Presentation: 'An example of open research sharing Hodges’ Health Career Model'

From: Ulster University Open Research Conference 2026 

Simms, V., Jacobs, N., Magee, J., De Ornellas, K., Mollik, E., Kernohan, W. G., Leacock, J., Akter, J., Sempey, C., Beech, S. E., Naz Asif, R., Yap, L. K., & Miller, K. (2026, Jan 16). Ulster University Open Research Conference 2026: Conference Speaker Abstracts. Ulster University. Advance online publication. https://doi.org/10.21251/0d7780ce-ce97-468f-b5d5-69201ca90b20

Speaker: Professor George Kernohan 

School or Department: School of Nursing and Paramedic Science Ulster University 

Email: wg.kernohan AT ulster.ac.uk 

The area(s) of open research talk relates to: 
  Practice as research; Open data/ Open code 

Talk Title: An example of open research sharing Hodges’ Health Career Model 

Abstract: 

This paper examines a blog post [see below, pj], “Thinking about a comprehensive framework for dementia,” as a case study illustrating the integration of open research practices within dementia palliative care research. The post introduces the Hodges’ Health Career Model— a four-domain conceptual framework encompassing biomedical, psychological, social, and policy perspectives— to articulate the multidimensional nature of dementia and inform care planning. As an openly accessible research communication, the blog contributes to transparent and inclusive knowledge exchange beyond traditional academic channels. 

The blog exemplifies practice-as-research, translating conceptual development from theory into a form of scholarly exposition that invites engagement from practitioners, policymakers, carers, and people living with dementia. It forms part of a wider programme of work in which the research team openly documents methods, emerging findings, and reflections across scoping reviews, surveys, and service case studies hosted on the same platform. These materials complement peer-reviewed open access outputs, including open publications. 

The project demonstrates alignment with open research principles through prospective protocol registration: the scoping review protocol is publicly available on PROSPERO. The team’s prior work on blogging as a mechanism for knowledge mobilisation strengthens the methodological coherence of using this medium to disseminate conceptual frameworks and preliminary insights.

Although the blog does not itself provide underlying datasets or analytic code, it outlines methodological approaches that could facilitate future open data practices, particularly in qualitative and mixed-methods research. Overall, the case illustrates a pragmatic and pluralistic adoption of open research methods across dissemination, protocol transparency, and public engagement, offering a model for enhancing accessibility and reproducibility in dementia palliative care research.

.

Title: “Thinking about a comprehensive framework for dementia”

Author: Professor George Kernohan

Date: 7 November 2019

Link: https://pallcare4dementia.com/thinking-about-a-comprehensive-framework-for-dementia/

"In HIFA - let's save a space to make sense of mountains of data"

Dear All, (HIFA mail list)

While rather expansive in scope not just reaching to the arts but also referencing nature and mountains, the following blog post may be of interest:

"Health & Care results in mountains of data: c/o Burke & Cao 2024"

https://hodges-model.blogspot.com/2024/08/nan-shepherd-.html

While the focus and purposes for HIFA are clear, in practice 'information' (data, facts, knowledge, wisdom) must always be contextualised, situated, and (potentially) justified.

In addition to relying on the sciences, medicine, nursing and healing practices are also characterised as arts.

See also, the digital humanities and more specifically - 'Intima: A Journal of Narrative Medicine' https://www.theintima.org/

There have been many posts about records recently, but of course it what goes into the record that is critical.

Salience, what we pay attention to is key.*

The record is critical if something goes wrong and a professional finds themselves in a Coroner's court, and/or disciplinary hearing. The previous posts also discuss the patient's access to their medical record.

I'm not sure if the point has been made but even before 'health literacy' is taken into account, given access a patient may identify many mistakes/errors within the record on many details including demographics and procedures, treatments, diagnoses applied. (There are studies confirming the same - a benefit of IT systems.)

In mental health service - England the care programme approach (CPA) has ended - been retired. Some argue this has been done 'quietly'.

While the emphasis on documentation since 1990s has been onerous for some practitioners in the need for a 'comprehensive' record, the principles of CPA are well-based in practice: Patients (families) are entitled to - 1. A care assessment 2. A care plan 3. A named care-coordinator - keyworker 4. A review 6 monthly; annually as a minimum

For more than a year 1995.., I worked full and p/t as CPA co-ordinator for Chorley and South Ribble Health Authority; and produced a report highlighting the potential benefits of information technology in data gathering and processing and information reporting. (A conference was also organised with 60+ delegates, and 10 software vendors demonstrating their wares.)

The news drove the development and introduction of CPA during the late 1980s, with often stigmatising headlines for many people affected with mental illness - including psychosis it must be added. Recent events are troubling for society and services now, and in terms of history repeating itself:

"On average over a hundred people in Britain a year are killed by someone with serious mental illness. On the day the NHS is Nottingham is found to have missed opportunities to stop Valdo Calocane killing 3 people we ask why lessons aren’t being learned." 'X' https://x.com/BeckyJohnsonSky/status/1823459379846271002

"Between May 2020 and February 2022, eight risk assessments were completed for Calocane by the trust, which the CQC said appear to have been carried out for each of his admissions to hospital and updated at other times during his care. The regulator said that while some risks were highlighted, other assessments “minimised or omitted key details”. https://careappointments.com/care-news/england/211213/cqc-review-of-nottingham-killers-care-finds-key-risk-details-minimised-or-omitted/

The state of mental health services in the UK is much debated and here too 'information' is critical, especially 'seeing' the person and the nuances of interpersonal communication skills. These are often encountered through non-verbal communication and 'clinical intuition' which must be related to professional experience.

So information must simultaneously be recognised as a mechanistic and humanistic melange of processes, purposes, practices and policies (4P's in Hodges' model).

As highlighted before we can also contrast HIFA's and practitioners efforts to combat the severe implications and risks of 'information disorder'. And yet, also recognise how the arts, innovation and creativity also contribute to interpersonal engagement, therapeutic goals, case formulation, health and other literacies using *metaphor* and *analogies* - as per Nan Shepherd's musings explored in the blog post by -

Burke, R., Cao, E. To Care for a Mountain - What medical practitioners can learn from Nan Shepherd. Oxford Review of Books, Summer 2024, Volume 8, Issue 2. p.14. In association with Stanford. (open access)

Patient, public and practitioner safety is always the aim & objective.

Further reading & notes: https://www.cqc.org.uk/publications/nottinghamshire-healthcare-nhsft-special-review-part2/risk-assessment

Whiting, D., Gulati, G., Geddes, J.R., Dean, K. and Fazel, S. (2024), Violence in schizophrenia: triangulating the evidence on perpetration risk. World Psychiatry, 23: 158-160. https://doi.org/10.1002/wps.21171

*I hope to contribute to a 'philosophy of attention' research project, my contribution will draw on clinical experience above and apply Hodges' model to explore and debate ... 'attention', starting in 2025 to c.2030.

Regards to all, Peter Jones

The Art & Science of Health: [conceptual scraps iii]

In clinical administration and informatics the question of 'ownership of information' is one of what I've described as legacy problems. Here's a stab at a definition:

A legacy problem is characterised by being:

An aspiration that presents as a problem due to its scale, complexity, and the fact that they are passed-on from one generation of professionals to another. As such legacy problems are common across disciplinary and professional groups. They are embedded within professional education, teaching, learning, practice, management and are expressed in successive  policy developments and within public and media discourse. In scale legacy problems are inherited by new learners and governments.

This is admittedly a broad brush treatment - and a work in progress (I focus upon and list the characteristics). Here, I'm not concerned with the whys and wherefores, or the minutiae. (Perhaps this post is a result of not burn-out(!?) but professional and organisational exposure otherwise known as experience?)

Clinically then legacy problems include:

• integrated care;

- across physical, mental health and social care
- between disciplines (location, co-working - teams)
- as experienced by the patient, carer (as proxy)
- financially

• holistic care;
• person centred care;
• reflective practice;
• critical thinking;

To these we can add:

• the electronic health record
• and as mentioned above 'ownership' of the record (as a whole and the data within).

The question is - are the above being miscategorised? Are they problems or features of healthcare that no matter how much you might wish you cannot dodge them?

Records are critical to the definitions of being a professional and professionalism - public safety, care planning and delivery, accountability, responsibility, research... Perhaps though the existence and consequent longevity of the above are bound to give rise to their analogues and not just their solution, but how they are framed?

Comprehensive record anyone and is that a computer before me...?

What are your thoughts - h2cmng@yahoo.co.uk I'd be pleased to hear from you. Can you add to the list?

To be continued ... [ and there's the legacy conundrum that is the National Health Service? ]

See also:

Daniel Bayley: The problem with Patient Online and the NHS App
Related posts i & ii:

The Art & Science of Health: [conceptual scraps i]

The Art & Science of Health: [conceptual scraps ii]

ii) A map as well as an app...? - c/o John Kulvicki

"Maps are picture-language hybrids." p.149.

"The features covering maps are like lexemes of a language that play a predicative role." p.149.

"Maps are pictorial in their use of space." p.149.

"Maps, pictures, and diagrams differ from language not in whether
they make use of predication, but in the way they organize predicates.
In maps, predicates are introduced holistically, in groups, as degrees of
freedom to which any location on a map must commit.
This proposal constitutes a different way of understanding the
coarse-grained distinction between maps, pictures, and diagrams
on the one hand, and linguistic representations on the other." p.150.

"In maps, failing to indicate the presence of something—a town, a river, a road, or an island—is tantamount to indicating its absence." p.150.

Kulvicki, John, Maps, Pictures, and Predication, Ergo, Volume 2, No. 07, 2015

DOI: http://dx.doi.org/10.3998/ergo.12405314.0002.007

https://kulvicki.org/

See also: i) A map as well as an app ...

"One-size-fits-all" Assurance of Insurance needed?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

mental health problems affect Self-employed, single No previous history of MH problems PURPOSE# Psychology - Counselling	12.5 million adults - 1 in 4 PROCESSES (automated?)* 'Life cover' Insurer access to GP record - deemed high-risk 500,000 people affected by
Untimely death of a parent Mother killed by drug-using driver Refused IVF treatment PRACTICE	insurance company POLICIES driver jailed Voided application for life cover (figures) suggest insurers reject up to 625,000 people a year By law ins. companies cannot discriminate

*Need to discuss an application with a person, fill in 'gaps' then less likely to become subjected to an algorithm and an automated rejection.

^# What were the reasons for referral to psychology and counselling?

My source:
Miller, L. (2018) My fight to get life cover after mental health trauma, The Daily Telegraph, Money, 22 September, pp.1-2.

See also: https://www.telegraph.co.uk/insurance/life/get-life-insurance-mental-health-problem/

Technology can, will and is helping to 'disrupt' the insurance market.

Ticks in boxes and triplicate thinking

Having things in triplicate may be reassuring from an admin perspective. ...

That said, 1st year learners on wards can relax to focus on learning, not having to worry (too much) about the administration - the running of the ward 24/7.

Very soon though years 2... 3 come knocking and they must consider due process, they have to question and get to grips with the established routine that sets and keeps several plates spinning.

Of course IT has by and large (?!) removed the need for paper carbon copies (although those three copies should have three distinct purposes).

Despite that an obsession with ticks in just three boxes may not be enough when it comes to high quality multidisciplinary, holistic and integrated care - it's ticks in the mind and attitude that count.

Additional links:
Records Management Society

The Productive Ward

Image source:
Triplicate Girl - http://upload.wikimedia.org/wikipedia/en/6/63/Triplicate_Girl_LSH3.jpg

FROM: Personal Forms, Paper Forms and e-Forms TO: Forms of Transparent and Opaque Support

It is hard to outrun paperwork.

Even though the promise of a great E-scape has been around for so long that the original pronouncement has become an eerie technology-enhanced echo.

Even before we arrive at the paper forms that are the bureaucrat's delight, there is in our mind's eye a personal idealised version.

This is in turn a product of the professional training and experience to which we are subjected. The quality of this personal idealised version is also affected by individual traits (aptitude and attitude) that are further shaped by the situation and the unique individual(s) who becomes the focus of our undivided attention.

This personal form, its gestation and sustenance is important because it affects the other forms:

• paper forms - policy, legacy (we've always done it this way);
• theoretical (academic-the idealised standard) form(s);
• electronic forms:
• the computer based record
• scanned - archived forms (electronic document management systems)
• and other variations (e-mails)

- and how they are received, adopted, owned and used. ....

Very frequently we need to listen. No. I mean really listen. Not just to one person, but two and more people verbally (with yet others non-verbally). People like to play tennis and when they start slugging it out they often seek a referee. There you are, having to 'write' things down, but you are still learning the(ir) rules. And anyway, writing things down on paper or e-form is a distraction for all. This IS NOT a problem (the problem's the grunting you can hear in the background). It is just a natural interface. As with any communication hand-over or transition point we need to take care, to be safe, efficient and effective.

Another personal form has of course arrived in the very humanoid (person-centred!) shape of self-assessment and the personal health record. There are new challenges in how these hybrid, composite record forms are defined, interoperate, cooperate, and how they will be governed and are seen to accrue measurable (holistic) benefits.

If these different forms prove seamless in use and achieve transparency, well that is quite a trick. If alternately the forms are opaque then the misfit will quickly become apparent. So, have you got the forms? Or is that just the way you walk?

Soft thinking: Care Ideals & Real World Constraints

It would be marvellous to be able to practice comprehensive care in terms of assessment, planning, intervention and evaluation (apie). In reality of course the world at large conspires to upset the best laid plans. Let's call them constraints it sounds better.

Away from the theory there are so many constraints in practice that maybe they should be reflected in software applications or e-learning on Hodges' model? Now if you are looking for rocket science then please read no further, since what follows does not even qualify as a plastic bottle rocket project.

Let's imagine we are creating a data entry form for Hodges' model. Users of the form can specify a care domain and enter a care problem. The first constraint and a true reflection of the real care world is that the number of problems 'allowed' is limited; it might be 3 per domain, or something like this:

intra-INTERPERSONAL = 3
SCIENCES = 5
SOCIOLOGY = 3
POLITICAL = 4

So there's an essay for you: What would your total be? What if the fifteen possible problems can be allocated with the further constraint that a domain cannot exceed five in total? Does there need to be a minimum of at least one problem in a domain? What year is it? Are 'problems' a bit old hat? What about the individual's strengths?

If on completion (whenever that may be) the patient (plus carer...) has defined a set proportion of the problems, then there is one measure of holistic care. A further holistic measure could be the number of ticks for those four stages of care - apie. It does not take much when painting with care constraints and numbers to find complexity. And this does not even touch the surface.

Records 2: Flying the standard

'Records I' was posted last September, time to revisit this theme...

If I am a real champion of Hodges' model, convinced of the value and care-worthiness of this 21st century conceptual framework then why have I not been an agent of change@work?

Surely, I would not have stopped short of stepping on toes, or letting a lack of evidence get in the way of advocating the model as a solution to real problems? So why haven't I been the standard bearer where it really matters - on the shop floor? Excuses are many and include:

• the personal - part-time nature of my combined nursing-informatics interest;
• following local policy Care Programme Approach [CPA];
• professional accountability - risk assessment and management and working as a CPA lead;
• watching with interest as the Single Assessment Process joined the fray;
• and even more recently the Common Assessment Framework;
• plus, and this may be a cop out - I like people to decide/discover things for themselves.

Having been away from the clinical practice from Nov 2004 to last summer I was informed as to how much things had changed. After a short period of time I realised on the contrary how little things had changed.

We are still completing paper documentation designed for risk assessment, service engagement and case management of younger adults. Sometimes this focus and attention is justified with older adults, but this is rarely the case. Case files end up with pages of redundant white-space, white noise that slows what we might call conventional information retrieval.

It has been recognised for a long time that IT systems are key to unlocking multidisciplinary working and joining the dots of policy across health, social care and associated care sectors. The outcome of the CPA review is due later this month, it will be very interesting to see the direction this takes and what hooks there are for Hodges' model. The hooks I can see and well and truly intend to snag my lip upon here include:

• "paperless working";
• self-assessment;
• e-working at the point of care;
• collaborative working and treatment with education interventions;
• individual budgets and new commissioning models;
• social inclusion, social enterprise;
• social capital and employment.

Ultimately, I do believe Hodges' model will find its niche - why? Clearly, the 4P's with records and policy in particular are becoming ever more complex. At times like this a tool to -

simplify and summarise : engage and educate

- must have a place in our curricula, paper and e-record systems, client's and carer's hands and our cognitive tool sets.

Ack: links Care Services Improvement Partnership.

Records I: Idealism, Comprehensiveness and who's that behind the tree?

[Opening thoughts: Even in the 21st C. idealism peppers more than philosophy; influencing education, professionalism (in all fields) and much more. The comprehensive ideal is not just the preserve of education; it is spread widely...]

Where does idealism lie in records?

If you are a health or social care student reading this, then (hopefully) a good dose of idealism (plus your bursary and future prospects!) drives you on. This idealism, transformed into motivation, helps to ensure that your written efforts - both course work and clinical notes - are worthy of earning the ticks-in-boxes and your mentor's signature. These in turn reflect your aspirations as a professional and all that entails.

Your clinical records and theoretical accounts of care (assignments, case studies...) must also play the role of a bridge facilitating travel between practice and theory. Your idealism makes you a runner, an athlete of the gaps. As a student you are still learning how to navigate the QUAD. What is this 'space'? What corners can you cut? No, first let's cover the corners that must remain forever 90 degrees! As a student - and a lifelong learner - you help question existing practice.

As soon as we first pick up those crayons we realise that comprehensiveness is readily applied as a measure for many processes in which '100%' becomes or is associated with the ideal. The usual association calls upon comprehensiveness as a property of information - as are validity, accuracy, timeliness and others. Records and information do not sit still. They are full of energy. True, when the archivist gets hold of them that energy may be potential rather than kinetic, but in use they are multicontextual and travel takes time. Perhaps, this is how - as our records (and information) travel hither and thither - comprehensiveness sticks out its big foot and trips the unwary traveller. As all learners negotiate the QUAD, they need guidance, support and protection. The QUAD really is a learner's paradise, but there are dangers out there amongst the sun-dappled trees....

Keep your (socio-technical) eyes open, because sometimes when you least expect it comprehensiveness teams up with idealism AND policy to create conceptual (if not practical) mayhem. Tree of knowledge - yes sure - but keep an eye on the fauna.
More to follow...