iii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

In reading this book and others on W2tQ, I must make the following points:

  * my need to remember the purely USA context (I have never worked there);
  * my healthcare, nursing, informatics experience is NHS-based;
  * this review (and others) is motivated by the project here - Hodges' model;
  * as a result, I will be quoting heavily, there is much to bring to your attention.

As noted in post (i) there is much to whet the appetite, a paradigm shift, 'comprehensive, collaborative, and integrated care' (p.11) certainly have become popular topics in the medical literature. Not only that but 'interpersonal and intersubjective treatment models' too (p.12).

The role of 'Case Managers' is highlighted, plus the Case Management Society of America, which is committed to:

•  Improved Consumer Health Outcomes
•  Professional Diversity, Equity, and Inclusion
•  Cultural Competency and Humility
•  Advocacy for the Health Consumer
•  Integrity and Ethical Principles
•  Promoting Health Equity
•  Educating Case Managers Across the Care Continuum
•  Evidence-based Quality Care
•  Holistic, Compassionate Care
•  Fostering Communication and Collaboration
•  Advancing Research, Innovation, and Use of Technology
•  Fiscal Accountability [ https://cmsa.org/about/ ]

Whether the USA influences global trends in the structure and form of healthcare is another post, but there is a UK Case Management Society too: https://www.cmsuk.org. I can see a fit here [UK] with the development in recent decades on social prescribing. A different role, of course but part of a complex jig-saw.

As expected definitions are provided: 

'Roger Kathol has eloquently defined "health complexity" as "the interference with the achievement of expected or desired health and cost outcomes, due to the interaction of biological, psychological, social and health systems factors when patients are exposed to standard care delivered by their doctors" [1].' p.10. 

Roger G. Kathol, Rachel L. Andrew, Michelle Squire, Peter J. Dehnel (2018) The Integrated Case Management Manual: Value-Based Assistance to Complex Medical and Behavioral Health Patients. 2nd ed. Basel: Springer.

I can see where this definition comes from, but for me, it does not sit right. The problem when there is 'interference' is the assignment of responsibility and consequence that blame can follow. We've seen this, and in mental health too), with the recover model^. Some of the terms here may be completely innocuous politically speaking (which is the author's intent of course), but they can also be 'weighted'. Hence they can become concrete terms of judgement. Think about it: achievement, expected, desired, cost (and) outcomes, standard care, delivered (by doctors)? Or, am I over-thinking again.

In the margin I pencilled/drew:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Standard -	care
Other -	factors

As ever, the individual patient is our focus. The individual is supported (literally) by the social and political (infra-)structures that act as a scaffold, safety-net for most.

Time flies, I can't believe it was 2007 I posted 

Plush HQ foyer, shame about the mannequins!

I had this notion of life-size cardboard cutouts representing the average people who use a given health service provider (local, or not so local these days?). The data will be there in statistical annual reports. I'd noticed the displays - analogue and digital that greeted visitors at a local NHS Trust HQ. This would be the book's 'routine patients' who receive standard care. 

Chapter 3 introduces 'variables' which again is brief, but imporant as variables recur throughout the book. The 'Clinical Field' is first outlined, as in:

• Sources of clinically relevant factors;
• Dynamic factors;
• and: Variables representing contributions from practitioner(s).

Abstract variables are differentiated from those that are concrete. It's reassuring to read there is no true simplicity within the clinical field, and the author's goal is to 'unpack complexity so it remains as true to life as possible, not just manageable conceptually.' p.18.

Frankel et al. are primed to go beyond this. Maths, as in statistical procedures are one tool. Chapter 4 adds to this with a theoretical model to guide clinical understanding of patients with biopsychosocial complexities, the foundations of our paradigm shift. p.23.

If you have an understanding of Hodges' model you can picture my response to this. But, staying grounded, the whole book and paradigm shift represents a form of scientific "emergence". It is frustrating that literature searches fail to pick out Hodges' model. 

Frustrating too as reading of "awe", also on page 23, I have experienced this many times (over say 1977 - 2019 ...). So, I held on to my dummy (pacifier!?) and read on ...  

Chapter 4 Technical Considerations is one the longest and contributes all of Part III. Here you can read about science, measurement, statistics, empirical, operational definitions, intelligence, reliability. I often see a chapter, book section as a useful primer for students and the same applies here; with inter-judge realiability, validity, control, null hypothesis, statistical methods and much more. Reference to mathematics (axiomatic too) had me hoping for more. I picked out Structural Equation Modelling:

 'We would also like to suggest that following the steps involved in "structural equation modeling" (path analysis) is a good way of conceptualizing and reasoning about complex clinical variables altogether. For example, constructing a clinical model informally (intuitively, loosely from data) and thinking about (diagramming) how the variables involved may moderate and mediate each other can be a useful activity for clarifying the nature and requirements of a complicated clinica1 situation. 
 

 In simplest terms, an independent variable is the causal or influential variable that impacts and effects the dependent variable. A moderating variable is a dichotomy, and refers to two comparison groups (e.g., male/female; passed/fail; religious/nonreligious; tall/short; high versus low socioeconomic status) that display significantly different degrees of magnitude on a correlated relationship. For example, the relationship between a specific treatment for a medical disorder and treatment outcomes may be moderated by socioeconomic differences. The treatment outcome relationship may be stronger and more positive for individuals with elevated socioeconomic standing who therefore have better support systems and access to medical professionals, and fewer economic stressors.' p.36.

I think from this the authors might be sympathetic to giving 'life' to the POLITICAL domain and Hodges' model; after all it lives in people's daily experience - acknowledged or not. The book's structure works thus far: Chapter 5 Nature-Nurture (n.b. no escape!)  and the Epigenome. The structure - flow - works, as at just over four pages, it begs further reading (beyond the listed references). I still have my copy of:

Fritjof Capra and Pier Luigi Luisi (2014) The Systems View of Life - A Unifying Vision. Cambridge: Cambridge University Press.

 

With the epigenome being added to the 'patient complexity equation' in chapter 5, I wondered whether this was predictable, a promise, or a tease?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

nature?	NATURE?
NURTURE?	nurture?

 

Previously: 'complex' : 'nature' : 'mental health' : 'person(-centred)'

More to follow ...

^Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

ii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

I didn't have time to finish reading Frankel et al. before WCCS26. This book has an index which was very useful, to efficiently check certain points. It is amazing the number of books without an index.

Chapter 1 is 'Guiding Principles' and links really well with the index. At two pages it is brief and yet also constitutes Part 1. 

Part II The Clinical Situation, continues an introductory thread. Chapter 2 The “Clinical Situation”: An Introduction to Its Structure and Complexity is what attracted me to the book. At five pages, there was more in this vein. I looked ahead and found that the chapters all seemed short. Checking the book's web page, 50 chapters in 270 pages, so just over 5 pages and well referenced too.

Initially, you might feel short-changed, of course, I didn't with a review copy. But don't worry. You are in patient- person-centred hands here. Sometimes content matters. The three authors work and are researchers in psychiatry. For me, the guiding principles and part II provide a handshake with the index. The person here then, is given a literary hug. Immediately, there is a link between the variables of care and the structure of a case (or caseness). 

'But importantly that "structure" is dynamic changing over time. We classify variables as "clinical" as they are brought into play for the purpose of treatment, i.e., the goal of healing.

The clinician is not just challenged to unravel this complicated situation but also to represent the patient accurately, including his or her "human" elements as represented by temperament and personal attitudes. What are the patient's essential needs. tolerances, preferences? Yet, there is even more to know about each patient. Does she have children? What is her financial status, her ethnicity? What are her attitudes about medical professionals. Does she believe in medicine, or even in science?

Beware! None of these factors are dispensable when trying to understand a patient. Just try to leave out a few and you are left with a gutted rendering of that person, not a living human being.' p.7. 

(and continued in fragmented form below ...)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

'The result even when this level of detail, is available may still be an anemic version of the patient.    Traditionally a medical patient is subjected to an extensive workup that includes a mental status examination, in addition to a detailed past and present history, ...	... and an extensive "review of (organ) systems.
Now add the multiplicity of problems, psychiatric and systemic medical, from which the patient suffers. ...	Multiplicity may include systemic medical, psychiatric, social, financial, and lack of access to health providers.' p.7.

'From this description it seems logical that complex patients presenting with mixed medical-psychiatric disorders be managed with an ongoing collaborative approach delivered by a multispecialty team. Included may be a primary care physician, psychiatrist, and/or psychotherapists. One or more of the collaborating professionals may be a nurse practitioner and/or a physician's assistant.' p.7

I will return to the 'logical' in the final quoted paragraph above. The author's declare their intent from the outset, and by the literature-to-date they achieve this (may I please add? 'in spades!').

 

Over the years and as raised on W2tQ, several colleagues and contacts have asked "Where is the book on Hodges' model?" Not to sound weird, but this book asks that same question through some challenges to the usual 'medical' text. There are several lessons to take away here, even if only to keep a dream alive. While the physical size of a textbook, its practical appeal and stance makes it appear as something to pop in your top shirt/jacket pocket. A pocket guide: quite an impression just 10-20 pages in, and in this digital age.

 

As you would expect from mental health practitioners - psychiatrists - psychotherapists, interpersonal, subjective-objective and intersubjective factors are integral to how complexity is defined and measured. In Chapter 2, pp.11-12 there is mention and reference to the Value-Based Integrated Case Management Complexity Assessment Grid:

Specker, S., Andrew, R., Drexler, E., Koithan, E., Thurber, S., & Frankel, S. (2026). Development of the Self-Administered Health Complexity Screening Instrument. Professional case management, 31(2), 81–89. https://doi.org/10.1097/NCM.0000000000000845

I will check this instrument as I complete this review. As noted on April 9th this book was published in 2023, so I remain grateful to Daniela and colleagues at SpringerNature for the review copy (which also enjoyed WCCS!).

Previously: 'complex' : 'holistic bandwidth' : 'mental health' : 'person(-centred)'

More to follow ...

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

ii Learn your lines and the hyperplanes will follow

With these lines, partitions, axes and domains in mind, when a clinical practitioner is presented with a new person, whether as a patient, client, or carer ... they can, using Hodges' model (and other tools!) approach their assessment in an open and receptive manner.

This means that the information provided by the 'patient' can be readily fielded, captured whatever the context and situation.

As noted previously, my study of Hodges' model began in the late 1980s. Application in my work as a community mental health nurse, with an interest in informatics followed quite naturally(?). Primed as I was, for various reasons to carry this forward, I also carried a mathematical learning disability. At the risk of getting bogged down in my thought, use and approach to Hodges' model I need a challenge.

Mathematics is the challenge for me. It's fascinating how we have in-built 'calculators' that can help us catch a ball, and judge fairly well where to throw a ball for interception. There seems then to be an informal or naïve  mathematics, at work unconsciously. Does the same apply to Hodges' model? If so, how can I isolate, and identify it?

• Is it represented somewhere, implicit in Hodges' model itself?
• Is it (once again) to be found in the user of the model?
• Is it (more likely, and obviously) a combination of these two?
• Or, is it a product of the system, or a series of systems? 

I was reminded of what is a Sober toy, several years ago:

Is Hodges' model a selection machine?

All four original purposes of Hodges' model:

1. Person-centred, integrated and holistic care;
2. To bridge the theory - practice gap;
3. To facilitate reflection and reflective practice;
4. To support curriculum development;

- are concerned with conjunction and choice, selection. So is life itself through distinction, difference, and differentiation.

Hodges' model is a selection machine, that is both fhuman and machine driven.

A clinician may obtain the referral information through an email, a history of previous contacts can be retrieved from a clinical information system; the context and purpose supporting access to the information.   

A whole series of blog posts describe the role of Hodges' model to help assure parity of esteem across mental and physical health. What does this mean in practice?

For the practitioner, they take selected data from the referral, a history - if available, an initial telephone contact, a conversation with a colleague who remembers the person re-referred and starts to populate Hodges' model. What are the psychological concepts that arise? What are the physical?

If a referral in whatever form, or a database record can be viewed as a bag-of-words, then Hodges' model is a collection of care concepts. Four bags then. Sets or classes. An experienced user of Hodges' model may position care concepts that throws attention on the INDIVIDUAL↔GROUP axis. Lying between the INTRA- INTERPERSONAL and SCIENCES domains, this axis (like all the others) earns its keep. There is work to be done that is also of interest in machine learning:

'A support vector machine (SVM) is a supervised machine learning algorithm that classifies data by finding an optimal line or hyperplane that maximizes the distance between each class in an N-dimensional space.

SVMs were developed in the 1990s by Vladimir N. Vapnik and his colleagues, and they published this work in a paper titled "Support Vector Method for Function Approximation, Regression Estimation, and Signal Processing"¹ in 1995.' 

https://www.ibm.com/think/topics/support-vector-machine

Strange to think that perhaps the VERTICAL axis and others in Hodges' model are not precisely S-N-E-W in their bearing? There may also be several vectors at work in fact?

Image: c/o https://www.ibm.com/think/topics/support-vector-machine

The word 'naïve' has been bubbling away for a good-many years. A close colleague Silvana Bettiol, Univ. of Tasmania kindly read my draft on Hodges' model as a mathematical object, and mentioned the introduction points to Bayes theorem even if informally. Even in those initial 'clinical' encounters (and social meetings, that attend to empathy, rapport and engagement...) complex judgements are being made, beliefs tested, from what is often partial and disparate sources of information.

Checking other leads led to Frequentist and Bayesian Approaches

'Statistical inference is a series of methods used to make decisions and draw conclusions based on available data. There are two primary approaches for inference: Frequentist and Bayesian. Each framework relies on a different philosophical perspective on probability and modeling, leading to different techniques and interpretations. Each has its own strengths and drawbacks, so understanding the distinctions between them is vital for researchers, data scientists, and statisticians who aim to choose the most suitable approach for their specific analysis.'
https://www.statology.org/comparing-frequentist-and-bayesian-approaches/

More reading required and threads to run.

Earlier this week I posted re. Cromer's book -

Cromer, A. (1997) Connected Knowledge: Science, Philosophy, and Education, Oxford: Oxford University Press

Before passing the book on, p.198, Chapter 8 notes, #4:

'"Understanding" is a commonly used English word which has no precise meaning. It's sometimes taken to mean the ability to apply knowledge to new situations. In this sense, it is a very high-level skill. Benchmarks for Science Literacy says, "Learning to solve problems in a variety of subject-matter contexts, if supplemented on occasion by explicit reflection on that experience, may result in the development of a generalized problem-solving ability that can be applied in new contexts' (American Association for the Advancement of Science, 1993)." The key word here is "may." 'We really don't know how to help students develop a generalized problem-solving ability, or whether there is such an ability apart from mere knowledge of many different problem-solving strategies. Whatever the case, since we do know how to teach students to solve specific, problems. this should be the primary focus of science education' p.198.

Ack. IBM.

Learn your lines and the hyperplane will follow i

Take an empty [rectangular] space (A4 paper in landscape)

Blank! Isn't it?

Take a line. Yes, call it that.

Divide the space vertically, and equally, in two. 

Do this again but horizontally.

You can call these lines, partitions if you wish?

Or, as per adopted convention here, axes.

Now, there are four empty spaces.

These spaces can be called quadrants, planes, or domains. The latter term usually adopted here.

Labels can be decided, and assigned to the axes and the resulting domains.

Given a purpose, in practice (initially) the 'empty' spaces have the ability to assign significance to what may be placed within them.

Such decisions are non-trivial, in the sense that context and situation determine what follows, influenced by objective and subjective considerations.

The domains can contain concepts, or keywords with decisions driven by categorical reasoning.

The content of the domains can also be viewed as classes and sub-classes.

ii to follow (with revision here?)

ii Editorial: Persistent Positive Change in Challenging Times ...

To Howden's editorial it's worth highlighting that Hodges' model is situated. So, whether the 'challenge' that is faced is individual, or collective Hodges' model can help to identify the issues, problems, strengths, opportunities, threats, where we are, where we would like to be and more. Surely, reflection, critical thinking is about confiming, or regaining our perspective, correcting our orientation or improving alignment and synchronisation with others? The time this entails, whether exercised on paper, or cognitively (yes, humans thinking is still an option) this is equivalent to a time-out even if momentary. This can be critical in clinical encounters, were emotions are raised, or there is risk of escalation.

So whether the challenge is personal, lived experience, bullying, finance, physical, or mental health, simulation (fidelity, testing), ethical ...; or collective (a team) - service and organisational change, major incident, policy, clinical or management supervision, whistleblowing, public / patient engagement, complaints and challenging relationships; Hodges' model is a tool (one of many) to call upon.

It could be the context causes you to focus on one or two care (knowledge) domains. Or, there is a need to step back in order to 'see' the big picture (integrated care, risk assessment, holistic care, psychosocial view ...) - the spiritual too.

While Hodges' model is simple, please consider this: there aren't many tools that can facilitate articulation and dissemination of the 'big picture' in a form that is (imho) readily transferable and translatable.

Howden, S. (2025). Editorial: Persistent Positive Change in Challenging Times. International Journal of Practice-based Learning in Health and Social Care, 13(1), ii-iii.

Editorial: Persistent Positive Change in Challenging Times - IJPCLHSC

'What then is the common theme for this issue? It is the persistence of these authors, practitioners and academics to be curious about what could be better and engage with scholarly enquiry to advance practice-based learning.' 

The editorial introduces the content of -

International Journal of Practice-based Learning in Health and Social Care Vol. 13 No 1 August 2025
https://publications.coventry.ac.uk/index.php/pblh/issue/view/96

Howden,  S.  (2025).  Editorial:  Persistent  Positive  Change  in  Challenging  Times.  International  Journal  of  Practice-based Learning in Health and Social Care, 13(1), ii-iii.

- which I have mapped to Hodges' model (with some additions):

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

restlessness (- in mind) (curiosity) patient's lived experiences* intra- inter-personal pastoral support engagement - enjoyment workshop, case study ... psycho-	restless legs syndrome remote, rural, urban community-based :: clinical settings (infra-) structures processes - procedures simulation, major incident forensic, podcasts
-social factors interdisciplinary (integrated?) working social structures (This is how we 'do it' here)	'Institutional? “positive restlessness"' *clinical subjective exposure  (determinants of health) organisational (Inst.) structures

<>

The final paper is on workshops and continuing professional development:

Kenny, B., Bourne, E., & Li, J. (2025). Knowledge Translation from Clinical Education Workshop to Workplace. International Journal of Practice-based Learning in Health and Social Care, 13(1), 56-76. https://doi.org/10.18552/ijpblhsc.v13i1.1084 

The editorial notes:

'The authors integrate goal setting as part of a development session on supervision skills and follow up survey, to ask what happened next in relation to their goals and practice. When resources are scarce and CPD is so critical, these ideas about enhancing workshop effectiveness and feeding participants’ experiences back into sessions has never been more important.'

When presenting Hodges' model at events I will often tick for a workshop. This reflects former work experience with student nurses, OTs, social workers and other learners: when a workshop could cover the some 2 hours with a break in the middle. Hodges model is flexible, adaptable and in a workshop can be applied on an individual basis, or small group work - breakout sessions [this does not necessarily mean the participants are bored :-)]. A wide range of learning and teaching approaches can be considered. 

Kenny, Bourne & Li utilise role play, case studies for example, their approach and paper framed by the KTA Framework:

'Workshop design was underpinned by the Knowledge to Action (KTA) Framework. KTA acknowledges the importance of social interaction in the adaptation of research evidence, taking account of local context and culture (Graham & Tetroe, 2011).' p.58. ...

'The KTA framework comprises two major components: knowledge creation and an action cycle. During the workshop, knowledge creation was supported by CEs identifying factors that contribute to challenging clinical education situations and reflecting upon the impact of these factors in their workplace contexts. During Part 1 of the workshop, attendees focussed on understanding challenging situations. Each group was assigned a case study that included a complex mix of student, educator and workplace factors thatinteracted to create a challenging learning situation.' p.58. ...

'A focus on active learning within the workshop prepared CEs for translation of their knowledge of supervisory practices when they returned to their workplaces. In Part 2 of the workshop, CEs worked through a structured process for managing placement challenges by engaging in peer learning role play activities. The process was adapted to address challenges that included mental health issues in workplace learning, developing professionalism, providing inclusive learning environments, and facilitating clinicalreasoning and reflection.' p.58.

  clinical educators (CEs)

Reading KB&L: I wonder if Hodges' model provides a more 'accessible' map - as an output / summary, evidence of learning and teaching activity? 'Filtering' would be essential of course, as to what exactly is mapped. While I've no evidence (in theory), Hodges' model in being (imho) accessible, might also be primed for transferability (after all what does transferable mean?^); by being recognised more consistently across larger groups, and (as per the conclusion) other individuals, and broader educational contexts.

Currently, working with three co-authors on a draft paper revision (dental health and policy frameworks) for a journal, I noticed our leading author refers to 'translational'. In the paper below, (cited by KB&I): 

Graham, Ian D. PhD1; Logan, Jo RN, PhD2; Harrison, Margaret B. RN, PhD3; Straus, Sharon E. MD, MSc4; Tetroe, Jacqueline MA5; Caswell, Wenda RN, MEd2; Robinson, Nicole6. Lost in knowledge translation: Time for a map?. Journal of Continuing Education in the Health Professions 26(1):p 13-24, Winter 2006. | DOI: 10.1002/chp.47

Graham et al's, Table 1 Definitions of Terms, is (still) really helpful.

See also on W2tQ: 'reflect' : 'holistic' : 'map' : 'situation'

^Translation; transfer - dual, two-way, inversion?

'Domain-specific is wider than specific domain knowledge' Kalyuga (2013)

 'Developing learner ability to apply knowledge in relatively new situations is an important aim of learning and instruction, and many instructional programs and materials explicitly state this goal. However, not many of them demonstrate a consistency in achieving this goal using sufficiently well-specified instructional procedures and techniques. According to a popular view, transferable knowledge and skills in complex domains result from problem solving experiences (e.g. Inagaki and Miyake 2007). At the same time, there is evidence indicating the importance and effectiveness of explicit learning generalized theoretical frameworks and abstract conceptual knowledge for deep understanding of tasks and en hancing transfer capabilities (Karpov and Bransford 1995; Hinds et al. 2001). Gick and Holyoak (1983) convincingly demonstrated the value of the acquisition of abstract schémas as mediators of analogical transfer between very different task areas.'

'Many studies in expert problem solving have demonstrated that relying on highly contextualized domain-specific knowledge associated with concrete situations is the most effective way to solve problems in familiar task areas and that expert performance is largely based on the acquisition of organized domain-specific knowledge structures (schémas; Chi et al. 1982). ... For example, the game of chess has traditionally represented a classical example of expertise based on the acquisition of a huge amount of highly specific knowledge structures (chunks) corresponding to various concrete game situations (De Groot 1965; Chase and Simon 1973). However, more recent studies have indicated that experts use not only concrete chunks but also more general patterns, such as "templates" (Gobet and Simon 1998) or generalized chunks (Walczak and Fishwick 1997) representing typical classes of chess positions with substantial variations in concrete board locations. Based on his observations of the behaviour of rats in maze situations, Tolman (1948) was one of the first to discuss the role of broad vs. narrow cognitive constructs (cognitive maps) in both animal and human learning. 

Domain-specific knowledge that is applicable only to a limited range of tasks represents the most powerful tool for dealing with these tasks in terms of efficiency of achieving immediate results. On the other hand, knowledge that can be applied more broadly is likely to be less efficient for solving specific problems since it would require additional searching, reasoning, and elaborating activities, whilst specific knowledge directly leads to a definite solutions.' pp.1478-1479.

Kalyuga, S. (2013). Enhancing transfer by learning generalized domain knowledge structures. European Journal of Psychology of Education, 28(4), 1477–1493. http://www.jstor.org/stable/23580919

"How did you get that answer? Show your working out!"

As students of - math, maths, mathematics (pick one!) or arithmetic, algebra - know only too well: Learning, no doubt, through a series of prompts, especially if numerically challenged:

The way you derived your answer is an important - the most important part of the exercise. It is the exercise in most cases.

As may be apparent here on W2tQ, in addition to visual methods, mind-mapping, diagrams and computers, the professional basis for the study and the draw of Hodges' model was models of care and nursing theory. I've blogged previously about if we stress the theoretical, this variously invites yawns, and critique (always welcome), if not ridicule from outside.

In practice we seem struggle to do the ideal. This is one aspect of the theory-practice gap; bridging this gap was one reason for the creation of Hodges' model. What the student health professional learns in the  class/lecture theatre/online, may not be reflected and realised 100% in practice. 

On clinical placements the real-world intervenes, upsetting the academic comforts. Suddenly the armchair hypotheses do not sit so comfortably. Reality bites. Are there enough staff, is the skill-mix 'ideal'. Patients present their own variables. Which are also often at least binary (and invariably more), to include carers, family, with prior experiences. There are specific life experiences and situations of the patient; and yes, in plural.

Competence with paperwork, the electronic health record (EHR) is key to a student's progress:

From communication skills, establishing a therapeutic relationship (yes, so 'old school'?), enabling and concurrent with care assessment, care planning, intervention and evaluation. Plus, the 'writing' of the same including all the processes, messages received, clinical team meetings, allocations, supervision. All the while being mindful of ethics, professionalism and accountability.

Regarding theory: I do wonder; are we missing something? Something that artificial intelligence may (will) pick-up eventually (quite quickly in-fact!). With the legacy of largely abandoned nursing theories, models of care, health frameworks … do we need to look at theory in a more literal (yes, idealised) form? To have any chance of success do we need to leave behind what we have thus far? In addition to science, nursing, medicine are often described as an art. Even if this theoretical treatment is impressionistic surely it is worth trying - to be creative, innovative, to hypothesise and speculate on the edge?

Can we use Hodges' model, or another 'tool' you might care to propose even more suited to the purpose? 

Throwing caution to the wind: this is a theoretical exercise. It may be based upon sand? Then so be it! If there is a practical, pragmatic and practice-based application that would be marvellous. Why does this matter? The rationale here is driven by the fact that health has its feet, or draws every-other-breath in the humanities. Yes, evidence is grounded in science, anatomy, physiology, life sciences and the rest. The humanistic care - knowledge domains need, demand their own unique theoretical space. A sandpit to play with a theoretical language. And make no mistake, the sand is already hurting these eyes.

There are malign agents who would deny any practical benefits of such an effort, and yet this should be in prospect. This should be an outcome to follow in the near future (although delayed by COVID). In fact it is a necessity, a requirement even, given attention and prioritisation of the SDGs, and the determinants of health,. Add to this the politics of health, and health in politics and the world🌍🌎🌏🌐today; full implementation, achievement and ongoing development will costs billions (trillions of dollars) and once-and-for-all a long-term perspective. 

There is a now, a holistic need to show your working out. How you have arrived at your answer. 

Book for review: iv "Philosophy of Care - New Approaches to Vulnerability, Otherness and Therapy"

Don't worry this is not a chapter-by-chapter review. Having cast the stone that is Hodges' model we will skip a few times.

The use of footnotes varies from chapter to chapter. They inform the text, in several instances being quite illuminating. Beside the footnote (1/3 of a page) I noted - 'baby, cacophony, perception - brain - not overwhelmed but can't ignore' (p.41). Stoicism is the focus in chapter 3; perception, fields, manifold, circles of care, self, time, situation! We have field, subfields, domains.

"Perception is always about a diagnosis of the situation in which the living being finds itself. ...

... perception is always about finding one's "whereabouts" or one's "location" in life's journey." p.42.

On the features of perception, 4/4: "might be termed the breadth or width of the perceptual field." p.42. 

"As pointed out above, all perception has the structure of a compact, continuous, and uninterrupted manifold. In other words, it forms what we have termed a field. But the perceptual field  could contain nothing but the "bare bones" of "inert" qualia, (a manifold of simple qualities impinging themselves upon the perceiver)." p.42. 

The author, Jorge de Carvalho continues another view of qualities that take place in "each given moment". This is the challenge of salience, what is significant? How to 'read' in care: the spoken, the unspoken? 

Developing notes on Hodges' model as a mathematical object, Hodges' model in its basic form as a template, I'm proposing as an empty set. The structure of Hodges' model, its two axes instantiate the "bare bones". In programming/instruction terms ... Hodges' model provides INITIALISATION. A reset. This can act as a prompt for learners to acknowledge the person - the other and consider 'unconditional positive regard'. There's polarity too (p.46) and each living being lives in its own global field, in its own global 'map' - in its own geography" (p.49). Physical geography and the change 'there' is giving rise to cogeographical (a neologism?) disruption - eco-anxiety and climate-angst. 

Psycho-geography: the polarity of our times?

Previously: NHS data breaches: the 'cogeography' of who and where?

Another note, amongst Hierocles' circles is 'reflex arc'. So many feedback loops, cascades to worry about. 

As Jorge de Carvalho writes: 'what we are talking about is a very complex field of fields. ... described both as a compass rose and as a framework of concentric circles" (p.51). [There's a relay race, a torch relay in ancient terms p.54. Care is the object that is passed on. I've a dual-shaped baton to pass on.]

Care is more than perception (p.52), care presupposes a degree of activity or action. I like the acknowledgement of 'vigilant waiting' too. For me this draws in the importance of communication; Watzlawick's Five Axioms of Communication. After all, what happens to all these perceptions? There's vulnerability, fragility and care for the sheer existence and the whole content of a given being (p.56). Jorge de Carvalho, deploys a series of numbered points which helps reading. Page 60's footnote had me drawing circles, unborn at the centre: as one. But the collective unborn in another rough circle. Eachtimeness: I like this Stoic formulation through circles. Fourthly, we arrive at pure care. I'm still pondering on ".. there is no absolute either/or dichotomy between care and its opposite" (p.61). Integration is also here, an issue for modern times, a legacy problem from ancient times?

Luis Mendes's chapter I must read again. The abstract includes:

"Three fundamental aspects will be identified: (a) the need to consider self-existence from a global point of view; (b) the need for an axis for that life-view; (c) the need for correspondence between self-existence and life-view. Apparently, this structure is formal and arbitrary. Secondly, I will analyse the structure of despair. Three fundamental aspects will be analysed: (α) the requirement for a life-view which can be applied to the totality of subjective existence; (β) the requirement for an unconditioned instance of meaning; (γ) the requirement for the exclusion of the possibility of failure." p.79.

I'm sure Kierkegaard has featured in Philosophy Now, and The Philosophers' Magazine. Mendes' focus is arbitrariness. The hypothesis is well explained (p.80) structure of care. There's much for me here: care, life-view (health career - life chances), "a global understanding maps the world" (p.81), existential map, fulfilment, meaning (of course!). Reading -

"So, a life-view needs to be stabilized, to have unity. It needs an instance that works as an axis and as a point of support. We need something to support our life" (p.83).

I could have jumped up, waved and shouted "OVER HERE!" Would Kierkegaard have been pleased? Perhaps I should have read Kierkegaard, not Michel Serres (please see bibliography in the sidebar)? Still time (fingers x'd); especially if there's any interest in the form of co-author(s)? Care is full of ideals. Mendes through Kierkegaard gives my  project encouragement: "Truth is to live for an idea." p.84. Not necessarily truth but the idealism in care, including identity. It is helpful in care to be reminded of the ideal as a calling, hence motivation (intrinsic and extrinsic) is still key. If you're intrinsically motivated, devoted to your chosen vocation, is your pay that important - to the government/organisation that employs you? A shame this is so often lost to political leaders; who, given their chosen vocation, exhibit a markedly short memory.

Braga, J. & Santiago de Carvalho, M. (Eds.), (2021) Philosophy of care: New approaches to vulnerability, otherness therapy. Springer. 

Many thanks again to Springer for my copy, especially given a follow-up request, well post-publication date.

Individual

|

      INTERPERSONAL    :     SCIENCES                   

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

 SOCIOLOGY  :    POLITICAL 

|

Group

personal courage relational - (emotional) care despair - fulfilment motivation ideals	unity - stability maps compass - orientation models - frameworks geography
life as a whole society - community of practice external validation extrnisic motivation	sustainable development goals policy accountability failure (courage here - political convictions?)

See also:

body & soul - Book: Philosophy of care: New approaches to vulnerability, otherness therapy

Book for review: ii "Philosophy of Care - New Approaches to Vulnerability, Otherness and Therapy"

Book for review: iii "Philosophy of Care - New Approaches to Vulnerability, Otherness and Therapy"

Can a whole discipline act as an interface?

Abstract

"In this article, we consider how certain types of contemporary biosocial psychiatric research conceptualise and explicate biology-social relations. We compare the historic biopsychosocial model to recent examples of social defeat research on schizophrenia and cultural neuroscience work on affective disorders. This comparison reveals how the contemporary turn towards the ‘biosocial’ within psychiatric research relies upon ideas of the psychological as an interface. This is problematic because psychological notions of ‘experience’ are used as the central mechanics of biosocial processes, but lack any meaningful engagement with considerable debates within psychology and cognitive science about what the mind, and indeed the psychological, actually is, its relationship to social life, and how we should study it. The psychological interface is therefore vital to these biosocial hypotheses but is remarkably underdeveloped in comparison to its biological and sociological components. We argue that biosocial psychiatric research could gain a great deal from engaging with contemporary theorisations of experience and being more critical of vague appeals to psychological phenomena." p.317. [my emphasis]

Fletcher, J. R., & Birk, R. H. (2022). The conundrum of the psychological interface: On the problems of bridging the biological and the social. History of the Human Sciences, 35(3-4), 317-339. https://doi.org/10.1177/09526951211070503 

Individual
|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

PSYCHOLOGY - as interface? Intrapersonal - Interpersonal Individual psychology	BIOLOGICAL
Group psychology SOCIAL

Does each of the disciplines in Hodges' model act as an interface in certain contexts/situations?

If there is a primary discipline (domain), that determines the context, is this also the interface (interstitial)? Discuss.

If care is integrated, holistic, with parity of esteem demonstrably assured should each discipline have its turn as interface?

My source/prompt:

Preparation for a conference video: 5 ppt slides, Samsung Notes drawing of Hodges' model, 7 slides.

If I can't put this together, it is still worth the effort.

Constructivism in Hodges' model: Situated, cognitive, pragmatic

INDIVIDUAL
|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

"From the constructivist perspective, every field has its unique ways of knowing and the overarching goal is to move the learner into thinking within the knowledge domain as an expert of that domain might think. In geography, for example, the goal would not be to teach geography facts or principles but to teach learners to use the domain of geographic information as a cartographer, geographer or navigator might do. Just as the cartographer or geographer must bring new perspectives to bear and construct a particular understanding or interpretation of a situation, so too must the learner. And just as different geographers identify different relevant information and come to different conclusions, we must also leave identification of relevant information and 'correct' solutions open in the teaching situation. The process of constructing a perspective or understanding and developing reflexive awareness of that process are essential to the constructive view of learning." pp.96-97.

Zwozdiak-Myers, Paula. (2012). The Teacher's Reflective Practice Handbook: Becoming an Extended Professional through Capturing Evidence-Informed Practice. Abingdon, Oxon: Routledge. 

https://www.routledge.com/The-Teachers-Reflective-Practice-Handbook-Becoming-an-Extended/Zwozdiak-Myers/p/book/9780415597586

See also: 


Cognitive apprenticeship . . .

Hodges model: What is it? [4] A Periplus for Lifelong Learning

The cognitive map ...

"... in infra-humans should be viewed as a spatial map in which representations of objects experienced in the environment are ordered within a framework generating a unitary space. However, the central property of the locale system is its ability to order representations in a structured context. We hope to show, in this final section of the book, that mapping structures can represent verbal, as well as non-verbal, information. For both of these forms the locale system will be shown to be central to a particular form of memory: that concerned with the representation of experiences within a specific context. We shall argue that memory comes in two basic varieties: (1) memory for items, independent of the time or place of their occurrence; (2) memory for items or events within a spatio-temporal context." p.380-381.

John O'Keefe and Lynn Nadel. (1978) The Hippocampus as a Cognitive Map. Chapter 14, An extension of the theory to humans. Oxford: Clarendon Press. pp.380-410.

The Hippocampus as a
Cognitive Map

(with a dedication)

TO
E. C. TOLMAN
Who first dreamed of cognitive maps in rats and men
D. O. HEBB
Who taught us to look for those maps in the brain
AND
A. BLACK
Who insisted that we pursue our route with rigour

 

 

Source: my notes mid-1990s.

Book cover: https://www.goodreads.com/book/show/2645838-the-hippocampus-as-a-cognitive-map

Review: iii Fundamentals of Person-Centred Healthcare Practice

 

Previously, I recognised the many links throughout the book and on p.54 there are five relating to professional standards. These reflect the book's international scope and multidisciplinary relevance. Those on page 54 do work and support the text. One of them I was presented not with the expected page and missed the outcome of the 'click'. I wasn't going to re-type but found the page through the site's menu. Some links are long, as I found, whether permalinks [usually shorter] or fallback search text might improve link-longevity I'm not sure.

As a reassurance the contrast issue black-text-on-dark-green is limited to one figure.

The book is well referenced with an additional reading list. I've been made aware through plagiarism detectors (one paper) which - it appears - have 'read' an introductory section to Hodges' model as self-plagiarism. I wondered if in comprising a community of practice the references here maybe somewhat insular. I've no analysis to support this and the same no doubt may apply to other to emergent ideas, including threshold concepts. You have to start somewhere. At fear of contradiction there are many theories called upon and referenced.

Students may find the more attention to the position and specificity of references useful p.75 "we cannot not communicate." How times, chapters (8 - Communicating and Relating Effectively), theory, practice and management are challenged. The art of  'sympathetic presencing' working on the phone triaging acute community mental health referrals, 'Being kind and warm'.

For a text on person-centredness the book is imho mental illness-health light, but then as noted what is the book about? Am I suggesting that such books should attend to disciplinary equality? That said if there is a test for parity of esteem here, what do you conclude from one dedicated chapter? I was surprised, but is there a dilemma here? Beside 'Trust in self and others' I made a note, 'intuition'. Is person-centredness and being person-centred taken for granted within mental health practice? Research suggests not. 

Reading the table of contents you will find:

Chapter 18: Being person-centred in the acute hospital setting
Chapter 19: Person-Centred Rehabilitation
Chapter 20: Being person-centred in community and ambulatory services
Chapter 21: Experiencing person-centredness in long-term care
Chapter 22: Being person-centred in mental health services
Chapter 23: Person-centred support for people with learning disabilities
Chapter 24: Being Person-centred in Maternity Services
Chapter 25: Being person-centred in children’s services
Chapter 26: Being person-centred when working with people living with long-term conditions
Chapter 27: Palliative and end of life care services

I had a sense that the chapters were not sufficiently differentiated despite the titles. This may say more about my reading and the (editor's achieved) coherence of the book overall. Perhaps also for me, person-centredness is realised in-situ with personalised details. Not just vignettes (which are used) but the detailed intra- interpersonal, social, physical, political and spiritual choreography that is person-centred care: whether or not there is engagement (a dance).

Dementia is represented but the context appears to be residential care. You will find challenging / courageous conversations, but not challenging behaviour in situations that test interpersonal skills and person-centredness especially for staff, students, carers and families (dementia in general hospitals - despite numerous initiatives). Trauma has its place in the mental health chapter (and in current literature), but again the challenge of psychoses, anorexia are missed opportunities to reveal the potential and delivery of the Person-Centered Practice Framework.

Since the book's publication with its stress on the welfare and well-being of staff and educators too, the need to make explicit the politics in health is even more extreme. The need to protect the title of 'nurse'; mis-information generally and relating to COVID. Person-centred decision making and shared decision making are described as systems. Perhaps this misses the nuances of a health care professional, the team and family working with a person were they are making an unwise decision (pp.83-92). Another chapter indicates the need and utility of disciplinary bridges:

Chapter 17: Socio-political context in Person-centred Practice

 

individual - PERSON - patient
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

family - group - population

MIND :: Parity -	- of esteem :: BODY
Culture Child - Parent - Guardian FAMILY SOCIO -	Refugees Homeless title of 'nurse'* mis-information Organisational culture? - POLITICAL

One more to follow with many thanks to the publisher for the review copy.

Review i

Review ii

Review iv

Fundamentals of Person-Centred Healthcare Practice,  McCormack, B., McCance, T., Bulley, C., Brown, D., McMillan, A, Martin,S. (Eds.). ISBN: 978-1-119-53308-5 February 2021 Wiley-Blackwell.

* https://twitter.com/hashtag/ProtectNurse?src=hashtag_click

 

Review: ii Fundamentals of Person-Centred Healthcare Practice

With 30+ pages left I need to remind myself of the book's focus -  the Person-Centered Practice Framework [PCPF]. 

The 'practice' in the title is key too and I am envious of the attention afforded to the PCPF. The book very much seeks to inform student learning and in section 4 on learning and development. The book is very effective in operationalising person-centred care and person-centredness.

I'm constantly fascinated by the way processes arise everywhere. This is inevitable. Time, space, events, the flows of data, information, knowledge and the systems we use are necessarily process-oriented. Who are you at 2pm compared with 8pm - shift patterns permitting?

Purposes are discussed and the 34 chapters cohere very well in style and vocabulary. Perhaps I expect too much. A vocabulary that bridges the process-laden world of the sciences and political machinations with the humanistic - experiential - world of lived experience? I need to accept that 'whole systems' rely on processes that are not just physical, but social, psychological and political. I can't though help but read "Committed to healthfulness as process and outcome" in task-oriented and politicised (outcome) terms (p.15).

In table 2.2 (p.16) on associated concepts a list that includes patient- client- woman- child- family- relationship- centredness, I see this as humanistic and hence as a matter more of purposes and practice than process. A letter explaining 'person-centredness' to an alien visitor the Oscleans, is a welcome creative distraction and reminder for me of SETI@HOME which has stopped distributing work. Here, I read 'service-users' as an unconscious bias towards the dark-side to bring the Force in to the mix. 

On twitter (and here) I've tried to highlight that the BIO-PSYCHO-SOCIAL model is incomplete.

IT IS NO LONGER SUFFICIENT.

Yes: Person-centredness is about an individual's being.

To BE person-centred your stance must include the POLITICAL* (p.19, p.35).

I'm still deliberating on what sort of tool is Hodges' model?

It is far more than a Johari Window (p.36):

https://hodges-model.blogspot.com/search?q=johari

'Situation' litters the text - oh for a situated model: "Look for alternative ways of explaining a situation (i.e. reframing a discussion)" (p.37).

As you can see, this books gets you thinking and reflecting ...

The book's editors and publishers are courageous and true to the format by including weblinks. I will try some of these and report back.

 

self - individual - PERSON - patient client carer
|

INTERPERSONAL : SCIENCES

HUMAN ----------------------------------------------- MACHINE

SOCIOLOGY : POLITICAL

|

family - group - population

patient- client- beliefs wishes identity hope	time place space
woman- child- family- relationship-	policy power £$

More to follow with many thanks to the publisher for the review copy.

Review i

Review iii

Review iv

*Update 6 August: See 'Political Quotient'

Fundamentals of Person-Centred Healthcare Practice,  McCormack, B., McCance, T., Bulley, C., Brown, D., McMillan, A, Martin,S. (Eds.). ISBN: 978-1-119-53308-5 February 2021 Wiley-Blackwell.

 

"Nurses' ability to reflect on their practice is vital to the profession" Is it?

I beg to differ with the title of this editorial, as I wonder how vital reflection really is; and not just to nursing, but to the profession. I wonder from the rather detached perspectives of:

• Wigan Pier - and the parochial view this engenders (#globalhealth - where on Earth do I think I am?);
• As a 'local' nurse practising in Bolton;
• As a mental health nurse practising in the community within the NHS
• As a champion of a pivotal* resource for reflection and critical thinking (where is everyone?);
• and several others ...

Nursing Management

Quinn notes how "Nursing continues to develop to meet the needs of the society in which it operates." Plus: "A core part of revalidation is the ability to reflect on, and learn from, our interactions with others." My reading of Kinchin (and others over the years) suggests that reflection needs to be more a practice and revalidation based. I understand this is not what Quinn is saying in this issue on "Reflection as part of revalidation". Reflection using Hodges' model can be preemptive and anticipatory. We need to get beyond introspection and the retrospective important as this is.

As to where people are, it seems they are elsewhere, maybe reflecting in the sciences domain seeking theories and evidence. Perhaps, current teaching and exposure to models and theories of nursing and healthcare has them reaching for 'pure' models of reflection - Boud, Gibbs et al. when necessary. As we talk about the legacy issue that is integrated care, in Hodges' model here is a tool - a 'freebie', a 'takeaway' yes an Ubercare, that can grow with students, newly qualified nurses and experienced staff as lifelong learners.

Now that is vital to me. When reflection is hard-wired**, a part of a practitioner's cognitive apparatus and their educational toolkit to share with the public explicitly or implicitly as the context and engagement demands.

*Pivotal? Yes, and of course in light of the above, I'd be pleased to explain and even argue the case. The irony here is the current (ongoing!) focus upon recruitment and retention. Hodges' model is 'just' a tool, I recognise this; but could the application of Hodges' model energise, inoculate and so prime students for their course of education and practice placements?

**soft-wired too - humanistic

Quinn, B. Nurses' ability to reflect on their practice is vital to the profession, Nursing Management, April 2019. 26:2, p.5.

'situated' in Hodges' model #2

So, Hodges' model is person-centred and situated
- a conceptual springboard for all.

In the 1970-80s the nursing process challenged task-based care.

Ever since we have stressed individualised, personalised care and now today self-care.

Interpersonal and communication skills are central to nursing theory,
practice, management and informatics.

In Hodges' model the individual is the primary focus*.

The science and art of nursing
is predicated upon the
nurse - patient
relationship.

Situated = 'Its a duet' (anagram)

*Inclusion of the 'group' in the model also facilitates
consideration of relatives, parent-child, family, community and populations.

'situated' in Hodges' model #1

I'm not exactly sure how many times I've cut and pasted the paragraphs that introduce Hodges' model as person-centered and situated. Quite a few!

Thanks to the HIFA-2015 list I realised last week that there is no tag for 'situated' on W2tQ. Well, this post corrects that omission, but what does situated mean in Hodges' model?

Here is a definition c/o Google:

• situated/s'ɪtʃueɪtɪd/
  Synonyms:

  • adjective: located
  • If something is situated in a particular place or position, it is in that place or position. ADJ adv ADJ v-link ADJ prep
    ...

Related phrases

• situate
  If you situate something such as an idea or fact in a particular context, you relate it to that context, especially in order to understand it better.
  ...

Hodges' model is based on the belief that health and social care are multicontextual. Without wishing to substitute one term for another context and situation are inter-related and bear closer examination here on W2tQ.

Hodges' model prompts the user to consider that the person (-at-the-center) of care is simultaneously residing within four primary situations or contexts (five - if we include the spiritual aspects). Veterans and new recruits appreciate from the dizzy heights of the model, how quickly we find complexity in the multiple contexts that exist in health and social care. The many perspectives and views that must be taken into account to achieve safe, integrated and holistic care. Together with the above there are other definitions of relevance to scholars, champions and users of Hodges' model:

located: situated in a particular spot or position; "valuable centrally located urban land"; "strategically placed artillery"; "a house set on a ...
wordnetweb.princeton.edu/perl/webwn

In artificial intelligence and cognitive science, the term situated refers to an agent which is embedded in an environment. ...
en.wikipedia.org/wiki/Situated

Located in a specific place; Supplied with money or means
en.wiktionary.org/wiki/situated

The first definition about location is important as Hodges' model puts the person at the center. It is from there that the care domains are considered in turn and revisited as required. Hodges' model provides a locus around which care activities can be placed. Usually we view self-centeredness in a pejorative way. When you think about it though this is precisely what is needed to achieve person-centered care. In this case we need something that constantly re-centers - reorientates the subject(s) and agent(s) of care.

The second definition which looks to A.I. for inspiration is relevant as the concept of embodiment, embeddedness already has academic form* as a means to explore self-centeredness. Not only is the individual embedded in a (the) situation, but the carer (formal - informal) must also reside there and share to an extent the experience, if empathy, rapport and communication are to arise.

That final definition can be utilised due to the inclusion of means. People have skills, strengths and coping strategies and this sense of situated rings very true at present, with the emphasis on recovery, staying well, relapse prevention and adjusting to what may be permanent change. People also need knowledge as a means to maximise their health and well-being, which takes me back where I started with Health Information for All by 2015.

So, amid all the complexity, over-arching infrastructures, policies,
debate (and definitions!) it is refreshing that as I revel in the
scope of Hodges' model - two axes, four domains,
its holistic bandwidth... I can find the
word 'situated' planted
firmly
at the model's
center.

* Ref:
Paley, J. (2004) Clinical cognition and embodiment, International Journal of Nursing Studies, Volume 41, Issue 1, Pages 1-13.

Image source - with thanks: Ariel Bravy - http://www.arielbravy.com/photoblog/
http://www.arielbravy.com/photoblog/images/20060719214447_glenn%20x%20millenium%20park.jpg