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... they will miss out on the life-affirming experience of the playing field. |
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... as they prepare to make their way in the [un-] level playing field. |
Ashton-in-Makerfield has been in the news of late. With Andy Burnham MP championing the communities of the north; local issues, socio-economic gaps, needs and everyday lived experience up North.
But Makerfield holds much more as a veritable rabbit-hole supporting lifelong learning, character development, reflective practice and critical thought:
* - a political constituency.
Previously: 'map'
After a first mention on page 23, it is chapter 6 that discusses "awe" - the chapter's title. I wrote (in light pencil!) 'It keeps you going'. This is deeper than job satisfaction, but in healthcare is a contributing factor. And different again to (clinical) intution (with many mentions), which recurs, despite (or due to) its subjective nature.
Within its 3.5 pages you will find 'interpersonal awe', Piaget's 'accomodation', the neuroscience of awe, and humility. From a physiological and experiences with short-sightedness and vision, I have applied the concept of accommodation over the years. All this, quite rightly, places emphasis upon the therapeutic relationship. Even since the book's publication in 2023, this relationship has grown in importance.
'The sense of awe is an emotional reaction to events characterized as "vast" or to experienced stimuli outside the domain of the usual and prototypical. A sense of "awe" is often described by scientists who peer through telescopes (immensity) or who observe the uniqueness and expansiveness of the microscopic world. A similar emotional reaction can ocur with respect to the overwhelming experience of the clinician processing the complexity of intertwined variables experienced with a patient. When interpersonal awe occurs, it potentially opens the mind of the clinician to enhanced information gathering, cognitive processing, and empathic understanding.' p.49.
(SPIRITUAL [Intra- Interpersonal; Sciences; Political; Sociology] )
So, Hodges' model is embedded within - should be viewed as surrounded by the spiritual.
Chapter 7, 'Clinical Decision-Making' utilises the thought of Daniel Kahneman. I like the use of ratiocinations here. I do try to bear in mind the 'traps' afforded by Hodges' model. To be clear, it is not the only clinical cognitive tool I have used. For some reason, against ratiocinations I scribbled 'running the axes, or the corridors of care'. Formal training brought to mind training to assure the marking of student's work (if still needed!), and mentoring student nurses. Case-based learning features here, and in the conclusion: CBL 'will be the central element of this book and will involve actual patients with pronounced biopsychosocial complexities.' p.56. How I wish there was an extra reference (a #16) here: clinical decision-making is fundamentally political; both reflectively and reflexively.
Part V then begins (p.59) on further technical considerations with chapter 8 Introduction to Clinical Complexity. A shift is flagged from a linear, logical-based approach to mix of logic and clinical content. At two pages I did hope for more: biological complexity and resolution left me hungry for more. There is however a key learning point on p.62, re. resolution; that of suffering. Connected to this and a well made point is priorities and what is clinically important and any contrast for the clinical team and the patient.
In a BASIC program from the 1980s on the 'Nursing Process' (essentially p.11 in the book, and somewhere on W2tQ?) I'd included a woman, medical ward with chest pain, who was agitated and couldn't explain herself that well. It wasn't delerium, but we eventually found out she was alone at home and worried about a cat. Attention and listening are not in the index, but should be in all clinical texts. An essential ingredient in the aforementioned reflective/reflexive aspect of interpersonal exchange. In the summary for C8 it was good to read of constellations. Our forebears joined the stars to provide meaning and explanation for what was life, being and experience for them, who had passed, and who was to follow. Without that political domain, the meaning is incomplete, may be repeatedly mistaken. How impoverished [we are / are we] as a result?
Chapter 9 starts to present the clinical model, with clinical illustrations - case examples. The focus here is underrepresented factors. There is always an issue about granularity in how much data/information is needed for a comprehensive assessment/evaluation. A paragraph considers The problem of simplication. A question is raised:
'How can a clinician think of all the contributing factors on the spur of the moment, the point at which many if not most clinical decisions are made? Our guess is that your response, as a reader, may be to wipe your brow and decide to return to "treatment as usual." reverting to comfortable algorithms.' p.67.
This 'treatment as usual' is surely institutional in origin? Back to the 'political' again. Well I can think of a way to frame, apprehend all the contributing factors and on the spur of the moment. Healthcare is inherently situated. Healthcare professionals need to proceed with care, especially with constant reference to statistics and algorithms. Hodges' model can provide an anchorage, a safe harbour even if the visit is fleeting. These harbour fees, or dues, service charges are negligible.
In Chapter 10 brings the complexcity of the clinical "field", once more through a case illustration, a woman with chronic schizophrenia, complexity based on clinical diagnosis. The process of diagnosis (and a medical matter) is largely a matter of data reduction, a means to simplify, and provide an avenue to aggregate and group. There is a history lesson in the development of hospitals, even as in the UK bed numbers have seen whole scale reductions. Interestingly (for further study), of course, diagnosis is also a way to abstract away details. The problem is that although this makes the unknown a known, it is binding when it comes to complexity. It ties down a flux, a dynamic that doesn't just want to be free it is constantly changing and may also achieve a more ordered state. The authors try to get to grips with this, they highlight housing, employment, comorbidity and how these may prevent recovery. All this as they seek to define complexity in clinical terms. No easy task: itself part of the problem.
In the summary for chapter 10 it was encouraging to see the cultural aspects for the person and group emphasised, plus how identical demographic factors can still result in disimilar prognoses, hence the importance to 'see' the person and their respective 'self-management'.
More to follow ...
^Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311.
Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.
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"Hungarian-American psychologist Mihaly Csikszentmihalyi (1934-2021) identified a type of highly focused mental state conducive to productivity and creativity. He called it the 'flow'. He described flow as "being completely involved in an activity for its own sake. The ego falls away. Time flies. Every action, movement, and thought follows inevitably from the previous one, like playing jazz. Your whole being is involved, and you're using your skills to the utmost." Csikszentmihalyi advanced a model odf creativity that stresses the importance of a 'specific domain' to make meaningful contributions within a culture - a time and place in history where many variables come together to form a situation where creativity can bloom. . . .Csikszentmihalyi work focuses on creativity as a cultural phenomenon. It is useful, he says, to think about culture as systems of interrelated domains. He puts forward a model of creativity consisting of a domain, a field, and a person. The domain is the wider area of cultural application, whether that be sculpture, mathematics, reason or science. Inside the domain is the specific field; and inside the field is the person. Csikszentmihalyi outlines the creative person as having "a sense that one's skills are adequate to cope with the challenges at hand, in a goal directed, rule-bound action system" (Flow: The Psychology of Optimal Experience, 1990)." p.10.
person domain field creativity | person domain field creativity |
domain field culture creativity | domain field culture creativity |
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| Mathematics without Apologies: Portrait of a Problematic Vocation |
Neither maths/mathematics, numeracy, nor arithmetic are indexed in:
If present, such detail might suggest a concept-based curricula approach, but the dichotomies of qualitative-quantitative and subjective-objective work to good effect; performing as per the axes of Hodges' model. Perhaps, there are nonetheless, more similarities between mathematics and nursing than an axial first-glance might suggest?
I've noted (if not lamented) the fall in prominence of nursing theory, models of care in nurse education and practice. Within the corpus of books the phrases are still common in terms of usage:
It seems that 'models of care' are not the sole preserve of nursing and health disciplines. These models are also defined by management consultancies*, care commissioners, economists, philosophers and policy makers. Hodges' model itself can be used to argue this is a legitimate activity, desirable and to be expected.
An admittedly small sample, but here in NW England student nurses I encounter struggle to recall 'a' model, or theory that has caught their attention. With discussion, they realise they have been to this abstract place before. The attention on models and theory does not appear to match the focus afforded in North America. The political background of national health systems provision, the state of development of health services and systems and education make a huge difference between nursing academia globally, even as we strive to be one-family.
Harris writes of the quest narrative in mathematics. There are problems solvers and the theory builders in mathematics. Tenured mathematicians seek the 'golden goose'. Hodges' model is the quest here: a golden goose in cognitive form that all can possess with requisite basic literacy and explanation. While as noted in (i) mathematics is a relaxed field (Preface, p.xi), it seems nursing theory is a (largely) deserted field. Ironically, seeking person-centredness, this is where Hodges' model begins - a necessarily conceptually deserted field that offers only structure but with the prospect of unconditional positive regard.
Harris, M. (2015) Mathematics without Apologies: Portrait of a Problematic Vocation. Princeton University Press.
My copy of Harris (2015) is secondhand, £8.50 from 'Green Ink' in Hay-on-Wye last November.
Apparently, the (professional - high-level) study of mathematics is a relaxed field. McCleary reviews the book and the good, truth, and beauty of mathematics; 'relaxed field' relates to the latter:
"That leaves beauty, the deepest source for Hardy, and the most challenging motivation for mathematical activity. Challenging because it calls into question how external support of mathematics is justified. Hardy tells us that “a mathematician, like a painter or poet, is a maker of patterns.” Throwing mathematicians in with the painters and poets leads to justification of mathematics as an art. Harris situates his discussion of beauty in the notion of play. Play needs to take place in a “relaxed field,” a notion introduced by ethologist Gordon Burghardt to describe animal behavior when not preoccupied with food, mating, territory, or predators—'the opposite of stress.'"
Mathematics without Apologies:
Portrait of a Problematic Vocation
John McCleary, Book Review, NOTICES OF THE AMS VOLUME 65, NUMBER 10 pp.1280-1283. https://www.ams.org/journals/notices/201810/rnoti-p1280.pdf
Talk of absolutes is common in mathematics. There is absolutely no mathematician involved in the writing of this post and others. That said, I have been privileged to work in a 'relaxed' manner.* When I trained mental health and then general nursing, we were part of the 'numbers' on the duty-rota. Your presence was not just a matter of learning, there were concrete things - tasks - to do. Completing the Community Psychiatric Nursing Certificate course 1987-8, involved a secondment to another community team (thank you Bolton!). My caseload was left to the support of colleagues, so I could concentrate on the course. A course in which Brian Hodges (not Wilfred Hodges - the logician) taught his eponymous model. Post-Project 2000 with nurse education an undergraduate pursuit, students were designated supernumerary. Student nurse finances are precarious, worthy of a post in itself.
If relaxed and stress are opposites, nurses would seek to be 'relaxed'** suffice to have the time and resources to deliver care safely, professionally and to a high standard. Adequate time + resources also brings a dividend: person-centredness, health promotion and education, preventing relapse. As it stands, however, for nurses be they students or qualified, nursing is far from relaxed.
tbc... ii
Harris, M. (2015) Mathematics without Apologies: Portrait of a Problematic Vocation. Princeton University Press.
*But without the charisma Harris describes.
**The notion of slack resource could be applied, space for creativity and innovation in assessment, planning, interventions (case formulation) and evaluation.
See also: 'Four Fields'
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| Brian E. Hodges - c/o Brian's family. |
Born in Liverpool, NW England, UK.
Community Mental Health Nurse NHS, Part-time Lecturer,
Researcher Nursing & Technology Enhanced Learning
Registered Nurse - Mental Health & General
Community Psychiatric Nursing (Cert.) MMU
PG Cert. Ed.
BA(Joint Hons.) Computing and Philosophy - BIHE - Bolton
PG(Dip.) Collaboration on Psychosocial Education [COPE] Univ. Man.
MRES. e-Research and Technology Enhanced Learning, Lancaster Univ.
Live and work in NW England - seeking a global perspective.
The views expressed on W2tQ are entirely my own, unless stated otherwise.
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