New citations - Practice Without Theory: A Philosophical Inquiry into Contemporary Nursing in South Asia

It is always welcome news when I learn of a paper (Asmat, 2024) recognising and citing Hodges' model from the nursing and wider literature. In this case an educational journal, focussed upon health and social care:

Kainat Asmat (2024). Practice Without Theory: A Philosophical Inquiry into Contemporary Nursing in South Asia: Nursing Practice without Theory. International Journal of Practice-based Learning in Health and Social Care. 12. 125-131. 10.18552/ijpblhsc.v12i2.1068. 

I have quoted at length, but it is good to have a different 'excuse' (not just extending the tail of a relevant book, or paper). ... 

'Similarly, Hodges' Health Career Model exemplifies its use as a tool for reflection during clinical assessments, care planning, and decision-making processes (Doyle & Jones, 2013). The model encourages nurses to reflect on their practice through multiple lenses, ensuring a comprehensive understanding of patient needs and care strategies. The Interpersonal domain emphasizes the relational aspects of nursing, including communication and empathy. The Sociological domain highlights the impact of societal factors and social determinants on health. The Scientific domain focuses on evidence-based practice and the integration of scientific knowledge into care. Finally, the Political domain addresses the influence of healthcare policies and organizational structures on contemporary nursing practice. In contemporary nursing practice, a nurse might use Hodges’ model to provide holistic and personalized care by considering the patient's social background, the scientific basis of their care, interpersonal dynamics, and relevant political or policy-related factors. According to Jones (2017), using conceptual models like Hodges' can greatly enhance nurses' critical thinking, fostering a reflective and engaged nursing workforce.' p.126.

'Collectively, nursing theory remains a cornerstone of contemporary nursing practice, providing an essential framework that guides clinical decision-making, promotes critical thinking, and supports reflective practice. Peter Jones, in his seminal works, underscores the critical role of theoretical models in enhancing nursing practice. His insights provide compelling evidence for the continued relevance of theory in contemporary practice. In "Humans, Information, and Science", Jones (1996a), articulates the interrelationship between human factors, informational processes, and scientific principles in healthcare. He argues that nursing, as a discipline, uniquely integrates these elements to form a comprehensive approach to patient care. This integration is fundamental in moving beyond task-oriented care towards a practice that is reflective and evidence-based. Jones emphasizes that without a theoretical foundation, contemporary nursing practice risks becoming fragmented and superficial, lacking the depth required for truly effective patient care. Similarly, in "An Overarching Theory of Health Communication",  Jones (1996b) explores the necessity of robust communication theories in healthcare. He posits that effective communication is not merely a skill but a complex process grounded in theoretical understanding. This perspective is particularly relevant to nursing, where communication is pivotal in patient interactions, interdisciplinary collaboration, and health education. Jones’ work illustrates that theoretical frameworks in communication enhance nurses' ability to engage with patients and colleagues thoughtfully and effectively, fostering better health outcomes and professional practice. Jones’ analyses reinforce the argument that nursing theory is indispensable in contemporary practice. Likewise, McEwen and Wills (2021) also highlight that nursing theory is integral to the development of nursing as a discipline. They assert that without the theoretical underpinnings, nursing risks regressing to a technical occupation devoid of critical thinking and judgment that characterize nursing professional practice. Thus, the survival and progression of nursing as a distinct profession depend on the continued integration and application of theory in contemporary nursing practice.' p.127.

In addition, the short conclusion is supportive and encouraging for ongoing efforts. As with all discovered citations thus far, I'm not sure of how Kainat Asmat located the publications on Hodges' model? A literature search - no doubt, or perhaps the blog's sidebar listing? The selection made, fits the author's purpose. 

Over the years, I've tried to indicate the scope and scale that Hodges' model can 'reach'. Especially in self-care, family, local, global and planetary health. Now, c/o Asmat (2024), Hodges' model has a much valued connection with South Asia. The required scope of Hodges' model (its inter- and transdisciplinary potential^) is also conceptual, referred to previously as holistic bandwidth. Hence the model's relevance and potential in theory and practice.

Many thanks to Kainat Asmat and the journal's editorial team.*

I will read again and return to the paper in our New Year.

Listed in the bibliography:

Doyle, M., Jones, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. 20, 7, 631-640.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2012.01961.x/abstract

Jones, P. (1996a) Humans, Information, and Science, Journal of Advanced Nursing, 24(3),591-598. https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2648.1996.23321.x

Jones, P. (1996b) An overarching theory of health communication? Health Informatics Journal,2,1,28-34.

^Still on the agenda as a paper; as with 'revisiting' 1996a. Happy to support others in referencing, or writing more specifically about Hodges' model (a case study, mapping exercise?); especially student nurses, carers and personnel in social care and early career researchers. To which, I'd better add later career nurses, allied disciplines, nurses returning to practice (surely a UK and global policy focus?) and proof of reading (your choice of course on the paper, chapter, book...); and reflection for continuing professional development (CPD). If you're still unsure, it was a relief to put the 'pen' down, well writing is still a major challenge (and pain) here. 

*And, of course - Brian E. Hodges RIP - too.
https://hodges-model.blogspot.com/2023/08/brian-e-hodges-r-i-p.html

Just one library ... A world of difference

Born in Walton.

 'good prose is like a windowpane'

George Orwell, WHY I WRITE

<>

Walton, Liverpool, UK 12th December 2024

'Spellow Library, in Walton, Liverpool, was forced to close when it was set alight on 3 August amid unrest which swept across the country after the stabbings in Southport.

The city was determined to not let hatred win, with £250,000 raised and books being donated from the Queen and a host of celebrities.

An official ceremony marked the re-opening, including readings from Liverpool poet Levi Tafari while a letter from Queen Camilla was also read aloud.' ..

BBC News: Riot-hit library reopens after community campaign

Claire Hamilton/BBC: An official ceremony marked the re-opening on Thursday morning

Break the Windows on Learning and
New Ones Will be Found to Look Out on the World.

INDIVIDUAL

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

GROUP

My Learning My Literacies	'The World(s) of Learning'
Society - Community Social Justice	Justice Social/Public Services

Previously:

Related post: 'forms of Hygiene'

literature : window

Hornberger (1989) 'Continua of Biliteracy'. Review of Educational Research

The axes of Hodges' model present a problem in:

• theory
• practice
• evidence - research terms (data!).

The easiest to resolve is practice, which is were Hodges' model can lay claim to being a pragmatic solution. Of course, it isn't the axes that are the difficulty, it is the labels that Brian Hodges originally applied in the early-mid 1980's, followed by other users of the model since. From:

INDIVIDUAL <> GROUP - variations here in 'Welcome to the QUAD' [W2tQ] Patient <> Carer - Family : Client <> Health professional. You can progress to the "patient zero" and a population in an pandemic.

These are fundamental elements in clinical encounters, whether face-to-face, online, and across settings.

The same applies to the horizontal axis: HUMANISTIC <> MECHANISTIC.

As presented - in the sidebar, and the two-by-two table found in many posts - the model has a distinct dichotomous quality. It seems to set up, or invite opposition, or polarities. Sometimes I've viewed the axes as continua, but they are not graduated, incremental in a quantitative sense.

Do the axes of Hodges' model serve a need (do their work) by allowing the user to differentiate through opposition and relational appraisal (testing)? Perhaps, qualified in a respective profession / subject area, the user of Hodges' is employing other axes?

This brings us to intersectionality and the cognitive work of placing the person (couple, family, community ... biosphere) at the centre of our deliberations.

In biliteracy studies, Hornberger (1989) is perhaps more accurate in seeing a series of multidimensional and interrelated continua (p.273) which form a framework.

There are three figures in this paper and many other points of use:

"Contexts of biliteracy are defined, then, by these three continua. Any particular instance of biliteracy is located at a point of intersection among the three." p.280.

In health care this is readily understood given the varied contexts of the centre, the nexus of Hodges' model. When we say Hodges' model is situated, the centre of the model is the sweet and sour spot. For Hornberger, the context determines the use and significance of the continua.

This opens up Hodges' model as a potential tool to better understand the dimensions of diversity, inclusion and intersectionality.

Hornberger, N. H. (1989). Continua of Biliteracy. Review of Educational Research, 59(3), 271–296. https://doi.org/10.2307/1170183

No! This post hasn't been in draft since 1990. ;-)

NURSING -:- INFOTECH - worlds apart? Software testing

Another draft from over a decade ago ... duly revisited and updated:

https://www.statista.com/statistics/793628/worldwide-developer-survey-most-used-languages/

Reading up on Ruby and Rails and attending Scotland on Rails, I've been struck by the emphasis on testing. Testing in this context is about reliable software and building this into the 'product' from the outset. A book on Rails gets criticized because it leaves the chapter on 'Testing' until the end (even if the authors had their reasons - as they explained).

This take on testing is sufficient if (of course) it is appropriate and it is applied (as per the manual) to the application concerned. There are other more formal methods that extend to writing a specification for code which entails the use of formal specification languages such as Zed (as encountered in BA(Hons.) studies. This arises in situations were software is being developed for safety-critical situations. Clearly, robotic surgery, nuclear energy, and keeping an aircraft in the sky, take-off and landing are mission-critical. In the latter case a company is still dealing with life threatening loss of life that can follow, should the software system fail or more covertly introduce an error.

Reading about Rails, there are specific tests and these are provided as a result of scaffolding, a process whereby the bones of a web application are created within the Rails framework: with tests.

Rails creates a test directory for you as soon as you create a Rails project using bin/rails new application_name. If you list the contents of this directory then you will see:

$ ls -F test
application_system_test_case.rb  controllers/                     helpers/                         mailers/                         system/                          fixtures/                        integration/                     models/                          test_helper.rb

Source: https://guides.rubyonrails.org/testing.html

Rails uses a popular convention to organise and integrate the elements of a web application that includes a database, and dynamic interface. The approach is known as:

Models, Views and Controllers - MVC

MVC underpins several programming languages and frameworks. As displayed above, the tests that Rails creates have specific names and you can quickly see where they come from and how they encompass Rails (an essential property of course).

Today, I still wonder [ what's new! 😉 ] what is the equivalent to MVC in nursing? Models seems to fit! Over the years at many IT events, you can't help but reflect on nursing and its 'API' - application programming interface. Worryingly, in humanistic terms there is an instrumental potential in Hodges' model. If Nursing on Rails was a thing, what would the tests look like? Identity would be a feature, to demonstrate person-centredness, safety in medication and other treatment procedures. Is there a way to demonstrate the integration of care, and for a patient - the extent of holistic bandwidth? Of course, nursing comprises just a part of a clinical information system. It must be in sync in accord with other disciplines, medical and pharmacy and other multidisciplinary team members and yet ensure that 'nursing is visible'.

Previously: API : 'Waste not - want not'

Fragile: This way up - Frozen goods!

Apollo 17 'Blue Marble' Photograph

 

Apollo 17 1972 NASA Original Blue Marble Photograph

Or, some water 'heading your way' ...

'NASA’s archival designation for it is AS17-148-22727, and the original image was taken upside down with the South Pole at the top. In its myriad reproductions, it’s flipped up to match what we would normally expect to see.'

Text: https://www.thephoblographer.com/2013/12/09/behind-blue-marble/

Does the model still 'work' -

Group
|

 POLITICAL        :     SOCIOLOGY  

MECHANISTIC --------------------------------------  HUMANISTIC

            SCIENCES       :    INTERPERSONAL

|

Individual

POLITICAL	SOCIOLOGY
SCIENCES	INTERPERSONAL

- this way ...?

Image source: https://www.forum-conquete-spatiale.fr/t15428-apollo-17-1972

Prompt for 'Blue Marble' - Plate 1 in Brotton, J. (2024) The Four Points of the Compass: The Unexpected History of Direction, London: Allen Lane.

Previously: 'compass'

A planet is not just for Christmas.

Does the model still work - this way?

Does the model still 'work' -

Group
 |

 POLITICAL       :     SOCIOLOGY  

MECHANISTIC --------------------------------------  HUMANISTIC

          SCIENCES    :    INTERPERSONAL

| 

Individual

POLITICAL	SOCIOLOGY
SCIENCES	INTERPERSONAL

- this way ...?

The Science of Conceptual Systems - and Hodges' model

Wallis, S.E. The Science of Conceptual Systems: A Progress Report. Found Sci 21, 579–602 (2016). https://doi.org/10.1007/s10699-015-9425-z

From the conclusion:

'The approaches presented here do not provide a ‘‘map’’ for advancing the sciences. Indeed, none is available because we are advancing across that new terrain. What it does provide is a compass suggesting a new and potentially exciting direction to travel. Historically/traditionally, scholars have travelled about the countryside of the social/behavioral land making useful observations and gathering interesting data. They have often staked claims regarding the importance of their terrain. They could not advance more purposefully because they were guided only by intuition. So, they did not know what direction was ‘‘forward’’ although it seemed to have something to do with empirical analysis. Today, with the creation of a new science, we have a new direction.

When we do have a choice between theoretical maps, generally, and metaphorically, this paper suggests that we should choose to create and use roadmaps with many dots connected by many lines; not maps with few disconnected dots.' p.594.

There is also a glossary [pp.594-599] that includes:

'Integral thinking

Understanding (or attempting to understand) the world from a transdisciplinary perspective where those many perspectives are interrelated'

'Integrative propositional analysis (IPA)

Combined processes of qualitative and quantitative analysis involving rigorous hermeneutic deconstruction of propositions found in formal texts including the rigorous reintegration of propositions from those texts following a structured methodology. Also a process of meta-analysis for investigating conceptual systems to determine the Complexity of conceptual systems (diversity of concepts) and the Systemicity of the conceptual system (connectedness between concepts)'

'Mental model 

A representation within one’s mind about how the world works. Useful for understanding and engaging the world and for making predictions'

'Parsimony 

Generally, the understanding that a theory is better when it is smaller. Or, as small as possible while including ideas that are necessary or useful. Ockham’s Razor is a common example'

INDIVIDUAL

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

GROUP

more SUBJECTIVE	more OBJECTIVE
QUALITY	QUANTITY

'Reflexive dimensional analysis (RDA) 

A process for creating a unified conceptual system from multiple conceptual systems through a process of categorization, abstraction, dimensionalization, and the identification of causal connections'

'Theory 

An ordered set of assertions. Weick (1989, p. 517. Drawing on Southerland)'

Cited above: 

Weick, K. E. (1989). Theory construction as disciplined imagination. Academy of Management Review, 14(4), 516–531.

Previously:

terrain : landscape : line-of-sight (with overlap; of interest in itself)

COVID-19: a Stamp of protection

INDIVIDUAL

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

GROUP

	Austria - Embroidered COVID-19 mask - Mint souvenir sheet

Source: Nordfrim.com - https://www.nordfrim.com/austria-covid-19-maske?

.. with apologies for the reminder!

forms of Hygiene

A gift for Hodges' model:

 'good prose is like a windowpane'

George Orwell, WHY I WRITE

https://www.ft.com/content/83625fad-f101-4712-ba2b-483b87ef0e12

'How is it that Orwell has become the single answer to so many questions, in so many different subjects, for so many people? His name conjures an amorphous idea of fair play and “common sense”; his spare prose supposedly brings cool nonpartisanship to a world of impassioned blusterers. In keeping your sentences clean, the theory goes, you practise intellectual hygiene (“good prose is like a windowpane” and all that). A single word, “Orwellian”, evokes the great man’s foresight about the dangers of an overweening nanny state, a censorious far-left or whatever else may be getting your goat that day.'

Naoise Dolan, Why weak thinkers love Orwell, FT Weekend Magazine, October 19/20, 2024, pp.16-18.

INDIVIDUAL

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

GROUP

INTELLECTUAL MENTAL - EMOTIONAL - SPIRITUAL (Coping with the 21st Century) SELF-LIFE SKILLS (control anxiety - being organised) Health Literacy: Knowledge and aptitude for forms of HYGIENE	PERSONAL ENVIRONMENTAL DOMESTIC FOOD HANDS (How to sneeze, cough) ORAL - DENTAL CLOTHES BODY HAIR (frequency?) Sustainability - balance
SOCIAL COMMUNITY/RACIAL HYGIENE Insertion of memory lest we forget Insertion of a hook to do - think as we tolerance for x,y,z	POLITICAL HYGIENE aka. The Paradox To Vote : To be counted CIVIC

 

Reflecting about this in some contexts, more than others(?) I'm struck by the overlap between hygiene and literacy.

Completing, or attending to, being motivated to undertake - complete hygiene duties depends on knowledge and ability to act. Having basic needs met.

'

'Opening windows always ...'

literature : window

Reith Lectures: Gwen Adshead - 4 Questions about Violence

Individual
   |

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :   POLITICAL 

|

Group

Is there such a thing as Evil?	What is the relationship between trauma and violence?
Is violence normal^?	Can we change violent minds?

BBC Radio 4: Lecture 1 - Is there such a thing as Evil?

^'normal' -isation.

Webinar: 11 December - Universal Health Coverage (UHC) Day 2024

"The UHC Compass and Social Participation:

empowering patient organisations to hold governments

 accountable for universal health coverage"

Register for the UHC Compass launch!

To mark Universal Health Coverage (UHC) Day 2024, IAPO will officially launch the UHC Compass at an exciting webinar titled "The UHC Compass and Social Participation: empowering patient organisations to hold governments accountable for universal health coverage" on 11 December 2024, from 11:30 to 13:00 GMT via Zoom.

The webinar will be conducted in English with simultaneous interpretation into Spanish.

Panellists include:

• Dani Mothci – International Alliance of Patients’ Organizations (IAPO) 
• Dr Pamela Cipriano – UHC2030 & International Council of Nurses
• Lara Brearley – Special Programme on Primary Health Care Universal Health Coverage - Life Course, World Health Organization
• Dumiso Gatsha – Success Capital NGO & Civil Society Engagement Mechanism for UHC2030 (CSEM)
• Nicola Bedlington – Global Patient Think Tank & Millwater Partners
• Smitha Sadasivan – Global Patient Think Tank, Inclusive Health Policy, Disability Rights India Foundation & CSEM 
• Paul Mendoza – Psoriasis Philippines and Psoriasis Asia Pacific & IAPO

The UHC Compass is a dynamic tool created by patients for patients, empowering local leaders and communities to advance universal health coverage (UHC). In the context of the World Health Assembly resolution on social participation and UHC Day 2024, this session will explore how the Compass can serve as a tool to hold governments accountable for investing in UHC.

Co-created by the Global Patient Think Tank (GPTT), a diverse group amplifying the patient voice in the UHC movement, the Compass is proudly hosted by IAPO. Our mission is to ensure this resource reaches and benefits our global network of patient organisations.

Join us to discover how the UHC Compass can help make UHC a reality for everyone!

Learn more & register [https://www.iapo.org.uk/node/15686] Share https://iapo.cmail19.com/t/d-fb-sfiudt-iuqjytrli-o/ Tweet https://iapo.cmail19.com/t/d-tw-sfiudt-iuqjytrli-b/ Share [https://iapo.cmail19.com/t/d-li-sfiudt-iuqjytrli-h/]

[http://www.iapo.org.uk]

The International Alliance of Patients’ Organizations is registered in England and Wales as charity no.1155577 and company limited by guarantee no.08495711.

Registered office: Hounslow House, 7 Bath Road, Hounslow TW3 3EB, UK.

It is also the IAPO's 25th Anniversary.
More details at:

https://www.iapo.org.uk/node/15687

I will post again in the New Year.

My source: HIFA

Previously: compass : UHC : patients

Baseball: One of the games people play ... Fisher (2001) ii

Critical Thinking 
2nd Ed. Cover

Returning to Fisher's excellent book I mentioned an analogy from basket ball in discussion about Richard Paul's definition of critical thinking and 'thinking about your thinking'.

'Critical thinking is that mode of thinking - about any subject, content or problem - in which the thinker improves the quality of his or her thinking by skilfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them. (Paul, Fisher and Nosich,1993, p. 4).' pp.4-5.

Fisher's daughter aged eleven wanted to learn how to play basket ball and attended coaching sessions. At the first the raw recruits were divided into two teams and with simplified rules set to play. Initially, getting the ball and in a position to score: shoot.

After the chaos, the coach had them practice shooting after he demonstrated how they had been playing. He explained and pointed out the basics of technique and 'drew attention to how he held the ball, where he looked, how he stood and so on.' p.5. Acknowledging their efforts, they subsequently moved on to passing, then guarding, or marking - practising each skill. 

This is a great analogy and can be applied to health, social care, medicine, nursing and other novices. Hodges' model is the basket ball, tennis, squash court, football, hockey pitch. You might move to a position to obtain an advantageous point of view. In reflective, critical thinking terms, additional data to support or negate a line of thought.

The axes of Hodges' model, serve as a scaffold to help structure our 'game player', and possibly better co-ordinate a group or team's efforts. The domains of Hodges' model cover the knowledge or subject bases that will relate to any context. Hodges' model is situated. If there is need to consider spiritual matters - experiences, then a conceptual journey ... at least, as befits an individual's or group's beliefs and purpose can be made. So forms if intelligence (emotional, cultural, spiritual ...) can also be factored in, as necessary.

 

Are there relational, logical, even mathematical standards that can be applied (formally, in theory) to our thinking? Does 'subject, content or problem' equate with 'situated'? Another book to pass on.

Fisher, A. (2001) Critical Thinking: An Introduction. Cambridge University Press, Cambridge, England. PB. 

Previously: LANDscape : ground : line-of-sight : role-model : structure

Post: ... 'anyone for tennis'.

Critical thinking: several definitions

Critical Thinking 
2nd Ed. Cover

An original purpose of Hodges' model was to facilitate reflection, and so help to develop practitioners who were also competent reflective practitioners, and critical thinkers.

Continuing to clear books, I've arrived at:

Fisher, A. (2001) Critical Thinking: An Introduction. Cambridge University Press, Cambridge, England. PB. 

Now in a 2nd edition (2011), my copy has several definitions of 'critical thinking' quoted below, with my emphasis.

There is a pdf of this 1st edition online which may be useful. The reward of the book, however, is in the discussion about each definition and how more recent work has built upon Dewey's legacy.  There is also a baseball analogy, which I will return to soon, or append here. I have omitted a definition by Richard Paul, which is nonetheless important to me, as it draws on meta-cognitive qualities:

"1.1.1 John Dewey and 'reflective thinking' ...

In fact, people have been thinking about critical thinking and have been researching how to teach it for about a hundred years In a way, Socrates began this approach to learning over 2,000 years ago, but John Dewey, the American philosopher, psychologist and educator, is widely regarded as the 'father' of the modern critical thinking tradition. He called it 'reflective thinking' and defined it as: 

"Active, persistent, and careful consideration of a belief or supposed form of knowledge in the light of the grounds which support it and the further conclusions to which it tends. (Dewey, 1909, p. 9)."' p.2.

 'Glaser defined critical thinking as:

(1) an attitude of being disposed to consider in a thoughtful way problems and subjects that come within range of one's experience; (2) knowledge of the methods of logical enquiry and reasoning; and (3) some skill in applying those methods. Critical thinking calls for a persistent effort to examine any belief or supposed form of knowledge in the light of the evidence that supports it and the further conclusions to which it tends. (Glaser, 1941, p.5).' p.3.

1.1.3 Robert Ennis - a widely used definition ...

'Critical thinking is reasonable, reflective thinking that is focused on deciding what to believe or do. (Cf. Norris and Ennis, 1989).' p.4.

Notice the emphasis on being 'reasonable' and 'reflective', which picks up on earlier definitions, but notice also that Ennis speaks of 'deciding what to do', which was not explicitly mentioned earlier; so decision making is part of critical thinking in Ennis's conception. Unlike Dewey's definition, this definition needs no further explanation

A final definition of critical thinking 

One last definition is worth reviewing. Michael Scriven has recently argued that critical thinking is 'an academic competency akin to defines it thus: reading and writing' and is of similarly fundamental importance. He defines it thus:

'Critical thinking is skilled and active interpretation and evaluation of observations and communications, information and argumentation. (Fisher and Scriven, 1997, p. 21).' p.10."

Multicultural Group (NWMG) NW Region - RCN

There is a group that that may be of interest, even if you are not located in the NW of England. If located elsewhere, perhaps you can help start a group in your respective region, and together mobilise and liaise with groups internationally. The group is also on WhatsApp, and Facebook; the website's introduction begins ...

The RCN North West Multicultural Group (NWMG) creates a community for members across the region from multicultural ethnic backgrounds to connect with each other, share their lived experience, knowledge and diverse ideas that help drive change around racism to ensure that their various organisations is the best place to work.

Membership is open to RCN members of Royal College of Nursing from multicultural backgrounds and their allies.

Mission statement: 

The aim of the North West Multicultural Group is to stand against racism and discrimination by using members lived experiences, encouraging organisations to be anti-racist and with the support of allies.  ...

 

Source and continued... https://www.rcn.org.uk/northwest/Get-Involved/NW-Multicultural-Group

Int. Conference on Improving University Teaching 2025

Redefining Education:

Navigating Sustainability and Innovation in a VUCA World

In a world increasingly subject to volatility, uncertainty, complexity, and ambiguity (VUCA) the goal of sustainability is aspirational, yet elusive.  A UN report published in 2024 notes that “intensifying, interconnected challenges continue to endanger the realization” of the seventeen sustainable development goals identified by the UN Sustainability Conference twelve years ago in Rio de Janeiro.  This is especially true in education, which the report correctly terms “the bedrock of sustainable development.”   It notes the negative effects of the COVID epidemic, regional conflicts, climate shock, and economic turmoil and paints a picture of a planet struggling to make progress towards them. While the big picture may be less than perfect, there is still much cause for hope, as we strive towards a better future.

Against this backdrop, the International Conference on Improving University Teaching seeks to address the challenge of sustainability, equity, and innovation as they affect higher education. In particular, we are exploring how to prepare students for a “VUCA world” in which they will have to contend with multiple challenges, while at the same time ensuring their wellbeing—and that of all academic staff—in the present. By definition, a future subject to uncertainty and ambiguity will require flexibility and adaptability on the part of students. ..

Continued ...

Previously: IUT, VUCA

iii 'Our Housing Disaster'

'Our Housing Disaster'
Image: Goodreads

Here on W2tQ many posts have referred to 'common sense' over the years. Apparently, there is no such thing - which may be another blog post).

https://www.psychologytoday.com/gb/blog/too-many-goals/202005/theres-no-such-thing-common-sense

In 'Our Housing Disaster' Julian Richer is simultaneously analytic in identifying problems and potential solutions, logical and to me commonsensical. There is a need for debate and decisions at a political level. Residents, must also be involved, have a say. Chapter 10 lists shorter-term actions and longer-term. 

The history of this disaster is tackled in chapter 3. Chapter 4 links very well explaining the rise of renting. If there was ever to be another edition - which the book and issue well-deserve; it would be good to a nod to evidence-based housing policy? This is suggested, as is integrating the many threads of housing; work, transport, infrastructure, shops, water and services. I've posted here about the number of All-Party Parliamentary Groups and talk of joined-up government. Housing is anything but joined-up. You could argue all MPs and Lords should read this book. 

Overall, the book is well produced, the text very readable, large size and well laid out. The 'references' for each chapter are in the form of links. Needless to say, I have only tried a few. The book seems smaller - narrower than a standard paperback, so may have fewer words / line. For posts i & ii, I extracted text from photos, which is a challenge without stressing the book's spine (as I've written before no doubt, I'm squeamish when it comes to books).

In the UK, the Right to Buy and Help to Buy, have long been a feature of housing policy. Of Help To Buy, it has 'cost taxpayers £29 billion in cash terms by 2023' (p.45) and has additional consequences. Milton Keynes is the 'right-to-buy-to-let' capital of England (2017, p.48). Surely, it is time to move on -  and quickly. The history of how we got here is fascinating, like a slow car-crash with critical events that accelerated the inevitable. Taxpayers and citizens all: we have missed out. There is mention of preventing corruption (but yes, more effort on money-laundering and tax evasion please!). The need for buildings inspection, standards of construction and materials and responding to the climate crisis and high energy costs are also stressed.

Richer's stance is tempered, and sets an effective tone. He is not preaching, even as he points to land owned by the Church of England. I remember the NHS selling estate, and yet there is more. While the book is not long, an index would help. I like the final summarising and concluding sentences for each chapter. Physically, they are bound to be there obviously, but there's a welcome sensible thread to these imho. With an index, perhaps I could check back to look up 'productivity, reduced', a problem that has plagued the UK economy. To what extent does housing contribute to this now; since the 1960s? The King's Fund and many other organisations and commentators advocate daily for social care. While it is acknowledged, social care is not one of the government's 5 key 'missions', and now (5th Dec.) there are milestones. Richer refers to the problem of bed-blocking in the NHS, and the need for suitable future housing so older adults can continue to 'live' in their homes.

So often in health we are taught, and learn to assess, plan, intervene, and evaluate a person-centred set of needs, a patient's needs, and a carer's needs. It is welcome to see a collective - population-based focus on needs. The book delivers on the title. So there are no details of nations (or cities) that have a  much better housing system and controls. Over the years it's been interesting and encouraging to read about Vienna in the FT. Below I have mapped/associated selected concepts to the care / knowledge domains of Hodges' model:

INDIVIDUAL

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

GROUP

psychological security mental health 'my' home, my space identity peace of mind when costs met facilitate well-being memories LAND - the 'hope' value sense of continuity / permanence children being safe making friends access to 'GREEN' spaces my life course - personal history Cognitive assurance: my area - family & friends / pets /school / work - attachment	LAND - UK geography physical shelter physical health (NO damp, mould, noise...) House building targets/programmes my space/room having an address - identity displacement public/environment health eviction house building - infrastructure land - costs transport links bed-blocking in hospitals Climate Change
place to make a home raise a family belonging sense of community friends & neighbours  anti-social behaviour by tenants social care - older adults social care disabled access to work, schools resources to service a community lack of spare capacity to support people & families in need/crisis	the economy: interest/mortgage rates indebtedness - poverty housing POLICY :: COSTS national housing & land assets inspection and building standards forms of tenure: private, rented, housing assoc. LAW - housing & land legislation housing rights migration, refugees independent advocacy / NGOs compulsory purchase

Thank you Mr Richer for an excellent read and synopsis. I do hope the government listens! My daughter's partner works in estate agency, so I know where my copy is heading: a new home!

OHD i

OHD ii

'Our Housing Disaster' ii

'Our Housing Disaster'
Image: Goodreads

Late to reading about economics, apart from the 'quality press' and an 'O' level in social history (which has actually been really useful in my nursing career), this book can ground and crystallize 'housing' as heard and viewed in the news.

I've a love for hi-fi that I share with Julian Richer, but my wealth lies elsewhere and is decidedly non-monetary. Reading his column in The Sunday Times, I'm impressed with Mr Richer's insight and the extent of his philanthropy. The book notes several initiatives and collaborations, e.g. TaxWatch -https://www.taxwatchuk.org/

On the news you hear of 'intervention' in the market - usually equity or bonds. You - the government - can intervene, or let the market, a market by implication, look after itself. Markets find their own equilibrium, shift to stability ultimately; and this despite economic crises, billion-busting scandals and political parties totally screwing-up.

So, it appears governments have allowed the housing market, to make its own moves.

It's back to the future, the 18th century of laissez-faire: the market has spoken, and its a utter mess.

The book's contents are well structured and delivered in full.

Introduction
1 Disaster? What Housing Disaster?
2 A Housing Crisis That Harms
3 Where Did Housing Go Wrong?
4 The Rise of Renting
5 The Shrinking of Social Housing
6 Underregulated and Oversubscribed
7 Land and Planning: The Price of Permission
8 Making Better Use of Buildings and Land
9 Building a Solution
10 Time for Action - My Housing Manifesto
Conclusion

OHD covers the population as a whole, but 'health' is very well represented in terms of personnel and the impacts of lack of housing and poor quality, unregulated housing: 

'Inability to afford housing is one of the grievances feeding into strikes by public sector workers - even better-paid ones. A survey by the British Medical Association (BMA) in December 2022 found that nearly half (45.3%) of junior doctors had struggled to afford their rent or mortgage in the past year. To earn more, some were taking on extra shifts and the BMA said this added to its concerns around junior doctor exhaustion and burnout. 

The consequences reach out to the public at large, as housing problems hit staff recruitment in health services, education and so on. The NHS visibly cant cope: basic structures are crumbling.' p.25.

We can imagine the anxiety and depression this might provoke. Even for people you might think (assume) would be ordinarily resilient. These are clearly extraordinary times. An email - RCN Magazine - today supports the same conclusion:

The relationship between health and housing is not limited to chapter 2. In chapter 2 though damp and mould (yes a specific case), unsanitary conditions the loss of environment health officers and skilled personnel, reminded me of decades ago an article in HSJ, or in that 'quality press' about the community health councils - CHCs having their teeth extracted. Public (MENTAL) health has taken a stunning fall and desperately needs to be put back together.

More to follow...

'Our Housing Disaster'

Our Housing Disaster

I must finish the spring and summer's reading as pictured, with another two books in the wings. While the smallest text Our Housing Disaster is cheap to buy, an important read and insightful.

Politically, in the UK and many other nations, housing and its opposite -  homelessness, and the supply and cost of housing are ongoing issues.

Julian Richer's book is low cost £4.99 post free with a promo-code; even as I obtained a free copy, learning of the book in Business section of The Sunday Times. 

Our Housing Disaster gets off to a flying start:

'Falling or stagnant house prices are seen as national 'ill' that we must recover from but, in fact, fast-rising house prices and interest rates have proved to be the real ill, destroying the dream of a property-owning democracy that was supposed to benefit all.

Britain's housing policy, such as it is, has failed on its own terms.' p.9.

I remember when Grand Designs appeared on our TVs. Especially the episode with the wood-frame eco-house by Ben Law. This seemed sustainable and time-limited too. Julian Richer really nails the housing problem without delay. Unfortunately, the audience appeal of TV programmes like Grand Designs, Location, ... seem to me symptomatic of the issue Richer raises above. I used to think that the 'middle class' were shooting themselves in the foot; as house prices rose and rose. There was a collapse at one point with the trap of negative equity that my family almost got caught in (had we bought a new home). Richer corrects this view, with a national perspective across ten chapters and 180 pages.

 If the link between health and housing needs to amplified Richer ably achieves this, and quickly:

'Poor housing is harming the nation's health. The housing ombudsman, Richard Blakeway, whose office deals with complaints from social housing tenants about disrepair and mould and damp in their homes, problems recognised now to be a threat to health, has found the situation to be so bad that he has called for a Royal Commission to look at the links between housing, health, and welfare. Too often, the various agencies in housing, health and social care tend not to link up, or even know what the others are doing. which can end up making people's housing situation worse. Someone who has been homeless or who has mental health needs, for example, can require a lot of support once they are housed so that they can pay the rent and maintain the tenancy. If they just get housed and then left to cope on their own, they can struggle, lose the tenancy, become homeless and whole cycle starts again, with all that waste of money and damage to lives.' p.16.

'In addition to the 8m, there must be millions more who are not in crisis, but who have a blight on their future: typically, young, working people, perhaps with children, who are living in private rented accommodation, with a roof over their heads but always worrying they might be evicted. The insecurity and uncertainty that they experience is not good for them or their children. Just as job insecurity makes it hard for people to build a career, housing insecurity makes it hard for people to establish a life.' p.19.

The statistics flow thick and fast but as readable as they are focussed they weave an effective narrative referring to the history of just how we got to this point. The text make stark the dire crisis and need for action and an urgent government response. 

More to follow.

'Un Caso Clinico' BUZZATI (I906-I972)

Reading The Theatre of the Absurd earlier this year was a very enjoyable and disconcerting experience. In acknowledgement: I have quoted from the book at length below. I do so to better convey the context, and in the hope other people may similarly obtain and enjoy this classic theatrical text.

Reading, I was reminded of starting my career as a nursing assistant and student nurse, and the 'lock-up' wards: male and female. Listening now to the current Reith Lectures I will post regards: 

Gwen Adshead - Four Questions about Violence

https://www.bbc.co.uk/sounds/play/m0025cmg

As a community mental health nurse in community mental health teams and nursing home liaison, residents on the ground floor (of two or three floors - with 'general') 'knew' there were very poorly people on the top floor. In summer, windows open, they could often be heard shouting and in the night. Inside, for staff, family members, friends became advocates expressing concern for a lack of access to fresh air and sunshine. Something, of course, we can all benefit from. For some residents there was an in-house understanding of NOT wanting to be moved 'upstairs'. At times I gather, if a resident 'played up' such re-location (displacement) was used as a threat: a cue for education.^

DINO BUZZATI (I906-I972)

'In Les Bátisseurs d'Empire the flight from death takes the form of trying to escape upwards. The same image appears in the opposite direction in a remarkable play by Dino Buzzati, the eminent Italian novelist and journalist on the staff of the Corriere della Sera in Milan. This play, first performed by the Piccolo Teatro, Milan, in 1953, and in Paris in an adaptation by Camus in 1955, is Un Caso Clinico. In two parts (thirteen scenes), it shows the death of a middle-aged businessman, Giovanni Corte. Busy, overworked, tyrannized but pampered as the family's breadwinner, whose health must be preserved, he is disturbed by hallucinations of a female voice calling him from the distance and by the spectre of a woman that seems to haunt his house. He is persuaded to consult a famous specialist, and goes to see him at his ultra-modern hospital. Before he knows what has happened, he is an inmate of the hospital, about to be operated on. Everybody reassures him - this hospital is organized in the most efficient modern manner; the people who are not really ill, or merely under observation, are on the top floor, the seventh. Those who are slightly less well are on the sixth; those who are ill, but not really badly, are on the fifth; and so on downwards in a descending order to the first floor, which is the antechamber of death.

In a terrifying sequence of scenes, Buzzati shows his hero's descent. At first he is moved to the sixth floor, merely to make room for someone who needs his private ward more than does. Further down, he still hopes that he is merely going down to be near some specialized medical facilities he needs, and before he has fully realized what has happened, he is so far down that there is no hope of escape. He is buried among the outcasts who have already been given up, the lowest class of human beings - the dying. Corte's mother comes to take him home, but it is too late.

Un Caso Clinico is a remarkable and highly original work, a modern miracle play in the tradition of Everyman. It dramatizes the death of a rich man - his delusion that somehow he is in a special class, exempt from the ravages of illness; his gradual loss of contact with reality; and, above all, the imperceptible manner of his descent and its sudden revelation to him. And in the hospital, with its rigid stratification, Buzzati has found a terrifying image of society itself - an impersonal organization that hustles the individual on his way to death, caring for him, providing services, but at the same time distant, rule-ridden, incomprehensible, and cruel.' 

Esslin, Martin. Parallels and Proselytes, The Theatre of the Absurd. London: Pelican, 1982. (3rd Ed.).pp.277-279.

^Rest assured, there were and are excellent centers of care too.

ii Comparison and Contrasting the Meikirch Model and Hodges' model

Meikirch Model

Quite some time has passed since June 1st and part 1. I don't think this post can wait 18 years like that preceding! It is good to see '(Biologically given) potential' emphasized in the Meikirch Model; and the arrows which refer to:

'Whenever the five components and the ten complex interactions (double arrows) cooperate in a purposeful way, health may result. More specifically, a person is healthy, if by the two potentials she or he is in a position to respond satisfactorily to the demands of life.'

The interactions are explained in more detail. Mental health (illness) is there in 'personally acquired potential', but I wonder if it needs to be more explicit? Although, is this a welcome 'break' from the mind-BODY Cartesian divide and its legacy? A shift that enables a more constructive (less stigmatizing) formulation?

Given the climate crisis and experience of COVID, we can hopefully retain a sense of our individual proximity to the environment and green spaces. The importance of access to 'green spaces' seems to be sustained, even if action on air quality (and plastics in the environment) is still playing catch up with WHO air quality recommendations. The interdependence of nations and geography crystallizes more each month. The need for international cooperation apparent in cities, such as Lahore (1). Pollution and smog in Pakistan depends on what happens in India. Water flows, the how, when and whether is noted as a potential trigger for future conflicts.

Both models, the Meikirch, and Hodges' are of course idealizations. As such there are inevitable limitations, assumptions, pros and cons. Like many concepts, environment is a compound or expansive term. Simultaneously, from a primary meaning, we can proceed from the physical environment, to the social, political and the mental environment that these invoke or foster. 

In the SCIENCES domain of Hodges' model we are in 'a' - the environment. Physical reality presents itself in raw and fundamental terms. Across the world climate change is threatening many homes and places a stress the importance of 'shelter' and the homeless. Natural disasters, and acute local weather events which are now repetitive disrupt life and population. Conflicts continue to displace people, climate refugees will follow: (https://www.unhcr.org/refugee-statistics). Contrast this with the ideals of housing design that is sustainable and also enables occupants and communities to feel the environment. 

'Ecosystem' is being applied in ways beyond its original articulation. This past N. summer-autumn reading and reviewing -

Capra and Luisi's (2014) The Systems View of Life - A Unifying Vision.

(i) https://hodges-model.blogspot.com/2024/09/i-systems-view-life.html

- there was much emphasis on complexity, ecosystems, emergence, education, and obviously systems.

In their model, Bircher and Hahn incorporate Complex Adaptive Systems (CAS).

https://meikirch-modell.ch/wp-content/uploads/2017/12/Health-and-diease-as-CAS.pdf

This is helpful as the ecosystem is transformed, before our eyes. Clearly, there isn't one ecosystem, but several and they are all dynami: even if, outdoor clothing and car manufacturers want us to believe that we can create our own private ecosystem that is trans-portable. Systems are like the whirls in moving water, they come and go. Ironically there are now more opportunities to study them - if we so choose. Now weather events reveal the risks of people trying to sustain these mindsets when a local catastrophe strikes. The website for the Meikirch Model includes the table below. 

Theories Concerning
Health and Disease

Type of thinking	Epistemology	Means for comprehension
Prescientific	Personal experience	Intuition
Scientific: Meikirch-Model	Scientific argumentation	Rational mind

This is constructive as models should encompass what can be presented as 'knowledge' and from there: data, information, facts, myth, wisdom and folk theory. Intuition is listed as a prescientific 'means for comprehension'. Intuition is highly subjective, in contrast to the (supposed) objectivity of the sciences. Intuition is nonetheless significant in mental health care - psychotherapy, and in truth more generally (interpersonal skills); even if it remains 'unscientific' and an enigmatic phenomena. 

On twi/X and here on W2tQ, I've suggested that the bio-medical, and the biopsychosocial models are inadequate as conceptualisations for healthcare and education. We need to fully encompass the subjective and humanistic dimensions of health care and lived experience, giving more attention, if not credence to 'personal experience'. In England and Wales these past months and to follow our parliament has been debating assisted dying for people with terminal illness. Both sides acknowledge the sorry state of palliative care. Policy and ethics - hence the politics of health needs to be explicit in a model of/for healthcare.

Working in mental health you quickly understand how critical it is being able to relate to others, and  develop therapeutic relationships. Get this wrong, and problems may follow. If interpersonal - communication are essential to a health professional's knowledge then awareness and competence in relational skills are also key. In the past two years or so, I've realised the importance of this for Hodges' model and trying to develop a theory to underpin Hodges' model. I believe that this is a strength of Hodges' model. So we need to extend the table above. 

Individual
   |

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :   POLITICAL 

|

Group

choice - life style reasoning - rationality my literacy - responsibility mental illness - fear of stigma intuition / subjectivity	geography - environment air pollution - smog & plastics traffic regulation - metrics Planetary health 'truth' objectivity
community - relationships culture social systems family social (all) determinants	international cooperation transparency / accountability policies - funding determinants of health reporting - citizen science

As part 1 started, I will finish with the title of the paper that prompted these reflections:

Bircher J. und Hahn E. G., (2017). Will the Meikirch Model, a New Framework for Health, Induce a Paradigm Shift in Healthcare? Cureus 9(3): e1081. DOI 10.7759/cureus.1081 

The Meikrich model is not alone in seeking to facilitate and deliver a paradigm shift in healthcare; and, at individual, collective, planetary levels, across social care and education and the disciplines - old and new.

 

(1) https://www.independent.co.uk/climate-change/news/pakistan-lahore-air-pollution-schools-shut-aqi-b2640783.html

i Comparison and contrasting the Meikirch Model and Hodges' model