbook of Patient Safety
and Clinical Risk Management
About this (open access) book

Implementing safety practices in healthcare saves lives and improves the quality of care: it is therefore vital to apply good clinical practices, such as the WHO surgical checklist, to adopt the most appropriate measures for the prevention of assistance-related risks, and to identify the potential ones using tools such as reporting & learning systems.

The culture of safety in the care environment and of human factors influencing it should be developed from the beginning of medical studies and in the first years of professional practice, in order to have the maximum impact on clinicians' and nurses' behavior. Medical errors tend to vary with the level of proficiency and experience, and this must be taken into account in adverse events prevention. Human factors assume a decisive importance in resilient organizations, and an understanding of risk control and containment is fundamental for all medical and surgical specialties. 

This open access book offers recommendations and examples of how to improve patient safety by changing practices, introducing organizational and technological innovations, and creating effective, patient-centered, timely, efficient, and equitable care systems, in order to spread the quality and patient safety culture among the new generation of healthcare professionals, and is intended for residents and young professionals in different clinical specialties.


My source: HIFA - https://www.hifa.org/

"The complexity of many safety-critical systems makes an a priori analysis of possible system failures and human errors impossible and unreliable. Despite this, it is considered useful to apply this type of healthcare technique to promote reflection among frontline operators before introducing technical or organizational innovation. For example, before introducing a new procedure, it is useful to reflect on the possible, critical aspects of the different phases of the procedure, or, in the case of technological innovation, back-up solutions can be prepared to deal with any malfunctions of the instrument." p.139.

"The role of non-technical skills for patient safety has progressively become more evident through the years and, on this topic, one of the most striking moments of reflection for the healthcare community was Martin Bromiley’s report [10] on the death of his wife in 2005. Fixation errors, absence of  planification, teamwork breakdown, poor communication, unclear leadership, lack of situational awareness, and other non-technical aspects of performance in anesthesiology and critical care medicine can negatively impact patient outcome." p.161.

"In other words, HFE [Human Factors and Eronomics] takes a systems approach that acknowledges the importance of context, emergence and holism in elucidating interactions between various system elements and developing this understanding requires being embedded in the system." p.151.

 W2tQ: safety


Thursday, January 07, 2021

Special Malaria Issue: South Sudan Medical Journal


Special Malaria Issue

South Sudan’s New National Malaria Strategic Plan 2021-2025 is a Game Changer

Harriet Akello Pasquale

Director, National Malaria Control Program, National Ministry of Health, Republic of South Sudan

The Ministry of Health of the Republic of South Sudan has just approved an ambitious 5-year National Malaria Strategic Plan 2020-2025 to control and prevent malaria, the third since South Sudan became an independent country in 2011. Read more.


See all articles from Issue 13 5 December 2020

We look forward to receiving manuscripts relevant to health care in South Sudan from you  - remember we can help you prepare these.  Also, encourage colleagues to join the mailing list here, follow us on Twitter @SSMedJournal and find previous SSMJ articles at African Journals Online (AJOL) and the Directory of Open Access Journals (DOAJ).

Kind regards,

The SSMJ team
Email: admin AT southernsudanmedicaljournal.com

Wednesday, January 06, 2021

Convenzis Virtual Conferences: Also seeking speakers ...

Convenzis host a range of virtual conferences that will provide practical insight and support to our NHS network in a time of unprecedented demand and uncertainty. We as a company want to do our best to support the NHS and our clients so we will be similarly running these conferences to our in-person conferences, focusing on networking and ROI for our partners.

All our events are free to attend for the NHS and we are currently looking for speakers on the below topics:

Actioning the People Plan: NHS Workforce Strategy Virtual Conference, 2nd February

Shaping the Digital Future of Healthcare: Digital Primary Care Virtual Conference, 3rd February

NHS Facilities & Estates Virtual Conference: Building, Maintaining and Innovating, 4th February

Enhancing Emergency Care: Patient Flow Congress, 24th February

Turning Vision into Reality: Healthcare Digital Technology Congress, 25th February

The 2nd Innovation in Imaging: Virtual Radiology Conference, March 3rd

Driving Quality and Assurance: The Virtual NHS Patient Experience Conference, March 11th

The 3rd NHS Data & Information Virtual Conference: Utilising the NHS’s biggest asset, March 17th

Exploring the Future of Theatre: The Smart Surgery Virtual Conference, March 18th

Government IT Virtual Conference, April 20th

NHS Patient Safety Conference: A Strategy for continuous Improvement, April 22nd

All Events:


Please see the website and contact Convenzis if you are interested in any of the above and news of future events.


Daniel Snape
Convenzis Group
Office: 0161 820 0631
Mobile: 07880 367 659

Sunday, January 03, 2021

Deep *and* Broad ... Hodges' model is no blank slate ...

"Beyond deep learning

Steeper than expected
Different researchers have different ideas about how to try to improve things. One idea is to widen the scope, rather than the volume, of what machines are taught. Christopher Manning, of Stanford University's AI Lab, points out that biological brains learn from far richer data-sets than machines. Artificial language models are trained solely on large quantities of text or speech. But a baby, he says, can rely on sounds, tone of voice or tracking what its parents are looking at, as well as a rich physical environment to help it anchor abstract concepts in the real world. This shades into an old idea in AI research called "embodied cognition", which holds that if minds are to understand the world properly, they need to be fully embodied in it, not confined to an abstracted existence as pulses of electricity in a data-centre.

Biology offers other ideas, too. Dr Brooks argues that the current generation of AI researchers "fetishise" models that begin as blank slates, with no hand-crafted hints built in by their creators. But "all animals are born with structure in their brains," he says. 'That's where you get instincts from.'" p.11.

The Economist, Technology Quarterly: Artificial intelligence and its limits. The Economist, June 13 2020, 435:9198. [and image source].

'Deep and Broad' - as required.

Saturday, January 02, 2021

Nurse - Health - Education Theorists and Researchers: A question ...

The theoretical and practical basis for Hodges' Health Career - Care Domains - Model

[A living project or all Petered out?]

1. Assumptions underlying the conceptual model are made explicit.

Please see below:

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




2. A complete description of all four concepts of nursing's metaparadigm* are presented.

*person, environment, health / illness and nursing

Please see, or search - the relevant tags on this blog for posts on the above concepts and the bibliographical listing.
If in addition you would be interested in addressing this assumption specifically please get in touch.

3. Propositions of the conceptual model completely link the four metaparadigm concepts.
Hodges' model can be used to do this and link the health and related challenges as exemplified in the sustainable development goals.

4. The internal structure of the conceptual model is logically congruent.
As required, Hodges' model could utilise several 'logics' applicable across disciplines, domains and contexts; the challenge would be the interface and translation of logics and criteria by which 'congruence' is evaluated?

5-7. The conceptual model is socially congruent, socially significant and socially useful.
There are numerous posts on this blog that (to varying degrees) address assumptions 5-7 and in the bibliography to date.

8. Empirical evidence in support of the model has accumulated.

In 2020 it was encouraging to learn of two new papers - listed in the bibliography [sidebar] - the authors of which applied Hodges' model.

As noted above if I can help you apply Hodges' model, or assist you please let me know.

Fawcett, J. (1984). Analysis and evaluation of conceptual models of nursing. Philadelphia: Davis.

My source:
Personal notes c. 1988.

Friday, January 01, 2021

Mesmerized by the promise of 2021 ...


 ... while listening to the New Year's Day Concert ...