[Updated] AI Chat: Are the domains of Hodges' model comparable?

In drafting a future post: 'The Sciences: points, lines, angles and perspectives on domains', I thought I would ask Ecosia's AI Chat a related question, here is the (quick) prompt and reply:

PROMPT: 
In Hodges' model there are four care, or knowledge domains. The four domains are the sciences, sociology, political, and intrapersonal – interpersonal domain. In terms of potential content are these domains comparable, or is there an essential asymmetry? Please provide sources and references.

(I have saved the prompt for future reference and refinement.)

RESPONSE: [updated 21st June 2026]

Hodges’ model (also known as the Health Career Model or h2cm) is a conceptual framework that organizes knowledge and care into four quadrants, each representing a distinct domain of human experience and knowledge. These domains are:

1. Sciences (empirical, biological, and physical sciences)
2. Sociology (social structures, relationships, and community)
3. Political (power, policy, governance, and resource allocation)
4. Intrapersonal – Interpersonal (psychological, emotional, and relational aspects of the self and others)

Are the Four Domains Comparable or Asymmetrical?

The four domains in Hodges’ model are not strictly symmetrical in terms of their content, scope, or application. While they are presented as equal in structure (each occupying one quadrant of the model), their potential content, theoretical foundations, and practical implications can vary significantly. Here’s why:

1. Differences in Scope and Focus

• Sciences (Quadrant 1):
  This quadrant focuses on empirical, measurable, and biological aspects of health and care, such as anatomy, physiology, and pathophysiology. Its content is often highly specialized, technical, and evidence-based, rooted in natural sciences like biology and chemistry.

  • Example: The role of hormones in stress response or the pathophysiology of diabetes.

• Sociology (Quadrant 2):
  This quadrant addresses social structures, culture, and community dynamics. Its content is broader and more interpretive, drawing from sociology, anthropology, and social psychology.

  • Example: The impact of socioeconomic status on health outcomes or the role of family support in recovery.

• Political (Quadrant 3):
  This quadrant examines power, policy, governance, and resource distribution. Its content is highly contextual and often contested, influenced by political science, economics, and public policy.

  • Example: The effect of healthcare policies on access to services or the role of advocacy in shaping health priorities.

• Intrapersonal – Interpersonal (Quadrant 4):
  This quadrant focuses on individual psychology, emotions, and relationships. Its content is highly subjective and variable, drawing from psychology, psychotherapy, and ethics.

  • Example: A patient’s personal beliefs about illness or the dynamics of a therapeutic relationship.

2. Differences in Methodology

• Sciences and Political domains often rely on quantitative methods (e.g., experiments, statistical analysis, policy evaluations).
• Sociology and Intrapersonal domains frequently use qualitative methods (e.g., interviews, case studies, ethnography).
• This methodological diversity can create asymmetry in how knowledge is generated, validated, and applied.

3. Differences in Practical Application

• Sciences and Political domains  are often system-level and influence macro-level decisions (e.g., clinical guidelines, healthcare policies).
• Sociology and Intrapersonal domains are more individual- or community-level, focusing on personalized care, cultural competence, and therapeutic relationships.
• This can lead to asymmetry in impact, where some domains (e.g., Political) shape broad systems, while others (e.g., Intrapersonal) focus on direct human experience.

4. Theoretical Foundations

• The Sciences and Political domains are grounded in positivist and structuralist theories, emphasizing objectivity and external reality.
• The Sociology and Intrapersonal domains are influenced by interpretivist and constructivist theories, emphasizing subjectivity and lived experience.
• This theoretical diversity can create asymmetry in how knowledge is perceived and valued in different contexts.

Is There an Essential Asymmetry?

Yes, there is an essential asymmetry in the potential content of the four domains. While the model presents them as equal in structure, their content, methods, applications, and theoretical foundations are not interchangeable. The domains complement each other but serve different purposes in understanding and delivering care.

Sources and References

1. Conceptual Overview of Hodges’ Model:

   • Hodges’ Model: A Cognitive Periplus for - WikiEducator (PDF)
   • Hodges’ Model: Welcome to the QUAD
   • Hodges’ Health Care Model as a Framework for Quality

2. Theoretical Foundations:

   • Hodges’ Health Career Model and its role and potential application
   • Hodges’ model: the Sustainable Development Goals and public health

3. Discussions on Asymmetry and Complementarity:

   • The model’s holistic intent is emphasized in Hodges’ Health Care Model as a Framework for Quality, but its quadrants are not identical in content or application.
   • The differences in methodology and scope are discussed in Hodges’ Health Career Model and its role and potential application.

Summary Table: Asymmetry in Hodges’ Model Domains

Domain	Content Focus	Methodology	Theoretical Foundation	Level of Application
Sciences	Biological, empirical data	Quantitative	Positivist	Macro (systems, clinical)
Sociology	Social structures, community	Qualitative/Quantitative	Interpretivist, Structuralist	Meso (groups, communities)
Political	Power, policy, governance	Quantitative/Qualitative	Structuralist, Critical Theory	Macro (systems, policy)
Intrapersonal-Interpersonal	Psychology, emotions, relationships	Qualitative	Constructivist, Humanistic	Micro (individual, relational)

PROMPT: 
In Hodges' model there are four care, or knowledge domains. The four domains are the sciences, sociology, political, and intrapersonal – interpersonal domain. In terms of potential content are these domains comparable, or is there an essential asymmetry?

 

In Hodges’ model, the four care (or knowledge) domains are:

1. Sciences (biological, physiological)
2. Sociology (social, cultural, environmental)
3. Political (legal, policy, organizational)
4. Intrapersonal – Interpersonal (psychological, emotional, relational)

These domains are not strictly comparable in terms of content, scope, or function. Instead, they represent complementary perspectives that together form a holistic framework for understanding human health, well-being, and care. Here’s why there is an essential asymmetry between them:

1. Scope and Focus

• Sciences and Sociology are broad, well-established academic disciplines with extensive theoretical and empirical foundations. They provide generalizable knowledge about biological processes and social systems.
• Political is more narrowly focused on power structures, governance, and resource allocation. While critical for systemic change, it is less about individual experience and more about collective frameworks.
• Intrapersonal – Interpersonal is deeply personal and subjective, focusing on individual psychology, emotions, and relationships. It is less about universal laws and more about unique, context-dependent experiences.

This makes the intrapersonal-interpersonal domain inherently asymmetrical compared to the others, as it deals with subjectivity and variability rather than objective or structural phenomena.

2. Epistemological Differences

• Sciences, Sociology, and Political domains rely on external observation, measurement, and analysis. They are rooted in positivist or structuralist traditions, where knowledge is often generalized.
• Intrapersonal – Interpersonal is rooted in interpretivist and phenomenological traditions, where knowledge is co-created through subjective experience and dialogue. It resists universal generalization.

This creates a fundamental asymmetry in how knowledge is produced and validated across the domains.

3. Practical Application in Care

• The Sciences, Sociology, and Political domains provide frameworks for action (e.g., medical treatments, social policies, legal rights). They are instrumental in shaping systems and interventions.
• The Intrapersonal – Interpersonal domain is transformative—it shapes how individuals perceive, interpret, and respond to care. It is the domain where meaning is made and agency is exercised.

This means the intrapersonal-interpersonal domain is not just another “content area” but a lens through which all other domains are experienced and integrated.

4. Hierarchy of Integration

While the domains are conceptually equal in Hodges’ model, in practice, the intrapersonal-interpersonal domain often acts as the nexus where the other domains intersect. For example:

• A scientific understanding of depression (e.g., serotonin levels) must be interpreted through the intrapersonal experience of the individual.
• A sociological analysis of healthcare disparities must be understood through the political structures that enable or inhibit change.
• A political decision about resource allocation must be filtered through intrapersonal values and priorities.

This integrative role makes the intrapersonal-interpersonal domain asymmetrical in function, even if not in formal status.

Conclusion: Essential Asymmetry

The four domains are not comparable in content or function. Instead:

• The Sciences, Sociology, and Political domains provide structural and systemic knowledge.
• The Intrapersonal – Interpersonal domain provides subjective and relational knowledge, which is essential for meaning-making and agency.

The asymmetry arises from the epistemological and practical differences between objective/systemic knowledge and subjective/experiential knowledge. Hodges’ model emphasizes that all domains are necessary, but they operate in fundamentally different ways.

Drupal musings 13: Packaged care and modules

Although I do not need to sit at the front for presentations anymore, I did so at Drupalcon as the electricity plugs were few and forward. There was a bonus. Being in the right place... I picked up a free book c/o Packt Publishing who were among the exhibitors and valued sponsors. The book is Michael Peacock's Social Networking (don't panic I'm not going to review it!). Since returning from Copenhagen I've been using Drupal 6 and 7 on a daily basis. Checking just what some of the key modules, such as Taxonomy, Taxonomy Manager, and Groups have to offer. What are the configuration options and how well do modules integrate?

In the book Michael lists the Drupal modules he relies on to create a site worthy of the book's title. He explains that many modules are themselves 'packaged' for example - the Activity module:

Activity: Activity
Activity: Activity history
Activity: Comment activity
Activity: Node activity
Activity: OG# activity (#organic groups) p.140

This highlights the multifunctional capability of modules which leads me to wonder about what functionality might be found in future modules:

Intrapersonal: Communication Intrapersonal: Mood Intrapersonal: Cognition Intrapersonal: Diagnosis Intrapersonal: Interests Intrapersonal: Risk Intrapersonal: Skills-Education	Sciences: Observations Sciences: Physical attributes Sciences: Mobility Sciences: Nutrition Sciences: Diagnosis Sciences: Physical safety
Sociology: Relationships Sociology: Ethnicity Sociology: Interests Sociology: Religion Sociology: Carer assessment	Political: Marital status Political: Employment Political: Benefits-Welfare Political: Capacity Political: Autonomy Political: Mental Health Act status

ii Thoughts re. Ecosia's AI Chat 'answer'

The previous post has been updated, to the prompt is added:

 'Please provide sources and references.

[If you are new here, and too Hodges' model please see the bibliography in the sidebar.] 

A 'human' reading (still) makes me wonder if the 'answer' is what I want to hear (as a user)? Is it worrying that the first provides a 'Conclusion' the latest does not. The table is helpful as I believe that Hodges' model has a role across research (and political!) -isms through methodologies and methods. The model can also encompass ('eat'!) aspects of scale, or level.

The reply still gives me quadraphonic joy (if read out-loud). Not only are the domains recognised, but the LLM/agent ai takes the intrapersonal / interpersonal in its stride (from the blog?). Subjects related to each of the domains are given in brackets. 

There is of course a bias (several) in the prompt, as the care domains were never intended to be comparable. It is positive that each domain is seen as having its own specific scope and function. Over twenty years notes were started on a paper on Hodges' model and its role/function in helping to define 'scope of practice'. Significantly, in the UK the rise of associate positions across disciplines has provoked much debate, vitriol (on X and union and lobbying) and soul searching in certain professional groups. Given the increasing importance of the global health and social care workforce this trend is reflected globally. A situation set to be extended with uncertainties and tensions exacerbated by artificial intelligence in practice.

Before 'explaining' the asymmetries (in points 1-4) it seems the domains are complementary (for all their differences), and provide a holistic underpinning for the model as a whole (my reading).

1. Scope and Focus 

Interesting, how the science and sociology domains are described as broad. Perhaps I am underestimating the depth/density of sociology, after all folk theory is found there? Unfortunately, we can also add a myriad of conspiracy theories? Sociology can also lay claim to quite a few constructions of its own. Including aesthetics as a bridge to architecture and design(?).

On 'X', Hodges' model has been described negatively as inviting / fostering generalism. So, this is a bad thing? Is it not strange then that your Advanced Nurse Practitioner, Consultant doctors (all specialities) and students cross-curricula can all use Hodges' model? The fact that my own responses were never engaged has helped train my thought. Here the relevance of the model to students and continued professional development is made through generalizable knowledge.

The response to the political domain is supportive, acknowledging resource allocation and the distinction between individual and collective (see for example):

S. Bettiol, P. Jones, H. A. Onyedikachi, and W. G. Kernohan, (2026) Bridging Gaps in Oral Health Frameworks: Mapping With Hodges' Health Career - Care Domains - Model, Journal of Public Health Dentistry. 1–14, https://doi.org/10.1111/jphd.70034.  

I've seen tweets today regards IQ reductions in younger people. This is one reason for support of the top-left mental domain being designated as 'Intrapersonal – Interpersonal'. Our interpersonal skills and awareness are surely dependent upon our achieving a given level of inner mental life? Encouraging to see how subjectivity and objectivity is assigned too. Although, I think I'm in an echo chamber!

2. Epistemological Differences

In arguing for a model of health and social care that goes beyond:

• medical model;
• bio-medical model;
• bio-psycho-social model.

Reading 1-2 from the perspective of the Intrapersonal – Interpersonal domain you see how limiting this is, if an individual in a mental health/illness/mental capacity context can only point to sciences and sociological domains. Indeed, they may be relying guardians and advocates as they are unable to does this and raise the political matter of their rights. Without the POLITICAL domain (or as a result of it - neglect, structural racism) there is no law enshrining independent advocacy...

3. Practical Application in Care

To care is to act. Think about triage and emergency response.

Now in the 21st century 'care' must include self-care, health and social care, and (delayed or not you decide?) planetary care.

This necessitates a change of mindset at an individual and collective level. Consider the literacies that (again) young people must master to be effective, productive and happy citizens tomorrow?

So the following is a gift (in my eyes): 

"This means the intrapersonal-interpersonal domain is not just another 'content area' but a lens through which all other domains are experienced and integrated."

4. Hierarchy of Integration

'While the domains are conceptually equal in Hodges’ model' ..

This is interesting in itself.

[There does seem a emphasis upon the Intrapersonal – Interpersonal domain in this answer?]

This is quite a step, as the idea of a nexus and integration are picked up; and pointing to what are the determinants of health:

'For example:

• A scientific understanding of depression (e.g., serotonin levels) must be interpreted through the intrapersonal experience of the individual.
• A sociological analysis of healthcare disparities must be understood through the political structures that enable or inhibit change.
• A political decision about resource allocation must be filtered through intrapersonal values and priorities.'

I'm pleased I did this, as long as I'm not being trapped in an epistemological cocoon: otherwise known as a circle. Apart from a few occasions, I have not used AI/LLMs, perhaps it is time to explore more? I'd like to preserve my naivety, especially were maths is concerned. I'm not sure of what baggage I may pick up and lack the knowledge to interpret?

Previous post:  https://hodges-model.blogspot.com/2026/06/h2cm-domains-symmetry.html

Intra- Interpersonal in Hodges' model

As I'm sure I've already noted, the book reviews completed on W2tQ are not standard fare. They are applied reviews in that the reading informs my understanding of Hodges' model and demonstrates the scope, relevance and quality of the book for other readers.

I realised sometime ago that the 'interpersonal' domain also incorporates the intrapersonal. In the latest book for review which focuses upon the Person-centred Practice Framework and figure 10.1* supports this formulation. Unfortunately I cannot locate a graphic and will avoid resort to a photograph. Circular in form, there is a clockwise flow from intrapersonal emotions around to interpersonal emotions.

 

individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

intrapersonal emotions perceiving  ::  controlling using    ::   understanding     (motivation) interpersonal emotions

More to follow with many thanks to the publisher for the review copy.

Previously  on W2tQ:

interpersonal

intrapersonal

My source:

Lynch, B., Barron, D., McKinlay, L., Chapter 10, pp.93-101, Connecting with others, In. Fundamentals of Person-Centred Healthcare Practice,  McCormack, B., McCance, T., Bulley, C., Brown, D., McMillan, A, Martin,S. (Eds.). ISBN: 978-1-119-53308-5 February 2021 Wiley-Blackwell 384 Pages. p.96.

*Barron, D. and Hurley, J. (2012). Emotional intelligence and leadership. In: Emotional intelligence in Health and Social Care: A Guide for Improving Human Relationships (eds. J. Hurley and P. Linsley), 75-88. London: Radcliffe Publishing.

 

 

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

Relative poverty (1) - intrapersonal

There are many paradoxes in life and many of these are concentrated in the realm of health and medicine (a major sub-division of life and death).

For decades the link between poverty and standards and quality of health has been recognised and politicised in the media and policy. Just this past week was news of a Bill to make the eradication of child poverty a legal obligation not something that can be the political objective at the start of a Government and then cast aside.

Many things are relative and poverty is often described in this way applying to individuals, social classes, communities, regions and whole nations. Using the knowledge domains of Hodges' model what reflections does this prompt? Let us see:

INTRAPERSONAL: On one level highlighting poverty here appears a nonsense as usually we think of material wealth; the ability of people to be able to put decent quality - nourishing food on the table. In the miserable trap that poverty presents, it is perverse to suggest that health and social care workers - indeed all 'customer facing personnel' seek poverty. But they should exercise: poverty of thought.

Health and social care are often couched in terms of being a safety net, especially in community care - this conception emphasizes health and social care as a physical resource. In the intra-interpersonal domain though we are concerned with individual mental life, beliefs, attitudes, thoughts and emotions....

So here it is as if we must adopt the philosophy of Bruce Lee and turn the 'art of fighting without fighting' into the 'art of caring without caring' through a momentary forgetting in order to care effectively. We suspend our thoughts - take a mental breath, bring our training and current evidence to the fore. The conceptual safety net does not work if it comes pre-filled with bias, prejudice, pre-conceived ideas and negative expectations. There is of course a very poignant irony in calling for people to forget, suspend belief - even for an instant - at this time and in this domain. For health and social care workers in wiping the slate clean we do not think, but are VERY receptive to what follows.

This is where the wealth is:
between us.

We should not play the greedy capitalist and keep collaborative tools like Hodges' model to ourselves.

It was made to share: in my mind and yours a global health resource...

Image source: BBC

safety net: http://blogs.jamaicans.com/metinking/2009/04/30/a-jamaican-legacy-that-deserves-our-support/

Additional links: 'Poverty' on W2tQ

http://www.bmj.com/cgi/content/citation/325/7354/51

Website & Content Review: Inter - Intrapersonal

While grappling with Drupal is an opportunity to learn new skills and put the website on a more professional and potentially dynamic-database-driven footing that is just one step. The other step is the need to evaluate the content and have a right sort out!

One thing that has bugged me for a long time is the name of the top left care domain - this junction of the HUMANISTIC - INDIVIDUAL axes. Being focussed on the individual - the label should read INTRAPERSONAL not INTERPERSONAL as reflected in the following definitions:

INTRAPERSONAL: Existing or occurring within the individual self or mind.

INTERPERSONAL:

1. Of or relating to the interactions between individuals: interpersonal skills.
2. Existing or occurring between individuals: interpersonal communication or conflict.

Source: Answers.com

This is not a mistake as such, it merely serves to highlight the way Hodges' model relies on the underlying continua. This domain from a health, social care and family perspective can readily incorporate INTRA-INTERPERSONAL. Today when I sat down with my clients and their carers it was not exactly SOCIAL, the emphasis was on INTRA - INTERPERSONAL interactions (situations).

So, from now on I will refer to both INTRA & INTER in any new content to follow.

Speaking of future content: the 1st NW England Drupal user group meeting on Wednesday night in Manchester is at the Cornerhouse. Eight attendees so far including myself, with six people 'watching' and yet to decide - I can't wait. Don't think we'll manage the Apple store too - another ti:me.

If you have any pointers regards future content please get in touch - h2cmng AT yahoo.co.uk.

Relative poverty (2) - political

[The introduction is repeated across these posts: intrapersonal, sciences, sociology]

There are many paradoxes in life and many are concentrated in the realm of health and medicine (the  major sub-division of life and death).

For decades the link between poverty and standards and quality of health has been recognised and politicised in the media and policy. Just this past week was news of a Bill to make the eradication of child poverty a legal obligation not something that can be the political objective at the start of a Government and then cast aside.

Many things are relative and poverty is often described in this way applying to individuals, social classes, communities, regions and whole nations. Using the domains of Hodges' model what reflections does this prompt? Let us see:

POLITICAL: Although we are told that change is happening swathes of humanity face -

poverty of choice or no choice but poverty.

There are those who are able to decide and yet denied choice due to a politics or state that spits explicit corruption denying the people their expressed and collective will. Although previously described as 'black and white' politics must become participative AND must become 'green and (truly) global'. As events in 2009 attest here in the UK, politicians, those key workers / case practitioners in this domain (should paradoxically) disavow personal ambition and at times yet to be decided the party whip system. Yes, these matter, but again space (vacancy) is needed to accommodate - permit and facilitate true focus.

This is no chance opposition of domains in Hodges model.

The diagonal of INTRAPERSONAL and the seat(s) of power and governance
is mediated through the social domain.

Like health professionals, politicians and civil servants must wipe the slate clean: constantly. This is why transparency in politics is so crucial to trust, engagement, and grounded politics. ...

'P' is for politicians not just the 'people'.
Politicians need to be engaged coherently.
Touch is the interface for them too.

A week is a long time in politics because the sun never shines (not even in 'victory'). For these people being open, transparent, non-judgemental ... means their vision is refreshed by a perpetual rain.

Only then will they see poverty and be reminded of it -
even if poverty and even more so if poverty
represents where they came from ...

Image source: Equator Network

Additional links:

Reith Lectures 2009 BBC 'A New Citizenship'

'Poverty' on W2tQ

Political care (knowledge) domain links resource

Learning Disability & Hodges' model

It is Brian E Hodges who created Hodges' model in the early 1980s and one of his qualifications is RNMH - Registered Nurse for the Mentally Handicapped. Today this course and qualification is known as RNLD, that is - Registered Nurse for Learning Disability. What has not changed is the foresightedness and need for a political care domain within the model.

You might well ask:

What is so foresighted about that?

Well a moments reflection and we can soon appreciate the extent to which the following have changed since the early - mid 1980s, not only in terms of theory, policy and practice, but attitudes also:

• learning disability - independent living
• human rights
• institutionalised care
• role of medication - side effects, consent
• mental capacity
• epilepsy
• educational opportunity
• special needs
• social inclusion
• nurse training
• social care
• outcomes directed care

The foresight that Brian extended in realizing the opposition of intrapersonal - political retains its relevance today. There is still so much to do.

There is much more that the existing and any new website could offer in supporting the care agenda, its delivery and refinement for this group of people and their families. It pains me that to date there is a gap here on W2tQ (a paltry six tags), website and links content. By rights the links pages deserve a specific listing for this client group, either in the intrapersonal or political domains. What do you think? More than this though what future content types might support the care, welfare and well-being of people with a learning disability? If you have any ideas, suggestions, or guidance to offer please get in touch.

Additional links:

British Institute of Learning Disabilities
Centre for Studies on Inclusive Education
Foundation for People with Learning Disabilities
Mencap

Oh dear! I forgot to ask the nurse (doctor)....

Hodges' model introduction II:

The view from the other side of the fence

Have you ever been to see the doctor or nurse and shortly after leaving the surgery, or clinic you've remembered something? These days - very sadly - many people go to the doctor to seek help for their memory, but for others this is a fact of that frustrating mix of vital questions and issues to raise amid recognition that the time of nurses and doctors is very precious.

This post introduces a framework that can help people to prepare for a consultation and maintain a record of just where their care situation is up to. The framework in question is called Hodges' model. It is named after a retired Senior Lecturer - Mr Brian E. Hodges who lives in Sheffield, England. Brian Hodges created the model to help nurses and community staff ensure the care they deliver is holistic. Holistic in this sense means covering all the essential aspects that contribute to health and well-being, so that includes physical, emotional and mental and even spiritual health.

If you need to go into hospital you do not want to be treated like a faulty machine. Of course, in an emergency those machine-like things we do like heart beat, respiration, temperature regulation are of central importance. Should you ever need emotional care for a severe mental health problem then you would also expect that your physical needs are taken fully into account. Amidst these aspects of care the health care team must also pay attention to culture, equality, diversity and access to services.

Although the model was developed in the 1980s its relevance and potential increases in all the time. This is because of the following:

* health care and medicine is increasingly complex;
* people may have long term and multiple chronic problems;
* education is essential to 21st century care management - as people are expected to 'self-care';
- people may also be managing their own care budget and so need information and 360 vision;
* policy makers stress the need for 'patient choice';
* high quality health and social care is very expensive;
* as people live longer and may have several relationships spanning cultures and belief systems the notion of a health career is the career.

Hodges' model builds on two basic facts of life (and death):

From your point of view and that of any health or social care professional your health is about you - an INDIVIDUAL.

Your health affects other people - most significantly your family. Rather than you being ill, you may of course be a carer having to look after a relative. Also affected are work colleagues, the wider community through to whole GROUPS of people.

We now talk about medicine, well-being, and health in terms of global health since the population of Earth is so tightly linked and interdependent.

In order to maintain health there is a need to diagnose and intervene - or assess, plan, intervene and evaluate. Here the model can also take into account ethnic and transcultural aspects of health. Diagnosis and intervention in Western medicine is frequently MECHANISTIC and this is balanced (remember that HOLISTIC part of the model) by the need for HUMANISTIC interventions. This is what we mean by 'bedside manner' and people being 'caring'. The ability to empathise with others and develop a therapeutic rapport after physical and emotional trauma is a great gift - that while often innate can also be learned and honed.

Once Brian Hodges had identified the following dimensions of care:

INDIVIDUAL - GROUP and HUMANISTIC - MECHANISTIC

he considered the types of knowledge that health and social care workers need to not only do their job safely, effeciently and effectively, but also help people to help themselves. This led to the FOUR CARE or KNOWLEDGE DOMAINS, each covers a key aspect of care:

SCIENCES: e.g. anatomy, physiology,healing process, drugs, risk, diagnosis...

INTRAPERSONAL: e.g. mood, thinking, beliefs, communication, education, learning, coping...

SOCIOLOGY: e.g. relationships, roles, meaning, groups, resources

POLITICAL: e.g. choice, consent, autonomy, policy, legislation, finances

Students - young and mature - who decide to study health and social care can use the model to help them reflect on critical events in their training and learning. The model can help them gain some insights in completing essays and case studies integrating knowledge and experience. When you think about it: if it essential that care professionals are able to have an effective dialogue with patients and the public then they should also be capable of having an effective 'dialogue' with themselves.

Members of the public can also be taught the model to help them appreciate the factors involved in their care programs, solutions and ongoing management if required. Hopefully this brief explanation sheds some light on the model's mantra:

Hodges' Health Career (Care Domains) Model: h2cm
h2cm: help 2C more - help 2 listen - help 2 care

Hodges' model is no universal panacea it is just a tool; but while services stress the need for person-centered, integrated, value-for-money, high quality services ... built on respect, dignity, trust and choice - YOUR health career matters.

h2cm can help pull the many threads together....

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On the website's homepage there are four introductions based upon the care domains. Each one addresses a particular audience: learners (SCIENCES); patient (INTRAPERSONAL); carer (SOCIOLOGY) and policy maker / manager (POLITICAL). They all need updating (re-writing?!).

If you would like to contribute to this exercise please contact me through twitter or at h2cmng at yahoo.co.uk

(many) Care Transitions and The Little '-' That Could

Some people looking at Hodges' model may believe that the model perpetuates the dichotomies of old:

Human --- Machine
Individual --- Group
Sick --- Healthy
Supply --- Demand
Home --- Hospital
Self care --- Nursing care

In the 1990s as a community mental health nurse I was involved with a group of general nurses looking at ways of improving:

• discharge planning
• continuity of care

These issues remain and with the dichotomies of care above we can see how Hodges' model can assist our thinking and planning about transition. Not just one transition, but several.

This past week I was fortunate to attend one of a series of workshops -
Delivering High Quality Health Care for All: Bringing the social and technical together for a joined-up approach to deliver supporting systems and technologies
10th/11th December 2009, Leeds, UK

Organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group

The event was very good, stimulating and challenging. In the closing debate the appeal of 'socio-technical' and how to market a much needed joined-up approach in health IT came down at one point to the difference between:

'socio-technical' and 'sociotechnical'

In trying to find an alternative title, the hyphen was lost, and whilst it is not a crucial issue - for me that hyphen represents the axes of Hodges' model. Hodges' model acts as a high level aide-mémoire and that little hyphen can perform the same trick. The hyphen reminds us of the differences. The dichotomies that need to be navigated and negotiated in our dialogues about care AND caring. These are most evident in transfers and transitions (after all - "getting out of bed is a risk").

There are mini and macro transitions. Care pathways are not yellow-bricked unbroken splines from cottage to cottage hospital. They should be tortured if they do reflect person-centered experiences and needs.

Some transitions are process laden and repetitive, such as drug administration and must be protected - free from interruption. Although grounded in a social exchange of (correct) identities: a registered nurse, the right patient, right drug, right dose, right duration and right time these can be framed within the SCIENCE domain. That is where (for me) the conventional 'drug round' can be found. Counselling is another transition (if effective it also moves people on). 'Counselling' can be found in the INTRAPERSONAL domain - close to the border with SOCIOLOGY.

Other transitions and transfers are more involved:

• person's home to attend day care (for the first time!)
• person's home to residential home
• hospital ward to home
• home encounter with the crisis team
• telecare consultation
• ...

Care is constantly passed hence the need to write and record. Passed from -

person-to-person
team-to-team
team-to-carer
time-to-time
discipline-to-discipline
self-care

This is the outcome that is sought. Ultimately passing responsibility back to the individual and when applicable their family. Having formal integrated care pathways is one thing, but they are never truly continuous, clear and true. And as they say crossing bridges you may have to break step and surely different disciplines march to different tunes? Today though the most audible tune must be socio-technical. ...

Additional link: The Little Engine That Could
Image source:
Drug round tabard http://internet-workwear.co.uk/acatalog/Drug_Round_Tabard.html

Drupal musings 7: HTML5, CSS3 ... & Mr Hodges meets Drupal

At Manchester airport in May I noticed Web Design Essentials (WDE). Reasons of cost £14.99 and weight meant it was put back on the news stand. The content was excellent! Back in the UK a week later, no sign of it in the supermarket. I found a copy this week at WH Smiths and made the 'investment' - a belated holiday treat.

This is gold mine of nuggets on HTML5, design - wireframes, user experience (UX), fonts and typography:

http://www.font-face.com/
http://fontdeck.com/

- personas, CSS3, jQuery and much more. Now I think about it UX has been around for quite a while, it's a sure sign of how web design has matured such that practitioners can and must focus on the experience. There's another blog post there contrasting UX in web design with UX in health services. Reading about the use of personas in design and planning for a site might also deserve a specific post. As WDE indicates there are companies dedicated to UX. I do not have that luxury and yet I do have to define my initial target audience and their anticipated experience.

The web design related listing I maintain at LINKS I (Intrapersonal) are being updated as a result of the leads in WDE.

Through the scheduling and poll services of Doodle (thanks Chris) and with the Drupal NW England list I'm checking on which day in the autumn - November - is best for a group of volunteers to help jump start the new site. Everything is sorted now for Drupalcon next month.

Holistic Care: Squaring the Wheel of Disciplinary Domains

Over the past two years on W2tQ, I've defined h2cm in several ways, covering the model's axes and care domains, houses and sailing....

In January (2008) a dialogue was posted with Barbara Rylko-Bauer who shared some very helpful thoughts and suggestions on the model's name and the incorporation of culture and economics into the title of the respective SOCIOLOGY and POLITICAL care domains.

Thinking around this and my still limited (frustrated) reading of Michel Serres' and others I realised that the axes can be replaced with hyphens. This subtraction results in an interesting addition to the model's structure, perceived and potential content (domains).

Around the time the links page content were justified (or not) I also posted about the INTERPERSONAL domain and how this domain is more accurately described as the INTRAPERSONAL. That particular point was about a domain, but Barbara's point invited much more. Four hyphens certainly don't deliver, but the focus here has shifted:

the scope is not 90° but 180°

The hyphen forces contemplation of two domains and the axis in-between. See what you think:

Although hardly novel to geographers and those of a political bent 'PHYSIO-POLITICAL' is perhaps the most unfamiliar of these terms to people in health and social care - outside of public (mental) health - about which more to follow. ...

World Mental Health 'Day' - what about the night shift?

For convenience sake our lives usually follow the sun's traverse. The majority of events associated with World Mental Health Day will take place during office hours and early evening.


I am looking forward to a local event in Leyland, Lancashire on Monday, which includes speed dating. This will provide that 10-15 minute opportunity to share and obtain information about other services and people involved in local mental health care. The agenda looks excellent and includes the active participation of carers and service users.

So, what of World Mental Health 'Day'?

Mental health - like all health and social care is a 24 hour affair. How often do we forget this? Of all the care (knowledge) domains I write about here, mental health remains the 'silent one'. If you have had worries, anxiety and much more besides you know full well there are actually 24 hours in a day and the silence is not because 'mental health' sleeps. So 'Day' is quite apposite in shedding light on what remains a poorly understood and  stigmatised aspect of health care and our lives. 

Comprising all four declared domains and uncertainty - the spiritual domain is not referred to in Hodges' model explicitly and yet in our day-to-day existence spiritual matters figure in lives just begun, journeys ongoing and lives at an end and people remembered. Whether we practice a religion, follow a belief there is no escape from news that relates to religion. Strange then: not listed in Hodges' model and yet more evident and prevalent than mental health it seems. In my career I have noticed how religion and mental health can be very uncomfortable companions for some individuals. One exacerbating or being the cause of problems in the other. By the same, or maybe a different token, religion is also a great source of comfort, solace, affirmation, peace and reconciliation for many and a crucial resource through the many people who work under the auspices of the World's religions.

I have tried to catch this 'relationship' in my categorization of links in the INTER - INTRAPERSONAL domain which includes:

Psychology, Mental Health, Therapies, with Philosophy, Ethics, Ideas, Context, Creativity, Theology and Inter-Transdisciplinary resources.

So wherever you are, I hope you find peace especially through this day and night, whether or however you illuminate your mind, heart and soul.

Image source: http://www.daily-tangents.com/ImageCat/ErthMoon/
and NHS various.