Julian Tudor-Hart 'The Inverse Care Law' - c/o The Lancet

On the bottom of my notes re. Giarchi and 'distance decay' I'd written:

'Inverse Care law - p.60. - Giarchi. "those who suffer more ill health are less likely to be assisted."

It made me wonder about the origin of this law having posted about it in 2020.

The Lancet has an editorial and an associated podcast:

50 years of the inverse care law. The Lancet, Volume 397, Issue 10276, 767. February 27, 2021.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00505-5/fulltext

'“The availability of good medical care tends to vary with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.”

These understated opening lines of Julian Tudor Hart's paper, The Inverse Care Law, are as relevant now (50 years to the day since publication) as in 1971. The paper is one of the landmark publications in The Lancet's near 200-year history, and the resonance of Tudor Hart's definition of the inverse care law has global and timeless importance. Simply expressed, Tudor Hart observed that disadvantaged populations need more health care than advantaged populations, but receive less.

Tudor Hart's life and career took him from highly privileged beginnings in London and Cambridge to decades spent in the deprived and deeply socialist Welsh valleys. His experience and work has inspired a generation of influential health-care leaders including Andrew Haines, Allyson Pollock, Cesar Victora, and Graham Watt. Today's anniversary issue of The Lancet explores both the global reach of the inverse care law and primary care initiatives in deprived areas around the UK.

Although inequality in health and its many causes are widely understood, inequity in health-care service provision is enduring and fundamental: an intractable concept that lies at the heart of the inverse care law. The inverse care law is primarily about inequity (injustice) in health care that results in unfair social inequalities (imbalances) in health. Since the inverse care law was published, the UK's National Health Service (NHS) has strived to reduce inequity with mixed success. Notably, long-lasting progress was achieved through the 1970s resource allocation formula, which reduced geographical inequality in hospital and institutional expenditure. In the early 2000s, the NHS strengthened primary care provision in disadvantaged areas, leading to a temporary reduction in social inequality, although this progress has reversed following shifts in funding, a slowing of spending, and years of living with austerity.'

See also: 

https://en.wikipedia.org/wiki/Julian_Tudor-Hart

https://www.chpi.org.uk/blog/julian-tudor-hart-and-the-essence-of-primary-care/

ii Editorial: Persistent Positive Change in Challenging Times ...

To Howden's editorial it's worth highlighting that Hodges' model is situated. So, whether the 'challenge' that is faced is individual, or collective Hodges' model can help to identify the issues, problems, strengths, opportunities, threats, where we are, where we would like to be and more. Surely, reflection, critical thinking is about confiming, or regaining our perspective, correcting our orientation or improving alignment and synchronisation with others? The time this entails, whether exercised on paper, or cognitively (yes, humans thinking is still an option) this is equivalent to a time-out even if momentary. This can be critical in clinical encounters, were emotions are raised, or there is risk of escalation.

So whether the challenge is personal, lived experience, bullying, finance, physical, or mental health, simulation (fidelity, testing), ethical ...; or collective (a team) - service and organisational change, major incident, policy, clinical or management supervision, whistleblowing, public / patient engagement, complaints and challenging relationships; Hodges' model is a tool (one of many) to call upon.

It could be the context causes you to focus on one or two care (knowledge) domains. Or, there is a need to step back in order to 'see' the big picture (integrated care, risk assessment, holistic care, psychosocial view ...) - the spiritual too.

While Hodges' model is simple, please consider this: there aren't many tools that can facilitate articulation and dissemination of the 'big picture' in a form that is (imho) readily transferable and translatable.

Howden, S. (2025). Editorial: Persistent Positive Change in Challenging Times. International Journal of Practice-based Learning in Health and Social Care, 13(1), ii-iii.

Editorial: Persistent Positive Change in Challenging Times - IJPCLHSC

'What then is the common theme for this issue? It is the persistence of these authors, practitioners and academics to be curious about what could be better and engage with scholarly enquiry to advance practice-based learning.' 

The editorial introduces the content of -

International Journal of Practice-based Learning in Health and Social Care Vol. 13 No 1 August 2025
https://publications.coventry.ac.uk/index.php/pblh/issue/view/96

Howden,  S.  (2025).  Editorial:  Persistent  Positive  Change  in  Challenging  Times.  International  Journal  of  Practice-based Learning in Health and Social Care, 13(1), ii-iii.

- which I have mapped to Hodges' model (with some additions):

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

restlessness (- in mind) (curiosity) patient's lived experiences* intra- inter-personal pastoral support engagement - enjoyment workshop, case study ... psycho-	restless legs syndrome remote, rural, urban community-based :: clinical settings (infra-) structures processes - procedures simulation, major incident forensic, podcasts
-social factors interdisciplinary (integrated?) working social structures (This is how we 'do it' here)	'Institutional? “positive restlessness"' *clinical subjective exposure  (determinants of health) organisational (Inst.) structures

<>

The final paper is on workshops and continuing professional development:

Kenny, B., Bourne, E., & Li, J. (2025). Knowledge Translation from Clinical Education Workshop to Workplace. International Journal of Practice-based Learning in Health and Social Care, 13(1), 56-76. https://doi.org/10.18552/ijpblhsc.v13i1.1084 

The editorial notes:

'The authors integrate goal setting as part of a development session on supervision skills and follow up survey, to ask what happened next in relation to their goals and practice. When resources are scarce and CPD is so critical, these ideas about enhancing workshop effectiveness and feeding participants’ experiences back into sessions has never been more important.'

When presenting Hodges' model at events I will often tick for a workshop. This reflects former work experience with student nurses, OTs, social workers and other learners: when a workshop could cover the some 2 hours with a break in the middle. Hodges model is flexible, adaptable and in a workshop can be applied on an individual basis, or small group work - breakout sessions [this does not necessarily mean the participants are bored :-)]. A wide range of learning and teaching approaches can be considered. 

Kenny, Bourne & Li utilise role play, case studies for example, their approach and paper framed by the KTA Framework:

'Workshop design was underpinned by the Knowledge to Action (KTA) Framework. KTA acknowledges the importance of social interaction in the adaptation of research evidence, taking account of local context and culture (Graham & Tetroe, 2011).' p.58. ...

'The KTA framework comprises two major components: knowledge creation and an action cycle. During the workshop, knowledge creation was supported by CEs identifying factors that contribute to challenging clinical education situations and reflecting upon the impact of these factors in their workplace contexts. During Part 1 of the workshop, attendees focussed on understanding challenging situations. Each group was assigned a case study that included a complex mix of student, educator and workplace factors thatinteracted to create a challenging learning situation.' p.58. ...

'A focus on active learning within the workshop prepared CEs for translation of their knowledge of supervisory practices when they returned to their workplaces. In Part 2 of the workshop, CEs worked through a structured process for managing placement challenges by engaging in peer learning role play activities. The process was adapted to address challenges that included mental health issues in workplace learning, developing professionalism, providing inclusive learning environments, and facilitating clinicalreasoning and reflection.' p.58.

  clinical educators (CEs)

Reading KB&L: I wonder if Hodges' model provides a more 'accessible' map - as an output / summary, evidence of learning and teaching activity? 'Filtering' would be essential of course, as to what exactly is mapped. While I've no evidence (in theory), Hodges' model in being (imho) accessible, might also be primed for transferability (after all what does transferable mean?^); by being recognised more consistently across larger groups, and (as per the conclusion) other individuals, and broader educational contexts.

Currently, working with three co-authors on a draft paper revision (dental health and policy frameworks) for a journal, I noticed our leading author refers to 'translational'. In the paper below, (cited by KB&I): 

Graham, Ian D. PhD1; Logan, Jo RN, PhD2; Harrison, Margaret B. RN, PhD3; Straus, Sharon E. MD, MSc4; Tetroe, Jacqueline MA5; Caswell, Wenda RN, MEd2; Robinson, Nicole6. Lost in knowledge translation: Time for a map?. Journal of Continuing Education in the Health Professions 26(1):p 13-24, Winter 2006. | DOI: 10.1002/chp.47

Graham et al's, Table 1 Definitions of Terms, is (still) really helpful.

See also on W2tQ: 'reflect' : 'holistic' : 'map' : 'situation'

^Translation; transfer - dual, two-way, inversion?

Editorial: "The Meaning of Concept Analysis" i

Nursing Science Quarterly (NSQ)

 

 

This editorial, "The Meaning of Concept Analysis" is open access and concerns an academic activity that is 'bread and butter' in nursing theory. It is well worth reading, for students too.

"The purpose of this editorial is to clarify the meanings of the term concept and analysis and to offer some guidelines that show what is appropriate for publication of concept analyses."

 

The editorial is helpful in encouraging the effort here, even as it suggests I would be wasting my time, the editor's and referees (although quarterly has a certain appeal).

 

 

The journal's role and purpose is clearly described:

"Nursing Science Quarterly is unique in that it is the only journal devoted exclusively to the enhancement of nursing knowledge. Only Nursing Science Quarterly publishes original manuscripts focusing on nursing theory development, nursing theory-based practice and quantitative and qualitative research related to existing nursing frameworks, contributed by the leading theorists, researchers and nurse executives. including nurse theory development."

I've enjoyed the freedom here, on the periphery of academia. Afraid at the same time that this 'h2cm' obsession has, will ... impact my objectivity, subjectivity - by way of attitudes, openness and view within and without of nursing, in theory, practice and management. Added to being able to carry the weight that is nursing (responsibility). The load is made-up of history, the legacies, the global academic balance (or not), the current global state of the profession, the fight for professional recognition and more. All rolled-up, and rolled-out when the challenges of the 21st century warrant it. Yes, the future is always - out there.

Concepts are key in Hodges' model, as a conceptual framework, as a series of conceptual spaces, as domains for threshold concepts and much more. I think I'm struggling now, as I always have in giving 'a' concept my critical attention, and its being in uniform. Concepts are always 'seen' as a gestalt. This may explain why I'm not an academic and definitely not a professional philosopher. The editorial notes:

"Examples of some analyses of concrete concepts that would not contribute to discipline-specific nursing knowledge and therefore are not worthy of publication include nursing overtime, nursing shortage, cultural competencies, medical diagnoses, precision health, big data, sensor technology, health economics, omics, and symptom science, among others."

I have mapped these concepts to Hodges' model below (underlined), and added in italics some associated concepts:

 

 

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

psychiatric diagnosis data ethics [person-al] symptom science [here] person-centered care / health emotional/spiritual intelligence	medical diagnoses, precision health, big data sensor technology, omics, and symptom science procedure x,y,z - cost $$$
cultural competencies social prescribing health literacy public understanding of sciences	nursing overtime nursing shortage nursing crisis? data ethics [COP15] outcomes - patient safety information governance health economics

As an exercise you may like to consider the following, as relates to the care - knowledge domains of Hodges' model?

"For the discipline of nursing (which includes the extant theories and frameworks) appropriate analyses of abstract concepts that contribute to the advancement of discipline-specific knowledge include self-care, wellness, well-being, self-esteem, courage, trust, burden, comfort, resilience, betrayal, shame, and authentic presence, among others."

Along with the concern about my preoccupation with Hodges' model, every time I type reflection, reflective practice - it hurts. It feels like another form of navel gazing, and yet the need for reflection, and reflective practitioners, producing critical thinkers and reflective practitioners is recognised world-wide.

I can't help but get a sense that concept analysis is nurse's navel gazing. If I sound critical, it would be a greater problem if this was the view of others outside nursing? Maybe, this point itself, validates the production of discipline-specific knowledge for nursing? I can't escape though, the feeling that there is something limiting, narrowing, even apolitical here: (Is there a global nursing crisis)? There has been much needed conceptual work on race, justice, gender, equality [google 'concept analysis, ...']. I realise my expansive approach can - and does - fall dead from the press. If I can blame the Atlantic, then I hope that pluralism still has a role to play?

 

Parse concludes:

"Nurse researchers and emerging scholars should answer four questions before launching a concept analysis that could be worthy of publications.

1. Is the concept an abstract expression to illuminate the essences that can contribute to nursing knowledge development?

2. Is the conception critical to the advancement of discipline-specific knowledge?

3. Which extant concept analysis model is appropriate for this concept?

4. Will this concept analysis be worthy of publication in light of its level of abstraction and possible contribution to nursing science?"

In the 21st Century concept analysis will have its place, being key in philosophy, linguistics, ethics, law, artificial intelligence ... and yes, nursing too. But increasingly I think the true power of concepts (in theory, practice, management, policy) is found when they are related and conjoined.* 

More to follow ... then silence ... for a time ...

Parse RR. The Meaning of Concept Analysis. Nursing Science Quarterly. 2023;36(1):5-5. doi:10.1177/08943184221131957

*To state the obvious.

Editorial: "COP27 climate change conference: urgent action needed for Africa and the world" c/o HIFA

Dear HIFA colleagues,

Chris Zielinski and colleagues achieved a remarkable feat by publishing a climate emergency editorial simultaneously in more than 250 journals. What does this tell us about communicating health research to policymakers?

https://bjsm.bmj.com/content/early/2022/10/18/bjsports-2022-106442

The point was 'to demonstrate the united will of the medical profession, including all areas (nursing, mental health, veterinary medicine, etc.), to combat the health effects of climate change'.

The key message of the authors is to urge 'wealthy nations to finally step up', particularly to realise 'the promised target of providing US$100 billion of climate finance a year... ensuring these resources focus on increasing resilience to the existing and inevitable future impacts of the climate crisis, as well as on supporting vulnerable nations to reduce their greenhouse gas emissions'.

The message is supported by a well-worded case, and by a string of references to published research.

The piece is jointly authored by the editors of medical journals, which was presumably a deliberate decision to emphasise solidarity rather than including climate scientists and others.

In relation to 'communicating health research to policymakers' the exercise suggests more can be achieved when scientists work in solidarity and cooperatively than individually and in competition.

It will be interesting to see what happens at COP27. Will there be major steps forward along the lines that this editorial calls for? If so, what were the key contributing factors to the decisions made? One suspects the shared voices of 250-plus journals will play an important role. Moreover, their solidarity and cooperation is in place and ready to take on the next major advocacy challenge.

Best wishes, Neil

Joint Coordinator, HIFA Communicating health research https://www.hifa.org/projects/new-effective-communication-health-research-policymakers

Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil AT hifa.org Global Healthcare Information Network: Working in official relations with WHO

Editorial: Sex, gender and nursing

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Distinct concepts: personhood Gender identity Personal ethics/values Self‐identified gender Conflates sex and gender. The individual—not external others—identifies their gender identity/sex ... on the basis of subjective experience in which the person determines their identity as a man or woman on the basis of how they feel... Individual dignity Natal sex, gender, transgender Informed decisions My understanding/stance on sex - gender Young people who express feelings of gender dysphoria Biological sex—once one of the most solid and indisputable of ‘facts’ in healthcare

Academics and Researchers Sex is taken to refer to a biological reality which is observed at birth and distinguishes between male and female—normally on the basis of external genitalia | polarized discussion | Also determined at biochemical and chromosomal level and basis of internal and external organs Anatomy and physiology texts? Intersex? Binary: MALE :: FEMALE Biological essentialism Sex identity of the baby Documentation Puberty blockers for young people

- a social construction Evidence of ideological custom and practice Gendered Familial Care Work* Nurse clinicians (practice) and Researchers Cultural & social values and attitudes Gender: Feminism and women's studies Stereotypical behaviours and roles; male and female behaviour—the masculine and feminine Domestic abuse and sexual violence Social media debate Gender theorists - socially constructed ways of being

Dignity in Human Rights [SDGs] Gender inequality, Law ‘chestfeeding’ and ‘birthing partner’ Sex‐based rights Policy makers Activism, Protest movement 'Woke' movement Polarised DEBATE:NO debate GC Academia Network Implications for nursing Data? Service delivery and planning?

 My source:

Ion, R., Patrick, L., Hayter, M. and Jackson, D. (2021), Sex, gender and nursing. J Adv Nurs. https://doi.org/10.1111/jan.14843 

I am emphasising the distinction between quantitative and qualitative research, mixed methods also acknowledged.

The first section for me is supportive of a conceptual framework.

The SDGs are added as this debate must simultaneously address sex and gender from within nursing and as nursing is theorised and practised on an individual and population (collective) basis.

*See also: [c/o HIFA]

https://web.uri.edu/research-admin/gendered-familial-care-work-and-public-health-crises-conference/

Editorial: ".. Situating ‘illness narratives’ in recovery and mental health treatment"

"Models that put patients’ narratives at the core could perform as a connecting mechanism that provides a process to take account of ‘personalisation’, which is likely to create a better fit with individual context, structure and the complex diverse realities of recovery-oriented practice and routinely provided interventions." p.1.

 

Khan, N., & Tracy, D. (2021). The challenges and necessity of situating ‘illness narratives’ in recovery and mental health treatment. BJPsych Bulletin, 1-6. doi:10.1192/bjb.2021.4

 

INDIVIDUAL

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP - COMMUNITY - POPULATION

co-concepts: 'recovery' & ‘illness narratives’-  ‘Person-directed’ - Define 'recovery' psychologically (my understanding of this?) - Acceptability of terms 'service user', 'patient'... - Patient autonomy* - CHIME framework: Connectedness, Hope - - Identity, Meaning values - - Symptom reduction & individual recovery? - Measuring Recovery - reflection and critical thinking - personal individual storylines - 'Access' to information - personal narratives & construction of meaning - ‘narratives on social reality’ - 'Lived experience' Peer Support - Advanced planning: IF  THEN ... for me ... - ‘palliative psychiatric care’ -

- co-concepts 'recovery' & ‘illness narratives' - 'Professionally directed’ treatment - Define ''recovery' clinically (my understanding  of this?) - Conceptual Framework: CHIME - - Connectedness, Hope – optimism, Identity, Meaning – purpose, and Empowerment. - Symptom reduction & individual recovery? - pathology, clinicians as ‘chemotherapists' Px pad - Measuring Recovery - Mental Health (Min) Dataset (decades) Data? - h2cm: as simple/complicated as needed? - - a measure of holism, integration ...recovery? - - can conceptually encompass all 'spaces' - h2cm remains a response to legacy issues - - person-centred care - - holistic care/ ['holistic bandwidth'] - - integrated care - COVID-19 a corollary in ‘long-COVID’? - 'Biology' coercive and  impersonal

Practitioner Socialisation - (learned paternalism?) CHIME framework: Connectedness, Hope, Meaning - values ‘Person-directed’ Patient/Carer experience of CPA collaboration - care planning - - case formulation - - and small group work - - Meaningful illness narratives are a gift exchange: providing meaning, emotive steadiness - - narration & collective experience - - Anthropological models of Recovery - 'Illness behaviour' - pre-existing underlying relationship between the person and their illness - - healthspan, health career, career span - dialogues remain contested: patiency, recovery - ‘authentic alliances’ -

- 'Professionally directed’ treatment - 'Recovery' spans Quality and Quantity - Professionals ‘mainstream’ recovery concepts to their advantage? - Recovery-orientated practice guidelines for service provision include: --personal recovery --recovery-oriented services --provider competencies - *Patient autonomy: can it be 'exercised' here? - CHIME framework: - - Empowerment, Identity (am I seen/heard here?) - Care Programme Approach as Policy c.1991... - - Assessment, Care plan, Review, Care Coord. - - Role in Personalisation & Recovery? - ‘Illness management’ 'Illness problems' - ‘corporate’ recovery/criticism

  

My source: Twitter

'Recovery' on W2tQ:

https://hodges-model.blogspot.com/search?q=recovery

Jones (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. Int J. of Person Centered Med. 3,4,305-311.

Infinite space: Where do you 'read' the model?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

"The mind is king of infinite space, Hamlet said, "A book is better to read in the spot of choice..."	... and no better spaceship has yet been found than a book." "... 4.38 million books -
"But if one is banged up by lockdown, a book is a rope of knotted sheets."	- were bought in the first week of this month." "Escape is not the same as escapism."

My source:

Editorial, Infinite shelf space, The Daily Telegraph, 8 October, 2020, p.15.

Editorial: Dismantling racism in education: In 2020, the year of the nurse & midwife, “it's time.”

Maya Angelou:

"The plague of racism is insidious,
entering into our minds as smoothly
and quietly and invisibly as floating airborne microbes enter into our bodies
to find lifelong purchase in our bloodstreams"


individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

Mind (My) Education [Student - Teacher] Individual Ideology Cognitive bias INDIVIDUAL RACISM  reflection - cultural humility SUBJECTIVE Covert Racism  (What information I choose to share/not share) Mental Health Nursing Mental Health Disparities Healthcare Disparities (lived individual experience micro-MACRO aggressions) Cognitive access, languages NURSING?: "Abstracting the individual from

Body COVID crisis Physical Health (General) Nursing Covert Racism Overt Racism Geography - Areas Population Ethnicity Physical environment Statistical evidence - BAME/BIPOC population OBJECTIVE RACE: Physical access - Health access -> BURDEN OF DISEASE 'Placement' variation in experiences. Race in the curriculum - jaundice, "The colour of my skin is..." The visibility of 'whiteness' ..." (Visibility of gender in research...)   Silence is NOT                    (Profiling:) Racial

the context of a racialised society through well-meaning attempts to individualise care must also be critiqued." "Nursing's  ̳transcultural‘ or  ̳multicultural‘ practices, where proficiency is measured by gaining more ― ethnocentric knowledge" Social Determinants of Health Socially determined health risks Covert Racism/subtle abuse (Information I don't read/hear of...) Overt Racism Interpersonal exchange: Outright abuse (criminal) Healthcare Disparities (as experienced collectively micro-MACRO aggressions)  Sinophobic abuse of Asian/Chinese peoples  Social isolation Social exclusion  Social inclusion Social justice, fairness, equality, equity What does 'teamwork' really mean? Peer group (belonging) STRUCTURAL

neutral                                           Violence Education Inst. Diversity in Nurse Education Professors, Degree attainment ... Power: Faculty - Students - Race 'neoliberal discourse' Law & Order The 'Protected Characteristics' Codes of practice - Worldwide Institutional Ideology as 'sustained' in Org. Structures  [policies, governance, audit, reporting] Covert Racism Overt Racism - Political Groups (even if banned) Employment - Short-list, Selection Tokenism Healthcare Disparities - measures - change? Visible BAME/BIPOC in Faculty  "If you can‘t see one, you can‘t be one." #BlackLivesMatter curricula CHANGE championed by - Nursing and Midwifery leadership - RACISM ............ "No SIIR!"

The 'can of worms' that is SIIR infects, pervades and moves around each and all the care domains above and can affect the spiritual also. It can no longer evade individual, collective and institutional attention: action must follow.
.
SIIR: structural, individual and ideological racism

A. Burnett, C. Moorley, J. Grant, et al., Dismantling racism in education: In 2020, the YEAR of the nurse & midwife, “IT'S time.”, Nurse Education Today (2020). https://doi.org/10.1016/j.nedt.2020.104532
https://www.sciencedirect.com/science/article/pii/S0260691720311916

"Nurses' ability to reflect on their practice is vital to the profession" Is it?

I beg to differ with the title of this editorial, as I wonder how vital reflection really is; and not just to nursing, but to the profession. I wonder from the rather detached perspectives of:

• Wigan Pier - and the parochial view this engenders (#globalhealth - where on Earth do I think I am?);
• As a 'local' nurse practising in Bolton;
• As a mental health nurse practising in the community within the NHS
• As a champion of a pivotal* resource for reflection and critical thinking (where is everyone?);
• and several others ...

Nursing Management

Quinn notes how "Nursing continues to develop to meet the needs of the society in which it operates." Plus: "A core part of revalidation is the ability to reflect on, and learn from, our interactions with others." My reading of Kinchin (and others over the years) suggests that reflection needs to be more a practice and revalidation based. I understand this is not what Quinn is saying in this issue on "Reflection as part of revalidation". Reflection using Hodges' model can be preemptive and anticipatory. We need to get beyond introspection and the retrospective important as this is.

As to where people are, it seems they are elsewhere, maybe reflecting in the sciences domain seeking theories and evidence. Perhaps, current teaching and exposure to models and theories of nursing and healthcare has them reaching for 'pure' models of reflection - Boud, Gibbs et al. when necessary. As we talk about the legacy issue that is integrated care, in Hodges' model here is a tool - a 'freebie', a 'takeaway' yes an Ubercare, that can grow with students, newly qualified nurses and experienced staff as lifelong learners.

Now that is vital to me. When reflection is hard-wired**, a part of a practitioner's cognitive apparatus and their educational toolkit to share with the public explicitly or implicitly as the context and engagement demands.

*Pivotal? Yes, and of course in light of the above, I'd be pleased to explain and even argue the case. The irony here is the current (ongoing!) focus upon recruitment and retention. Hodges' model is 'just' a tool, I recognise this; but could the application of Hodges' model energise, inoculate and so prime students for their course of education and practice placements?

**soft-wired too - humanistic

Quinn, B. Nurses' ability to reflect on their practice is vital to the profession, Nursing Management, April 2019. 26:2, p.5.

VOGUE: As they say - don't judge a ''book' just by its cover ...

... there is a resource to help you really reflect!

individual - self

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group- population

"The 16th spot on the cover will appear  in print as a silver reflective mirror, to  show how you, the reader, are part of   this extraordinary moment in time –  and to encourage you to use your own  platform to bring change."	FORCE CHANGE
Vogue, September cover	CHANGE FORCE

*Whatever your chosen career at this 

point in time and throughout your 
lifelong aspirations and learning.

Best wishes!

Cover image source: Vogue.

Paper: IJIC - Building Competencies for Integrated Care: Defining the Landscape c/o Miller & Stein

individual

|

INTERPERSONAL : SCIENCES

humanistic ---------------- Integrated Care --------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

"Transformation does not only involve gaining new knowledge and skills but a more fundamental* shift in our conceptual paradigms about our roles, responsibilities and relationships." [RRR] Clinical integration (mental health) through person-centred care of someone's health and wellbeing	building blocks 1. Electronic health records, Functional integration (data, information) Uni-professional education   Clinical integration (physical health) through person-centred care of someone's health and wellbeing
through the active engagement of service users as partners in care    Act-ions - Practice [RRR] social change [ My obs.: Health literacy - need for a generic framework - for health education arbitration - as there is a sociopolitical dispute] Professional	through the active engagement of service users as partners in care 2. Budgetary processes, 3. Governance structures [RRR] political change (inc. policies, professional bodies...) Organisational & Systemic integration integration Normative integration

*There's that word again...

Q. Reflect upon the following using the above model - not only the text but the model itself:

"To achieve the transformation required by integrated care, this means three things: we need to include the principles of integrated working into our formal education and training systems; we need to recognize that learning continues in our workplaces; and accept that we ourselves will be informal educators throughout our careers."

The following dimensions are listed in the editorial and above :

• Dimension 1. Person-centred care (i.e. the improvement of someone’s health and wellbeing through the active engagement of service users as partners in care)
• Dimension 2. Clinical integration (i.e. care services are coordinated and/or organised around the needs of service users)
• Dimension 3. Professional integration (i.e. existence and promotion of partnerships between care professionals that enable them to work together)
• Dimension 4. Organisational integration (i.e. the ability of different providers to come together to enable joined-up service delivery)
• Dimension 5. Systemic integration (i.e. the ability of the care system in providing an enabling platform for integrated care, such as through the alignment of key systemic factors like financing and regulation)
• Dimension 6. Functional integration (i.e. the capacity to communicate data and information effectively within an integrated care system)
• Dimension 7. Normative integration (i.e. the extent to which different partners in care have developed a common frame of reference of vision, norms, and values on care integration)

Miller R, Stein KV. Building Competencies for Integrated Care: Defining the Landscape. International Journal of Integrated Care. 2018;17(6):6. DOI: http://doi.org/10.5334/ijic.3946
 

Editorial: Exploring the relationship of threshold concepts and Hodges’ model of care from the individual to populations and global health

At the end of July I was contacted by the editor of the journal Revista CUIDARTE published by Programa de Enfermería de la Universidad de Santander UDES and invited to write an editorial. There were publication guidelines and a deadline: two weeks. Despite my astronautic aspirations my feet remained on the ground as I realised that I am surely filling a gap.

There were other family pressures at the time, but I already had the draft paper on Hodges' model and threshold concepts. After some thought and work the draft was reduced from 5600 words and 56 references to 3600 and 20 references. The example of Deprivation of Liberty was removed to include more generic subject matter in the themes of global health and development.

Whatever the reason (and editors please note...) I greatly appreciate this opportunity to further disseminate Hodges' model and threshold concepts. Greater still is the privilege to contribute to a community who provided me with one of the highlights of my nursing career in 2011.

Here is a video introduction (English):

Exploring the relationship of threshold concepts and Hodges’ model: https://t.co/BRMJRjguwK a través de @YouTube

— Revista CUIDARTE (@RevCuidarteUDES) August 31, 2017

Jones, P. (2017) Exploring the relationship of threshold concepts and Hodges’ model of care from the individual to populations and global health. Revista Cuidarte. 8(3): 1697-720.

How do you define person-centredness? Editorial c/o Dewing & McCormack

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Individual values, choices and preferences* What matters to the patient. person-centredness = hard to define? compassion (the 6Cs) PERSON-	"We believe that a focus on person-centredness provides an opportunity for nursing to rise above particular theoretical 'fan clubs' and work within a coherent set of principles that are multivariate, context nonspecific and trans-specialist." Dewing & McCormack (2017). measures?
measures? A certain type (quality) of nurse-patient relationship Community of Practice Culture - isolating?	-CENTREDNESS *You can - as a nurse - ask the questions about the above, but how you advocate, realise this in nursing is very complex and challenging. policy Services (workplace)? Organisational memory=Organisational respect?

"An example is needed and will be provided next. The intention is to demonstrate the potential utility of Hodges' model to conjoin ipseity, that is; the self, individual identity and personhood with the group and population. Further studies will seek to establish how Hodges’ model can be used in case formulation not just at an individual level – were social factors inform assessments and evaluations – but in community and global health development. Hodges’ model is further suited to this task as the model supports precontextualisation by helping us to anticipate the future and recontextualization in seeking to make sense of the past. Overarching this temporal dimension is the fact that Hodges’ model by being so general and independent of any particular discipline the model is transtheoretical. There is no single theory that can explain, predict or account for the validity of Hodges’ model."
[Draft notes for an editorial that might follow? PJ ]

As the editorial describes, amid women-centred, child-centred and family centred care in Hodges' model we can place whatever the situation, or context demands at the center of Hodges' model and thereby at the focus of our care deliberations whether reflective, theoretical or practice based.

My source:

Tell me, how do you define person-centredness? https://t.co/T9fh7h3cpY @ProfBrendan @JanDewing @jclinnursing @OxINMAHR @ppr

— Prof Debra Jackson (@debraejackson) August 4, 2017

http://onlinelibrary.wiley.com/doi/10.1111/jocn.13681/epdf

Dewing, J. and McCormack, B. (2017), Editorial: Tell me, how do you define person-centredness?. J Clin Nurs, 26: 2509–2510. doi:10.1111/jocn.13681

Editorial: Assuring the Capture of Standardized Nursing Data... Ponte, Somerville & Adams (2016)

In their editorial Ponte, Somerville and Adams (2016) focus on the US nursing care situation and contrast with the UK experience from the outset:

As the U.S. health system moves toward value-based care, chief nursing officers (CNOs) are pressured as never before to demonstrate nursing’s contributions to improving the cost, quality, and efficiency of care, key elements of the value equation. The shift from fee-for-service to value-based care and reimbursement has been made possible through the implementation of electronic health records (EHRs), and the emergence of Big Data analytics, in which payers and healthcare organizations mine the streams of data produced by clinical and administrative systems to understand and evaluate care inputs, processes, and outcomes (Westra, Clancy, et al., 2015).

The contrast is implicit and is not the purpose of the editorial: Assuring the Capture of Standardized Nursing Data: A Call to Action for Chief Nursing Officers. From a still summery Lancashire the above really does seem a continent away, if not a world. It should not be this way. Questions of value for money, the quality of nursing care and outcomes are also central here and digital aspirations are ongoing: NHS Digital.

Perhaps Hodges' model lacks appeal not just because of its historical (mid-1980s) qualities, but a 4x4 checkbox appearance that seeks to standardize care concepts and the nurse's approach? Not only that but maybe the model dictates where they should be placed? The push for data to 'let the light in' and make nursing visible, can also seem a major, externally driven and intrusive distraction from nursing care. That is, doing the job, being a nurse, nursing delivery, caring ...

That Assuring in the title is important. It is the kernel of recursion, the crucial check that is governance and engaged management. Not remote via a screen - dashboard, but in-process - in-situ assuring that the nursing role can and is delivering. In the dash to data vision can become blurred. Socio-technical perspectives are skewed, what might be termed holistic bandwidth is constrained as per the system.

Ensuring that standardized, encoded nursing data are captured in EHRs is critical if nursing is to realize the potential of big data analytics. Having nursing data available for analysis will allow us to gain a better understanding of nursing practice, demonstrate nursing’s contributions to patient care and outcomes, and facilitate evidence-based practice and nursing research. Indeed, we will no longer be driving blind. Rather, we will be driving smart.

Somewhere in this big data lies person centered, holistic and integrated care. This needs to be transformed to self-care. Can these incremental positive changes be captured (once debated and defined)? Will nurses be empowered with access to this data: the big, little and what lies between? Where are the analysts? Who makes the decisions based on this data? Is transparency assured?

As technology advances we have much to do in the UK, lest we nurses find ourselves sat in what has suddenly become a self-driving vehicle that is bound who knows where....


Ponte, P. R., Somerville, J. G., & Adams, J. M. (2016). Assuring the Capture of Standardized Nursing Data: A Call to Action for Chief Nursing Officers. International Journal of Nursing Knowledge, 27(3), 127.