Brief introduction to Hodges' model

Hodges’ model is a conceptual framework of universal value in theoretical work, practice, policy and care management. While this model is a product of the health-education sector, it is global in scope, taking in the current situation, history and future as complicated by scientific, socio-political, technology and climate change. Practice-based, Hodges’ model is a tool simple in form and yet powerful in terms of how it can help users frame the problems and opportunities of the 21st century. The model was originally taught in studies for the post-registration certificate of care of the mentally ill in the community and other courses. Student assessment included the completion of a case study (vignette), demonstrating competence in application of the model and its embedded (implicit) values.

Access to education, especially early years, is emphasised as foundational for personal and community growth and development. For individuals this can set the course for lifelong learning and an ability to contribute to society and the economy. Given this primary challenge, global institutions and policy makers point to the need for curricula that are relevant. In turn employers and industry leaders need a (global) workforce who are: 

• reflective practitioners;
• critical thinkers;
• able to see the ‘big-picture’; and focus on detail and priorities when needed (risk and triage);
• decompose a problem, but also integrate (care);
• work as team-members;
• and extend across several literacies.

These challenges are ongoing for education (being health literate, so as to address personal, social, health and economic education, and the sustainable development goals), and increasingly climate impacts.

NHS Corridor Care – Urgent and Emergency Care Daily Situation Reports

If politicians & policymakers regularly 'walked'
 all the corridors of Hodges' model -
 they would see the false economy 
of their combined incremental works.

Incremental? Yes, in first being a 'temporary measure', then having a deleterious impact as the duration per patient and number of patients on corridors increased.

Now to the situation when the standard of care is unsafe, sub-standard, and denigrates the NHS as a social institution.

The fact of insufficient beds and its effect on care (pathways) and patient (and family) experiences severely affects staff morale, as they recognise subtle abuse, a precursor to structural and attitudinal changes that foster, encourage and establish institutionalised harm.

Staff also realise that they risk being de-skilled, 're-educated' -
becoming less compassionate ... (a 'lesser Nurse') as corridor care 
and its consequences are normalised.

Ignoring demographic trends and without an alternative concerted 
preventive/health education and health promoting plan, this is the result 
of the health and social care funding and policy
of successive governments, enacted by NHS management.

NHS England: Corridor Care – Urgent and Emergency Care Daily Situation Reports
https://www.england.nhs.uk/statistics/statistical-work-areas/corridor-care-urgent-and-emergency-care-daily-situation-reports/

Seeking UK Healthcare Workers: online pilot study on daily communications

C/o Olga Lainidi @LainidiO

Post Graduate Researcher and Teaching Fellow in Psychology @ University of Leeds

'I’m looking for UK Healthcare Workers to help me pilot an online study on daily communications in healthcare. Please fill in the expression of interest form if you want to find out more.'

Introduction to the study plans below from:

https://forms.office.com/e/5H84WqqTtT


UK Healthcare Staff - Daily Communications & Wellbeing at work

Thank you for your interest in this research study, which is part of a PhD project at the University of Leeds. The study explores how healthcare workers communicate about things that matter at work on a day-to-day basis, and how these decisions relate to their wellbeing. If you're a UK-based healthcare worker and would like to receive more information or take part in the study, please complete the short form below. This form helps us check eligibility and ensure we include a range of roles and experiences. It takes less than 2 minutes to complete. Completing this form does not commit you to participating - it simply lets us know you're interested and happy to be contacted. All information will be kept confidential and stored securely. Thank you for your time and interest!

The study has received ethical approval by the School of Psychology Ethics Committe, University of Leeds (2841 - 28/04/2025)

https://forms.office.com/e/5H84WqqTtT

My source:

https://x.com/LainidiO/status/1931414872840970470

I look f/w to learning of future findings and outputs.

Martha's mum, dad, guardian ...

Hayward, E. Parents really do know when
their child is sick, The Times,
30 May 2025, p.1.

The previous post highlighted the fact that while practice (and theory) based upon research finding that are 'evidence-based' and scientifically rigorous are a 'gold standard; there are other means by which knowledge is obtained. Cultures, often have systems to transfer knowledge - that which matters to the society, even if is not written in the conventional meaning of the term.

Intution is another source, and within social groups can be a powerful spur to action, and help seeking. This is demonstrated regularly in the knowledge that a parent, or guardian has about what is the normal presentation for a child in their care. 

In the UK Martha's Rule is being tested in NHS hospitals. It is encouraging then to hear and read news of a study in Australia (so in combination a 'multicenter' effort?).

Mills, E., Lin, P., Asghari-Jafarabadi, M., West, A., & Craig, S. (n.d.). Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: A prospective cohort study. The Lancet Child & Adolescent Health. https://doi.org/10.1016/S2352-4642(25)00098-7

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

"Not herself ..." Martha	"Not well" Martha
Mills parents, guardians, friends & family	Martha's Rule*

Hayward, E. Parents really know when their child is sick, The Times, 30 May 2025, p.1.

*Under test in the UK.

Previously: 'intuition'

Blankets and DNR . . .

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

Initially not person-centred, I -	Blankets
- recall several 'conversations' with junior doctors. The situation was 'recovered'.	"Blanket use of forms"

22:00-22:30 BBC News at Ten. DNR - Do Not Resuscitate 

DNR is a critical aspect of health care that will not go away. It can't as part of the interface (to put it mechanistically) between life, death, and quality of life and death. Ever since and even prior to the Liverpool Care Pathway, the issues raised in medical care, humanity, dignity and respect, ethics, professionalism, integrity and governance are challenging to reconcile.

Hodges' model can play a part in critical thinking about not just a troublesome concept, but the interaction of several and making sense of them and the situation to hand - and heart. 

As such Hodges' model isn't going away either.

Knights D, Wood D, Barclay S. The Liverpool Care Pathway for the dying: what went wrong? Br J Gen Pract. 2013 Oct;63(615):509-10. doi: 10.3399/bjgp13X673559. PMID: 24152449; PMCID: PMC3782767.

PROCESS 0 : 4 DOMAINS

No, 0 - 4 is not a sports score.   

Quite a while ago and over several years I associated 4P's with each of the domains of the model:

SCIENCES: process
SOCIOLOGY: practice
POLITICAL: policy
INTRA- INTERPERSONAL: purpose

 

Although, this brings home the model's being an idealisation - there remains much to learn and discover. In addition to physical processes there are political, psychological, social processes too. If you were to prioritise the concept of PROCESS across the model how would you do this?

 

My take - which could (will) differ tomorrow - and could well do so if the context was specific. 

 

I've tended to think of triage, physical and psychiatric emergencies the focus being on the SCIENCE domain (ABC medical emergency...!) and that is the starting point. If triage is excluded, then #MyNameIs follows crucially in obtaining a comprehensive assessment and addressing 1-1 parity of esteem. There is a need to (really) attend to the INTERPERSONAL domain.

 

In a way the 'individual' domains INTERPERSONAL - SCIENCES should (must) collapse into one. This is to help assure, strive to achieve person-centred and integrated care; and not to reduce, rationalise, and generalise the nurse curriculum. We need mental health nurses equipped for the 21st century.

 

Reflecting on this though I'm jumping ahead.

 

We actually start with the POLITICAL domain 0 - below. With nurses in the UK being balloted on strike action this is difficult medicine to swallow, but there we are. Globally, we saw the literal power of the POLITICAL domain in health during the (ongoing) pandemic. We will do so again in future security, health, and climate challenges to follow. We don't want future generations to face ours, they will have their own.

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

3	1
2	0

Spiritual - 4

So, in 0 is there an advanced directive? Even before this, can I as a nurse, or other practitioner - nurse, treat, care ... for this person? Do we have consent - can they give consent? Is there a Dr 'in the house', a responsible medic? Have they been admitted, their referral accepted and acknowledged? Are there cultural or religious reasons not to proceed as we might otherwise? POLICY, safety, protocol also dictates that if we are a first responder then we do not become a casualty - that is obviously undesirable. So we are checking the environment (SCIENCES domain 1*) - the specific context.

THEN - I'm selecting 2 the SOCIOLOGY domain. The information obtained from the person (if any) is crucial to what follows. The 'if any' is non-trivial too were the INTERPERSONAL domain 3 is concerned (and the aforementioned collapse [3-1]. Even if the person declines, or is unable to communicate with us, we can still glean essential details about physical AND mental status. So, yes, the specialist skills of the practitioner and lived experienced colleagues really do matter.

With the SPIRITUAL domain (which can encompass the model) we close a circle, back to the religious, cultural, human rights and values dimensions acknowledged above. This conjunction of political and spiritual is a little surprising in global terms, and so maybe encouraging too.

*Yes, the SOCIOLOGY domain 2 also. You may think you are only going to visit a 79 year old man/women; not realising that their grandchild also arrives with a forensic history. This could be a very positive rewarding encounter, or otherwise.

The paradox of Service Vs Person-Centred Care

Looking at Hodges' model and its basic structure of axes and care (knowledge) domains, I wrote a note to the effect that:

- the INTERPERSONAL (INTRA-) and SCIENCES domains are fundamental to individual care. 

This follows, of course, from the vertical axis.

Then I added, that the SOCIOLOGICAL and POLITICAL domains are fundamental to person-centred care.

 

Person-centredness is vested, is realised in and by the care domains that involve concepts mediated and related by the group, the collective.

 

There seems a (strong?) recognition of social justice and justice at work.

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

individualised	individualised
person-centred	person-centred

Perhaps this is the implicit origin of the call to new learners and professionals alike to 'Make a Difference', 'Be the Difference'?

Then I thought of the perennial duality of service-centred and person-centred care.

 

Accepting the idealised nature of these thoughts, when 'presented' with a case, health services - through their practitioners, focus on the individual. The individual may express personal choices, hopes, but the extent to which these garner a response, are acted upon, also depends on the SOCIOLOGICAL and POLITICAL domains. 

In terms of the ideals (that apply, and what I will call upon) there are two extremes - I have mentioned previously, consider:

In the triage situation, apart from establishing consciousness - communication and interpersonal are collapsed into seconds, and response to stimuli / pain, communication is not key. Task orientation, practice, procedure, events, rehearsal, stock and equipment checks are to the fore.

 

Alternately, there is the level of interpersonal skills that are exercised to communication with the patient, to learn of, recognise, and respond to their personal choices.

 

All of a sudden things seem to be reversed.

 

Short of being plain wrong (?) -

THIS seems powerful, essential and required medicine for the 21st century.

service	SERVICE
person	PERSON

It is even more nuanced, however, and I'm not trying to clever (mathematics and logic are definitely not my subject), but making the above easier to describe:

s	S
p	P

Above, I'm trying to suggest and represent:

1. A lack of regard and relative neglect of the humanistic domains [ s AND p ];
2. This is then reflected in the ongoing issues of parity of esteem for mental health, illness and psychological interventions [ s OR S ].

In #1, we can add the UK decade long, debacle of funding for social care and the status and recognition of the workforce; the legacy (lessons) of medical sociology and the potential of attention to the social determinants of health and the sustainable development goals (paper to follow mapping the SDGs to h2cm).

The [ S AND P] in the SCIENCES and POLITICAL domains - might (also) be indicative of the continuously espoused benefits of technology as part of health care delivery. While accessibility and improvements in this are emphasized, often Politically people are isolated due to lack of technology, or funds. There remains a SOCIO-technical divide.

The years to follow, will no doubt see the microscope from the SCIENCES placed in the humanistic domains and technology's impact - benefits examined there. Who knows: maybe a new instrument, simultaneously (transdisciplinary) qualified will be found?

Conclusion that might be drawn:

The bio-psycho-social model is insufficient for person-centred care (having an opportunity, then yes - I would say this).

The overall aim and objective of Hodges' model when applied, is not to tick boxes but to diffuse the disciplinary boundaries, to assure, and integrate.

More to follow... (a paradox?)

The poly-pill approach to health care ...

"A "polypill" packed with four different medications to treat high blood pressure and cholesterol can cut the risk of heart attacks and strokes by up to 40 per cent when taken with aspirin, a study has suggested." 

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

	aspirin (75 mg), for thinning the blood lisinopril (10 mg), for reducing blood pressure hydrochlorothiazide (12.5 mg), also for reducing blood pressure simvastatin (20 mg), for reducing “bad” LDL cholesterol

 

Does it follow then (triage aside) that in our health and social care interventions we should not restrict ourselves to a single care domain?

 

My source: 

News: 'Polypill' with aspirin offers hope of fewer heart attacks, The Times, 14 November, 2020, p.28.

 

See also:

https://blogs.bmj.com/bmj/2020/11/16/richard-smith-a-new-important-study-supports-wider-use-of-the-polypill/

Inverse Care Law ... at Social Care's Door

Since 2015 I've had four 'conversations' with the doctors at A&E upon mum's attendance and subsequent admission on a couple of occasions. Initially, I was surprised if not shocked by the speed with which the 'conversation' followed on treatment, the extent of this and the question of resus. The further interactions were still emotionally jarring, even when expected and telegraphed. I also understand: to an extent. Repeated chest infection or urine infection had resulted in confusion, delirium that varied. on one occasion, at the nursing home there was also suddenly talk of a diagnosis of dementia, which prompted social services to wonder, like family and staff, where exactly this diagnosis had come from and investigate. (Another post?)

Mum has been very poorly, most recently in November. What surprised and shocked was the 'conversation' at the end of the bed when I knew mum - with mental capacity at that time was most likely listening. The primacy of person-centredness seemed to be by-passed. I suggested the doctor ask mum since once hydrated she would be fine. There has been a sense of a script being followed with some pressure - urgency behind it, if not a 'prescription'. I empathised with the doctors, often FY1 FY2; such matters are never easy. Now amid COVID-19 there is alarm as social care are challenged with taking on a new role, for which they are ill-equipped. 

In health care you are always conscious of the inverse care law, it seems there is another care law in operation that gives cause to worry for those who cannot advocate for themselves or have no independent advocate. Perhaps there is another inverse law that runs concurrently concerning ethics. Triage, is real. Objectively, as a nurse you think "Am I being selfish?". But, as eldest son - absolutely not. These conversations, and the future aside, the doctors and team as a whole have worked (absolute) wonders for which mum and the family will always be grateful.

Be Well, Be Safe All.

 

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

"There should be no wrong door and every  service should reverse the ...	... Inverse Care Law, which simply states those people in need of health and social care the most  get them the least."
https://www.smithsltd.co.uk/doors/composite	By MrPanyGoff - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19702555

A comment at The King’s Fund, by Lord Victor Adebowale.

Partnership Working, Time to Talk, Drink and Drugs News, October 2018, pp.10-11
https://drinkanddrugsnews.com/wp-content/uploads/2018/10/DDN-October-2018.pdf

If anyone has a photo of a red door at a care or nursing home that I can display above please let me know.

Five Days at Memorial by Sheri Fink: Book

INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

Five Days at Memorial by Sheri Fink

group - population

Five Days at Memorial by Sheri Fink: The Indepedent - Review

Image source: http://www.barnesandnoble.com/w/five-days-at-memorial-sheri-fink/1114975091?ean=9780804128094

More SF (speculations on person-centred care...?)

I've been reading a bit more SF - this time Joe Haldeman's, The Forever War here's a fascinating excerpt:

I went to the phone in the kitchen and with some difficulty managed to get through to the hospital. A plain girl in her twenties formed in the cube. "Nurse Donalson, general services." She had a fixed smile, professional sincerity. But then everybody smiled.
"My mother needs to be looked at by a doctor. She has a --"
"Name and number, please."
"Beth Mandella." I spelled it.
"What number?"
"Medical services number, of course," she smiled.
I called into Mom and asked her what her number was.
"She says she can't remember."
"That's alright, sir, I'm sure I can find her records."
She turned her smile to a keyboard beside her and punched out a code.
"Beth Mandella?" she said, her smile turning quizzical.
"You're her son? She must be in her eighties."
"Please. It's a long story. She really has to see a doctor."
"Is this some kind of joke?"
"What do you mean?" Strangled coughing from the other room, the worse yet. "Really -- this might be very serious, you've got to--"
"But sir, Mrs. Mandella got a zero priority rating way back in 2010. "
"What the hell is that supposed to mean?"
"S-i-r . . ." The smile was hardening in place.
"Look. Pretend I come from another planet. What is a 'zero priority rating'?"
"Another -- oh I know you!" She looked off to the left.
"Sonya -- come over here a second. You'd never guess who .." Another face crowded the cube, a vapid blonde girl who smile was twin to the other nurse's. "Remember? On the stat this morning?"
"Oh, yeah," she said. "One of the soldiers -- hey, that's really max, really max." The head withdrew.
"Oh, Mr Mandella," she said, effusive. "No wonder you're confused. It's really very simple."
"Well?"
"It's part of the Universal Medical Security System. Everybody gets a rating on their seventieth birthday. It comes in automatically from Geneva."
"What does it rate? What does it mean?" But the ugly truth was obvious.
"Well, it tells how important a person is and what level of treatment he's allowed. Class three is the same as anybody else's; class two is the same except for certain life-extending--"
"And class zero is no treatment at all."
"That's correct, Mr Mandella." And in her smile was not a glimmer of pity or understanding.
"Thank you." I disconnected. Marygay was standing behind me, crying soundlessly with her mouth wide open. ...

Joe Haldeman, The Forever War, Gollancz, SF Masterworks, pp.148-149.

Link:
http://en.wikipedia.org/wiki/The_Forever_War

1st Contact: ET and care on the front line

ET as in 'extraterrestrial' may seem remote from nursing and health care, but where there's a will....

Health and social care appears to become ever more specialised with each turn of the policy machine. People's lives are experienced as being ever more complex. Health care is filled with uncertainty and the public present with multi-diagnostic, person-centred, choice bearing, (usually) recovery directed problems, needs and strengths.

Pity then the care workers on the front line, at the point of 1st contact. Like the baseball catcher it helps if they can field the knowledge and skills required to cover physical, mental health and possibly learning disabled clients. You have to hope that coaches recognise that Hodges' model can help the team be aware and fully prepared to cope with 1st contact supporting and facilitating what follows. So, how does your team get to grips with complex care?

Additional links:

Baileff, A. (2004) Developing high quality first contact nursing in Southampton NHS Walk-in Centres. At, Innovations in Partnership, Practice and Education, 3rd Annual Scholarship Conference, Portsmouth UK, 2 Jul 2004. Southampton, UK, University of Southampton. http://eprints.soton.ac.uk/9197/

Declaration of Principles Concerning Activities Following the Detection of Extraterrestrial Intelligence http://www.setileague.org/general/protocol.htm

Image and source: Louisville Slugger OXFB Omaha Pro Series 13 Inch First Base Baseball Mitt from
Formerly - anaconda sports