Living and Loving Dangerously

individual

|
INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

|

group

identity - choices   Memory - Cognition DEMENTIA - Early onset Inability to consent   inhibition-disinhibition  mental capacity	My liberty, my choices "What! I'm married to you? Oh!" Treatment - medication  'Secure (safe)' environment 'Holistic assessment'?
Marital/Initimate Relationships Social (our) identity Existing relational behaviours Interrelational needs Interpersonal grief Social identity/expectations Yes, but we're married ... had 40 years together ... Family bias, prejudices.. A 'new' step-parent ... Access to support:  relational - mutual vulnerability	Informed consent Assumed consent Rape, Sexual abuse, crime Capacity to give consent Consistency in decisions Lasting power of attorney - finance; health External safeguards Human rights Access to supervision - clinical & management

Prompts:

Previously post: Living and Caring Dangerously

Danny Leigh. Critic's choice - Films on release: Queen at Sea. Life&Arts, FTWeekend, 19/20 September, 2026, p.18.

https://depijp.rialtofilm.nl/en/films/queen-at-sea

So many difficult conversations. All on their own unique continuum in terms of sense-making for all concerned. 

A 'new' diagnosis at age 60; versus one at 44. Families seeking to control disclosure of the diagnosis from the patient. Clinical and family debate about this.

Finding a person locked-in the house, while their partner 'nips' to the shops. A person having their freedom to go out, on their regular walk  -despite acknowledged risks. (When they are known by people on their route - community care in action. Receiving a call from a neighbour; or the neighbour who knows where you park and can intercept you, on arrival or departure to express concerns. Or, even as you venture out for a walk with their neighbour of many a year. Categorise them as you will: [nosey, caring, concerned, public spirited, neighbourly, or (healthily) curious]?

Other discussions of grief at the loss of a person they have loved - in every way. A grief that presents new dark dimensions to what has gone before. Complicated by a state of early onset of memory loss. An ongoing disintegration of personhood and identity. An inability to consistently express thoughts, wishes, and choices. An inability to give informed consent. A loss taunted by retained physical desirability. What does love, sex, compassion mean now? What is the sum now, of love expressed over 'x' years? Hearts hollowed out, of what can be so important to a couple. Not vital to all. But for others, a source of conjoined affirmation, joy, warmth, companionship, a celebration of life and being human.

How to share that grief even amid close friends and family, who cannot cope themselves and withdraw? What of the preparedness of professions to manage such situations? What structures are in-place for team meetings, clinical supervision and inclusion in training, especially safeguarding?

From the bibliography (lower sidebar):

Hodges, B.E. (1989) The Health Career Model, IN, Hinchcliffe, S.M. (et al.) 1989 Nursing Practice and Health Care, 1st Edition only, London, Edward Arnold.

Adams, T. (1987) Dementia is a family affair. Community Outlook, Feb, 7-8.

Merritt MK, Procter N. Conceptualising the functional role of mental health consultation-liaison nurse in multi-morbidity, using Peplau's nursing theory. Contemp Nurse. 2010 Feb-Mar;34(2):158-66. doi: 10.5172/conu.2010.34.2.158. PMID: 20509800.

Murphy, K., Welford C. (2012) Agenda for the future: enhancing autonomy for older people in residential care.International Journal of Older People Nursing. 7, 75–80.

Kernohan, W. G., & Jones, P. (2023). Hodges’ Health Care Model as a Framework for Quality. Paper presented at Interprofessional work: developing oral care and the health workforce for the future, Brescia, Italy.
https://pure.ulster.ac.uk/en/publications/hodges-health-care-model-as-a-framework-for-quality

Jones, P. (2025). A Conceptual Mapping Exercise of Deprivation of Liberty Safeguards in Residential & Community Care Using Hodges' Model and Threshold Concepts. Journal of Evaluation in Clinical Practice, 31: e70085. https://doi.org/10.1111/jep.70085

Jones, P. (2025), A Generic Model and Conceptual Framework to Prime Curiosity Across Health and Social Care Disciplines to Facilitate Lifelong Learning. Journal of Evaluation in Clinical Practice, 31: e70252. https://doi.org/10.1111/jep.70252

Previously: 'capacity' : 'consent' : 'law' : 'safeguarding'

Living and Caring Dangerously

individual

|
INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

|

group

mental health   Cognition Inability to consent  mental capacity	My liberty Locked doors Treatment - medication  'Secure (safe)' environment
Family - friends dignity, privacy, respect vulnerability Best interest decision	Lasting power of attorney - finance; health External safeguards human rights

 

My source: BBC Radio 4 'Today' 25th September 2026: From 0841

Sir Ranulph Fiennes ‘kept unlawfully in care home’ [ The Times ]

The explorer, 82, is being ‘deprived of his liberty’, according to the watchdog, and his wife Louise Millington-Cotes is refusing visitors.

Hannah Crowe. Friday, September 25 2026, 12.41am, The Times

 See also:

Living Dangerously: An Interview with Sir Ranulph Fiennes [Brighton Dome]
Wed 10th Apr 2019

From the bibliography (lower sidebar):

Hodges, B.E. (1989) The Health Career Model, IN, Hinchcliffe, S.M. (et al.) 1989 Nursing Practice and Health Care, 1st Edition only, London, Edward Arnold.

Adams, T. (1987) Dementia is a family affair. Community Outlook, Feb, 7-8.

Merritt MK, Procter N. Conceptualising the functional role of mental health consultation-liaison nurse in multi-morbidity, using Peplau's nursing theory. Contemp Nurse. 2010 Feb-Mar;34(2):158-66. doi: 10.5172/conu.2010.34.2.158. PMID: 20509800.

Murphy, K., Welford C. (2012) Agenda for the future: enhancing autonomy for older people in residential care. International Journal of Older People Nursing. 7, 75–80.

Kernohan, W. G., & Jones, P. (2023). Hodges’ Health Care Model as a Framework for Quality. Paper presented at Interprofessional work: developing oral care and the health workforce for the future, Brescia, Italy.
https://pure.ulster.ac.uk/en/publications/hodges-health-care-model-as-a-framework-for-quality

Jones, P. (2025). A Conceptual Mapping Exercise of Deprivation of Liberty Safeguards in Residential & Community Care Using Hodges' Model and Threshold Concepts. Journal of Evaluation in Clinical Practice, 31: e70085. https://doi.org/10.1111/jep.70085

Jones, P. (2025), A Generic Model and Conceptual Framework to Prime Curiosity Across Health and Social Care Disciplines to Facilitate Lifelong Learning. Journal of Evaluation in Clinical Practice, 31: e70252. https://doi.org/10.1111/jep.70252

Previously: 'capacity' : 'law' : 'safeguarding' : 'health career'

I can't count the number of times in a nursing home, when a visit by a friend has re-ignited the flame of memory, passion and personhood; even if temporary. It was never my place to thank the friends for visiting, but they've made a difference, so crucial to acknowledge the courage on their part. Making the journey, being present and with. So difficult too, for families.

'Shattered' by Hanif Kureishi

Cathleen Schine, Ungovernable, Capricious Life, The New York Review of Books, April 10, 2025, Volume LXXII, Number 6, pp.15-16.

Shattered by Hanif Kureishi. Ecco, 328 pp., $28.00

'Shattered' c/o Penguin  

'Hanif Kureishi, the English playwright, screenwriter, and novelist, posted these words on his Substack in January 2023: 

  On Boxing Day, in Rome, after taking a comfortable walk to the Piazza del Popolo, followed by a stroll through the Villa Borghese, and then back to the apartment, I had a fall.

I had been following Kureishi's Substack for a while out of admiration, curiosity, and loyalty-though Id met him only once, briefly. His dispatches were warm and entertaining, often about the writer's life. But this one was shocking: 

   I cannot move my arms and legs. I cannot scratch my nose, make a phone call or feed myself. As you can imagine, this is both humiliating, degrading and a burden for others. 

According to his hospital report, his fall resulted in neck hyperextension and immediate tetraplegia. An MRI scan showed a severe stenosis of the vertebral canal with signs of spinal cord injury from c3 to C5. It was unclear, he said, whether he would be able to walk again "or whether I'll ever be able to hold a pen." He was speaking these words through Isabella, who was slowly typing them into her iPad.' p.15.

individual

|
INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

|

group

shattered	SHATTERED
SHATTERED	shattered

'A hospital is the place from which modesty and dignity disappear, desert you, seemingly forever, as soon as you cross the threshold. Kureishi, a reliably sexy, unrestricted writer, presents the physical deterioration and indignities he undergoes with his usual wit. The sense of vulnerability is crushing, but it is also one of the characteristics Kureishi reveals about himself that makes him so likable here, and the writing so intimate. The tone is remarkable: even the self-pity has no self-pity. One way he achieves this is by sprinkling punch lines throughout:

I woke up and started to cry. When you cry you must wipe away your tears, which is something I'm unable to do. So my eyes filled with bitter salty water and I got into a panic and thought I might lose my eyesight along with everything else. Finally, a kind nurse came into my room and downed me with a good dose of Lorazepam, then she touched me on my cheek and said, "It's not so bad, at least you're not in a coma."' pp.15-16.

Dear Editorial Office,

Dear Dr. Jones,

My name is Editorial Office, and I am writing on behalf of the selected journal. I came across your article, "A Conceptual Mapping Exercise of Deprivation of Liberty Safeguards in Residential & Community Care Using Hodges' Model and Threshold Concepts". Its focus on deprivation of liberty safeguards, Hodges' model, older adults caught our attention. I would like to invite you to consider a new and unpublished contribution to the selected journal.

For this invited contribution, we are pleased to offer a Full APC Waiver. Invited manuscripts receive priority editorial handling, and we aim to provide an initial editorial decision within one week. This invitation does not imply acceptance, and editorial standards remain unchanged.

If you are interested, a working title or short abstract is enough for an initial discussion. If your current work is not closely aligned with this journal, you are also welcome to share your present research topic and we can check whether another journal in our portfolio may be more suitable.

I would be glad to answer any questions and look forward to hearing from you.

Best regards,
Editorial Office
the selected journal

Dear Editorial Office,

Re. 'the selected journal: Invited Contribution – Full APC Waiver'

Thank you for your communication and recognition of my recent paper.

Unfortunately you have not specified the 'selected journal'. Without this detail it is difficult to proceed at all, or ascertain what benefit is provided by the 'full APC waiver'. 

I am more troubled, however by your name. Is it really 'Editorial Office'?

Again the specific journal matters here. If it is materials science, chemistry, or quantum physics or related this is (slightly?) less of a problem. Otherwise, I do worry that with Hodges' model being person-centred your being de-personalised does not sit very well with the purposes and values of Hodges' model.

It is however reassuring to learn that I should not take your invitation to suggest acceptance, and that accordingly your editorial standards remain intact - especially in these times.

Again, even if I were interested, I am at a loss to provide either a working title, or abstract.

I do hope you understand my difficulty? 

Although perhaps I ask too much.

Can it be - this IS in fact the journal?

'The Selected Journal'?

Yours Faithfully,

Mr^ P Jones

^'Conceptual Surgeon' 4th class

(and not sent.) 

'Anthropological Theory of the Didactic' ATD - in learning mathematics

INTRODUCTION

Several studies have discussed the specific knowledge taught and learned in precalculus, calculus, and analysis courses, from different perspectives: for example, concept image and concept definition (e.g., O’Shea, 2016), APOS theory (e.g., Martínez-Planell, Trigueros Gaisman, & Mcgee, 2016), and the Anthropological Theory of the Didactic (ATD; e.g., Bergé, 2016). Our starting point is the general and relatively vague question of when in an undergraduate degree in mathematics does a student need (need in the sense of to succeed in the course) to engage in mathematical activities that may substantially, or meaningfully, lead to developing mathematical practices. We consider and frame this question within the ATD (Chevallard, 1999), which provides theoretical tools for modelling any human activity or practice. The semantic distinction between these two words is essential to us. Our hypothesis is that the kinds of didactic constructs to which professors and students are exposed are decisive in fostering the emergence of practices out of collections of local, particular, and relatively short-lived activities. From the theoretical stance we take, this means the development of mathematical knowledge out of local, particular, and relatively short-lived mathematical activities.' p.487.

THEORETICAL FRAMEWORK 

“Activity and practice”

'As mentioned above, we have come to see the semantic difference between activity and practice as pertinent to our work. The ATD’s notion of praxeology provides a fundamental model for defining mathematical practice, which, in the context of the theory, is equated to mathematical knowledge. According to the model, any practice (or piece of knowledge) can be represented by a quadruplet [T, τ, θ, Θ] involving four interconnected components: a type of tasks T, which generates the practice, the corresponding collection of techniques τ developed to accomplish T, the discourse used to describe, justify, explain, and produce the techniques (i.e., their technologies θ), and the underlying theories Θ that serve as a foundation of the technological discourse. As students progress in their studies of mathematics, they engage in numerous activities, which progressively determine the practices they develop'. p.489.

Laura Broley and Nadia Hardy. (2018). A study of transitions in an undergraduate mathematics program. In PROCEEDINGS of INDRUM 2018 Second conference of the International Network for Didactic Research in University Mathematics. pp.487-496. ERME topic conference.
https://indrum2018.sciencesconf.org/data/Indrum2018Proceedings.pdf

THEORETICAL CONSTRUCTS 

'ATD “postulates that any activity related to the production, diffusion or acquisition of knowledge should be interpreted as an ordinary human activity, and thus proposes a general model of human activity built on the key notion of praxeology” (Bosch & Gascon, 2014). The praxeology 𝛱 is represented by a quadruple [𝑇/𝜏 /𝜃/𝛩]: its praxis part (or know-how) consists of a type of tasks 𝑇 together with a corresponding technique 𝜏 (useful to carry out the tasks 𝑡 ∈ 𝑇 in the scope of 𝜏). The logos part (or know-why) includes two levels of description and justification: the technology 𝜃, i.e. a discourse on the technique, and the theory 𝛩, which often unifies several technologies. 

The elaboration of a reference epistemological model (Florensa, Bosch, & Gascon, 2015) as sequences of praxeologies, for a given body of knowledge, is an important step in any research carried out in the ATD framework. It is the tool that will be used by the researcher to describe, analyse, put in question or design the specific contents that are at the core of a teaching and learning process. In order to build such a model, “mathematical praxeologies are described using data from the different institutions participating in the didactic transposition process, thus including historical, semiotic and sociological research, assuming the institutionalized and socially articulated nature of praxeologies” (loc. cit. p. 2637).' pp.498-499.

Charlotte Derouet, Gaetan Planchon, Thomas Hausberger, and Reinhard Hochmuth. (2018). Bridging probability and calculus: the case of continuous distributions and integrals at the secondary-tertiary transition. In PROCEEDINGS of INDRUM 2018 Second conference of the International Network for Didactic Research in University Mathematics. pp.497-506. ERME topic conference.
https://indrum2018.sciencesconf.org/data/Indrum2018Proceedings.pdf

I came across this source as I'd read about the way chemistry as a discipline co-opted some mathematical symbols, but adapted them for their own use.

Previously: 'math' : 'threshold concept' : 'liminal' : 'learning'

iii Picking up sticks: when axes matter

It is one thing for us to break the stick, but quite another from a concept's perspective. They are accustomed to the dynamics at work, when as search terms they are exploded, or not. And, not just any concept but one that can be unique. Consider the concept, and how or where it finds itself [ in Hodges' or another model ]? Let us use the intra-INTERPERSONAL domain, as an example, and ask:

1. Is 'mood' fixed by the I-axis alone?
2. Does the humanistic axis have a role in where in the doomain the user of Hodges' model places 'mood'?
3. Acknowledging person-centredness, if the patient/client had a view, to what extent would this agree (with annonymity assured) with the professional's judgement, or a relatives / guardian?
4. What is as a result, 'mood' has become 'very low mood'? (To continue in this vein , invites complication, but we will continue.)
5. Introducing the 'Other' whatever their role and relationship, pushes us to the humanistic, but whether this is achieved in a person-centred manner (triage excluded) is a matter of opinion and judgement (evaluation).

If mood is fixed by the I-axis then if we determine the issue is 'low mood' are we introducing a combined quantitative and qualitative dimension, a continuum, at the selected point in the interpersonal domain? Writing previously about threshold concepts, I wondered, and proposed compound threshold concepts. There is a progression from the patient's subjective self-assessment, to in all likelihood of an objective measure being introduced, so spanning two domains. Definition of 'compound' aside; there is a compound structure at work.

What points 1-5 above reveal is triangulation. When it is argued that Hodges' model facilitates navigation as per my presentation on 21st April, this is a strategy from mixed-methods research in practice. Many years ago, Hodges' model was described as a 'cognitive periplus', reflecting the way ancient mariners initially charted the coastlines creating the first map, as per their culture and dispora. In the west more recently the value of social approaches and activities, especially in mental health. Care navigation is a role. Literally sign-posting to individually suited (which must be stressed) activities, resources, and agencies. So, in Hodges' model what are our three triangulation points? They are:

1. Axial;
2. Intra- InterDomain; 
3. Person-centred. 

Perhaps, we can describe 1-2 as conceptual anchors at least when dealing with a concept, while #3 is more about approach, values and philosophy. So, there is something of a 'cheat' going on, because each one is compound:

1. Axial: The axial is comprised of four points. The axes create a Cartesian plane (figure). And, as far as a patient is concerned, they mark off a point on the respective Individual and Humanistic-Sciences parts of the axes. This form of triangulation point can claim a general conceptual precision (language) in the applied terminal labels; but what happens in-between can be patently fuzzy. A mix of what may be objective and subjective.

2. Intra- Interdomain: This may be the most imprecise triangulation point. It appears the axes of Hodges' model are composite (figure). They have two-sides as a boundary. To be pedantic, in our example, one plays to the interpersonal domain, the other the sciences.

[The relationship between the axis and the domains in Hodges' model, is far from unique; but I wonder if there is something else here?]

2. Person-Centred: There is a paradoxical nature to person-centred(ness). It is also nebulous in nature, and yet in care it is definitive in practice (safety, purposes, values, professionalism, competency, ...).  It forms locus which can also be classed as a traingulation point, at the centre of the model. This is the point around which Hodges' model is built. This captures the individual's (life, care) context and situation, all influenced by their life chances as consequent health - and other - careers. Salience and our attention^ is key. Is it possible to frame our purpose(s)?

^A focus for [N] autumn.

Marrakech, Le Jardin Secret. 24th April. 1000-1830.

Millikan's Unicepts and Unitrackers

An underpinning theory of Hodges' model must help us make sense of what is happening within the care domains, between the domains, and possibly say something about what may be significant relation[s]-ships that are diametric. Arriving at threshold concepts I wondered in Hodges' model about there being compound threshold concepts. Consider, when 2-3 thresholds are (b)reached in one (the sciences) domain? Contrast this then, with 4-5 thresholds across care domains? There may also be care concepts applicable that are for example, person-centred: that is, patient, carer, 'management', or policy defined? These concepts while not threshold related per se, are nonetheless relevant.

I came across the work of Ruth G Millikan in London, several years ago as I followed 'epistemology' around the shop. It is time to pick this up and earlier work:

Millikan, Ruth Garrett. “Biosemantics.” The Journal of Philosophy 86, no. 6 (1989): 281–97. https://doi.org/10.2307/2027123

https://www.researchgate.net/publication/235734046_Biosemantics 

INTRODUCTION TO PART I

0.4 Unicepts and Unitrackers

'Neither the clusters in the world nor their properties are found at the sensory surfaces. The properties characterize distal objects and events. They are manifested in diverse and irregular ways through signs impinging on the sensory surfaces, energy patterns that are contingent on shifting intervening circumstances.' ...

'A unitracker is a mechanism or faculty for same-tracking something, for recognizing when incoming information concerns it, then linking and storing this information together as information about one and the same thing. Only then can it can be brought to bear together on inference and action. The link connecting stored information about the same thing together is a "unicept." The information is recognized, paradigmatically,by the initiation or strengthening of an intentional attitude of credence, which we tentatively model as a temporary or enduring connection between the unicept and unicepts for other things.'

'Both unicepts and unitrackers are particulars. You and I do not have any of the same unicepts or unitrackers. What we have in common is unicepts and unitrackers for many of the same things.' ...

'Unitrackers are same-trackers used for collecting knowledge about their targets.' pp.7-8.

Millikan, Ruth Garrett, Beyond Concepts: Unicepts, Language, and Natural Information (Oxford, 2017; online edn, Oxford Academic, 19 Oct. 2017), https://doi.org/10.1093/oso/9780198717195.001.0001, accessed 16 Feb. 2026.

vi Book: Bill Ross - 'Order and the Virtual'

'The Philosophy and Science of Deleuzian Cosmology'

Over time I have equated the center of Hodges' model with a nexus. Framing the whole model as a chaotic system, comprised of four domains, with two (or more?) Lorenz attractors, how do we make sense of what is going on? 

A previous post visited this too: Threshold Concepts: Reflection on chaos, complexity and AI 

Reading Order and the Virtual the new vocabulary, provides glimpses. The perspectives I'm adopting are no doubt naive and favour my context. If we freeze the situation from the center - the nexus the variables, parameters are frozen within their respective domains and tracks around the attractors. They tell us little (now), for obvious reasons, but (with AI and) acknowledging the social and political is a huge step forward (in healthcare).

'The word 'appetition' occurs not infrequently in Whitehead's work, though his own coining is 'prehension`. Both words convey essentially the same import. All individuals 'prehend' all others - the entire universe is expressed through the relations pertaining to any given individual therein.36 Prehension belongs cqually to the event as to the conscious decision. The 'nexus' or 'actual occasion' is the outcome of prior appetitive or prehensive enfolding for Whitehead as it is for Leibniz, and the aggregate of past prehensions shapes the future of the individual. The crucial refinement comes with the term 'negative prehension'. 

For Whitehead, accepting those same tenets that characterise Leibniz's metaphysics, the interconnection of all things and the tendency of systems to enfold elements from their total situation, negative prehension is a necessary corollary to positive appetition. It belongs to the 'principle of limitation' which Whitehead saw as a necessary supplement to Spinozist metaphysics, and which we shall encounter in some detail in following chapters.' 

It helps me, that Spinoza is heard here. 

'Instead of how is it that all things are interconnected, the question becomes, "Given that all things are interconnected, how is it that individuation is possible?'

Before recourse to Lorenz's butterflies, I saw 'oscillations', a constant swing from individual to other(s); then back again. 

`Every present state of a simple substance is a natural consequence of its preceding state, in such a way that its present is big with its future',37 (all p.47.)

While concerning a 'simple substance', is this a prelude to self-care and preventive health care?

I noted in pencil: In Hodges' model 'nexus' is framed as the now - that just was. Ross carries on to discuss 'the multiplicity of components in the nexus can enter explicit feeling as contrasts.' p.48.

Yes. 'The local and global are entwined' p.49; and now with the glocal too. Ross points out how Deleuze draws upon Simondon's treatment of the organic and inorganic within the same framework, p.50.

I've also been reminded about resolving some abbreviations:

https://hodges-model.blogspot.com/2025/07/axiomatic-simondon.html

Many thanks to Edinburgh University Press for my review copy.

More to follow here ...

Bill Ross (2024) Order and the Virtual: The Philosophy and Science of Deleuzian Cosmology. Edinburgh: Edinburgh University Press.
https://edinburghuniversitypress.com/book-order-and-the-virtual.html

Problem solving, case formulation and policy formulation

On W2tQ this year, and possibly in a previous paper, or conference presentation, I've stated that the nursing process is basically a problem solving algorithm. Nothing profound there of course. 

'Problem solving' is a developmental threshold and an evolutionary skill obvious in humans, with learning passed on across generations. Evidence of problem solving in animals and nature is becoming increasingly apparent; with examples over recent decades of problems solved not witnessed before.

In healthcare, and psychotherapy more specifically, we shift to case formulation. Again a step-wise process to arise at a sufficiently complete rationale for therapy. Ideally, this extends beyond the individual. As an parent, grandparent, guardian, teacher, supervisor ... teaches a child so therapy is an opportunity for learning and, it must be added, unlearning.

Returning to (and passing on):

Hague, R., & Harrop, M. (2007). Comparative Government and Politics (7th ed.). New York, NY: Palgrave Macmillan.

Chapter 18 (pp.377-395) concerns 'Public Policy'. Clearly, here there is a shift from the individual to the collective, population and citizenry. The chapter's second page on 'Initiation and Formulation' quickly provides a flowchart 'Figure 18.1 Stages of the policy process'. Box 18.1 informs readers about 'Rational and incremental models and policy-making' (p.380):

'The key contrast between the two models is this. The rational model views policy formulation as emerging from a systematic search for the most efficient means of achieving defined goals. By contrast, the incremental model sees policy as emerging from a compromise between actors who have goals which are ill-defined or even contradictory. Where the rational model seeks the best policy in theory, an incremental framework seeks out a practical policy acceptable to all the interests involved.' p.380.

The book highlights Simon (1983) as a source for the rational or synoptic model:

 

Simon H.A. (1983) Reason in human affairs. Oxford: Basil Blackwell.

Plus, for the incremental model:

Lindblom, C.E. 1979. Still muddling, not yet through. Public Administration Review 39: 517–526.

If needed, online, you will find accounts and diagrams on problem solving, the nursing process, case formulation and policy formulation. That's quite a family is it not? 

While not referred to as explicitly today, the nursing process (now routinized) should address parity and integrate care across mental and physical health. The individual (person, patient) should be assessed and care planned with their social and community context taken into account. Collaboration in care should help assure that this is indeed the case. The nursing process in the sociological domain acknowledges the role of parents, guardians, and families as informal carers. The social care sector can also be represented and further the objectives of a more open and integrated care community as per the local situation. While not added to the sciences domain; case formulation should also factor in the physical and political. 

Politically, are all instances of problem solving, and formulation recognised for their importance and influence on outcomes and effectiveness, economy, efficiency (another 'box' p.357), plus efficacy? Are services politically afforded the resources, as defined across the domains of Hodges' model required to deliver, improve and change (achieve sustainability, educational, preventive)? 

The elephant here of course are the determinantS. Ultimately, all these forms of problem solving should be at 'home' in the political domain, but they are rarely there. It is not just the practitioner who can make the difference - be the difference.

Enough of l-implementation

Policy needs to be fit for 21st century purposes, and not hollowed-out but allowed out - beyond the legislative walls where it can make a real difference.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

Nursing process Case  formulation	Nursing process
Nursing process Case  formulation	Policy formulation

    

See also: https://herbertsimonsociety.org/

 'nursing process' : 'case formulation'

Just imagine ... caseloads, payloads and careloads

Just imagine ... no, not like that - really imagine!

You are in a situation. Unsurprisingly, let's say it's in health, or social care. We find ourselves in a care or nursing home, on a ward, or in the individual's home, even if the patient does not currently recognise it as such.

The patient is mobile. That is, and isn't a problem.

Physically, apart from thoughts about a chest, or urine infection, yes they are mobile, but they're also confused - disoriented.

We are concerned about their safety. 

Noisy, increasingly agitated, they are making it clear they want to leave.

Their carer, family, or staff are trying to limit the patient / resident's access to the exits, be that the front, or back door, the spare room, their room, or main entrance. They are not in agreement about where they need to be. Persuasion and distraction aren't working either. They appear to lack the level of mental capacity required to decide for themselves what needs to happen.

It is one thing to have this assessment of the situation running through one's mind; but quite another to 'pick up' a care concept mentally and carry it over the care (knowledge) domains of Hodges' model.

Hodges' Health Career - Care Domains - Model

Try it for yourself ...

Have a think about the following care concepts: mobility, capacity, consent, confusion, mobility, liberty, a locked-door while spouse/partner goes shopping, and safeguarding? 

As we engage in critical thinking, these concepts have a literal payload. They carry varying degrees of informational value, salience that helps us prioritise, what else do we need to factor in, what help is needed, and when; how do we  decide what to do?

As a concept is evaluated against Hodges' model, it changes. It is as if it morphs subtely, or starkly as other concepts, by association, are brought into play.

This process is influenced in so many ways; our training to date, our prior experience, biases and cultural baggage we might also carry, who else is present (this is of course potentially both a positive and negative), past and current role-models, our (team's) preparedness - what to do if .., teamwork, access to leadership (who is 'duty'?), and our confidence in them (Oh no!). And, them in us.*

Vitally, there is the small matter of our understanding, attititude and response to the person in-front of us. 

The delivery of healthcare is often stressed as emotional labour. Whether we use Hodges' model or not, perhaps the labour, the physical and psychological work involved, is experienced through carrying and feeling the careload. A reason too for supervision.

*Do seek help - advice if needed.

Further reading [ please contact me if needed - h2cmng AT yahoo.co.uk ]:

Jones, P. (2025), A Generic Model and Conceptual Framework to Prime Curiosity Across Health and Social Care Disciplines to Facilitate Lifelong Learning. Journal of Evaluation in Clinical Practice, 31: e70252. https://doi.org/10.1111/jep.70252

Jones, P. (2025). A Conceptual Mapping Exercise of Deprivation of Liberty Safeguards in Residential & Community Care Using Hodges' Model and Threshold Concepts. Journal of Evaluation in Clinical Practice, 31: e70085. https://doi.org/10.1111/jep.70085

Nursing models of care: "There is another"!

It seems Star Wars forums continue to debate the meaning of Yoda's response to Obi-Wan that "There is another". 

The lack of practice-based debate in nursing and health education about 'nursing theory' and 'models of care, confirms that these academia sagas did indeed take place in a galaxy far, far away.

There is, as ever, positive and negative news too. The bibliography in the sidebar keeps growing. I'm hoping for news of additions dropping into the inbox before the end of the year. Not just prospective papers I know about (yes, there is another prospect!), but other work. In a way the latter is even more special. As these sporadics reveal that there are research heroes out there, on their own path and journey of discovery. Finding Hodges' model, they have applied it to their respective field.

Yesterday, searching for 'Activities of Daily Living' (first published in 1980) while writing the DASH post, on BMJ Careers I came across:

'What models do nurses use to guide their care?'

Is that 'models' plural?

Perhaps the response to the question says something about:

• nurse academia;
• how our medical colleagues view nursing;
• and more importantly - their understanding of nursing, the nursing profession, ongoing aspirations and relevance to self , health and social care in the 21st century?

In January, frustrated at the effort that is getting published (a shared experience then) and lack of attention to theory I posted:

Are you planning a health* study in 2025?

The literature trail for Hodges' model is not voluminous, but it is there:

• as a model of care, conceptual framework;
• person-centredness;
• integrated and holistic care;
• holistic bandwidth
• SDGs
• life chances, health career, prevention, life-style and literacies
• socio-technical approach
• global health;
• reflection and reflective practice;
• critical thinking
• mind-mapping;
• concepts, conceptual spaces, threshold concepts

- with much more to do, even in the above.

Please, call this a gentle nudge. Thank you.

Image: http://www.quickmeme.com/

Paper - (finally!) "A generic model and conceptual framework to prime curiosity across health and social care ..."

 It has been over a decade but at last the second* paper has been published in Journal of Evaluation in Clinical Practice:

Jones, P. (2025), A Generic Model and Conceptual Framework to Prime Curiosity Across Health and Social Care Disciplines to Facilitate Lifelong Learning. Journal of Evaluation in Clinical Practice, 31: e70252. https://doi.org/10.1111/jep.70252

ABSTRACT 

Rationale: The Corona virus pandemic highlighted the importance in continuity of the physical and emotional labour across all care sectors. Synergy between healthcare in hospitals, and community services must be allied with social care; and be central to integrated and efficient policy and service delivery. Services were found wanting in the pandemic and in recurring winter crises. The politics of funding for care delivered in rest and nursing homes remains contested, awaiting long‐promised governmental action. The workforce is recognised as dedicated, skilled, compassionate and yet under‐valued and under‐paid; managers face ongoing recruitment challenges, with a national shortage of staff, and high turnover of personnel. A National Care Service is awaited in England and Wales. 

Aims and Objectives: This study explores the ongoing care crisis, using the educational lens of threshold concepts, projected, analysed and synthesised of a generic conceptual framework, known as Hodges' model. Readers will understand Hodges' model and threshold concepts being equipped to explain both. 

Methods: The study is descriptive and uses a conceptual mapping approach supported by discussion and literature. Additional resources and avenues for ongoing study are also provided. 

Conclusion: In conclusion, Hodges' model is a pragmatic, practice‐based tool, that can support and sustain curiosity for workforce learning and development. 

Acknowledgements I would like to thank Messrs Mark Bird and Matthew Graham and the journal's reviewers for comments on drafts of this study; and acknowledge the effort of Dr Michael T. Flanagan in creating the informative threshold concepts resource (referred to above). 

https://onlinelibrary.wiley.com/share/author/IRPNBR2KHJNYJK8XUAW6?target=10.1111/jep.70252

*This paper was originally the first of a two-part work. Feedback from reviewers suggested the papers be standalone. United now, in one journal.

Many thanks to the reviewers, editor, editorial and publications team at JECP.

This paper has been added to bibliography in the blog's sidebar.

Paper: "A generic model and conceptual framework to prime curiosity across health and social care disciplines to facilitate lifelong learning"

 What seems a long time ago now (a decade!) I started writing a paper on:

• Threshold concepts
• Deprivation of Liberty Safeguards (DoLS)
• and Hodges' model

This ended up as a two part work, which after review ended up as two separate papers:

One appeared in April:

Jones, P. (2025). A Conceptual Mapping Exercise of Deprivation of Liberty Safeguards in Residential & Community Care Using Hodges' Model and Threshold Concepts. Journal of Evaluation in Clinical Practice, 31: e70085. https://doi.org/10.1111/jep.70085

The other should be published soon - same journal. I appreciate the editor's patience and team's support:

"A generic model and conceptual framework to prime curiosity across health and social care disciplines to facilitate lifelong learning"

Unfortunately, I've no funds to pay for open access. I will bear this in mind, as I resurrect another project - with two versions of 13,000 and 6,000 words. This is on (and began during) COVID-19, society, information and technology.

Biblio - addition: Conceptual Mapping Exercise of DoLS in Residential & Community Care Using Hodges' Model and Threshold Concepts

After a great many years of on-off effort, radical revisions - from one to two papers - part 1 and part 2; and then finally two standalone papers, I received news this morning from ORCID and Wiley of online publication.

News of the second paper (part 1 - to me) is still to follow.

Many thanks to the individuals who read earlier drafts, the editor and team of JECP.

It is a real delight to add an item to the blog's bibliography in the sidebar.

Apologies in advance, the paper is not open access, I cannot personally cover the fees. Happy to assist with an earlier draft.

Once again, if you can add to the bibliography, or are interested in using Hodges' model please let me know. Or as several researchers have done: 'Just get on with it!'. Learning post-publication of a citation for Hodges' model, is a welcome surprise too.

Jones, P. (2025), A Conceptual Mapping Exercise of Deprivation of Liberty Safeguards in Residential & Community Care Using Hodges' Model and Threshold Concepts. Journal of Evaluation in Clinical Practice, 31: e70085. https://doi.org/10.1111/jep.70085

News on two papers: Deprivation of Liberty Safeguards & Threshold Concepts

 - plus of course Hodges' model

While I could find out (here on W2tQ!?), I can't remember exactly when I started a writing project about threshold concepts, deprivation of liberty safeguards in the context of residential care and nursing homes. It was at least 2013, and may date back to 2011. Well, whenever it was: what a palaver! 

One paper, rejected, the advice was to split the work and create two. The two papers were then also rejected. My writing is always off-piste as it were, on-off too; and then ironically COVID-19 may have helped too? Afterwards, I started to pick it up again - the same title but parts 1 & 2. I never heard from one journal, so quickly moved on. Each time, the work improved thanks to two reviewers and their feedback. All the time my thought about Hodges' model has itself changed: I like to think progressed. With further revision, I finally had two standalone papers.

The important thing is the news received this week: Re. ...

'"A Conceptual Mapping Exercise of Deprivation of Liberty Safeguards in Residential & Community Care using Hodges’ Model and Threshold Concepts". I am pleased to be able to tell you that has been accepted for publication in Journal of Evaluation in Clinical Practice.'

A further paper (part 1 originally) same journal, to be referenced in the above, needs some minor revisions.

I am worried about another paper, with a similar history, that I can now turn my attention to (this itself speaks volumes!). I can see I need to alter the emphasis, balance of Hodges' model, diagrams, psychological therapies and case formulation. A co-author would help, but of course everyone's busy.

So if you're writing and struggling: do keep going!

Alliance for Responsible Citizenship

Last month on two occasions, I came across the Alliance for Responsible Citizenship (which is a registered company). 

In the Sunday Times, "Philippa Stroud: ‘Everyone’s moaning — I think humanity can sort things out’":

https://www.thetimes.com/uk/politics/article/philippa-stroud-alliance-responsible-citizenship-km8z26b8b

and Financial Times "'Part megachurch, part political rally: inside London’s ‘rightwing Davos’".

https://www.ft.com/content/7ff1614c-38a2-4b5c-81d3-80cea1196dad 

Apparently, a right wing, conservative movement with a three-day conference, one commentary suggested it has struggled to define itself, which is understandable given the ongoing (increasing?) prompts for its creation.

You recognise early on in your nursing career and not just as a student (pre-Project 2000 UK), but as a Nursing Assistant that character is a key element in your professional development. By the time you qualify, you more accurately see that without a doubt it is your formative education that is a critical factor. That and your 'home' circumstances - and not necessarily the two-parents good, one bad formulation. This is why with students excluded from school, society is taking a wrong turn. There is obviously a problem but what is the 'correct' approach?

An 'alliance' already suggests a given level of organisation. By definition 'grassroots movements' must struggle to establish and retain their identity.

This is a project Hodges' model can help address - with a balanced but not necessarily a neutral output.

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

identity personality attitude aptitude character faith individual beliefs religious engagement courage hope threshold concepts my destiny well-being trust	future physical thresholds  waste climate change circular economy AI truth - information disorder science technology PAST - work - FUTURE our future destiny - (what does the clock say?) future generations?
grassroots social movement arts family community culture - diversity social - cultural identity society - support social change social capital social contract social values our shared destiny our children's children welfare - living wage employment - leisure quality of life	power political systems past policy UK: 'Troubled Families' economics organisations, institutions corporations political (manifest! - colonialism ) destiny policy systems political engagement health of leaders trust international law - justice control of fraud, corruption, crime human rights political thresholds

Book review: Handbook on the Ethics of AI #2

Well, I am sold. So, encouraging again to read 'reflect -ion' on the first page and throughout chapter 1:

'... why the very idea of AI gives rise to (or should give rise to) ethical reflection.' (p.21), and I'm sure the book as a whole.

Most readers may pass this by, but to me this matters. Ethics scholars however will see how important and conjoint reflection is to deliberation and argumentation of ethics. Especially, as noted in post #1 the five part division of the text Foundations and Context; Responsibilities; Rights; Politics and Power; and Thinking Otherwise. 

Tables break up and inform the text. I like the way for many tables the source is: Author's own elaboration.

Given the subject matter, yes, the authors have the literature but they are also formulating their chosen theme against the present, near future, socio-political scenarios and much more. So, reflection - this should be expected. With Hodges' model I'm often asked why are those concepts placed in that particular domain? Perhaps that is a question for general artificial intelligence? Subjectivity is a key challenge, and its effective communication.

If I say, chapter 1 is a great primer on What Is This Thing Called the Ethics of AI and What Calls for It? I'd sell the book short, the whole text fulfills this purpose. The definitions and responses to What is A.I. are very helpful, taking into account ancient to more recent history. I've a book in a box by David Chalmers (sorry Prof.) - one day - which helps here discussing intelligence and consciousness.

I'm primed to pick up on 'gaps' (Theory-Practice) and in human experience they are inevitably legion. The responsibility gap (and meaningfulness!) c/o Sven Nyholm is a place to return to, to debate why A.I. raises such a broad range of ethical issues. Patiency is never far away. Here, the patient is stark: in  moral agents and moral patients (p.20 and 89). This blog is littered with posts on Drupal, which to date I have never mastered. I remember sitting in DrupalCon presentations, in the midst very skilled professional coders. A member of the community stood at the podium recounting their lived experience of impostor syndrome. In November with a presentation of my own, I had my own encounter. Well into reading this book, it really did help. The conclusion of chapter 1 contrasts the frequent need for a big-picture overview and reflection on more specific issues. That's quite fitting for me.

I am biased in the encouraging kernels I find: as seek them I do. Yes, as chapter 2 AI Ethics before Frankenstein begins: 'there remains work to be done in charting the long-range conceptual development of  AI in the history of political thought.' (p.27, my emphasis). And much more I hope. Chapter 2 combines literature, myth and I enjoyed the discussion on techne, Prometheus, Hobbes, the interdisciplinary bridge of techno-politics and articulating the mechanistic in our lives. Focussed recently on thresholds and threshold concepts in revising two papers: Hunt writes, 'Frankenstein is a "threshold" text for "modern political science fiction" (p.31). 

This  resonated - especially 'for its prediction that the nascent Enlightenment-era sciences of chemistry, anatomy, and electricity could be used to artificially make a human being' (p.31). The exploration of bad education and bad governance through Shelley and social history is other-worldly in itself. Hunt's conclusion which includes 'Wollstonecraft was the pivotal figure in the process of refracting ideas of AI from Hobbes to Shelley, ...' left me wondering about the refactoring of code. 

Chapter 3, Smith's Faith, Tech, and Ethics of AI brings more reflect -ion with the bonus for me of Descartes. On faith, the human situation is also repeatedly stressed. Delving into creation too, this is detailed on forms of theology - Augustine, Bede, for example, and philosophy Bacon, Hume, Kant and their role in diminishing the influence of religious thought and epistemology (p.39). How long a push was that? Surely it is ongoing - in some quarters? Medieval thought is discussed, and I recall this broad period also being regarded as misunderstood [Medieval Philosophy - Bryan Magee & Anthony Kenny (1987)] . 

On a personal level, I've always placed belief in the intra- interpersonal domain of Hodges' model. In psychosis, depression, anxiety, phobias in short mental health, beliefs can be disrupted, and influenced of course when all is well. Religion I have framed at the individual and socio-political level. Clinically, it is the individual patient's beliefs, if they follow a particular religion that we also need to be cognizant of as health personnel. Machine, or human; object or being as Smith asks:

SELF / INDIVIDUAL  -  OBJECT / THING

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

GROUP

the human - the machine -	- can become machine - can become human
socio-	-political

There is depth of discussion too: in AI and Power; a Christian response to AI ethics. This handbook is not just for quick reference. There is indeed redemption (p.43) to be found:

'It is easier to cover a blemish than examine why it resulted in the first place: genetics, diet, stress, or lack of self-care.'

I argue for Hodges' model as a tool to identify, (re)present, and relate the determinants of health: all of them. The points and paragraphs on theology, mind, body and self are well worth revisiting.

Johnson's chapter 4, What are Responsible AI researchers really arguing about? provides support for my ongoing belief in the value of sociotechnical theories and approaches, and another book on enactivism. Given the ethics of the global south (and technological/electronic colonialism) more could perhaps be made of LMIC, but the point is made in Table 4.1 (Examples of functionalist evaluations of AI models, p.52). Constructivism 2.2 is a rich seam for me. Table 4.2 touches on medical diagnosis and socio-technical. Johnson notes that in seeking answers to AI ethics problems, scientists see constructivist approaches and '.. constructivism as a metaethic, holding a rich space for more research into pluralistic AI-Alignment', (p.53). And, the potential for much more. This is suggested (for me) in reference to the need for a holistic view of AI model's genesis, and 'two sides of one coin' - dichotomy, polarity, oppositions, binary reductions ... ? 

Johnson's conclusion is an indirect thumbs up (cue Arnie style - of course) to Hodges' model as a project. Conceptual frameworks can indeed:

'... offer unique perspectives on the methods commonly employed and to understand and mitigate the risks and dangers of AI.' (p.62).

If ethics gets 'technical' then the book's full title is well-earned. Two case studies demonstrate functionalist and constructivist debates in responsible AI. I don't remember Capt. Kirk et al. stating to a malign alien 'intelligence' "The trophy doesn't fit in the suitcase because it's too large (small)," (p.58). The writer's put other solutions to the characters lips. Spock, however, would find the discussion here on 'Artificial General Intelligence, 4E Cognition and Enactivism' - "Fascinating!"

Much more to follow ...

Handbook on the Ethics of Artificial Intelligence. David J. Gunkel (ed.). Cheltenham, UK: Edward Elgar Publishing Ltd. ISBN: 978 1 80392 671 1245
https://www.e-elgar.com/shop/gbp/handbook-on-the-ethics-of-artificial-intelligence-9781803926711.html

Book review: Handbook on the Ethics of AI #1

Related previous posts: 'general + AI'