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.

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?

c/o SDOH list "Liberal/Individualized Versus Materialist/Structuralist Approaches"

Abstract

Background: While consensus exists that the sources of health inequalities are social inequalities brought on by the experience of qualitatively different living and working conditions, means of addressing these conditions continue to be the subject of dispute. Whether to emphasis education or income as a social determinant of health is one such example of differing views on the sources of these inequalities and the means of addressing them. These different emphases are often justified through the narrow examination of the magnitude of statistical relationships between educational attainment and income with health outcomes.

Purpose: We offer a broader view, seeing these differing emphases as indicative of contrasting views of the nature of society and means of responding to these inequalities with emphasis on education representing a liberal reformist view of the issue while an emphasis on income representing a materialist structuralist view.

Research design and study sample: We examine, the validity of this hypothesis through an analysis of content of five representative publications that consider educational attainment as a social determinant of health and five that do so for income.

Analysis and results: We find that the emphasis on education as a social determinant of health focuses on the attributes of the individual and is generally accepting of the structures and processes of the existing economic and political order. In contrast, an emphasis on income – when placed within a materialist analysis – views existing systems as inequitably distributing income and other resources thereby requiring their reform or transformation.

Conclusion: Considering evidence of deteriorating living and working conditions for many in Canada and elsewhere, we see the latter emphasis as more useful for understanding and addressing these disturbing developments.

Ervin A, Raphael D. Liberal/Individualized Versus Materialist/Structuralist Approaches to Addressing Social and Health Inequalities: Education and Income as Social Determinants of Health. Community Health Equity Research & Policy. 2025;0(0). doi:10.1177/2752535X251316086

At present differentiating and conceptualising the individual and the collective (society) is ongoing. Ervin and Raphael's paper is helpful then:

'Grabb’s definition of social inequality leaves room for the importance of individuals’ attributes such as educational attainment and income – while Crossman’s definition directs explicit attention to the structures and processes of society9,10:'

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

'Social inequality can refer to any of the differences between people (or the socially defined positions they occupy) that are consequential for the lives they lead, most particularly for the rights or opportunities they exercise and the rewards or privileges they enjoy.9, p.1'	Physical processes Physical structures Infrastructures
'Social inequality is characterized by the existence of unequal opportunities and rewards for different social positions or statuses within a group or society. It contains structured and recurrent patterns of unequal distributions of goods, wealth, opportunities, rewards, and punishments.10'	Political processes  (bureaucracy) Political structures (inc. Institutional) Power

In Ervin and Rapahael (2025) there are also two tables:

Table 1. Four Primary Aspects of How Educational Attainment Comes to be a Social Determinant of Health.

Table 2. Five Primary Means of Conceptualizing How Income Comes to be a Social Determinant of Health.

- the main headings of which I have mapped to Hodges' model below.

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

Personal cognitive and decision-making skills (Cognitive) Access - Literacies	(Physical) Access to healthcare
Behavioural risk factors SOCIO-	Life Chances - Health Career -ECONOMIC status

To leave, manage or join list: https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1

Call for Papers: Compassionate Futures for Collective Well-Being

Despite an academic affiliation, without any (part-time) tutoring hours this past year, it may be difficult to avoid article processing fees (APCs). A shame as I believe that Hodges' model can address this call (below) in a somewhat novel manner. 

If anyone is interested in exploring a writing project framed around Hodges' model and employing a relational - diagrammatic approach please let me know.

The exercise would be greatly enhanced by:

1. Engaging with one of more academics, adept in formal methods (maths, logic..?) and keen to apply their talents within the social sciences - humanities.
2. And, exploring the possibility of working with early career researchers, including from developing nations, independent and 'late career'(!) scholars would also be very welcome.

Previously:

Jones, P. (2004) Viewpoint: Can informatics and holistic multidisciplinary care be harmonised? British Journal of Healthcare Computing & Information Management, 21, 6, 17-18.

Jones, P. (2004) The Four Care Domains: Situations Worthy of Research. Conference: Building & Bridging Community Networks: Knowledge, Innovation & Diversity through Communication, Brighton, UK.

Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

Jones, P. (2009) Socio-Technical Structures, the Scope of Informatics and Hodges’ model, IN, Staudinger, R., Ostermann, H., Bettina Staudinger, B. (Eds.), Handbook of Research in Nursing Informatics and Socio-Technical Structures, Idea Group Publishing, Inc. Chap. 11, pp. 160-174.

Compassionate Futures for Collective Well-Being

Academic Editors: Karin Hannes (KU Leuven) and Natalia Martini (KU Leuven)

Deadline for Abstracts: 15 September 2025
Deadline for Articles: 30 January 2026

Social Inclusion, peer-reviewed journal indexed in the Social Sciences Citation Index (Web of Science; Impact Factor: 1.4) and Scopus (CiteScore: 3.5), welcomes new and exciting research papers for its upcoming issue "Compassionate Futures for Collective Well-Being," edited by Karin Hannes (KU Leuven) and Natalia Martini (KU Leuven).

In an increasingly unequal world, the concept of “compassionate futures” offers a new paradigm to address the pressing challenges of social inclusion. Compassionate futures recognize vulnerability, interdependency, and mutual responsibility as fundamental features of social relations, and emphasize care and empathy as fundamental principles in designing socio-cultural, economic, and political systems where the collective well-being of diverse actors, human and other-than-human, can flourish.

We encourage contributions that engage in an interdisciplinary dialogue among scholars, practitioners, and policymakers about what it means to create a caring society in the face of persistent inequalities. In addition, we welcome papers that demonstrate where and how humans take up the responsibility to conceptualize compassionate futures from a multi-species perspective, as well as those that focus on what hinders or supports the idea and the project of compassionate futures. We accept theoretical papers presenting frameworks on compassionate futures, prospective policy analyses, cases featuring the use of futures studies and co-creative approaches that promote compassion and care as central principles in re-imagining the future, and reflection papers focusing on global cooperation for fostering compassionate futures. Authors should connect to the general idea of how humans could or should relate to other agents with whom they share the planet or illustrate how the new narratives they developed support collective well-being.

Authors interested in submitting a paper to this issue are encouraged to read the full call for papers here:

https://www.cogitatiopress.com/socialinclusion/pages/view/nextissues#CompassionateFutures

Abstracts welcome until 15 September 2025.

Kindest regards,

Mariana
Mariana Pires
Social Inclusion
Cogitatio Press
1070-129 Lisbon 

Portugal

New issues (open access):
Public Participation Amidst Hostility: When the Uninvited Shape Matters of Collective Concern
https://www.cogitatiopress.com/socialinclusion/issue/view/419

Violence, Hate Speech, and Gender Bias: Challenges to an Inclusive Digital Environment
https://www.cogitatiopress.com/socialinclusion/issue/view/415

My source: https://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=COMPLEXITY-PRIMARY-CARE

‘Nursing Narratives: Racism and the Pandemic’

This film was made as part of ‘Nursing Narratives: Racism and the Pandemic’. A research project funded by the Arts and Humanities Research Council under the UKRI Covid-19 Urgent Response Call.

 

'Exposed is a groundbreaking documentary that combines the stories of 19 Black, brown and migrant nurses and midwives to speak about their powerful experiences of racism before, during and after the pandemic. If you want to organise a screening of the film please send us the details of date, time and location so we can let people know about opportunities for people to watch, share and discuss the issues that have come out of the film, as well as what action can be taken.'  

https://www.shu.ac.uk/centre-culture-media-society/projects/nursing-narratives

RCN North West Region - North West Multicultural Group

What does 'exposed' mean . . ?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

exposed	exposed
Exposed	EXPOSED

c/o Ridgway - assimilation & accommodation

An approach to testing and teaching

'Consider the problems of acquiring new knowledge; two ideas are particularly important. The first is that existing knowledge and conceptual structures affect the way that new materials are perceived and learned; the second is that new experiences bring about changes in our knowledge and conceptual structures. These two processes are referred to as assimilation (analogous to the way in which the stomach digests food, whose later structure cannot be recognized as being similar to its earlier structure) and accommodation (analogous to the way that the pupil of the eye adjusts itself different light levels). Biological analogies make it easier to understand these concepts but leave unresolved the question of when one accommodates and when one assimilates. In general, one accommodates (i.e. changes one's conceptual structures) when fresh knowledge provides strong challenges to what is in mind; so dramatic counter-examples to currently held beliefs, or coherent patterns in the world, which cannot be explained by existing beliefs are both likely to bring about accommodation. Assimilation (interpreting new events in terms of old ideas) can be made to work when the number of counter-examples to predictions made from old beliefs are rather low. It follows, therefore, that if misconceptions are to be remedied (i.e. the mechanism of assimilation is overcome and the mechanism of accommodation stimulated) a representative sample of questions in the domain of interest is unlikely to have the desired effect because the number of cases which violate pupils' misconceptions and which therefore  might cause accommodation, will be relatively small. To foster accommodation it is necessary to provide dramatic examples which violate current conceptions and to provide these examples in quantity. Examples which are most likely to be dramatic are those in which it is obvious to pupils that the results they are obtaining using particular misconceptions are at variance with what they 'know to be true' from everyday experience.' pp.46-47.

Jim Ridgway (1988). Assessing Mathematical Attainment. Chapter 3, Using Test Results.Windsor Berkshire. NFER-NELSON. pp.40-52. [Ack. length of quote - See also: https://www.nfer.ac.uk/ ]

Thanks to Lancaster Univ. Library.

Previously 'assimilation' : 'accommodation' : 'math'

Dramatherapy ii - from Sociometry, Sociogram to Sociatry

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

A personal journey

"... Moreno soon began to seek ways of measuring the form and structure of relationships in groups. The techniques of sociometry which he invented have since been widely and successfully adopted by his successors, becoming an accepted field of social research in their own right. At its simplest, this approach relies on asking of the social grouping under investigation to indicate their relationship to each other so that, for example, a pattern of dominance (vertical structure) or affinity (horizontal structure) can be discerned. These measures may be committed to paper in diagram form (a sociogram) or expressed by the individuals arranging themselves in positions symbolising their relationships (an action sociogram)". p.106.

"More complicated interconnections and patterns can be demonstrated and the group asked to explore alternatives in order to recognise sources of conflict and misunderstanding and to modify them. Moreno foresaw a new discipline for which he coined the name 'sociatry' in which the social organisation rather than the individual is the object of the healer's endeavours, a truly 'group' psychotherapy". p.106.

Anticipating future theory-practice policy and education change. Could the reduction in the options for student mental health nursing placements be compensated in-part by addressing the concurrent change in the range of therapeutic (modalities) interventions available?

Davies, M.H. Dramatherapy and Psychodrama, Chap. 5. pp.104-123. In Jennings, S. (Ed.), (1987) Dramatherapy. Theory and Practice for Teachers and Clinicians. Routledge, London. p.106.

Previously: theatre , space , diagram

The Digital Collective (DC) a Symposium: Digitalisation, Subjectivities, and Care

Dear colleagues, 

We recognise that many people who wanted to join our symposium on Digitalisation, subjectivities, and care were unable to join in person. For this and other reasons we have moved our symposium to be fully online. Our intention is for the symposium to be accessible to all of our colleagues including those who are outside the NL. 

If this is you, we hope you will now consider submitting an abstract, and as such we have extended the deadline to 31 January 2024.

Decisions will be made by 14 February 2024.

Please find the amended call below.

CFP: Digitalisation, subjectivities, and care
7 March 2024, 9.30am – 6pm, online
Deadline abstract submission: 27 November

The Digital Collective (DC) at the University of Twente in the Netherlands is planning a symposium on digitalisation in care. More information below. Please consider submitting an abstract for a talk or poster presentation, deadline: 31 January 2024. 

Any questions to: dc-bms AT utwente.nl 

Introduction

Digitalisation is more than a technological phenomenon. It concerns an ever shifting relation between digital technologies and societal developments. Digital tools are increasingly common in care contexts, reshaping practices, institutions, relations, and social structures. Understanding digitalisation of care therefore requires a multidisciplinary approach to distinct yet related issues that cover the scale of technology innovation, societal impacts (benefits and drawbacks), as well as the pace of development and its ubiquitous nature. In this interdisciplinary symposium we will therefore explore the relation between digital tools and those who use them, willingly or otherwise. 

Topics of interest:

Possible topics related to digitalisation include, but are not limited to: 

• Digital users and digital tools
• Care institutions
• Data development / use in digital care contexts
• Epistemic injustice in digital care contexts 
• Perspectives on ‘users’ of digital care content
• Realities and subjectivities of ‘digital users’ 
• (Multi-)methodological approaches to digital care
• Care labour economies
• Global justice perspectives on care
• Human-technology relations
• Health economics 
• Health Technology Assessment of digital health technologies

The DC is a multidisciplinary platform and we welcome submissions from a broad range of disciplinary and interdisciplinary perspectives, including from outside academia.

Overview of the symposium:

Schedule and further information about the day to follow.

Submission deadlines:

• Extended abstract submission: Wednesday, 31 January 2024
• Notification of decisions: Wednesday, 14 February 2024

Please note:

• Extended abstracts should be between 500 and 1000 words. 
• Submissions should be sent by email to dc-bms AT utwente.nl 
• Poster proposals should be sent to the same email, and clearly labelled as such. 
• If you want your work to be considered for both a presentation and a poster, please make this clear in your submission. Abstracts not accepted for presentation may be invited to present a poster instead.
• Each submission will receive at least two reviews. 

Additional information:

The Digital Collective (DC) is an interdisciplinary research platform on digitalisation at the University of Twente in the Netherlands. DC consists of social scientists and philosophers specialised in digitalisation and with domain expertise in health, higher education, artificial intelligence, and related technologies. 

After the symposium the DC intends to build a consortium with a view to developing collaborative work, including for a Horizon Europe funding proposal.

 

Event and venue information:

 

The event will be free for all participants. It will be fully online. Further details to follow.

Symposium organisers and programme Committee:

Please send questions to: dc-bms AT utwente.nl 

Dr Y. J. Erden

Associate Professor in Philosophy
University of Twente
AISB Vice Chair 

My source:

Philos-L "The Liverpool List" is run by the Department of Philosophy, University of Liverpool https://www.liverpool.ac.uk/philosophy/philos-l/ 

Follow the list on Twitter @PhilosL. Follow the Department of Philosophy @LiverpoolPhilos 

n.b. With the event now including provision for online presentations I am submitting an abstract.

"Diagrammatic Immanence"

Diagrammatic Immanence

"There is thus a naturally 'pragmatic' epistemology intrinsic to categories: from the standpoint of category theory objects are investigated and known only via their interactions with other objects, not 'in themselves''. The space of possible maps from one object to another determines what can be known of those objects as such. Over the past several decades, category theory has proven extraordinarily successful in unifying diverse fields of mathematics and providing a less arbitrary and more productive foundation for mathematics than set theory. Because of its intrinsic orientation towards relations, it connects more readily and with fewer idealist assumptions than set theory to the real world and its component structures." p.10. 

"A meaning of whatever sort is necessarily determined by its position in a space of various intersecting structures, each with its own rich tangle of relations. Each of the 'single' topics being discussed opens up internally into a complex arrangement of mappings between, words, sentences, semantics, phonemes - all the systematic orders of differential relations that structuralism has taught us to recognise. And these orders are themselves embedded in actual material and historical processes.

The seemingly intractable complexity of actual language (parole and not only langue) is one of the reasons linguistic semantics have tended to resist mathematical and logical formalisation so stubbornly. Meaning is enacted in singular events and in this way resists abstract treatment. Yet at the same time, meaning presupposes translatability.  All the singular grain of the interlocking systems of some actual conversational exchange connects potentially to the systems of innumerable others. Any adequate categorical representation of linguistic events and, more generally, semiotic processes must be both rigorous and and flexible enough to track the logical and structural underpinnings of meaning and at the same time facilitate the blurring and affordances of translation." p.141.

Gangle, R. (2016). Diagrammatic Immanence: Category Theory and Philosophy. Edinburgh University Press. http://www.jstor.org/stable/10.3366/j.ctt1bgzc38

Seeds in 'architecture' iii

Prof. Younés describes 'three essential dualities': 

• IMAGE and WORD 
• TYPE and MODEL
• IMITATION and INVENTION

IMAGE and WORD 

Nursing has its historical images, that are continually presented, the lamp, hands imbued with care and support and others. The attraction to Hodges' model was through its similarity to mind-mapping, but with offering an foundational structure for reflection and critique (learning). So image has been there from the start.

Younés writes: "Within the dialectic of the visible (objects apprehended by the senses) and the invisible (ideas or forms apprehended by the mind), the image acts as a symbol when it supports the visibility of an idea." ... "Forms can be seen as structural potentials ..." p.238.

Younés classifies images (p.241), or the artistically factual through three divisions:

1. visual images (that would include icons and interface features)
   
2. mental images
3. verbal images (including metaphors and descriptions).
   

 "... the mind constructs a world within a world, and then reflects upon its own activity, as well as its own aesthetic appreciation of such activity."

I must stress the Younés context is architecture (and philosophy), but here extending to meaning I'm reminded of the way Hodges' model can span the arts and sciences, and original influences on why this model stood out for me through its facility for mind-mapping.

TYPE and MODEL 

 Here (p.242) Younés returns, not just to the origin, but the concept of origin through Form, the word and the type. Searching for universally shared purposes, within the permanences of human experience  this is health and social care too.

Taking in data, information, knowledge from assessment and other activities, this is usually contextualised - associated with a care domain. A return to the origin (nexus) of Hodges' model, the center is vital to retain balance and provide assurance in what we are doing, or not, and why.

"The architect imitates things as they have essential significance, but he or she does not copy any particular thing. This enables the layered transformation of natural models, without which the column would have always remained a tree. The form of the imitation is always different from that of the model. The roof is different from the forest's canopy. It is here that the pleasure of invention and the evaluation of the new enter, for it is within the recognized distance between the forest's canopy and the roof, that much of art occurs." p.244.

How times change in two decades. So many seek a roof, with architects having a recognized role in providing solutions post-natural disaster and political displacement of people. Not just homelessness, but homes that can cope, adjust to climate change. COVID has reminded us of the rejuvenating properties of nature, of the forest canopy, even that afforded by city centre gardens. 

We now see a roof not merely in physical terms, but social. As the night skies brighten we try to secure the canopy of the stars.

IMITATION and INVENTION 

Have we forgotten the contribution of positive role-models in learning? Imitation is the sincerest form of flattery and this throws up the constant educational dilemma of the theory - practice gap. Should we be exposed to practice without the guiding mentor represented in theory - that is also evidence-based?

There is an interesting exploration of SCOPE, DISCOURSE and NATURE: On Scope

"Thus a theory that is systemic aims at a certain level of completeness for it establishes the internal organization of architecture as a discipline, and it explains its external relations to other arts, to techniques, to social factors. Put differently, the interior individual realm concerns the intellectual freedom, the inner reflection of the architect-maker. The exterior individual pertains to the thoughts resulting from one architect reflecting upon another architect's work, as well as the individual architect's reflections on the suitability of her or his building to a context. The interior collective bears upon the conscious or unconscious content of culture which thrive within the images of of operative myths that inform architectural production. The exterior collective designates that commonly built sense regarding the suitability of architecture (decorum) within its milieu par excellence: the city. The above concerns the scope of an architectural theoretical system, on the urban, architectural, aesthetic, social, and practical levels." p.245-246.

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

interior individual	exterior individual
interior collective	exterior collective

 

I started these three posts noting the addition of 'architecture' to titles, concepts, and 'stretching' disciplines. Also guilty here; in mitigation, I'm aware of how in the mid-late 1970s technical drawing as taught was to change radically in the digital wave.

Hodges' model provides a drawing board, with analogue and digital potential.

I will continue to draw upon the (inspirational) discipline of architecture, it informs and sustains thought, construction, meanings, language use, and effort here.

There is much more to glean from this paper, so I hope to revisit it in the future - with further annotations on my copy.

Over the years I have noted related items in the press (yes, I saved the following):

Designs for life: architecture in the disaster zone, FT Weekend.

and read - A Bed for the Night: Humanitarianism in Crisis

By David Rieff

See also: 

Seeds in 'architecture' i 

Seeds in 'architecture' ii

Younés, Samir. “Constructing Architectural Theory.” Philosophy 78, no. 304 (2003): 233–53. http://www.jstor.org/stable/3752046.

ii Seeds in 'architecture'

There is something seductive in architecture, the imagination of ideas on paper, the promise of the cornerstone, the reality of the construction, the space it grasps and the space it bestows.

Arriving at Younés paper, the history and reference to Valéry's Eupalinos ou l'architecte, Socrates and Phaedrus had me captured. 

Healthcare is dialogue. Spoken and unspoken. Discourse. Dialectic. Perspective: One : Shared : (the) Many.

What is said, gestured, and unsaid. Valéry's dialogue sounds worthy of follow-up, appreciating Plato and this form of theatre and learning. There is a latent architect in us all. Patiency too - but not yet - let us build first. Every day and night we construct (hopefully). When necessary we know when to disassemble, de-construct, to initiate change.

Reading Younés I can readily relate the paper to nursing, Hodges' model, and healthcare generally. The paper's three main questions concern (of course) architectural theory:

1. the causal relation between building and theory;
2. the necessary mental conditions that precede theory;
3. a definition of theory in its scope, discourse, and nature.
   

There are many points of note (reading my yellow highlighter) here. 

'Reflection precedes realization, but theory does not necessarily precede practice'. p.234.

'Theory however, is a systemic elaboration that operates based on definitions and concepts, in the sense that definitions build concepts, and concepts in turn build a theory, but not the reverse of the sequence.'

'Theory, then, comes 'late', only because it is the synthesis of a content that was already present'. It is constructed after a prolonged reflection over many experiences, based on common, comparative, or contrasting sets of criteria.

Younés focus is specific the development of theory in architecture, but as he writes: 'there is some element of reflection which can be termed the building's efficient cause' p.234. I wonder about Nursing Theory and the nurse's theory based on the person - in-person: reflection of care, assessed, planned, delivered, evaluated and recorded. There are nurses still preoccupied with Q.1, even if the (primary) focus is within academia(?).

Q.2 seems an invitation for philosophy (as per the journal's title!). Being non-judgemental, if not starting to build nursing Theory, then especially for the nurse co-constructing, co-designing a theory of care with the patient/family. Hodges' model is not just a series of set squares, facilitating design; it is an empty set. Never completely empty, due to the structure. A structure that contradicts. A structure paradoxical as it constrains and releases, records and forgets.

Q.3? Did someone call - continuity? Yes, (and how!) we can carry on from Q.2. Scope - yes. See the space? Listen to all the dimensions. Reduced to those that count, in discourse and nature, by nature.

Person-centred? New patient. RESET. Re-build - but remember humanistically.

See also:

Seeds in 'architecture' i

Seeds in 'architecture' iii

Younés, Samir. “Constructing Architectural Theory.” Philosophy 78, no. 304 (2003): 233–53. http://www.jstor.org/stable/3752046.