Questions in eclipse

 Last Friday 9th I had a Zoom chat for 30 mins, regards Hodges' model with faculty in the USA.

We touched upon:

• background to Hodges' model
• courses taught across the water and interests
• overlaps, inc. person-centered care - socio-technical
• informatics & literacies
• maths/logic

As an outcome it was suggested I forward some questions I'm currently of Hodges' model. Questions that for me, are challenging, put me in the dark, and may not even be valid?

Going through my draft notes I picked out 20, beginning with the working title:

Hodges’ Model as a mathematical object and relational ontology:
category theory or category mistake?

1. Can it be argued there is what amounts to a care locus - that can 'locate' person-centredness?
   
   
2. Can the model's domains be seen as functions?
   
   
3. Are the domains placeholders?
   
   
4. Is there a case to test, and if logical implement co-domains (e.g. parity of esteem)?
   
   
5. Are there other 'structures' in Hodges' model,  for example L-shaped forms, that is relations that involve three domains and (seemingly) omit one?
   
   
6. Are there practical - case studies - that can be associated with such structures?
   
   
7. Can Hodges' model be considered as a single conceptual space (Gärdenfors), or a series of four? (blog posts)
   
   
8. Can Hodges' model be used to identify and apply threshold concepts (Meyer & Land)? (blog posts)
   
   
9. Can we argue that the structure of Hodges’ model as defined by the axes extent, provides and invites inverse relations?
   
   
10. Is Hodges' model as a structure only (a template) equivalent to an empty set (empty set as an initial object)?
11. Is this a mathematical analogue (being neutral) to a practitioner's unconditional positive regard?
    
    
12. Taking its axes and four (care/knowledge) domains can Hodges' model be reduced to a graph?
    
    
13. If Hodges' model acknowledges/incorporates Cartesian duality, are there Cartesian products?
    
    
14. In these Cartesian products are critical operations, e.g. relating to psychotropics - physical health; eating disorder - physical/mental health; complex emotional needs - policy (evidence-based care)?
    
    
15. If the model is inverted, mirrored ... what follows: is the structure - function - consistency retained?

    
    
16. Is Hodges' model 'closed' in comparison with Buzan's (open?) approach to mind-mapping?
    
    
17. There is an 'equation of time': is there an 'equation of care'?
    
    
18. Thought experiments: (semantic distance... cognitive linguistics)
    
    

    Which concept (INTERPERSONAL :: SCIENCES) is closer to the ‘INDIVIDUAL’ axes; which is closest to the ‘GROUP’ (SOCIOLOGY :: POLITICAL)?

    
    

    Which concept (SOCIOLOGY :: INTERPERSONAL) is closer to the HUMANISTIC axes; which is closest to the MECHANISTIC (SCIENCES :: POLITICAL)?

    
    
19. Role of 'types' in Hodges' model - that is, patient / model as a whole as objects (with identity)?
    
    
20. What significance can be gleaned given commonality between several mathematical terms, e.g. group, object, (co-)domain and Hodges' model?

I can no doubt structure - group these questions, and I've not picked out many concerned with Hodges' model as a set, or, as yet, those venturing into category theory. I am wondering, what the commutative law might tell us about holistic, integrated care, and parity of esteem when applied through Hodges' model? Also refining 3-4 case examples to explore and illustrate the same?

While it is maths that prompts this diversion, perhaps ultimately health care disciplines can determine its own formal approach that can produce its own context-sensitive rules, that straddle mathematics/logic and the humanities?

In initial emails, I'd noted the forthcoming eclipse across the USA. Checking, my interlocutor is just N of the path of totality (I wish!) for April's total eclipse. I'm enjoying the darkness here too.

https://science.nasa.gov/eclipses/future-eclipses/eclipse-2024/where-when/

#TotalEclipse2024 #SolarEclipse2024

Leapspace? Why not ...?

Referred to a paper in an email: https://doi.org/10.1016/j.jclinepi.2026.112401.

- I noticed an invitation to try Leapspace. 

So I leapt (with much editing - for formatting here). ...

 

Copilot steps

Creating a plan to respond to your query

Performing search for foundational documents
Performing keyword search
Using data from Scopus
("Hodges' model" OR "Hodges model" OR "Hodges' health career model" OR "health career model" OR "care domains model") AND (nursing OR healthcare OR "health care" OR education) AND (domain* OR component* OR framework OR concept* OR definition*)

Performing natural language search
Using data from Scopus
What are the conceptual definitions, domains, and components of Hodges' model in nursing and healthcare education?

Performing keyword search
Using data from Full text
("Hodges' model" OR "Hodges model" OR "care domains") AND (diagram* OR figure* OR visual* OR schema) AND (teach* OR education OR curriculum OR learning) AND (critique OR adaptation* OR application*) AND (method* OR framework OR discussion)

Performing natural language search
Using data from Full text
How is Hodges' model represented, taught, and adapted in nursing or healthcare education, including diagrams and critiques?

Performing keyword search
Using data from Scopus
("Hodges' model" OR "Hodges model" OR "care domains framework") AND (application* OR use OR implementation OR practice) AND (critique* OR limitation* OR adaptation* OR evaluation*) AND (nursing OR healthcare OR "health care")

Performing natural language search
Using data from Scopus
What applications and critiques of Hodges' care domains framework have been reported in nursing and healthcare practice?

Done

Generated by LeapSpace, Thu Jul 09 2026

Hodges' health career - care domains - model

Hodges’ Health Career – Care Domains – Model is a generic, practice-based conceptual framework for health and social care that organizes thinking into four knowledge/care domains: science, political, sociology, and interpersonal. It is presented as broadly applicable across healthcare contexts and is used to structure reflection, critical thinking, and care planning. [1] [2] [3]

Core domains

Domain	What it covers	How it is used
Science	Cause and effect, evidence, costs, benefits, and trade-offs	Helps frame the “hard” evidence side of care and service decisions. [1]
Political	Policy, systems, and structural influences on care	Helps connect care to wider health and social policy contexts. [1] [4]
Sociology	Social context, culture, stigma, and relationships	Helps explain how social factors shape health and illness experiences. [1] [5]
Interpersonal	Therapeutic relationships, patient/carer engagement, and human interaction	Supports person-centred and relational practice. [1] [2] [6]

What the model is for

• It is described as universal in structure and adaptable to many healthcare settings, including informatics, dementia/palliative care, forensic mental health, and oral health. [2] [3] [4] [7] [8]

• It helps practitioners map concepts into domains, build a mind-map-like structure, and support reflective practice and critical thinking. [3] [9]

• In forensic mental health nursing, it is proposed as a way to guide assessment, decision-making, and recovery-oriented practice. [2]

Bottom line

Hodges’ model is best understood as a four-domain lens for integrating clinical evidence, policy, social context, and relationships into one framework for care and reflection. Its main value is not in prescribing a single care process, but in helping users think more holistically and systematically about health problems and care systems. [1] [2] [3]

Confidence level: High — multiple sources consistently describe the model’s four domains, generic structure, and broad healthcare applications.

References

1. Fox, Siobhán, FitzGerald, Carol, Harrison Dening, Karen, (...), Timmons, Suzanne (2017) Better palliative care for people with a dementia: summary of interdisciplinary workshop highlighting current gaps and recommendations for future research. BMC Palliative Care. https://doi.org/10.1186/s12904-017-0221-0

2. Doyle, M., Jones, P. (2013) Hodges' Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/j.1365-2850.2012.01961.x

3. Jones, P., Wirnitzer, K. (2022) Hodges' model: The Sustainable Development Goals and public health - Universal health coverage demands a universal framework. BMJ Nutrition, Prevention and Health. https://doi.org/10.1136/bmjnph-2021-000254

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

5. Jones, P. (2008) Exploring serres' atlas, Hodges' knowledge domains and the fusion of informatics and cultural horizons. Social Information Technology: Connecting Society and Cultural Issues. https://doi.org/10.4018/978-1-59904-774-4.ch007

6. Merritt, M.K., Procter, N. (2010) Conceptualising the functional role of mental health consultation-liaison nurse in multi-morbidity, using Peplau's nursing theory. Contemporary Nurse. https://doi.org/10.5172/conu.2010.34.2.158

7. Jones, P. (2009) Socio-technical structures, 4Ps and hodges' model. Nursing and Clinical Informatics: Socio-Technical Approaches. https://doi.org/10.4018/978-1-60566-234-3.ch011

8. Jones, P. (2011) Socio-technical structures, 4Ps and hodges' model. Clinical Technologies: Concepts, Methodologies, Tools and Applications. https://doi.org/10.4018/978-1-60960-561-2.ch215

9. 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. https://doi.org/10.1111/jep.70252

Follow-up Suggestions 

What are the key components of Hodges' health career care domains model?

How does Hodges' model apply to interdisciplinary health care practices?

What are the implications of Hodges' health career care domains model for patient-centered care?

Hodges' model: What is the Question? (ii)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

What is the basis for meta-cognitive and meta-conceptual claims for Hodges' model? Does Hodges' model have a role in secondary education and if so, what is it? If Hodges' model facilitates reflection and is reflexive how is this achieved and demonstrated? Is Hodges' model a meta-semantic framework and if so, is this what provides genericity? What is the foundation of the axes in Hodges' model and what characteristics can be described?

Is Hodges' model safe? "Cold, Warm, Hot, Hotter!" nearer to 'navel gazing' than 'reflective practice'? Are 'concepts' sufficient to explain the structure of Hodges' model, and account for its claimed role(s) in assessment, planning, evaluation and assurance? Is Hodges' model a constant: as the contemporary model? Are 'individual', 'group', 'humanistic', and 'mechanistic' sufficient as conceptual anchors; and if so are they sufficient to give rise to the two continua that then invoke four knowledge (care) domains?

Can Hodges' model simultaneously preserve, protect and assure 'patiency' whilst also facilitating self-care? What forms of literacy are encountered by users of Hodges' model and are they accessible to the public, patients and carers? Hodges' model: Show me the praxis. What does Hodges' model say about holism (and consequently reductivism) and why should anyone listen?

Is there such a thing as a generic 'model of care' in a multidisciplinary world? Is there a 'logic' to the seemingly diametric opposition of 'power' as exercised here and the two individual domains in Hodges' model? If claims for Hodges' model of universality, genericity and global scope are 'true' is this also a risk for healthcare professions and specialisation, as it supports the 'universal worker' and automated processes?

 

ii Learn your lines and the hyperplanes will follow

With these lines, partitions, axes and domains in mind, when a clinical practitioner is presented with a new person, whether as a patient, client, or carer ... they can, using Hodges' model (and other tools!) approach their assessment in an open and receptive manner.

This means that the information provided by the 'patient' can be readily fielded, captured whatever the context and situation.

As noted previously, my study of Hodges' model began in the late 1980s. Application in my work as a community mental health nurse, with an interest in informatics followed quite naturally(?). Primed as I was, for various reasons to carry this forward, I also carried a mathematical learning disability. At the risk of getting bogged down in my thought, use and approach to Hodges' model I need a challenge.

Mathematics is the challenge for me. It's fascinating how we have in-built 'calculators' that can help us catch a ball, and judge fairly well where to throw a ball for interception. There seems then to be an informal or naïve  mathematics, at work unconsciously. Does the same apply to Hodges' model? If so, how can I isolate, and identify it?

• Is it represented somewhere, implicit in Hodges' model itself?
• Is it (once again) to be found in the user of the model?
• Is it (more likely, and obviously) a combination of these two?
• Or, is it a product of the system, or a series of systems? 

I was reminded of what is a Sober toy, several years ago:

Is Hodges' model a selection machine?

All four original purposes of Hodges' model:

1. Person-centred, integrated and holistic care;
2. To bridge the theory - practice gap;
3. To facilitate reflection and reflective practice;
4. To support curriculum development;

- are concerned with conjunction and choice, selection. So is life itself through distinction, difference, and differentiation.

Hodges' model is a selection machine, that is both fhuman and machine driven.

A clinician may obtain the referral information through an email, a history of previous contacts can be retrieved from a clinical information system; the context and purpose supporting access to the information.   

A whole series of blog posts describe the role of Hodges' model to help assure parity of esteem across mental and physical health. What does this mean in practice?

For the practitioner, they take selected data from the referral, a history - if available, an initial telephone contact, a conversation with a colleague who remembers the person re-referred and starts to populate Hodges' model. What are the psychological concepts that arise? What are the physical?

If a referral in whatever form, or a database record can be viewed as a bag-of-words, then Hodges' model is a collection of care concepts. Four bags then. Sets or classes. An experienced user of Hodges' model may position care concepts that throws attention on the INDIVIDUAL↔GROUP axis. Lying between the INTRA- INTERPERSONAL and SCIENCES domains, this axis (like all the others) earns its keep. There is work to be done that is also of interest in machine learning:

'A support vector machine (SVM) is a supervised machine learning algorithm that classifies data by finding an optimal line or hyperplane that maximizes the distance between each class in an N-dimensional space.

SVMs were developed in the 1990s by Vladimir N. Vapnik and his colleagues, and they published this work in a paper titled "Support Vector Method for Function Approximation, Regression Estimation, and Signal Processing"¹ in 1995.' 

https://www.ibm.com/think/topics/support-vector-machine

Strange to think that perhaps the VERTICAL axis and others in Hodges' model are not precisely S-N-E-W in their bearing? There may also be several vectors at work in fact?

Image: c/o https://www.ibm.com/think/topics/support-vector-machine

The word 'naïve' has been bubbling away for a good-many years. A close colleague Silvana Bettiol, Univ. of Tasmania kindly read my draft on Hodges' model as a mathematical object, and mentioned the introduction points to Bayes theorem even if informally. Even in those initial 'clinical' encounters (and social meetings, that attend to empathy, rapport and engagement...) complex judgements are being made, beliefs tested, from what is often partial and disparate sources of information.

Checking other leads led to Frequentist and Bayesian Approaches

'Statistical inference is a series of methods used to make decisions and draw conclusions based on available data. There are two primary approaches for inference: Frequentist and Bayesian. Each framework relies on a different philosophical perspective on probability and modeling, leading to different techniques and interpretations. Each has its own strengths and drawbacks, so understanding the distinctions between them is vital for researchers, data scientists, and statisticians who aim to choose the most suitable approach for their specific analysis.'
https://www.statology.org/comparing-frequentist-and-bayesian-approaches/

More reading required and threads to run.

Earlier this week I posted re. Cromer's book -

Cromer, A. (1997) Connected Knowledge: Science, Philosophy, and Education, Oxford: Oxford University Press

Before passing the book on, p.198, Chapter 8 notes, #4:

'"Understanding" is a commonly used English word which has no precise meaning. It's sometimes taken to mean the ability to apply knowledge to new situations. In this sense, it is a very high-level skill. Benchmarks for Science Literacy says, "Learning to solve problems in a variety of subject-matter contexts, if supplemented on occasion by explicit reflection on that experience, may result in the development of a generalized problem-solving ability that can be applied in new contexts' (American Association for the Advancement of Science, 1993)." The key word here is "may." 'We really don't know how to help students develop a generalized problem-solving ability, or whether there is such an ability apart from mere knowledge of many different problem-solving strategies. Whatever the case, since we do know how to teach students to solve specific, problems. this should be the primary focus of science education' p.198.

Ack. IBM.

Hodges' model - as 'a' philosophy c/o TPM

As much as I might like, or aspire to write, this is not a treatise on Hodges' model as a philosophy. Anyway: why limit ourselves to one 'philosophy', when several might apply, or at least be found?

Other TPM articles within the 50 new ideas issue point to Hodges' model (of course 😉).

Philosophy itself may benefit. Philosophy is "the love of wisdom". While there are dangers in siloed kowledge and the thought that put it there, what is classed as wise across the domains of Hodges' model in a given context? Contexts change, but how can philosophical reasoning help us 'keep our options open'? Or is the situation and context 'closed'? 

Again much as I might like, in response to Benatar's Forsaking wisdom (pp.23-24) I'm not trying to clever - even my sense of humour does not extend that far. We do want to apply Hodges' model  practically. Maybe disciplines exist in a perennial state of self-doubt? Peter Boghossian discusses Philosophy that matters (pp.29-30). Nursing is no exception being challenged still regards its professional and academic identity. In mental health nursing there are concerns about the field as a specialty being genericised. The nursing discipline for which identity and meaning is key finds its own identity challenged. Helen De Cruz writes of The Philosopher's rut (pp.41-42). A contributing factor is the tendency in philosophical debates to be dominated by two-well-outlined opposing positions. This framing can stifle exploration, and yet in Hodges' model with oppositions built-in the model as a whole provides conceptual escape; a series of conceptual spaces to explore. 

Hodges' model can help postpone what De Cruz refers to as cognitive closure, another reason for the philosopher's rut. We tend, psychologically to draw quick conclusions such that we are averse to ambiguity. This may be innate to a degree, as seen in 'black and white' thinking. Ironically, for me with Hodges' model is the counterposition of reflection as navel-gazing, resulting in too many options, and no decision at all.  

With the self, I, individual appearing to take a prime position in Hodges' model, Michael Cholbi reminds us of the philosophical significance and history of self-knowledge (pp.35-36). Student nurses need to acquire sufficient substantial self-knowledge to be safe, effective, competent, satisfied and lifelong learning practitioners. In another issue 98 4th Quarter 2022, Jonathan Matheson asks Why Think for Yourself (pp. 26-32), is there a rationale in intellectual autonomy and love of truth? You can exercise your intellectual autonomy and make it collaborative, by deciding on the port of entry to Hodges' model. This is a determinant in terms of the context, the situation that prompts you reach for the model in the first place. 

me - you INDIVIDUAL - the few
  |

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

others - GROUP - many

inherent philosophy in Hodges' model the mind - my mind Personal identity epistemology ontology - being - identity my - beliefs - (yours) abstraction logic - mathematics concept of opposition^ opposition of concepts^ representation of -isms ethics - moral reasoning values - value unconditional positive regard	physicality - materialism the brain - my brain - body Organic identity implicit binary structure superimposed relations vectors coding and classification language corpora reality as orientation: (e.g., what three things do we need to know?) personalised medicine ('up here') professional scope - curricula silos of knowledge scientific method/methodologies
language - semantics - meaning dialectics 'other minds' practical reasoning applied philosophy individual-collective debate: utilitarian principles social philosophy socialisation of learners (professions) conformance - group think	health in politics politics in health human rights the unborn - future humans protected human characteristics diametrical oppositions in Hodges' model (e.g., 1. my mental state - mental health law; 2. public understanding - of science; 3. my freedom - the law. 4. culture - (techno-culture!) - science...) power - freedom political philosophy

In John Corvino's Applied philosophy out of the closet (pp.39-40), I'm not sure if it was Martha Nussbaum who stressed the need for philosophy to be practical. Is this the same as applied? I note her work on capabilities. Hodges' model seeks to reduce the gap between the learning involved in (between - hence bridging) theory and practice - to achieve competencies. For the future of (Brian) Hodges' model this matters, as I understand that efforts are ongoing to apply category theory to the social sciences. It is a pragmatic conceptual structure. To return to identity, A M Ferner tackles (literally?) Organic identity (pp.49-50); while Kerrie Grain takes on what is next-door in Hodges' model - Personal identity (pp. 51-52). As I continue to sort papers, journals and books there is more to follow. 

The Philosopher's Magazine, "50 New Ideas", 1st Quarter 2016. Issue 72. pp.20-120.

TPM #72 cover image: https://ericthomasweber.org/correcting-political-correctness/

^Ack.

Needham, R. (1987). Counterpoints. Berkeley: University of California Press.

(Looking f/w - I think - to chapters 7-8. With specific post(s) to follow.)

Working title: 'Can Hodges’ model provide a foundation for a mathematically informed ...

... epistemology and relational ontology? Part 1'

Abstract

Aims: To begin a process of examining a ‘model of care’ and conceptual framework known as Hodges’ model as a mathematical object. This paper examines the structural elements of this model, its axes and domains through a formal, logical and mathematical lens. To establish the extent to which a combined relational understanding and mathematical approaches can provide avenues for further research.

Design: This study adopts the design of a two-part exploratory and descriptive paper, using an inquiry-based approach throughout.

Methods: The method is interdisciplinary, descriptive, and involves conceptual analysis. Rather than Hodges’ Model acting as a model of, and for care, here the model is used to investigate how health and social care can be better conceptualised. The question is: What is the result when Hodges’ Model is treated as a mathematical object? Here, Hodges’ model is used as an inquiry-based model with reflection and critique.

Results: Readers will see the development of ideas, driven by the structure of a model of care, existing taxonomy defined by nursing theory, associated with foundational mathematical concepts.

Conclusion: The questions introduced and deliberated here will identify avenues for further study. And highlight Hodges’ model to other researchers; less familiar with Hodges’ model, and yet more skilled – adept mathematically.

What does this paper contribute to the wider global clinical community?

Re-assert the importance of theory development in nursing and health disciplines.

Draw attention to the relational (and reflexive) potential of Hodges’ model and in healthcare to abstract the collective dimensions of healthcare, especially those that are political.

Given the problems faced in the century to follow, encourage researchers within and without healthcare to further develop these ideas.

Impact:

Extend the relevance and scope of mathematical abstraction, in healthcare disciplines and the humanities, beyond statistical analysis.

This paper confirms: the conceptual utility of Hodges’ model; the challenge of requisite mathematical skills; the need for interdisciplinary cooperation.

Theorists in health and social care, policy makers and researchers seeking to apply mathematical techniques, especially category theory in the social science may find this work helpful and encouraging.

Reporting Method: N/A

Patient or Public Involvement: This study did not include patient or public involvement in its design, conduct, or reporting.

Keywords: nursing, theory, relational ontology, health, Hodges’ model, mathematics

See also: Draft notes - 'Hodges' model - Locus of Care & Control?'

Reference [ii] "Practice in forensic psychiatry: A proposed interdisciplinary model"

Practice in forensic psychiatry:
A proposed interdisciplinary model

Expanding on the post about a further reference for Hodges' model:

Holmes, D. Perron, A. Jacob, J.D. Paradis-Gagné, É. & Gratton, S (2018). Pratique en milieu de psychiatrie légale: proposition d’un modèle interdisciplinaire. Recherche en soins infirmiers, (Practice in forensic psychiatry: A proposed interdisciplinary model). 134, 33-43. DOI: 10.3917/rsi.134.0033

Here, and on twitter I have sought to stress the limitations of the biopsychosocial model in healthcare, and I value Holmes et al. recognition of Hodges' model as politico-biopsychosocial. 

The authors also identify the structural nature of the model.

 

In comparing 'models of care' there is the question of whether Hodges' model is a model of care. As a generic conceptual framework Hodges' model can of course be used in the health care (as per its original design and creation) but it can be used to compare models of care.

Below, translated by Google are the models used in the paper.

I have altered the listing bringing the Tidal and Recovery model s together. Some I've 'mapped' in pairs, using formatting to indicate the differences.

Tidal Model

"The Tidal Model is a humanistic nursing model of recovery developed by Barker (12) with the premise that the person with mental disorder has strengths, abilities, personal priorities and a future ahead (13). This model of care, popular in forensic psychiatry circles, recognizes certain deficits of the hospitalized patient but it is especially interested in the meaning that the latter attributes to them. The sick person is the expert in his life and is therefore the one who contributes the most to his own recovery. This nursing perspective is therefore centered on the phenomenological experience (lived experience) of the patient and on the role of the staff, which is to allow healing and restore hope (12,14)."  

Recovery Model

"A popular model in mental health care, the recovery model is increasingly gaining ground in psychiatric care settings (28). The postulates of this humanistic model state that anyone, including those suffering from mental disorders, can aspire to a fulfilling future, participate in rewarding and inspiring activities, self-determination and finally, be able to live in an environment free of stigma and discrimination (29). The peculiarity of this model lies in the fact that recovery is part of a process where the person with mental illness can continue to show symptoms while being able to adapt to their condition (often chronic) and pursue their goals. life (30)."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

recovery strengths, abilities, personal priorities deficits healing and hope phenomenological - (lived experience) personal responsibility fulfillment - life goals patient as expert personal adaptation living with x,y,z... coping strategies	place as context my future deficits signs - symptoms chronicity Institutional settings clinical - hospital
humanistic - human qualities social expectations social contribution participation - social inclusion free from stigma deficits	Institutional settings politics of recovery free from discrimination forensic deficits

<>

Integrated Practice Model

"This model was developed by Virginia Lynch, a pioneer in forensic psychiatry, and it guides the role of practicing staff in this care setting (15). There are three main theoretical foundations: 1) the fields of expertise involved (nursing, criminal justice and forensic science), 2) the health system (victim and offender, health care and forensic nursing ) and 3) the social impact (social sanction, human behavior, crime and violence) (16). According to this model, patients should be cared for using an interdisciplinary and holistic approach (15)."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

nursing forensic psychiatry 2. health system interdisciplinary holistic OFFENDER	nursing theoretical foundations forensic science 1. fields of expertise 2. health system interdisciplinary holistic
VICTIM role of practitioners 2. health system 3. social impact (social sanction, human behavior, crime and violence)	criminal justice 2. health system

<>

Model of Nursing Interaction

"This model of care includes six categories of forensic nursing interaction with the goal of establishing a relationship with the patient: establishing and maintaining a relationship (relationship based on honesty, respect and trust), encouraging and support interactions (help the patient to recognize his qualities and use his resources), the learning of social skills (encourage the patient to do social activities and talk to others), reality orientation (help the patient patient to be aware of his way of being and of acting), reflective interactions (the perception of the patient and his problems) and the learning of practical skills (encouraging the patient to develop good lifestyle habits) ( 17,18)."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

patient qualities, resources reflective interaction self-perception of problems reality orientation awareness of way of being and of acting	practical skills develop lifestyle skills
reality orientation learn social skills develop lifestyle skills encourage social activities talk to others	encourage and support interactions reality orientation perception of patient and problems

<>

Healthy Living Program

"This model was developed in response to metabolic syndrome and physical illnesses that may develop in people with severe mental illness (19). It includes programs related to health promotion activities such as weight reduction, smoking cessation, physical exercise, etc. It is a voluntary approach that not only improves physical health, but also independence and recovery. For the program to work in the institution and to fit into its organizational culture, the approach must be flexible and systematically maintained by the entire interdisciplinary team."

[ PARITY OF ESTEEM ] 

mental health - metabolic syndrome physical illnesses

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

independence recovery voluntary approach	(physical) health promotion activities such as weight reduction, smoking cessation, physical exercise,
independence recovery	voluntary approach for program to work in the institution and to fit into its organizational culture, the approach must be flexible and systematically maintained by the entire interdisciplinary team

<>

Holistic Model

"This model is used in forensic care in the assessment, health care and psychotherapy of patients with personality disorder (22). Holistic care includes the physical (diet and exercise), cultural, spiritual, and psychosocial needs of the patient. This model is based on problem solving, anger management and decision making. Caring is a central concept in the holistic model and is actualized in an emotional, psychosocial, constant and authentic caring response (23). It is for caregivers to be present for the patient, to respect his situation, to understand his experience and to demonstrate a desire to help."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

holistic care personality disorder [mental] health care psychotherapy assessment emotion problem solving, anger management decision making actualized psycho-	holistic care 'caring' assessment diet, exercise health care 'being present'
-social culture holistic care 'being present' constant and authentic caring understand person's experience respect person's situation desire to help	forensic care holistic care desire to help (also exemplified in the organisation?)

<>

Good Lives Model

"This model focuses on the offense committed by the mentally disordered offender, his recovery, the promotion of personal goals, the reduction of the risk of reoffending, and the treatment of mental illness (24,25, 26). The model favors an approach based on the strengths of the patient. In addition, mechanisms of change are present, that is to say that behaviors judged to be poorly adapted are replaced by adapted behaviors when the patient is equipped with the skills, resources and support provided by the nursing staff. This model contextualizes the offense, focuses on the symptoms of mental illness while conceptualizing both as inappropriate behaviors.This model helps to better understand the relationship between mental illness and crime in order to create an individualized plan of care."

Risk-Need-Responsivity Model

"This model (27) imported from the correctional environment was adapted to the psycho-legal context by the addition of the “mental illness” dimension. It was developed primarily to reduce the risk of recurrence. Care interventions are geared towards the identification and treatment of criminogenic factors. This model is based on three major principles: the risk principle (granting the highest level of resources to the group most at risk of crime), the needs principle (identifying dynamic criminogenic risk factors and targeting them in treatment) and the principle of receptivity (adjusting programs according to the characteristics of the person: learning style, motivation, strengths, etc.) (24,25)."

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

mentally disordered (diagnosis) recovery characteristics of the person learning style (evidence?) motivation, strengths 3. principle of receptivity treatment: skills, resilience personal goals “mental illness” <-> crime recurrence individualized plan of care	1. risk principle -> resource allocation recurrence treatment 2. dynamic criminogenic risk factors  support of nursing staff
treatment [social determinants?] mechanisms of change adapted behaviours inappropriate behaviours recurrence	offense reoffending correctional environment contextualise the offence treatment principles [policy] recurrence

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Hodges' Health Career Model

"This model has a politico-biopsychosocial structure which is consistent with contemporary interdisciplinary practice (20); that is, it relies on a multidimensional critical approach, incorporating writings in sociology and politics, in order to understand the person in context. It is based on four objectives: measuring learning, providing holistic care, supporting reflective practice and closing the gap between theory and practice (21). This model is applicable in various clinical situations in a psycho-legal context. When this model is used as a frame of reference, it emphasizes the role of caregivers who must meet the patient's needs and focus on their problems. It also serves as a guide to assess and provide assistance to the patient vis-à-vis their physical, psychological and social needs as well as with the justice system in order to promote their recovery. The theoretical foundations call on four sources of knowledge: interpersonal, scientific, sociological and political (21)."

The PERSON in Context 

(situated)

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

INTRAPERSONAL INTERPERSONAL reflective practice conceptual structure psychological needs measure of learning psycho-	SCIENTIFIC physical needs theory-practice gap
SOCIOLOGICAL reflective practice (develop self-awareness) social needs practice-theory gap	POLITICAL justice system (needs) -legal

[ all embedded within the SPIRITUAL ]

Not just 'problems' Hodges' model can incorporate any desired stance, perspective or philosophical approach - strengths, disease, skills, weaknesses or deficits, psychosocial for example.

I am not sure about explicitly 'measuring learning, but the model can be used by learners and teaching staff / mentors to demonstrate their understanding and justify their output - formulation.

There is an instrumental potential in Hodges' model as a whole. Hodges' model can illustrate the degree of holistic intent - whether this is realised could also be indicated using the model.

Once again I am grateful to the authors for their inclusion of Hodges' model. The reference is listed in the blog's bibliography (please see the sidebar for others) which includes:

Doyle, M., Jones, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. 20, 7, 631-640.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2012.01961.x/abstract

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.

See also on W2tQ (with overlap):

https://hodges-model.blogspot.com/search?q=forensic

https://hodges-model.blogspot.com/search?q=justice

https://hodges-model.blogspot.com/search?q=interdisciplinary

Dualistic- thinking checks and balances [II]

Continuing from Thinking checks and balances [I] how can Hodges' model help us understand and provide ready access to three forms of thought: these being -

1. Dualist
2. Multiplistic
3. and Relativistic thinking?

To recap, resort to dualist thinking might be a pathway to evidence for Hodges' model building the case for the model in education, healthcare theory, practice and policy making ... Taking each form of thinking in turn, dualist thinking in Hodges' model can be identified in six ways. Before discussing these, there are some general observations to make.

The axes provide an initial compass for differentiation.

The model is first situated (as per B.E. Hodges).

Situation precedes person but should not subvert the latter when the model is applied.

Upon arrival in any context it is what we draw in the sand.

The most obvious influence on thinking is in what the model gives to us through its structure - the two axes. Firstly, the individual - group axis can stand for the many variations of self and other: from patient - health care team; patient - family; citizen - civil society; person - friends (work colleagues); child - parents (or guardian - a status vested legally by others); clinical case - demographic (world) population. This might be considered a compound view, potentially incorporating scope and roles (as per the context).

Secondly, the individual aspect of the vertical axis also serves the reductive requirement of movement between many-one. Reductivism is a fundamental approach in scientific enquiry and quantitative research. There is in the above the reduction to the individual in the intra- interpersonal domain. Reductive descriptions and phenomena from the sciences can then be ascribed to the individual as per the conceptual content of the sciences domain.

The third factor is derived from the first and is evolutionary and developmental. It has a certain irony in also being a child's developmental milestone - the so-called 'terrible twos'. Whatever age an infant starts to assert their independence, establishing, coming to terms with their difference from the adult figures in their lives - this is a pivotal moment. As they set out to become them-selves, we can say that developmentally they, this nascent individual is drawn out of this particular axis. The axis is first of all then not dualist. The self is always a product of the group (even if the latter is absent). The individual, the self emerges from the other. This is an extended dynamic action, through our first 2-3 years. Self flows from otherness.

Illness, disease disruptions what should be the expected relation, crises whether of temperature or emotion places self-other in contention on a temporary or more permanent basis. The ‘health career’ in the full title of Hodges’ model is also pertinent, as this refers to life chances and the life course.

Perhaps, to borrow a term from genetics / chemistry the vertical axis represents a bivalent quality? The vertical axis has that telescopic property. The vertical axis is reflective the individual sees the group; the group sees the individual. Even as we contemplate the patient in person-centred care, what, who are we - the observers?

The fourth cognitive prompt utilises the model's horizontal axis which spans dualist thinking defined by the categories of humanistic and mechanistic. This can also be viewed as human - machine. This axis also gives an indication for the final, fourth type of dualistic thought. Since the 1960s this axis can also be described as the social - technical, or socio-technical (Baxter and Sommerville, 2011). The notion of machine logic then suggests objectivity and the contrast with subjective types of knowledge. This is a fundamental dualism that is debated by philosophers.

The fifth type a dualistic thinking could be described as replacing the axes above and inviting a free-for-all. Is this where creativity and innovation lie? Does this dualistic form open up conceptual probes and avenues to insight (association and relation)? There are a great many dualities, dichotomies, polarities that can (literally) be shot through the model. Through the centre, between adjacent care domains, within domains: consider, for example; demand-supply, mind-body, public sector-private sector-third sector and voluntary admission-sectioned.

Finally and sixth there is a translation, a progression from the axial duality to the epistemological background of the care domains. This can be constructed from the founding (root) disciplines of Hodges' model:

• Psycho-Social
• Psycho-Somatic
• Physico-Political
• Socio-Political

Superimposed on Hodges' model there is then another set of axes. This could be a means to explain Hodges' model. These trace out the domains of Hodges' model. Is this self-referential quality a coincidence or evidential towards making the case for Hodges' model? These axes act as either, or both a bridge and a brace. Since structure is all about geometry we can close at this point by noting that the strength of the triangle. In Hodges' model there are several diametrical dualities (oppositions), for example:

medicine - society*

individual - political involvement

a society's engagement in - the sciences

individual (demand) Political - health services (supply)

the individual who is mentally ill and the State, Mental Health Act legislation

As we see in this post in addressing dualities Hodges' model is concerned with DISCIP-LINES.

*Medicine and society represent a duality and an established discipline in medical sociology? Socio-technical is not a discipline in this sense and might provide a theoretical contrast - marker?

(The above and posts to follow are a work in progress and will form a larger - referenced - whole in terms of studies.)

Baxter, G. Sommerville, I. (2011) Socio-technical systems: From design methods to systems engineering. Interacting with Computers, 23 (1): 4-17 doi:10.1016/j.intcom.2010.07.003
http://iwc.oxfordjournals.org/content/23/1/4.full

a Paper: Hodges' model and mental health nursing in bushfire-affected communities

An email from ResearchGate informed me that a co-authored paper:

Doyle, M., Jones, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. 20, 7, 631-640.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2012.01961.x/abstract

- had been cited in another publication. A check was rewarded. It always feels good to be able to add a  study to the bibliography listing (please see the sidebar). This is an early view, by Brent Hayward in Australia:

Hayward, B.A. (2020), Mental health nursing in bushfire‐affected communities: An autoethnographic insight. Int J Mental Health Nurs. DOI: 10.1111/inm.12765

What stands out to me are Hayward's profession of mental health nursing within a public educational service and disaster response. I'm not sure how many times I have referred to the generic nature of Hodges' model, but this shift from reading a forensic paper to applying h2cm in disaster response is encouraging. While the immediacy of today's media brings home the catastrophic scale and tragedy of bushfires - work like this also reveals the humanistic side.

The research method of autoethnography has definite currency. Since the MRES at Lancaster, I have wondered if there is any autoethnographic merit in this blog? Hayward has clearly seen the value of the model with regard to reflection and self-reflection. Over the past few years - Brexit, climate change, the bushfires (and California) the importance and relevance of the political domain within Hodges' model continues to increase. (The content of many posts should provide evidence of this.)

It also appears that Hodges' model can draw out the distinction between intrapersonal and interpersonal relations and reflexivity. It could be argued that the humanistic-mechanistic axis also demarcates what is intrapersonal and what interpersonal. The latter standing for the (overt) skills so essential to effective mental health nurses. Hence, what are labelled the interpersonal and sociological domains. The combination of autoethnography, gestalt and use of a visual prompt for reflection is also informative and as Hayward notes could provide an avenue for the work of others. ...

"My unsuccessful attempt to locate literature about mental health nursing in bushfire-affected communities caused me to look towards nursing models more broadly. I was drawn to Doyle and Jones’ (2013) paper on the application of Hodges’ Health Career Model in forensic mental health nursing because of its deliberate consideration of political issues. This resonated with me as a public sector employee. Hodges’ model was originally developed in 1983 but has received little attention in the literature. Doyle and Jones’ paper was in response to this deficit, and in this frame, the present study continues this legacy. Hodges’ model is appealing here because of its attention to reflective practice and the theory-practice gap–two purposes which are of particular relevance in the present study." pp.2-3.

"Second is the use of a nursing theory or model to interpret findings. Only Gardner and Lane (2010) used a model, and this was one for clinical supervision rather than mental health nursing practice per se. Mental health nurses who are considering autoethnographic approaches should consider these methodological elements for both rigour and practical purposes. This study has also contributed the second published clinical application of Hodges’ model and its effectiveness here suggests that further exploration of its application would be useful." p.6.

I would like to express my sincere thanks to Brent for not only recognising the potential of Hodges' model, but actually applying it in research* and in such a vital context.

Hopefully I can reflect more on what is clearly for Hodges model and the concepts of health career, life chances and global health - a very significant paper.

*See also:

https://hodges-model.blogspot.com/2013/12/papers-actual-post-grad-studies-and.html

"Hi! I'm new to Hodges' model - and this blog - what's it about?"

INDIVIDUAL

|

   INTERPERSONAL : SCIENCES              

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

 SOCIOLOGY : POLITICAL   

|

GROUP

The model was created in the early - mid 1980's with four purposes in mind - to facilitate: 1. reflection & develop reflective practitioners; 2. person-centred, integrated (holistic) care; 3. help bridge the theory-practice gap; 4. curriculum design, planning and development. This was prompted by the change in the UK to university-based nurse education, which was to commence in (Project) 2000. Learning and applying Hodges' model in 1987-88, and creating a website 1998-2015, I am clearly invested in Hodges' model and biased, questions and debate are welcome. Created by Brian E.

Hodges' model is a generic framework -  a conceptual framework. This model is situated, as 'generic' suggests which means of course it is universal. If you've a problem, scenario forthcoming project, or one that is nearing completion Hodges' model can assist in reflection and critical thinking to plan, scope, or evaluate as per your purpose. This blog has posts about papers, events that interest me (PJ), plus many posts using this two-by-two table approach that suggests how the model can be applied in a variety of contexts. This blog also has a bibliography and template in the sidebar.

Hodges^ As noted previously (and last month!), it is marvellous to hear news of a paper citing Hodges' model. If you are planning a piece of writing, research and believe that Hodges' model may be of help please get in touch. If you don't and can see merit in Hodges' model asit is presented, that is fine also. In fact, although I mention collaboration unique - untainted perspectives are probably much needed. Learning of a citation after publication is great news and encouragement. This could and should be an amazing community: Welcome to the QUAD Thank you for your visit and interest. Any questions pleased to try to help: h2cmng AT yahoo.co.uk

As a nurse who trained in learning disability, Brian Hodges was acutely aware of the political in health care, the role of the institutions and the aspiration of community-based and person-centred care. Yes, you can use the model. It is open source.  All we* ask is that you cite and credit the source. With the 'politics of health' much in mind there are many papers to write on the model that includes: reflection; person-centredness; integration of care; self care TO planetary health FROM ?; Inter- multi- transdisciplinary in Hodges' model; A model of healthcare viewed mathematically: Surely you're joking Mr Hodges? This blog started in 2006, the template is dated, comments are disabled. A new site - repository is needed.

*In Brian's memory too : Brian E. Hodges (1942-2022) RIP^

WCCS26: Abstract 'Presenting a Universal and Simple Conceptual Workbench to Situate and Encompass Complexity'

ABSTRACT

Background

In health and social care there is, as yet, no universally recognised model, or framework applied and taught across all academia, fields of practice, professional disciplines and apprenticeships. At a time when ‘truth’ is challenged by information disorder, AI, and curricula are overload, this is both a stark and hidden problem. Medicine was quick to embrace complexity as an additional scientific tool. Complexity extends our understanding of epidemiology, demographic trends, the birth of modern bio-genomics, pharmacokinetics, public health, workflows, patient safety and more. The medical and bio-medical models are subject to critique, especially in psychiatry in terms of their conceptual scope and holistic bandwidth. Consider for example, the representation of patient and public engagement, human rights, climate change, poverty, refugees and natural disasters? The field of psychiatry extended these models to the bio-psycho-social model.

Methods

Despite this ‘progress-ion’, profound legacy issues remain: 

• The dualities of INDIVIDUAL-GROUP and HUMANISTIC-MECHANISTIC
• Sustainable services and systems, change to emphasize prevention and education (not just cure)
• A lack of parity of esteem between mental illness and physical illness
• A complicated relationship between psychiatry and psychology

The 21st century demands we also factor in economics, technology, social media - especially AI, education and literacies, geopolitics, security and more. This paper argues that we need a bio-psycho-socio-political model stat! This paper introduces and demonstrate the generic conceptual framework known as Hodges’ model.

To date, Hodges’ model has been explained and studied by guided discovery through lectures, workshops, posters, show and tell, and discussion groups; plus descriptive means of case study, and in practice patient care assessments and case formulation. Journal papers include conceptual analysis and synthesis, concept mapping of issues, e.g. nutrition and the sustainable development goals, plus oral health and policy frameworks (in-process). This paper ‘workbench’ encourages and facilitates reflective practice and critical thinking on an individual and collective basis. The derivation of the structure and content of Hodges’ model through guided discovery will be shared.

Results & Discussion

The background to Hodges’ model and its creation is introduced. In health care delivery, evidence-based interventions are of course paramount to patient, and public safety. Work to ‘see’ Hodges’ model as a mathematical object has begun. Help and collaboration is welcome; especially with supervisors of early career researchers and scholars in LMICs. Examples of complexity will be mapped to the knowledge (care) domains of Hodges’ model, which can itself be embedded within the spiritual. This paper responds directly to WCCS26’s main theme; and the need to listen to the lessons of history and isolate, weigh, refine and seek to preserve the often hard-won values that sustain humanity, humanistic care and qualities at a time when these are under assault, e.g. assisted dying – a right to die, or a duty? A small but growing bibliography, a template, plus illustrations of Hodges’ model are provided. Background on Hodges’ model can be found in the blog ‘Welcome to the QUAD’ - https://hodges-model.blogspot.com

Keywords: Healthcare, Nursing, Hodges’ model, Humanities, Global health

Topic: Complexity in Health and Medicine

🔷

News of acceptance was received on 29th November: brilliant! The deadline for submission of full-papers is 25th December. Try as I might, I can't meet this date. 

Helpfully, a presentation based on abstract alone is acceptable. I am hoping to network and learn too. The draft notes on Hodges'model as a mathematical object (6k words) are helpful in framing thoughts about the presentation and a future paper as a writing project. All in, a marvellous end to 2025 and prospect for 2026.