Hodges' conceptual framework: A model for Narrative Medicine ...

Abstract

The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. Adopting methods such as close reading of literature and reflective writing allows narrative medicine to examine and illuminate 4 of medicine's central narrative situations: physician and patient, physician and self, physician and colleagues, and physicians and society. With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care. ...

 

Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA. 2001;286(15):1897–1902. doi:10.1001/jama.286.15.1897 

With my emphasis.

#Identity #Group #Individual #Collective #Mind #Body #TheOdysseyHasBegun

RCN Congress: Ebola, privacy and 'care bundles'

The first discussion at RCN Congress #RCN26 on Nursing as a STEM profession, or STEAM, with the arts added, became a resolution:

https://www.rcn.org.uk/congress/congress-events/nursing-as-a-stem-profession-2026

This was marvellous as it touched so many aspects that Hodges' model readily encompasses.

There is scope for the addition of emergency items:

https://www.rcn.org.uk/congress/Submit-an-emergency-agenda-item

Yesterday I wondered about the latest ebola outbreak, national and international aid^. Plus, privacy, having noticed a stream on twitter regards the NHS and a contract with Palantir. Yes, 'X' as a source is a problem, but concerns about access to confidential clinical information is found in the quality press. What does the Information Commissioner's Office say? Well, it seems there is a history:

https://icosearch.ico.org.uk/s/search.html?collection=ico%7Esp-search&query=PALANTIR&profile=_default

While searching for 'care bundles' I came across this:

 'The scope and force of medical privacy is further supported by a secondary layer of protections based in sectoral and other forms of regulation. Anti-discrimination laws, disability rights, and employment law, for example, all recognize and operate to preserve medical privacy by restrictions of use of medical information outside of the medical setting. 

 These intersecting normative strands of medical privacy, derived from different sources, together form a set of norms designed to protect a bundle of interests that is essential to the maintenance of an effective healthcare system that encourages and protects appropriate care-seeking and treatment. Whether and how technological changes in the collection, storage, and processing of data affect the construct of medical privacy is a pressing question. Just as a bell cannot be unrung, erosion of the sphere of medical privacy is unlikely to be restored.' p.330.

I realised over the past twenty years or so I've paid less attention to the fact that sections of a population, those often most in need of healthcare will not engage, be care-seeking - if they have no faith and trust in how their information is managed and protected. Minority groups, the digitally excluded (whether by choice, or literacy, economics) the influence of media are all vulnerable. Protection of data and the integrity of health services and systems is surely a matter of professional import both clinically and informaticians? As a registrant, I've always put it to student nurses that they should be aware of what happens to the data they as a registered nurse, enter in the electronic health record.

Pierce, R. (2018). Medical Privacy: Where Deontology and Consequentialism Meet. In B. van der Sloot & A. de Groot (Eds.), The Handbook of Privacy Studies: An Interdisciplinary Introduction (pp. 327–332). Amsterdam University Press. https://doi.org/10.2307/j.ctvcmxpmp.17

 

^What, only one sentence? Yes, but I'm still worried; geography - distance now matters little. While, on the other-hand: care-seeking...?

 

Previous posts: 'ebola' : #RCN26

'Nurses and Nursing's Issues' ...

1975 .. plus ça change, plus c'est la même chose .. 2025

"The question I ask myself all the time is not can we close the gaps in practice and administration, but, more importantly, can we develop a nursing system, not the profession of nursing, but a nursing system which will weave together all practitioners with what-ever skills they bring to the system" Jessie Scott, p.1854. 

 
Nurses and Nursing's Issues. The American Journal of Nursing, Vol. 75, No. 10, 75th Anniversary Issue (Oct.,1975), pp. 1848-1859. Stable URL: https://www.jstor.org/stable/3423579

Now, in 2025 we can make an impression - not just on the nursing profession, but in how all the health professions work, learn and relate to each other and social care colleagues too.

https://en.wikipedia.org/wiki/Jessie_M._Scott

https://en.wiktionary.org/wiki/plus_%C3%A7a_change,_plus_c%27est_la_m%C3%AAme_chose

'Super/man'

‘Super/Man’ Review:
Christopher Reeve’s Life and Activism Are Beautifully Laid Bare in New Doc

Sundance 2024:
The actor’s journey from playing Superman
to becoming disabled gets explored
 in this inspirational tearjerker

See the 'Super/person' ...?

Individual
   |

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :   POLITICAL 

|

Group

dreams imagination	A still from "Super/Man: The Christopher Reeve Story" Photo by Herb Ritts / AUGUST (Courtesy of Sundance Institute)
Image: https://www.timesunion.com	activism

Review of the documentary 'Super/Man' at Sundance 2024: Christopher Reeve's life and activism showed beautifully. From playing Superman to his disability, a life journey that brings tears. https://t.co/V8pkd3hqNO #Disability #Accessibility #axschat@JudgeWren @kurtyaeger pic.twitter.com/KrUZkAai3l

— Antonio Vieira Santos (@AkwyZ) January 22, 2024

My source:
https://x.com/AkwyZ/status/1749379978519576654?s=20

#Identity !

"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.

Book: "In Search of Mary Seacole"

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

Community - GROUP - Population   

Mary	In Search of Mary Seacole
Seacole "Known by the British Troops in Crimea as 'Mother Seacole', she was a nurse, pharmacist, humanitarian, businesswoman and patriot."	The Turkish Order of the Medjidie French Legion of Honour British Crimea Medal

 

Photo taken in Richard Booth's Bookshop, Hay-on-Wye, 19th February 2022.

Owolade, T. (2022) The myth of Mother Seacole, Culture, The Sunday Times, 13 February, p.22.

 

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