Just imagine ... caseloads, payloads and careloads

Just imagine ... no, not like that - really imagine!

You are in a situation. Unsurprisingly, let's say it's in health, or social care. We find ourselves in a care or nursing home, on a ward, or in the individual's home, even if the patient does not currently recognise it as such.

The patient is mobile. That is, and isn't a problem.

Physically, apart from thoughts about a chest, or urine infection, yes they are mobile, but they're also confused - disoriented.

We are concerned about their safety. 

Noisy, increasingly agitated, they are making it clear they want to leave.

Their carer, family, or staff are trying to limit the patient / resident's access to the exits, be that the front, or back door, the spare room, their room, or main entrance. They are not in agreement about where they need to be. Persuasion and distraction aren't working either. They appear to lack the level of mental capacity required to decide for themselves what needs to happen.

It is one thing to have this assessment of the situation running through one's mind; but quite another to 'pick up' a care concept mentally and carry it over the care (knowledge) domains of Hodges' model.

Hodges' Health Career - Care Domains - Model

Try it for yourself ...

Have a think about the following care concepts: mobility, capacity, consent, confusion, mobility, liberty, a locked-door while spouse/partner goes shopping, and safeguarding? 

As we engage in critical thinking, these concepts have a literal payload. They carry varying degrees of informational value, salience that helps us prioritise, what else do we need to factor in, what help is needed, and when; how do we  decide what to do?

As a concept is evaluated against Hodges' model, it changes. It is as if it morphs subtely, or starkly as other concepts, by association, are brought into play.

This process is influenced in so many ways; our training to date, our prior experience, biases and cultural baggage we might also carry, who else is present (this is of course potentially both a positive and negative), past and current role-models, our (team's) preparedness - what to do if .., teamwork, access to leadership (who is 'duty'?), and our confidence in them (Oh no!). And, them in us.*

Vitally, there is the small matter of our understanding, attititude and response to the person in-front of us. 

The delivery of healthcare is often stressed as emotional labour. Whether we use Hodges' model or not, perhaps the labour, the physical and psychological work involved, is experienced through carrying and feeling the careload. A reason too for supervision.

*Do seek help - advice if needed.

Further reading [ please contact me if needed - h2cmng AT yahoo.co.uk ]:

Jones, P. (2025), A Generic Model and Conceptual Framework to Prime Curiosity Across Health and Social Care Disciplines to Facilitate Lifelong Learning. Journal of Evaluation in Clinical Practice, 31: e70252. https://doi.org/10.1111/jep.70252

Jones, P. (2025). A Conceptual Mapping Exercise of Deprivation of Liberty Safeguards in Residential & Community Care Using Hodges' Model and Threshold Concepts. Journal of Evaluation in Clinical Practice, 31: e70085. https://doi.org/10.1111/jep.70085

Reflective equilibrium and equipoise

I can't believe, or don't want to, that it's nearly 15 years since I posted - 

h2cm and clinical equipoise in 2010. 

The post didn't try to be 'technical', but perhaps demonstrates the journey here.

In a post to follow, in London 4-7th July I came across a book by Edouard Machery and upon return up north, found a paper which refers to reflective equilibrium. This, one again technical or not, is a purpose of Hodges' model.

Machery, Edouard, Philosophy Within Its Proper Bounds (Oxford, 2017; online edn, Oxford Academic, 24 Aug. 2017), https://doi.org/10.1093/oso/9780198807520.001.0001, accessed 24 June 2025.

Reflective equilibrium has an entry in the The Stanford Encyclopedia of Philosophy:

'If you believe that conduct in some case is right or wrong, you have a moral judgment or intuition. Perhaps you have many such judgments about different cases. You might, nevertheless, consider that judgments alone do not justify the moral views they express. You and your moral interlocutors might be concerned that “what we actually accept is fraught with idiosyncrasy and vulnerable to vagaries of history and personality” (Elgin 1996: 108) or displays “irregularities and distortions” (Rawls 1971: 48).

John Rawls proposed to address these concerns through the method of reflective equilibrium.We first ensure that our judgments are considered, being made in circumstances appropriate for moral deliberation. We are then to consider general principles that might accommodate our set of considered judgments—and more than that, explain and extend them. On the standard wide reflective equilibrium, we are to consider

all possible descriptions to which one might plausibly conform one’s judgments together with all relevant philosophical arguments for them. (Rawls 1971: 49)

This requires that we reflect on a wide range of principles, arguments, and theories. Equilibrium is reached where principles and judgments have been revised such that they agree with each other. In short, the method of reflective equilibrium is the mutual adjustment of principles and judgments in the light of relevant argument and theory.'

The encyclopaedia entry is informative for studies here. I will revisit clinical equipoise in the near future; and bring in the idea of 'holistic bandwidth'.

Knight, Carl, "Reflective Equilibrium", The Stanford Encyclopedia of Philosophy (Spring 2025 Edition), Edward N. Zalta & Uri Nodelman (eds.), URL = <https://plato.stanford.edu/archives/spr2025/entries/reflective-equilibrium/>.

Rawls, John, 1971, A Theory of Justice, Cambridge, MA: Belknap Press of Harvard University Press.

Occupational therapist Joël inspires elderly to get in motion ...

Or, "Excuse me. How many movements are there in that watch?"*

"Joël Kruisselbrink’s creativity in designing exercises and games inspires elderly people to keep moving and live life to the fullest.

Nursing home residents are often understimulated and have little motivation to exercise. As an exercise instructor, Joël Kruisselbrink knows better than anyone how important exercise is for the elderly. His passion for creating exercises and games enables older people to continue enjoying life while keeping them moving."

Brightvibes: Exercise is life: Joel’s exercises and games inspire older people to keep moving

Individual

|

      INTERPERSONAL    :     SCIENCES                   

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

 SOCIOLOGY  :    POLITICAL 

|

Group

What do you think the impact is upon the resident's mental health and emotional well-being? Psycho-
-Social?	Standards & Quality of Care Policy

*Hodges' model: A tool to watch the complications of Care

My source: https://x.com/Rainmaker1973/status/1802268229361967404

Re. 'Lagoonscapes' - previous post ...

It was the title of the journal in the previous post that caught my attention:

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

	'Lagoonscapes' made me think of the periplus, used by ancient explorers - sailors to 'map' coastlines and their features. I also realised that people living with: more advanced stage dementias reduced mobility / balance partial sightedness stroke - may negotiate their immediate surroundings (living room ...) using 'furniture walking'. The first explorers did likewise by analogy?
Is a lagoon - a resting place/space - an offering of respite (care)? In 2018 the Oceania exhibition at the Royal Academy of Arts https://www.royalacademy.org.uk/exhibition/oceania - highlighted knowledge of the peoples who could read the currents, winds - perhaps in as differentiated manner similar to the Inuit and their environment and cultural beliefs?

Previously 'landscape'

C+nto

"The female body is a political space."

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

My - MIND C+nto	My - Body
& Othered Poems Art / Arts :: [Counter] Culture Othered Minds :: Othered Bodies	C+anto

Joelle Taylor. C+nto & Othered Poems. Saqi Books. April 2021 Paperback 128pp 9781908906489

What's in a word - 'hysteric-al'?

 INDIVIDUAL

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 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

Hysterical: Exploding the Myth of Gendered Emotions Pragya Agarwal	"Rolling resistance is a compound of two factors: hysteric and dampening losses. Hysteric loss is the energy surrendered when a soft tyre deforms; as pressure rises, deformation decreases, therefore diminishing hysteric loss." p.17.

Sources:

Book - various.

Bates, D. How time lords win race against clock. Sport, Cycling, The Times, 17 September 2022, p.17.

Cycling image: c/o @DavidSBates

https://twitter.com/_DavidSBates/status/1570789552985632771?s=20&t=KPyb7YjvVHMZhuvtAFDa7A

The mechanics of Empire (or Not) c/o Yinka Shonibare

INDIVIDUAL

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

  GROUP

	Yinka Shonibare MBE – End of Empire, 2016, Turner Contemporary

 

"The Salzberg show, at the Museum der Moderne in Monchsberg, will show works going back to the mid-1990s, and though still in development, its title - End of Empire - is secured. This refers to a work Shonibare created for the 14-18 Now project, which commemorated the 100 years since the end of the first world war: two figures with globes for heads sit either end of a moving see-saw, their precarious balance representing the fragile conditions of conflict. 'It's this idea that the arguments are shifting constantly; I didn't want it to be didactic or simplistic,' he says."

Yinka Shonibare

Image: https://publicdelivery.org/yinka-shonibare-end-of-empire/

My source: Roux, C. All a question of power, Life&Arts, FTWeekend. 20-21 February, 2021. p.13.

 

Patients as Persons not Things: [Nursing] Theory - Practice

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

"Is there something perverse, if not archly insistent, about complicating things with theory? Do we really need anything like thing theory the way we need narrative theory or cultural theory, queer theory or discourse theory? Why not let things alone? Let them rest somewhere else-in the balmy elsewhere beyond theory. From there, they might offer us dry ground above those swirling accounts of the subject, some place of origin unmediated by the sign, some stable alternative to the instabilities and uncertainties, the ambiguities and anxieties, forever fetishized by theory. Something warm, then, that relieves us from the chill of dogged ideation, something concrete that relieves us from unnecessary abstraction." p.1.

 

My source:

Brown, B. (2001). Thing Theory. Critical Inquiry, 28(1), 1-22. Retrieved September 18, 2020, from http://www.jstor.org/stable/1344258

c/o BBC Radio 4 & Facts4Life - Balance Ball

The following is taken from the transcript of the BBC Radio 4 programme "Inside Health" which I heard today and an image from the resources of Facts4Life which featured as an item.

I have always wondered what is the youngest age at which Hodges' model might be taught. I have noted before how the model can be used implicitly - guiding the professional - or explicitly with the patient or group having insight into the model. The approach of Facts4Life is well worth publicising in the ability and intelligence that children can and should be credited with ...

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

... We might have somebody else who’s representing emotions, you say oh I’m feeling a bit sad and grumpy, so their hand might come off.  As each hand comes off whilst the body or the ball wobbles it doesn’t actually fall but as more and more compromises are made, there’s more and more problems to encounter, then it could get to the point where they drop the ball altogether.  And that could be oh perhaps we need a bit of help here, what could we do to help get this body back in balance. ... Green

Around year three we’ll say okay homeostasis we can explain it by using a balance ball.  So a balance ball like a yoga ball.  And the ball represents the body and then we talk to the children about how an illness might look. ... Green  Traditionally there’s been a lot of focus around very black and white concepts that you have good drugs and bad drugs.  Adults tend to make things black and white because they think that’s simplifying things and actually children are really good at grappling with big ideas. Green

Facts4Life

Do you think historically that we have been too black and white then, that we’ve sort of had health in one pocket and illness in another and never the twain shall meet? Porter I do, as a profession yes and as a society there is at the moment an easy contract between the population, as it were, and the health professionals and the contract is that whatever’s wrong with people we will deliver a solution. Toft

I also note on Facts4Life's website, the audiences they are appealing to. I see Hodges' model as being applicable to:

Students - Learners (the research community)
Carers - members of the public
Teachers - Lecturers
Policy makers and Managers

So, if you need a conceptual balance ball: here + catch!

@Facts4Life
Inside Health - BBC Radio 4

Metamorphosis (Ste p e-learning [curve?] )

I'm walking over ground of a gradually steepening pitch. At a certain point, I pause and start using my hands; the real mountain begins. I am climbing. Do I, as soon as my back slopes forward, return to the state of the quadruped? Almost: my body transforms; feet become hands and my two manual grips secure balance. Homo erectus, the standing man, of recent date, reverts back to the one from whom he is descended: the archaic quadrumane. This thunderbolt recollection became so black, in me, that I no longer fear to speak of the beast; I remember who we were (p.3).

Michel Serres (1999) Variations on the Body, Univocal.

Foundations, projects, corners and cornerstones

Ok, so you have a new project - that's great!

Yes, we are going to build something - outstanding!

Sounds marvellous!

We are going to use up-to-the-nanosecond project management tools.

And you're going to do it by the book, charts and real-time tags.

Yes, with a dash of intuition plus - you know - gut instinct!

Well sure, pleased to hear that too.

We will take account of history, learn the lessons -
we've a researcher onboard you know?
Building a world-class team that's all fleet of foot and mind.

We'll tick all the boxes, check all the corners and leave no stone un-turned.

Truly admirable, but how many boxes and corners have you got and how many cornerstones* will you need?

Eh?

Hey listen up. Corners are for losers,

naughty children

and people lost in the dark.

Nobody is going to be stuck standing in the corner on this one!

Oh - right.

Well good luck....

Image sources:
'Cornerstone office': Cornerstone Corp. Center
Dan Flavin: at Artnet.

Inspired by the word 'cornerstone' and Untitled (Corner Piece) 1969 on visit to Tate Liverpool, 25 September 2009 (not the piece illustrated above):

Flavin made a number of works intended to be shown in corners, engaging directly with the architecture of the gallery. His use of commonly available fluorescent tubes enabled him to explore light as a non-physical material, animating gallery walls. The size of the work was determined so that the units could be fastened in the centre only, without having to be anchored to the floor. The artist rejected any symbolic significance of the object, insisting that it was simply a form that made good use of a corner.

Question: How many corners are there in Hodges' model?

*Cornerstones: here referring to stakeholders, sponsors, owners, partners, investors, builders, architects, designers...?

Mind the glass! Socio-technical engineering and vision

Amid the efforts to increase the ease with which technology integrates into our lives is the realization that some areas are more challenging than others. Education and health care spring to mind. In both of these fields if you are something of an expert in ICT and a subject domain expert then you can potentially pull off something of a coup. Being able to sit on the fence and appreciate two critical dimensions of an ensuing discussion about a clinical or learning system (perhaps even both) you can climb down off said fence and make a real difference.

From experience as a nurse, though it is (always) wise for any one practising as an informatics 'clinician' to constantly look over their shoulder. This domain is one that could be rationalised, automated, by-passed especially when we contrast new and emerging informatics roles across health disciplines with generic trends in health records EHR and PHR?

In the forthcoming generations of health record systems, informatics specialist will need to make their technical knowledge more accessible in their role as:

key contributors to -
SOCIO-TECHNICAL
- balance and patient (public and carer) engagement.

As community and personalised models of care influence the development of PHR, then hospital based EHR will themselves be forced to become transparent. There is also the matter of how the service integration agenda will influence how systems are described and 'sold' as a product and (essential) benefit. As the majority of readers will recognize at the end of the day - it's about the information - knowledge: not the technology.

Perhaps on reflection this is the key to new or existing informatics roles:

- we are engaged in "engineering transparency" ....

Inspired by a discussion on the LinkedIn HIMSS list.