Review: ii Fundamentals of Person-Centred Healthcare Practice

With 30+ pages left I need to remind myself of the book's focus -  the Person-Centered Practice Framework [PCPF]. 

The 'practice' in the title is key too and I am envious of the attention afforded to the PCPF. The book very much seeks to inform student learning and in section 4 on learning and development. The book is very effective in operationalising person-centred care and person-centredness.

I'm constantly fascinated by the way processes arise everywhere. This is inevitable. Time, space, events, the flows of data, information, knowledge and the systems we use are necessarily process-oriented. Who are you at 2pm compared with 8pm - shift patterns permitting?

Purposes are discussed and the 34 chapters cohere very well in style and vocabulary. Perhaps I expect too much. A vocabulary that bridges the process-laden world of the sciences and political machinations with the humanistic - experiential - world of lived experience? I need to accept that 'whole systems' rely on processes that are not just physical, but social, psychological and political. I can't though help but read "Committed to healthfulness as process and outcome" in task-oriented and politicised (outcome) terms (p.15).

In table 2.2 (p.16) on associated concepts a list that includes patient- client- woman- child- family- relationship- centredness, I see this as humanistic and hence as a matter more of purposes and practice than process. A letter explaining 'person-centredness' to an alien visitor the Oscleans, is a welcome creative distraction and reminder for me of SETI@HOME which has stopped distributing work. Here, I read 'service-users' as an unconscious bias towards the dark-side to bring the Force in to the mix. 

On twitter (and here) I've tried to highlight that the BIO-PSYCHO-SOCIAL model is incomplete.

IT IS NO LONGER SUFFICIENT.

Yes: Person-centredness is about an individual's being.

To BE person-centred your stance must include the POLITICAL* (p.19, p.35).

I'm still deliberating on what sort of tool is Hodges' model?

It is far more than a Johari Window (p.36):

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

'Situation' litters the text - oh for a situated model: "Look for alternative ways of explaining a situation (i.e. reframing a discussion)" (p.37).

As you can see, this books gets you thinking and reflecting ...

The book's editors and publishers are courageous and true to the format by including weblinks. I will try some of these and report back.

 

self - individual - PERSON - patient client carer
|

INTERPERSONAL : SCIENCES

HUMAN ----------------------------------------------- MACHINE

SOCIOLOGY : POLITICAL

|

family - group - population

patient- client- beliefs wishes identity hope	time place space
woman- child- family- relationship-	policy power £$

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

Review i

Review iii

Review iv

*Update 6 August: See 'Political Quotient'

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.

 

Notes (II) for a 2010 introduction to the Health Career Model

... Where to start?

By its very nature as already suggested Hodges' model is difficult to explain. There are so many elements that demand our attention and so many avenues to run. Despite revealing one heading to be followed, Murphy (2002) describes how a theory of concepts is still elusive. From this we might focus purely on nursing and take a professional stance. We should be able after all to assume solid grounds for the system that supports nursing: namely nurse education. There is no need to do this as existing theories of concepts can provide a vehicle for explanation and research of Hodges' model.

Frequently acknowledged as a science AND an art, the individual-group axis in Hodges' model and the accent on communication makes individual and group psychology as much a pivotal source of knowledge as human anatomy and physiology. There are differences in the methods of verification, but the dependency is there and evident in the core nursing curriculum. Even though psychology remains a young science, resort to psychology is advantageous in other respects as the development of cognitive science and computer science can also inform our thought and research on Hodges' model. Fundamental to this is the basic form of the model construct the 2 x 2 matrix.

There are a great multitude of models that take this 2 x 2 matrix form. Apart from mathematics examples one the most commonly cited and influential is the so-called Johari window model of Harry Ingham and Joseph Luft which dates from 1955. Luft and Ingham were psychologists who created their model at the University of California, Los Angeles, while researching group dynamics. The Johari model has found a home in soft systems problems and can now be found in many other variations and one-off examples. There are whole books devoted to the subject of '2 x 2', an acknowledgment indeed of their utility and ubiquity (Lowy and Hood, 2004). From the OHP transparencies of old to the latest data projection forms, the 2 x 2 matrix is the tool of choice in the management consultant's armamentarium. This special cognitive device can also serve the local and global health and social care community.

Ref:
http://www.amazon.com/Power-Matrix-Thinking-Decisions-Management/dp/0787972924

The Power of the 2 x 2 Matrix - at Wiley

Additional links:

http://hodges-model.blogspot.com/2008/02/big-book-of-concepts.html
[ Murphy, G. L. (2002). The big book of concepts. Cambridge, MA: MIT Press. ]

http://hodges-model.blogspot.com/2010/02/notes-for-2010-introduction-to-health.html

Agnostic qualities in Hodges' model

In the previous post I highlighted "Holistic approaches to learning are agnostic as to method." 

I added that there would be more to follow as Hodges' model can be viewed as agnostic on several levels. The following is taken from a paper on Hodges' model and its application in forensic nursing:

Hodges’ model claims to be person-centred and situated (Jones, 2008). What exactly does this mean for forensic nursing? The utility of Hodges’ model lies in it being agnostic. By ‘agnostic’ this means that the model is not dependent upon, dedicated to, sanctioned by, or owned by any particular discipline (even nursing). It was not designed with a particular media, clinical setting, situation or organization in mind. It is true, however, that the model was formulated within academia and health and social care, being taught and applied by community mental health nurses, learning disability and health visiting students. Apart from the history and universality of the model’s cruciform structure and its inherent 2 x 2 matrix form [often referred to as a Johari window (Luft and Ingham, 1955)], the model is also culturally neutral. This is an essential requirement to reflect and enact nursing values and codes of conduct (Nursing and Midwifery Council, 2008).

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

Book review: "The Power of the 2 x 2 Matrix" iv

Yes, it is a literal reading but if I didn't 'see' Lowy and Hood's discussion of "The team goes to work" (p.74) with symptoms identification and "Listen, listen, listen" (p.75) I'd miss a trick.

In healthcare the team really matters; in mental health care (especially) it is a professional and therapeutic* ... duty to listen; symptoms are not enough, we must seek signs too; what goes unspoken? A 2x2 matrix once created and agreed can also help identify positive and negative symptoms, in healthcare we differentiate this in several ways. The individual whether psychosis or cancer; and the group (socially and politically) through the impact of constraints and opportunities. There's a 'Health Magazine Marketplace Matrix' (p.76).

Strategy is central with tactical and operational factors in business and commerce and chapter 6 deals with strategic frameworks. The chapter starts: 

"Strategy is the art and science of competing more effectively than one's competitors." (p.91).

Below are two of the matrices described which I've placed within Hodges' model. Nursing is all about seeking, testing, trying, accepting, parking and respecting unexploited opportunities, not only 'in' the intra- interpersonal domain, but the other domains too. I will let you reflect upon the commodification of health and 'end of life'. 

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

Beyond Customer Led Matrix p.96.	Discontinuity and Life Cycle Matrix p.101

The social and political domains are obviously well represented throughout the book: value, customer, prosumer, civics and much more. An example is the Librarian Scenario Matrix which comprises of the dimensions - Locus of Concern  and Social Contract (p.119).

There's mention of architecture in the book which in a business context is understandable. I can not find where I read it but recently the addition of 'architecture' as in 'care architecture' represents a misuse? This is not architecture. This book and Hodges' model makes concepts the bricks, mortar, spans and splines of architecture. 

 

There is much more I could draw out. The Johari Window, individual frameworks - in which the quadrant's significance (size) varies, Myers-Briggs. In addition to a couple of references with the chapters, a notes section provides a full-list. The index is thorough and there are copyright notices for the many tables and figures.

A great book - just lacking one-other model, but I would say that!

Here are the previous posts:

Q. What is Hodges' model? A. It is NOT a 2x2 matrix

Book review: "The Power of the 2 x 2 Matrix" i

 
Book review: "The Power of the 2 x 2 Matrix" ii

Book review: "The Power of the 2 x 2 Matrix" iii

'Proof' of the Four Quadrants

Alex Lowy, Phil Hood (2004) The Power of the 2 x 2 Matrix: Using 2 x 2 Thinking to Solve Business Problems and Make Better Decisions, San Francisco, CA: Jossey-Bass. ISBN: 978-1-118-00879-9

With many thanks to the publisher for my review copy.

 *All effective carers (formal and informal) are 'good listeners' and not just 'good listeners' they respect what is said and if presented with it: a silence.