Hodges' conceptual framework: A model for Narrative Medicine ...

Abstract

The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. Adopting methods such as close reading of literature and reflective writing allows narrative medicine to examine and illuminate 4 of medicine's central narrative situations: physician and patient, physician and self, physician and colleagues, and physicians and society. With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care. ...

 

Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA. 2001;286(15):1897–1902. doi:10.1001/jama.286.15.1897 

With my emphasis.

#Identity #Group #Individual #Collective #Mind #Body #TheOdysseyHasBegun

European Character and Virtue Association (ECVA) Conference 2026

Theme: Bridging the Knowledge – Action Gap in Character Development

Re: invitation to the ECVA 2026 conference: reminder ...

Established in 2022, the European Character and Virtue Association offers a forum for promoting research, training and networking in the field of character education. We bring together educational institutions in Europe and scholars from around the world, providing unrivalled opportunities for members to share best practices and shape European policies affecting higher education and research. 

The 2026 conference of ECVA will take place in Trnava University, Slovakia, in cooperation with the Jubilee Centre for Character and Virtues, University of Birmingham, the Private University College of Teacher Education of Christian Churches, and the Virtues and Values Education Center of Francisco de Vitoria University. 

The Executive Board of the European Character and Virtue Association (ECVA) cordially invites you to attend the 2026 ECVA Conference in Trnava, Slovakia. 

• President: Prof. Dr. James Arthur (Harvard University)
• Vice President: Prof. Dr. Verónica (Francisco de Vitoria University Madrid)
• Secretary: Prof. Dr. Tom Harrison (Jubilee Centre for Character and Virtues, University of Birmingham)
• Treasurer: Prof. Dr. Roland Bernhard (University of Teacher Education of Christian Churches Austria)

Conference Information Trnava, Slovakia, 2026, 24th to 26th of June 

We expect more than: 📍100+ researchers 🏫 40+ universities 🌍 20+ countries 🎤 60+ presentations & keynote addresses 

📝 Submit your abstract and find all conference details at the link below:

👉 https://ecva-character.org/ecva-conference-2026

Deadline for Abstract Submission: 31st of January, 2026.

All abstracts will undergo a review process over the course of the following month. Once your proposal has been accepted, you will receive detailed information about registration, conference fee (275,- EUR) processing, accommodation options, and other necessary information.

Notification of Acceptance: 1st of March 2026.

Contributions that demonstrate high quality and close relevance to the main theme of the conference will be accepted for review in preparation for the next scientific monograph produced by the ECVA.

Warm regards,

Dr. Martin Brestovanský
(Trnava University, Slovakia)

on behalf of the ECVA Steering Group

Prof. James Arthur (Harvard University)
Prof. Verónica Fernández (Universidad Francisco de Vitoria, Madrid)
Prof. Tom Harrison (Jubilee Centre for Character and Virtue, University of Birmingham)
Prof. Roland Bernhard (University of Teacher Education of Christian Churches, Vienna)
Prof. Claudia Navarini (Università degli Studi Europea di Roma)
Prof. Ines Weber (Paris Lodron Universität Salzburg)

Conference description 

Bridging the Knowledge – Action Gap in Character Development 

Moral education often assumes that ethical knowledge or cognitive competence alone will result in moral behaviour. Yet lived experience, philosophical reflection, and empirical research consistently show otherwise. A persistent gap exists between what individuals know is right and what they actually do—a phenomenon recognized since antiquity. 

Aristotle observed that “we reason here not to know what virtue is, but to become good” (Nicomachean Ethics, 1103b), highlighting that moral reasoning is directed toward formation, not just information. Immanuel Kant similarly acknowledged that a person may clearly understand moral duty and yet lack the will to act accordingly, pointing to the human struggle between reason and inclination. 

David Hume went further, arguing that “reason is, and ought only to be the slave of the passions,” insisting that moral knowledge without rightly ordered desires lacks the power to move us to action. And Martin Buber wittily adds: “The worst notorious liar in the classroom will write a brilliant treatise on the destructive power of falsehood”. 

This enduring challenge – now referred to as the knowledge–action gap – remains a pressing concern across education, psychology, and the social sciences. Scholars have described related phenomena in various conceptualizations, such as the reason–action gap, attitude–behaviour gap, intention–behaviour gap, or the knowledge–attitudes–practice (KAP) gap. Each term reflects a common concern: knowing what is right does not reliably lead to doing what is right. 

Bridging this divide is a complex task, compounded by the dynamic, deeply personal, and context-sensitive nature of character formation. Educational and behavioural sciences are increasingly turning to integrative approaches that go beyond cognitive instruction. Interventions such as moral sensitization, dramatization, habit training, and reflective practice are being explored to enhance the coherence between values and actions. 

There is growing consensus that this so-called “gappiness problem” cannot be resolved through one-size-fits-all solutions (e.g., moral emotions alone or identity-based interventions). Instead, promising “multi-component” models are emerging that draw on diverse disciplines and methodologies to address the challenge. 

Conference Goals 

By bringing together interdisciplinary perspectives and diverse methodologies, the ECVA 2026 conference aims to deepen our understanding of the knowledge–action gap and to promote innovative, research-informed strategies for strengthening moral coherence and character development in real-world settings. 

We look forward to welcoming those committed to advancing theory-informed practice and practice-informed theory in the service of ethical integrity and flourishing lives.

Previously: 'character' 

Subjective-Objective: Thinking of Holistic Cake and Eating it

'Our natural awareness of our own activities is holistic. We experience ourselves as embodied beings, complete organisms, directly perceiving physical objects, making choices, engaging in conversation with other people. The attempt to split the human being into a combination of immaterial self and physical body makes a coherent account of these processes impossible. As Heidegger says, “The ‘scandal of philosophy’ is not that this proof has yet to be given, but that such proofs are expected and attempted again and again.”35 Given the Cartesian conception of the “real world”, organisms are “really” mechanisms, while “choices” and “actions” have no place in a world where there are only events, subject to the laws of mechanistic cause and effect. The whole person becomes a metaphysical oddity, straddling two incompatible metaphysical realms.

A theoretical framework that renders the previously straightforward inherently problematic is by no means an unequivocal advance. Materialist authors have attempted to “solve” this problem by denying the reality of the subjective side of the Cartesian picture, replacing his dualism with radical metaphysical reductionism.36 Such authors insist that the “objective” world (still understood as something devoid of phenomenal properties, containing only causes and effects as understood in reductionist science) is all there really is. On this view, we do not have to bridge the gap generated by Descartes, between the subjective and the objective features of human life, because the objective features are the only ones that exist.' p.20.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

My Mind Subjective	My Body Objective

Mitchell, D., Loughlin, M. (2023) The philosophy of person-centred healthcare, Cambridge: Cambridge Scholars Publishing. https://cambridgescholars.com/product/978-1-5275-9058-8/

Previously: 'Descartes' : 'mind' : 'body'

Will it? Won't it? Artificial general intelligence - AGI

In the media - notably the financial press (radio, TV, Times, FT here) there have been recent questions raised about whether the generative AI bubble is about to burst. The latest releases of GAI are not the step-change that might have been expected. Artificial General Intelligence may not be quite in-sight. As a result I've been reminded of Prof. Peter Gärdenfors work on 'Conceptual Spaces':

'Within cognitive science, two approaches currently dominate the problem of modeling representations. 

1. The symbolic approach views cognition as computation involving symbolic manipulation. 

2. Connectionism, a special case of associationism, models associations using artificial neuron networks. 

Peter Gärdenfors offers his theory of conceptual representations as a bridge between the symbolic and connectionist approaches.' MIT Press.

Hodges'model facilitates a hybrid response to situations, as needed.

A further prompt is the programme for November's AI Health 2025:

https://www.bcs-sgai.org/health2025/?u=programme

Peter Gärdenfors. (2000) Conceptual Spaces: The Geometry of Thought. MIT Press.
DOI: https://doi.org/10.7551/mitpress/2076.001.0001

https://direct.mit.edu/books/monograph/2532/Conceptual-SpacesThe-Geometry-of-Thought

Bridging more than theory |-----| practice

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

A purpose of Hodges' model  is to help bridge the theory-practice gap. Theory-	' BRIDGES TO PROSPERITY 'We've built more than 500 trail bridges, serving over 1.8 million community members throughout the world. At Bridges to Prosperity, we envision a world where poverty caused by rural isolation no longer exists.'
Practice Communities Histories	BRIDGES to PEACE

https://bridgestoprosperity.org/

Suqi, R. Bridge the GAP, HTSI. Autumn Design Special. FTWeekend, 14 October 2023, p.67.

Can a whole discipline act as an interface?

Abstract

"In this article, we consider how certain types of contemporary biosocial psychiatric research conceptualise and explicate biology-social relations. We compare the historic biopsychosocial model to recent examples of social defeat research on schizophrenia and cultural neuroscience work on affective disorders. This comparison reveals how the contemporary turn towards the ‘biosocial’ within psychiatric research relies upon ideas of the psychological as an interface. This is problematic because psychological notions of ‘experience’ are used as the central mechanics of biosocial processes, but lack any meaningful engagement with considerable debates within psychology and cognitive science about what the mind, and indeed the psychological, actually is, its relationship to social life, and how we should study it. The psychological interface is therefore vital to these biosocial hypotheses but is remarkably underdeveloped in comparison to its biological and sociological components. We argue that biosocial psychiatric research could gain a great deal from engaging with contemporary theorisations of experience and being more critical of vague appeals to psychological phenomena." p.317. [my emphasis]

Fletcher, J. R., & Birk, R. H. (2022). The conundrum of the psychological interface: On the problems of bridging the biological and the social. History of the Human Sciences, 35(3-4), 317-339. https://doi.org/10.1177/09526951211070503 

Individual
|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

PSYCHOLOGY - as interface? Intrapersonal - Interpersonal Individual psychology	BIOLOGICAL
Group psychology SOCIAL

Does each of the disciplines in Hodges' model act as an interface in certain contexts/situations?

If there is a primary discipline (domain), that determines the context, is this also the interface (interstitial)? Discuss.

If care is integrated, holistic, with parity of esteem demonstrably assured should each discipline have its turn as interface?

My source/prompt:

Preparation for a conference video: 5 ppt slides, Samsung Notes drawing of Hodges' model, 7 slides.

If I can't put this together, it is still worth the effort.

World Health Day

"The pandemic is a portal.
We can walk through it with our dead ideas.
Or we can walk lightly,
ready to imagine another world."
Arundhati Roy

The pandemic represents five portals:

SOCIAL
SPIRITUAL
POLITICAL
INTRA- INTERPERSONAL
SCIENCES

On our respective journeys, 

we can reflect and think critically 

using the disciplinary-bridges provided to us:

socio-political
psycho-social
physico-political
psycho-political
socio-economic

socio-technical

bio-ethical

...

and through 
love, teamwork and perseverance
we see that ...

"Discipline is the bridge between
goals and accomplishment."
Jim Rohn.


individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

https://twitter.com/WHO/status/1247547729879891968?s=20

State of the World’s Nursing Report - 2020

Roy, A. (2020) The pandemic portal, Life&Arts, FT Weekend, 4-5 April, pp.1-2.

Caution! spanning the Theory - Practice Gap

As a new academic year begins and we endeavour to bridge the theory - practice gap we need to be cautious:


While we may not burn our bridges we need to be aware of which bridge spans are redundant and which are still active and serving their purpose.

As ever - standards, inspection, audit and governance are critical.

So in our efforts to bridge the theory - practice gap do we also maintain it?

(many) Care Transitions and The Little '-' That Could

Some people looking at Hodges' model may believe that the model perpetuates the dichotomies of old:

Human --- Machine
Individual --- Group
Sick --- Healthy
Supply --- Demand
Home --- Hospital
Self care --- Nursing care

In the 1990s as a community mental health nurse I was involved with a group of general nurses looking at ways of improving:

• discharge planning
• continuity of care

These issues remain and with the dichotomies of care above we can see how Hodges' model can assist our thinking and planning about transition. Not just one transition, but several.

This past week I was fortunate to attend one of a series of workshops -
Delivering High Quality Health Care for All: Bringing the social and technical together for a joined-up approach to deliver supporting systems and technologies
10th/11th December 2009, Leeds, UK

Organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group

The event was very good, stimulating and challenging. In the closing debate the appeal of 'socio-technical' and how to market a much needed joined-up approach in health IT came down at one point to the difference between:

'socio-technical' and 'sociotechnical'

In trying to find an alternative title, the hyphen was lost, and whilst it is not a crucial issue - for me that hyphen represents the axes of Hodges' model. Hodges' model acts as a high level aide-mémoire and that little hyphen can perform the same trick. The hyphen reminds us of the differences. The dichotomies that need to be navigated and negotiated in our dialogues about care AND caring. These are most evident in transfers and transitions (after all - "getting out of bed is a risk").

There are mini and macro transitions. Care pathways are not yellow-bricked unbroken splines from cottage to cottage hospital. They should be tortured if they do reflect person-centered experiences and needs.

Some transitions are process laden and repetitive, such as drug administration and must be protected - free from interruption. Although grounded in a social exchange of (correct) identities: a registered nurse, the right patient, right drug, right dose, right duration and right time these can be framed within the SCIENCE domain. That is where (for me) the conventional 'drug round' can be found. Counselling is another transition (if effective it also moves people on). 'Counselling' can be found in the INTRAPERSONAL domain - close to the border with SOCIOLOGY.

Other transitions and transfers are more involved:

• person's home to attend day care (for the first time!)
• person's home to residential home
• hospital ward to home
• home encounter with the crisis team
• telecare consultation
• ...

Care is constantly passed hence the need to write and record. Passed from -

person-to-person
team-to-team
team-to-carer
time-to-time
discipline-to-discipline
self-care

This is the outcome that is sought. Ultimately passing responsibility back to the individual and when applicable their family. Having formal integrated care pathways is one thing, but they are never truly continuous, clear and true. And as they say crossing bridges you may have to break step and surely different disciplines march to different tunes? Today though the most audible tune must be socio-technical. ...

Additional link: The Little Engine That Could
Image source:
Drug round tabard http://internet-workwear.co.uk/acatalog/Drug_Round_Tabard.html

Combining h2cm, Informing Science and informatics on the Rainbow Bridge

Thor

As a boy one of my favourite superheroes and subjects of myth was Thor and his retinue - Loki, Odin, The Rainbow Bridge. These remain tantalizing escapes for young minds should a corner shop sell comics.

As I mentioned previously in posting about the informing science journal, a paper currently in preparation makes use of holistic bridges and I have had in mind Thor and his ilk and Rainbow Bridge between worlds. In Hodges' conceptual framework the domains of knowledge that make up the model could almost be disparate worlds. This disciplinary repulsion presents several challenges at a time when disciplinary in-fusion is needed (demanded by our problems):

Integration of health and social care in the form of:

• physical - emotional health;
• applied socio-technical informatics
• personalised and service centred care

Academic cross-disciplinary working, e.g. informatics -

• clinical
• urban
• e-governance

Last summer I posted a suitably colourful mix of holistic bridges that included the image below. These hyphenated cross-disciplines conjoin the four care or knowledge domains of Hodges' model.

My interest in ICT began with the ZX81 in 1981 and ever since I've been intrigued as to how we can integrate the above. Why does this matter? It matters not just because of the complexity of the problems we face in in our work and home lives. The real challenge lies in communication.

To take one problem the application of ICT in health care. Here the technical world, the mechanistic butts up against - clashes with - the humanistic. The paper published in spring focused upon socio-technical structure in nursing informatics.
Structure whether virtual, conceptual framework, mythical rainbow is one thing; but what purposes can arise from structure?

In highlighting communication (critical in health care) our purpose is -

using information technology to help convey
the meaning of information in order to inform.

The two axes (or hammers?) in Hodges' model are:

HUMANISTIC - MECHANISTIC [H-M]
and
INDIVIDUAL - GROUP [i-g]

These axes provide the bridge to link informing science and Hodges' model. In the act of communicating, imparting information we may be concerned with the concept of information from its mathematical formulation, the channel, noise through to the semantics and meaning from a sociocultural perspective. This seems to match with the (horizontal) axis [H-M], while the task of informing is concerned with the agents that is the (vertical) axis [i-g].

So what is the relevance of Thor? Well that role of engaging clients (patients, carers, managers, service users....) in communication sees a group communicate with an individual and vice-versa. The processes involved are not necessarily discrete as might be captured 'on paper'. The axes of Hodges' model labelled 'information' and 'informing' become blurred.

We are constantly reminded of the multi-contextual nature of healthcare. Now, I don't know if care is suddenly more complex on a Thursday, I just figure that when Thor starts to swing his hammer there is suddenly not one axis, but a great many. We are not just aware of multiple contexts we are forced to consider the multi-dimensional too.

Additional links:

Informing Science Journal

Thor image and interesting discussion:
http://afewshotstoshaman.blogspot.com/search?q=thor

Thor - movie 2011?