My source:
O'Grady, J. (2021) Think yourself better, Reviews. The Daily Telegraph, 9 January. pp.12-13.
Sellars, J. The Fourfold Remedy, London: Allen Lane / Penguin.
If, when you see, or hear of Hodges' model, you think 'Oh, that's about dividing the world up, putting things - including people! - into boxes.'; I'd request you to please reconsider?
Hodges' model, the two axes, the four care - knowledge domains or quadrants can be thought of as a temporary home. It's like a tent. No, it's actually more simplified than that. More like a bivouac. A shelter that needs to be constructed not with ready-to-hand materials and terrain, but what can be - ready-to-mind.
This construction makes use of two 'sticks' to form the model's axes. A key element too are the dichotomies - polarities - oppositions - continua that the model can reveal with a situated search. This search can variously be local, regional, global, or glocal (as I explained earlier this week - to follow).
This past week has been Self Care Week and the resulting bivouac is an idea-l-isation; a temporary home for a person and a group.
On twitter @SelfCareForum featured the 'continuum of self care':
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| The Self Care Continuum |
Using Hodges' model, reflection on the above picture soon demonstrates the scope of the model. You can navigate the full range of care displayed above. There is however much more to discover.
Amid the ongoing pandemic, we've recognised anew, or afresh, the importance and value of the outdoors, nature and the environment in all its forms. Recently, I've had to take walks with patients/clients in the community, being unable to take in the aspect of assessment that stepping indoors usually provides.
Personally, for many of us, self care is predicated on the care of others: children, older parents, friends, colleagues and the community. A parent you haven't hugged, or kissed since March 2020.
Infants and children are missing out on truly formative years of schooling and teenagers on socialisation. Apparently, among the young, eco-anxiety is a real phenomena, whether it is debated as an unsurprising fact of 21st century life, or a medical problem.
Hodges' model is much more than axes, continua and boxes. While as shown on this blog (since 2006) Hodges' model is made up of several axes and dichotomies, the model's boxes provide the means to weigh the evidence. The model can help that a given situation and context is considered holistically (parity of esteem in physical and mental health) and in a person-centred way. Then, having fulfilled their purpose, we can collapse the boxes, the bivouac and carry forward the conceptually integrated care.
To deal with eco-anxiety, we need tangible signs of social and political progress, as action is taken to tackle the climate crisis. Physical evidence is the best emotional therapy of all. Just imagine when the news media reports that CO2 has decreased, sea-level rise is slowing, plastic and air pollution are reducing.
When will that be?
I'm not sure and as with COVID-19, the uncertainty is a collective and protracted pain.
As the arts continue to inspire us, there is no doubt that caring for self and all are now inextricably linked: from self-care to planetary health.
What do you think - Self Care Tree Girl?
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My sources: And with many thanks.
Or if you have plenty of time, @WoncaWorld also has a full webinar to watch and consider. Environment & Healthy recovery https://t.co/iNepXRhUZD via @YouTube pic.twitter.com/hyTVQgJLEq
— SCwE (@SelfCareWeekEU) November 21, 2020
Mental health (use of groups) One-to-One Interpersonal skills Psychological therapies PURPOSE Psychotherapy | Time, Place Efficiency Cost-effectiveness Evidence-based same conditions PROCESS |
Group Consultations Group Therapy - an established therapeutic modality Group CBT for Older Adults PRACTICE | POLICY Treatment Therapy Education Doctor or Nurse led other disciplines too... |
It’s great to hear #RCGP lead acknowledging the value of group consultations. Many of these pilots have been formulated & run by #nurses in general practice. It’s a shame their work wasn’t acknowledged on .@BBCr4today @weGPNS @theRCN https://t.co/zh4H7swoUv— RCN GPN Forum (@RCNGPNForum) October 6, 2018
Personal Responsibility
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Service
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"Success in this personal task is in large part the result of the self-awareness, self-discipline, and inner resources by which each person regulates his own daily rhythm and actions, his diet and sexual activity... The level of public health corresponds to the degree to which the means and responsibility for coping with illness are distributed among the population."
On my community visits I see many horses out in the fields. There are 'horses' in information systems too:
What are "horses"?
“As an intentional nod to Clever Hans, a 'horse' is just a system that is not actually addressing the problem it appears to be solving.” (Sturm, 2014).In healthcare we keep talking about the need for more emphasis on prevention, health education and promotion. So much of what we do is not futile, despite the growing* debate on euthanasia, but as a 'system' that incorporates and enacts prevention, health education and health promoting principles (and literacies) we continue to fail. In short, the healthcare system is a horse as defined by Sturm.
Dear Welcome to the QUAD reader
I would like to invite you to join HIFA. HIFA (Healthcare Information For All) is a growing global health movement working in collaboration with WHO Geneva and supported by around 300 health and development organisations. HIFA has more than 16,000 members (health workers, librarians, publishers, researchers, policymakers and others) committed to the progressive realisation of a world where every person has access to the information they need to protect their own health and the health of others. We have about 5000 members in Africa, 5000 in Europe, and 6000 in the rest of the world, across 177 countries. We interact on five forums in three languages (English, French, and Portuguese). HIFA members have experience and knowledge which they can use to bring clarity to challenging questions around global health issues in general and healthcare information issues in particular. Our website is www.hifa.org and membership is free! Join here: www.hifa.org/joinhifa
Many thanks,
Peter Jones
If you use Facebook or Twitter, please spread the word. The HIFA Twitter handle is @hifa_org (with thanks to our HIFA twitter coordinator Jules Storr) and the HIFA Facebook page is https://www.facebook.com/HIFAdotORG/ (with thanks to HIFA Facebook coordinator Tara Ballav Adhikari)
You can also point people to our latest HIFA Annual Review:
http://www.hifa.org/sites/default/files/other_publications_uploads/HIFA_Annual_Review_2016.pdf
Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org
My source: Neil Pakenham-Walsh - coordinator of HIFA
Recent discussion on a HIFA forum included mention of the Social Determinants of Health SDH and inequality. Revising the draft paper on h2cm and threshold concepts (abstract to follow soon) social determinants arose in references there also (Aronsson, 2016).
I realised that I have not stressed enough how readily (and obviously) Hodges' model facilitates reflection and critical thinking about SDH. Hodges' model can really come into its own in this particular application.
So, just in case I take Hodges' model for granted in its potential utility, below I have drawn on the following figure (the findings within will no doubt vary over time and with further research).
By Jsonin - Created this open source diagram for our research into standard human data elements Previously published: http://determinantsofhealth.org, CC BY 4.0, LinkI have mapped the main percentage items to Hodges' model below. Clearly there is great deal of overlap; what for example, is the effect of the physical environment upon individual behaviours? Medicine and medical care does not just rest upon several sciences, but it is inherently political and about power.
individual behaviour |
7%
physical environment
11%
medical care
21%
genetics and biology
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SOCIAL DETERMINANTS OF HEALTH
23%
social
circumstances | As if we needed to be 'told': This space suggests that there really is still much more to do. To those who would say: "We have done so much!" I would say: "But, we have only scratched the surface of the three 'easiest' care domains." |
The following is a reply to a thread on HIFA - Healthcare Information For All:
Dear Lucie, Thelma and All,
The Austrian economist Joseph Schumpeter (1883-1950) defined a dynamic economy as that which is in equal parts destructive and constructive (Abbott and Ryan, 2000).
As Lucie points out in the NHS we are set-fast in ill-health delivery, curricula and workforce planning. Breaking this demand-supply is to try to stop a runaway process that has spawned many other processes: specialties, disciplines, treatments...
Policy makers repeatedly place the solution in reducing demand by eliminating - providing cures for diseases and through technology.
Innovation through technology is still sold as a (the) solution (2002.. NPfIT - currently NHS Digital). Technology has a role to play. The benefits however must be Socio-Technical.
We can readily see the connection between Schumpeter's definition and our present preoccupation with innovation and technology driven disruption?
Talk abounds of the healthcare system / market / economy being disrupted (as per HIFA and this thread!).
Innovation is often stimulated through seed funding.
In computing a runaway process may need to be 'Killed'. Clearly and despite the resultant irony, we cannot do this to our respective healthcare systems (whatever their constitution and ideology).
We cannot Kill the NHS, private and 3rd sector systems we have at present and have them newly reconfigured on 31 December 2016, 23:59:60 UTC to be primarily:
HEALTH PROMOTING, PREVENTIVE - Self-caring and with a health literate populous
Even with the addition of a leap second; this would be a leap too far.
Change of our health care systems will need to be 'seeded'.
Many small gains can be compounded, the seeds must be broadcast across the domains of Hodges' model:
As I work on my research proposal this paper (in press) is a very useful and timely reference...
Abstract - Background
Sinclair et al. refer to:
"One suitable framework that is congruent with e-learning research is Kirkpatrick’s four levels of evaluation." (p.53).
I have taken the rest of the paragraph and mapped the stated levels to Hodges' model:
Level two pertains to learning and the evaluation of knowledge. |
Kirkpatrick’s model is hierarchically based with level one relating to student reaction and how well the learner is satisfied with the education program.
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| Finally, level four evaluates the impact on outcomes such as cost benefit or quality improvements. |
Peter M. Sinclair, Ashly Kable, Tracy Levett-Jones, Debbie Booth, The effectiveness of internet-based e-learning on clinician behavior and patient outcomes: a systematic review, International Journal of Nursing Studies, Available online 4 February 2016, ISSN 0020-7489, http://dx.doi.org/10.1016/j.ijnurstu.2016.01.011 (http://www.sciencedirect.com/science/article/pii/S0020748916000122)Keywords: e-learning; Systematic Review; Education; Information Communication Technology; Health Care Professional
"Patient education is Article 25 of the universal Declaration of Human Rights, and Article 4 of Patients' Rights Law - The right for information, the ethical principle of respect and a component of the nursing professional standard that prove the examples of good practice. The patient, with the exception of life-threatening situations, and when the relatives or contact persons are not available, receives educational information on expected handling, treatment and care processes, medication, and all that is followed by the agreement on the part of the patient to receive treatment, rehabilitation or prevention process." (p.1957)
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I read Nortin Hadler's Missing the Forest For the Granularity (July, 2014) on The Health Care Blog with great interest. The article draws attention yet again to the risks and preoccupation with processes and systems. This provides me with another opportunity to highlight the 4P's within Hodges' model: Process, Policy, Practice and Purpose and add some of the points that Dr Hadler addresses.
The 4Ps by themselves might have meaning but they can't do work. For that we need a context and several perspectives. As Dr Hadler points out big data intrudes on the clinical encounter determining not just what is collected, but how it is captured and structured.
There are frequently two datasets at the practitioner level: one is administrative and managerial in form and purpose; the other is clinical - patient, person centered. Effective communication already presents a challenge. On top of that then how relevant are the IT systems. The holy grail of IT systems still seems to be benefits for clinicians and patients - the public. Until then will the IT continue to push the patient-clinical relationship as if it is some wobbly toy? You bet it will!
Where exactly should the “Physician’s Dashboard” reside? Is it a case of "the ayes have it" but only on the right?
Nortin also refers to the United States postponing ICD-10. From Wigan Pier I clearly do not understand the issue, but this seems from here more like a very prolonged delay. A delay that perhaps says more; not just about the healthcare 'system(s)', but the many interfaces to be found there.
Many thanks to Dr - Prof. Hadler for his article:
https://thehealthcareblog.com/blog/2014/07/11/missing-the-forest-for-the-granularity/
| “cognitive” specialists, the care of the patient revolves around the “granularity” of the narrative. PURPOSE individual attention and focus ability to share purposes Using individual differences and idiosyncrasies |
patients as widgets (here)?
Can you see the dashboard here? PROCESS data gathering big data, ICD-10 Electronic Medical Record - templates and “smart sets” |
| PRACTICE Patient - BIG DATA - Doctor relationship empathy 'NOISE' empathy life-course (“social”) epidemiology | POLICY Europe, health care systems, United States, health economists, hospital administrators, patients as “units of care”, physicians as “providers”, clinical demand = “throughput.” common denominators invoicing |
| my well-being |
prescribing
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social prescribing | economics |
With the NHS under ever greater strain, the Arts Council and health authorities are collaborating on schemes around the country ...
Peter Bazalgette
The Observer,
In the previous post I highlighted "Holistic approaches to learning are agnostic as to method."
I added that there would be more to follow as Hodges' model can be viewed as agnostic on several levels. The following is taken from a paper on Hodges' model and its application in forensic nursing:
Hodges’ model claims to be person-centred and situated (Jones, 2008). What exactly does this mean for forensic nursing? The utility of Hodges’ model lies in it being agnostic. By ‘agnostic’ this means that the model is not dependent upon, dedicated to, sanctioned by, or owned by any particular discipline (even nursing). It was not designed with a particular media, clinical setting, situation or organization in mind. It is true, however, that the model was formulated within academia and health and social care, being taught and applied by community mental health nurses, learning disability and health visiting students. Apart from the history and universality of the model’s cruciform structure and its inherent 2 x 2 matrix form [often referred to as a Johari window (Luft and Ingham, 1955)], the model is also culturally neutral. This is an essential requirement to reflect and enact nursing values and codes of conduct (Nursing and Midwifery Council, 2008).Doyle, M., Jones, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. 20, 7, 631-640.
This book is available as an open access pdf. Here is an extract from chapter 2 on Social Learning Theories.
Holistic approaches to learning are agnostic as to method. Drawing from connectivist and older models, they valorize diversity and the socially distributed cognition afforded by the read-write Web and other publishing models, accepting that every learning experience is unique, and every learner’s needs are different. Connectivist approaches, for all their extensive reliance on networks of people engaging socially, are at heart focused on the individual—specifically, the individual’s learning. Holistic models embrace the fact that it is sometimes more important that a group learns, rather than an individual, especially in collectivist cultures (Potgieter et al., 2006). Holistic models recognize that, sometimes, guidance is what is most needed, that people can learn without direct engagement with others and, even that transmittive instructionist models of teaching have a place. p.61.In the next post I will explain the emphasis placed in the quote.
Dear all,
The Lyon Declaration on Access to Information and Development
http://www.lyondeclaration.org/ was
successfully launched at the World Library and Information Congress
2014 in Lyon. Since then, over 280 organisations from across the library
and development community have signed the document and called upon
United Nations Member States to incorporate access to information in the
new post-2015 development framework. The Declaration has now been
translated into 13 languages.
Following the release of the Open
Working Group Outcome Document in July, IFLA is now waiting to see what
UN Secretary General Ban Ki-Moon will present to the UN General Assembly
later this year in New York. The Secretary General is currently
overseeing preparation of a ‘synthesis report’ that will bring together
the outputs of various processes on the post-2015 development agenda and
help UN Member States find a way forward in negotiations over the next
twelve months. The synthesis report is expected to be released at the
end of October/early November.
What are the next steps?
Once
the synthesis report is issued it is crucial that policymakers in the
capitals of UN Member States get to hear what libraries want to see in
the new framework. As outlined in the Lyon Declaration, IFLA wants the
United Nations to acknowledge that access to information, and the skills
to use it effectively, are required for sustainable development, and to
make sure that the framework’s goals, targets and means of
implementation reflects this.
Your voice will be needed for us to achieve this goal.
IFLA
is currently preparing an advocacy toolkit which will help library
representatives to approach decision-makers in order to talk to them
about the importance of access to information in development. IFLA wants
to help its members and partners to take the opportunity to position
themselves inside development debates in their home countries, so that
their governments recognise the value libraries bring to development.
Ultimately, libraries can benefit from being included in the national
plans that will implement the new development agenda from January 1st,
2016.
The advocacy toolkit will be available in early October 2014.
What can you do to help?
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| The Angler by Paul Klee (1879-1940, Switzerland) |
This is just a rock pool I reflect | So is this, even before Pollock just a single drip in the ocean |
Fishing for praise | Here we trawl, as we do we maul. Why owns the holistic ocean? Does it bleed, does it leak? Abs-orbs all angles? just? |
On Monday I have a quick visit for 15 minute slot on care pathways at an interprofessional study day for 2nd and 3rd year students.
After the short presentation I'll ask the question of what difference the students can make to the patient's care pathway. There may be value in continuing the 'journey' metaphor?
They can ensure the care pathway is well-documented (otherwise it doesn't exist, and travel on it never happened) they can check it is accessible (an achievable goal) and that it does not trip anyone up (we don't do - iatrogenic).
There are further tests: is it navigable, tried and tested, a safe (evidenced-based) route? As the student's contemplate a major step in their health career, we really need them to focus on the health career of the persons in their care.
[ There won't be time for this: but do we need to wait until the 'end' for the outcome and capturing that (feedback). Or can do we this verbally, incrementally (positive impact on quality)? ]
I could ask them all to stand and make like sign-posts, but for the risk of poked eyes. It's true though, sign-posting is an important job, but how we do that is another post (the value of self-discovery as learning).
Once medically fit the key thing should be checking the person's (not viewing them totally as patient) wayfaring skills.
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| OK, who took my care pathway? |
Art in Global Health: Reflections |  The exhibition brings together artworks including painting, photography, sculpture, film and performance, made during residencies at medical research centres funded by the Wellcome Trust in Kenya, Malawi, South Africa, Thailand, Vietnam and the UK.http://www.wellcome.ac.uk/News/2013/WTP054754.htm |
"Health issues are usually addressed by women
menbecause of their standing in society. The question is: how do we bring the
into the picture?"
Elson Kambalu |
About Art in Global Health
‘Global health’ is a phrase we hear more and more frequently. As it attracts more attention it attracts more investment and more research. But what does it mean? ...
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| Brian E. Hodges - c/o Brian's family. |
Born in Liverpool, UK.
Community Mental Health Nurse NHS, Part-time Lecturer,
Researcher Nursing & Technology Enhanced Learning
Registered Nurse - Mental Health & General
Community Psychiatric Nursing (Cert.) MMU
PG Cert. Ed.
BA(Joint Hons.) Computing and Philosophy - BIHE - Bolton
PG(Dip.) Collaboration on Psychosocial Education [COPE] Univ. Man.
MRES. e-Research and Technology Enhanced Learning, Lancaster Univ.
Live and work in NW England - seeking a global perspective.
The views expressed on W2tQ are entirely my own, unless stated otherwise.
Comments are disabled.
If you would like to get in touch please e-mail me at
h2cmng AT yahoo.co.uk
orcid.org/0000-0002-0192-8965
