ii WCCS26: World Conference on Complex Systems 20-22nd April

Day 1

Plenary Talk: Reda Benkirane - Lost in Complexity: Welcome to the Real World

A first slide considered Abraham Maslow's book The Psychology of Science and his thought on the "law of the instrument". Maslow's hierarchy of needs is a key primer for new students to many disciplines, including nursing, and psychology. The purpose of Benikrane's focus on instruments concerns the emergence of civilisation and roles of agriculture, and war in the rise of community at several scales from village, to cities, states and nations. In terms of flow the slides highlighted the next speaker Peter Turchin's END TIMES, and two books by Johann Chapoutot, LES IRRESPONSABLES, and FREE TO OBEY.

In response to the slide with Einstein's -

"We cannot solve our problems with the same thinking we used when we created them":

- may I please class 'health - care' as a world? The thought that the medical, bio-medical, and bio-psycho-social encourages, sees enacted, and sustained a : is this fit for the problems of the 21st century. I like the slide's heading 'Beyond Complexity'. Such is the pace of change, which is labelled 'progress' that each one of us wakes up momentarily stupified and lost in complexity.

Keynote Speaker: Peter Turchin - The Great Holocene
Transformation: What Complexity Science Tells Us About The Evolution of Complex Societies

Turchin's keynote reminded me of Jared Diamond's book Guns, Germs and Steel. Reading GGS I realised there is more to 'axes' than I thought, especially from the individual to collective scales. It appears that whichever label - academia, research or education - you would like to apply, they all need a conceptual framework. Just as, individually, we all need a model of self, others and the world. This was a marvellous journey, through millennia of humanities' evolution, social, and political development, all realised through complexity. While attractors are to the fore, architecture and archaeology are regular distractors for me. Reading Holocene then had me hooked. 

Star Maker

A fellow delegate and speaker I dined with a few times encouraged me to read 'END TIMES'. I will seek it out later this year, (the next Hay-on-Wye visit?). Turchin is seeking to account for how human societies have reached their current state of organisation. The role of self-protection, seeking food, shelter, co-operation are all factors, with the emergence of religions, and agriculture. Several theories to date were covered [including, cultural multilevel selection, see Wilson et al. (2023)], plus a major project on cultural evolution: The Seshat: Global History Databank. For all the current loss and misery, conflict has paid a major role in cultural and political development. The prefix 'macro' features here. There was a social scale (people): FROM 10s - in foraging bands through TO 100,000,000s large nation-states. Mention of levels of scale, took me back to the work of Mario Bunge. The application of the Hertzsprung-Russell 'main sequence' (H-R) diagram is a great idea. I think Olaf Stapleton, author of Star Maker would have approved. 

This itself, for me, is reason enough to read Turchin. There is evolutionary biochemistry too, which is required in terms of a systems account. Is there a reflection of a main sequence construct between the SOCIOLOGICAL and SCIENCES domain of Hodges' model? 

 It is incredible the way new findings are regularly pushing even further the dates of human milestones stepping-stones. Perhaps we should always view progress in this way, and enjoy the 'moment'. There is still the puzzle of ultrasociality, and how to explain it? Turchin is seeking a mathematical history, with a journal Cliodynamics. There is another SF reference here, in Asimov's psychohistory in the Foundation books, but with less emphasis upon maths. This is encouraging for Hodges' model, and the inevitable transdisciplinary approach these questions demand.

More to follow ...

D.S. Wilson, G. Madhavan, M.J. Gelfand, S.C. Hayes, P.W.B. Atkins, & R.R. Colwell, Multilevel cultural evolution: From new theory to practical applications, Proc. Natl. Acad. Sci. U.S.A. 120 (16) e2218222120, https://doi.org/10.1073/pnas.2218222120 (2023).

Maker-field: More than just a point* on a map

Ashton-in-Makerfield has been in the news of late. With Andy Burnham MP championing the communities of the north; local issues, socio-economic gaps, needs and everyday lived experience up North.

But Makerfield holds much more as a veritable rabbit-hole supporting lifelong learning, character development, reflective practice and critical thought:

 'maker' - 'field'

* - a political constituency.

Previously: 'map'

Colour my quadrants - theme my domains

Quite a while ago a basic colour scheme emerged for the care domains - quadrants of Hodges' model. It may be useful to explain why these particular colours were adopted.


INTER-INTRAPERSONAL: [mental health, psychology, psychological therapies, philosophy, creativity, theology ...] It is often said that green is a colour that calms people, it is and must remain a constant in our lives and hence in our world. Green reminds us of nature and who we are. There should always be a place for green wherever and whenever we live, for every individual one of us, whether residing in a metropolis, village or wandering across the land, or with no land. We must hope that green (and the blue) will always be.

SCIENCES: [anatomy, physiology, physics, biochemistry, neurology, systems, process ...] Blue is a mystical and spiritual colour. It suggests the metaphysical. It is our ET-ernal umbrella that points the way to the most external other that which is outside and beyond ourselves and our comprehension. Whether it is day, night or the inbetween with the terminator passing overhead it is there - clear sky or rain. It reminds us if you look, listen and feel our frailty, the true position of our laws, preoccupations and the passage of time that we cannot understand. But still we reach out.

POLITICAL: [policy studies, law, democracy, standards, development, activism, governance, citizenry ...] Black and white was adopted here as politics is often portrayed and practiced as being polarised. It is nice (economical of effort) when decisions are literally cast in black and white terms - true or false, yes or no; however, in politics things are never clear cut (especially when claiming expenses). This is another reason for 'black and white'. Not so much for the colours as the pattern they can pose. As posted previously Michel Serres cast Harlequin as a trope for mischief maker (and more) - something we all see in politics - especially at the moment.

SOCIOLOGY: [sociology, patients & carers, the seven ages, collaborative computing, anthropology, history ...] While a warning in nature and many cultures, red was assumed for its warmth. The gathering around the flame of the community, the flame of the hearth. Vibrant. Full of life. This is red. Love, passion and courage you will find here.
Red still stands. No, runs - as a warning. The flame can become a source of chaos in the hands of the mob, when families, peoples and nations fight each other. Red is the ember that is hatred, but red the creative, innovative spark can and will win through. From darkness : To light ...

In the near future I will write more about the positional relationships between the care (knowledge) domains.

Study on attitudes to epistemic uncertainty in safety - Call for participants

From: Eugenio Alberdi, e.alberdi AT CSR.CITY.AC.UK
To: SOCIOTECH AT JISCMAIL.AC.UK
Sent: Tuesday, 17 September 2013, 19:57
Subject: Study on attitudes to epistemic uncertainty in safety - Call for participants

The Centre of Software Reliability and the Department of Psychology at City University London are running a study on reactions to epistemic uncertainty in decision problems about safety.

Perceived errors in such decisions are often debated hotly after the fact, but there is still a need to study how the input to the decision maker can help or hinder correct decisions.

If you are involved in any capacity with probabilistic reasoning about safety and risk, we would be grateful if you take the survey at:

...

This study arises from research project UnCoDe -
(UNcertainty and COnfidence in safety arguments: effect on expert DEcision makers).

All participants will have the opportunity to read the final report from the study and the other project outputs.

Regards,

_eugenio

Dr. Eugenio Alberdi

Research Fellow, Centre for Software Reliability,

City University, London, Northampton Square, London EC1V 0HB

What sort of field is 'nursing'? (i)

. . . It is NOT 'relaxed'.

My copy of Harris (2015) is secondhand, £8.50 from 'Green Ink' in Hay-on-Wye last November. 

Apparently, the (professional - high-level) study of mathematics is a relaxed field. McCleary reviews the book and the good, truth, and beauty of mathematics; 'relaxed field' relates to the latter:

Mathematics without Apologies:
Portrait of a Problematic Vocation

"That leaves beauty, the deepest source for Hardy, and the most challenging motivation for mathematical activity. Challenging because it calls into question how external support of mathematics is justified. Hardy tells us that “a mathematician, like a painter or poet, is a maker of patterns.” Throwing mathematicians in with the painters and poets leads to justification of mathematics as an art. Harris situates his discussion of beauty in the notion of play. Play needs to take place in a “relaxed field,” a notion introduced by ethologist Gordon Burghardt to describe animal behavior when not preoccupied with food, mating, territory, or predators—'the opposite of stress.'"

John McCleary, Book Review, NOTICES OF THE AMS VOLUME 65, NUMBER 10 pp.1280-1283. https://www.ams.org/journals/notices/201810/rnoti-p1280.pdf 

Talk of absolutes is common in mathematics. There is absolutely no mathematician involved in the writing of this post and others. That said, I have been privileged to work in a 'relaxed' manner.* When I trained mental health and then general nursing, we were part of the 'numbers' on the duty-rota. Your presence was not just a matter of learning, there were concrete things - tasks - to do. Completing the Community Psychiatric Nursing Certificate course 1987-8, involved a secondment to another community team (thank you Bolton!). My caseload was left to the support of colleagues, so I could concentrate on the course. A course in which Brian Hodges (not Wilfred Hodges - the  logician) taught his eponymous model. Post-Project 2000 with nurse education an undergraduate pursuit, students were designated supernumerary. Student nurse finances are precarious, worthy of a post in itself. 

If relaxed and stress are opposites, nurses would seek to be 'relaxed'** suffice to have the time and resources to deliver care safely, professionally and to a high standard. Adequate time + resources also brings a dividend: person-centredness, health promotion and education, preventing relapse. As it stands, however, for nurses be they students or qualified, nursing is far from relaxed.

tbc... ii

Harris, M. (2015) Mathematics without Apologies: Portrait of a Problematic Vocation. Princeton University Press.

*But without the charisma Harris describes.

**The notion of slack resource could be applied, space for creativity and innovation in assessment, planning, interventions (case formulation) and evaluation.

See also: 'Four Fields'

Naive holism II - Hodges' model and String theory

Where were we? Oh yes, maybe string theory can help...?

Health is complex, labyrinthine and while there is no Minotaur to slay (?) we must constantly mine* for information. If we venture forth then best to take some string for reassurance:

• Fully navigate the labyrinth (use technology if you must - audit trails count);

• Find your way out and then you can report your deeds to the wider world.

The maze entrance is revealed when the pin is 'stuck' onto the referral source map. Post or ZIP code: "use it for geographies sake." You want to get out don't you?

Then start laying the thread - REASON-4-REFERRAL

weight loss, fatigue, tremor: SCIENCES domain
low mood, anxiety, agitation: INTERPERSONAL domain
carer under stress: SOCIOLOGY domain - and so on.

Check the health policies hurriedly scrawled on the walls (you may well find the Garden of Policy Delights#, but otherwise make do with the graffiti). Are you truly client-centred or service-centred?

What do you mean you don't know?

OK, well check the string. What sort of pattern have you made?

It's a right mess... Chaotic, even! Yes - mm... well that's OK. It actually looks like you are client centred to me. Just remember to backtrack, check and fill those string-less voids if need bee.

What's that? You are worried because you're tying yourself in knots!

Look don't panic! On the contrary - rejoice! It's what makes health care the magical job it is...

You see 'cc' also stands for 'cat's cradle' as well as 'client-centred' and 'complex care'!

If you never move out of the sciences domain (highly unlikely!) then in string theory that is a closed loop. The care is prescribed - not much room for creativity there - pretty vacuous in fact. Nature abhors a vacuum though, so attend to the care needs within the closed loop with due diligence and utmost priority. Otherwise the vibrations of this critical loop may become universal and the loop resemble a noose.

Prior to evaporating a closed loop can do a lot of damage.

If on the other hand your care winds its way across the care domains, back and forth, play the lace-maker - the artisan you are.

If you become tired, struggling in poor light: keep laying the thread - help may be at hand.

Whether it is a professional or volunteer who takes the lead, apart from those critical exceptions in the SCIENCES and POLITICAL domains, the string must be open at the ends from the start.

The dialogue always begins with an explanation, a rationale.

As soon as the closed loops are cut, the way is open to fully communicate, to comprehensively explore care possibilities.

Patient and carer can then take the other end, indeed if/when able they lead the way!

(Of course, just don't let it become a tug-of-war).

At the end reel the string in and measure (count the knots too).

Whether or not you met the Minotaur - there is the evidence, the outcome of your holistic reach.


Hodges' Health Career - Care Domains - Model

- sufficient to reach and engage the whole community.


Images: Thanks to medeba.com (skipping) & (fractal)
Paul Bourke

#Ack. William Latham 1990s CD-ROM Garden of Earthly Delights.
* From the last post: There are vast and rich seams to mine here (without damaging the environment) and they run under ALL the subject disciplines....
This particular mine is also renewable.

Seeds in 'architecture' iii

Prof. Younés describes 'three essential dualities': 

• IMAGE and WORD 
• TYPE and MODEL
• IMITATION and INVENTION

IMAGE and WORD 

Nursing has its historical images, that are continually presented, the lamp, hands imbued with care and support and others. The attraction to Hodges' model was through its similarity to mind-mapping, but with offering an foundational structure for reflection and critique (learning). So image has been there from the start.

Younés writes: "Within the dialectic of the visible (objects apprehended by the senses) and the invisible (ideas or forms apprehended by the mind), the image acts as a symbol when it supports the visibility of an idea." ... "Forms can be seen as structural potentials ..." p.238.

Younés classifies images (p.241), or the artistically factual through three divisions:

1. visual images (that would include icons and interface features)
   
2. mental images
3. verbal images (including metaphors and descriptions).
   

 "... the mind constructs a world within a world, and then reflects upon its own activity, as well as its own aesthetic appreciation of such activity."

I must stress the Younés context is architecture (and philosophy), but here extending to meaning I'm reminded of the way Hodges' model can span the arts and sciences, and original influences on why this model stood out for me through its facility for mind-mapping.

TYPE and MODEL 

 Here (p.242) Younés returns, not just to the origin, but the concept of origin through Form, the word and the type. Searching for universally shared purposes, within the permanences of human experience  this is health and social care too.

Taking in data, information, knowledge from assessment and other activities, this is usually contextualised - associated with a care domain. A return to the origin (nexus) of Hodges' model, the center is vital to retain balance and provide assurance in what we are doing, or not, and why.

"The architect imitates things as they have essential significance, but he or she does not copy any particular thing. This enables the layered transformation of natural models, without which the column would have always remained a tree. The form of the imitation is always different from that of the model. The roof is different from the forest's canopy. It is here that the pleasure of invention and the evaluation of the new enter, for it is within the recognized distance between the forest's canopy and the roof, that much of art occurs." p.244.

How times change in two decades. So many seek a roof, with architects having a recognized role in providing solutions post-natural disaster and political displacement of people. Not just homelessness, but homes that can cope, adjust to climate change. COVID has reminded us of the rejuvenating properties of nature, of the forest canopy, even that afforded by city centre gardens. 

We now see a roof not merely in physical terms, but social. As the night skies brighten we try to secure the canopy of the stars.

IMITATION and INVENTION 

Have we forgotten the contribution of positive role-models in learning? Imitation is the sincerest form of flattery and this throws up the constant educational dilemma of the theory - practice gap. Should we be exposed to practice without the guiding mentor represented in theory - that is also evidence-based?

There is an interesting exploration of SCOPE, DISCOURSE and NATURE: On Scope

"Thus a theory that is systemic aims at a certain level of completeness for it establishes the internal organization of architecture as a discipline, and it explains its external relations to other arts, to techniques, to social factors. Put differently, the interior individual realm concerns the intellectual freedom, the inner reflection of the architect-maker. The exterior individual pertains to the thoughts resulting from one architect reflecting upon another architect's work, as well as the individual architect's reflections on the suitability of her or his building to a context. The interior collective bears upon the conscious or unconscious content of culture which thrive within the images of of operative myths that inform architectural production. The exterior collective designates that commonly built sense regarding the suitability of architecture (decorum) within its milieu par excellence: the city. The above concerns the scope of an architectural theoretical system, on the urban, architectural, aesthetic, social, and practical levels." p.245-246.

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

interior individual	exterior individual
interior collective	exterior collective

 

I started these three posts noting the addition of 'architecture' to titles, concepts, and 'stretching' disciplines. Also guilty here; in mitigation, I'm aware of how in the mid-late 1970s technical drawing as taught was to change radically in the digital wave.

Hodges' model provides a drawing board, with analogue and digital potential.

I will continue to draw upon the (inspirational) discipline of architecture, it informs and sustains thought, construction, meanings, language use, and effort here.

There is much more to glean from this paper, so I hope to revisit it in the future - with further annotations on my copy.

Over the years I have noted related items in the press (yes, I saved the following):

Designs for life: architecture in the disaster zone, FT Weekend.

and read - A Bed for the Night: Humanitarianism in Crisis

By David Rieff

See also: 

Seeds in 'architecture' i 

Seeds in 'architecture' ii

Younés, Samir. “Constructing Architectural Theory.” Philosophy 78, no. 304 (2003): 233–53. http://www.jstor.org/stable/3752046.

Why the posts about books?

Since I started this blog in April 2006 book tagged posts are numerous; almost 300 in fact.

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

As with the previous post "Spare Parts" many are not even a review of the book in question. Use of about here is a misnomer. Currently, there are 51 posts tagged 'review', probably not all text book.

So, why bother? These posts are intended to suggest and possibly show the scope of Hodges' model. The placement of the book within a particular care (knowledge) domain is no accident.

Even though there is often overlap between the domains there is often a primary placement. 

This is were you the reader (learner, teacher, policy maker ...) come in, as the model invites you to interrogate the book's title and often, its very informative (for commercial reasons) subtitle.

A question. An answer - in response to recent media (HSJ Ack.)

Here are a couple of quotes from HSJ Roundtable meetings:

"What I hear around the country is that we have masses of information but we need to turn that into something that is intelligible and can be used for strategic decision making."...

"We need to look at how information links together to get a holistic picture of the situation." p. 20.

Dr Shahid Ali, (2012) Commissioning Information. Full Measures. HSJ, June 28, 20-23.

 "I don't think we should be integrating systems, we should be integrating around patients."  p. 20.

Dr Shahid Ali, (2012) Integrated Care. Let the Data Flow. HSJ, June 21, 20-25. 

"There's no integrated view of integrated care. The danger is that you have an integrated care system and everyone says, 'I will do one as well', and you end [up] with six of them." p. 22.

Owen Powell, (2012) Integrated Care. Let the Data Flow. HSJ, June 21, 20-25.


A question or two, or three ...

Is there a generic framework that can be shared and utilised across all health and social care?

A free resource that can be deployed in imagination, in solo on paper, in tandem and within a group potentially shaping collaboration, innovation, change and transformation. Applied in the clinical environment, the home, the lecture theater, the sports field...

A tool that can help support reflective practice not only at a strategic level, but the tactical and operational. What is happening on the ground floor? A framework that can help represent not only processes and policy, but practice, individual and group purposes.

Yes, policy maker and CEO meet with your information manager ... and discuss strategy.

But what is data, information, knowledge ....? What is 'health care' for it appears above we do not know?

Is there really no integrated view - even at a basic level that deserves further study?

Yes, health care practitioner meet your patient (client), their carer, your other partners (social enterprise...) and pursue what really counts: the best quality of care you can deliver given several constraints.

What is the outcome to be?

For the majority of the population (those not living with a long term medical condition) the transformation must be self-efficacy:
if 'shift happens' it must be from ill-health to health through education.

One answer:
The health care system cannot do this alone.

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From Harriet Ruysen - Harriet.Ruysen AT lshtm.ac.uk

Time - for care to commute [an appendum]

Addendum: Because we are (still) living in a post-Project 2000 World ...

"The whole thrust of nursing in the last decade [1981-91] has been directed towards seeing the patient as an integrated, individual human being rather than as a piece of malfunctioning anatomy. The patient is a person not 'the mastectomy in bed 3' or 'the man with the leg'. This means that any model of nursing must take into account the patient's psychological and social functioning as well as anatomy and physiology." p.53.

Ack. Walsh, M. (1991). Models in clinical nursing: The way forward. London: Bailliere Tindall.

[Book now bound for students.]

 INDIVIDUAL
|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

psychology	anatomy, physiology
social	employment, studying ... life chances / end of life choices

We need to consider concepts of care for a person, patient, and carer, not only in terms of their respective, or primary care domain [ e.g. leg, mastectomy; anatomy, physiology; sciences ] and associations with the academic disciplines; but in Hodges' model, focus upon the horizontal, vertical and diametric relation across and between care domains.

As described by Walsh, talk of  'the mastectomy in bed 3' or 'the man with the leg', is a dated trope; yet sadly it can signify the nature of staff (team) attitudes, the quality of care and experience of patients and their families. 

 

Technically, I see Hodges' model as a relational ontology. What this means basically, is that the model facilitates, encourages the user of the model to consider what they identify in a situation as objects (entities), events, concepts, relationships, data, and so on. An important assumption here is that what 'stands out' is what has salience (what the patient says - non-verbally too, what they mean, what they don't say?); that is, meaning and significance. 

 

Returning to Walsh's example: What does this event, diagnosis, prognosis (including anatomy and physiology) mean for this person as an individual? (If it means 'nothing' this may still - in a mental health context - be important.) What will it mean for the person's friends and family? What do the person it will mean to friends and family - significant other? What about their ability to work, and study? Can they resume their life plans and what of the person's life chances and those also affected? 

 

Crucially, there may not be a connection, a relation, across the care domains of Hodges' model. Asking the question is key, however; to go beyond what can be(come) task-based care. The ability of the model to assure and improve health care rests on this. The same applies for self-care too, with the model's support of reflection and critical thinking, essential to health and other forms of literacy.

Parity of esteem means we have to travel across the model. If we are 'collapse' the model's domains - four sets, into one that actually means something for the nurse, patient, manager, policy maker and researcher. This something, at least conceptually; is no less than person-centred, holistic and integrated care.

Q. Can care commute?

Reading the signs - Idealised Care

With the axes of the health career model labelled and the care domains - that fall between - identified, what can we read into and from the health career - care domains - model?

What basics of care and caring can we find there, what assumptions can we jump upon?

Here is a list ... (which also illustrates how the model grows with the learner) :)

• Health, well-being and social care are not declared in the face of the model, this suggests the model is high-level - generic.
• Health care (here) has at least seven disciplinary degrees of freedom:


• Sciences (biology, physics, chemistry)
• Politics
• Psychology
• Sociology
• Spirituality

• Health and social care theory and practices are reductive.
• Health care involves the traversal of space - distance.
• Health and social care has the potential to be depersonalising and alienating.
• Health and social care is simple and complex.
• The environment is inherent within the model in its varied forms.
• There is a moment of imbalance within the INDIVIDUAL - GROUP.
• Context is essential as a means to situate care (co-ordinate in an 'x','y' sense).
• The means is provided to situate the care context in a person-centred way.
• This model provides a template for personal and group reflection (shallow or deep).
• The model is open in terms of the final content, the content as expressed in care approach, philosophy, discipline, description (concepts, problems, priorities, strengths, a 'mash-up') is not dictated.
• In acknowledging the existence and primacy of the individual (located at the top so - must be important), the model provides a (potential) focus and vehicle for individualised, personalised, person-centred care.
• Whilst individualised care is at the center of care theory, practice and management, it cannot be defined purely by virtue of the INDIVIDUAL-group axis and the claim of an associated INTRA-INTERPERSONAL care domain.
• The individual must also be considered as a POLITICAL entity, a citizen, a legal entity that falls under the auspices of human rights. As such the individual is someone who can (or has previously) expressed their choices, wishes as to their health, care, well-being, best interests.
• Being an INDIVIDUAL within the family of humankind - 1 of some 6.x or > 7 billion - this person is unique and deserving of highest quality care, dignity and respect that should be accorded to all people.
• Health and social care whilst organisationally distinct (POLITICAL - POLICY) are to the INDIVIDUAL and carers (GROUP) concurrent, transparent and ideally integrated activities.
• Physical care (SCIENCES) can be, and is, defined in mechanistic terms; for example, time (objective), events, place, outcomes, observations / data (discrete, quantitative).
• Physical care is hence primarily objective.
• Emotional INTERPERSONAL care can be, and is defined in humanistic terms; for example, time (subjective), communication, responses to events (behaviour), feelings, beliefs, relationships (SOCIAL), expectations, fears, observations / data (subjective, qualitative).
• Physical care, emotional care is often mediated through the SOCIAL domain and the group - the family unit.
• Since this model indicates an initial structure and content the model is of potential use as a reflective resource for novice through to expert.
• The model is generic and as such not limited to health and social care.
• Such is the generic nature of the model it can support all learners in lifelong learning.
• The Spiritual is not there: it is ineffable. It is everywhere, everything, every'I' and everynow.
• Time is inherent in several forms within health and social care.
• The economics of health care is infused to all the domains, notably in the first instance to the SCIENCES and SOCIAL domains.
• The economic effects upon the individual in a humanistic sense, may be remote, but is inverse in terms of its impact.
• The model reinforces dualism: mind - body (but cognitively innoculates also).
• In highlighting boundaries, dichotomy, limits the model can stress the need for integration.
• The model suggests an antipodean fracture in relationships*: the patient and clinician (across physical care and mental health) inhabit the Northern hemisphere; while the carer (public), manager and policy maker the Southern.
• Health and social care is grounded in human communication (and that which is mediated).
• 'Sense making' must be a key issue in health and social care.
• Given the scope of the model, technology must be making a major impact across all fields of health and social care.
• The model can simultaneously represent the SOCIO- and the -TECHNICAL.
• A great many (potentially - all) values and standards are inherent in the model.
• This model can be represented using many media.
• This model is open to the Management Consultant's delicacy alphabet soup, i.e. using letters to represent approaches / methods, e.g. 4P's, 4C's.
• Health and social care can also be described holistically.

*Clearly, given the relationships and issues that arise this bears further examination and discussion.

This list is subject to revision - addition.

Image source:
http://en.wikipedia.org/wiki/File:Antipodes_LAEA.png

Social media: Sanity saver or Mischief maker..?

Individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

Group

	"The Mercury Project is a global consortium of researchers dedicated to combating the impacts of mis- and disinformation on public health and to finding interventions that support the spread and uptake of accurate health information."

 

My source: https://twitter.com/ssrc_org/status/1460619132437774337?s=20

See previous posts:

WHO: Infodemic Management News Flash Thursday 4 November 2021 #25

COVID: Logic is the patient - again..

'Hermes'

Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, 24(3),591-598.

 

Self-care - Care of other (Mother Earth)

'Maze Maker' by Michael Ayrton

1965, pencil and watercolour on paper 34.9 x25.4 cm

Negotiating the Healthcare Maze

SELF - individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - POPULATION

*Tate Etc. issue 44: Autumn 2018, p.84.

Image: Christie's

*Thanks to Tate Liverpool's Cafe for art magazines for reading...

Hardy (1940) A Mathematician's Apology

A Mathematician's Apology

In Liverpool I came across G.H. Hardy's short book A Mathematician's Apology. At £2.00 - a pristine bargain and a  marvellous read, especially the latter sections.

From being taught and applying Hodges' model in a case study in 1987 through to online work since 1998; I have to ask myself. Do I need to write:

'A Nurse's Apology'?

Aware of Hardy in the history of mathematics, and having read his apology, I'm no Hardy. My antics are a lesson in addition, but this is more 'Laurel and Hardy' - with apologies to comic genius of course. 

By their nature professions seek to maintain, and assure their continuity. A professional body can point to a definable body of theory, practice (curricula), that carries social and political status, if not patronage. There is national agreement that the NHS needs reform; radical reform no-less. The new Labour government is drawing lines to negotiate with the BMA, other professional bodies and unions. Specificity, specialisation is key. In healthcare people have suggested to me that Hodges' model invites genericism. Any suggestion of genericism is to be shunned. There seems an almost allergic reaction such is the threat to professional identity; unless, of course, you are a 'General Nurse', or General Practitioner - GP family doctor). Even Hardy warns:

"'GENERALITY' is an ambiguous and rather dangerous word, and we must be careful not to allow it to dominate our discussion too much." p.105.

This also applies to the quality and solidity of professional agencies and bodies whose role is to provide governance and set standards. The NMC has stumbled? Life and death is made up of details AND big pictures. How do you provide for - balance both? Curricula are another concern. Is the future of mental health nursing guaranteed as a profession? 

https://hodges-model.blogspot.com/2016/08/future-of-mental-health-nurse-training.html

The instrumental potential of Hodges' model is obvious. It invites a checkbox approach. One-to-one clinical encounters and interactions reduced to a tick-box exercise. This reduces any sense of specialist knowledge, training and education needed to assess, plan, deliver and evaluate high quality, effective, sustainable healthcare.

'THE second quality which I demanded in a significant idea was depth, and this is still more difficult to define. It has something to do with difficulty; the deeper? ideas are usually the harder to grasp: but it is not at all the same.' p.109.

Hardy's thoughts (and no doubt similarly expressed by other mathematicians and logicians) can be 'found' in Hodges' model; with an addition. Depth and difficulty rests on the uniqueness of  the 'one'. 

Here, Hardy is comparing between 'real mathematics' and chess:

'A chess problem also has unexpectedness, and a certain economy ; it is essential that the moves should be surprising, and that every piece on the board should play its part. But the aesthetic effect is cumulative. It is essential also (unless the problem is too simple to be really amusing) that the key-move should be followed by a good many variations, each requiring its own individual answer. 'If P-B5 then Kt-R6; if .... then if .... then ...., ....' - the effect would be spoilt if there were not a good many different replies. All this is quite genuine mathematics, and has its merits; but it is just that 'proof by enumeration of cases'  (and of cases which do not, at bottom, differ at all profoundly*) which a real mathematician tends to despise.' p.114.

*I believe it is now regarded as a merit in a problem that there should be many variations of the same type. (footnote)

While Kings, and Queens et al. undoubtedly have their own unique personalities, in healthcare effective clinicians make a concerted effort not to merely enumerate cases. The professional emphasis is (idealistically, professionally, purely and in application to) person-centredness; with the compassion, complexity, cussedness, and (sometimes literal) complications this brings. From 1-1 interaction, the clinical encounter, the therapeutic relationship, and alliance are the reason for practitioners achieving and sustaining intra- and interpersonal communication skills. Our attitudes towards knowledge, what is thoughts affects what we feel individually and collectively. Science should be neutral. It might be concluded that this question is for the philosophers and ethicists to wrestle with. In healthcare ethics are central: 'Do no harm'. Whether the practitioner, theorist, manager, policy maker is a nurse, scientist or mathematician such questions impact upon the person. As they are social, cultural and political. Revisiting Bronowski's Ascent of Man, this question arose in Archive on 4.

'It seems that mathematical ideas are arranged somehow in strata, the ideas in each stratum being linked by a complex of relations both among themselves and with those above and below. The lower the stratum, the deeper (and in general the more difficult) the idea.' p.110.

(my emphasis)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

logical & mathematical reasoning depth of reasoning (memory) mathematical aptitude intelligence(s) pure maths identity	vector relations mathematics logic depth of analysis, complexity Cricket! pure - applied maths "1" problem per visit
patient - health practitioner  relationship Watching cricket - conversation	reports - outcomes enumeration of cases

Back-tracking to page 104, Hardy:

'The relations revealed by the proof should be such as connect many different mathematical ideas.'

Our proof is person-centredness, placing the person at the center (in this case - of Hodges' model). The proof can be quantitative and qualitive. There are a great many ideas at work. Critically, the ideas that might be called upon (even improvised) are not all health-related, but can extend beyond to encompass the four care (knowledge) domains of Hodges' model. In healthcare as in Hardy's life the spiritual is encountered. So, the determinants of health are ALL available to us - as required. Well not available as a resource might be, they are available in the hope they will be seen as factors. Hardy would approve I think of the direction of travel, not just as a vector, but a model of multidimensional vectors - reaching for relations.

Hardy, G.H. (1940) A Mathematician's Apology, Cambridge: Canto.

https://www.cambridge.org/core/books/mathematicians-apology/B90D81A8E28674119781863988A3E11B

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