c/o [hifa] WHO Webinar: Compassion - mapped to Hodges' model

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

sympathy, empathy, compassion mental states, feelings, emotions communication (verbal - non-verbal) experience, sorrow, suffering personal ethics, learning reflection, self-compassion psychometric instruments mentor, role model listening, non-judgemental student idealism  meditation, contemplation (drug concordance) Poor psycho-	Research Teaching methods and methodologies measure compassion Technical competence diagnostic accuracy studies - literature (drug compliance) QUANTITY health & compassion as a 'science'
social support  QUALITY culture peer support - sharing reflexive, desire to help rapport, PRACTICE based research Research on empathy > compassion role models teamwork	better outcomes, public demand (for more compassionate) health workers - high workload mission statements Health Institutions Regulatory organizations Medical councils harassment - poor team functioning compassionate leadership

See also and c/o HIFA:
c/o [hifa] WHO Webinar: Compassion – the heart of quality people-centred health services

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

Governance:
"Yes, in theory and practice!"

SELF - individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - POPULATION

compassion	THEORY
PRACTICE	governance

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

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

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

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


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

RCN Congress 2026 & RCN North West Multicultural Group (NWMG)

England's North West is certainly in the news at present, on two counts:

1. The current Labour party machinations in the Makerfield ward;
2. and RCN Congress in Liverpool.

 As I attend Congress a key focus is the debates and how I can relate these to Hodges'model - (with some links to previous posts):

1. Nursing as a STEM profession
Matter for discussion submitted by the Eastern Board
That this meeting of RCN Congress discusses the recognition of nursing as a STEM (Science, Technology, Engineering, and Mathematics) profession, valuing the scientific, technical and analytical expertise of nurses.

STEM - science : technology : engineering : mathematics

2. Safe, ethical, person‑centred nursing
Resolution submitted by the Cheshire Branch
That this meeting of RCN Congress calls on RCN Council to urgently develop and implement a UK‑wide framework for realistic person‑centred care, ensuring that nursing practice is safe and ethical.

safe : ethics : person-centred 

3. Regular redeployment
Matter for discussion submitted by the Wiltshire Branch
That this meeting of RCN Congress discusses the impact of the daily redeployment of nursing staff on morale, team work and patient safety.

re- deployment

4. Unpaid hours
Matter for discussion submitted by the North East London Inner Branch
That this meeting of RCN Congress discusses the culture of nursing staff missing breaks and working beyond their contracted hours.

work

5. National safety standards for lone working
Resolution submitted by the Health and Safety Reps Committee
That this meeting of RCN Congress calls on RCN Council to lobby for the implementation of national safety standards for lone working, ensuring access to appropriate safety equipment, technology and protocols to protect staff across all care settings.

lone working

6. Accountable, compassionate and psychologically safe leadership
Matter for discussion submitted by the Cheshire Branch
That this meeting of RCN Congress discusses how the RCN can help create a culture where accountability, compassion, and psychological safety coexist, enabling managers to lead effectively while ensuring all staff feel respected and protected.

accountability : compassion : leadership 

7. Misinformation in health care
Matter for discussion submitted by the Women's Health Forum
That this meeting of RCN Congress discusses misinformation in health care and the impact this has on the nursing workforce.

misinformation : information disorder

8. Confidence to address racism
Matter for discussion submitted by the South West London Outer Branch
That this meeting of RCN Congress discusses how to build the confidence of nursing staff in addressing racism.

confidence : racism

Once again the North West Multicultural Group will have a stand:

The RCN North West Multicultural Group (NWMG) creates a community for members across the region from multicultural ethnic backgrounds to connect with each other, share their lived experience, knowledge and diverse ideas that help drive change around racism to ensure that their various organisations is the best place to work.

Membership is open to RCN members of Royal College of Nursing from multicultural backgrounds and their allies.

Mission statement: 

The aim of the North West Multicultural Group is to stand against racism and discrimination by using members lived experiences, encouraging organisations to be anti-racist and with the support of allies.  

Aims and objectives: 

• To raise the issues around race, discrimination and equality in the workplace and to find potential solutions. 
• To challenge misconceptions about people from different ethnic backgrounds.
• To recognise the skills and contribution to care for people from all backgrounds make.
• To acknowledge that racism is a social construct that needs to be eradicated together.  Together we are stronger.
• To be a platform for black, Asian and minority ethnic staff and allies to work collaboratively to address racism in practice.
• To help amplify the voice black, Asian and minority ethnic staff.
• To be role models, set examples as allies and develop confidence.
• To provide training and support about anti-racist practice.
• To work with the RCN to support campaigns to make sure communication is fit for purpose and acknowledges any cultural differences. 

Your executive team:

Chair: Olanike Babalola
Vice Chair: Susan Owen-Naz
Communications Officer: Mark Anthony

9. Advanced nursing practice
Resolution submitted by RCN Council
That this meeting of RCN Congress agrees that the RCN will act upon attempts to undermine advanced nursing practice.

advanced : practice : theory

10. Protecting nurse education
Resolution submitted by the Education Forum
That this meeting of RCN Congress asks RCN Council to lobby UK governments to protect nurse education from university sector economic pressures.

protect

11. Quality of clinical placements
Matter for discussion submitted by the Students Committee
That this meeting of RCN Congress discusses ways in which the quality of clinical placements can be ensured and consistent across all 4 countries.

quality : placement

12. Bank rates
Resolution submitted by the South Yorkshire Branch
That this meeting of RCN Congress demands that employers pay nursing staff bank shifts at their substantive rate.

pay

13. Are external reviews meaningful?
Matter for discussion submitted by the Midwifery Forum
That this meeting of RCN Congress discusses whether external reviews and inquiries are genuinely driving meaningful improvements in safety across health and social care.

inquiry : review

14. Improving acute mental health crisis services for children and young people
Resolution submitted by the London Board
That this meeting of RCN Congress calls on RCN Council to lobby UK governments to improve the provision of services to children and young people presenting in acute mental health crisis.

children : mental health

15. Access to specialist pain services
Matter for discussion submitted by the Pain and Palliative Care Forum
That this meeting of RCN Congress discusses access to specialist pain services and the role of the registered nurse in caring for those in pain.

pain

16. Palliative and end-of-life care
Resolution submitted by the Pain and Palliative Care Forum
That this meeting of RCN Congress calls on RCN Council to lobby UK governments to ensure everyone living across all 4 nations has access to specialist palliative and end-of-life care.

palliative

17. Accessible and affordable travel
Matter for discussion submitted by the North Central London Inner Branch
That this meeting of RCN Congress discusses what accessible and affordable travel means for the nursing workforce.

18. Uptake of physical health checks
Resolution submitted by the Public Health Forum
That this meeting of RCN Congress requests RCN Council to lobby UK governments to improve the uptake of physical health checks for people with learning disabilities and serious mental illnesses (SMI).

serious mental illness (SMI)

19. Eye donation
Matter for discussion submitted by the Greater Glasgow Branch
That this meeting of RCN Congress discusses the role nursing has in eye donation in end-of-life care planning.

eye : vision

20. 35-hour week
Resolution submitted by the Lothian and Borders Branch
That this meeting of RCN Congress calls on RCN Council to instigate a campaign for a maximum 35 hour working week for the nursing workforce.

21. Inappropriate delegation
Matter for discussion submitted by the Berkshire Branch
That this meeting of RCN Congress discusses the delegation of health care tasks to school staff and non-health care professionals.

22. Access to medicinal cannabis
Matter for discussion submitted by the Cheshire Branch
That this meeting of RCN Congress discusses the impact of current NHS prescribing practice on access to medicinal cannabis.

medicinal cannabis

23. SPA time
Resolution submitted by the Wiltshire Branch
That this meeting of RCN Congress calls on RCN Council to lobby for the inclusion of Supporting Professional Activities (SPA) time in all nursing job-plans.

See: https://www.rcn.org.uk/Congress/Agenda 

Are there any lessons from this exercise? Well, I have no posts tagged 'donor', or 'medicinal cannabis' - to make an important distinction. Something to correct and try to follow this week. 

See you there ...?

(I may need to reduce the link-count here.) 

Paper: Geopolitical factors and mental health I [mapped to h2cm]

" ... we propose that mental health must be seen as a key strategic goal of foreign policy and be used as a measure of success of the foreign aid to ensure that individual people with mental illness are guaranteed a role and support in the civil society and their needs – clinical or social – do not get swept under the carpet. To this end, we examine some key statistics and to address the mental health needs of those worst placed, we propose an index – the Compassion, Action, Pragmatism and Evidence (CAPE) Vulnerability Index – that identifies the most vulnerable communities so that international aid may be more appropriately targeted, possibly ‘ring fenced’ making mental health a strategic building block of foreign policy." p.779.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

wither mental health in relief, shorter life compared with general population,  poverty including  As a child As an adult Vicious cycle 1: Disaster experiences - mental health Traumatic Stress Disorder**

Natural & man-made disasters, health crises, e.g. Ebola, Conflict, War Climate warming Humanitarian intervention: Emphasis on physical survival and physical health Statistics: globally Proposed index: the Compassion, Action, Pragmatism and Evidence (CAPE) Vulnerability Index – that identifies the most vulnerable communities

Vicious cycle 1: [**Intergenerational transmission of stress and trauma - Epigenetics, social memory]  Social upheaval, migration and displacement mental illnesses assoc with social failures such as poor parenting, school failure, domestic violence and toxic stress, impacted prospects on earning a living, stigma social exclusion Social Determinants of Health Displacement refugees, poverty, women, children,  trafficking, rape

Foreign Policy Relief: mental illness = denial of - human rights, vote, marriage, inheritance, make a will Vicious cycle 2: corruption - inequality sequestration of assets crime, law & order Disaster ('declaration') Mental health problems cost the world some US$2.5 trillion per year  (US$16.1 trillion by 2030) Foreign aid & assistance Foreign policy Populism

Persaud, A. et al. (2018) Geopolitical factors and mental health I. International Journal of Social Psychiatry, 64(8) 778–785. DOI: 10.1177/0020764018808548
https://journals.sagepub.com/doi/abs/10.1177/0020764018808548?journalCode=ispa&

n.b. I have added epigenetics and the intergenerational transmission of stress and trauma.

ImROC: Briefing Paper 24 - Recovering Adult Acute Psychiatric Inpatient Wards

"Explanation, compassion and a holistic understanding of the person’s situation are critical (Royal College of Psychiatrists, 2017)." p.39.

(my emphasis)

"It requires practitioners to critically reflect on their values, beliefs, and biases and actively work to reduce as far as is possible the oppressive systems and practices within inpatient wards." p.15.

What models / frameworks for/of care do practitioners use? 

What models invite - are primed for:

• critical reflection (individually, or as a group, p.56)?
• recognition of oppressive situations, phenomena, ethical dilemmas?
• citizenship - citizenry (p.18)?
• deciding whether it is a journey, or not?
• a possible role in burnout (p.54) mitigation?
• reflection, development, and restoration (p.56)?
• are all models situated?

Individual
   |

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :   POLITICAL 

|

Group

neurotypical neurodivergent/autistic [Yes.] Can what has been stressed for decades - compassion, listening, validating, empathy, rapport, the therapeutic alliance, seeing the person ... in mental health nurse education, theory and practice, be strengthened through review of skill-mix, and workforce? Whilst, in-turn, being sensitive to the pressures on mental health RNs, as cohorts of students, seek to assure their learning experiences; and as qualified nurses old and new seek to protect their professional identity, values, standards, and ethics - responsive to the demands of the 21st century.

close to home transport physical environment: noise, smells, space, decor, light.. While (originally?) aimed at elective in-patient care, the mantra of discharge planning begins upon admission (even before) has reached mental health services and community mental health teams. Even as the reduced number of beds (perversely) provides ideal conditions, this should (must) not mean the 'game' becomes 'pass the parcel', 'musical chairs' - the person lost in the many processes.

Hell is other people - as the saying goes ... When the therapeutic value and potential of relationships are recognised, the need for a tool to identify and critique what is relational is even more critical. Not just to realise what has long-been psycho-social, but the 'alt-def' of person-centred. This demands simultaneity in assurance. We contrast the humanistic with the mechanistic - service-centred. Let's not forget the need for integrated** care. See community/society as the safety net it can be. So DO NOT: raise a patient's / family's expectations (p.49) only to let them down.

least restrictive Let's not re-learn the lessons of history, but if you insist...?^ One mention of (social) 'determinants' (p.37)! Please take a look out of the [safety] window; and beyond the APPG Committee room...  Wither ambition, courage in policy - to discover what is evidence-based (the lesson since 5th July 1948)? In-patient care is too late.* For sustainable health services and systems we need to act sooner, educate, to try to address all the determinants. Please remember what 'you' (through policy..) have done to the patient as a concept: patiency. <- Recovery carries political heft.

Please remember what 'you' (through policy..) have done to the patient as a concept: patiency. Recovery carries political heft. No one wants to create, foster, instill dependency, but (emotional labour) care delivery demands space and time: being with, or at least available.

*If this was the guiding principle for all disciplines, stakeholders, policymakers, researchers could this:

• place emphasis (again) on prevention; staying well - relapse prevention;
• help generate alternate modalities for therapy / care;
• help concentrate services to deliver person-centred, recovery and trauma informed in-patient experiences - where therapeutic outcomes are  at least feasible/possible;
• begin from literacy-first stance: take up educational focus in schools - PSHE, work-place;
• health career - life chances?

**physical-mental, care context, philosophy of care - trauma - recovery - strengths, funding, disciplines, pastoral, health - social care - housing ...

^Dept. of Health. Caring for people: the CPA for people with a mental illness referred to specialist mental health services. London: 1990

Joint Health/Social Services Circular  C(90)23/LASSL(90)11

Rachel Perkins, Sharon Gibbard, Yasmin Blackwood, Simon Barnitt, Lowri Smith, Anna Cheetham, Poppy Repper, Anne Rackham, Ben Dorey, Jo Luck, Julie Repper. Recovering Adult Acute Psychiatric Inpatient Wards: Creating Recovery-Focused, Trauma-Informed and Neuro-Inclusive Culture, Relationships and Practice. ImROC. Briefing Paper 24. 2024.


See also:

ImROC (2023) Thinking about Recovery Together

ImROC (2023a) Team Recovery Implementation Plan for Acute Inpatient Wards

Wand, T. (2024), We have to cancel psychiatric nursing and forge a new way forward. Int J Mental Health Nurs. https://doi.org/10.1111/inm.13301

Warrender, D., Connell, C., Jones, E., Monteux, S., Colwell, L., Laker, C. et al. (2024) Mental health deserves better: Resisting the dilution of specialist pre-registration mental health nurse education in the United Kingdom. International Journal of Mental Health Nursing, 33, 202–212. Available from: https://doi.org/10.1111/inm.13236

Plus:
Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311.

Nursing Rubens

6Cs Care Compassion Competence Communication Courage Commitment

Rubens Tour - themes Poetry Elegance Power Compassion Violence Lust

Health as Art and Science?

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

(Lust, Royal Academy of Arts, Gallery Guide)

Rubens and His Legacy

B(e) nurse

Fundamentals of Care - mapped to Hodges' model

I came across a paper on 'fundamental care':

Jackson, Debra & Kozlowska, Olga. (2018). Fundamental care - the quest for evidence. Journal of Clinical Nursing. 27. 10.1111/jocn.14382. 

The definition Prof. Jackson subsequently pointed to is as follows:

"Fundamental care involves actions on the part of the nurse that respect and focus on a person’s essential needs to ensure their physical and psychosocial wellbeing. These needs are met by developing a positive and trusting relationship with the person being cared for as well as their family/carers."

I've taken the fundamentals of care from the International Learning Collaborative and mapped them to Hodges' model. The psychosocial list has been divided across the two applicable domains - you'll see what I've done.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

PSYCHOsocial fundamentals of care Communication (verbal and non-verbal) Privacy Education and information Emotional wellbeing Choice Having values and beliefs considered and respected

Physical fundamentals of care Personal cleansing (including oral/mouth care) and dressing Toileting needs Eating and drinking Rest and sleep Mobility Comfort (pain management, breathing easily, temperature control) Safety (risk assessment & management, infection prevention, minimising complications) Medication management

PsychoSOCIAL fundamentals of care Being involved and informed Dignity Respect Education and information Having values and beliefs considered and respected Social engagement, company and support Feeling able to express opinions and needs without care being compromised Having interests and priorities considered and accommodated (where possible) Relational fundamentals of care Active listening Empathy Engaging with patients Compassion Being present and with patients Supporting and involving families and carers Helping patients to cope Working with patients to set, achieve and evaluate progression of goals Helping patients to stay calm

As this domain seems to be 'empty', I  will add some thoughts in the POLITICAL domain...  You can imagine a series of layers here.  As per the physical fundamentals above include - safety and homeostasis would be uppermost. Difficulties in the above instantly raise alarm bells and the old chestnut construct of dependency.  The lack of specifics on mental health suggests something that is incomplete and appears to assume a certain degree of functioning? The psychosocial actions invariably overlap and with the relational. We are hopefully socialised into dignity, respect, compassion, empathy and related attributes. What impacts  on a person's privacy, dignity may vary from person to person to some extent. This however introduces the humanistic care of engaging with people, their carers and the need to be person-centred. On privacy ... and preserving the integrity of an individual (and their 'group'), there are of course (duty of care and) professional standards (in this domain) that help guide our advocacy and accountability. Clearly, there is much to do..

Previous posts on 'fundamental-ism'

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

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

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

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

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

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

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

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

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

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

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

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

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

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

Reminded via:

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

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

memo FROM: Classroom health TO: Global health - PSHE education and model standards

Health care and educational professionals learn and adopt the key tools of the trade whilst training. Although for several decades experiential learning has also gained recognition and weight, it is the learning of theory and relation to practice in basic training that shapes the future career. We can describe this as formative professional education. We then trust that this learning and the tools in use are updated according to research, evidence and best practice. There is much navel gazing at present as to how to measure, nurture, instill and strengthen the character trait of compassion. This applies not only to children, but within nursing.

This issue highlights of course what students bring with them to the lecture theatre, clinical arena and what they take from there to carry them through their professional career. My ideal would be that students have already learned and used Hodges' model as 14-16 year old's, as they negotiate their personal, social, health and economic (PSHE) education.

While Hodges' model is a world away from a de jure standard
- that is, defined and enforced by the ISO -
it might just :) become a de facto standard,
because of its widespread adoption in and beyond the classroom.

There is a great opportunity here for Hodges' model in the UK as PSHE education becomes compulsory in 2011. Perhaps you can help in or beyond the UK?

Reference:
Mooney, H. (2009). Can you measure compassion?, Nursing Times, 21 April 2009.

Blog post inspired by adamatronics groups.drupal.org Drupal in Education: Joint effort on a D6 SCORM API

tags: 'preventive medicine' + 'preventive medical sociology'?

"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'

A sentence in a word - precarity - and a bad spell of 'whether'

In the past couple of months I've acquired three books to review. One of them is:

Philosophical And Theoretical Perspectives For Advanced Nursing Practice, Cody.

I'm pleased to say that over half the book now has extra notes (in pencil). Within the text and my reflections there are a great many potential posts. In chapter 18 though Doane and Varcoe write:

Subsequently, there has been little discussion about what is required to develop and enact that sensitivity and/or the knowledge, capacities, and skills required for ethical and responsive nursing relationships within the complexities of current health-care milieus. For example, as social inequalities deepen and neoliberal ideologies hold individuals responsible for their own health and well-being regardless of how poverty, disability, remote geographical locations, or other inequalities determine health, notions of obligation, responsibility, accountability, and efficiency are as vital to nursing relationships as are notions of compassion, responsiveness, trust and respect. Thus, nurses require a broader understanding of relationships and their significance to ethical nursing practice. p.204.

The sentence in (my) italics can be summed up in one word - a recently discovered concept for me - that of: precarity.

Here the definition on Wikipedia (c/o the above link):

Precarity is a condition of existence without predictability or security, affecting material or psychological welfare. Specifically, it is applied to the condition of intermittent or underemployment and the resultant precarious existence. The social class defined by this condition has been termed the precariat.

Nursing is bound to be affected by the socio-economic environment. Caution is needed as the weather impacts, puts pressure on nursing's values.

Doane, G.H., Varcoa, C. (2013). Relational Practice and Nursing Obligations. In Philosophical and Theoretical Perspectives for Advanced Nursing Practice (5th ed.), by W. K. Cody (Ed.). (Burlington, MA: Jones and Bartlett.

Nursing human rights and Int. Human Rights Day: fao Sir Gerry Robinson

On last nights BBC Two TV program: Can Gerry Robinson Fix Dementia Care Homes?

- amongst the angst his visits and engagement with several care homes provoked Sir Gerry highlighted the need for a moral compass and compassion. The themes I expected to find were there: the need for person-centered care, knowledge of the clients and their backgrounds, being occupied and having access to a secure environment when the weather permits, staff morale and the level of staff training and competence. Although not necessarily 'enjoyable' viewing the program was very good in raising awareness and included either directly or indirectly:

person-centered care, attitude, memory loss, vulnerable individuals, training, risk, assessment, review, motivation to change, interpersonal skills, motivation, listening, life skills, knowledge and skills, feedback, aggression, agitation, change, measures, rapport, empathy, +ve care, boredom, diurnal variation of mood, personal choice & autonomy	physical environment, colour, decor, noise, outside access, physical security, nutrition, tasks, processes, measures 'dementia care mapping', routine, meal times, time, physical risk - falls, mobility, assessment, care files (paper!), bed occupancy, staffing : resident ratios, models of care
the residents, visitors, family, love, social attitudes, dignity and respect, relationships, social values, personal-social history, engaged activities, involvement, 'social' norms, inclusion, community - institution, being valued by others, distraction	records, freedom, care funding costs / weekly charges, funding, inspection, consultancy, audit, legislation, rules (meals), pay, investment, business, staff morale, recruitment and retention, financial risk, confidentiality, plans and initiatives, management style, qualifications, standards

Today 10 December 2009 is also International Human Rights Day. To many people elderly care issues in a Western democracy may seem a world away from 'human rights' as per:

• false imprisonment
• denial of justice, law and order
• political repression
• freedom of expression
• education and health for all
• discrimination
• ....

- and yet the situations that arise within nursing, health, social care are never far from ethical and human rights concerns:

• Mental capacity
• Consent
• Physical restraint
• Mental health law
• Environmental health law
• Conscientious objection
• Medicine and nursing in the armed forces
• Equity and equality
• Accessibility
• ....

Moral dilemmas can and do arise in any and all of the care domains of Hodges' model and all combined (the spiritual). In addition to a moral compass, it seems we need a compass in nursing in order to be compass-ionate.

Hodges' model can provide a compass.

A compass to help navigate open waters, new coastlines and the uncharted corners and recesses of human nature.


Additional links: Amnesty International

POLITICAL care domain resources


Compass image: http://clipart-for-free.blogspot.com/2008/07/compass-rose-clipart.html

What is the foundation of h2cm? Gabora & Aerts 2009

I've described h2cm as a foundation, a substrate for the health and social care assessments that follow. And that's the question: what is there before the conceptual framework is populated? As a foundation the model is initially empty, void, null. In terms of theory, practice, values and judgements there are none. The piece of paper is blank. So is the screen. Once (quickly) learned, the professionals have the conceptual framework in mind (ready to call upon), but it is not exercised. Until they encounter a patient, client, carer amid a situation, the conceptual space is empty.

Lund, Hobykrok B&B in the distance - the farm track

If we allow for the structure to permanently reside what then? Does this situation produce an array of potential? An array of potential concepts? Nurses are used to potential and actual problems (often re-framed as strengths). It seems this is the case with language, the amazing compositional scope of different words to produce sentences and meanings.

In a way I don't want to venture into this space. There are monsters there. I know the above is far removed from nursing. Where is  compassion, dignity, respect, plans and empathy in all this? ... Once the care concepts are realised then: yes - do lead the way. But before the light is turned on: no.

No: but there is no choice. The question needs to be asked and settled.

Liane Gabora gave a talk at Conceptual Spaces At Work. Checking back on her previous work I found this (SCOP: State COntext Property theory of concepts):

An important notion in SCOP is the ground state of a concept, denoted p. This is the ‘raw’ or ‘undisturbed’ state of a concept; the state it is in when it is not being evoked or thought about, not participating in the structuring of a conscious experience (such as, most likely, the concept ZEBRA when you began reading this paper). The ground state is the state of being not disturbed at all by the context. One never experiences a concept in its ground state; it is always evoked in some context. The notion of ground state is somewhat similar to the notion of prototype. The ground state is a theoretical construct; it cannot be observed directly but only indirectly through how the concept interacts with various contexts (which may include other concepts). p. 436.

Gabora, L., Aerts, D. (2009) A model of the emergence and evolution of integrated worldviews, Journal of Mathematical Psychology. 53, 434–451.

Narketpally syndrome: A different approach to medical education and research

From: Marc Jamoulle
MD (UCL 1974), PhD (ULg 2017)
Family physician, Belgium (INAMI 15324119004)
marc.jamoulle AT uliege.be
Associate researcher at HEC-Liège, BAS-SCM, University of Liège, University of Rouen, D2IM & CAMG-UCL, Brussels

hi friends,

in an unknown syndrome, another way to deal with the patient, to learn from the patient, to develop a partnership with the patient, caring while waiting for the cure,

Jamoulle, M., & Soylu, S. (2025). Phenotyping Long COVID in Children in Primary Care: A Case-Based Study Using the Human Phenotype Ontology. ORBi-University of Liège. https://orbi.uliege.be/handle/2268/334447

From: Rakesh Biswas
rakesh7biswas AT gmail.com

This paper illustrates a global patient-centered learning ecosystem, anchored in Narketpally, that adopts a syndromic approach to medical education and research. Rooted in the etymological origins of 'syndrome' ("together we flow"), this approach reframes medical research as a collective, contextual response to individual patient needs.

https://pubmed.ncbi.nlm.nih.gov/40674544/

Methods: The structure of the paper is intentionally modeled as a team-based learning exercise, grounded in our prior Web 2.0-based cognitive tools: CBBLE (Case-Based Blended Learning Ecosystem) https://pmc.ncbi.nlm.nih.gov/articles/PMC6163835/ and PaJR (Patient Journey Record) https://pajr.in/. These are framed against the conceptual scaffolding provided by three key publications: a framework by Sturmberg et al. and two contrasting commentaries by Greenhalgh and Ioannidis.

Results: Through our ongoing CBBLE-PaJR workflow, thematic learning outcomes emerged in response to these frameworks. Sturmberg's stratified realism helped us recognize how individual patient connections, recorded in our daily practice and online learning portfolios, can drive both contextual learning and meaningful changes in patient outcomes. Greenhalgh's commentary inspired our conceptualization of a 'wildebeest river crossing value model,' contrasting population-based efficiency with individual-centered compassion. Ioannidis's critique of methodological rigor highlighted the potential for expanding low-resource, high-impact research through patient-centered designs, particularly in phases 1 and 4 of the clinical trial hierarchy.

Podder, V., Kulkarni, R., Samitinjay, A., Salam, A., Gade, S., Agrawal, M., Surendran, A. K., & Biswas, R. (2025). Narketpally Syndrome and the Embedding of Contextual Values in Real-Life Patient Pathways. Journal of evaluation in clinical practice, 31(5), e70186. https://doi.org/10.1111/jep.70186
[Citation added PJ].
--

My source:
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Reflection, Revalidation, RCN Congress and Research

Thinking Out Loud: Journal 'Regulars'

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

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

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

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

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

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

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

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

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

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

Be Well :: Be Safe All

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

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

Auction: Twenty-two photographs of psychiatric patients at the Surrey County Lunatic Asylum [1850s]

DIAMOND, Dr Hugh Welch (1808–1886)

Twenty-two photographs of psychiatric patients at the Surrey County Lunatic Asylum [1850s]

Estimate - GBP 100,000 – GBP 200,000

Christie's London - December 10th 2025

https://www.christies.com/en/lot/lot-6564110?ldp_breadcrumb=back

Asylum patient by Hugh Welch Diamond, c1850-58
Hugh Welch Diamond (English, 1808-1886)
Public domain, via Wikimedia Commons

'The women Iook out at us across 170 years of history with a variety of expressions - bold and shy, serene and distressed. Yet all of them were regarded at the time as "lunatics". These faces were the  subjects of a pioneering project by the 19th-century psychiatrist Hugh Welch Diamond, superintendent of the female division of an asylum in London and the world's first photographer to take pictures of patients for the purpose of diagnosis and therapy.

Twenty-two of Diamond's asylum portraits - the largest surviving group - will be put up for auction on December 10 at Christie's in London, as part of a sale of books, manuscripts and photographs from the library of The Royal Society of Medicine. If they achieve their estimated prices, RSM, a membership charity, will raise more than £2mn to invest in physical and digital infrastructure.' ...

'Diamond was working at a time when society's views of people suffering from mental illness were changing. The earlier practice of shutting patients away in secure "madhouses" was giving way to more humane treatment. Diamond seems to have believed that photography would help doctors both to diagnose and to treat patients. His diagnoses were based partly on the idea, popular in Victorian medical circles, that an individual's physiognomy - their physical features, particularly the face - could reveal their mental state.

"He wanted to make people better and put them back into the world," says Sharrona Pearl, a medical historian at Texas Christian University who has studied Diamond's work. "He also enjoyed experimenting and liked the idea of bridging his expertise in medicine and photography.' p.32.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

Mental Illness PERSON - SUBJECT Patient's names not recorded Portrait - Consent?	Diagnosis and Treatment person - DATA - SUBJECT Photography as records Eagerness to classify - label
Social history Change in social attitudes Stigma and fear of mental illness Current relatives?	Confidentiality Institutional change Power imbalance Shift from 'custodial' to health care

My source:
Clive Cookson, Mind Hunter, FT Magazine, November 15, 2025, 1151, pp.30-34.

I have noticed Prof. Brendan Kelly is a regular FT respondent, as with this article:

'These photographs were likely to have been taken without meaningful consent and in the context of power imbalance. Yet publication can reclaim their individuality, address historical injustice and underscore our common humanity. Compassion, respect and humility should guide decisions. 

 Proceeds should support medical, educational, or justice-oriented programmes. Most importantly honouring forgotten patients of the past demands better care for people with mental illness today, who often languish, neglected, in homeless hostels or prisons. We can do better.'

Brendan Kelly Professor of Psychiatry, Trinity College, Dublin, Ireland.

Letters, FT Weekend. 22-23 November 2025, p.10.

See also: 'asylum' : 'photos'