iv WCCS26: World Conference on Complex Systems 20-22nd April

Day 1: Panel 2 - Rethinking Knowledge in the Age of Complexity

• Helena Knyazeva - Dancing with Complexity: How the World Thinks Through Us
• Carlos Gershenson - The Implications of Complexity
• Leonardo Rodríguez Zoya - Can Statistics Think? Complexity, Future, and Freedom in the Age of Large Language Models
  Panel Chair: Nigel Gilbert 

Courage is one of the 6Cs in nursing, and was on display at WCCS26.

Carlos Gershon began by offering two references, the first:

De Domenico, et al., (2019). Complexity explained: A grassroot collaborative initiative to create a set of essential concepts of complex systems. https://complexityexplained.github.io

This is a brief 20 pages, larger text, and provides a helpful primer to complexity and related concepts covering:

Interactions
Emergence 
Dynamics 
Self-organization
Adaptation
Interdisciplinarity
Methods

For each concept, the authors explain:

Definition/Description
Examples
Relevant Concepts
References

Plus, secondly:

Gershenson, C. The Implications of Interactions for Science and Philosophy. Found Sci 18, 781–790 (2013). https://doi.org/10.1007/s10699-012-9305-8

I liked the practical feel here, the encouragement to think anew, and perhaps taste the "flavors of emergence": synchronic - space; diachronic - time, weak and strong feedback, transversal of scale - upwards and downwards.

There is further conference on complexity later this year (and also online!):

CCS 2026:
The 2026 Conference on Complex Systems
OCTOBER 9 - 16, 2026 BINGHAMTON, NY, USA & ONLINE

In my search I also found:

Carlos Gershenson; Complexity, Artificial Life, and Artificial Intelligence. Artif Life 2025; 31 (3): 289–303. doi:https://doi.org/10.1162/artl_a_00462

Gershenson, C. Self-organizing systems: what, how, and why?. npj Complex 2, 10 (2025). https://doi.org/10.1038/s44260-025-00031-5

Leonardo Rodríguez Zoya's presentation helpfully connected social practice, interdisciplinary bridges, statistical rationality, complex (human) rationality and the future(s): desirable, possible, latent and probable.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

COMPLEX (HUMAN) RATIONALITY   cognition	STATISTICAL RATIONALITY Techopraxis LLMs - technology
socio- HUMAN PROBLEMS SOCIAL PRACTICE PRACTICE (one of the 4Ps)	ELECTION - CAMPAIGN SPENDING PEACE NEGOTIATIONS ISLAND ECONOMY CRYPTOCURRENCY

To answer the prompt - 

"Give me a less likely but more fruitful interpretation of this [concept]*."

*Replace with a significant concept in your practice

Would it might help to have a simple, and yet complexity (and simplicity!) primed conceptual framework to assist reflection, argumentation, and progress?

 

I missed the poster at the afternoon break, and followed track 1. I greatly enjoyed Julian Arevalo's - Adaptive Readiness: an Agent-Based Model of Peace Negotiations. Perhaps this accounts for my having no notes or photos for this track except for one. I realise now we did speak, sitting together for the conference dinner. I'm sure I remember Negotiation Lab 1.0 - 

https://www.comses.net/codebases/1256dc74-9ae4-4f49-a235-1ec129be1930/releases/1.0.0/

 

This past week I heard discussion (BBC Radio 4) of the 'income' Norway obtains from its expertise and engagement in peace negotiations.

 

Nicholas Roxburgh, and colleagues Rachel Creaney, Mindi Premarathne and Ruth Wilson through 
Exploring Interdependencies in an Island Economy, reminded me of public engagement in research. Especially when it involves their community; and that community is somewhat rural, or remote.

 

Remah Dahdoul, with Jan Korbel and Stefan Thurner presented -

Campaign-Spending Driven Polarization Transition in a Double-Random Field Model of Elections. The following paper brings home the mathematics in complex systems. The reference is:

 

Jan Korbel and Remah Dahdoul and Stefan Thurner. (2026) Empirical validation of the polarization transition in a double-random field model of elections. arXiv. https://arxiv.org/abs/2510.00612.  doi.org/10.1103/9gjj-1df6.

 

The paper by Saida Hachimi El Idrissi and Mohamed Nemiche is not open access, but the abstract follows. 

 

S. H. El Idrissi and M. Nemiche, "Formation of Complex Societies: An Agent-Based Model Inspired by Freudian Theory," 2024 World Conference on Complex Systems (WCCS), Mohammedia, Morocco, 2024, pp.1-6, doi: 10.1109/WCCS62745.2024.10765573.

Abstract: The rise and emergence of complex societies in the Old World mark a pivotal chapter in human history, characterized by the transition from small, kin-based communities to large, hierarchical states. This transformation raises fundamental questions: How did human societies progress from small, cohesive groups characterized by face-to-face cooperation to the expansive, anonymous societies of today, often organized as states? What factors account for the significant variation in different human populations' capacity to construct stable and functional state structures? To address these questions, we developed an agent-based model grounded in Freud's hypothesis, which posits that civilization could neither emerge nor evolve without the repression of human desires. In the context of social evolution, this repression of desires can be interpreted as the repression of intra-societal competition, ultimately strengthening the society and facilitating the formation of complex social structures. We implemented this model within a realistic representation of the Afroeurasian landmass, incorporating various geographical factors. To validate our model, we compared our simulated results with historical data. The model-predicted pattern of expansion of complex societies demonstrated remarkable congruence with the observed historical patterns in the Old World. The emergence, growth, and distribution of large-scale societies predicted by our computational model showed remarkable consistency with the archaeological and historical record.

keywords: {Analytical models; Computational modeling; Predictive models; Data models; Agriculture; Rivers; History; Complex systems; component; Agent-based Modeling; Repression of satisfaction; cooperation; competition; Social Simulation},
URL: https://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=10765573&isnumber=10765499 

Unless you are a microsurgeon (increasingly with robotic co-workers), is the word practice, more likely to manifest what is larger, the big picture, a sense of space, even at a societal or continental scale? In reading, I came across four forms of attractors. For me, how they fit into the question of scale makes this paper worthy of seeking out. 

M. Nemiche was unable to attend the conference, and was greatly missed.

Infraethics <-> Infrastructure c/o Floridi & TPM

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

moral education^ character development^ personal values courage, commitment .. 6Cs Your - Registration What does being a professional mean to you? What does belonging to a profession mean to you?

"The idea of an infraethics is simple, but the following “new equation” may help to clarify it further. In the same way as business and administration systems, in economically mature societies, increasingly require physical infrastructures (transport, communication, services etc.) to succeed, likewise human interactions, in informationally mature societies, increasingly require an infraethics to flourish. The equation is a bit more than just an analogy between infrastructure and infraethics."*

"Any complex society—be this the City of Man or the City of God to put it in Augustinian terms—has an implicit infraethics, which can be more or less morally successful, and more or less evil-unfriendly. Theoretically, even a society of angels, that is, of impeccably good moral agents, needs infraethical rules for coordination and collaboration. ... The right sort of infraethics is there to support the right sort of axiology. Designing it, maintaining it and keeping it updated is one of the crucial challenges for our information society. It is one of the reasons why our age is the age of design. Clearly, when talking about infrastructures, politicians have more on their plates than just networks of bits and atoms." socio-

"When economists and political scientists speak of a “failed state”, they may refer to the failure of a state-as-a-structure to fulfil its basic roles, such as exercising control over its borders, collecting taxes, enforcing laws, administering justice, providing schooling and so forth. Or they may refer to the collapse of a state-as-an-infrastructure or environment, which makes possible and fosters the right sort of social interactions." -political infrastructure

^Raised on In Our Time:
https://x.com/h2cm/status/1720095205012251114?s=20

*Point noted.

See also:

Floridi, L. Infraethics–on the Conditions of Possibility of Morality. Philos. Technol. 30, 391–394 (2017). https://doi.org/10.1007/s13347-017-0291-1.

My original source:

Floridi, L., Infraethics, The Philosopher's Magazine, 1st Quarter 2013. Issue 60. pp.26-27.
(Still clearing books, journals, magazines... )

Review: iv Fundamentals of Person-Centred Healthcare Practice

Chapter 15 on 'Being sympathetically present' is a timely review of empathy, sympathy and compassion. As students learn and are exposed to experiences in practice and socialised (or not) in how these are practised this is very useful allied with exposure to the 6Cs. Mentioned in post iii: chapter 19 on Person-Centred Rehabilitation would benefit from the addition of reablement and resettlement. Given resort to a single chapter [22] on mental health it is understandable that the extreme form of trauma - physical and psychological experienced (but not necessarily wholly remembered) for people sexually assaulted points to forensic and Criminal Justice Liaison and Diversion Services. The authors here are to be congratulated on a feat of explanatory gymnastics. This just hints at the PSYCHO-dynamic* world that is mental illness, health and well-being (*physical and political).

Perusal of W2tQ reveals how readily Hodges' model can encompass the sciences and the arts (humanities). This is by design (the model's structure). The book stresses art with some (very well-balanced and executed) illustrations and prose. Once again (sorry) though, I thought of veterans, homeless, veterans, prisoners and newly released offenders and their circumstances. Being person-centred is very much attitudinal but this is physical not just cognitive and how we apply knowledge. Where this person is in space that is the centre of gravity. How best to approach, a person living with dementia and impaired senses, a homeless person lying under a bridge - even before we speak. 

 

I'm sure I read 'touch' in here, but it is not indexed. Post-COVID and in nursing as part of person-centredness this is an important part of communications skills, safeguarding and being safe. 

For the newly released prisoner, how prepared are they to be the person they can be, even before we are 'person-centred'?

"For the first time in 25 years the one-off payment given to adult prison leavers in England and Wales is to be raised. The Prison Discharge Grant will increase from £46 to £76, but what difference will that make?"

https://www.bbc.co.uk/sounds/play/m000y5sq

Released On: 24 Jul 2021  Available for over a year

 

The book identifies different interventions and models relevant to the respective practice area, i.e. rehabilitation. Chapter 33 presents a personal challenge in (being a lifelong learner) whether you have a fixed or growth mindset, which of four archetypes of self-awareness applies to you (pp.322-323)? It's worth reading for heutagogy (p.327). I was prompted to consider the ongoing journey here. If anyone would like to test the reflexive credentials of Hodges' model (p.328) please get in touch. Salience is a key concept in Hodges' model. What is important to the patient - person? What is now? Are we only person-centred dealing with conscious persons? Again, perhaps a missed opportunity - care of the unconscious patient? I enjoyed chapter 30 on critical thinking. I was reminded of (verbal) accounts of people applying the Tidal model in forensic care. This proved not exactly straight forward, whereas, once learned Hodges' model can function as an aide-mémoire. If shared then collaboration may be enhanced since as the latter sections of this book show specific concepts need to be identified, articulated, agreed and applied.

The final chapter's title made me laugh a little: A call to action. Sometimes you can't win on the periphery of academia (a privileged position nonetheless?). KISS (Keep it simple stupid) applies to Hodges' model, but whether simple, or deemed complex the model fails to be recognised as a vital tool for all health and social care practitioners. Especially learners taking their seats (in-situ or online) on course 101. I take heart in believing that Hodges' model has a very long tail in relevance and global potential.

Once again model/framework envy creeps in, as I have no evidence (yet). 

Paradoxically (or not) this book will have me try to take note of instances when an interaction calls for a suspension of person-centredness: for me, the patient, client, carer - for us simultaneously.

This is the 'take-away' for me from this book which I also heartily recommend.

I will refer to 'healthful' in another book review.

SPIRITUAL

 

individual - PERSON - patient
|

INTERPERSONAL : SCIENCES

SPIRITUAL  humanistic ---------------------------- mechanistic  SPIRITUAL

SOCIOLOGY : POLITICAL

|

family - group - population

 

SPIRITUAL

Mindset :: Parity - attitude aptitude (My choices*) Hodges' model - disassembly for care	- of esteem :: Touch aptitude attitude Hodges' model assembly of care
Culture Child - Parent - Guardian FAMILY- Social network Be the 'person' the Social Determinants of Health predict/dictate?	prisoner release grants and welfare *(Are you joking - without attending to the politics of health and social care? Diet, green spaces, identity, community (facilities), housing ...)

Many thanks to the publisher Wiley-Blackwell for the review copy.

Review i

Review ii 

Review iii

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

What is 12.5% of Nursing's effort?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

skills, responsibility, accountability, 6Cs, morale, motivation, trust, self-esteem	12.5% ?
	"What happens here?"

And .. all embedded within, surrounded by ... the Spiritual domain...

  Fair Pay For Nursing

Find out more about the Fair Pay for Nursing campaign and how you can get involved

#FairPayForNursing

What it means to me / us.

Reflection, Revalidation, RCN Congress and Research

Thinking Out Loud: Journal 'Regulars'

Like many people I looked forward to experiencing RCN Congress again in June. Now of course Congress itself is a casualty of COVID-19.

Last May as already posted, I picked up several nursing journals too. Having time(!) I've read about reflection, I submitted the required reflective accounts to complete my revalidation last month (so good through to March 31 2023) and I've time to reflect now.

Reading some of the papers and browsing through the journals I notice one has "CPD reflective questions" which are specified for full-length article submissions. Here are some examples from one journal issue:

"If a patient presents with red flag signs of impeding airway obstruction, consider the aspects of the 6Cs in nursing and reflect on the care, compassion, and communication required to the patient and family.
Consider the different dimensions of a person-centred climate of a long-term care setting.
Reflect on the nurse's role in the provision of person-centred care in an older adult residential setting.
How could you make the care of patients in your setting more person-centred?
Reflecting on the case study, what do you consider may help nurses in recognising the condition early and minimise the need for investigations?
Reflect on how the time perspective [can] be an indicator of health and quality of life in people with HIV or another patient group.
Consider how the time perspective can be incorporated into the health care of people with HIV.
Think about how nurses can assess the time perspective in people with HIV."

If you understand Hodges' model then you will appreciate how the model can facilitate reflection on all of the above.

The contents page of many publications usually differentiate between 'features', or 'special focus' and pages listed as 'regulars'.

For quite a while I've not only worked on papers (two advanced drafts at present) but (quietly) wondered about those 'regular' pages and what would it take for journals to adopt Hodges' model as a common resource?

Of course, this begs questions of legitimacy, evidence-base, standards ... and as I have acknowledged Hodges' model is no panacea for a practitioner's or a health system's limitations. Hodges' model itself may constrain the adopted perspectives of readers; as opposed to as I believe, liberating them? If all the posts here were analysed, what is the holistic bandwidth of the content?* If Hodges' model was adopted what trends, if any, would be revealed? If students used Hodges' model to reflect on their own well-being in year 1 - year 3 what would they learn? Are there wells of reflection about which reader's reflections would congregate? Would this in turn be influenced by other recognised biases in publishing and the way the above questions are selected?

It would still be amazing to see Hodges' model as a regular and universal prompt. Even as a research project - the aide-mémoire it is intended to be. The journal would then actively engage with its readership and provide invaluable CPD.

My new folder is already open for the next three years ...

Be Well :: Be Safe All

*I admit that there are topics I have avoided posting, as they are potentially fraught 'politically' or in other respects.

British J. of Nursing, 28,9. 2019 (9 May, Congress Bumper Issue!).

What should be written in a HC Professional's DNA?

Before putting twitter down for a break, I was reminded about a form of DNA.

There are previous posts on the 6Cs in nursing here on W2tQ and taking these essential qualities as an obvious starting-point:

1. care,
2. compassion,
3. courage,
4. communication,
5. commitment
6. and competence

- and mapping them to the care (knowledge) domains of Hodges' model, you realise how they apply across the model. Care, Compassion and Communication are the essence of what it is to be human and humanistic. If however the time 'allowed', environment and accessibility are not attended to, then the mechanistic domains can disrupt the most caring of efforts.

What about courage? This is surely a very individual character trait? A personal quality in this context, with an emphasis on the humanistic domains.

Care is relational and we can consider courage in respect to scientific knowledge. As a member of the multidisciplinary team, or specialist practitioner a nurse may need courage to share scientific knowledge, evidence concerning genomics, for example. The public's knowledge and understanding of science is brought to the fore. There is the alternate scenario with the 'patient' as expert, for example in the case of rare diseases (especially next month).

Courage is a continua, that like strands of DNA runs through all the domains of Hodges' model and the 2020s ... will see the political realisation of courage in nursing and healthcare; locally, regionally, nationally and globally.

Reading (another) book for review, the authors draw attention to how Maslow's hierarchy says little, if anything, about altruism (but is implied?).

As these brief observations should demonstrate, Hodges' model facilitates relational, person-centredness, the cross-fertilization of ideas and high standards of care.

Who needs a double-helix when you can have a quadruple form?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

	Shankar Balasubramanian in front of a mural in his office representing quadruplex DNA, called ‘Living by the code’ by artist Annie Newman.

My source:
MindScience, Biochemistry, FT Magazine, FT Weekend. 26-27 January 2013, p.50.

Reminded via:

Thanks David, It's that last bit my focus (meme won't let go!)
individual and a collective 'mindset' all disciplines have from intro 101.
Professional DNA vital
*must* be preserved too [#AI]
*Rapid response calls for X-fertilization Quad-DNA?* ;-)https://t.co/CUuRsRPXl0#h2cm

— Peter Jones: 2020s will demand '2020' vision #h2cm (@h2cm) January 24, 2020

Compassion TO Governance: "Meet you in the middle?"

Governance:
"Yes, in theory and practice!"

SELF - individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - POPULATION

compassion	THEORY
PRACTICE	governance

While compassion must be demonstrated by the individual practitioner [as one of the 6Cs], it is also a positive phenomena that should be found, experienced and readily transferred - communicated within the team and community of practice.

Allied with governance, health systems should then ensure that there is time and space for compassionate care. While 'middle' might work as a metaphor in Hodges' model, the qualities of compassion and governance are not about the 'middle', as in, being average.

Hodges' model can also help us appreciate the role that self-governance plays in personal responsibility, accountability and professionalism.

The great amount of effort and work to place assure the person is at the center of care (and #h2cm) also becomes apparent.


My prompt: https://twitter.com/PippaJL01/status/1121399893225037824

c/o The King's Fund: Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England

When I see a 'model' I ask myself; what does this mean in itself? What is its purpose? I also (invariably) ask how does it relate to, or how might it support the theory and application that might underpin h2cm?

In February 2018 The King's Fund posted this item on integrated care systems. It wasn't just the 2x2 figure that caught my eye, but the axes and the additional amber tab (figure 1). Pondering for a time I have transposed this to Hodges' model below figure 1. Beneath that, I've provided an explanation for the altered schematic; recognising that as with h2cm such models are idealised representations.

c/o The King's Fund

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Individual care management Care for patients presenting with illness or for those at high risk of requiring care services	Population Health (systems) Improving health outcomes across whole populations including the distribution of health outcomes [Improving population health outcomes requires multiple interventions across systems]
'Making every contact count' Active health promotion when individuals come into contact with health and care services	Integrated care models Co-ordination of care services for defined groups of people (eg. older people and those with complex needs)

INTRA- INTERPERSONAL:
Individual care management has been changed from care services and individuals to this domain, which conceptually preserves the original placement. In h2cm as can be seen the interpersonal domain combines the individual and humanistic. In the 4Ps this domain also includes 'purpose'. Whenever possible it here (individual motivation) that self-care and self-efficacy and staying as well as possible relies on the patient's awareness and education about their condition and level of health literacy. There is recognition now that children need some awareness of mental health issues and the law needs to protect what images and content youngsters are exposed to on social media. So, ultimately 'how I manage myself' has a major bearing on the 'whole care management enterprise.' The focus on 'high risk' also denotes a need for an assessment and one that is part of the move to parity of esteem in respect of physical and mental health.

SCIENCES:
I have shifted Population Health (systems)from population to this (physical) individual domain, on the basis that our research, as in, quantitative and qualitative, needs to be synthesized and then ultimately generalised - across populations. While complex systems cannot be taken apart it is from the sciences (including social sciences) that evidence-based practice flows. There should be a feedback loop here, research that also takes into account the multiple interventions across systems (the amber tab in figure 1) and the outcomes achieved.

POLITICAL:
The King's Fund's figure 1 stands as it is of course, but I have 'moved' Integrated care models most radically. If there is no organisation, rules, order, policy, procedures ... then things will NOT happen (as they should). Agreement is also needed on definitions for reasons of standards, measures and accountability. Such matters are political (even if ignored - kicked in the long-grass). For services that are evidence-based (as just mentioned in SCIENCES) we need when possible for health and social care policies to also be evidence-based (for reasons of efficiency, equity, effectiveness and equality). While we cannot 'break' complex systems we can break models; 'health care systems' need to break ("be broken whilst still in flight") in order to be transformed for the 21st century.

SOCIOLOGY:
Making every contact count I have placed in the h2cm's Sociology domain. To me this initiative remains with care services, but I have switched this from individual to group-population within h2cm. Health care education places constant emphasis (research, CPD, mandatory training) upon interpersonal - communication skills and this is where clinical and social care interactions and interactions ultimately count. It is here that trust, the 6Cs, unconditional positive regard ... are 'counted' in qualitative terms. If the psychological represents the theory of psych-social intervention, it is in the social outcomes and benefits were the practice is (truly) delivered. It is also here that partnerships are forged and social capital found.

In social care as an example, the integrated care model should politically permit - allow for a sufficiently skilled and remunerated work-force (socially valued?) with sufficient time to ensure that every contact really does count.

<>

Forty years in the NHS suggests that when ever 'integrated care' is being written and even spoken about, then the context should be indicated at the same time; so at least - integrated care^1-5 as above?

'integrated' as in -

• philosophy (ethics, morality, values)
• spiritual (values) (and part-whole of 1-5)
• political - policy, government funding
• economically - commissioning (models of care, sustainability)
• management
• care delivery
• team organisation
• community involvement
• patient involvement
• health literacy, health promoting

...?

Accessibility: apologies that there is no equivalent text to figure 1.

My source: https://twitter.com/TheKingsFund/status/1093556280248147969

Courage: One of the 6Cs - for Individual & Governments? [i]

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Courage is perhaps one of the more challenging of the 6Cs for learners to grasp and even for experienced staff  to exercise. As a concept a definition is easy to find. Courage is often associated with whistleblowing. Over the decades whistleblowing has proved critical and vexed to both an individual's career and organizations.  Hodges' model encourages us to expand on this ...

The courage of seeking data, information, knowledge, diagnosis and prognosis Address: assumptions : misinformation : disinformation ["Dr Google", fake news, drugs online..?] Disclosure or withholding information ||||||||||||||| LONG GRASS |||||||||||||||

Husbands, wives, partners, sons and daughters with many friends find courage every moment of everyday (and many nights) when caring for someone living with dementia and other chronic illnesses. Practitioners may need courage to challenge promises made by family members that - "A nursing home? Never!" But, is the patient still at the centre of concern in these cases? Care at home at any cost? This can be the 'record' that matters to families.

Governments of all hues and globally are vested with courage, but how they exercise this quality depends vitally on governance. This is same reason, constraint that operates on the individual. "Do I? Don't I?" becomes "Do we? Don't we?" But then that individual practitioner is (must be) supported (governed) by supervision and the deliberations of the multidisciplinary team. What is the governments' record? Do governments have the courage to address the problems sustainable health and social care presents? Or, do they just kick the  problem...

Courage [ii]: One of the 6Cs - for Individual & Governments?

'Virtuous Practice in Nursing' Research Report c/o The Jubilee Centre

6Cs

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

individual character                virtues and values philosophy         ethics        courage          commitment             [moral selection / recruitment criteria      caring         attitudes       compassion reflective practice-think, think, think? knowledge and skills subjective - 'soft'?	time, pressures, tasks, robotic competence vacuum]              theory -(ethical)- practice gap evidence-based care  objective - 'hard science'? e-learning platforms-things to read, read, read?
(professional) socialisation role modelling mentoring         practice patient's experience    communication public perception, media public involvement patient/person-centeredness	policy Professional bodies autonomy     whistleblowing      advocacy     career pathway, education and training, organisational culture, appraisal and development of staff management, business, finance*

See also 'Virtuous Medical Practice' plus others*

How do you define person-centredness? Editorial c/o Dewing & McCormack

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Individual values, choices and preferences* What matters to the patient. person-centredness = hard to define? compassion (the 6Cs) PERSON-	"We believe that a focus on person-centredness provides an opportunity for nursing to rise above particular theoretical 'fan clubs' and work within a coherent set of principles that are multivariate, context nonspecific and trans-specialist." Dewing & McCormack (2017). measures?
measures? A certain type (quality) of nurse-patient relationship Community of Practice Culture - isolating?	-CENTREDNESS *You can - as a nurse - ask the questions about the above, but how you advocate, realise this in nursing is very complex and challenging. policy Services (workplace)? Organisational memory=Organisational respect?

"An example is needed and will be provided next. The intention is to demonstrate the potential utility of Hodges' model to conjoin ipseity, that is; the self, individual identity and personhood with the group and population. Further studies will seek to establish how Hodges’ model can be used in case formulation not just at an individual level – were social factors inform assessments and evaluations – but in community and global health development. Hodges’ model is further suited to this task as the model supports precontextualisation by helping us to anticipate the future and recontextualization in seeking to make sense of the past. Overarching this temporal dimension is the fact that Hodges’ model by being so general and independent of any particular discipline the model is transtheoretical. There is no single theory that can explain, predict or account for the validity of Hodges’ model."
[Draft notes for an editorial that might follow? PJ ]

As the editorial describes, amid women-centred, child-centred and family centred care in Hodges' model we can place whatever the situation, or context demands at the center of Hodges' model and thereby at the focus of our care deliberations whether reflective, theoretical or practice based.

My source:

Tell me, how do you define person-centredness? https://t.co/T9fh7h3cpY @ProfBrendan @JanDewing @jclinnursing @OxINMAHR @ppr

— Prof Debra Jackson (@debraejackson) August 4, 2017

http://onlinelibrary.wiley.com/doi/10.1111/jocn.13681/epdf

Dewing, J. and McCormack, B. (2017), Editorial: Tell me, how do you define person-centredness?. J Clin Nurs, 26: 2509–2510. doi:10.1111/jocn.13681

Pushing the envelope: Reflections in mind, health and social care ...

Hodges' model can do 'envelopes', but it's first form is as an aide-mémoire. In this way it helps facilitate reflection, reflective practice and more besides.	Envelopes are just a start, the germ of ideas. Hodges' model needs to be evidence based - can you assist?
If you need to share your reflections as case formulations, care plans, or evaluations; the model can help to engage with patients, clients, carers, staff and residents...	Amid healthcare's legacy issue which is achieving integrated, person-centred and holistic care, Hodges' model can help the practitioner assure integrity on several levels (6Cs).

Original image source:
http://www.strengthweekly.com/2014/10/02/new-blue-towel/envelope-back/

Nursing Rubens

6Cs Care Compassion Competence Communication Courage Commitment

Rubens Tour - themes Poetry Elegance Power Compassion Violence Lust

Health as Art and Science?

"The triumph of Ruben's nudes is his magnificent evocation of the texture of human skin, represented in such a way it feels almost palpable. We see blood coursing through the veins of voluptuous flesh. The delicate mother-of-pearl complexions of the female bodies radiate with light. ..." 

(Lust, Royal Academy of Arts, Gallery Guide)

Rubens and His Legacy

B(e) nurse

Book review: Quinn's Principles and Practice of Nurse Education [ 6th Edition ]

I owned the 3rd edition of this book and approached the publisher for a copy of the most recent, which is gratefully received. This review is quite delayed in fact, I've a few other reviews to get on with too.

From the outset while a book on nurse education, the text serves general students and practitioners in education in parts one and two. I completed my PG Cert almost twenty years ago and this book would be an asset to current students (see the content listing for parts 1-2 below). There are many technical concepts within what is a comprehensive text; for example, there are 54 index entries related to 'assessment'.

Much of the book's value is accentuated for readers here in the UK. Here is an established and high quality textbook that provides a UK perspective. As a 7th edition the references for each chapter are expansive taking in key historical sources and more recent publications. There are many illustrations in the form of flowcharts and figures. Following each chapters references, suggested further reading is provided. Review exercises at the end of chapters serve the added purpose of sign-posting content. The information architecture and design of the book makes for a logical, clear and readable experience. Even if the content were lacking, which it is not, the book is fairly substantial at 550 pages. The book is well produced, the paper quality (lending to the weight) and the binding works! Yes, the binding serves to secure the pages and works well when the book is opened flat. This is an obvious requirement and yet so frequently it is a struggle.

As to specifics: Parts 1 and 2 are a welcome refresh. The discussion on thinking and critical thinking are sufficiently detailed and of special interest (pp.58-66) to me. Intuition receives a 'nod' with a dedicated paragraph on p.66, sufficient no doubt to give our students a troubling 'prod' in their future and ongoing careers? I wonder if pages 51-59 might benefit from review and more references, acknowledging what is a well-executed historical account within part 1? An educational challenge I am pondering at present is that of values within nursing. How can we teach these (including the 6Cs)? Amongst what is new to the book is that it meets NMC standards. It would be easy to produce a list of omissions, but I would expect to see abuse, safeguarding, whistleblowing, and vulnerability in this book. How students encounter these concepts and subsequently learn about such sensitive topics must be critical to their insight (life experience to date), self-awareness and skills development. Reflection is very well represented throughout the parts of the book which encourages my efforts with Hodges' model.

I mentioned the book's relevance to current PG Cert Education students and must add that I have referenced the text in a paper for my current studies in technology enhanced learning. On this front the publishers clearly recognise the extended potential of additional e-learning services through CourseMate. An Instant Access Card accompanies the book. Part 4 extends this relevance to continuing professional development and lifelong learning. Chapter 11 is very helpful for its practical dimension, describing placement learning, link lecturers, mentoring and the challenge of the failing student. Sometimes ESOL - English for Speakers of Other Languages is a factor and 'language' could be noted more specifically. This is not a matter for student selection but should be ongoing and would also be addressed within the public (equality and diversity pp.129-134). In mental health I am acutely aware of the importance of communication skills. This comprehensive treatment includes supervision, sign-off mentoring, practice educators plus triennial review.

If I have a bad habit it's looking through the index of a book and asking: What might I expect to see here? The bad aspect is it's tantamount to reviewing by exclusion. And I'm already guilty too. The book fulfills its purpose and does not need to reflect the whole nursing curriculum. But... I would have hoped to see 'open source', Massive Open Online Courses (MOOCS), the role of mobile e-learning, learning management systems - Blackboard is mentioned but not Moodle. Perhaps there are commercial considerations at work? 'Threshold levels' are mentioned but not 'threshold concepts'. This is understandable as we are only just on the cusp of a special interest group in health and social care (more on that to follow I hope). For those like myself who are on the service-practice side chapter 8 is insightful, on marking and providing student feedback beyond the student-mentor relationship. There is constructive support and encouragement for new lecturers and advice on quality and evaluation in higher education.

A year ago I reviewed an even larger textbook on Nursing Informatics, and in truth informatics still has a long way go to prove itself to most of the nurses I meet and work with. I keep doing the sales pitch and this includes acknowledging the student's awareness of coding and classification, or  pointing them (usually 1st and 2nd years) to this knowledge. Health Informatics is represented in the text and the glossary (pp.539-541). In terms of professional accountability it is vital that as nurses we are aware of what happens to the data we help to create. Students are also the researchers of tomorrow and as such they need to be aware of diagnostic schemas and ongoing issues in this area. It is true that this is the curriculum and yet the authors do right by including classification in the context of the library, and coding as in the types of fractures (figure 3.6, p.77); some mention of coding and classification within nursing and healthcare surely seems justified?

Nursing has struggled to make itself visible - for the right reasons for many years. As we look to our students to resolve this are they to rely upon some form of reverse-magic* alone? Despite this proverbial bee, I can highly recommend this book - it is a great resource.

1 Introduction: Nurse Education in the university and the clinical setting
PART ONE – THE PSYCHOLOGICAL BASIS OF TEACHING AND LEARNING
2 Adult learning theory
3 Perspectives on teaching and learning
PART TWO – LEARNING, TEACHING AND ASSESSMENT
4 Curriculum theory and practice
5 Planning for teaching
6 Teaching strategies
7 Assessment of learning
8 Student feedback / feed-forward
9 Teaching study skills
10 Evaluation
...

*It is of course customary to marvel at the visible becoming invisible.

HUGHES, S.J. & QUINN, F.M. (2013) Quinn's principles and practice of nurse education. 6^th Edition. Andover, Hampshire: Cengage Learning.

I would like to extend my thanks to Mr Matthew Keown at Cengage for my copy of this book.
 

"You're a nurse? How much do you know?"

individual
INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

Yes, I am a nurse - thanks for asking.

So come on - how much do you know?

Actually, I know very little.

Eh?
Why is that?
Surely you have to be quite knowledgeable,
all the lectures, the training on wards, clinics, out in the community, staying updated too?

ethics, giving bad news, communication, self-awareness, empathy and rapport, recovery model, education...	anatomy & physiology, healing, homeostasis, medicines, basic life support, drug side effects, risk of falls, observations, infection control...
cultural competence, team work, respect and dignity, the 6Cs, carer education, handling conflict, family therapy...	policy, records, scope of practice, continuing education, professional development, confidentiality...

Surely, this little snip points to a packed 'curriculum'?

So it does, but as a nurse you can't make too many assumptions?

Well, yes I suppose so; no-one should pre-judge but you'll have to explain?

[ Now, why am I so pleased you said that...? :-) ]

Well a nurse has to be dispassionate in order to be compassionate.

So... as a nurse you contradict yourself?

No, not exactly. I suppose, given your opening gambit, we have to be neutral, neither hot, nor cold. That way we are sensitive to difference and spotting change. If we think someone is cold, or has a fever then we measure - we find out we check their temperature. So of course some things we can learn based on fact-finding.

Inevitably, assumptions are made as there's a job to do, but it's important not to prejudge. There's a big difference between assumptions, judgements, stereotypes, biases, hypotheses, and the like.

So a nurse can be tepid all the time? Where's the warmth in that, eh?

Good point, but you know what we're about here.
There's general warmth, friendliness, being approachable, civil, being professional.
Then there's warmth as an ingredient in those critical instances.

So, it's a case of yes and no. At first you've to be open-minded. Take the conceptual  framework Hodges' model. Initially it is all structure, but this structure provides four empty care domains - five when wrapped by the spiritual. This can act as a great aide-mémoire.

With a referral you make use of any information that is provided because that's very important too. The information that is received initially is hopefully sufficient to indicate the nature of the problem in broad terms. It may be more specific pointing to an existing diagnosis, a relapse, or multiple diagnoses.

Yes I see. Hodges' model is the blank sheet and as such it is open, non-judgmental.

Yes, but there are also indicators that point to risk, physical - falls for example, plus psychological and mental health aspects like risk of self-harm, harm to others and possibly self neglect. These are the things that must also to be assessed and as such ruled-out.

SELF - SELF -	HARM NEGLECT
HARM TO OTHERS HARM BY OTHERS - ABUSE	VULNERABLE ADULTS ABILITY TO GIVE CONSENT, MENTAL CAPACITY

So when does that 'open-mindedness', or 'neutrality' become closed?

As we learn about someone, we build up a picture that kind-of notion, once known some things are closed as they don't tend to change.

They're concluded?

Yes, but one of the reasons that nursing is such an ace job - and yes I know why your grimacing - but it IS!

Anyway, that first day can be a lesson in dynamics. If not the first day it will soon follow!

So, you have to use many different sources and kinds of knowledge.

Yes, that's right and the best knowledge of all is...?

Well, I guess learning for ourselves is the best, most permanent way.

You have it there. It's a really exciting time for nursing, health and social care. Although they go on about technology and clearly technology has a major role to play. 'IT' is playing a major role and if you listen carefully you can hear the robots...

There is much more to do on that 'humanistic' side.

The open-mindedness, openness and acceptance is a baton that we must pass back to the patient. Self-care, when possible, health literacy skills and competence are crucial now.

It's not just the days that are different either. The people we encounter, the patients, the clients - call them what you will, they are all pearls. Aggregated, yes sure, you see so many oysters; but open and face-to-face as a nurse each one shines, unique and peerless with individuality.

OK. Thanks - that's cool indeed!

Acknowledgement - Stu Young, Royal College of Nursing Students

"You're a nurse? That's cool. How much do you make?"