Paper - (finally!) "A generic model and conceptual framework to prime curiosity across health and social care ..."

 It has been over a decade but at last the second* paper has been published in Journal of Evaluation in Clinical Practice:

Jones, P. (2025), A Generic Model and Conceptual Framework to Prime Curiosity Across Health and Social Care Disciplines to Facilitate Lifelong Learning. Journal of Evaluation in Clinical Practice, 31: e70252. https://doi.org/10.1111/jep.70252

ABSTRACT 

Rationale: The Corona virus pandemic highlighted the importance in continuity of the physical and emotional labour across all care sectors. Synergy between healthcare in hospitals, and community services must be allied with social care; and be central to integrated and efficient policy and service delivery. Services were found wanting in the pandemic and in recurring winter crises. The politics of funding for care delivered in rest and nursing homes remains contested, awaiting long‐promised governmental action. The workforce is recognised as dedicated, skilled, compassionate and yet under‐valued and under‐paid; managers face ongoing recruitment challenges, with a national shortage of staff, and high turnover of personnel. A National Care Service is awaited in England and Wales. 

Aims and Objectives: This study explores the ongoing care crisis, using the educational lens of threshold concepts, projected, analysed and synthesised of a generic conceptual framework, known as Hodges' model. Readers will understand Hodges' model and threshold concepts being equipped to explain both. 

Methods: The study is descriptive and uses a conceptual mapping approach supported by discussion and literature. Additional resources and avenues for ongoing study are also provided. 

Conclusion: In conclusion, Hodges' model is a pragmatic, practice‐based tool, that can support and sustain curiosity for workforce learning and development. 

Acknowledgements I would like to thank Messrs Mark Bird and Matthew Graham and the journal's reviewers for comments on drafts of this study; and acknowledge the effort of Dr Michael T. Flanagan in creating the informative threshold concepts resource (referred to above). 

https://onlinelibrary.wiley.com/share/author/IRPNBR2KHJNYJK8XUAW6?target=10.1111/jep.70252

*This paper was originally the first of a two-part work. Feedback from reviewers suggested the papers be standalone. United now, in one journal.

Many thanks to the reviewers, editor, editorial and publications team at JECP.

This paper has been added to bibliography in the blog's sidebar.

'New' citation of Hodges' model - Kennedy (2019)

This morning an alert from ResearchGate brought news of a further not so new citation of Hodges' model:

Kennedy, Harry G. (2019). National Forensic Mental Health Service (NFMHS) Model of Care. 10.13140/RG.2.2.30103.59041.

I've extending thanks to Prof. Kennedy, and have added the details to the blog's bibliography (in the sidebar). It is not as if Hodges' model played a key role in service design (care architecture?), but it is nonetheless marvellous to achieve this visibility.

This does make me wonder if there are others?

Any further news welcome.

A citation of Hodges' model IN "Excellence in forensic psychiatry services..."

McLaughlin, P., Brady, P., Carabellese, F., Carabellese, F., Parente, L., Uhrskov Sorensen, L., . . . Kennedy, H. (2023). Excellence in forensic psychiatry services: International survey of qualities and correlates. BJPsych Open, 9(6), E193. doi:10.1192/bjo.2023.578

Background

Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development.

Aims

To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security.

Method

A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire.

Results

Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score.

Conclusions

Larger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.

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As the second citation  for Hodges' model from ResearchGate this month, I hope this is a trend. If I can assist any researchers, please let me know. 

While welcome, I'm not interested in being a co-author; if I can help your understanding and application of Hodges' model this is what counts.

Delighted to add McLaughlin et al. to the bibliography.

Many thanks to Harry G. Kennedy and team.

Citation of Hodges' model IN "Application of the Threshold Concept Framework in Nursing: An Integrative Review"

This morning ResearchGate informed me of a further citation for Hodges' model:

Kistler KB, Tyndall DE. Application of the Threshold Concept Framework in Nursing: An Integrative Review. Nurse Educ. 2022 Mar-Apr 01;47(2):91-95. doi: 10.1097/NNE.0000000000001041. PMID: 34033613.

I have requested a copy and added Kistler and Tyndall to the bibliography listing in the blog's sidebar.

Here, I am still sitting on the two-part draft paper on threshold concepts, liberty protection safeguards, residential forms of care and Hodges' model.

Last week, during a break I received news of acceptance for another online conference. Details to follow, as I complete two abstracts this month.

Evidence-based care: The original Gordian Knot

or - Choose your audience carefully.

Within health and social care (and other - safety-critical - academic and professional fields) evidence-based care is pivotal as proof of safety, reproducibility, effectiveness, efficacy, professionalism, and benefits for the subjects of care and public. How best then to prove the scope, scale, relevance and safety of Hodges' model? How to demonstrate in theory and practice the utility and increasing relevance of Hodges' model? There are times I have to temper my belief, passion and enthusiasm for h2cm; am I too ardent, and at risk of coming across as preaching? There is a further tension. The one that is constant: language.

As a nurse, attention to language and terminology is vital to effective communication, establishing and sustaining rapport and empathy. This concern applies across situations, contexts and encounters; with patients, patient and carer (family), and colleagues. We are encouraged to avoid jargon, abbreviations  and technical terms. I use Hodges' model implicitly (aide-mémoire, assess, plan, evaluation, prioritise) and explicitly - sharing the model on some occasions but not all.

In the role of researcher / author, the audience, especially - editors, reviewers, and readers have expectations in how concepts, ideas, theories are expressed and explained. To a degree, the very title of a publication, preempts the language to follow. As I present, or write, sources must be declared and  referenced. Again, resort to jargon is discouraged. Clarity and brevity are strengths. And yet how likely is it that at least 1/3 reviewers will demand more technical rigour and explanation? If terms are used from other disciplines, the expectation follows that their cross-disciplinary application is explained and argued for, and meanings differentiated.

With potential theoretical underpinnings for Hodges' model to be found in Gärdenfors's Conceptual Spaces, and Meyer & Lands's Threshold Concepts and others (nursing and healthcare no-less); John D. Cook provides additional pause for thought - as I look even further afield:

"When I was in college, I sat in on a communication workshop for Latin American preachers. ...

Another lesson from that workshop, the one I want to focus on here, is that you don’t always need to convey how you arrived at an idea. Specifically, the leader of the workshop said that if you discover something interesting from reading the New Testament in Greek, you can usually present your point persuasively using the text in your audience’s language without appealing to Greek. This isn’t always possible—you may need to explore the meaning of a Greek word or two—but you can use Greek for your personal study without necessarily sharing it publicly. The point isn’t to hide anything, only to consider your audience. In a room full of Greek scholars, bring out the Greek.

This story came up in a recent conversation with Brent Yorgey about category theory. You might discover something via category theory but then share it without discussing category theory. If your audience is well velrsed in category theory, then go ahead and bring out your categories. But otherwise your audience might be bored or intimidated, as many people would be listening to an argument based on the finer points of Koine Greek grammar. ...

Some things may sound profound when expressed in esoteric language, such as category theory or Koine Greek, that don’t seem so profound in more down-to-earth language. Expressing yourself in a different language helps filter out pedantry from useful ideas. (On the other hand, some things that looked like pure pedantry have turned out to be very useful. Some hairs are worth splitting.) 

Sometimes you have to introduce a new terms because there isn’t a colloquial counterpart." ...

 Category theory and Koine Greek: John D. Cook. 

Category theory and Koine Greek: John D. Cook. 
https://www.johndcook.com/blog/2016/06/27/category-theory-and-homiletics/

See also: Applied category theory: John D. Cook

https://www.johndcook.com/blog/applied-category-theory/

Additional citation: IRMS Bulletin - November 2022

 Last May I presented Hodges' model at the IRMS Conference in Glasgow.

When I walked in to set up I had the room to myself. I was able to attend on the final day, that of my talk - travelling and staying at my own expense.

The concurrent - streamed format for the conference means you are competing for hearts, minds and existing conceptual frameworks, how well they are populated, what are the 'gaps' and delegate's curiosity and desire for lifelong learning. Next year's event is in Manchester, I'd encourage you to submit, attend if you can.

Five minutes before the start of my session, I counted 8-10 people. The Chair had arrived and suggested we wait a bit longer. 4-5 minutes later I was really pleased - all the seats were occupied and people still arrived by the door. Altogether there were over 30 people.

I'm probably better 1-1 - perhaps that's the 'nurse inside', but the session went well, as the Chair acknowledged and some questions afterwards.

At the end, I was also approached by Jonathan Fryer, in response to a slide showing how Hodges' model can conceptually encompass the various forms of literacy and schools and informatics (posted previously on W2tQ).

Jon immediately saw the relevance of the model, as at The British Library (Head of Corporate Information Management Corporate Information Management Unit) he was currently thinking about literacy.

IRMS Bulletin is a member-based publication, so not open access. I'm grateful that Hodges' model has some exposure and that Mr Fryer found it helpful:

"Information Literacies - Learning, to thrive in a digital age"

IRMS bulletin 230

"I am indebted to Peter Jones, who shared Hodges’ Health Career Model¹ with the 2022 IRMS conference in Glasgow. Although originally used in a healthcare setting, this simple, two-axis intellectual model can be readily used to analyse any complex interaction between the individual and their environment – in this case, information literacies.

The diagram² shows a number of distinct yet overlapping literacies that were potentially in play in our problem example, although there are likely to be many more – even emotional literacy played a part, with the frustrations of the young people in question causing them to dismiss potential solutions before they had been tried or even considered. Likewise, socio-political and socio-economic literacies may have been a factor – if you are unaware that something exists in the world due to blind-spots in your own cultural background then you cannot even begin to look for it."

Jon Fryer, "Information Literacies - Learning, to thrive in a digital age". IRMS Bulletin, Issue 230, November 2022.

[ I will add a detailed citation when obtained and add to the blog's bibliography. Apparently some details referring to Hodges' model were omitted from the published article, I understand IRMS editors are addressing this is a future issue. ]

See also:
https://hodges-model.blogspot.com/search?q=blind-spot

I am planning a submission to the bulletin myself in 2023.

CLOSE(D) CARE: Group climate in a secure forensic setting for individuals with mild intellectual disability

This morning ResearchGate alerted me to a new paper/thesis citing Hodges' model. 

I will add this to the bibliography and post again in the new year, relating selected conceptual content of Elien's thesis to Hodges' model.

Background

CLOSE(D) CARE

This study examines associations between group climate, aggressive incidents and coercive measures in adults with mild intellectual disability or borderline intellectual functioning (MID‐BIF) of a secure forensic setting.

Method Participants (N = 248) were interviewed about their perception of group climate utilizing the Group Climate Instrument. Data on aggressive incidents and coercive measures were retrieved from the facilities’ electronic database. A multilevel structural equation model was fitted in which variability in perception of group climate within and between living groups was examined.

Results An open and therapeutic group climate was associated with lower levels of aggression within and between groups. A higher number of aggressive incidents were significantly associated with a higher number of coercive measures.

Conclusions The findings have implications for the understanding of how group climate may play a role in reducing aggressive incidents at the living group in treatment of individuals with MID‐BIF in secure forensic settings.

Elien G Neimeijer (2021) "CLOSE(D) CARE: Group climate in a secure forensic setting for individuals with mild intellectual disability." Radboud University, ISBN: 978-94-6416-713-9
https://www.trajectum.nl/sites/default/files/proefschrift_e._neimeijer_pdf.pdf