"How did you get that answer? Show your working out!"

As students of - math, maths, mathematics (pick one!) or arithmetic, algebra - know only too well: Learning, no doubt, through a series of prompts, especially if numerically challenged:

The way you derived your answer is an important - the most important part of the exercise. It is the exercise in most cases.

As may be apparent here on W2tQ, in addition to visual methods, mind-mapping, diagrams and computers, the professional basis for the study and the draw of Hodges' model was models of care and nursing theory. I've blogged previously about if we stress the theoretical, this variously invites yawns, and critique (always welcome), if not ridicule from outside.

In practice we seem struggle to do the ideal. This is one aspect of the theory-practice gap; bridging this gap was one reason for the creation of Hodges' model. What the student health professional learns in the  class/lecture theatre/online, may not be reflected and realised 100% in practice. 

On clinical placements the real-world intervenes, upsetting the academic comforts. Suddenly the armchair hypotheses do not sit so comfortably. Reality bites. Are there enough staff, is the skill-mix 'ideal'. Patients present their own variables. Which are also often at least binary (and invariably more), to include carers, family, with prior experiences. There are specific life experiences and situations of the patient; and yes, in plural.

Competence with paperwork, the electronic health record (EHR) is key to a student's progress:

From communication skills, establishing a therapeutic relationship (yes, so 'old school'?), enabling and concurrent with care assessment, care planning, intervention and evaluation. Plus, the 'writing' of the same including all the processes, messages received, clinical team meetings, allocations, supervision. All the while being mindful of ethics, professionalism and accountability.

Regarding theory: I do wonder; are we missing something? Something that artificial intelligence may (will) pick-up eventually (quite quickly in-fact!). With the legacy of largely abandoned nursing theories, models of care, health frameworks … do we need to look at theory in a more literal (yes, idealised) form? To have any chance of success do we need to leave behind what we have thus far? In addition to science, nursing, medicine are often described as an art. Even if this theoretical treatment is impressionistic surely it is worth trying - to be creative, innovative, to hypothesise and speculate on the edge?

Can we use Hodges' model, or another 'tool' you might care to propose even more suited to the purpose? 

Throwing caution to the wind: this is a theoretical exercise. It may be based upon sand? Then so be it! If there is a practical, pragmatic and practice-based application that would be marvellous. Why does this matter? The rationale here is driven by the fact that health has its feet, or draws every-other-breath in the humanities. Yes, evidence is grounded in science, anatomy, physiology, life sciences and the rest. The humanistic care - knowledge domains need, demand their own unique theoretical space. A sandpit to play with a theoretical language. And make no mistake, the sand is already hurting these eyes.

There are malign agents who would deny any practical benefits of such an effort, and yet this should be in prospect. This should be an outcome to follow in the near future (although delayed by COVID). In fact it is a necessity, a requirement even, given attention and prioritisation of the SDGs, and the determinants of health,. Add to this the politics of health, and health in politics and the world🌍🌎🌏🌐today; full implementation, achievement and ongoing development will costs billions (trillions of dollars) and once-and-for-all a long-term perspective. 

There is a now, a holistic need to show your working out. How you have arrived at your answer.