Bio-Psycho-Social model: The L-shaped room

Qualification, induction, together with continuing professional development and mandatory training should see all health professionals having due regard for the 'political' in their respective roles. The 'Law and the Nurse' session, used to be, and remains a welcome reminder; also appropriately scary for this time of year. While at work the meaning of 'political' is nuanced with so many aspects and dimensions, e.g.

Public Service

Safety - Statistics - Quality

Zero tolerance - Never events

Leadership

Operating Procedures

Audit - Reports

churn of policy cranked by governments / parliaments

cost - savings - budgets - the plan

pay negotiation - Unions, Professional Organisations

Litigation

Administration Human Resources

Recruitment & Retention 

Disciplinary processes

Planning

Estates - Procurement - Supplies

The organisational tree - communications

structures - providers, commissioners, integrated

News: NHS, private sector, Social Care, Gov. 'Papers'

organisational (footprint) footprint

sustainability, green initiatives

signage - national - local

combined local policy initiatives and national emphasis e.g.

equality, equity, inclusion, 

management of violence abuse in the workplace, bullying, 

managing complaints, confidentiality
changes in reporting incidents, data returns,

information systems, governance and records management)

Is it me, or do the medical model, bio-medical model and the bio-psycho-social model somehow seem lacking?^

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC =========================  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

psycho	bio
social	?

In surgical terms, how is the political domain best realised within a model of health and social care: anastomosis or transplant?

^As seen by a certain lens.

Previously: 'models' : 'bio-psycho-social' : surgery

The creation of Hodges' model: "All aboard!" 200 years

28th May 1997

When I interviewed (Mr.) Brian Hodges in Manchester on 28th May 1997, I learned he had created the model in 1983, mainly while commuting to Manchester Polytechnical College by train from (Totley) Sheffield, and back. 

I wish I could have been sat by him, to strike up a conversation. Although (among other points) I'm not sure how much he relied upon, or was chasing down the visual side of the model, with some skethces and drawings. So would I have noticed him thinking, drawing, crossing-out, and labelling? This I would have noticed, not that I have a habit of 'spying' and being nosey. Although nowadays, with the repeated announcements on the trains: ‘See it. Say it. Sorted’; perhaps I should?

In 1983 I was a general student nurse (SRN), and still over a decade away from becoming a community psychiatric nurse in 1985, and being (well) taught by Brian and colleagues in 1987.

I also enjoy a (reliable!) train journey, and used to read a lot travelling from the NW England through the London underground (Euston-Waterloo) to Plymoth, and later to Portsmouth in the 1970s. Happy days, then and today; with the railways reasserting their relevance. A quality shared with a certain little-big model I know.

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC =========================  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

	Rail 200
	Nationalised - Private Private - Nationalised Charity - CIC

Nurses - Ask 5 complimentary questions

I received an email from RCNi subject heading - 'Q. What questions are nurses asking?'

An invitation to sign-up and ask five free questions: https://rcni.com/ask 

Question 1

Is there a model of care, or nursing that encompasses the sciences, mental health, sociology and political domains of care?

Several models of care and nursing frameworks integrate diverse domains beyond purely biological aspects, encompassing scientific, mental health, sociological, and even political dimensions. These models emphasise a holistic approach to patient well-being, recognising the complex interplay of various factors in health outcomes.

• Social Model of Health: This model focuses on salutogenesis, examining what contributes to health rather than just illness, by considering broad social, economic, environmental, and cultural influences on an individual's well-being .
• Person-Centred Nursing Framework: This framework extends beyond individual biological health to include the person's intricate cultural context, family, spirituality, and life experiences, defining health as encompassing intellectual, social, and spiritual dimensions .
• Biopsychosocial Model of Care: This approach integrates biological, psychological, and social factors to address a patient's holistic needs, moving beyond the biomedical model's sole focus on physical illness .
• Dual Registration Degrees: Educational programmes for nurses and social workers combine life sciences with social work principles, law, and policy, preparing professionals to understand factors influencing health, social justice, structural inequalities, and anti-discriminatory practises .
• Multidisciplinary Team (MDT) Care Model: While not a nursing model itself, the MDT approach enhances patient care by integrating expertise from various professionals, including specialist doctors, nurses, psychology counsellors, dietitians, and pharmacists, to deliver individualised treatment plans and coordinate care .

Modern healthcare increasingly recognises the necessity of comprehensive care models that extend beyond traditional medical approaches. These integrated frameworks, including the social model of health, person-centred nursing, and the biopsychosocial model, provide a foundation for understanding and addressing the multifaceted nature of health, incorporating scientific, mental health, sociological, and policy-related aspects to improve patient outcomes. [Five references provided - hence poor formatting in transfer.]

Question 2

What model of care has the conceptual scope to critique parity of esteem in mental health nursing?

Critiquing the concept of parity of esteem in mental health nursing requires models that move beyond a purely biomedical focus to embrace holistic, person-centred, and culturally sensitive approaches. These models emphasise equality, social justice, and comprehensive care, addressing the historical imbalance between physical and mental health provision.

• Biopsychosocial Model: This model offers a conceptual framework to critique parity of esteem by considering biological, psychological, and social factors in a patient's health, aiming for holistic needs rather than just biological ones . It contrasts with the biomedical model, which has historically led to paternalistic decision-making in healthcare .
• Culturally Sensitive and Competent Care: Essential for critiquing parity of esteem, culturally sensitive care requires nurses to appreciate diverse cultures and adopt personalised, flexible approaches to mental health support . Culturally competent care, underpinned by equality and diversity principles, involves behaviours and attitudes that value patients' diverse backgrounds, improving satisfaction and outcomes .
• Person Centred Care: This approach is crucial for addressing the historical paternalism in healthcare, ensuring patients participate in decisions about their care and re viewed as individuals with unique experiences rather than just labels or symptoms . Recent mental health reforms, such as the Mental Health Bill 2025, aim to embed person-centred and equitable care further .
• Holistic Care: The Nursing and Midwifery Council (2024) emphasises assessing spiritual needs to provide effective holistic care, recognising that "seeing the whole person supports better care" . This aligns with the biopsychosocial model's aim to meet holistic needs and challenges the organisational and practice divisions between mental and physical healthcare .

Effective critique of parity of esteem in mental health nursing necessitates a shift towards models that integrate biopsychosocial, culturally sensitive, and person-centred approaches. These frameworks are vital for fostering equality, social justice, and comprehensive care, moving beyond traditional biomedical limitations to address the full spectrum of patient needs. [Eight references.]

I'll leave it there. I think. PJ

<>

My emphasis: In the spring I tried to engage and see if I could write a short article about Hodges' model for RCNi. After an online chat and following up by email, Hodges' model isn't for them apparently. It was kindly suggested that I try another journal.

I must improve my prompt writing.

I must improve my prompt writing.

I must improve my prompt writing.

I must improve my prompt writing.

Nurse, you must improve your prompt writing ...

Nursing models of care: "There is another"!

It seems Star Wars forums continue to debate the meaning of Yoda's response to Obi-Wan that "There is another". 

The lack of practice-based debate in nursing and health education about 'nursing theory' and 'models of care, confirms that these academia sagas did indeed take place in a galaxy far, far away.

There is, as ever, positive and negative news too. The bibliography in the sidebar keeps growing. I'm hoping for news of additions dropping into the inbox before the end of the year. Not just prospective papers I know about (yes, there is another prospect!), but other work. In a way the latter is even more special. As these sporadics reveal that there are research heroes out there, on their own path and journey of discovery. Finding Hodges' model, they have applied it to their respective field.

Yesterday, searching for 'Activities of Daily Living' (first published in 1980) while writing the DASH post, on BMJ Careers I came across:

'What models do nurses use to guide their care?'

Is that 'models' plural?

Perhaps the response to the question says something about:

• nurse academia;
• how our medical colleagues view nursing;
• and more importantly - their understanding of nursing, the nursing profession, ongoing aspirations and relevance to self , health and social care in the 21st century?

In January, frustrated at the effort that is getting published (a shared experience then) and lack of attention to theory I posted:

Are you planning a health* study in 2025?

The literature trail for Hodges' model is not voluminous, but it is there:

• as a model of care, conceptual framework;
• person-centredness;
• integrated and holistic care;
• holistic bandwidth
• SDGs
• life chances, health career, prevention, life-style and literacies
• socio-technical approach
• global health;
• reflection and reflective practice;
• critical thinking
• mind-mapping;
• concepts, conceptual spaces, threshold concepts

- with much more to do, even in the above.

Please, call this a gentle nudge. Thank you.

Image: http://www.quickmeme.com/

Questions in eclipse

 Last Friday 9th I had a Zoom chat for 30 mins, regards Hodges' model with faculty in the USA.

We touched upon:

• background to Hodges' model
• courses taught across the water and interests
• overlaps, inc. person-centered care - socio-technical
• informatics & literacies
• maths/logic

As an outcome it was suggested I forward some questions I'm currently of Hodges' model. Questions that for me, are challenging, put me in the dark, and may not even be valid?

Going through my draft notes I picked out 20, beginning with the working title:

Hodges’ Model as a mathematical object and relational ontology:
category theory or category mistake?

1. Can it be argued there is what amounts to a care locus - that can 'locate' person-centredness?
   
   
2. Can the model's domains be seen as functions?
   
   
3. Are the domains placeholders?
   
   
4. Is there a case to test, and if logical implement co-domains (e.g. parity of esteem)?
   
   
5. Are there other 'structures' in Hodges' model,  for example L-shaped forms, that is relations that involve three domains and (seemingly) omit one?
   
   
6. Are there practical - case studies - that can be associated with such structures?
   
   
7. Can Hodges' model be considered as a single conceptual space (Gärdenfors), or a series of four? (blog posts)
   
   
8. Can Hodges' model be used to identify and apply threshold concepts (Meyer & Land)? (blog posts)
   
   
9. Can we argue that the structure of Hodges’ model as defined by the axes extent, provides and invites inverse relations?
   
   
10. Is Hodges' model as a structure only (a template) equivalent to an empty set (empty set as an initial object)?
11. Is this a mathematical analogue (being neutral) to a practitioner's unconditional positive regard?
    
    
12. Taking its axes and four (care/knowledge) domains can Hodges' model be reduced to a graph?
    
    
13. If Hodges' model acknowledges/incorporates Cartesian duality, are there Cartesian products?
    
    
14. In these Cartesian products are critical operations, e.g. relating to psychotropics - physical health; eating disorder - physical/mental health; complex emotional needs - policy (evidence-based care)?
    
    
15. If the model is inverted, mirrored ... what follows: is the structure - function - consistency retained?

    
    
16. Is Hodges' model 'closed' in comparison with Buzan's (open?) approach to mind-mapping?
    
    
17. There is an 'equation of time': is there an 'equation of care'?
    
    
18. Thought experiments: (semantic distance... cognitive linguistics)
    
    

    Which concept (INTERPERSONAL :: SCIENCES) is closer to the ‘INDIVIDUAL’ axes; which is closest to the ‘GROUP’ (SOCIOLOGY :: POLITICAL)?

    
    

    Which concept (SOCIOLOGY :: INTERPERSONAL) is closer to the HUMANISTIC axes; which is closest to the MECHANISTIC (SCIENCES :: POLITICAL)?

    
    
19. Role of 'types' in Hodges' model - that is, patient / model as a whole as objects (with identity)?
    
    
20. What significance can be gleaned given commonality between several mathematical terms, e.g. group, object, (co-)domain and Hodges' model?

I can no doubt structure - group these questions, and I've not picked out many concerned with Hodges' model as a set, or, as yet, those venturing into category theory. I am wondering, what the commutative law might tell us about holistic, integrated care, and parity of esteem when applied through Hodges' model? Also refining 3-4 case examples to explore and illustrate the same?

While it is maths that prompts this diversion, perhaps ultimately health care disciplines can determine its own formal approach that can produce its own context-sensitive rules, that straddle mathematics/logic and the humanities?

In initial emails, I'd noted the forthcoming eclipse across the USA. Checking, my interlocutor is just N of the path of totality (I wish!) for April's total eclipse. I'm enjoying the darkness here too.

https://science.nasa.gov/eclipses/future-eclipses/eclipse-2024/where-when/

#TotalEclipse2024 #SolarEclipse2024

Nursing a dinosaur: Or, "Computer on your face? Still not cool" c/o Chen, NYT

A gifted copy of the NYT has already paid a dividend providing a post. There's another reporting the launch of Apple's $3,500 Vision Pro. 

Through Chen's tech report we learn, or are reminded that "Google, Meta, Snap, Samsung and Sony" and other companies, have been trying to create VR headsets as an experience for over the past 12 years. Familiar barriers to entry (for all) still make themselves known: physical - weight, energy - battery, purpose - getting tasks done, the graphics - 'tech', hence the market key - of cost. It is integrating these that might also be termed 'maturity' - the time is, finally right. The term has always been somewhat unfortunate but where is the killer-app?

Jurassic World: Aftermath. Credit: Coatsink

Chen's trials of VR headsets old and new includes what seems the ubiquitous dinosaur app.

I can relate to the 'dinosaur' moniker, given the veritable dinosaur represented by models of care and nursing theory; and yes that one, the dinosaur riding the bike to a new (health) career in 1977.

Apple bills this launch as the start of:

"'spatial computing,' which blends data with the physical world to make our lives better."

In a way, this oft-repeated situation can be summed up as socio-technical reality, travelling through various iterations until capability and maturity of technology come of age. 

Now it's not just hi-res graphics, it is video quality imagery. Recalling an interface in my first HTML editor, I wonder if there is an opportunity being missed?

Unpicking Apples' 'spatial computing' which in short = data + physical world + lives better (purposes) tech is persistently predictable in going for the commercial jugular. Perhaps there is an intermediate step which software developers have sought to leverage over many years. 

'Data' here, means care concepts, or as the context dictates. Hodges' model as a data, information, knowledge, educational (e.g., case study) portal. 

Given a specific context what concepts might we 'find' at a,b,c and d below; and elsewhere in the model? How do we characterise the 'individual', the group? While in a virtual (and conceptual / threshold space: Hodges' model!) this might, encountered as text be a less virtiginous and tiring  experience*? Hodges' model is an ideal fit in fact - well a candidate space at least.

Consider how far, since the early 2000s and 2012 (not to mention 1991) technology (hard and soft)  has come in terms of language understanding and AI - ChatGPT. Hodges' model can leverage this in the first instance. As a template Hodges' model is a proverbial virtual lab - a potential situated corpus - also awaiting its dinosaur.

Individual
   |

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :   POLITICAL 

|

Group

a) user (sector) purposes concepts critical thinking reflection model, modelling	b) space 3D - graphics representation health / nurse theory models  of care
patient/carer engagement metric for: self care integrated care person-centred care integrated care c)	open source/commercial apps outcomes prevention sustainable health care determinants of health d)

Brian X. Chen, Computer on your face? Still not cool. Tech, The New York Times International Edition, January 30, 2024, p.14.
https://nytimes-en.com/2024/01/25/why-making-face-computers-cool-isnt-easy/

*https://www.msn.com/en-us/news/technology/the-vision-pros-scary-side-effect/ar-BB1i6Hln

(The tech giants will battle it out.)

Images: 

Jurassic World: Aftermath - https://www.nme.com/news/gaming-news/jurassic-world-aftermath-brings-vr-horror-to-the-oculus-quest-this-week-2840584

Fossilized evidence of the dinosaur - as expected from the archive:

WHERE HAVE ALL THE NURSES GONE? (1991)

https://web.archive.org/web/20091205090804/http://www.p-jones.demon.co.uk/Introvrn.htm

The above is included in the fourth row of the SCIENCES collection of links at:

https://web.archive.org/web/20100327172004/http://www.p-jones.demon.co.uk/linksTwo.htm

Curation of posts on W2tQ

     Curation: Quote(s) to follow?

Several years ago I reviewed the blog's posts starting from post #1 in April 2006. Some posts, such as, journal calls for papers, conference announcements ... were clearly of time-limited value, even as to the degree they may document the history of ideas. The exercise also highlighted my adopted role of curator, which had not occurred to me before. 

Previously, tentatively, I tried to weigh the value of content. The value to scholarship of Hodges' model, and not wishing to sound grandiose - nursing theory (someone should - given the vacuum over the past 20-30 years?). There are person-centred items, with some that make me cringe (the personal ones, the ones premature and not quite 'fully-formed'), while others stand the test of time (I think). 

Eighteen years is not long and yet the change in several dynamic histories is very obvious, across society, politics, ecosystems, policy, education, nursing and of course technology. Many posts were deleted, others with:

• too many links (for which you can be penalised?)
• broken links;
• missing images / videos;
• typos ...

- where updated accordingly.

Revision #2 beckons in the near future, an effort to rationalise the wheat from the chaff.

It is - same old, same old regards the elephant in the room: that is, the missing new 'platform' - as it keeps reminding me.

W2tQ - "Welcome the the QUAD" - this blog.
Book image: Waterstones.

(ii) What sort of field is 'nursing'?

Mathematics without Apologies:
Portrait of a Problematic Vocation

Harris quickly differentiates between pure and applied - practical mathematics. Nursing can claim mathematical tenure in being a constant. A constantly problematic vocation for governments worldwide. Temporarily recognised for its criticality, in terms of the population's dependence on nursing by the COVID pandemic. The global nursing workforce while often a political football in its host country, is in intensive care amid demographic change and policy imperatives. 

Neither maths/mathematics, numeracy, nor arithmetic are indexed in:

Curriculum Development In Nursing Education (4th. Edition).

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.

*Reimagining the nursing workload: Finding time to close the workforce gap. https://mck.co/43tMB7v
via @McKinsey [A post may follow.]

See also: 'commissioning'

'nursing theory'

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.

Where is NURSING THEORY: integrated, holistic, and person-centered care ... ?

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

"Be the difference!"	Nightingale
"Be the difference ... to All others."	What is 'different' here? Locally Nationally Internationally Biosphere

#HealthTheory

Previously on W2tQ: 'Nightingale'

My source/prompt: c/o @Jasonforrestftw
https://twitter.com/Jasonforrestftw/status/1621224549848170499?s=20&t=KHJSqwCsE6r3Ch8lRoDioQ

Out of hand ...

This blog is a pain, as is twitter.

I've known for ages -

H2CM new website - A short-form project brief

Twitter on hold: Blog a trickle ... 

Dries! I promise ...  (Sorry!)

I've known since the start of W2tQ back in April 2006. The web - software is change.

 

Blogging and twitter are a distraction.

 

The blog has helped to frame ideas. I can see now though (hindsight eh!), how unprepared I was in 2014 for a PhD, not just financially (self-funded), but having a question. I've had a project since 1988, but what's the Question?

 

People get in touch (SPAM reaches the inbox) with web design, SEO service offers. They point to how 'ill' my website / blog is. No website/blog are specified, no business address, details, there's a personal/business name that doesn't reflect the email signature.

I know that 'analysis' of the blog reveals a pile of errors, missed opportunities. And, yes; there is a much better online solution to drive income ...?

So, after the past year and especially last month, 2023 will be much much quieter on W2tQ. What will be posted?

• Book 'reviews'
• Quotes, insights from books I'm clearing as relates to Hodges' model
• Occasional timely insights from press / media*
• Conferences, Calls for papers, Journal news
• Q&A with other people about h2cm; critique of the model (well you never know!)
• Update on draft papers, and new citations

So, yes similar threads but the volume must be much, much less.

Twitter will likewise be less, but that doesn't mean - like many - I'm running elsewhere.

I'll be reading, writing, drawing 👍, following webinars and specific YouTube sessions ... studying and will pick up Drupal, github and Pharo. There's a hosting account to put to work, or at least experiment with. Over the past year my thinking about Hodges' model has (imho) progressed. I'm quite excited about what might follow. I'm also daunted, by the dual challenges of the 'development stack' (Drupal is at version 10 and counting...) on the one hand, and logic - relational analysis on the other.

Many thanks for your interest thus far.

HAPPY NEW YEAR TO ALL.

 

*Oh gee! I replied to a thread on #HIFA yesterday and tweeted this a.m.. It would be remiss of me not to pick this up, so post to follow soon.

Editorial: "The Meaning of Concept Analysis" i

Nursing Science Quarterly (NSQ)

 

 

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

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

 

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

 

 

The journal's role and purpose is clearly described:

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

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

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

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

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

 

 

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

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

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

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

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

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

 

Parse concludes:

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

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

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

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

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

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

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

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

*To state the obvious.

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

Patients as Persons not Things: [Nursing] Theory - Practice

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

"Is there something perverse, if not archly insistent, about complicating things with theory? Do we really need anything like thing theory the way we need narrative theory or cultural theory, queer theory or discourse theory? Why not let things alone? Let them rest somewhere else-in the balmy elsewhere beyond theory. From there, they might offer us dry ground above those swirling accounts of the subject, some place of origin unmediated by the sign, some stable alternative to the instabilities and uncertainties, the ambiguities and anxieties, forever fetishized by theory. Something warm, then, that relieves us from the chill of dogged ideation, something concrete that relieves us from unnecessary abstraction." p.1.

 

My source:

Brown, B. (2001). Thing Theory. Critical Inquiry, 28(1), 1-22. Retrieved September 18, 2020, from http://www.jstor.org/stable/1344258