Hodges Model: Need for a glossary and a comment!

Claire's use of Hodges model in residential care highlighted that terminology is an issue for some staff. This reminds me that a glossary is underway, but who knows when it will be completed. Some of the terms listed at present include:

• Career
• Conceptual framework
• (Care) Domain
• (Knowledge) Domain
• Model
• Situated
• Syndetic

Claire's application also flags the need to think practically about the model and not to get carried away with jargon. As the Health Care Assistants are engaged in care delivery what terms are being used? Are there any terms also common to Hodges model that staff already used? What are the core terms within Hodges model? These might be terms that Brian used in his course notes, plus some additions. Definitions would certainly help people adopt and use the model in a consistent way.

If you have any suggestions about definitions that would help, or specific terms you would like to see in a Hodges model glossary let me know and at least they can be added to the 'to do' list.

Before I close - thanks to Dan Bassill, Tutor/Mentor Connection, Chicago for his comment (our first through Blogger) to last month's post There Are Four P's in "Hodges model

Dan is also using graphics to create a simple, visual understanding of complex community and health ideas and provides an example link.

Hodges Model in Residential Care, Ireland

Claire Welford, Clinical Link Facilitator – Gerontology: a joint appointment between the National University of Ireland, Galway & The Nursing & Midwifery Planning Development Unit, HSE West - e-mailed me to say she is using Hodges' model.

It was great to hear this news. I put some questions to Claire as follows:

Q. What attracted you to Hodges model?

A. Its ability to address social needs.

Q. What are your objectives?

A. To prompt staff to address older people's social participation needs in long-stay residential care. To include all team members in care planning, including Health Care Assistants.

Q. How are you finding using the model - pros and cons (any surprises)?

A. No major problems yet. Some staff are struggling with new terminology. So many staff are used to Roper, Logan & Tierney, which I believe is not suitable for older person care.

Q. What feedback are you receiving from staff and students?

A. Staff as above. Students are interested and their Clinical Placement Co-ordinators have attended the educational sessions.

Q. Any comments from your colleagues?

A. User-Friendly. Succinct.

Q. Did you use any resources from the website, Brian's notes for example?

A. I didn't really use the notes, just used the general theory and went from there myself.

Q. Have you created any tools to help you, or do you feel there is something missing?

A. I have included assessment tools for nutrition, pressure sores, continence, manual handling and falls risk assessment.

Q. Would you be interested in doing a podcast interview, (if I can fully master the technical aspects)?

A. Happy to do a podcast. It would be great to see Hodges' model used more.

Q. Can you tell me about your role and work Claire?

A. For my role please see above, while my research interests include:

* Promoting quality care for older people.
* PhD work looking at autonomy in long-stay care of older people.
* Person-Centred Care.
* Action research/Qualitative methodologies.
* Currently a member of the Departments research cluster for older person research.

Claire also forwarded a publication on care planning in relation to the introduction of this model.

It sounds like Claire's use of Hodges model is at quite a high level, which supports the idea that the model is not prescriptive in terms of care philosophy or approach (note also the range of assessment tools). The way the model has been adopted also suggests it is quite accessible. Hodges' model is helping to extend the thinking and reflection of staff as they assess, plan and evaluate care in the residential setting.

For some people there may be a problem with Claire picking up the model and applying it in this way. Where is the evidence that the model is being used consistently? What about quality assurance? This brief Q&A sesssion prompts many more questions, that I hope we will have an opportunity to explore in the future.

On the other hand information literacy and knowledge management allied with the Web, are supposed to encourage the dissemination AND use of tools and resources. Given Claire's role and skills she has made a professional judgement, evaluated and appraised Hodges' model and found it of potential use and has set about testing her assumption. She is not doing this alone, but has Clinical Placement Co-ordinators on board. Quality assurance and detailed research do need to follow (this is why I created the website), but lack of this should not hamper progress.

Claire asked about keeping in touch - definitely - and thanks++ for sharing your work.

[For an introduction to Hodges model there is a 30 minute podcast.]

What are you - mathematician, book-reader or book-reading clock-watcher?

Sometimes you don't realise you are on a long-term cherry-picking escapade. I say escapade because this captures the rather haphazard, accidental and part-time nature of my fruit gathering.

In 1992 in the Engineering Computing Newsletter [SERC] Science and Engineering Research Council's EASE programme #38 p.4-5 Michael McCabe asked readers - "How would you label the quadrants of this diagram?"

I cannot find the brief article "Human Factors Aspects of User Interfaces Design" on the web, but I kept the original. It obviously meant something to me, McCabe shows why...

As a mathematician you might choose -

A clock-watcher -

- for a book-reader.

And a book-reading clockwatcher -

So, how would you label Hodges' model and does this say anything about how you would populate and read the model?

Advocacy No. 2

Where was I..? Oh yes - if we have largely withdrawn from the role of advocate, than what is left politically (no pun intended)? The nursing pioneers set an agenda that in many respects we have still not addressed. They made a difference - have we?

So what was the agenda set by the nursing pioneers and why does this matter now? Amongst many other things their efforts highlighted:

* the elements of basic nursing care
* importance of data - information - knowledge
* the diverse scope of nursing (health care)

They helped to define nursing and what constitutes nursing's standing agenda items. This post is not a denial of progress, because of course giant strides have been made, but where are we now? And, more crucially where do we need to be in the next 10, 20, fifty years...?

I cannot speak first-hand, because I am no longer at the sharp-end of general nursing care. From what the media says though what frequently passes as 'nursing care' these days fails to meet basic care needs. Especially, it seems when older people are the focus care delivery. Lobbying and action to protect the tenets of high quality basic nursing care is ongoing. This, however, is were our language changes and we shift from advocacy at that nurse-patient level to activism. What can nursing do as the population pyramid changes? And this is just the start as the issues in-tray is overflowing:

* ecosystem health - global warming
* global health: Aids, diarrhoea, TB...
* migration - refugee status
* public mental health
* health promotion
* public literacy, engagement, expectations
* ...

In order to wave a banner (never a shroud) effectively, you need hard and soft data. A banner is insufficient. Yes, true - it might get you noticed, but attention span is all with this issue set. That data needs to be transformed into information, knowledge - in short intelligence. All too frequently the facts we need are incomplete, inaccurate, or too late. Two circumstances are guaranteed:

1. There are facts critical to furthering the cause and
2. they are totally absent
(and not expected to arrive within the interval of a pregnant pause)

So much of what NU S NG does remains invisible. This must change.

We noted previously what the students may ask, I wonder what the pioneers would say? One thing for sure - they would not balk at the challenge and neither should we. Nurses as advocates begins with patients and their care, but it should not and must not end there.

There Are Four P's in "Hodges model"

People are not very good at multitasking (surprise, surprise!).

In conversation people discuss one topic or thing at a time. If the subject alters, the change of context is indicated through a verbal redirect "There's something else...", or a gesture. When writing, paragraphs help structure our prose. If there are several tasks to perform, then it really is a case of "one at a time thank you!". Although, as the saying goes though - where there's a will, there's a way - hence the constant emphasis on EFFECTIVE team working.

Reality is of course rarely presented to us in discrete contextualised packets. Experience is not always filtered to the extent that only information relating to one context is delivered to our senses. Can you imagine the informational equivalent of the IV drip? (Virtual reality?) And yet this is what our brains are tasked with, to select, sort and prioritise....

There are exceptions:- the arrival of news about an impending birth or sudden illness or accident. Then informationally speaking the world is ordered and yet a personal chaos ensues. We move like the wind...

So usually several contexts are knotted and presented together. Predicatable consequences may follow; confusion, a task may be left incomplete, risk becomes a dance partner, although at first this passes unnoticed as we are still going with the flow. A key message becomes garbled, the meaning fails to get through.

The amount of information needed by a team is erm... well - a big number! The demand for data and information on just process and policy is monumental. Project management tools are no guarantee against satisficing. The volume of information and human fallibility can fracture discipline and has us saying "that’s far enough", or "that will do for now".

So without untying the contexts, unwrapping the complexity - key parts of the picture may be missing. Sometimes even when the picture is complete, we forget about the frame and picture hook? Just which way is 'up' if that matters a[r]t all?

In the same way that items of data can have meta-data (that is data about data), could it be that Hodges’ care domains have their own meta-terms of reference? These terms characterise each of the care domains and their respective contents. In the same way that process is integral to project management, perhaps there are terms that can contribute to the overall effectiveness and scope of Hodges’ model? What I have in mind is the following:

Purpose Process
Practice Policy

Surely this rather complicates matters? For an artist this would actually prove a very limited palette. And yet this is a common strategy – reduce the palette to four colours. This greatly affects the 'masterpiece' assuring discipline and influencing style before the paint is even amb(r)ushed.

For project managers armed with their PM tools the 4Ps really are a handful, but well worth getting to grips with.

Advocacy No. 1

What’s your view on nurses as advocates?

For nurses advocacy is seen as a constant facet of the role. It may not be as pronounced these days, but it is always present. If a person (patient or carer) needs an advocate in that 'non-legal' sense, then as nurses we are ready and willing to assist and present the patient's views. Quite a few years ago there was much navel-gazing that questioned the appropriateness of nurses as advocates. Where are the boundaries and how do you define non-legal? How independent can nurses be?

This no doubt presaged the advent of formal and dedicated advocacy worker schemes, a development reinforced by the emphasis on human rights over the past decade. Rather than travelling along the care pathway WITH the patient, carer(s) and health care team, advocacy workers are ready to get involved - independently - as the care situation reaches a crossroads (and pauses momentarily). In my experience though it is not easy to find longer-term independent advocacy input. Sometimes it is the very need to call 'time' - to seek space to reflect and weigh pros and cons - that is an issue.

Unless their role is radically changed, nurses will always be an initial advocate. Nurses are in the midst of care, their privileged relationship and proximity to the patient, their knowledge of the issues, diagnosis, interventions and prognosis makes advocacy a natural (caring!) response. I raise this because if advocacy is a political concept and the nurse’s role as advocate is less than it used to be, then what is left - beyond the political essentials of pay & pensions?

This blog is in danger of becoming a litany of examples by which I reveal my age. ... Back in the late 1970s and 1980s nursing was far more political and in the UK those were certainly employee-employer troubled times. They had quite an effect did those Union badges! Metallic drops of red, blue and green that adorned so many lapels, instant decoration for the grey suit with waistcoat that I used to wear (my mum thought I looked smart for once). Mental health always seemed more, shall we say union-attuned, than general nursing and yes the power of the unions had a lot to answer for in the UK; but where are we today?

Acting as an advocate you really can make a difference. Individual needs are nursing's bread & butter; but why stop at one person, when the needs of the many...?

Perhaps my view on this is a personal illusion, brought on by the purchase of Jane Salvage's ‘Politics in Nursing’ (1985)? Did this book, like most, merely reflect the times? I must confess the book did not 'activate' me. (Although, as the website may demonstrate, my head was lost above the clouds.)

In my student and early years the advice was keep your nose clean; deposit your assignments on time into the school of nursing's coffers and get through the current placement. There were exceptions as might be expected in a huge aged asylum, though thankfully when necessary action did not fall upon the conscience of one individual (that takes real conviction, courage & dedication). The issue was 'public' witnessed by several colleagues, all dedicated to high quality care. A case of a problem shared…...

The point of all this: If nursing has largely withdrawn from the role of advocate, than what is left politically? Maybe for you nursing is still there, the sparks flying as the activists sharpen advocacy's edge? The nursing pioneers Nightingale, Seacole, Makiwane, Breckinridge, Walking Bear Yellowtail, Peplau; and many others set an agenda. To what extent have we (nurses) addressed this? What remains to be done and what new challenges do we face?

The pioneers made a real difference. Not only did they build the ship, they set us on a course. If I were a student I'd be shouting "Are we there yet!" Has nursing arrived? If not, why not, how can we correct course and where - in the time of constant re-invention - is the new horizon?

Multi-touch interface demo 10mins TED2006

If you have not already seen it - check out this video demo of a hands-on interface from TED2006 - Technology, Entertainment, Design conference in February featuring:

Jeff Han

I came across it c/o the Instructional Technology Forum. Enjoy.

TED2007 watch that space!

Podcast part 1: available at last....!

I've an audio file that I feel passes for muster. I've tried to inject some animation and enthusiasm, which is not easy at 0000 hours. Anyway - thanks to ccPublisher and the Internet Archive you can now download it if you wish.

In the podcast I mention that it will run for just under 30 minutes. In the end it's actually 31:33.4 - not too far out. There are no bells and whistles (thank goodness), no fancy opening music.

There are three files provided (a learning package?):

1. The podcast itself in mp3 at 30MB 128bit.
2. The podcast notes including my responses to the two questions posed.
3. A powerpoint summary of 10 slides.

At 30MB it is a large file, but it will I trust reward your patience. As I'm writing this I've just noticed that ccPublisher has also created a 64bit version 15MB, plus Ogg Vorbis 22.2MB (Open Source).

I've checked the files (except for the XML & OV) and they download fine.

If you find the podcast of help please let me know, especially if it proves useful within education. Wherever you are working, if Hodges model appears to offer something to you get in touch.

Part 2 will follow in due course, after I complete that other project...

Podcast part 1: delayed but ... this weekend!?

Well it's November and no podcast. Yes, mention was made of October, but I did say don't hold your breath. There are two test audio files at 27 mins and 25,000k that I can point to, so very nearly there except that the microphone stand (hey this guy's serious!) got in the way of my foot. Should be fully cooked and served this weekend, if the walking windmill can stand still...

I have to get part 1 through the door sharpish because I need to finally nail the Serres-Hodges paper. I've to reduce the current version from 8k words to between 5-7k when completed, which MUST be at the end of the month. To support this effort I'm reading 'Small Places, Large Issues' by Thomas Hylland Eriksen, excellent introduction to social and cultural anthropology.

Before I go (and gargle) the Idea Factory did the job in terms of my getting on board with Skype. I now have a working internet phone - at least the test call worked. It was easy to install too.

The event also rekindled a potential research question I've wondered about for many years. A question that like Hodges' model grows in relevance each year - more to follow ...