Holistic care: What is 'holistic bandwidth'?

The old website with its pages is static. In thinking about how to mix the old and create new dynamic content for a Drupal based site, I came across a possible way to define and explore our notions of holistic care. Here are some very initial musings....

First to focus on quantity. In completing an assessment whichever care domain I start in (let's say the intrapersonal domain) then as that domain is populated can it be argued that within the other domains the same number of placeholders for our assessment data are created? If my patient has eight problems (and two strengths) then according to one definition of holistic bandwidth the remaining domains should have the same number of problems (and strengths). Balance in all things - including holistic care?

One thing that the ADLs teach us is that (holistic) care as represented in Hodges' model is asymmetrical.

This does not mean that the ideal of holistic care is lost.

It might mean that strident efforts to assure holistic bandwidth can interfere with our attaining person-centred, integrated and multidisciplinary care.

It is essential that we recognise holistic care as an ideal, as a constraint and the primacy of functional considerations in:

• assessment;
• planning;
• care interventions;
• evaluation;
• and governance.

It comes as no surprise then that there are several versions of holistic bandwidth:

1. If we want to be inclusive then version #1 is epistemological. This anticipates the total number of semantically associated concepts that can potentially arise in a given care episode. This is what might be termed the 'semantic web of care'.
2. The sum total of concepts across all the care domains (inc. spiritual) that are actually activated in the course of a care episode.
3. The concepts that are deemed relevant by the patient, carer, family and guardians.... These add holistic value to and may well (must!) overlap with the care concepts recorded by the clinical team and reflected in the health record(s).
4. The degree of expressiveness of the care recording system - its capacity to represent holistic care and capture (measure) holistic bandwidth pre- or post- care episode completion.
5. The (idealised and learner generated) collections of care concepts identified and enacted within education.
6. The idealised and actual collections of holistic arrays applied and recorded by the combined clinical and social care disciplines* involved (there are two sets in practise and theory). As per #3 these (should) overlap with the patient and carer's....
7. The final combined lexis of written, electronic and other record(ed) media that constitutes the final:
• personal health record;
• summary health record;
• historical health record;
• clinical record;
• ....
• all the above combined;
• an individual and group's (family) health career!
8. In addition there are the anonymised and aggregated data items that form part of clinical / management reports, local, central government statistics and returns that inform national health and social care policy and global health intelligence at the WHO.
9. Throughout 1-8 holistic bandwidth must also incorporate education, engagement and informatics.

It is reasonable to speak of personal and impersonal forms of holistic bandwidth.

Students - if this is helpful or confusing please let me know h2cmuk @ yahoo.co.uk

Holistic Bandwidth [II] 16, 180, breadth, depth and thoughts initial

If we were able to put the care record into an appropriate text analysis program is there a measure of the conceptual span - the holistic bandwidth of care - somewhere in there? Could there be a disciplinary or task-based mesh, a tag cloud that could be superimposed on Hodges' model to represent care as holistic bandwidth?

Very early on in the web site's history a page was added on the multicontextual nature of health (and social care). This contexts page like the others has not been properly researched, which I recognise is a risk for readers in terms of 'evidence based sources' and a risk for me since of course the Web is a rather public arena to air initial thoughts.

Since the site and this blog are a call for research in this area, I'm sure a search would reveal a literature, but without recourse to said literature I'm not sure how explicitly - my incomplete - notion of holistic bandwidth has been studied in care contexts. On the context page I included several basic diagrams to indicate how Hodges' model might be used as a 'measure'. This page plus the others need revising with a bin (icon) close to hand, in the meantime how can we measure holistic bandwidth?

We could add the problems identified in each care domains, e.g.:

INTRA-interPERSONAL = 3
POLITICAL = 2
SOCIOLOGY = 5
SCIENCES = 6
= 16

Continuing in a fit of numerics we could throw in some multiplication - 3*2*5*6 = 180 ?
'180' is much more impressive than a paltry '16'.

What next...? Could the domain scores be weighted in some way? Is it valid to assign a primary domain? And while we are at it where does self-care fall (intra-interpersonal surely)? Wither the literary heavyweights of severity, chronicity, strengths, recovery and well-being. ...? Oops - how could I forget - dependency measures are nothing new; but the literature bearers are not the issue.

If we still frequently fail to deliver holistic care, then what is holistic bandwidth (actually measuring)? Is it -

• The scope of care [in one or all of - assessment, planning, intervention, evaluation, outcome]?
• Simplicity [breadth]?
• Complexity [breadth and depth]?
• (Rapid) care integration [time, connectedness]?
• Concordance: clinical problems + patient (carer) problems + outcome set?
• ....?

Holistic Bandwidth: All or Nothing

Quite a few years ago (Jones, 2004), I took the term bandwidth from the information and communication technology (ICT) world and applied it to health and social care. We seem to have been trying to achieve holistic and integrated care for decades. When care assessment, planning, intervention and evaluation is limited in scope this creates a narrowing of perspective, a bottleneck. Just as bandwidth problems used to affect the quality of on-line experience, so the bandwidth in health and social services ultimately affects the quality of care.

There's nothing wrong with perspective.

It's essential to making sense of the world. And after all, that railway line travels all the way to the vanishing point and it doesn't stop there. Road or railway - there's enough space reading between the lines to launch a whole film and literary genre.

I've said it before – but it really is ironic that many of the constraints in ICT have been overcome through broadband, memory costs/capacity and multi-core processors; while health services still struggle, still need to change:

From DISEASE - TREATMENT to PREVENTION - ENABLING ...

Single-track thinking is no longer sufficient, even if it is reassuring being able to see where you came from.

There’s an interesting non-trivial aside that follows from this bandwidth notion. The old conundrum of quality versus quantity.

Quality and quantity are the ties that bind, the Gordian knot. Cut this one at your peril!

Failure to focus on priorities, to take in that single, that utmost life-threatening perspective could result in disaster. Intensive care is the obvious example. Failure to attend to the physical priorities because of what seem new-age, airy-fairy ideas will quickly get you noticed.

There’s probably a paper out there on quality, quantity and appeals to holistic care. Returning to bandwidth I have wondered about how to measure this? Integrated care pathways and variance might be one approach, serious incident reports may be another revelatory approach? If it’s a care concept and moves ((uses energy) has currency) measure it!

There are a raft of measures for all sorts of things including, mood, behaviour, nursing care related, quality, risk and dependency. If you know of any that might measure holistic bandwidth, please let me know and add a comment here.

In the meantime I’ll ramble on - travelling h2cm's tracks…


Jones, P. (2004). Viewpoint: Can Informatics And Holistic Multidisciplinary Care Be Harmonised? British Journal of Healthcare Computing & Information Management, 21, 6, 17-18.

Gordian knot image c/o Bernice Steinbaum Gallery.

Holistic Bandwidth [I] - Where's the brush?

Apart from those intervals and instances (times!) when emergency intervention is needed, holistic care is seen as a primary goal in health and social care theory, practice and policy.

IF care is not holistic THEN it could be argued that there is care dissonance.

The high quality non-critical, general efforts in the PHYSICAL [SCIENCES] care domain -

fluids, diet, warmth, pressure sore care, comfort, security, infection control ....

can be compromised by lack of attention to the EMOTIONAL [Intra-INTERPERSONAL] care domain -

respect, empathy, unconditional +ve regard, non-judgemental attitude, time, space, attention ....

- what the patient (carers and others*) expect to follow does not occur.

Rather like cognitive dissonance acute discomfort results when care of the required high quality (holistic, timely, person-centred...) is not applied across the board (h2cm).

(In being human) everyone recognises the BASICs of CARE (discuss?):

It is the remembering that is the problem.

Remembering demands an assured space in the organisational memory - such that staff in those other spaces - wards, clinics, patient's homes, residential homes are able to fulfil the holistic spectrum of care needs.

Dissonance encourages game playing with beliefs [1-n players].

It is very easy and a fairly well understood human trait for us to become pre-occupied with what we do. (As you will have noticed I have a problem with brackets and italics...) When at work (i.e. not day-dreaming) "It is what we do that counts."; but care variances bound to professional disciplines and particular clinical settings should not be wielded as a foil.

So, perhaps this dissonance can be represented as distance:

• patients and carers may not articulate their discomfort - at the time

(and hence is perceived of less consequence to the service - at the time);

• as the distance between concepts and their meanings.

Could this distance provide a measure of holistic bandwidth? No doubt, it already has somewhere in the literature? The first holistic bandwidth metric suggested above is acknowledged in policies around the response to complaints, which stress the need to deal with the complaint there and then if possible. Is this enough and what about the distances between concepts and meanings?

more to follow....

I Googled 'organisational dementia' and found the following reference:
‘Sustaining New Industrial Relations in the Public Sector: The politics of trust and co-operation in the context of organisational dementia and disarticulation’ (with M. Martinez Lucio), in P. Dibben, P. James, I. Roper, and G. Wood (eds.) Modernising Work in Public Services London: Macmillan. 2007.

*There is probably a major cost on staff morale here also.

The Communication Initiative Network and holistic bandwidth

In 2004 I attended a day at a community informatics conference in Brighton, UK (see the side bar for details). My interest in that event stems from recognising the different schools of informatics and the multidisciplinary potential for Hodges' model that extends beyond health and social care. The model provides a cognitive gymnasium for us to test and exercise our holistic bandwidth.

The notion of 'holistic bandwidth' really comes into its own within global development and communication. In 2004, or soon after I discovered The Communication Initiative Network. They kindly posted the Brighton position paper on their site and were very encouraging regards the model. Now they are developing a new Communication Initiative Social Networking Platform - http://groups.comminit.com/

There are many groups including:

• The Future of ICTs and Development
• Communication and Climate Change Adaptation

In the above group I learned of the following initiative :

There is an interesting initiative in Africa called AfricaAdapt. It is a network that works to facilitate the flow of climate change adaptation knowledge for sustainable livelihoods between researchers, policy makers, civil society organisations, and communities who are vulnerable to climate variability and change across Africa. There is a whole section on their website that allows for communities to upload their own information on how they are adapting to climate change. The initiative also offers an award for best community project which helps elicit contributions.

Africa: never far from the news. Lets hope this next week there is some +ve news from COP15 Copenhagen.

• Students - Communication for Development
• HIV/AIDS Strategy: Future Directions
• Polio Communication Consultation Group

There are diseases lost to the developed nations and with diseases like polio and leprosy communication and education are central to those who are ill and their families. Even as a nurse there is a stark reminder in the need for an International Leprosy Day.

• Gender, Education, and HIV/AIDS

On the teaching psychology list someone asked this past week about alternatives to structure a student's lifespan assignment. I suggested Hodges' model an approach that can also be adapted to educate people about disease ....

SCIENCES: aetiology, prevention, transmission, hygiene, diagnosis, prognosis, evidence, research, physical resources, drugs, nutrition, age, weight...
INTRAPERSONAL: attitudes, beliefs, education, literacy, personal responsibility, mood...
SOCIOLOGY: social networks, cultural beliefs, gender expectations, community, family, friends, trust...
POLITICAL: policy, leadership, funding, activism, infrastructure: housing heating..., access to services, media, employment, governance...

• Ethics in Communication for Development
• Gathering Theories and Models

This group only has 5 members and is of obvious interest to me. I can't recall whether I signed up: must check! Planning and development in this context covers topics and issues I know nothing of and yet I am sure that dressed in its socio-technical guise Hodges' model can contribute to the theoretical development here. It could be that there are other perspectives, models and conceptual frameworks to be found that can inform the global health agenda?

• DRAFT: Technical Update on Social Change Communication and HIV/AIDS
• Human Rights and Technology
• Web Site Directors

So, do visit the Communication Initiative both the new groups above and the general website.

Is there such a thing as the holistic bandwidth of 'resilience'?

In preparing my presentation for World Conference on Complex Systems 2026 (WCCS26) next month^, I am reading:

Bridging the Macro and the Micro by Considering the Meso: Reflections on the Fractal Nature of Resilience

ABSTRACT. We pursued the following three interconnected points: (1) there are unexplored opportunities for resilience scholars from different disciplines to cross-inspire and inform, (2) a systems perspective may enhance understanding of human resilience in health and social settings, and (3) resilience is often considered to be fractal, i.e., a phenomenon with recognizable or recurring features at a variety of scales. Following a consideration of resilience from a systems perspective, we explain how resilience can, for analytic purposes, be constructed at four scales: micro, meso, macro, and cross-scale. Adding to the cross-scale perspective of the social-ecological field, we have suggested an analytical framework for resilience studies of the health field, which incorporates holism and complexity by embracing an ecological model of cognition, something supported by empirical studies of organizations in crisis situations at various spatial as well as temporal scales.  

Key Words: human resilience; organizational resilience; resilience; resilience engineering; societal resilience 

Since the turn of the millennium, it appears 'resilience' has exploded across the media, and literature. As a result, it has also been viewed negatively by mental health service advocates, and activists as they decry the run-down state of formal services. The 'recovery model', undoubtedly closely associated with personal resilience is not the only answer.

This paper is helpful, in several respects but specifically to illustrate the idea of how Hodges' model can frame holistic bandwidth, across its care / knowledge domains.

INDIVIDUAL

|

    INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

individual - emotional - mental resilience	resilience engineering
human & societal resilience	organizational resilience

 

I think the answer is yes. 

But, what do you think (h2cmng AT yahoo.co.uk)?

Bergström, J., & Dekker, S. W. A. (2014). Bridging the Macro and the Micro by Considering the Meso: Reflections on the Fractal Nature of Resilience. Ecology and Society, 19(4), art22.
https://doi.org/10.5751/ES-06956-190422

 

See also:

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.  

 

Previously: 'complexity' : 'resilience' : 'holistic bandwidth' : 'fractal'

^Fingers x'd!

Interested in writing? [ II ] Hodges' Health Career - Care Domains - Model

In the side bar beneath the bibliography (on a desktop) I've listed a few topics worthy of critical attention. The real need is to link practical application of Hodges' model and further some theoretical underpinnings for the model. This is now happening and it's quite a challenge as I chase questionnaires and write up a draft report for next week. This report is set out as a paper using an author's template from a nursing journal.

Trying to get the message out on writing about this free, holistic bandwidth defining, holistic wrangling, (self-) caring info-portal I blogged an appeal of sorts in 2010. Here we are again. The existing topics in that list relate to the original purposes of the model, plus a few 'extras':

• reflection;
• curriculum development;
• case formulation;
• holistic care;
• conceptual spaces

I'll revise the above as a result of this post and ongoing studies at Lancaster University. I will also add the journal to the most recent recovery paper. Expanding on the above for the benefit of anyone interested in using Hodges' model, reflection (as in 2010) is for me the primary purpose of the model.

Reflection: I'm sure that Hodges' model can complement existing and established approaches to reflection. It would be interesting to compare the use of Hodges' model with a control in clinical reflection, reflective practice with a patient/client, and in clinical or managerial supervision. (You see why this is a challenge, and I appreciate it is easy to generate suggestions!)

Curriculum development: If you need a map that incorporates an academic compass (sat-nav even) look no further. Where are the curricula hot-spots and how are they distributed?

Case formulation: There is an existing draft that needs to be revisited at some point, but the scope here is huge in terms of disciplines and applications. As mentioned above it is coming up with questions and research methods.

Holistic care: Is it time to revisit this phrase? Break it apart and put it back together if it still fits?

Is it a case of damaged goods?

Is this a broken currency as it originally did not include the patient as an active participant? Is it one of several linguistic tropes, said in earnest yet what does it mean? How do we measure it? Could there be a role for Hodges' model in defining or measuring it in theory (through the health record) in practice through outcomes that are demonstrably holistic? Does this make sense...? What is this holistic bandwidth that PJ witters on about? Is an informatics metaphor too far, or this a means to a definition?

To conceptual spaces I need to add threshold concepts and there is a literature here for health and social care, something to build upon and post here....

H2CM: Some Reflections on Purposes

Of the purposes associated with h2cm:

1. To produce a curriculum development tool.
2. Help ensure holistic assessment and evaluation.
3. To support reflective practice.
4. To reduce the theory-practice gap.

(Source: Brian Hodges)

- the primary purpose must be to facilitate and support holistic practice. The reasoning for this runs (it is hoped) as follows:

Although reflection is often conducted with a particular task - frequently a question - and hence a set of associated experiences in mind; the individual should be encouraged to think universally. If in general reflection is constrained then perhaps the activity is no longer reflection?

If the curriculum developers intend to produce holistic practitioners* then once again holistic considerations should preempt and influence curriculum development.

Theory and practice are surely as 'holistic' as holistic is? This purpose though seeks to assist in closing the theory-practice gap and the existence of this gap suggests that there is something else – even if only space. This space means we must once again defer to holistic.

Or am I getting confused...? What do you think? h2cmng at yahoo.co.uk

*holistic in terms of the range of thought (holistic bandwidth) - not holistic new-age therapies.

TO: EU -omics research community; if you are seeking a holistic approach for personalised medicine...

The relevance of Hodges' model as a resource in 21st century health care and research can be found within personalised medicine.

This is in addition to the need to assure holistic bandwidth within existing health care delivery, when it is person centered care that is the concern. Personalised medicine brings with it further challenges as it emphasizes the scientific, the inevitable reductionist work can potentially increase the distance between the humanistic and the mechanistic. The working document from the European Commission -

Brussels, 25.10.2013 SWD(2013) 436 final COMMISSION STAFF WORKING DOCUMENT. Use of '-omics' technologies in the development of personalised medicine
http://ec.europa.eu/health/files/latest_news/2013-10_personalised_medicine_en.pdf

on page 7 we read:

The figure is instructive as it shows that a holistic approach is needed to fully appreciate the challenges and opportunities presented by personalised medicine. 

'Holistic' is a much maligned word, with its fuzzy, new age connotations. Especially when the word count = '1'. Another related document also picks up the holistic call:

IMI2 will deliver tools, methods and prevention and treatment options (directly or indirectly) that will progress the vision of personalised medicine and prevention. Through providing the framework required to support collaboration between scientists, regulators, HTAs, patients and healthcare providers, IMI2 will ensure that research is translated into implementable solutions to current healthcare challenges. Solutions that are not purely focussed on the development of new medicines, but that provide a holistic personalised healthcare package as well as maintain people healthy and productive through out their lifetime. Reclassification of diseases based on their root cause and not symptoms will help addressing unmet needs even in areas where a range of options exist but patients do not respond, because their symptoms are misleading therapy choices.
[ IMI - Innovative Medicines Initiative ]

Outline Strategic Research Agenda for a biomedical research public private partnership under Horizon 2020: (draft) The right prevention and treatment for the right patient at the right time. 08 July 2013. (pdf link removed file not readable)

On page 10:

A sustainable healthcare system is a holistic one in which the patients are responsible for their wellness and quality of life; physicians, therapists, nutritionists, community carers, and all other actors in the value chain are motivated to this goal; delivery of care takes into account patient beliefs, values and both rational and irrational behaviors; the care is affordable to both public and private payers and promotes health; sustainable businesses can thrive; and the education, prevention and management of chronic conditions are aligned to achieve this goal.

The focus of these documents is -omics and the development of new medicines. By its very nature this research, data and knowledge lies deep within many sciences: new sciences no less. This recognition of the need for holistic approaches and perspectives is still very encouraging. As the first document on personalised medicine notes, future treatments must be from "bench to bedside". We can equate this as "mechanistic to humanistic", but only as long as the patient in that bed is a person and not just viewed as a diagnosis with an associated -omic profile.

Have a look also at the figure on page 7, the medical innovation cycle. As discussed previously on W2tQ patient safety needs situated awareness and holistic perspectives.

My original (and seemingly incomplete) source:
http://www.researchresearch.com/index.php?option=com_news&template=rr_2col&view=article&articleId=1339313 [no longer available]

Post Tokyo Olympics 2021: Yes 'Shun' fits, Gaia knows ...

MOST individual

   patient / client  PERSON student / practitioner
|

INTERPERSONAL : SCIENCES

MOST humanistic ------------------------------------- MOST mechanistic  

SOCIOLOGY : POLITICAL

|

society - community of practice - profession

 MOST group

"There's this wonderful Japanese word shun, which is when something is full of its life force," says Pearson. "In that peak, when the meadows are flourishing, everything is reaching for the solstice, and you can feel the energy pouring from it. It's quite overwhelming - you're aware of this special time slipping through your fingers and you can't take it all in because it's so alive."p.36.

On second reading, maybe not? And, not for the fact that the next solstice is mid-winter here in the Northern hemisphere.

'Glances'

Visiting McDonalds for a coffee (only) at the end of 2020, I noticed one of the merchandising screens was displaying an error message. The message referred to glances, which I read as the content that changes after several seconds in succession. I meant to take a photo for a post such as this, and back in the area, I'll take my chance if spied again. [Success!]  I did speak to a member of staff but they couldn't help. The take away (you could say!) is of a 'glance' as the content of a single care domain. This isn't very accessible, emphasizing the visual nature of Hodges' model, but I'm kicking ideas around...

Media - marketing screen

Reading the above I thought of 'holistic bandwidth' in Hodges' model. If the model was fully populated with care concepts and, no doubt, some annotations, key relationships then I thought shun might be appropriate. By holistic bandwidth I mean the semantic distance between care concepts. This is what 'MOST' suggests above. Beyond these concepts we are in the realm of the spiritual: do they join up in some way? Obviously, 'complete' in fulfilling the purpose of assessment, care planning, intervention, evaluation whether clinical or learning activity. But then shun as a celebration of nature seems inappropriate in many clinical contexts, especially palliative and end-of-life care. Yes, time for second thoughts here too.

The role of nature in healthcare, the value of green spaces, for recovery or a peaceful ending is well documented. Then again, the shun as experienced in 2021 by a person, do they really see how it is diminished, how it has changed, is changing? The point was made recently, of the different experiences of the Seasons, the weather, now across generations: diminishing 'norms' birds, bees ...?

Perhaps, after all, shun can signify a complete care matrix. If we carry on as we are then Nature will act, is acting now. Gaia knows.

Coulson, C. Double Act, Work, rest and weed: Dan Pearson and his partner Huw Morgan share their garden vision, HTSI, FTWeekend, April 2021,  pp.36-39. 

https://www.ft.com/content/74061538-d1ef-4922-a821-09ed5484e7ec

Photos added 8/9/21.

 

ii SNAP! Abstract [working] Hodges’ model as a mathematical object, a lens for social care and inclusion: category theory or category mistake?

Snap! 

As suspected the elasticity in the holistic bandwidth of the working abstract just failed.

The abstract rejected, I'm not surprised.

[ Prev. https://hodges-model.blogspot.com/2023/03/category-theory-or-category-mistake.html ]

I hoped 'no news' ... might fuel progress for a little longer.

Clearly (again), holistic bandwidth is never enough - focus, focus.

I'm grateful to learn from the call however, that there is a need to address:

How can prevention in social care be better conceptualised?

So I've a start at least ...

Grateful too, in the call, for Wright Mills sociological imagination:

“Know that the human meaning of public issues must be revealed by relating them to personal troubles—and to the problems of the individual life. Know that the problems of social science, when adequately formulated, must include both troubles and issues, both biography and history, and the range of their intricate relations. Within that range the life of the individual and the making of societies occur; and within that range the sociological imagination has its chance to make a difference in the quality of human life in our time.” Wright Mills (1959:226). [My emphasis.]

Clearly the current and previous governments have not got a clue!

I have rarely felt the fury that I feel at todays @DHSCgovuk “announcement” on social care. A massive retreat from what was already bare minimum first steps in long term reform. So on top of previously announced delays to the cap and a better means test, here’s what we now have..

— Sally (@so_says_sally) April 4, 2023

'Holistic confrontation' Gadgil et al. - a useful construct for h2cm?

The possible explanatory utility of what I've termed holistic bandwidth is an ongoing prompt for me to study Hodges' model as a conceptual space, or series of spaces. In the literature recently I discovered Gadgil et al. who explain what they term holistic confrontation in their paper:

Chi (2008) has characterized three kinds of student misconceptions that increase in their representational complexity from false beliefs to flawed mental models to incorrect ontological categories. This framework suggests that different kinds of cognitive processes and instruction may be differentially effective in facilitating conceptual change for a given level of representational complexity. We hypothesize that as the representational complexity of the misconception increases, so does the amount of transformation needed to rectify it. Specifically, we hypothesize that conceptual change at the mental model level requires knowledge revision to the interrelations between the features of the prior knowledge, which is different from revising individual false beliefs or reassignment of a concept to an ontological category. Furthermore, we propose that instruction that focuses the learner on revising systems of relations of the misconception, what we call “holistic confrontation”, should be more effective in facilitating change of a flawed mental model than instruction that focuses on revising false beliefs or the type of ontological category. p.47.

One of the more specific applications for Hodges' model I see and in need of demonstration is case formulation, or case conceptualization. This could extend from a general counselling, long-term medical condition self-care management level through to collaborative case formulation in formal psychological therapies, such as cognitive behavioural therapy and cognitive analytic therapy.

Gadgil et al. use a diagram test of the circulatory system with two instructional conditions for subjects: compare or explain-diagram. The introduction, method, design and six hypotheses in this paper comprise an interesting approach for due consideration here.

Gadgil, S., Nokes-Malach, T. J., & Chi, M. T. H. (2011). Effectiveness of holistic mental model confrontation in driving conceptual change. Learning and Instruction: 22, 1, 47–61.

Naive holism, Hodges' model and a lesson from NeuroLinguistic Programming

The pen is mightier than the sword.

Words are indeed very powerful, which means we should be careful how we use them.

In the mid 1980s when artificial intelligence (AI) had a temperature well above normal limits, personal studies brought me to the words that represent commands in expert system and artificial intelligence applications. The question - how might language influence our expectations of such programs? In what was a major personal project at the time (which never saw the light of day - but whose effects may be evident in the main website and this blog?) I discovered and referenced work on problems discussed by McDermott (1985).

This included the choice of mnemonics used in AI programs, with McDermott comparing the mnemonics in two systems - Planner and Conniver.

True: things have moved on - but history, history....

Planner : Conniver
GOAL : FETCH & TRY-NEXT
CONSEQUENT : IF-NEEDED
ANTECEDENT : IF-ADDED
THEOREM : METHOD
ASSERT : ADD

Upon executing 'GOAL' or 'THEOREM' into a computer 'you can just feel the power at your fingertips. It is, of course, an illusion.'

'If a researcher tries to write an "understanding" program, it isn't because he has thought of a better way of implementing this well understood task, but because he thinks he can come closer to writing the first implementation.' Ibid.

Legally, today the world is very different and yet without care extreme enthusiasm and the market may blur our vision and (rather ironically) dull our reason; McDermott observes that:

'If he calls the main loop of this program "UNDERSTAND" he is (until proven incorrect) merely begging the question.' Ibid. p.144.

I believe there is a similar lesson in terms of 'holistic care'.
As the track is swept and the starting blocks are put in place for decision making in the clinical forum - what sense are the users to make of the language used? Will eagerness to engage ("wow!") the user community cause a false start and what might the impact be?

Words are like sub-atomic particles: strange, ordered, chaotic, true, honest, noisy, quixotic.

Repeat some over and over and they become nonsensical.

Repeat yet other words over and over at the behest of those who know and they
conjoin, concatenate
to become belief-bearing,
an energetic property with a sharp edge that can turn the tide of history
(departmentally, locally, nationally and globally).

Here are (just) two reasons why holistic care has proved so elusive:

1. It is easy to add 'holistic' into care and ward/service philosophies and policies.
2. Actually measuring holistic care is not straightforward, but the measures should be specified as the word is first used - enacted. (If the service in question has someone working in a professional practice development role this might well fall to them.)

The usual outcome is what we might call 'naive holism'. The word is there in policy (for all inspectors to see). There are concerted and authentic efforts to step beyond the physical and the interpersonal domains, but there is still much to do. As for the social and political - maybe tomorrow.

If such a thing is possible an evaluation of 'holistic bandwidth' would of course need to be done at upon completion of a care episode. Maybe there is a test...?

While physicists struggle on with it - perhaps String theory can assist us? More to follow....

McDermott D (1985) Artificial Intelligence Meets Natural Stupidity, In MIND DESIGN, Haugeland J (Ed), MIT Press, London, p.144-145.
(I hope the quote is correct - old notes - and no time to check, but you have the gist).

Holistic Skills Assessment and Assurance

Just lately - by virtue of mailing list subscriptions - I've received several calls for research proposals and notice of workshops providing advice on how to proceed. In response let me just say this is 'frustrating' - as I'm not in a position to:

• (OK, on your marks! Get set! GO!) - formulate the real question;
• seek partners;
• put in a bid;
• and put conceptual frameworks for (global) health and social care on the map.

They deserve to be there. For me the really interesting note to take home here is that these potential research projects could be grounded in several disciplines:

• nursing;
• health economics;
• informatics;
• public health;
• public and civic engagement. ...

While universal in scope they (e.g. Hodges' model) are not the universal solution.

They can and must complement other tools and resources as the care agenda shifts to quality and the measure of quality.

More than ever the holistic reach of not only 1st-line but 2nd-line ... staff is going to be crucial to how well policy-bearing organisations carry their load.

As the (quickly formulated, rapidly fixed) physical and emotional bandages are renewed and re-assurances given, we realise that (ill-) health is not just a condition specific conundrum. Health is a melange of choices, multiple diagnoses, beliefs, attitudes, educational opportunities, concentrated resources and much more that are difficult to focus. Strange thing this notion of inclusion. At the end of the day it comes down to:

The art of focusing without focusing ... ?

Holistic bandwidth means that that the holistic skills demonstrated at any time will be dynamic and vary according to the viewer, the context (and there will be several), the care domain and of course the measure(s). ...

Additional links:Measuring of health and health-related quality of life with the EuroQol-5D

Image c/o - Wordle - and based on this blog.

So, Hodges' model is all about Vision ...?

... It depends how you define 'vision'
and even then,
Hodges' model is about so much more ...

Inclusion, Holistic bandwidth, Holistic care ...

This is what we should all aspire to
especially as children -
to realise our person-al potential.


INDIVIDUAL

|

INTRA- INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP

Dreams Empathy Rapport Attending Listening INSIGHT Knowledge / Learning Communication / Liaison Palliative Medicine Holistic Care DeafBlind Alexandra Elaine	Senses Sight- VISION 0% - 5% Touch Negotiation / Navigation Physical Physical examination Vital signs Observation Surgery  Patient assessment Total:  DeafBlind?
Adams Negotiation - Acceptance "A DeafBlind Doctor?"  Patient Reactions Colleagues - Reactions ‘A doctor said, what are you doing with a patient’s cane?’ DeafBlind	Negotiation Human Rights Law Employment Law Equality, Equity Governance Political Accessibility 'Tick Boxes' Activism: TEDMED DeafBlind

Sources:
BBC and Andrew Gregory, Healing touch of the deaf and blind doctor-to-be, The Sunday Times, September 29, 2019, p.3.


This post is a reminder for me about the accessibility of this blog...

Holistic bandwidth (and the dangers) of political care

The attack on MP Stephen Timms here in the UK highlights not only the ongoing importance of personal safety for public service personnel, but how much politicians value their constituency work. It is no accident that these sessions are called "surgeries".

The politician meets not just a citizen, but a political obligation and duty to care. In the media reports it was interesting to hear of how much satisfaction MPs get from their constituency work. Listening to the reporting and debate prompted me to realise that although politicians vary in how well they engage and empathise with their constituents the problems they are asked to deal with covers a broad holistic spectrum. Consider this listing written by Tony Wright MP:

• The education system
• The transport system
• The social services
• Health services
• Housing
• The environment
• Government bodies
• The justice system
• Immigration and asylum
• Finances and employment
• Trade unions
• The media

I am a community nurse five days a week.

Our MPs are community politicians one day a week with 'Constituency Friday'.

So to The Rt Hon. Stephen Timms (and his staff) I wish you a speedy recovery and congratulations on the extent of you and your peer's constituency work.

Holistic in a word and deed.

Congratulations also to the Green Party on the success of their leader Caroline Lucas MP.

Reflection = 'navel gazing'?

Individual and Collective reflection ...

THE NEED FOR HOLISTIC BANDWIDTH

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

Reflection Critique of reflective practice Risk of navel gazing
	"GLOBAL BRITAIN" 'Rules-based order' in the 21st C? Government - Governance Preoccupation with COVID-19, Brexit ... "We have not had enough bandwidth to deal with International issues to use our position on the security council and in the G7 ..." Jeremy Bowen Risk of navel gazing*

BBC Radio 4, Today, 25 October 2022 c.0816. Jeremy Bowen, International Editor.

Related:

Horta, H., Veloso, F., & Grediaga, R. (2010). Navel gazing: Academic inbreeding and scientific productivity. Management Science, 56(3), 41.

Ronald J. Pelias. (2009). Pledging Personal Allegiance to Qualitative Inquiry. International Review of Qualitative Research, 2(3), 351–356. http://www.jstor.org/stable/10.1525/irqr.2009.2.3.351

*A constant consideration here.

 

Quadratic Social Erosion..?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

(a) lived experience	mobility
SOCIAL MOBILITY	SOCIAL MOBILITY COMMISSION

Please see (for context):

BBC News

Social mobility board quits over lack of progress

"Mr Milburn, a former health secretary, took up his role at the commission in July 2012, under the coalition government led by David Cameron and Nick Clegg.Speaking on the BBC's Andrew Marr Show, he said divisions in Britain were becoming wider - pointing to the ongoing squeeze on wages.
The government lacked the "bandwidth" to tackle social division while also dealing with Brexit, he said, describing his task as being like "pushing water uphill". [My emphasis]

As can be seen, in broad terms, above, Hodges' model can help to promote awareness of holistic bandwidth, facilitating reflective practice, critical and transdisciplinary thinking and person-centeredness. Social mobility is clearly sociopolitical.

Hodges' model - the pros ...

Having posted the cons, here are the pros with part of the initial twitter thread once again:

If it is not too confusing, by another - Peter Jones @innov8tor3

4 #h2cm can be a generic conceptual framework for all disciplines: health, education,
contexts: development, edtech, socio-tech*
So scope *global* (utopic?) – more pragmatically - a utility across communities of practice.
*Plus other domain 'bridges': https://t.co/SqzQQnYuKz

— Peter Jones (@h2cm) February 14, 2021

A further query followed:

"can be", but is it?

What would you say has stopped that from happening?

— Peter Jones (@innov8tor3) February 15, 2021

The short answer is clearly that Hodges' model isn't the generic conceptual framework, it follows that is not global either. The reasons why are many and I've posted about several over the years, indirectly and more recently in a more direct manner:

My Moon Mission? "The Stack"

Hodges' model and trial by vampires ... 

Continuing the post on 'cons' here are the 'pros' outlined again along the INDIVIDUAL - GROUP axis (some re-ordering may be needed). To state from the outset that research on Hodges' model is limited, but there is hope for a basic resource for all:

INDIVIDUAL

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP - COMMUNITY - POPULATION

h2cm complements mind-mapping 1. - a cognitive tool: the model has individual utility - formulating the - h2cm provides learners with a scaffold - h2cm can help integrate, understand forms of (health, reflective) literacy/informatics - overvalued? h2cm can encompass value & values - seek pilot study res care / student well-being - ownership: use 'health career model'? - reflection and critical thinking still vital - generation of ideas/associations IS the idea - situation/context bounds model use and scope of inferences - h2cm can be used for lifelong learning - h2cm's application changes with user's vocabulary - Peter's ready to pass this 'baton' - Yes, Nurse 1st -

- h2cm is easy to explain, best via workshop - there is a small bibliography [sidebar] - - 2020 two new independent papers (2. below) - research question is ongoing [ dhyb 3.] - there are ideas/theories h2cm can draw upon - invented here: NW could celebrate - literature still reflects on reflection - student nurses do 'hear of' models & theory - h2cm: as simple/complicated as needed? - - measure of holism, integration ...? - - can encompass all 'spaces' - h2cm remains a response to legacy issues - - person-centred care - - holistic care/ ['holistic bandwidth'] - - integrated care - 'exposure' to Drupal ongoing - learning+ - - Drupal distributions also an option? - 'Peter' is in 'Persistence' (Go Perseverance!)*

h2cm can assist in 1-1 collaboration - care planning - - case formulation - - and small group work - - re. ownership: more 'cost of adoption' not high - there is interest - Yes, time to stop blogging/tweeting - we need a tool to bridge lifespan, healthspan, health career, career span - many dialogues remain contested, patiency, recovery: try this 'space?' - h2cm can help represent the 'hidden' value of labour social, relationships, psychological -

- Safety via Assurance role? - - Spans Quality::Quantity of Care - sense of ownership - make it 'yours' - COVID-19 reveals need & role for h2cm - the model is CC [power to your elbow?] - funding for research would be a bonus - - partnership / studies always welcome - carry the model f/w to 'LeaveNoOneBehind' - - address SDGs at 'home' too - h2cm can also outline the scope of a discipline - an original purpose was in curriculum design - h2cm useful in evaluation/regulation - still seeking benefits: [yes] policy instrument? - reflection/r. practice stressed for nurse re-validation

Further additions / revisions may follow and to the cons post.

To expand on Drupal: the question of its appropriateness to build a new website/platform is not an omission. Drupal 9.0 - 10.0... appear to make the update process and overall experience for non-developers much more user-friendly. I'm looking f/w to a virtual DrupalCon North America in April.

A co-authored paper is on its third journal transfer. Then to address the two-part draft well advanced, related to a conference in July.

1. 

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

2.

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

Iris Lohja, Yves Demazeau, Christine Verdier. A multi-agent system approach to dynamic ridesharing for older people: State-of-the-art work and preliminary design. 18èmes Rencontres des Jeunes Chercheurs en Intelligence Artificielle, RJCIA’20, Jun 2020, Angers, France. pp.52-59. ⟨hal-02897446⟩ 

3. Don't hold your breath!

*... and yes, at times my head hurts. 

⁺ ... I think and yes to be demonstrated. If not, I do have a 'requirement' and there may be value in that..?

Hodges' model: a tool for progressive disclosure

[Warning! This post extends (plays havoc with) the meaning of progressive disclosure.]

Trying to get on the surf board of the latest web-programming kind is proving to be very difficult. For many years now and as acknowledged on W2tQ the four links pages - one per care domain - have become a monster in motion. As the user scrolls down the links pages the sense of info overload becomes overwhelming. That is assuming they do scroll. There is no prompt apart from the right-hand scroll bar suggesting 'more'. Even though the links are only sitting in html tables, the experience is not exactly an exemplar of user interface design. It is poor on other counts too:

• The arrangement of the rows and categories are mine.
• Yes, reveal the holistic bandwidth of the care knowledge domains, but whatever happened to Socratic dialogue, discovery and subtlety? The user should be able to have a dialogue with the system - with Hodges' model. The holistic aspects should be revealed gradually, an act of discovery not a slap straight in the face.

Several of the books and magazines I've been reading over the years and more recently speak of the user interface design technique of progressive disclosure. Hodges' model is progressive disclosure incarnate in several respects:

• The model is revealed to the student progressively as the student learns (this means of course that Hodges' model remains forever dynamic).
• A further level of unfolding occurs in curriculum development terms. As the curriculum is revealed and subjected to review and development. In this way the model is constantly pruned, grafting may take place - such is the model's need to be progressive (and academe's need to ensure the model is fit for purpose).
• As the previous post hinted progressive disclosure is a baton. So, who do you want to pass it to? Remember the model is neutral. It does not prescribe. Is the patient free to progressively disclose, or is the process directed by the health or social care agent? Perhaps, things are driven by a bureaucracy, which must in turn provide its own progressive disclosure c/o freedom of information legislation?

There are other priorities, but looking at the links pages I'm wondering if I can finally through jQuery display just the categories and then have the user toggle the actual links display on and off. Having the user reorganise the listing would be cool. Then they would really become a part of the progressive disclosure, but it may be better to just toggle before I drag and drop.