'Nurse as Engineer' by Josefson

'Engineering' and 'architecture' have both been co-opted by cross-disciplinary explorers to help traverse what are usually cravasses between disparate fields. Or, if not a serious journey - more a day-trip than an expedition, it's an effort to create the impression of progress being (rapidly) made. Fields of knowledge being pulled - fused-together. These are transdisciplinary times:

'Individualization is best achieved in the engineering model, in which cach patient is seen as a unique case. The nurse collects and analyses the patients' data to arriye at a diagnosis, which includes, but is not limited to, issues that concern medical diagnosis and treatment. "The nurse sets obiectives based on knowledge and experience of what is desirable and achievable and designs an individualized care plan by selecting from a known repertoire of nursing interventions those most likely to lead to achievement of the objectives. After implementing the interventions, the nurse evaluates their effectiveness by comparing the client's subsequent condition with previous diagnoses and objectives."

In the last model - the non-routine model, which is a research model - the patient is still seen as unique. The problem is that the search procedures cannot be analysed because more judgement and intuition is required in making decisions.' p.25.

n.b. Two other models are described: the nurse acting as a craftsman; and the routine.

Josefson asks in a section (pp.28-29):

Who draws the boundary between Man and Machine?

Who - indeed!

Ingela Josefson. The nurse as engineer—the theory of knowledge in research in the care sector. In.  Knowledge, Skill and Artificial Intelligence. Bo Göranzon & Ingela Josefson (Eds). (1988), ISBN038719519X. pp.19–30. Berlin, Heidelberg: Springer-Verlag.

In the above paper/chapter Josefson draws upon the work of Katie Eriksson and Judy Ozbolt.

Previously: 'engineer' : 'architecture'

NURSING -:- INFOTECH - worlds apart? Software testing

Another draft from over a decade ago ... duly revisited and updated:

https://www.statista.com/statistics/793628/worldwide-developer-survey-most-used-languages/

Reading up on Ruby and Rails and attending Scotland on Rails, I've been struck by the emphasis on testing. Testing in this context is about reliable software and building this into the 'product' from the outset. A book on Rails gets criticized because it leaves the chapter on 'Testing' until the end (even if the authors had their reasons - as they explained).

This take on testing is sufficient if (of course) it is appropriate and it is applied (as per the manual) to the application concerned. There are other more formal methods that extend to writing a specification for code which entails the use of formal specification languages such as Zed (as encountered in BA(Hons.) studies. This arises in situations were software is being developed for safety-critical situations. Clearly, robotic surgery, nuclear energy, and keeping an aircraft in the sky, take-off and landing are mission-critical. In the latter case a company is still dealing with life threatening loss of life that can follow, should the software system fail or more covertly introduce an error.

Reading about Rails, there are specific tests and these are provided as a result of scaffolding, a process whereby the bones of a web application are created within the Rails framework: with tests.

Rails creates a test directory for you as soon as you create a Rails project using bin/rails new application_name. If you list the contents of this directory then you will see:

$ ls -F test
application_system_test_case.rb  controllers/                     helpers/                         mailers/                         system/                          fixtures/                        integration/                     models/                          test_helper.rb

Source: https://guides.rubyonrails.org/testing.html

Rails uses a popular convention to organise and integrate the elements of a web application that includes a database, and dynamic interface. The approach is known as:

Models, Views and Controllers - MVC

MVC underpins several programming languages and frameworks. As displayed above, the tests that Rails creates have specific names and you can quickly see where they come from and how they encompass Rails (an essential property of course).

Today, I still wonder [ what's new! 😉 ] what is the equivalent to MVC in nursing? Models seems to fit! Over the years at many IT events, you can't help but reflect on nursing and its 'API' - application programming interface. Worryingly, in humanistic terms there is an instrumental potential in Hodges' model. If Nursing on Rails was a thing, what would the tests look like? Identity would be a feature, to demonstrate person-centredness, safety in medication and other treatment procedures. Is there a way to demonstrate the integration of care, and for a patient - the extent of holistic bandwidth? Of course, nursing comprises just a part of a clinical information system. It must be in sync in accord with other disciplines, medical and pharmacy and other multidisciplinary team members and yet ensure that 'nursing is visible'.

Previously: API : 'Waste not - want not'

"Models, Theories and Concepts" c/o Smith (1994). Plus ça change ...

"Whilst the impracticality of unified approaches has been noted for some time (McFarlane, 1976), it is still considered that many theories, in their efforts to explain everything, succeed only in explaining nothing (Draper, 1990). Therefore, as Kenny (1992) points out, the use of theories and models in nursing has resulted in sweeping generalizations which 'are not always personally, culturally or contextually appropriate'.

In overcoming this difficulty many authors advocate that theories of lesser scope and abstraction are considered (McFarlane, 1976; Clarke, 1986; Draper, 1990; Moore, 1990; Ingram, 1991; Reid & Bond, 1991). Such theories have been termed 'mid-range' and address a more limited number of variables in particular situations (scope), whilst being empirically grounded and focusing on practical problems (abstraction) (Rogers & Shoemaker, 1971; Walker & Avant, 1983; Fawcett, 1984; Lowenberg, 1984). According to Clarke (1986), mid-range theories should appeal to practitioners as being more directly accessible conceptually and linguistically. Reed & Robinson (1991) contend that, given the diversity of nursing practice, the search for grand theory is inappropriate and nursing would be better served by developing mid-range theories that are 'more precisely stated, more easily treated and produce more specific indications for practice'." pp. 59-60.

Smith, J.P. (1994) Advanced Nursing Series - Models, Theories and Concepts. Oxford: Blackwell Scientific Publications.

While the structure of Hodges' model is global - 'grand' in scope, the model, as a template is blank and open to whatever conceptual content follows in the practice situation, or context. 'Precision' can be assured using Hodges' model as it can facilitate person-centred care, integrated care, reflection, critical thinking and conceptual development. 

Delivery of high-quality health care is not a given. 

Safe, effective and equitable care is variously dependent upon staffing, the skills and attitudes of individual nurses, staff numbers, skill-mix, team effectiveness and resource allocation. Hodges' model can also assist users to recognise and call-out unmet needs, deficits in the quality of care, and risks to the safety of patients, the public, staff and the profession.

At risk of sounding grand if not grandiose ...

Change will and must follow - in respect of models and theories, not just of and for nursing but health and care at scale.

Is Hodges' Model anathema to 'Extant Nursing Theories' ?

 INDIVIDUAL
|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

	Nursing Science Quarterly

"Are the extant nursing theories endangered species? Some nurse leaders think so. A cursory review of major nursing journals reveals the conspicuous absence of articles using nursing theories as guides to research and practice. These articles are often written by seasoned scholars and doctoral students in nursing, yet nursing science is absent. How can this be when PhD students are being prepared to be knowledge builders for the discipline and their teachers are the seasoned scholars?

This question took center stage in a recent international gathering of nurse researchers and theoreticians."

Parse RR. Are the Extant Nursing Theories Endangered Species? Nursing Science Quarterly. 2023;36(2):109-109. doi:10.1177/08943184221150254

 

 

Hodges' Model is a stranger in a strange land; and as usual I am writing from Wigan Pier - so vastly differing contexts and experiences acknowledged.

 

Whatever its status as a model of nursing, model of care, conceptual framework, nursing theory (level 'x'); as the editorial indicates, if the model were to have a 'home' it might be the USA with its nursing science PhD programmes. 

 

Clearly, this is not the case.

 

Unsuccessful in trying to learn of the international event mentioned, I can take encouragement from Hodges' model being 'stateless' and as such, being global, local and glocal in scope. There is succour in having an origin the model can call home here in the NW England (literal - person-centredness).

The medicalisation of nursing science may be an issue for PhD programmes in the USA, but the inter- multi- transdisciplinary potential of Hodges' model can encompass this - preserving and even assuring disciplinary identity as needed. An original purpose of the model was also curriculum design, and development.

"In all university systems it is the faculty and administrators of nursing programs who make curriculum decisions. These same faculty and administrators promulgate the use of theories from other disciplines to guide nursing research for PhD dissertations. What is wrong with this picture?"

I would suggest it is not 'big' - rich enough.

"What is the uniqueness of nursing as a discipline when medical science content has replaced the nursing theories and frameworks in PhD programs? The extant theories and frameworks concretized nursing as a unique discipline different from medicine in the 20^th century. Can nursing now be distinguished from medicine when the content of PhD programs is bereft of extant nursing theories and frameworks?"

Yes, nursing can and is being distinguished from medicine and all other disciplines: abstraction and scope of practice are key. 

So many 'literature searches' are incomplete (but I would say that).

It is actually a sad state of affairs should PhD programmes of study be the primary motivation for the development of nursing science. This is the 21st Century.

Nursing should be defined by the needs of national and global populations and associated national and global policy - especially ongoing gaps in those needs.

Because we are (still) living in a post-Project 2000 World ...

Hodges' model #h2cm is history ...

Ack. Walsh, M. (1991). Models in clinical nursing: The way forward. London: Bailliere Tindall.

"The emphasis of Project 2000 on community care also has implications for curriculum design, since the way nursing is taught must at least in part be applicable to the non-hospital situation. p.144.

"The power and autonomy of nursing have been under continual attack since 1985 with the Griffiths Report and the introduction of general management." p.148.

"Models act as broad organizing concepts, as philosophies or frameworks of care, and in that sense operate at the large-scale or macro-theory level." p.149.

"Models, therefore, are essential in defining nursing. Only by saying that 'This is nursing' and that only a trained qualified nurse can do whatever nursing consists of will be able to hang on to the domain of nursing. Once that is lost an army of low-paid health care assistants (HCAs) acting as 'basic carers' and 'physician's assistants' can be employed to take over."  p.150.

Figure 1 (p.155)
Sorry about the image quality (will try again)
but hopefully the meaning is conveyed.

" ... we can say that at the macro level of theory different models place differing emphases on areas of the patient for the nurse to explore. Each model also has its own unique philosophy of care. At the micro level, nursing theory remains an independent body of knowledge, applicable under any model of nursing, but which may be implemented in different ways, subject to the approach of that model."
p.150.

"British nursing has been talking for too long about models; it is time to see whether they can be made to work!" p.152.

See Figure 1 - "Perhaps nursing models may be best thought of as subjective views of nursing which by virtue of widespread discussion become generally accepted by nurses, leading to a series of coherent frameworks which have consistent value systems applicable to the delivery of care." p.154.

"The Sir Humphreys of the nursing world are quick to point out that nobody has shown that implementing a model of nursing has improved nursing care. This is true, although nobody has shown that a model makes care any worse either!" p.153.

... it is now and the future too ... [PJ]

Walsh, M. (1991). Models in clinical nursing: The way forward. London: Bailliere Tindall.

Context:

https://www.google.com/search?client=firefox-b-d&q=nursing+project+2000

https://en.wikipedia.org/wiki/Humphrey_Appleby

Fragmentation in Nursing ...

Jarrin, Olga F., "An Integral Philosophy and Definition of Nursing: Implications for a Unifying Meta-Theory of Nursing" (2006). School of Nursing Scholarly Works. 46.
https://opencommons.uconn.edu/son_articles/46

 - begins (page 2):

"From the frame of reference of mainstream thinking, a major issue in
nursing is our failure to achieve unity. ... From a feminist perspective,
the real issue involves divisiveness and fragmentation that sustains
oppressive relations in an industrialized, patriarchal medical system.
Remaining divided from one another serves the interests of the
dominant group. Rather than benefiting us, fragmentation in nursing
serves to confuse us, to keep our minds and hearts focused on the
dominant system for solutions that never materialize."

~ Peggy L. Chinn¹

 

"Fragmentation within the profession of nursing is still a pressing concern fueled by differences in educational preparation, specialization, disparities in working conditions, divergent worldviews, and, where I hope this paper will make a difference, a lack of a basic nursing theory that is easily understood. The following pages will lay the philosophical and theoretical foundation for a unifying meta-theory of nursing, which retains all the diversity of nursing while providing common ground for communication, both within our profession, and for better articulation of our work to other professions and the general public. The contemporary philosophical and epistemological grounding of nursing in systems theory is challenged, but not rejected, in this new vision for unification and growth of nursing as a discipline and a profession."

Previously on W2tQ:

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

Illustration of Hodges' Health Career - Care Domains - Model

Hodges' Health Career - Care Domains - Model

 

This image is available as a .tiff file 300ppi. Please get in touch if needed h2cmng AT yahoo.co.uk

It is figure one of four within the (previously mentioned) co-authored paper mapping the SDGs to Hodges' model. 

Hodges' model and trial by vampires ...

Hodges' model was created in the mid-1980s.

 

Since then models of nursing, models of care and nursing theory are no longer fashionable.

 

Hodges' model was produced in Manchester, NW England, so as far as the rest of the World is concerned: it was 'not invented here'. 

The eponymous title, means many people may defer: this model is clearly not mine, or ours. Why should we use this one, let alone consider it?

In addition ...

"Academics are novelty vampires. They crave new stuff ..."

Brian Foote

Nurse - Health - Education Theorists and Researchers: A question ...

The theoretical and practical basis for Hodges' Health Career - Care Domains - Model

[A living project or all Petered out?]

1. Assumptions underlying the conceptual model are made explicit.

Please see below:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

INTRA- INTERPERSONAL domain	SCIENCES domain
SOCIOLOGY - CULTURE domain	POLITICAL domain

2. A complete description of all four concepts of nursing's metaparadigm* are presented.

*person, environment, health / illness and nursing

 

Please see, or search - the relevant tags on this blog for posts on the above concepts and the bibliographical listing.

 

If in addition you would be interested in addressing this assumption specifically please get in touch.

 

3. Propositions of the conceptual model completely link the four metaparadigm concepts.

 

 

Hodges' model can be used to do this and link the health and related challenges as exemplified in the sustainable development goals.

 

4. The internal structure of the conceptual model is logically congruent.

 

 

As required, Hodges' model could utilise several 'logics' applicable across disciplines, domains and contexts; the challenge would be the interface and translation of logics and criteria by which 'congruence' is evaluated?

 

5-7. The conceptual model is socially congruent, socially significant and socially useful.

 

 

There are numerous posts on this blog that (to varying degrees) address assumptions 5-7 and in the bibliography to date.

 

8. Empirical evidence in support of the model has accumulated.

 

In 2020 it was encouraging to learn of two new papers - listed in the bibliography [sidebar] - the authors of which applied Hodges' model.

 

As noted above if I can help you apply Hodges' model, or assist you please let me know.

Fawcett, J. (1984). Analysis and evaluation of conceptual models of nursing. Philadelphia: Davis.


My source:
Personal notes c. 1988.

Nursing: The Adult Patient 1966

"To the Student"

"To the Teacher"

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

"The ways in which the nurse helps people are infinitely varied, and she is being called on constantly to exercise the very delicate judgment." p.xiii "Nurses respond to pressure in many different ways. Some withdraw, going as far from patients as possible. (They clean the medicine cabinet; it does not complain.) Some go about their work mechanically, refusing to get involved emotionally because involvement brings too much worry." p.xiv "The  particular aim of the authors of this book is to assist you in understanding and helping each individual patient for whom you care. ...

"For a particular patient at a particular time, one aspect of nursing care may outweigh all others in importance." "We believe that nurses need to develop a broad orientation to the care of patients, wherever the patient may be." p.xii "All divisions in the study of nursing are arbitrary. There is unity of nursing, regardless of whether it is practiced at home, in a hospital, in a jungle or a desert; whether the patient is a child or an adult; whether the illness is physical, mental, or both." p.xiii "Neither the "intercom" system nor the monitoring device that indicates the patients' vital signs was meant to supplant the nurse. ... In the future there will be more machines to perform mechanical tasks, but no machine can establish the creative, sustaining relationship with people that helps them to get well." p.xiv.

... Whatever their differences in social and economic background, temperament or relative state of health, your patients will have in common certain basic human requirements - skilled care, understanding and respect." p.xiii  "Some try old social skills in new situations. These may or may not be applicable. Social chit-chat may make the nurse feel at ease but may be one way to avoid learning abount the patients' needs. Some nurses manage t ofind a a formula that is exactly right for them. They become involved enough to be concerned about helping patients, while continuing to grow and learn." p.xiv

"The nursing situation today is far from ideal. Many nurses face a staggering workload - not only in relation to the number of patients for whom they are responsible but also because of the greater responsibility that is being delegated to them as advances are made in medical science." p.xiv. "Chapters on disaster nursing and world health problems have been included in the conviction that the profession of nursing has an important role to play during any disaster." p.x-xi

There is a definition of 'health' in this book (p.53), but no specific reference to nursing theory or models of nursing. Reading the references, the definition of health is neither derived from nursing or a WHO source. The definition does refer to health being more than the absence of illness.

Addressing acute contemporary issues, Chapter 59 'Nursing in Accident Disaster' includes Nuclear Disaster pp.1103-1114; while Chapter 60 on 'World Health Problems' is more comprehensive than I expected in such a book and at this time. Although the Cuban missile crisis was only fours years prior to publication.

Smith, D. W., & Gips, C. D. (1966). Care of the adult patient: Medical-surgical nursing. Philadelphia: Lippincott.

30 Years of Progress: Nursing informatics and Nursing theory

Going through some papers I found some notes written in the 90s:

Allan Curtis a clinical services manager described the experience of setting up a 24 hour information service to a hospital paediatric hospital service.

Creating a system using Sensible Solution (a database package), Curtis noted how:

"The intricacies of programming were more difficult than I imagined."

Problems occurred when the school of nursing changed its adopted model of nursing, some information was then either redundant or incompatible.

"Although it would be nice to redesign the program to take account of such changes, it would take too much time - and money."

  <>

I do not have the article and a search failed to locate the full reference. I am assuming the link above is the 1980s-90s database package in question. When able to visit a university library I will update accordingly. It would be interesting to see if the model of nursing and the change was noted and any reasons. I'm sure they were? The point for me are the divides in skills, academic - service settings, finance and the status of 'models of nursing' (care). There is also the extent of change in programming and information systems. What is now referred to as 'the development stack' is far more powerful and yet more complex and complicated.

Curtis, A. (1990) Nursing Times, February 28, 86, 9, pp.69-70.

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

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

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

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

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

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

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

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

https://kulvicki.org/

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

i) A map as well as an app: A De Facto Map of Health

A consulting - interview room 


Patient:
This all seems quite complicated!

:Healthcare Practitioner

Yes, I can understand that. It is complex and complicated. You're having to take a lot of information in. And.., crucially make a decision that is right for you, as well informed as can be.

Has the app helped?

Patient:
Yes, sure. The app has helped - being in touch with other people - with similar experiences and yet different experiences and stages.

:Healthcare Practitioner

You don't sound fully convinced there..?

 Patient:
Well, someone with a relative - you know...? A health practitioner, erm.. Jo! Well, Jo argued that while the app is useful, for both the community and auto upload of tests... Jo made a joke too: "we need a map as well as an app".

:Healthcare Practitioner

A map - like on your phone? 

Patient:
Well no, not exactly. Jo said in medicine and healthcare there's long been talk and work on 'maps of medicine', atlases of various kinds and maps of where disease outbreaks are - I suppose.

:Healthcare Practitioner

Ah, yes of course. Maps are central in public [ mental ;-) ] health.
I'm not sure how a map can help here - beyond the app?

Patient:
When I said it's complicated - and yes complex too - we discussed how bizarre it is that with something so perplexing on so many levels there's no map! Not even a compass to get your bearings. 

:Healthcare Practitioner

A compass? How on Earth would that help?

 
Patient:
To center things. The whole cussed situation. To weigh up what needs to be thought about, discussed, given up and even grieved for.

:Healthcare Practitioner

I see.

Patient:
Yes, and that's an important point too - as a compass can help orientate us both. And ... are we focussed on your clinical priorities or my domestic and social circumstances. A compass and a map might help capture the context and 'my' health career insofar as what is happening to my life chances at present? ... Yes, I've been reading a bit...

:Healthcare Practitioner

This sounds quite an idea but I'm not sure where we'd begin. Perhaps we can pull some people together to discuss this? When you mentioned centering things in a way that would also help 'ground' things too. The small matters of money and politics that are sat with us already! 

What do you think?

Patient:
Well actually, I think we've got a starting point!

After 41 years of listening - now it's your turn [ please ]...

If you are a researcher, author, lecturer or editor ... (you get the gist already...) and the project that currently has your undivided attention (well, almost) is a draft paper or literature review on any of the following:

metamodels of care / nursing / healthcare / global health
metacognition of care / nursing / healthcare / global health

holistic care / nursing
integrated care / nursing

models of care

models of nursing
theories of nursing

models of healthcare

conceptual frameworks in health, social care or education
(across - theory, practice, commissioning, funding)
history, current state, future of the above..

(I could add more)

- then please consider this request.

If there is no reference in the work to Hodges' model, as in:

The Health Career Model

Hodges' Health Career Model

Hodges' Health Career - Care Domains - Model

The Health Career - Life Chances - Model

- then I would humbly suggest to you that the work in front of you is incomplete.

Yes. I am variously disappointed, dispirited, desperate* since the terms of a well thought out, comprehensive search strategy should surely pick up a breadcrumb leading to Hodges' model? Fellow mentors and supervisors I need some help.

But, help with which one you may well ask?

Well, here's some background to account for the seeming lack of version control:

The Health Career Model

 &
Hodges' Health Career Model

These were the original titles for the model. The 'health career' has always referred to the idea and phenomena of 'life chances' (see bibliography in sidebar for Hughes).

Hodges' Health Career - Care Domains - Model

The original website from 1998 appeared to cause some confusion with visitors taking career to relate to work and professional opportunities. The 'care domains' addition sought to distract from that, to emphasize the care knowledge quality of the model.

The Health Career - Life Chances - Model

I have always tried to include Hodges' in the titles I have employed. More recently, it appears that using a name appears to accentuate the perception for others that the model was "Not invented here". Plus, there may be copyright and other proprietary provisions.

The reference to Hughes and life chances goes back to 1958, but seems even more relevant now given the importance of epigenetics, technology, sustainability, ecology, universal health care, access to information and healthcare knowledge and global health.

So, even if not germane to the main arguments of the paper or work at hand I would hope that the model might at least be referenced, as per:

Maffissoni, André & Vendruscolo, Carine & De Lima Trindade, Letícia & Zocche, Denise. (2018). Redes de atenção à saúde na formação em enfermagem: interpretações a partir da atenção primária à saúde. Revista Cuidarte. 9. 1-13. https://revistacuidarte.udes.edu.co/index.php/cuidarte/article/view/549

Many thanks!

Buses, Students, Tech and Models of Care

I continue to be surprised, informed and stimulated by the many contrasts and similarities between nursing and information technology. A constant encounter as a mentor is hearing accounts about student nurses and their learning experience. After 12-18 months since beginning their student career what are student's learning, being taught? And yes: nursing theory and models of care still seem twee, out-of-date, out-of fashion.

Change is inevitable of course; in tech if you are not on-board (as in the web), there is a progression of buses and you can get on at any time. At least I hope that's the case. As Web Design magazine asks: "How will CSS be styling the web in 2017, 2018 or 2019?" So for students there are many university blocks, lectures, clinical placements, mentors...: so many buses. Hopefully they really do get on-board sooner rather than later.

The snapshot of evidence as I have it re. models of care, nursing theory and reflection suggests there is quite a vacuum at a time when there is both a need for a tool like Hodges' model and an opportunity.

There are valuable lessons in the history of models of care while we relish the challenges of the future. Those lessons are still relevant as the nursing community and its practitioners constantly travel between the mechanistic and humanistic forms of knowledge that nursing demands.

Technology changes all the time and with it, the buses, the roads and even the bus stops. Clearly, we need our students to be as well equipped as possible. Not to deal with change, then it is too late. We need future practitioners to be able to critique potential change. This is crucial when future change involves nursing itself and nursing's values.

Pigeonholes and a Matrix 4 Care

The structure of Hodges' model is 

not an invitation to pigeonhole. 

It is an equation: a matrix for care. 

What is done in one quadrant, 

needs to be counter-balanced 

in the other care domains. 

The operations here are not mathematical,

 but reflective, reflexive and ideally communicative.

ZX Spectrum: Whatever next - models of nursing / care?

My computing interest began with the Sinclair ZX81. Back then models of nursing and nursing theory were seemingly everywhere. Do they say history repeats itself: well almost.

Ngrams: E-portfolios, nursing theory, models of nursing...: Do the lines run true?

For the latest module I'm looking at e-portfolios in nursing education and possibly wider afield. In the FT Weekend Life & Arts there is an extract -

Capitalism’s secret love affair with bureaucracy

- from David Graeber’s book: The Utopia of Rules: On Technology, Stupidity, and the Secret Joys of Bureaucracy published this week on March 12. It includes a graph from Google Books Ngram a word count through time of 'bureaucracy'. I'd read about Ngrams and tried them quite some time ago, but never used them. Now's my chance.

The graph below began with e-portfolio and eportfolio. I tried nursing e-portfolio... but these were not found. With conceptual framework the scale was disrupted. Adding models of nursing and nursing theory provided a frame that also nicely encompasses, at least in this rendering, conceptual space and threshold concepts.

At the risk of asking too much of the graph if not the source, we might be disappointed that models of nursing is not running concurrent with e-portfolio and reassured that nursing theory has waned but is 'still up there'. This is to forget though that the count for e-portfolio here is general not nursing specific.

Ngrams are another tool and a dynamic one no doubt, when the API is utilised, the data downloaded and words are re-examined over time. In answer to the title's question, I do not believe the lines do run true but this is about nursing and e-portfolios.

Pushing the envelope: Reflections in mind, health and social care ...

Hodges' model can do 'envelopes', but it's first form is as an aide-mémoire. In this way it helps facilitate reflection, reflective practice and more besides.	Envelopes are just a start, the germ of ideas. Hodges' model needs to be evidence based - can you assist?
If you need to share your reflections as case formulations, care plans, or evaluations; the model can help to engage with patients, clients, carers, staff and residents...	Amid healthcare's legacy issue which is achieving integrated, person-centred and holistic care, Hodges' model can help the practitioner assure integrity on several levels (6Cs).

Original image source:
http://www.strengthweekly.com/2014/10/02/new-blue-towel/envelope-back/

"You're a nurse? How much do you know?"

individual
INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

Yes, I am a nurse - thanks for asking.

So come on - how much do you know?

Actually, I know very little.

Eh?
Why is that?
Surely you have to be quite knowledgeable,
all the lectures, the training on wards, clinics, out in the community, staying updated too?

ethics, giving bad news, communication, self-awareness, empathy and rapport, recovery model, education...	anatomy & physiology, healing, homeostasis, medicines, basic life support, drug side effects, risk of falls, observations, infection control...
cultural competence, team work, respect and dignity, the 6Cs, carer education, handling conflict, family therapy...	policy, records, scope of practice, continuing education, professional development, confidentiality...

Surely, this little snip points to a packed 'curriculum'?

So it does, but as a nurse you can't make too many assumptions?

Well, yes I suppose so; no-one should pre-judge but you'll have to explain?

[ Now, why am I so pleased you said that...? :-) ]

Well a nurse has to be dispassionate in order to be compassionate.

So... as a nurse you contradict yourself?

No, not exactly. I suppose, given your opening gambit, we have to be neutral, neither hot, nor cold. That way we are sensitive to difference and spotting change. If we think someone is cold, or has a fever then we measure - we find out we check their temperature. So of course some things we can learn based on fact-finding.

Inevitably, assumptions are made as there's a job to do, but it's important not to prejudge. There's a big difference between assumptions, judgements, stereotypes, biases, hypotheses, and the like.

So a nurse can be tepid all the time? Where's the warmth in that, eh?

Good point, but you know what we're about here.
There's general warmth, friendliness, being approachable, civil, being professional.
Then there's warmth as an ingredient in those critical instances.

So, it's a case of yes and no. At first you've to be open-minded. Take the conceptual  framework Hodges' model. Initially it is all structure, but this structure provides four empty care domains - five when wrapped by the spiritual. This can act as a great aide-mémoire.

With a referral you make use of any information that is provided because that's very important too. The information that is received initially is hopefully sufficient to indicate the nature of the problem in broad terms. It may be more specific pointing to an existing diagnosis, a relapse, or multiple diagnoses.

Yes I see. Hodges' model is the blank sheet and as such it is open, non-judgmental.

Yes, but there are also indicators that point to risk, physical - falls for example, plus psychological and mental health aspects like risk of self-harm, harm to others and possibly self neglect. These are the things that must also to be assessed and as such ruled-out.

SELF - SELF -	HARM NEGLECT
HARM TO OTHERS HARM BY OTHERS - ABUSE	VULNERABLE ADULTS ABILITY TO GIVE CONSENT, MENTAL CAPACITY

So when does that 'open-mindedness', or 'neutrality' become closed?

As we learn about someone, we build up a picture that kind-of notion, once known some things are closed as they don't tend to change.

They're concluded?

Yes, but one of the reasons that nursing is such an ace job - and yes I know why your grimacing - but it IS!

Anyway, that first day can be a lesson in dynamics. If not the first day it will soon follow!

So, you have to use many different sources and kinds of knowledge.

Yes, that's right and the best knowledge of all is...?

Well, I guess learning for ourselves is the best, most permanent way.

You have it there. It's a really exciting time for nursing, health and social care. Although they go on about technology and clearly technology has a major role to play. 'IT' is playing a major role and if you listen carefully you can hear the robots...

There is much more to do on that 'humanistic' side.

The open-mindedness, openness and acceptance is a baton that we must pass back to the patient. Self-care, when possible, health literacy skills and competence are crucial now.

It's not just the days that are different either. The people we encounter, the patients, the clients - call them what you will, they are all pearls. Aggregated, yes sure, you see so many oysters; but open and face-to-face as a nurse each one shines, unique and peerless with individuality.

OK. Thanks - that's cool indeed!

Acknowledgement - Stu Young, Royal College of Nursing Students

"You're a nurse? That's cool. How much do you make?"