Hodges' Model: Welcome to the QUAD

Hodges' model is a conceptual framework to support reflection and critical thinking. Situated, the model can help integrate all disciplines (academic and professional). Amid news items, are posts that illustrate the scope and application of the model. A bibliography and A4 template are provided in the sidebar. Welcome to the QUAD ...

Wednesday, March 31, 2021

'Clean tools' - fit for Conceptual Engineering?

Posting previously news of a conference on 'Conceptual Engineering' I was drawn and try to follow the following series:

Conceptual Engineering Seminar | Simon Blackburn (Cambridge): TBA 

March 30 @ 3:00 pm - 5:00 pm 

ABSTRACT. — When I hit upon the term ‘conceptual engineering’ in the Introduction to my book Think, I suppose I thought of it as simply a cute way of introducing what philosophers do. I had no idea that the term had already been used, although I have subsequently learned that it was. I have therefore been surprised that books and seminars have subsequently been devoted to the idea: it is as if books and seminars were simply entitled ‘Philosophy’ rather than directed at particular problems within philosophy. In my talk I hope to go further into that and try to understand why it happened. 

Yesterday, Simon Blackburn cited Austin (1956) and the need for 'clean tools', which led me to the following source*:

"First, words are our tools, and, as a minimum, we should use clean tools: we should know what we mean and what we do not, and we must forearm ourselves against the traps that language sets us. Secondly, words are not (except in their own little corner*) facts or things: we need therefore to prise them off the world, to hold them apart from and against it, so that we can realise their inadequacies and arbitrarinesses, and can re-look at the world without blinkers. Thirdly, and more hopefully, our common stock of words embodies all the distinctions men have found worth drawing, and the connexions they have found worth marking, in the lifetimes of many generations: these surely are likely to be more numerous, more sound, since they have stood up to the long test of the survival of the fittest, and more subtle, at least in all ordinary and reasonably practical matters, than any that you or I are likely to think up in our armchairs of an afternoon - the most favoured alternative method."

*my emphasis

Simon's talk of 'clean tools' prompted me to reflect:

The assumed neutrality of Hodges' model. As noted on W2tQ previously, Hodges' model is an invitation to start with a new slate. To leave behind bias and prejudice, to assure unconditional positive regard and a non-judgmental approach and attitude.

'Engineering' is usually conducted within a dedicated physical space. Apprentices will soon be familiar with the discipline of leaving the work environment clean and prepared for the next day. They will learn that tools have their place (even on the screen). Tools themselves also need care; so don't be care-less.

If Occam's razor is a preparatory rule for conceptual hygiene, perhaps we can take this further, or at least propose an addition? There is a 'rule of forceps' (which, it might be argued, is person-centred, or clearly patient-centred?) but not only are forceps a tool, we can utilise a divider too.

In use, Hodges' model suggests and facilitates dichotomous thinking. The forceps may help grasp the the key parts - the polarities of a situation. The divider may serve to help us to weigh and measure the 'distance' of two concepts, especially if they seem to be grounded across two of the model's care (knowledge) domains.

So Hodges' model may have a role in 'conceptual engineering', variously as a dialectic divider or dialectical forceps?

Austin, J. (1956). A Plea for Excuses: The Presidential Address. Proceedings of the Aristotelian Society, 57, new series, 1-30. Retrieved March 30, 2021, from http://www.jstor.org/stable/4544570Austin, J. (1956). A Plea for Excuses: The Presidential Address. Proceedings of the Aristotelian Society, 57, new series, 1-30. Retrieved March 30, 2021, from http://www.jstor.org/stable/4544570

There is a legal case of historic interest also described in the Austin's paper.

Tuesday, March 30, 2021

A window on social history ...

individual
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INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group

Ask a child to draw a house ..?

Light
Air*
A row of coal miners' houses with no windows to the street,
Halifax, 1937 by Bill Brandt
 
 
HUMAN RIGHTS

 

Source:

 

https://www.billbrandt.com/bill-brandt-archive-print-shop/sp03-coal-miners-houses-with-no-windows-to-the-street-c1937

*and its quality

Thursday, March 25, 2021

Anticipatory Prescribing as part of Anticipatory Care

This post is derived from a selection of the main concepts found within three papers (references listed below) on 'anticipatory prescribing'. Some explanation may assist. I have duplicated 1. What is current practice? across the domains to suggest that the question needs to be answered for each of the care (knowledge) domains. The same principle applies to the repetition of the attitudinal questions at the individual and group (sociological) level. Person-centredness demands that the patient's views are paramount plus the aggregated responses of the group as a whole.

Perhaps there is a 'drug TIME' too, which operates across all the domains once more, and each variously weighted objectively and subjectively? The concept of control and assessment of control is also critical.

I've placed GP decision-making across both 'individual' domains described as it is as a 'process' and for the patient as 'bedside manner', as also reflected in the GP and healthcare professional's communication with the family.

Clinical effectiveness and observations are likewise span the interpersonal and sciences domains. This is to denote the need to achieve and sustain parity of esteem and integrate physical and mental health care - pastoral and spiritual also.

'Cost' is anchored in the political domain, but clearly there are much wider economic ramifications, both in quality of life, quality of death and the way 'cost' is determined, measured, analysed, evaluated and reported.

For me nursing, medicine, healthcare are most effective when they are anticipatory. Observation, reflection and critical thinking are key. In a way for an individual to be health literate is a preparation for self-care. Although clearly in a general sense of health and well-being; not necessarily being literate with respect to a long-term medical condition.

Hodges' model is an idealisation and the detail is obviously described in the papers listed. The intention below is for readers to gain an appreciation of anticipatory prescribing and the application and scope of Hodges' model.

 Taking a larger perspective anticipatory prescribing is part of anticipatory care.

@GeriSoc https://twitter.com/GeriSoc/status/1374716732120645632?s=20


individual
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INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group

Anticipatory Prescribing

Reassurance for patient, family &  friends
clinical effectiveness
subjective TIME
observation
agitation, distress (mood, anxiety, orientation, communication, identity - self, fear, understanding, mental capacity...)

The patient's spiritual well-being needs are met*.

1. What is current practice?

2. What are the attitudes of patients?
3. What are the attitudes of family carers?
4. What are the attitudes of community healthcare professionals?
[as individuals]


GPs’ discussion with patients

(Advanced care planning - choices)

5. What is its impact on patient comfort and symptom control?

Anticipatory Prescribing

Physical access to medication and treatment is assured.
clinical effectiveness
objective TIME
observation
remote anticipatory prescribing increased 24 hours availability
(out-of-hours)


The intervention seeks to improve [my] symptom control

pain, nausea and vomiting, agitation, and respiratory secretions.

The Covid-19 pandemic has accelerated the practice of Anticipatory Prescribing; more terminally ill patients are having end-of-life care at home and in care homes.

1. What is current practice?

New routes of administration

injection, oral, sublingual, or rectal

5. What is its impact on patient comfort and symptom control?
GPs’ decision-making processes
Research:
Systematic review and narrative synthesis
Semi-structured interviews
Web-based survey
An important intervention in supporting patients and families who wish to have last days of life care at home.

1. What is current practice?

2. What are the attitudes of patients?
3. What are the attitudes of family carers?
4. What are the attitudes of community healthcare professionals?
[collectively]

5. What is its impact on patient comfort and symptom control?
Patient and families’ well-being throughout the end-of-life journey

*There is concord and respect regards patient's spiritual well-being needs.

GPs’ discussion with family

family caregiver administration

The Independent Review of the Liverpool Care Pathway found that the use of Anticipatory Prescribing without adequate explanation or justification led to families being concerned about over-sedation and the medication hastening death.

1. What is current practice?

5. What is its impact on patient comfort and symptom control?

6. Is it cost-effective?

Revise pharmaceutical regulations to permit repurposing of anticipatory prescribing medications in care homes, wider community drug access, and recycling unused medications returned to pharmacies.
Address stock shortages.


Bowers B, Ryan R, Kuhn I, Barclay S (2019) Anticipatory prescribing of injectable medications for adults at the end of life in the community: A systematic literature review and narrative synthesis. Palliative Medicine 33(2): 160-177 https://doi.org/10.1177/0269216318815796

Antunes B, Bowers B, Winterburn I, Kelly MP, Brodrick R, Pollock K, Majumder M, Spathis A, Lawrie I, George R, Ryan R, Barclay S. (2020) Anticipatory prescribing in community end-of-life care in the UK and Ireland during the COVID-19 pandemic: online survey. BMJ Supportive & Palliative Care; http://dx.doi.org/10.1136/bmjspcare-2020-002394

Bowers B, Barclay SS, Pollock K, Barclay S (2020) General Practitioners’ decisions about prescribing end-of-life anticipatory medications: a qualitative study. British Journal of General Practice; 70(699) e731-739 https://doi.org/10.3399/bjgp20X712625 

 

Wednesday, March 24, 2021

Hodges' model: Not just rectilinear, but bubbles too ...

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

"To the holistic absorption by the One – upon which the success of so many religions and philosophies was premised for centuries – Sloterdijk opposes the proposition of a dyadic theory of intimacy. This is a distinction between an acute appearance of unity, experienced from a cosmic position of being fully contained inside a whole, and an ontological insistence that this position is itself contingent on a constitutive relationality. It is not possible to attain an overview, an outside bird’s-eye view of spheres (Neither Sun Nor Death, p263). By contrast, ... 


"Sloterdijk’s anthropological theory of shared, auto-poetic space, carries ontogenetic force. This is, by example, expressed in the discussion of the relationship between birth and thought, or between the birth of a child and that of a world.35 Sloterdijk dedicates the bulk of Bubbles to birth, providing a detailed discussion of intrauterine dwelling, including the sensory presence of liquids, soft bodies, the early experience of spatial boundaries, fluidal communion in the medium of blood, the constitution of an intimate acoustic bipolar sphere and, above all, cohabitation with the placenta, conceived as primal, anonymous companion. Intrauterine space is approached as the most vivid illustration of the spherological principle according to which coexistence precedes essence. At once enclosed and porous, poetic and connected, intrauterine space is the production of a dense and connected ‘two’: ‘What we call ‘mother and child’ in the abbreviated terms of subject-object language are, in their mode of being, only ever poles of a dynamic in-between’ (Bubbles, p320)." p.47.


By contrast, ... the relational ontology of spheres aims to rehabilitate the relation at the expense of the essential, and the situation at the expense of components (p151). Against any form of substantialism, a relational ontology emphasises the centrality of being-with [Mitsein] in relationships of mother and child, mesmerist and subject, therapist and patient, foetus and placenta, and so forth." p.47.


 
 



https://muse.jhu.edu/issue/39847

My source:

Duclos, V. (2019) Falling into Things: 
Peter Sloterdijk, Ontological Anthropology in the Monstrous. 
New Formations, 95, Spaces and Stories, pp. 37-53.

Tuesday, March 23, 2021

TEDxNHS #1 – Why teaching a man how to fish won’t solve food poverty

individual
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INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group


Friedrich
1845
Engels

 “social murder ...

 
 
... meeting too early a death."

My source:

https://www.tedxnhs.com/tedxnhs-unlocked/

Friday, March 19, 2021

Healthcare Systems & Services: Yes, attend to the battlements ...

 Yes, attend to the battlements, but 

don't neglect your 'Towers of Observation'?

Illustration by Luca D'Urbino: https://www.durbodesign.com/
 
individual
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INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
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group




"More than 27,000 tests have been carried out, with 459 positive results and eight deaths." p.20.



"A report last year estimated that there were some 100,000 vacancies across the health service." p.21.

My source:

Britain. The NHS and covid19. Is it ready? Britain’s NHS is well suited to dealing with crises. But it is overstretched and faces an enormous task. The politics of pandemics, The Economist. Mar 14th 2020, pp.20-21. https://www.economist.com/weeklyedition/2020-03-14

Illustration by Luca D'Urbino: https://www.durbodesign.com/

Thursday, March 18, 2021

Universal Health Coverage: Every Day - All Year - All Weathers [ #COP26 ]

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







Related posts on W2tQ:

Global Health

Universal Health Coverage

My source:

Wednesday, March 17, 2021

Does “#AI” stand for Augmenting Inequality in the era of Covid-19 healthcare? c/o BMJ

Fig 1 Cascading effects of health inequality and discrimination manifest in the design and use of artificial intelligence (AI) systems [BMJ]


Original graphic surgically re-rendered as per the knowledge (care) domains of Hodges' model:

individual
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INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group

My source: