Attending: Active listening c/o Baggini & TPM

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

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

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

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

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

 Individual
  |

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

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

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

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

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

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

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

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

Draft figure: Selected processes and sources that can contribute/influence the content of Hodges' model

This draft figure is intended to ultimately show how the final application of Hodges' model, that is, the selection and placement of concepts in the care (knowledge) domains is not determined by a specific rule, 'law', or theory. The user of the model as a reflective, problem solving agent must justify their 'completed' matrix - addressing the four care domains. This could be a combined effort, with a colleague, fellow student, patient, or carer. 

Being situated the figure should highlight how the final result, output is not only dynamic, changing over time, but it is dependent upon context. Contrast using the model in a seminar, with a nurse and student reflecting on a forthcoming or post a best interests or safeguarding meeting.

The most important point here, across all healthcare, education and other use-cases, is that when applied the user of the model begins with a blank 'sheet' ... template 

Any thoughts welcome. [image updated 18 March 2022].

Draft figure: Selected processes and sources that can contribute/influence the content of Hodges' model

Gatekeeping: Across the care domains

individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Cognitive gate (access): Mental state: Risk to Self/Others? Literacy: My articulation of my needs Understanding of Consultation/plan Service name: acronyms My understanding hence awareness of services, referral Opt-in Self-neglect	Physical gate (access): Physical state 'emergency'? Telephone call, reception Obtain appointment Phone/Video, Face-to-Face Surgery, Clinic, Hospital, Home Letter: 'x' days? [ Triage Assessment, Planning Intervention Evaluation ] Individual: Collective: WAIT data?
Social-Cultural gate: Cultural diversity/Accessibility Service - Semiotics/Semantics/Signage Family/Social commitments (access) Sociology of Illness/Sick role Carer role Community/Local Understanding & Involvement? Reporting, Info sharing	Political gate: Service Provision/Use [by postcode?] Referrer's knowledge ... "Policy says..." ... URGENT, routine, 1,5 days... Service Pathways/Signage/Appearances Work commitments (access) Previously known? [ MAIN GATE: Therapeutic Modality? ]

 

Open to suggestions... 

Stranger in a strange land: 'Adult' CMHT

I've started working in an 'adult' community mental health team. This is a change in character from older adults and in Hodges' model we can draw the discussion on this out in several directions.

The 'adult' - 'older adult' distinction on one hand may seem discriminatory. So, once you are aged 65 you move to another service? On the other hand there are many scholars / professionals who have over many decades fought to have older people's needs recognised, represented and funded as a distinct speciality. There are protocols accepted and practiced that should - must also take into account the patients (carers) wishes allied with needs and circumstances.

The 'character' is also different between adult - older adult, but both carry unique challenges*. This must always be the case if the patients and their situation are viewed as unique.

3.5 days in - I'm already aware of changes in community mental health provision. My previous experience 16-65 goes back to 1995, apart from having some patients during studies in psychosocial intervention in psychosis.

There seems to be more chronicity and I have a sense that suddenly 'nursing' has a welfare and benefits problem solving flavour to it.

The summit I've just posted about is invaluable learning, as I have inherited a caseload of people living with varying forms of diagnosed personality disorder. I'll expand on this experience over the next few weeks. This is timely as I have re-validation next year.

Over many years I have heard of Paris the clinical record system. Now I will be having training and become a 'user'. Looking forward ...

*With challenges also come rewards!

Study the hoops, but care about the thresholds

When you are on a course you really have - quite rightly - to do things by-the-book. That is the way - they say - you learn which corners of the pages you can turnover. Students learn early on that you have to jump through various hoops in order to complete the course and earn the stripes. The art and science of caring presents its own hoops, but in addition it is thresholds that present a barrier, thresholds that need to be negotiated in order to meet need.

Suddenly this is not about one person (you) it is about a partnership. A partnership of professionals allied and directly collaborating with a 'patient' and their carers.

One of the hoops is the paper or electronic referral form. Are you still sure this referral of yours is necessary? Are those two assessments really necessary?

There are a host of thresholds that may (or may not?) shift like a tide around the local and increasingly extended health and social care community, or 'economy' if you prefer, for example:

The threshold at which a nursing home will contact a GP surgery; or mental health services?
Just exactly what is residential care's capacity to cope internally and manage with a given range of health and social care challenges? What exactly should that capacity be? Should the public have access to referral data from care homes - to accident and emergency, mental health services, primary care? What proportion of 'referral problems' are dealt with at the nursing - social work level? What is the mental health service's threshold in terms of responding to a referral? What is the threshold for relatives believing that sufficient is being done for their loved one?

As lifelong learners of course we are all perennial hoop jumpers, learning the art of scaling and re-framing the thresholds that cross our way.

Image sources:

Seed-and-threshold segmentation

hula hoop (no longer available)