iv Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

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.

I often feel obliged to apologise that the spiritual does not have a concrete home in Hodges' model. Personally, it is INTRA- and interpersonal. Our religious beliefs, and committments were they apply. Unfortunately, the spiritual is often expressed politically: 'shock and awe'(?). Socially, the spiritual is manifest in the world's religions, our cultures and upbringing, recognition of others - in our communities, the media, ability to 'see' beauty, experience empathy, rapport and shared emotions. On twitter I've often written -

(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.

viii Book: Bill Ross - 'Order and the Virtual'

 'The Philosophy and Science of Deleuzian Cosmology'

So much of what we experience is nuanced. What was conscious thought, becomes tacit knowledge and unconscious. Is that consciousness nullified as Ross writes on page 76? I wrote a note 'reflection as hesitation'; also prompted to think about intution (p.83) and our word uses in 'retardation' (which here is no problem at all - in physics and complex sciences/systems. Again the 'principle of least action' arises (p.82). With more physics and cosmology to follow, it helps a little that 'manifold' has landed begging to be understood across the contexts. Bill Ross notes how Delueze and Michel Serres used the game metaphor [Game analogy #1]. Again, lifting this to a scribble 'Health-Illness is quite a game'! This will be the subject of a post soon. In England at least the law and manifold on health (being productive) and illness has been utterly disrupted. The game-table has been kicked over, by those in society who still able? New spaces, and canvases are needed. Kantian thought and interpretations are added to Leibniz. A heady mix but clearly essential as Bill Ross's critique is developed. 

 

The book was a must-read, as in the contents: Complexity (with a presentation next month), cosmology, Serres, and Claude Shannon. In Game Analogy #2, "Communication is understood here to encompass much more than meaningful exchange; all phenomena 'communicate'". p.85. I couldn't agree more with with these 'games', this thought being 'situated within the purchase of information theory' (p.86). Bizarrely (or not), in the same year two papers:

Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, 24(3),591-598.

Jones, P. (1996) An overarching theory of health communication? Health Informatics Journal,2,1,28-34. 

Ross explains the global view of Michel Serres when it comes to 'information'. This entranced me, and I only scratched the skin:

Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

Here there's a pointer to the cosmology to follow - Ross is true to the title. I have let most of the Astronomy Yearbooks go, but retain a few. Not just for key birth-years, but articles that are well written and researched historical snapshots. Here, Bill Ross discusses the game of Cepheid variables and their significance in mapping the universe. Truly, fascinating. Weaver's three levels of salient action are listed. Threads are tied too, with conclusions offered. These rules are reappraised, physics ever present. In light of one of the above papers I should revisit Serres, and Leibniz; the search for 'overarching explanatory power' (p.91) is ongoing. This game draws on Serres invitation to imagine a diagram, a network of nodes, channels, and propositions. This tabular formulation and its relations for me, spans the history of economics (Quesnay's tableau), the current state of economics (human values), and next (mathematical?) steps for Hodges' model. So many questions here: surely node  can't be an axis? I felt like Hansel, picking up sweets, Cartesian lines, scalene forms, thresholds, coming across hoops to jump through through to terminal equilibri. As you walk the sound of the thalweg, downstream... where Bergson features once again.

 

Reading Ross, over several months coincided with several key themes gaining in personal coherence. Bayesian ideas as might be applied to Hodges' model, even if in a naïve way (c/o feedback on draft notes). The remainder of chapter 3 includes time (thought), percept (space), to close with Deleuze's Ideal Game. I looked up Cortázarian Hopscotch https://en.wikipedia.org/wiki/Hopscotch_(Cort%C3%A1zar_novel), as the preface is titled. Ross reflects on the Ideal Game (does it exist, for Deleuze, only in thought?), and the distinction between 'domestic' chance (Baysian) and radical contingency belonging to the clinamen. In response to 'physical action and and the thought being on the same continuum', don't ask (please!), but I scribbled: 'corridor care' - a dangerous game, far from ideal. Plus, bird's using quantum entanglement to navigate. 'Kant's chaotic manifold', I will also investigate for next month(?).

Chapter 4 'Order as Complexity' proved most relevant. Every page is touched by graphite.

Deleuze has a 'blind spot' (p.111), something that Hodges' model seeks to ameloirate. But then of course at the model's center (nexus - as noted) that decussation of the axes invites a darkness of its own. If Hodges' model assists forethought and foresight  While inviting complexity, this interdisciplinary palette can also facilitate trandiscipinary sense-making. 'Magnitudes of intensity' reminded me of logarithmic thresholds within our perceptual apparatus. This is like reading Serres. A flow of punctum, simultaneity, delay (again) but its contribution to causal series, and Aionic time. I was taken (frequently)  to plane, person, personhood, chronicity, scales, local to global to glocal.

'BwO' (p.117)? That's 'body without organs: DELEUZE, GUATTARI a thousand plateaus - capitalism and s c h i z o p h r e n i a'.

There is a 'corner' amid those thousand plateaus. n.b. to self - 'triangulation always needs one other'. I cannot resolve the frameworks as yet, scientific - otherwise or otherwhere; but you can take flight from here. Physics takes it place as 'complexity begets complexity'. Bill Ross utilises well-recognized sources, Penrose, Kauffman, Kolmogorov and Bohm.

As with the frameworks internal and external complexity must be untangled 1-4 (p.124?). I can laugh now, did I really try to marry up Order  - Disorder :: Simple - Complex (complicated?) to the domains of Hodges' model? So often reading philosophy, you feel an imposter playing games with words, as in: 'different similarities' and 'similar differences' (p.125). But of course, this is serious scholarship. Especially, when it involves lines, a rough circle, segments and dimensions: disorder becomes different degrees of order. Page 126 delivers Deleuze in spades, Ross pulls his thoughts together. It is fitting for me that Ross closes chapter 4 with a nod to transdisciplinarity.

Chapter 5 deals with symmetry and disymmetry; indifference and difference; limits and non-locality. There is an argument to follow (p.133). With 'group theory' mentioned on p.131, I've a lot of things to 'look up' [topology too]. Despite appearances I recognise the lack of symmetry in Hodges' model. This is what the situation does (practice) and means (theory): 'There is no reason under the sun which can rely on perfect symmetry' (p.135).  Where do/can we locate 'spooky action at a distance' in Hodges' model (p.140)? 

The Higgs role! Who knew? 'the speed of light. It represents a retardation.' Thanks Bill Ross, fascinating pp. 135-174. Plus, axes too. Note to self: when we die do we 'simply' set sail on the Dirac Sea? Attending the Bill Ross Memorial Workshop – BSP Special Event 2025 last September:

https://hodges-model.blogspot.com/2025/09/bill-ross-memorial-workshop.html

the esteem .. and love .. that Bill Ross engendered in the people that knew him. The preface refers to chats in university cafes. How I wish. I wonder what Bill would have made of Hodges' model and the ongoing project here? Vitally, I get a distinct sense that he would have found time to listen ... 

'Bill Ross (1964 – 2022) had interests ranging widely across contemporary philosophy and culture, with a particular interest in the relations between science and philosophy. As managing editor, he was the driving force behind Clinamen Press, which in the early 2000s published new works by contemporary philosophers, and English translation of important works by continental philosophers such as Henri Bergson, Gaston Bachelard and Michel Serres. He completed his PhD in philosophy at Staffordshire University, where he taught on the MA in the Philosophy of Nature, Information, and Technology. Bill had a lifelong passion for the connections between science and philosophy, on which he had published several important articles. Bill was working on a monograph on the philosophy and science of Deleuzian cosmology, which was has been posthumously published by Edinburgh University Press. This event is to celebrate Bill’s book and his life, and to allow his friends, his colleagues, and anyone interested in his work or the topics and issues addressed by his work to continue the conversation that Bill’s work inspires.'

https://www.thebsp.org.uk/bill-ross-memorial-workshop-deleuzian-cosmologies/

 

Many thanks again to Edinburgh University Press for my copy - a keeper! Bill Ross RIP.

 

Bill Ross (2024) Order and the Virtual: The Philosophy and Science of Deleuzian Cosmology. Edinburgh: Edinburgh University Press.
https://edinburghuniversitypress.com/book-order-and-the-virtual.html

Reflective equilibrium and equipoise

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

h2cm and clinical equipoise in 2010. 

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

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

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

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

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

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

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

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

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

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

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

Martha's mum, dad, guardian ...

Hayward, E. Parents really do know when
their child is sick, The Times,
30 May 2025, p.1.

The previous post highlighted the fact that while practice (and theory) based upon research finding that are 'evidence-based' and scientifically rigorous are a 'gold standard; there are other means by which knowledge is obtained. Cultures, often have systems to transfer knowledge - that which matters to the society, even if is not written in the conventional meaning of the term.

Intution is another source, and within social groups can be a powerful spur to action, and help seeking. This is demonstrated regularly in the knowledge that a parent, or guardian has about what is the normal presentation for a child in their care. 

In the UK Martha's Rule is being tested in NHS hospitals. It is encouraging then to hear and read news of a study in Australia (so in combination a 'multicenter' effort?).

Mills, E., Lin, P., Asghari-Jafarabadi, M., West, A., & Craig, S. (n.d.). Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: A prospective cohort study. The Lancet Child & Adolescent Health. https://doi.org/10.1016/S2352-4642(25)00098-7

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

"Not herself ..." Martha	"Not well" Martha
Mills parents, guardians, friends & family	Martha's Rule*

Hayward, E. Parents really know when their child is sick, The Times, 30 May 2025, p.1.

*Under test in the UK.

Previously: 'intuition'

Attending: Active listening c/o Baggini & TPM

Reading through more past issues of The Philosopher's Magazine, I came across Baggini's short contribution of Attending one of "50 New Ideas".

That Hodges' model has a role in attention must follow from its main purpose as an aide-mémoire. To 'know', to recognise that your memory has been jogged is surely to attend.

I realise that Hodges' model represents a philosophical smörgåsbord, rather like the 50 ideas in this issue.^

Baggini draws on a film for inspiration on empathy, feelings for other, humanity and moral philosophy. For Hodges' model our context can encompass media, but the focus remains empathy, ability to relate in the clinical, social care context. Attention and interpersonal skills come the fore here.

If you are not hungry, the model (smörgåsbord) can be considered as empty. This is a precondition for 'attending' - having unconditional positive regard. Apart from information that relates to the patient's, student's, and your safety the domains of Hodges' model are vacant spaces. How they are populated depends on how we attend. There are important lessons for students here. The first is their phone. Its being on their person, may impact their ability to attend to the other (person). The window to outside isn't a screen either.

 Individual
  |

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

previous experience cognitive furniture - elephants in the room (for all?) attend/attending attention active listening authenticity observation empathy - rapport therapeutic relationship unconditional +ve regard I see, I hear you ...	physical space physical environment measurements furniture - layout position / posture observation

Attending needs to be active listening. This includes all the senses, although sniffing the air is probably  best avoided - body odour may announce itself. Attention, then is synonymous with observation and in this context must span an individual's physical and their psychological presentation. You may draw social, political and spiritual assumptions, it is human to do so. Intuition has a role in healthcare but initial conclusions must be recognised as potentially premature and be verified. 

To initiate, be-in, partake-in such situations is to attend to the verbal, and non-communication; the data you already have and information communicated, including in a referral. Is this confirmed, challenged, what is your opinion? What about your colleagues? Most importantly, what does the person (patient, client... say)? What is unspoken? Do you understand? Did you seek clarification? 'Where' have you been / not been in Hodges' model? What picture is emerging at this stage?

It is gratifying that this is the first of the 50 'new' (2016) ideas in TPM #72. 

More to follow - drawing on TPM and (I think, Hodges' model as a 'philosophy? Surely not!)

Baggini, J., Attending, The Philosopher's Magazine, 1st Quarter 2016. Issue 72. pp.21-22.

TPM #72 cover image: https://ericthomasweber.org/correcting-political-correctness/

Myers-Briggs 'in' Hodges' model (Discuss?)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

INTUITION THINKING   INTROVERSION JUDGING

While thinking and thought span the intra- interpersonal and sciences domains, the bias is towards objectivity not subjectivity.

While individual's exercise judgement and the outcome of many decisions may be inconsequential, when situations are misjudged, the consequences can be very political, i.e. professional and legal. The overlaps here are many (as per the function of the MBTI) - in judgements that are adverse socially, for example, shame and embarrassment may also result.

Intuition is usually experienced in a person's 'gut' and yet despite this somatic reference it is a very subjective and humanistic quality. In clinical contexts it is interesting when a colleague or a team try to make sense of this in terms of action to take.

This interplay between subjectivity-objectivity, personal-other, quality-quantity and other dichotomies are inherent in Hodges' model.

My source:
Ahuja, A. (2018) The eternal appeal of Jung (Review of: What's Your Type? The Strange History of Myers-Briggs and the Birth of Personality Testing, Merve Emre, William Collins. Life&Arts, FTWeekend, 15-16 September. p.9.

What does professionalism mean to me? #IND2017 (dnf: draft never finished)

Something along, within and across these lines...

INDIVIDUAL

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

POPULATION

Being self-aware, reflective and reflexive including aspects of your role that either you don't especially like, or you're just not 'good' at. Recognise when to ask for help, advice, supervision. Anticipating needs. Indicating pros and cons. Keeping up-to-date. *Have the courage to blow that whistle if you must. Communicate to the best of your ability and learn constantly as human nature dictates you must. Look after yourself: if ill Be ill. Take care of your personal ethics and values, don't be bullied into lowering them and running with the crowd. Nurse = Lifelong Learner ... then you will question your own competence. As you strive to be someone else remember you can be yourself. The things you take personally are those you open the door to. Learn from them. Never forget your shield, protect yourself and others in what you disclose about yourself and others.

Being compass-ionate requires 360 degree vision, hearing ... learning and forgetting... Your keen are you? So really observe. Care about time, your management of it as a resource and the time frames of past, now, future, hoped for and imagined. Remember you need to understand information systems, data management in so far as it supports or places at risk the care you deliver and the safety of your patients. If I use IT based media I bear in mind the scope of the platform. Open to innovation: but see the elephant as an elephant. When the robots knock on your door being professional means you won't be in: "Moved On" As you care, draw on learning regards where you stand -  you are a guest in someone's home, As your feet are then grounded politically, so too is touch and negotiating personal spaces.

Learn from others  Expectations Expectations Expectations Manage them in a way such that you do not make promises you can not keep. Be committed to what you do. Learn from your peers, especially for safety's sake, but also form your own opinion. Talk this and work through with colleagues. Not everyone will 'like' you; you in turn may not 'like' people. Working through this (without experiencing abuse) as your role demands is being professional. By all means be a team player, but don't let the games that people play distract you from being professional. Patient-Carer Community Care End of Life Care  As you learn from others  pay most attention to the lessons  in Love as you will witness many.

The trust and respect of others take time to earn, but can be lost in an instant; if you have 'it' use it to foster trust and self-respect in others. You have to remember constantly you are accountable here. Remind yourself of codes of conduct the legal aspects of your role. Know your lines - especially when crossed | STANDARDS. With your ID have your whistle ready*. What you do and who you are is a privilege. Know your scope of practice, but be ready to question it. If you do not the future will. This domain is the most powerful and neglected to the professional nurse. As a professional what are YOU going to DO here? The art of leadership is filled with wonder: at what together you can all achieve. Take stock and ask in Year 1 what are the legacy issues my seniors are wrestling with? In years 10 20 30 40 ... (robotics permitting) repeat and reflect.

... because, being professional means learning and unlearning when the lines are there for a purpose and when they need to be shifted, lifted or plain erased ...

Previous post c/o NMC

Book review: Quinn's Principles and Practice of Nurse Education [ 6th Edition ]

I owned the 3rd edition of this book and approached the publisher for a copy of the most recent, which is gratefully received. This review is quite delayed in fact, I've a few other reviews to get on with too.

From the outset while a book on nurse education, the text serves general students and practitioners in education in parts one and two. I completed my PG Cert almost twenty years ago and this book would be an asset to current students (see the content listing for parts 1-2 below). There are many technical concepts within what is a comprehensive text; for example, there are 54 index entries related to 'assessment'.

Much of the book's value is accentuated for readers here in the UK. Here is an established and high quality textbook that provides a UK perspective. As a 7th edition the references for each chapter are expansive taking in key historical sources and more recent publications. There are many illustrations in the form of flowcharts and figures. Following each chapters references, suggested further reading is provided. Review exercises at the end of chapters serve the added purpose of sign-posting content. The information architecture and design of the book makes for a logical, clear and readable experience. Even if the content were lacking, which it is not, the book is fairly substantial at 550 pages. The book is well produced, the paper quality (lending to the weight) and the binding works! Yes, the binding serves to secure the pages and works well when the book is opened flat. This is an obvious requirement and yet so frequently it is a struggle.

As to specifics: Parts 1 and 2 are a welcome refresh. The discussion on thinking and critical thinking are sufficiently detailed and of special interest (pp.58-66) to me. Intuition receives a 'nod' with a dedicated paragraph on p.66, sufficient no doubt to give our students a troubling 'prod' in their future and ongoing careers? I wonder if pages 51-59 might benefit from review and more references, acknowledging what is a well-executed historical account within part 1? An educational challenge I am pondering at present is that of values within nursing. How can we teach these (including the 6Cs)? Amongst what is new to the book is that it meets NMC standards. It would be easy to produce a list of omissions, but I would expect to see abuse, safeguarding, whistleblowing, and vulnerability in this book. How students encounter these concepts and subsequently learn about such sensitive topics must be critical to their insight (life experience to date), self-awareness and skills development. Reflection is very well represented throughout the parts of the book which encourages my efforts with Hodges' model.

I mentioned the book's relevance to current PG Cert Education students and must add that I have referenced the text in a paper for my current studies in technology enhanced learning. On this front the publishers clearly recognise the extended potential of additional e-learning services through CourseMate. An Instant Access Card accompanies the book. Part 4 extends this relevance to continuing professional development and lifelong learning. Chapter 11 is very helpful for its practical dimension, describing placement learning, link lecturers, mentoring and the challenge of the failing student. Sometimes ESOL - English for Speakers of Other Languages is a factor and 'language' could be noted more specifically. This is not a matter for student selection but should be ongoing and would also be addressed within the public (equality and diversity pp.129-134). In mental health I am acutely aware of the importance of communication skills. This comprehensive treatment includes supervision, sign-off mentoring, practice educators plus triennial review.

If I have a bad habit it's looking through the index of a book and asking: What might I expect to see here? The bad aspect is it's tantamount to reviewing by exclusion. And I'm already guilty too. The book fulfills its purpose and does not need to reflect the whole nursing curriculum. But... I would have hoped to see 'open source', Massive Open Online Courses (MOOCS), the role of mobile e-learning, learning management systems - Blackboard is mentioned but not Moodle. Perhaps there are commercial considerations at work? 'Threshold levels' are mentioned but not 'threshold concepts'. This is understandable as we are only just on the cusp of a special interest group in health and social care (more on that to follow I hope). For those like myself who are on the service-practice side chapter 8 is insightful, on marking and providing student feedback beyond the student-mentor relationship. There is constructive support and encouragement for new lecturers and advice on quality and evaluation in higher education.

A year ago I reviewed an even larger textbook on Nursing Informatics, and in truth informatics still has a long way go to prove itself to most of the nurses I meet and work with. I keep doing the sales pitch and this includes acknowledging the student's awareness of coding and classification, or  pointing them (usually 1st and 2nd years) to this knowledge. Health Informatics is represented in the text and the glossary (pp.539-541). In terms of professional accountability it is vital that as nurses we are aware of what happens to the data we help to create. Students are also the researchers of tomorrow and as such they need to be aware of diagnostic schemas and ongoing issues in this area. It is true that this is the curriculum and yet the authors do right by including classification in the context of the library, and coding as in the types of fractures (figure 3.6, p.77); some mention of coding and classification within nursing and healthcare surely seems justified?

Nursing has struggled to make itself visible - for the right reasons for many years. As we look to our students to resolve this are they to rely upon some form of reverse-magic* alone? Despite this proverbial bee, I can highly recommend this book - it is a great resource.

1 Introduction: Nurse Education in the university and the clinical setting
PART ONE – THE PSYCHOLOGICAL BASIS OF TEACHING AND LEARNING
2 Adult learning theory
3 Perspectives on teaching and learning
PART TWO – LEARNING, TEACHING AND ASSESSMENT
4 Curriculum theory and practice
5 Planning for teaching
6 Teaching strategies
7 Assessment of learning
8 Student feedback / feed-forward
9 Teaching study skills
10 Evaluation
...

*It is of course customary to marvel at the visible becoming invisible.

HUGHES, S.J. & QUINN, F.M. (2013) Quinn's principles and practice of nurse education. 6^th Edition. Andover, Hampshire: Cengage Learning.

I would like to extend my thanks to Mr Matthew Keown at Cengage for my copy of this book.
 

Book review "Clinical Intuition in Psychotherapy: The Neurobiology of Embodied Response"

Clinical intuition is something that in formal learning terms is intangible, but in practice is earned and relied upon as a gift of experience. When I first received this book from the author Terry Marks-Tarlow, leafing through I thought the emphasis was on the neurobiology presaging a rather technical read. The references to brain structures, neocortex, brain waves ... seemed to suggest a reductive approach, remote from my conception of intuition in clinical practice. I need not have worried, the initial discussion on the brain and evolutionary development is not just a foundation for what follows but as the title suggests underpins and integrates the whole text. Despite the title and as the foreward advises you do not have to be a psychotherapist to read and appreciate this book. The stall is set from the outset in the introduction which explains that chapter one defines clinical intuition:

Clinical intuition is defined from a neurobiological perspective as a right-brain, fully embodied mode of perceiving, relating, and responding to the ongoing flows and changing dynamics of psychotherapy. (p.3)

The introductory material here is essential foundation reading for people starting a career in psychology and mental health related disciplines. The evolutionary development of the brain from reptile through to the mammalian brain is invaluable. Tying this to specific brain functions and circuits - care, fear, panic, play, lust, rage and seeking - helps integrate brain anatomy, perception, emotion, and behaviour. The advances in neurobiology to follow will no doubt demand that we all extend our understanding of this interdisciplinary fusion.

Clinical Intuition in Psychothreapy

The book itself (hardback edition) is very well produced, the type face easy to read and the book well structured and with a well balanced mix of illustrations and photographs. The reference listing at the end runs over thirteen pages and is well grounded historically and in having regard to ongoing research. The index is comprehensive (fourteen pages) and a resource itself providing a look-up approach. The book's use of case studies, thirteen in total informs the text and provides some continuity through the book. Dialogue between therapist and client is easy to follow and illustrations are provided with ample explanation in situ. The references also utilize web-based resources.

I recall intuition coming up as a thread on several occasions on the psychiatric-nursing list especially between 1998 and 2004. Intuition is a central quality for all personnel working in health and social care. We must also recognise intuition as a human trait as when non-health professionals exercise the judgement that: "Wait a minute, we need a clinical opinion here." Self-care is also discussed. I had a Pythonesque moment - "Is this the right room for an argument?" - considering psychotherapy as a therapeutic modality within therapies as a whole. Here in the UK (and no doubt elsewhere) self, brief and solution based therapies rule economically. Even though the shortage of psychological intervention is recognised in the UK through IAPT improving access to psychological therapies, we need to ask: how does psychotherapy fare in the current (austerity) climate? To what extent can clinicians exercise intuition? Therapy relies on caseness, relationships and narrative, but to what extent can these be acknowledged and delivered within the economical time frames that frequently operate? 

Although there's no specific chapter on training for clinical intuition, Marks-Tarlow provides a list of how researchers have characterized clinical intuition (more recently in the 1980-1990s); five characteristics are proposed:

• Sudden recognition;
• Immediate knowledge;
• Emergent awareness;
• Non-verbal insight; and 
• Holistic integrative sensibilities. (pp.42-43).

 Of the first two sudden recognition and immediate knowledge, I thought of the intuitive sense that is applied upon receiving a referral. That is the assumptions (not always helpful) that arise from the information provided (and missing) and where this leads you? But of course, is this clinical intuition? Intuition as the author makes clear (p.3 and) throughout the book is in psychotherapy. Intuition here (and for me) depends on interpersonal - therapeutic - interaction. What precedes is something else (data integration, hypothesizing, reasoning...?). I can however still see explanatory avenues in the above that can help us travel from the conceptual (reduced) to a holistic whole. I did wonder about the role of intuition in suicidal ideation and risk management, but this is also a question of referral criteria and caseness.

I would very much like to write myself about information and complexity and these themes recur in the text, especially the latter. Several 'spaces' are discussed too: social, physical and spatial schemas. The work of Buzsáki on the hippocampus, navigation and maps - landmark navigation - is fascinating in chapter 7 Navigating the Seas. I have likened Hodges' model to a cognitive periplus - an ancient maritime map. Over the next few months I'll post some quotes from the book.

This is an excellent book that I heartily recommend. The discussion of what is implicit in the brain and so in therapy, what is embodied and wisdom in mentoring invites re-reading. Finally but vitally there is much humour and humanity here too.

Many thanks to Terry Marks-Tarlow for the review copy.

Papers in process, book reviews and volcanoes

There are three papers currently in process. There is some good and bad news; plus some similarity with volcanoes. This is in the sense of active, dormant and extinct.

The papers are - with no prizes for guessing the common feature:

1. The Scope of Nursing and Hodges' model
2. Case Formulation (Conceptualization), Diagrams and Hodges' model
3. Recovery and Hodges' model

Two papers are active, that's Case Formulation and Recovery. On the stove is Recovery and it's cookin. I've two co-authors providing invaluable input.

I've just read Terry Marks-Tarlow's Clinical Intuition in Psychotherapy The Neurobiology of Embodied Response and a review will follow my recommending this book right now.

There's a review copy of another book in the post that I believe can inform the recovery paper:

Values-Based Commissioning of Health and Social Care (thanks CUP)

I'm sure the concept of values-based commissioning is a gift to Hodges' model and the recovery paper. A theme to return to on W2tQ. The paper includes the Recovery STAR and relates this to Hodges' model.

The case formulation effort is with my co-author, and after a meeting in Manchester one early evening may incorporate risk formulation too.

The good news is none of these projects are extinct. The first nursing scope paper was rejected. The nursing scope paper is dormant, but is stirring following the symposium on person centredness in nursing early in May 2013.

There are two other books to get to grips with and a project that is in danger of extinction. The sight of Vesuvius next month may help: shift matters.

Drupal and 'access'

As a mental health nurse, informatics enthusiast and website developer, I have a multi-fold appreciation of the meanings of 'access-ability':

1. Cognitive access to buildings/facilities
2. Physical access to buildings/facilities
3. User access as per human-computer (device!) interface
4. User access to content on a website - beyond pure interface considerations

Item #4 has been at the forefront of my mind for a few days, as most serious sites/blogs require users to create an account. This can be a pain in the form of yet another log-in sequence to remember (in case the browser forgets). My fear is that visitors might reason that "I only want to see whether stag beetles are thriving where I live ...".

It is possible that the future structure of the new site could hide content that visitors really wish to access. I could argue that if visitors need the text that much, then they will create an account.

There must be a logical way to do this? Sketching the content and whether it is public or private is quite critical at this stage. It will affect the roles adopted within the new site. My initial thoughts are encouraging, because they suggest that the bulk of the content - introductory material - can remain accessible to anonymous users (casual visitors). So, here is grandiose "take 1":

PUBLIC anonymous :: PRIVATE registered users
Brian's original notes :: Blog - edit own blog
Chronology :: Book
Biographies - BH, PJ and You!? :: Education - Scheme of Work; Session Plans
Informatics (updated!) :: h2cm and Philosophy
Podcasts :: MCQ - other questions
Resources - templates; reference pack ::

There's a few more possibilities, but we'll save them for another time: Manchester beckons tomorrow tonight - so back to Drupe!