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"

h2cm = 'GI - General Intelligence'?

"In 1990 a paper curiously- titled "Elephants don't play chess", published by Australian roboticist Rodney Brooks, ushered in the idea that artificial intelligence could become smarter by learning as the human brain does. Building simple connections that gradually become more complex could help AI emulate the way we think."


"AGI [artificial general intelligence] is a really tough problem, making something that is as flexible and efficient across a wide range of domains as a mammalian brain is a tough challenge.."


"In a new paper published in Nature yesterday, DeepMind unveiled how an area of AI , known as reinforcement learning, has shed new light on the way the brain learns. ... At the heart of the paper is a new idea of how dopamine works. Known as the "motivation molecule" or "surprise signal", dopamine has come to be of significant interest." Chowdhury, 2020.

AI or G(A)I ? Specific and General ...
... depending on the situation ...

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

cognitive decision making intellect motivation learning	science neuroscience dopamine data  information

Brooks, Rodney (1990), "Elephants Don't Play Chess" (PDF), Robotics and Autonomous Systems, 6 (1–2): 3–15, CiteSeerX 10.1.1.588.7539, doi:10.1016/S0921-8890(05)80025-9

Dabney, W., Kurth-Nelson, Z., Uchida, N. et al. A distributional code for value in dopamine-based reinforcement learning. Nature (2020). https://doi.org/10.1038/s41586-019-1924-6

My source:
Chowdhury, H. Why scientists just had a brainwave in quest for artificial intelligence, Business, The Daily Telegraph, 16 January, 2020, p.5.

Finding motivation ...

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

INTRINSIC	EXTRINSIC
INTRINSIC	If 'you' activate the intrinsic motivation of a people 'here' by extrinsic means, be prepared to suffer the consequences.

 

Previously:

Conveying the Message: Channel, Noise, Redundancy, Information ...   

Social care ... 

 

Nursing human rights and Int. Human Rights Day: fao Sir Gerry Robinson

On last nights BBC Two TV program: Can Gerry Robinson Fix Dementia Care Homes?

- amongst the angst his visits and engagement with several care homes provoked Sir Gerry highlighted the need for a moral compass and compassion. The themes I expected to find were there: the need for person-centered care, knowledge of the clients and their backgrounds, being occupied and having access to a secure environment when the weather permits, staff morale and the level of staff training and competence. Although not necessarily 'enjoyable' viewing the program was very good in raising awareness and included either directly or indirectly:

person-centered care, attitude, memory loss, vulnerable individuals, training, risk, assessment, review, motivation to change, interpersonal skills, motivation, listening, life skills, knowledge and skills, feedback, aggression, agitation, change, measures, rapport, empathy, +ve care, boredom, diurnal variation of mood, personal choice & autonomy	physical environment, colour, decor, noise, outside access, physical security, nutrition, tasks, processes, measures 'dementia care mapping', routine, meal times, time, physical risk - falls, mobility, assessment, care files (paper!), bed occupancy, staffing : resident ratios, models of care
the residents, visitors, family, love, social attitudes, dignity and respect, relationships, social values, personal-social history, engaged activities, involvement, 'social' norms, inclusion, community - institution, being valued by others, distraction	records, freedom, care funding costs / weekly charges, funding, inspection, consultancy, audit, legislation, rules (meals), pay, investment, business, staff morale, recruitment and retention, financial risk, confidentiality, plans and initiatives, management style, qualifications, standards

Today 10 December 2009 is also International Human Rights Day. To many people elderly care issues in a Western democracy may seem a world away from 'human rights' as per:

• false imprisonment
• denial of justice, law and order
• political repression
• freedom of expression
• education and health for all
• discrimination
• ....

- and yet the situations that arise within nursing, health, social care are never far from ethical and human rights concerns:

• Mental capacity
• Consent
• Physical restraint
• Mental health law
• Environmental health law
• Conscientious objection
• Medicine and nursing in the armed forces
• Equity and equality
• Accessibility
• ....

Moral dilemmas can and do arise in any and all of the care domains of Hodges' model and all combined (the spiritual). In addition to a moral compass, it seems we need a compass in nursing in order to be compass-ionate.

Hodges' model can provide a compass.

A compass to help navigate open waters, new coastlines and the uncharted corners and recesses of human nature.


Additional links: Amnesty International

POLITICAL care domain resources


Compass image: http://clipart-for-free.blogspot.com/2008/07/compass-rose-clipart.html

Review: A systematic review and mixed- methods synthesis of the experiences, perceptions and attitudes of prison staff regarding adult prisoners who self-harm

The systematic review featured here was tweeted:

https://twitter.com/t_hewson/status/1533800510343499779

- and being mixed-methods caught my eye. 

Below, I have mapped some of the concepts, themes and findings of the review to Hodges' model, adding some italicised points of my own.

The relevance of Hodges' model, in carceral, forensic, health and justice contexts is marked. The vertical axis's distinction of individual and group and the need to protect the public from dangerous individuals stands out. As does an individual's physical and mental state to the State - in the political domain. This extends to the Sociological as to the public's expectations over 'law and order' and what - should, must - happen to wrong-doers.

Where the model can help reflection, scoping, critical thinking and problem solving is in the disciplinary bridges it provides between knowledge, or what can be 'silos'; and, the many interfaces that are found within our activities, health, educational or generally. There are several interfaces in this systematic review: Prison staff - prisoner; prisoner - prisoner; prisoner - family; and where the custody function, butts up against that of the health - and how physical and mental health needs are met - or in this environment (literally) negotiated. There is a related finding (page 6):

"In contrast, in one establishment with low rates of self-harm, staff felt that their roles of ‘carer’ and ‘security officer’ were well integrated."

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

SELF: Prisoner / Prison Officer (and Other roles) Prison staff - perceptions & attitudes self harm (thoughts, motivation) suicide (thoughts, motivation) Staff confidence, skills: Awareness - Prevention Caring - empathy 'manipulative', 'attention seeking' Insufficient training expressed emotion Staff member's wellbeing Capacity to care 'deep acting' emotional intelligence 'hope' QUALITATIVE

SELF: Adult Prisoner, Prison Staff [repetitive] self harm (means, action) suicide (means, action) Carceral environment (PRISON) self-harm - factors Research: Methodology, [Mixed] methods Systematic Review self-report - non-validated questionairres TIME [shift]: 'all the time', 'every time' location, time Staff member's wellbeing Capacity to care 'surface acting' Effect of COVID on self-harm: men/women Assessment tools ACCT - Assessment, Care in Custody and Teamwork processes QUANTITATIVE

Prison - Staff Culture male::female staff -> prisoner -> relatedness Staff - Prisoner interactions in self-harm management Behavioural - learning/copying role - models clarity 'shared/pervasive sense of hope' 'Life skills - literacies' Social determinants of Health (Crime?)

Self-harm: Policy NICE guidelines 'Correction', Young Offender Inst. control–support model demands - resources model Occupational stress Staff Support Training Prison officer training 'Intro 101'?

The comments gleaned from staff are very informative. Also of interest here are ongoing developments in trauma-informed care and this can cover emotional trauma, as in abuse, plus head injury which is a key screening initiative. Achieving parity of esteem across physical and mental health, demands a more delicate balance in health and justice.

'Hope' is a concept subject to much analysis, for example, in the healthcare, sociological and philosophical literature. Incarceration, must bring its own 'trauma', which will vary in its signature across individual, age, first-offence, recidivism, offence, legal processes ... and its impact upon hope. From the challenge of the individual prisoner and their hope, there is the challenge for prison management and policy to instill, facilitate a shared, sense of hope. Amid the news on the state of prisons, there are no doubt examples where this can and is delivered.

Hewson, T., Gutridge, K., Bernard, Z., Kay, K., & Robinson, L. (2022). A systematic review and mixed-methods synthesis of the experiences, perceptions and attitudes of prison staff regarding adult prisoners who self-harm. BJPsych Open, 8(4), E102. doi:10.1192/bjo.2022.70

 

Time to Define: Person-Centred Care...

In a global, planetary context self-care also takes on new meanings and urgency:

INDIVIDUAL

|

INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP - POPULATION

::

Greta Thunberg

|

ANXIETY : TIME

LOVE - CARING --------------------------------- biospherics
responsibility ------------------------------ evidence

CONSUMERS : POLICY VACUUM

|

Global Consciousness
Gaia's Friends*

personal growth self-motivation, anger, sense of betrayal, trust in political motivation	PLANETARY HEALTH cloud air water soil land glacier weather: temperatures, rains, winds, sea level ...
Communities Societies People's Bound to 'consume': but a collective  aspiration to be  more than: CONSUMERS	economic growth ... ? Climate activist Greta Thunberg photographed on the shore in Lisbon, Portugal December 4, 2019 Photograph by Evgenia Arbugaeva for TIME

*Gaia does not have 'friends' of course.
Get this wrong - 'We' are gone.

Depression Worskhop: c/o and with thanks to AffecTech

As posted last September I enjoyed an evening at the launch of AffecTech at Lancaster. This post is prompted by a tweet:

AffecTech Design Workshop: Discussion on Cross-disciplinary Methods for Depression Treatment: https://t.co/7xVinrvmWf #wearables #tech #innovation #research #digitalhealth #mentalhealth #depression

— AffecTech (@Affec_Tech) February 16, 2018

I should add that this post is not intended to represent an endorsement by AffecTech but there is an opportunity to reflect and show how Hodges' model can be used.  I contacted the researchers who - in the spirit just mentioned - kindly forwarded higher resolution images. Of course, not being present at the workshop a lot of information is lost. The reference to art is interesting in itself. It is difficult to capture the context of the whole workshop but - as per the tweet - a short article sets the scene:

AffecTech Design Workshop: Discussion on Cross-disciplinary Methods for Depression Treatment

I have provided two examples of Hodges' model mapping the contents of the workshop. The first,  covers Figure 1: Concept maps of depression causes and symptoms. I don't have a key so there may be the thoughts of several individuals - as per the colours and codes on the flipcharts. Some terms are immediately not only cross-disciplinary but multicontextual in terms of their everyday meaning, for example, darkness, falling, stuck-ness, negative spiral (thoughts, actions), imprisonment mentally, physically, and politically due to dependency, financial constraints.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Unreachable hope                                     Pain                                           Weight - burdened        Immobility - motivation                   DEPRESSION    Anxiety DESPERATION                                          Stuck                 Darkness    Grief             Falling Insomnia       Negative filter         No hope Nowhere   Negative spiral                             Lack of interest and motivation Internalising rage   Suppressed emotions Anger Not being listened to                  Darkness

Pain Im-mobility  Physical decline Weight Stuck Chained/Locked to go energy imprisonment Darkness

Imprisonment – Social Isolation No support Hiding Loneliness

Imprisonment – Powerlessness? Loss of control

Next, I have examined the text immediately following and mapped this [my emphasis] to the model.

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------- THE SYSTEM --------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

Identified, general state of lack of interest as a main symptom of depression (lack of energy, negative spiral), and as one of the obstacles for technology-based treatment of it. Therapist input: the emotion regulation component of the system should be suggestion-based (promoting novelty in the patient daily routine). system should be able to continuously monitor* (and predict) the user mood should have an appealing and trust-worthy interface from which it can communicate with the user and modifying his/her immediate context. If depressed - the agent engages the user in a discussion in which a range of emotion regulation techniques is proposed to him/her. Includes: (i) modifying environment (light changes, playing music); (ii) recommending activities; (iii) proposing mindfulness exercises; (iv) engaging the user in a discussion; or (v) recommending the user to look for the support of a friend. Further, at the end of each day the user and the agent discuss progress made over recent days, and define small steps that could be taken in the near future.

Requirement for a pro-active intervention system, and engage the user as soon as (or better just a bit before) a critical situation is detected. System should: *real time - 'always on'? provide daily feed-back to the user (giving a sense of incrementally overcoming problems). Low-fidelity prototype of a system that meet these requirements. Composed of two components: (i) wrist-band device worn by the user that monitors the user mood; and (ii) an assistive agent that is responsible for the emotion regulation system component. Working principle of system - wrist-band devices communicates to the agent when the user is in a depressed mood (- use of biosensors)

Should strive to connect the user with his/her close friends.  Emotion regulation techniques - (v) recommending the user to look for the support of a friend (see above).

The above is provided as a 'pause for thought'. I'm no expert on NLP, but I am acutely aware of the power of the words we use. And how what is said to patients, carers can be returned as a sizzling hot potato that may reveal: great foresight in what you have missed; a major lack of understanding of a situation and treatment plan; and (then) as follows a need for urgent educational intervention. In applications such as this - care needs to be taken in when and were particular words are used. 'Treatment' is in the title, but can be a loaded term as understood by the patient, client, carer, or user. People will say, "No it isn't - this is a 'balanced' approach." but herein risks lie.

Services should be non-ageist and yet culturally if you survey treatment and related terms - from a decennial perspective I wonder what you would find? I have patients who refer to Dr Google and will challenge and ask about their care and if not satified seek further opinions - a fresh pair of eyes; and others who are quite institutionalized in respect of passively accepting what is 'prescribed'. This may be reflected in the length of their mental 'health career' and their previous mental health history.

Please note the inclusion of THE SYSTEM above in the axes and domains of Hodges' model. This is non-trivial. 

At the end of the day (and the start of the night - for someone with depression?) what is the system? I'm not being awkward, but the 'system' in research can become a lay-by. As a compound term it is shorthand, but obviously we need to focus on the elements, constituents and what glues the system together: coherence. As an example, how often in IT project are 'Requirements' the sought after token that signifies "We are on the right track!"? The focus from the above is laudable being clearly person- patient-centred. Is there more that can be said about the system and requirements in the social and political domains? Is there a way also for the agent to figure higher up the design ecosystem (hierarchy)? This is no doubt were the hard work matters - theory, practice - the thesis!

Given the complexity of the (design, care, technical, global...) problems we face I do believe that Hodges' model may serve a purpose in helping to sustain, or ‘recover’ the context – of a situation. This is the purpose of stories of course. The aim of AffecTech's project here is no less than detecting a critical situation. Perhaps this is the truth of 'integrated health records' from wrist device, to agent, patient's record and health services'? It is brilliant to see such initiatives getting underway they are the future....

 (I may add to this post in coming days - weeks.)

With thanks to Alan Cole and Andrea Patane of AffecTech at Lancaster University.

Nursing human rights - dementia care II: fao Sir Gerry Robinson

The 2nd and final edition of BBC Two's TV programs Can Gerry Robinson Fix Dementia Care Homes? was on last night and made for uneasy viewing.

The saving grace for the public's confidence (if there is one) was repetition of the excellent care at one home.

For all the negatives presented on TV, before mapping the key content of this program using Hodges' model it must be acknowledged that the staff and both managers involved are to be congratulated in allowing and facilitating the production of this program. Sir Gerry and the program's producer(s) obviously travelled an especially difficult course in this episode.

Unless qualified or having undergone some training, many staff will behave and eventually modify their norms and expectations according to what they are exposed to within a short period of starting to work in residential care. Perhaps, this explains in part the adage 'start as you mean to go on'? It was apparent that many staff knew they were failing, they recognised the lack of leadership, their inability to sustain the effort for positive change.

This is why (in 1977 at least) the school of nursing I attended was a little more than churlish about students initially working as a nursing assistant. If you were not working on a ward that also trained student nurses then you may adopt the wrong attitudes and with it what we might call 'non-skills'. This includes 'learning' means of avoiding contact and interaction with patients; and possibly interpreting behaviour in a purely negative and non-therapeutic way. This may extend to the point of becoming personally involved - taking things personally - whether the behaviour exhibited is aggression or sexual dis-inhibition, for example.

Here then are some of the points I noted, many are repeated from the first program with some very unfortunate and troubling additions (which I may further review as per the above text):

PURPOSE, CARE PHILOSOPHY (none?), person-centered care, attitude, memory loss, vulnerable individuals, training, risk, assessment, motivation to change, interpersonal skills, motivation, listening, life skills, knowledge and skills, feedback, aggression, agitation, measures, rapport, empathy, +ve care, boredom, personal choice & autonomy, access to personal belongings, dolls, personal focus, anxiety, psychological stress and trauma of physical relocation

physical environment, colour, decor, noise, outside access - physical security, physical restraint - use of furniture, position of furniture, day-to-day items, tasks, PROCESS, measures 'dementia care mapping', routine tasks, time with residents, assessment, care files (paper!), bed occupancy, activities - painting, gardening, sheds, staffing cover : resident ratios, models of care (none?), objective measures

PRACTICE (common minimum standards), the residents, team work, day staff:night staff, collective faith and trust, collaborative objectives, care, shared enthusiasm, social attitudes, dignity and respect, relationships, social values, personal-social history, engaged activities, involvement, 'social' norms, inclusion, community - institution, being valued by others, impact on families and local community of home closure

POLICY (the lines in the sand?), management spot checks, '24 hour care', disciplinary procedures, professionalism in management relationships, duty of care, ratings: tokenistic inspection regime, home closure, consultancy, audit, legislation, sickness, pay, business ethos, staff morale, recruitment and retention, confidentiality, sanctions, management style, qualifications, standards, institutionalised care, re-location, lessons learned (business involved, local authority)?

There are also Open University learning resources associated with the program.

My closing thought: in closing the asylums over the past 40+ years I hope we have not and are not creating a series of micro-institutionalised replacements.

This is an issue for everyone.

Paper: Wang and Nickerson (2017). A literature review on individual creativity support systems

Hodges' model can lay claim to being a creativity support system [CSS]. While I do not have evidence, the model presents a diversity of stimuli in its structure and the care - knowledge - domains. It follows then that from the outset it is a motivational primer on both affective and achievement counts. Immediately, there is the motivation provided by the blank space, viewed as one or four conceptual spaces to find an initial starting concept. Affective as users gravitate towards their chosen reflective and creative journey, and achievement priming as having a goal that is prompted by professional, interpersonal and educational goals. If there is a case of 'creativity block' then perhaps a group approach can be adopted? Hodges' model then becomes a collaborative creativity support system. With Hodges' model and no doubt the proposed CSSs the collaborative agents add their own affective and achievement priming, whether student-student; patient-student (supervised); or mentor-student.

With the important caveat that the studies identified do not include healthcare but many papers are general. The authors provoke many questions: "Creativity support systems, like other information systems, are most effective when they instantiate underlying theories..." (p.140). I have already posed this question - which is (as ever) compound. As per the review's general domain papers, is there an underlying theory for all of Hodges' model; or is there a need for a theory per care domain?

"The literature on individual creativity support systems has drawn from theories about design, human computer interaction, information systems, and creativity.. " (p.140). 

If 'design' can be complex, what of 'care design'? That is what we are about. This in turn impacts upon the other sources of theory above.

There is much to draw upon in Wang and Nickerson (2017) but finally on page 145:

"the authors did a survey to verify the notion that creative self-efficacy, individual knowledge and IT support affect individual creativity through mediating variables: individual absorptive capacity, exploration and exploitation." 

Creativity must contribute to literacy, Wang and Nickerson allude to a relationship, referring to self-efficacy above. This is what we are seeking in health literacy and self-care. An ability to explore and exploit available resources being a sign of autonomy and efficacy.

Table 3
A framework for designing individual creativity support systems.

Aspects	Components	Features to Support the Component
Motivation	Motivational priming	Affective priming Achievement priming
Creative Process	Process completeness Process control	Modules to support each step in a complete creative process Allowing iteration and selection of steps
Divergent thinking	Stimuli Long term memory Working memory Creativity techniques	Providing different levels of stimuli, Providing stimuli dynamically External long term memory, such as knowledge base and case library; Facilitating search Supporting association, Visualization, Random combination Facilitating the use of creativity techniques; Computational creativity techniques
Convergent thinking	Comprehension Decision	Labeling, classification, simulation Criteria based comparison, Decision support

Table 4
The steps in a complete creative process.

Process Stage	The Divergent Step	The Convergent Step
Problem finding	Formulating problem presentations in various ways	Selecting the best ways to present the problem
Information finding	Collecting potentially relevant information	Selecting the most relevant information
Idea finding	Generating many ideas	Selecting the best ideas
Solution finding	Improving the selected ideas	Selecting the improved ideas and integrating them into a solution

Reference:
Wang, K., & Nickerson, J. (2017). A literature review on individual creativity support systems. Computers In Human Behavior, 74, 139-151. (tables p.145).
http://dx.doi.org/10.1016/j.chb.2017.04.035

Laws, Rules, Promises & Campaigns

They are not all represented on W2tQ, but many have been posted over the years. Campaigns launched in the aftermath of avoidable deaths within NHS delivered care. The initiatives seek to translate grief into positive affirmative action by making a difference to patient safety, the quality of professional care, policy and funding in some instances. At least drawing attention to the latter.

It is staggering that staff need to be 'reminded' of what should be professional, practice-based, and philosophical (personal - team, ethics and ethos, and values integral to nursing, and healthcare interaction that should be integral and ingrained. 

I thought "What's my motivation?" was a theatrical cliché?

Poppy's Promise is a commitment to making every healthcare experience more compassionate, respectful and person-centred. It supports staff to work in partnership with patients, families and carers, ensuring every voice is heard and every person feels valued.

Oliver's Campaign: The Oliver McGowan Mandatory Training on Learning Disability and Autism is named after Oliver McGowan, whose death shone a light on the need for health and social care staff to have better training. The Health and Care Act 2022 introduced a statutory requirement that CQC-registered providers must ensure their staff receive learning disability and autism training appropriate to their role.  

Jess’s Rule makes sure GPs take a ‘fresh eyes’ approach with patients, making them think again to diagnose and catch serious illnesses earlier. Jess’s Rule – Three Strikes and we Rethink - was launched in England on the 23rd September 2025 by Department of Health and NHS England and in The Isle of Man on the 31st March 2026 by Manx Care. It is endorsed by the Royal College of General Practitioners.

Martha’s Rule helps us notice early signs that someone may be deteriorating and gives you the right to request a rapid review if you’re worried that your or your loved one’s condition is getting worse. This may include a review by the Critical Care Team. Sometimes small changes happen before they show in tests. These can be early warning signs. Martha’s Rule makes sure we listen to concerns and act on them.

Nobody should be separated from the people they love and who care for them. John's Campaign works for the right of people with dementia (and other disabilities or individual needs) to be supported by their family carers — in hospitals, in care homes, and wherever care happens.

Dáithí's Law: Dáithí Mac Gabhann was born in October 2016 with a condition called Hypoplastic Left Heart Syndrome, which basically means that Dáithí was born with half a working heart with the left side not forming correctly in the womb. More information on HLHS can be found here. Dáithí has now been waiting for the gift of a new heart for over 7 years.

Activism is not restricted to patients, parents or guardians but key campaigns have followed through staff efforts:

A message from Kate about the campaign…
“Hello, my name is Dr Kate Granger MBE and I’m the wife of Chris and the co-founder of the #hellomynameis campaign”

⃟ 

The initial website for Hodges' model 1998-2015 and now archived, featured four pages of links to resources associated with the domain they represented. The SOCIOLOGY links included:

Patients, Carers & Self-Care

individual

|
INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

|

group

Patient - Nurse ...	Patient - Nurse ...
Guardian - Parent Family Carer	Government Funding Policy makers

In Hodges' model, if neglect, accidents, untoward - serious - never incidents, what is complex, complicated, preventable signify anything; it is the collapse of a situation to the individual-group axis.

For the people involved they will simultaneously hear and feel a catastrophe.

Armed with Hodges' model, plus early insights into informatics, the oscillation between the person on your caseload, and not just beyond the spouse, partner and family but out to the political-zone of aggregation that is your caseload, the local and national population and statistical reports has always been fascinating.

Viewed theoretically, or practically the vertical axis of Hodges' model appears simple, and yet holds great power. A gift of abstraction and dramatic effect - for actor and audience alike. As an 'actor' we can see  our practice and its character humanistic - mechanistic played-out literally through the horizontal axis. Before we act, we can reflect upon the quality and humanity of our care. The audience, peers, families, managers, community, commissioners can also follow the 'narrative', (or lack of it!). Is there a paradox here in these virtual-digital times that the what is really material in care and caring is missing? We must hope the coroner does not need to attend [the play], being able to concentrate on other matters.

Previously: 'compassion' : 'communication' : 'safety' : 'listen' : 'motivation'

Reference [ii] "Practice in forensic psychiatry: A proposed interdisciplinary model"

Practice in forensic psychiatry:
A proposed interdisciplinary model

Expanding on the post about a further reference for Hodges' model:

Holmes, D. Perron, A. Jacob, J.D. Paradis-Gagné, É. & Gratton, S (2018). Pratique en milieu de psychiatrie légale: proposition d’un modèle interdisciplinaire. Recherche en soins infirmiers, (Practice in forensic psychiatry: A proposed interdisciplinary model). 134, 33-43. DOI: 10.3917/rsi.134.0033

Here, and on twitter I have sought to stress the limitations of the biopsychosocial model in healthcare, and I value Holmes et al. recognition of Hodges' model as politico-biopsychosocial. 

The authors also identify the structural nature of the model.

 

In comparing 'models of care' there is the question of whether Hodges' model is a model of care. As a generic conceptual framework Hodges' model can of course be used in the health care (as per its original design and creation) but it can be used to compare models of care.

Below, translated by Google are the models used in the paper.

I have altered the listing bringing the Tidal and Recovery model s together. Some I've 'mapped' in pairs, using formatting to indicate the differences.

Tidal Model

"The Tidal Model is a humanistic nursing model of recovery developed by Barker (12) with the premise that the person with mental disorder has strengths, abilities, personal priorities and a future ahead (13). This model of care, popular in forensic psychiatry circles, recognizes certain deficits of the hospitalized patient but it is especially interested in the meaning that the latter attributes to them. The sick person is the expert in his life and is therefore the one who contributes the most to his own recovery. This nursing perspective is therefore centered on the phenomenological experience (lived experience) of the patient and on the role of the staff, which is to allow healing and restore hope (12,14)."  

Recovery Model

"A popular model in mental health care, the recovery model is increasingly gaining ground in psychiatric care settings (28). The postulates of this humanistic model state that anyone, including those suffering from mental disorders, can aspire to a fulfilling future, participate in rewarding and inspiring activities, self-determination and finally, be able to live in an environment free of stigma and discrimination (29). The peculiarity of this model lies in the fact that recovery is part of a process where the person with mental illness can continue to show symptoms while being able to adapt to their condition (often chronic) and pursue their goals. life (30)."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

recovery strengths, abilities, personal priorities deficits healing and hope phenomenological - (lived experience) personal responsibility fulfillment - life goals patient as expert personal adaptation living with x,y,z... coping strategies	place as context my future deficits signs - symptoms chronicity Institutional settings clinical - hospital
humanistic - human qualities social expectations social contribution participation - social inclusion free from stigma deficits	Institutional settings politics of recovery free from discrimination forensic deficits

<>

Integrated Practice Model

"This model was developed by Virginia Lynch, a pioneer in forensic psychiatry, and it guides the role of practicing staff in this care setting (15). There are three main theoretical foundations: 1) the fields of expertise involved (nursing, criminal justice and forensic science), 2) the health system (victim and offender, health care and forensic nursing ) and 3) the social impact (social sanction, human behavior, crime and violence) (16). According to this model, patients should be cared for using an interdisciplinary and holistic approach (15)."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

nursing forensic psychiatry 2. health system interdisciplinary holistic OFFENDER	nursing theoretical foundations forensic science 1. fields of expertise 2. health system interdisciplinary holistic
VICTIM role of practitioners 2. health system 3. social impact (social sanction, human behavior, crime and violence)	criminal justice 2. health system

<>

Model of Nursing Interaction

"This model of care includes six categories of forensic nursing interaction with the goal of establishing a relationship with the patient: establishing and maintaining a relationship (relationship based on honesty, respect and trust), encouraging and support interactions (help the patient to recognize his qualities and use his resources), the learning of social skills (encourage the patient to do social activities and talk to others), reality orientation (help the patient patient to be aware of his way of being and of acting), reflective interactions (the perception of the patient and his problems) and the learning of practical skills (encouraging the patient to develop good lifestyle habits) ( 17,18)."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

patient qualities, resources reflective interaction self-perception of problems reality orientation awareness of way of being and of acting	practical skills develop lifestyle skills
reality orientation learn social skills develop lifestyle skills encourage social activities talk to others	encourage and support interactions reality orientation perception of patient and problems

<>

Healthy Living Program

"This model was developed in response to metabolic syndrome and physical illnesses that may develop in people with severe mental illness (19). It includes programs related to health promotion activities such as weight reduction, smoking cessation, physical exercise, etc. It is a voluntary approach that not only improves physical health, but also independence and recovery. For the program to work in the institution and to fit into its organizational culture, the approach must be flexible and systematically maintained by the entire interdisciplinary team."

[ PARITY OF ESTEEM ] 

mental health - metabolic syndrome physical illnesses

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

independence recovery voluntary approach	(physical) health promotion activities such as weight reduction, smoking cessation, physical exercise,
independence recovery	voluntary approach for program to work in the institution and to fit into its organizational culture, the approach must be flexible and systematically maintained by the entire interdisciplinary team

<>

Holistic Model

"This model is used in forensic care in the assessment, health care and psychotherapy of patients with personality disorder (22). Holistic care includes the physical (diet and exercise), cultural, spiritual, and psychosocial needs of the patient. This model is based on problem solving, anger management and decision making. Caring is a central concept in the holistic model and is actualized in an emotional, psychosocial, constant and authentic caring response (23). It is for caregivers to be present for the patient, to respect his situation, to understand his experience and to demonstrate a desire to help."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

holistic care personality disorder [mental] health care psychotherapy assessment emotion problem solving, anger management decision making actualized psycho-	holistic care 'caring' assessment diet, exercise health care 'being present'
-social culture holistic care 'being present' constant and authentic caring understand person's experience respect person's situation desire to help	forensic care holistic care desire to help (also exemplified in the organisation?)

<>

Good Lives Model

"This model focuses on the offense committed by the mentally disordered offender, his recovery, the promotion of personal goals, the reduction of the risk of reoffending, and the treatment of mental illness (24,25, 26). The model favors an approach based on the strengths of the patient. In addition, mechanisms of change are present, that is to say that behaviors judged to be poorly adapted are replaced by adapted behaviors when the patient is equipped with the skills, resources and support provided by the nursing staff. This model contextualizes the offense, focuses on the symptoms of mental illness while conceptualizing both as inappropriate behaviors.This model helps to better understand the relationship between mental illness and crime in order to create an individualized plan of care."

Risk-Need-Responsivity Model

"This model (27) imported from the correctional environment was adapted to the psycho-legal context by the addition of the “mental illness” dimension. It was developed primarily to reduce the risk of recurrence. Care interventions are geared towards the identification and treatment of criminogenic factors. This model is based on three major principles: the risk principle (granting the highest level of resources to the group most at risk of crime), the needs principle (identifying dynamic criminogenic risk factors and targeting them in treatment) and the principle of receptivity (adjusting programs according to the characteristics of the person: learning style, motivation, strengths, etc.) (24,25)."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

mentally disordered (diagnosis) recovery characteristics of the person learning style (evidence?) motivation, strengths 3. principle of receptivity treatment: skills, resilience personal goals “mental illness” <-> crime recurrence individualized plan of care	1. risk principle -> resource allocation recurrence treatment 2. dynamic criminogenic risk factors  support of nursing staff
treatment [social determinants?] mechanisms of change adapted behaviours inappropriate behaviours recurrence	offense reoffending correctional environment contextualise the offence treatment principles [policy] recurrence

<>

Hodges' Health Career Model

"This model has a politico-biopsychosocial structure which is consistent with contemporary interdisciplinary practice (20); that is, it relies on a multidimensional critical approach, incorporating writings in sociology and politics, in order to understand the person in context. It is based on four objectives: measuring learning, providing holistic care, supporting reflective practice and closing the gap between theory and practice (21). This model is applicable in various clinical situations in a psycho-legal context. When this model is used as a frame of reference, it emphasizes the role of caregivers who must meet the patient's needs and focus on their problems. It also serves as a guide to assess and provide assistance to the patient vis-à-vis their physical, psychological and social needs as well as with the justice system in order to promote their recovery. The theoretical foundations call on four sources of knowledge: interpersonal, scientific, sociological and political (21)."

The PERSON in Context 

(situated)

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

INTRAPERSONAL INTERPERSONAL reflective practice conceptual structure psychological needs measure of learning psycho-	SCIENTIFIC physical needs theory-practice gap
SOCIOLOGICAL reflective practice (develop self-awareness) social needs practice-theory gap	POLITICAL justice system (needs) -legal

[ all embedded within the SPIRITUAL ]

Not just 'problems' Hodges' model can incorporate any desired stance, perspective or philosophical approach - strengths, disease, skills, weaknesses or deficits, psychosocial for example.

I am not sure about explicitly 'measuring learning, but the model can be used by learners and teaching staff / mentors to demonstrate their understanding and justify their output - formulation.

There is an instrumental potential in Hodges' model as a whole. Hodges' model can illustrate the degree of holistic intent - whether this is realised could also be indicated using the model.

Once again I am grateful to the authors for their inclusion of Hodges' model. The reference is listed in the blog's bibliography (please see the sidebar for others) which includes:

Doyle, M., Jones, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. 20, 7, 631-640.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2012.01961.x/abstract

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.

See also on W2tQ (with overlap):

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

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

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