A Scope with the Big Picture in Mind

Coverage plans are ready for NASA’s Nancy Grace Roman Space Telescope prelaunch and launch activities. Roman is NASA’s next-generation observatory designed to explore some of the universe’s biggest mysteries, including dark energy. NASA and SpaceX are targeting Roman’s liftoff for no earlier than 7:26 a.m. EDT Sunday, Aug. 30, aboard a SpaceX Falcon Heavy rocket from Launch Complex 39A at the agency’s Kennedy Space Center in Florida. Launch coverage begins at 6:20 a.m. Live coverage of these events will stream through a variety of platforms. Learn where to watch online: 

https://www.nasa.gov/live ...

individual

|
INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

|

group

education for ALL life chances Nancy Grace	STEMM Observation Scale
ROMAN Girls - Women in Science	Political investment in Science for Public and Planetary Good

See also:

Nancy Grace Roman

https://science.nasa.gov/mission/roman-space-telescope/

Previously: 'women' : 'astronomy' : 'big picture'

'From Tree to Sea [5] - The Bare Necessities' c/o BBC R4

My name is not Robinson Crusoe, but I feel privileged to live on an island. The sea has always been close. Liverpool (Scouser) has a history, to celebrate and seek forgiveness for. It was a surprise and yet wasn't from the map in the Bluecoat of the slave ships that plied the route to West Africa, to the West Indies and USA to see the same reflections in the dock area of Nantes in May 2025.

These reflections followed a BBC Radio 4 programme this afternoon (one of a series):

5. From Tree to Sea - The Bare Necessities

https://www.bbc.co.uk/sounds/play/m002ztzy

'We are living in turbulent times and it is easy to feel anxious about the state of the world. The pace of change is fast, and the future often seems uncertain and out of our control. Given our reliance on technology, any sort of outage could be catastrophic. Could you survive - and thrive - in a world without global supply chains, the internet and 24-hour energy?

In this series the writer Dan Richards seeks out the tradition bearers and carriers of ancient knowledge who actively choose to live in close connection with the natural world around them. A return to first principles of what it means to be human and the kind of people you would like to be around if things fell apart.

Dan heads to Whithorn in Dumfries and Galloway where he meets Traditional Boat Builder Gail McGarva who is putting the finishing touches to a skiff before its launch. Gail has gathered knowledge of the ancient craft of wooden boat building through her relationship with tradition bearers and mentors, without whom the knowledge would disappear completely. What Dan finds is that this small wooden boat represents not only an evolution of form and process, but soul. The souls of all who have gone before and how they might influence a sustainable future with community at the heart of it.'

In making the skiff there is a marvellous observation about:

 "when the boat hits the water it knows what to do ..".

For students entering a profession or trade (any) that strikes a chord.

"Train midwives as nurses" - Ockenden

Re. Ockenden Report

Catching up on the newspapers, I noticed in the Times reporting of Ockenden calling for midwives to train as nurses first. Provoking debate about nurse education.

Within maternity services there are problems with continuity of care and skills in dealing with complex cases:

'Maternal Deaths 

60. The Review examined 27 maternal deaths that occurred between 2006-2024. Five cases fell outside of the Terms of Reference of the Review. Of the 22 remaining cases, reviewers identified failures in care that may have or substantially impacted on the outcome in six deaths. 

61. The profile of maternal deaths at NUH over this period broadly aligned with the known demographics and causes as identified by MBRRACE. 11 of the deaths occurred to women living in the most deprived areas of the city and 14 occurred amongst women who were not white British.

62. The common failures reviewers identified that might prevent future maternal deaths included: listening to women and families and acting promptly on concerns; continuity of care particularly for those with additional social/medical complexities; robust clinical governance to ensure timely information sharing across organisations and prompt access to imaging for women presenting with concerning neurological symptoms.' xiv

AI Overview (Ecosia) suggests that although direct entry to midwifery has always been possible(?), the English National Board created the pathway some 39 years ago.

The Ockenden Report describes how in combination health systems, culture, leadership and training can contribute to compassion fatigue (p.313).

When you look at Hodges' model and our languages, a great many challenges for curricula, training and education programmes can be found. The most powerful of what can be progressive, or threats are invariably mechanistic:

• shorten
• bypass
• shortcut
• cutting corners
• short-circuit

Nursing must always move forward, continuous professional development is built on this principle. In the late 70s and 1980s post-registered qualifications were held in high esteem. Especially midwifery, paediatrics, health visiting, emergency and intensive care. 

Clearly, decision and policymakers can underestimate the value of basic nurse training. Having an idea since childhood is brilliant, but at interview saying you're compassionate and want to make a difference will soon be tested. Sometimes as a student rather bluntly, as with a first placement in forensic nursing. I wonder how many students have been lost there? I'm sure the majority will cope, manage, enjoy and prosper, but I've seen the student peers who miss these cohort members on subsequent learning experiences. What preparation is employed?

Basic nurse training, is just that. Demonstrating competence in communication, awareness of basic needs and how these are expressed behaviourally. What interpersonal skills and knowledge are needed. As highlighted before, the director of nurse education worried about those of us who worked as nursing assistants risked being trained in poor care. Not recognising 'bad practice', a 'poor attitude', not using observation and most important of all listening: to what is said and unsaid. When I started I remember thinking about not responding - as individually programmed to do so, through a reflex action. That was a worry back then. 

While the news in the Ockenden Report is bleak. The depth of the report (for me) is manifest in identification of not only socioeconomic factors, but sociotechnical too (with five mentions) and the critical interplay of seeing (and hearing!) the individual amid the collective:

'2. Fetal monitoring

Rather than reflecting simple failures of individual interpretation, growing evidence suggests that intrapartum fetal monitoring is best understood as a complex sociotechnical practice, shaped by system design, workload, team dynamics, guideline variability and organisational culture.119 Continuous CTG itself has well-recognised limitations, including poor specificity for predicting long-term neonatal outcomes and substantial inter- and intra-observer variation in interpretation.5 Reviews of intrapartum care are therefore unavoidably influenced by retrospective bias, with greater apparent clarity afforded by knowledge of the outcome than was available to clinicians at the time. 

However, despite this, a sociotechnical understanding does not negate the importance of examining individual cases in which intrapartum monitoring was demonstrably substandard. National inquiries and confidential reviews repeatedly describe cases involving sustained failure to recognise pathological fetal heart-rate patterns, delayed escalation despite repeated triggers, and missed opportunities for timely intervention. 2,3,120,121 These cases cannot be explained solely by the inherent limitations of CTG or by hindsight bias.' p.143.

It is quite shocking to hear this conclusion: the need to train as a nurse first. Counterarguments: where is the evidence(?!) - have followed. But then if you undervalue and miss the fundamentals (see Hodges' model!) then individuals, families, communities, students, practitioners, services and systems suffer.

Previously: 'maternity' : 'report' : 'safety'

[Updated] AI Chat: Are the domains of Hodges' model comparable?

In drafting a future post: 'The Sciences: points, lines, angles and perspectives on domains', I thought I would ask Ecosia's AI Chat a related question, here is the (quick) prompt and reply:

PROMPT: 
In Hodges' model there are four care, or knowledge domains. The four domains are the sciences, sociology, political, and intrapersonal – interpersonal domain. In terms of potential content are these domains comparable, or is there an essential asymmetry? Please provide sources and references.

(I have saved the prompt for future reference and refinement.)

RESPONSE: [updated 21st June 2026]

Hodges’ model (also known as the Health Career Model or h2cm) is a conceptual framework that organizes knowledge and care into four quadrants, each representing a distinct domain of human experience and knowledge. These domains are:

1. Sciences (empirical, biological, and physical sciences)
2. Sociology (social structures, relationships, and community)
3. Political (power, policy, governance, and resource allocation)
4. Intrapersonal – Interpersonal (psychological, emotional, and relational aspects of the self and others)

Are the Four Domains Comparable or Asymmetrical?

The four domains in Hodges’ model are not strictly symmetrical in terms of their content, scope, or application. While they are presented as equal in structure (each occupying one quadrant of the model), their potential content, theoretical foundations, and practical implications can vary significantly. Here’s why:

1. Differences in Scope and Focus

• Sciences (Quadrant 1):
  This quadrant focuses on empirical, measurable, and biological aspects of health and care, such as anatomy, physiology, and pathophysiology. Its content is often highly specialized, technical, and evidence-based, rooted in natural sciences like biology and chemistry.

  • Example: The role of hormones in stress response or the pathophysiology of diabetes.

• Sociology (Quadrant 2):
  This quadrant addresses social structures, culture, and community dynamics. Its content is broader and more interpretive, drawing from sociology, anthropology, and social psychology.

  • Example: The impact of socioeconomic status on health outcomes or the role of family support in recovery.

• Political (Quadrant 3):
  This quadrant examines power, policy, governance, and resource distribution. Its content is highly contextual and often contested, influenced by political science, economics, and public policy.

  • Example: The effect of healthcare policies on access to services or the role of advocacy in shaping health priorities.

• Intrapersonal – Interpersonal (Quadrant 4):
  This quadrant focuses on individual psychology, emotions, and relationships. Its content is highly subjective and variable, drawing from psychology, psychotherapy, and ethics.

  • Example: A patient’s personal beliefs about illness or the dynamics of a therapeutic relationship.

2. Differences in Methodology

• Sciences and Political domains often rely on quantitative methods (e.g., experiments, statistical analysis, policy evaluations).
• Sociology and Intrapersonal domains frequently use qualitative methods (e.g., interviews, case studies, ethnography).
• This methodological diversity can create asymmetry in how knowledge is generated, validated, and applied.

3. Differences in Practical Application

• Sciences and Political domains  are often system-level and influence macro-level decisions (e.g., clinical guidelines, healthcare policies).
• Sociology and Intrapersonal domains are more individual- or community-level, focusing on personalized care, cultural competence, and therapeutic relationships.
• This can lead to asymmetry in impact, where some domains (e.g., Political) shape broad systems, while others (e.g., Intrapersonal) focus on direct human experience.

4. Theoretical Foundations

• The Sciences and Political domains are grounded in positivist and structuralist theories, emphasizing objectivity and external reality.
• The Sociology and Intrapersonal domains are influenced by interpretivist and constructivist theories, emphasizing subjectivity and lived experience.
• This theoretical diversity can create asymmetry in how knowledge is perceived and valued in different contexts.

Is There an Essential Asymmetry?

Yes, there is an essential asymmetry in the potential content of the four domains. While the model presents them as equal in structure, their content, methods, applications, and theoretical foundations are not interchangeable. The domains complement each other but serve different purposes in understanding and delivering care.

Sources and References

1. Conceptual Overview of Hodges’ Model:

   • Hodges’ Model: A Cognitive Periplus for - WikiEducator (PDF)
   • Hodges’ Model: Welcome to the QUAD
   • Hodges’ Health Care Model as a Framework for Quality

2. Theoretical Foundations:

   • Hodges’ Health Career Model and its role and potential application
   • Hodges’ model: the Sustainable Development Goals and public health

3. Discussions on Asymmetry and Complementarity:

   • The model’s holistic intent is emphasized in Hodges’ Health Care Model as a Framework for Quality, but its quadrants are not identical in content or application.
   • The differences in methodology and scope are discussed in Hodges’ Health Career Model and its role and potential application.

Summary Table: Asymmetry in Hodges’ Model Domains

Domain	Content Focus	Methodology	Theoretical Foundation	Level of Application
Sciences	Biological, empirical data	Quantitative	Positivist	Macro (systems, clinical)
Sociology	Social structures, community	Qualitative/Quantitative	Interpretivist, Structuralist	Meso (groups, communities)
Political	Power, policy, governance	Quantitative/Qualitative	Structuralist, Critical Theory	Macro (systems, policy)
Intrapersonal-Interpersonal	Psychology, emotions, relationships	Qualitative	Constructivist, Humanistic	Micro (individual, relational)

PROMPT: 
In Hodges' model there are four care, or knowledge domains. The four domains are the sciences, sociology, political, and intrapersonal – interpersonal domain. In terms of potential content are these domains comparable, or is there an essential asymmetry?

 

In Hodges’ model, the four care (or knowledge) domains are:

1. Sciences (biological, physiological)
2. Sociology (social, cultural, environmental)
3. Political (legal, policy, organizational)
4. Intrapersonal – Interpersonal (psychological, emotional, relational)

These domains are not strictly comparable in terms of content, scope, or function. Instead, they represent complementary perspectives that together form a holistic framework for understanding human health, well-being, and care. Here’s why there is an essential asymmetry between them:

1. Scope and Focus

• Sciences and Sociology are broad, well-established academic disciplines with extensive theoretical and empirical foundations. They provide generalizable knowledge about biological processes and social systems.
• Political is more narrowly focused on power structures, governance, and resource allocation. While critical for systemic change, it is less about individual experience and more about collective frameworks.
• Intrapersonal – Interpersonal is deeply personal and subjective, focusing on individual psychology, emotions, and relationships. It is less about universal laws and more about unique, context-dependent experiences.

This makes the intrapersonal-interpersonal domain inherently asymmetrical compared to the others, as it deals with subjectivity and variability rather than objective or structural phenomena.

2. Epistemological Differences

• Sciences, Sociology, and Political domains rely on external observation, measurement, and analysis. They are rooted in positivist or structuralist traditions, where knowledge is often generalized.
• Intrapersonal – Interpersonal is rooted in interpretivist and phenomenological traditions, where knowledge is co-created through subjective experience and dialogue. It resists universal generalization.

This creates a fundamental asymmetry in how knowledge is produced and validated across the domains.

3. Practical Application in Care

• The Sciences, Sociology, and Political domains provide frameworks for action (e.g., medical treatments, social policies, legal rights). They are instrumental in shaping systems and interventions.
• The Intrapersonal – Interpersonal domain is transformative—it shapes how individuals perceive, interpret, and respond to care. It is the domain where meaning is made and agency is exercised.

This means the intrapersonal-interpersonal domain is not just another “content area” but a lens through which all other domains are experienced and integrated.

4. Hierarchy of Integration

While the domains are conceptually equal in Hodges’ model, in practice, the intrapersonal-interpersonal domain often acts as the nexus where the other domains intersect. For example:

• A scientific understanding of depression (e.g., serotonin levels) must be interpreted through the intrapersonal experience of the individual.
• A sociological analysis of healthcare disparities must be understood through the political structures that enable or inhibit change.
• A political decision about resource allocation must be filtered through intrapersonal values and priorities.

This integrative role makes the intrapersonal-interpersonal domain asymmetrical in function, even if not in formal status.

Conclusion: Essential Asymmetry

The four domains are not comparable in content or function. Instead:

• The Sciences, Sociology, and Political domains provide structural and systemic knowledge.
• The Intrapersonal – Interpersonal domain provides subjective and relational knowledge, which is essential for meaning-making and agency.

The asymmetry arises from the epistemological and practical differences between objective/systemic knowledge and subjective/experiential knowledge. Hodges’ model emphasizes that all domains are necessary, but they operate in fundamentally different ways.

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

Day 2 Tuesday 21st April (Revisiting) Keynote Speaker: Abderrazak El Albani - 
Emergence of Intercellular Cooperation: At the Origins of Eukaryotic Complexity
Session Chair: Khawla Tadist

This keynote was fasacinating. As I begin this post on the 100th birthday of Sir David Attenborough, who would have us all see life in the broadest terms, value life and diverse habits, and Earth as our collective and shared home.

Abderrazak El Albani explained the search for LUCA the last universal common ancestor - 3.8 billion years ago. Many dates in the emergence story of humanity, have been progressively pushed back. The first fire, art, languages, our co-habitation and intimate relationships with Neanderthals.

In healthcare, as a practitioner you have to be aware of your scope of practice. At WCCS, scale (as in iv) was ever present across research in complexity, and complex systems. Not just physical size nano-to-mega but temporal too, as we journeyed billions of years. Several of the slides are presented here:

https://www.synchrotron-soleil.fr/en/news/discovery-oldest-macroscopic-planktonic-eukaryotes-contribution-nanoscopium-beamline (with a reference).

There is a video (French): https://www.youtube.com/watch?v=bh3t26cU7xc

I asked a question, which may have been psychological preparation for own presentation to follow. Listening, I could see how the work Abderrazak El Albani and his team are doing, could be readily translated to the search for life on Mars. There has been a 'routine' interchange of planetary material between Earth and Mars over the aeons. Fitting surely that the sedimentary rocks sought lie in  A key lesson, is that light helps us see, but not all lights are equal. Light sources brighter than the sun become incredible scientific instruments. The longevity of the dinosaurs was highlighted, at least 140 million years. There is no comparison with homo sapiens then, even as those dates have been pushed further back in time. Time defeated me as I tried to make the observation that even the dinosaurs did not make it to their first galactic birthday (c.250 million years - and what a carousel). I like the thought (slide) of 'Earth as Memory'. 

What really counted was the expressed concern about what is happening now: in the Anthropocene.

The second keynote:
Nigel Gilbert - Policy in a Complex World: Towards Complexity-Aware Policymaking
Session Chair: Ali Idri 

Was helpful to me, as the dated conundrum of benefits realisation from our technologies, and evidence-based policy still leaves a gap (for me) within the POLITICAL care/knowledge domain of Hodges' model. The illustration/graphic elements of Prof. Gilbert's slides were a brilliant complement to the content:

Prof. Nigel Gilbert - WCCS26 21st April

I wonder if within policy the constant in the equation is continuity and as a quantity it is an unknown? This seems to the case in health policy, across successive governments. You may (also) find this chart informative: https://www.cecan.ac.uk/news/the-visual-representation-of-complexity/

Perhaps, a key factor in complexity is the fact that nothing stays the same, so continuity is nuanced? Michael Quinn Patton's book Developmental Evaluation was noted re. learning while doing. Now I wish I'd held on to Qualitative Research & Evaluation Methods (4th ed.). The discussion of 'obesity system map' and 'whole systems analysis' was appreciated here.*

Since Marrakech and WCCS, I've noticed acknowledgement in the literature that 'research' is currently flooded with AI tools. I'm sure PRSM - Participatory System Mapper is a welcome addition, (as noted in iv) tools to facilitate participation are much needed:

Collaborative Creativity

The Participatory System Mapper (PRSM) is an app that makes it easy to draw networks (or 'maps') of systems, working together collaboratively.'

I will definitely check this resource out; and CECAN. After Prof. Gilbert, the next Track included my contribution, which I will return to. Rather distracted, I have a somewhat blurred slide, with: 'The global tensor of educational research is' then headed 'Learning poverty. Being unable to read and understsand a simple text; with points 1-4.'. I'm not sure which presentation this was, but zeroed in on the literacy theme, and the word tensor. Another slide refers to '6. Topological substitution for Success'. I think it is (writing this is helping recall!):

Harvey Spencer Sánchez-Restrepo, Jorge Louçã, Martha Belén Carmona-Soto and Sofialeticia Morales-Garza
Topological Patterns of Academic Success: Insights from Complex Network Analysis

'Always Label Your Axes' - Zazzle.

Before that there was another model, as the next keynote speaker: Chris Bauch demonstrated during the conference wearing a t-shirt:

Critical Transitions in Coupled Human-and-Natural Systems and their Early Warning Signals
Session Chair: Mohamed Essaaidi  

Previously: 'nexus'


*Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;5: doi:10.1136/bmjnph-2021-000254

Wirnitzer, KC. et al. (2025) Toward a roadmap for addressing today's health dilemma – The 101-statement consensus report. Frontiers in Nutrition. Volume 12.
https://frontiersin.org/journals/nutrition/articles/10.3389/fnut.2025.1676080 DOI:10.3389/fnut.2025.1676080

S. Bettiol, P. Jones, H. A. Onyedikachi, and W. G. Kernohan, (2026) Bridging Gaps in Oral Health Frameworks: Mapping With Hodges' Health Career - Care Domains - Model, Journal of Public Health Dentistry. 1–14, https://doi.org/10.1111/jphd.70034

Martha's Rule revisited ...

Last year in May, I posted about Martha's Rule. A year on, there is an update:

Evidence suggests Martha’s Rule is saving lives

'To support learning and assess the impact the programme is having, we regularly collect data from sites where Martha’s Rule is in place.

Early evidence suggests Martha’s Rule is saving lives and helping thousands of patients benefit from changes to their care.

Data from September 2024 to February 2026 shows 12,301 Martha’s Rule calls were made, with the highest proportion of calls (72%) made via the family/carer escalation process. 4,047 Martha’s Rule escalation calls (33%) related to acute deterioration.

Of those, 2,310 calls required changes in treatment. This includes 524 calls which resulted in transfers of care to high dependency or intensive care units, enhanced levels of care, tertiary centres or referral/transfer to specialists or a specialist ward. Other changes in treatment (1,786) did not require transfer of a patient from a ward in-patient setting. This includes the introduction of a new medication such as an antibiotic to treat infection, investigations including scans and procedural interventions including going to theatre.'

Source:
https://www.england.nhs.uk/patient-safety/marthas-rule/#implementingmarthasrule

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

"Not herself ..."   Listening  Martha	1,700 NHS staff Taking action escalation
Mills parents, guardians, friends & family   Familly input - Multidisciplinary Team   Teamwork	Martha's Rule

My prompt:
Koronka, P. '1,700 NHS staff use Martha's Rule to raise the alarm'. The Times, 1 May, 2026, p.6.

Previously: 'intuition' : 'observation' : 'listen' : 'communication' (Never as an afterthought.)

Invite to an In-person Interactive Workshop to Advance Action on SDoH [Geneva]

Advancing the Social Determinants of Health during the World Health Assembly

Dear Colleague

Is it possible to share in HIFA Network the following announcement?

Thanks a lot for your precious help

Dr Eric Comte Director of the Geneva Health Forum https://genevahealthforum.com

HIFA profile: Eric Comte is Executive Director, Geneva Health Forum, External Affairs Directorate, Geneva University Hospitals. eric.comte AT unige.ch

Bonjour,

We are pleased to invite you to take part in an interactive workshop dedicated to advancing action on the social determinants of health.

Forty years after the Ottawa Charter, there is broad consensus on the importance of health promotion and the determinants of health. Yet, translating this knowledge into effective policies and concrete action remains a major challenge. In a context marked by climate change, growing inequalities, rapid urbanisation and geopolitical instability, the need for more integrated, preventive and equity-oriented approaches has never been greater.

Building on this observation, this session will bring together, NGO, practitioners, policymakers and experts to move beyond general principles and focus on what really enables implementation in practice. Through the exchange of real-world experiences and case studies, participants will collectively identify actionable lessons, key barriers, and practical ways forward.

The expected outcome is a set of clear, operational messages to strengthen collaboration across sectors and support the implementation of strategies addressing the social determinants of health in diverse contexts. The session will also provide an opportunity to identify concrete avenues for further work, including potential projects that the Geneva Health Forum could support.

The workshop will take place on Tuesday 19 May from 9.00 to 12.30 at Campus Biotech in Geneva.

We would be delighted to count on your participation and active contribution to this important discussion.

👉 More information and registration on the link : https://worldhealthassembly2026.genevahealthforum.com/rethinking-determinants-of-health-in-todays-global-context-from-knowledge-to-action/

Space is limited, so only register if you really want to attend.

Registration is free but required so we can print badges and organize the workshop.

Link with the World Health Assembly discussions

This workshop is directly aligned with the strategic discussions taking place at the World Health Assembly, particularly in relation to document EB158/27 on well-being and health promotion. This report highlights the growing recognition of health promotion and the social determinants of health as essential pillars of public health, while also emphasizing the persistent gaps in implementation and the need to strengthen multisectoral action, governance, and measurable impact.

In particular, it calls for better integration of health promotion across the full continuum of policies and systems, stronger cross-sector collaboration, and a renewed focus on addressing structural determinants of health, including through more effective implementation mechanisms and improved coordination across actors.

Our session contributes to this agenda by focusing on practical experiences and implementation challenges, with the aim of identifying concrete, actionable lessons that can help accelerate the translation of global commitments into real-world action. In doing so, it also seeks to feed into ongoing reflections at the global level and to support more effective implementation of the priorities discussed at the World Health Assembly.

You are receiving this message because you are a member of the community HIFA - Healthcare Information For All.

View this contribution on the web site

Ann Hutchinson Guest (Obit.), 'Authority on dance notation ... '

'Although there are many forms of dance notation going back to Pierre Beauchamp's system for Baroque dance in the 1680s, Nijinsky had developed his own cryptic version. Ann Hutchinson Guest first tried to reconstruct his work in 1956 after the choreogapher's widow, Romola, gave her his notes. "I spent years trying to work it out," she said, adding with a laugh: And I'm supposed to be the leading authority on dance notation in the world. She told how Nijinsky had revised his notes many times, often contradicting himself. 'We couldn't get anywhere. Romolo was furious. She said it was taking much too long."

    Hutchinson Guest studied dozens of different dance notation systems, translating many of them into Labanotation, a system developed in the 1920s by Rudolf von Laban who was a central figure in European modern dance. According to a  press report in 1954: "The printed Labanotation page looks like a combination of hieroglyphs, pictographs, Morse dots-and-dashes, đoodles, and a musie score turned on edge" 

    It was not until 1980 that she and Claudia Jeschke, a dance historian, succeeded in cracking Nijinsky's code after finding a copy of his annotated score in the British Library.'

Register, The Times.

My source: Ann Hutchinson Guest (Obit.), 'Authority on dance notation known for reconstructing Vaslav Nijinsky's scandalous ballet, L'Après-midi d'un faune'. Register, The Times. 20 April, 2022, p.48.
https://www.thetimes.com/uk/obituaries/article/ann-hutchinson-guest-obituary-hkw8z88ns

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

abstraction representation interpretation observation - translation code - formalism	body (bodies) symbols - forms dance choreography movement - 4D - time
group ensemble 'anthropological composition?' 'diagnostic grouping'? social - cultural category . . .	'collective power & attention  evinced as time' 'The stage: the space for health'^

Hutchinson Guest in 1956
 Source: The Times.

'Dance has been called moving architecture, a truth which the complexities of contemporary choreography may mask. Not only does the dancer's body form shapes and groups of dancers form moving or static designs, but also group arrangements carve up the stage space, establishing areas of open as well as enclosed space which are significant in their changes and contrasting effects.

While the rccording of movement on paper-dance notation-does not look like movement (disregarding primitive stick figure drawings), there is an "architecture" in the sequence of graphic symbols used to record dance patterns. Over the centuries many different devices have been used to capture dance steps on paper. What are the elements that have to be represented?

The process of dance notation requires reducing four-dimensional movement (time being the fourth dimension) to a two-dimensional surface. The parts of the body in action have to be defined, as does the form of movement involved (flexion, extension, rotation, directional placement) and the duration of each in relation to the overall time structure. In group dances the relationship of dancers to one another must be determined and recorded, as well as their location on stage and their paths of travel. In a dance score each performer is like a small orchestra-arms, legs, head, torso, etc. in motion-this is then multiplied by the number of dancers who are performing individual sequences.'

Guest, A. H. (1990). Dance Notation. Perspecta, 26, 203–214. https://doi.org/10.2307/1567163

^Health is always performed in the political domain, make no mistake (excuses, or exceptions). It is not:

1. Acknowledged, masked - covered by the 'set design' (see #2 below);
2. Implied in the medical, biomedical, bio-psycho-social model;
3. The intermission is neither the time, or place, to reflect upon and critique the political in health :: health in politics.

See also: https://archives.nypl.org/dan/19629

https://en.wikipedia.org/wiki/Ann_Hutchinson_Guest

Previously: 'dance' : 'architecture' : 'movement'  : 'notation'

Paper: 'Intra-Personal Compromises'

ARGUMENTA

Issue 21

November 2025

https://www.argumenta.org/issue/issue-21/

Intra-Personal Compromises  

Juha Räikkä

University of Turku 

Abstract

The most usual philosophical questions about compromises have been those related to inter-personal compromises, in which parties are compromising with each other, rather than intra-personal compromises, which are often psychologically demanding. This paper aims to fill the gap in the discussion and briefly analyze the nature of intra-personal compromises. The starting point here is the assumption that inter-personal compromises cannot be made without intra-personal compromises, although intra-personal compromises are common even when they are not linked to inter-personal compromises. The main question addressed in the paper is whether the intra-personal compromises that we accept in all kinds of contexts are similar to those intra-personal compromises that we make when we compromise with others. I argue that they are more or less similar, although there are also some distinctive features in intra-personal compromises that are involved in inter-personal compromises. When a person makes an intra-personal compromise in the context of an inter-personal compromise she is forced to act under uncertainty, as she cannot know beforehand what options are really available. The price of the compromise is known only after the negotiation process. This is a special feature, or so I will claim. 

Keywords: Inter-personal compromise, Intra-personal compromise, Bargaining, Uncertainty. 

Räikkä, R. 2025, “Intra-Personal Compromises”, Argumenta 11, 1, 149–162.
https://www.argumenta.org/wp-content/uploads/2026/01/Argumenta-11-1-Juha-Raikka-Intra-Personal-Compromises.pdf
 

For a long time I have viewed the INTERPERSONAL domain of Hodges' model as being concurrent, interchangable, working as the INTRAPERSONAL domain. This paper is a helpful discovery, c/o Philos-L "The Liverpool List" which is run by the Department of Philosophy, University of Liverpool https://www.liverpool.ac.uk/philosophy/philos-l/

There are several examples/cases discussed. While brief, a HOSPITAL CEO example is relevant to studies for Hodges' model, as with, a CRITICAL CITIZEN:

'The above examples are rather similar but have small differences. In the ‘Judge’ example, the overriding principle is based on the importance of institutional rules. In the ‘Hospital CEO’ example, the main concern and the strongest value is pragmatic. In the ‘Critical Citizen’ example, the question is about omission rather than action.' p.157. 

The observation about the CEO speaks volumes, across public and private health sectors (and social care?). There is no discussion of reflection, reflexivity, or critical thinking explicitly. But individual, and collective distinctions, and impacts are explored, especially responsibility and mutuality. Three arguments precede concluding remarks. Further progress might be made exploring and relating these to the concepts of bargaining, uncertainty and compromise through Hodges' model and identity: both person-al and organisational?

Person-centredness, Holistic approach, Prevention c/o Hippocrates

“It is more important to know what sort of person 
has a disease than to know 
what sort of disease a person has.” Hippocrates

 

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

To say that Hippocrates was ahead of his time is a gross understatement. Hippocrates recognised the importance of person-centredness and prevention, and contributed to the emergence of several medical specialties. (Kostakopoulos, et al., 2024).

'Holistic Approach One of the most significant innovations of the founding father of clinical medicine was the holistic approach for the diagnosis and treatment of disease. This approach is based on the assumption that the human body is a sum of many parts that function in harmony and that if one part is ill, the balance will be affected and the whole person will suffer. Hippocrates considered that patients consisted of body, mind, and spirit and this is also the modern physicians' approach when treating a disease [2].'

Health and social care are still playing catch-up. The vitriolic 'debate' on X over psychiatry - anti-psychiatry and DSM-X. The total inability now to shift to preventive healthcare due to the perverse, entrenched economic incentives, which facilitate increasing inequity, inequality. Whichever Government does switch to preventive medicine, perhaps other governments had better take note?  I think Hippocrates would have approved - wholeheartedly - of Hodges' model.

'Prevention of Disease Another important aspect of Hippocrates' works that is widely applied in 21st-century medicine is the prevention of disease. The phrase “Κάλλιον το προλαμβάνειν του θεραπεύειν,” which means that it is better to prevent than to treat a disease, was the cornerstone of his teachings and is based on the observation that healthy Mediterranean diet and daily moderate physical activity can prevent disease. The ancient Greeks believed that all maladies started from the gut and that walking was the best available medicine [2].'

Kostakopoulos NA, Bellos TC, Katsimperis S, Tzelves L. Hippocrates of Kos (460-377 BC): The Founder and Pioneer of Clinical Medicine. Cureus. 2024 Oct 1;16(10):e70602. doi: 10.7759/cureus.70602. PMID: 39483540; PMCID: PMC11526839.

Gabbard, G. The Person with the Diagnosis. Psychiatric News. 49;6. 19 March 2014. 
https://doi.org/10.1176/appi.pn.2014.3b19.

Brigić, A., Hasanović, M., Pajević, I., Aljukić, N., Hamidović, J., & Jakovljević, M. (2021). Principles of Hippocratic Medicine from the Perspective of Modern Medicine. Psychiatria Danubina, 33(Suppl 4), 1210–1217. 

See also: 'medicine' : 'person' : 'diagnosis' : 'prevention'

The critical pathway leads to ...?

I missed the most salient information on this book's cover - at least for me. My copy is secondhand, but I picked the copy up recalling Dr Walsh's many publications on models of nursing.

The critical pathway for me is plural. It would include, the CPN(Cert.) course when I first encountered Hodges' model in 1987-8. Plus the fact that the pathway is not unidirectional, with some backward steps and reviews, but is multifold. Running the axes of Hodges' model to - pre-op, surgery, post-op, rehab ... we can add the whole corpus of nursing, social, self, and global health care.

The cover is of course illustrative, intended to support the title and suggest an explicit critical pathway. Apart from possibly pointing to collaboration "Mr Jones ... Let us discuss your critical pathway!" what has changed? Since the book's publication in 1997, we need health care services and systems to be sustainable. We are bit late here. Mr Jones is already a 'patient', bedecked in dressing gown and slippers.

This critical pathway needs to be replaced by one informed and oriented towards Mr Jones as self-caring citizen. This is of course easier said than done in policy terms. While governments globally and institutions stress the need for health literacy, informed life style choices, self-care, health promotion and prevention how much progress is being made? Nutrition remains a profound issue.*

The environmental challenges of climate change, pollution and waste disposal are seemingly contested even as the effects and cost of non-action are increasingly obvious.

The policy of 'care in the community' even while incomplete in the community, has provided me with a stimulating, challenging and rewarding career 1985 ... In the 21st century though, we have to ask of the assessment of mobility to follow and effort of the up-hill walk to 'home' begs the critical pathway that is now Planetary Health.

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Several points from Walsh (1997):

'Introducing a model to a clinical area is not an easy task to be undertaken lightly, as it involves fundamental changes in the way staff think and work. Luker (1988) has suggested that each nurse carries around their own informal model of nursing which guides their practice. It is probable that a formal model will be significantly different, although these differences can be minimized by full consultation and involvement with staff to ensure that the model chosen reflects their views of nursing as far as possible.' p.36.

Hodges' model can be 'carried around'. In truth it not strictly a model of nursing. Its scope extends beyond nursing and yet the model can incorporate thought about the patient, nurse, environment and what health, illness, recovery and self-care entail. Hodges' model is meta-cognitive and meta-conceptual, and (very) capable of mapping the terrain (p.26) of nursing from these and other perspectives. A nurse's 'views of nursing' will be dictated by the situation presented to them. Hodges' model can be retrospective, prospective and operate in the here-and-now: situated.

'There is a further point, however, that follows on from Luker's observation for expert nurses have an internalized model of care which is unique to them, it is possible that they may have internalized some practices which are outdated, taken for granted or inappropriate (Paley, 1996) but which are never made explicit as their care is not based upon a commonly understood model of nursing. This notion of every nurse having their own model therefore can lead to the situation where outdated rituals can be propagated under the guise of expert practice. Having a series of explicit models whose aims and ideas are common knowledge, shared by all, opens up care to critical scrutiny in a way that is not possible if each nurse has their own private internal model.' p.37.

Hodges' model can be used with other models, conceptual frameworks and systems across disiplines. Hodges' model is not intended to be prescriptive or prospective. It can be utilised for learning and unlearning. As a registered General Nurse who studied in the 1980s this does not mean I would be competent and safe to practice now. Continuing professional development, mandatory training and revalidation of nursing registration are all geared to support professional practice that has currency, validity, and is safe.

If nursing ever needed a commonly understood model ...?

'It will be apparent from the previous sections that use of a model will lead nursing into some new and unfamiliar territory that will involve seeing the patient in a more holistic fashion'. p.63.

'The nurse may find that models start to identify environmental problems whose solutions lie beyond the boundaries of nursing at present. This is particularly true of the community nurse.' p.63.

Walsh's concern here is the immediate community, but we can recognise the prescience of environmental problems here. Plus the need for the POLITICAL domain in Hodges' model:

'On a larger scale still, perhaps some patient's problems have their origins in political decisions made by national govemment or perhaps it is the factory down the road producing unacceptable levels of pollution. If nursing models make us recognize the political and environmental causes of some patient problems, there should ee no logical reason why nursing should not go forward into theee arenas as a legitimate part of nursing intervention.' p.63.

'There are senior NHS managers and health academics in so-called 'policy thínk tanks' who simply do not recognize the value of nursing and see only a collection of simpie tasks which anybody with an NVQ level 2 can perform. Nursing therefore has to demonstrate its worth; it has to evaluate what it is doing for patients.

Here it is important to remember that the care given may be very different from what is written down. Consequently, how a nurse evaluates care mentally may be very different from how this care is recorded in nursing process documentation. ...' p.64.

Hodges' model can (imho) have a role in argumentation for the quality and scope of healthcare, for nursing as a profession, evaluating and assuring nursing's values in the constant that are the demands of complexity and change. The (several) determinants of health are the other constant.

Mike Walsh (1997) Models and Critical Pathways in Clinical Nursing. London: Bailliere Tindall.

Luker K. (1988) Do Models Work? Nursing Times, 84 (5), 27-29.

Paley, J. (1996), Intuition and expertise: comments on the Benner debate. Journal of Advanced Nursing, 23: 665-671. https://doi.org/10.1111/j.1365-2648.1996.tb00035.x

*Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;5: doi:10.1136/bmjnph-2021-000254

Wirnitzer KC, Motevalli M, Tanous DR, Drenowatz C, Moser M, Cramer H, Rosemann T, Wagner K-H, Michalsen A, Knechtle B, Fras Z, Ritskes-Hoitinga M, Marques A, Mis NF, Stanford FC, Schubert C, Goswami N, Leitzmann C, Fredriksen PM, Ruedl G, Wilflingseder D, Lima RA, Kessler C, Jeitler M, Khan NA, Joulaei H, Fatemi M, Knight A, Kratky KW, Palmer KK, Haditsch B, Jakse B, Kofler W, Pfeiffer T, Cordova-Pozo K, Tortella P, Straub S, Lynch H, Schätzer M, Krishnan A, Fathima A. S, Gatterer L, Kriwan F, Abhishek M, Nandgaonkar H, Nandgaonkar S, Adedara AO, Haro JM, Gericke C, Neumann G, Akhtar A, Rashidlamir A, Thangavelu M, Ngoumou GB, Perpék É, Klaper M, Bhattacharya B, Kirschner W, Bessems KMHH, Jones P, Peoples G, Bescos R, Duftner C, Seifert G (2025). Toward a roadmap for addressing today's health dilemma–The 101-statement consensus report., 

Frontiers in Nutrition, Volume 12:1676080. doi: 10.3389/fnut.2025.1676080. https://doi.org/10.3389/fnut.2025.1676080