Review: iii Fundamentals of Person-Centred Healthcare Practice

 

Previously, I recognised the many links throughout the book and on p.54 there are five relating to professional standards. These reflect the book's international scope and multidisciplinary relevance. Those on page 54 do work and support the text. One of them I was presented not with the expected page and missed the outcome of the 'click'. I wasn't going to re-type but found the page through the site's menu. Some links are long, as I found, whether permalinks [usually shorter] or fallback search text might improve link-longevity I'm not sure.

As a reassurance the contrast issue black-text-on-dark-green is limited to one figure.

The book is well referenced with an additional reading list. I've been made aware through plagiarism detectors (one paper) which - it appears - have 'read' an introductory section to Hodges' model as self-plagiarism. I wondered if in comprising a community of practice the references here maybe somewhat insular. I've no analysis to support this and the same no doubt may apply to other to emergent ideas, including threshold concepts. You have to start somewhere. At fear of contradiction there are many theories called upon and referenced.

Students may find the more attention to the position and specificity of references useful p.75 "we cannot not communicate." How times, chapters (8 - Communicating and Relating Effectively), theory, practice and management are challenged. The art of  'sympathetic presencing' working on the phone triaging acute community mental health referrals, 'Being kind and warm'.

For a text on person-centredness the book is imho mental illness-health light, but then as noted what is the book about? Am I suggesting that such books should attend to disciplinary equality? That said if there is a test for parity of esteem here, what do you conclude from one dedicated chapter? I was surprised, but is there a dilemma here? Beside 'Trust in self and others' I made a note, 'intuition'. Is person-centredness and being person-centred taken for granted within mental health practice? Research suggests not. 

Reading the table of contents you will find:

Chapter 18: Being person-centred in the acute hospital setting
Chapter 19: Person-Centred Rehabilitation
Chapter 20: Being person-centred in community and ambulatory services
Chapter 21: Experiencing person-centredness in long-term care
Chapter 22: Being person-centred in mental health services
Chapter 23: Person-centred support for people with learning disabilities
Chapter 24: Being Person-centred in Maternity Services
Chapter 25: Being person-centred in children’s services
Chapter 26: Being person-centred when working with people living with long-term conditions
Chapter 27: Palliative and end of life care services

I had a sense that the chapters were not sufficiently differentiated despite the titles. This may say more about my reading and the (editor's achieved) coherence of the book overall. Perhaps also for me, person-centredness is realised in-situ with personalised details. Not just vignettes (which are used) but the detailed intra- interpersonal, social, physical, political and spiritual choreography that is person-centred care: whether or not there is engagement (a dance).

Dementia is represented but the context appears to be residential care. You will find challenging / courageous conversations, but not challenging behaviour in situations that test interpersonal skills and person-centredness especially for staff, students, carers and families (dementia in general hospitals - despite numerous initiatives). Trauma has its place in the mental health chapter (and in current literature), but again the challenge of psychoses, anorexia are missed opportunities to reveal the potential and delivery of the Person-Centered Practice Framework.

Since the book's publication with its stress on the welfare and well-being of staff and educators too, the need to make explicit the politics in health is even more extreme. The need to protect the title of 'nurse'; mis-information generally and relating to COVID. Person-centred decision making and shared decision making are described as systems. Perhaps this misses the nuances of a health care professional, the team and family working with a person were they are making an unwise decision (pp.83-92). Another chapter indicates the need and utility of disciplinary bridges:

Chapter 17: Socio-political context in Person-centred Practice

 

individual - PERSON - patient
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

family - group - population

MIND :: Parity -	- of esteem :: BODY
Culture Child - Parent - Guardian FAMILY SOCIO -	Refugees Homeless title of 'nurse'* mis-information Organisational culture? - POLITICAL

One more to follow with many thanks to the publisher for the review copy.

Review i

Review ii

Review iv

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.

* https://twitter.com/hashtag/ProtectNurse?src=hashtag_click

 

Person-centred care and semantic inflation

Time laughs at us, with us and has the last laugh. If you are ever complacent and by virtue of your years you venture to think to yourself:

Well we've been working on this now for 20-30 years look at the progress we've made. ...

Time is always there to remind you:
Hey, just who are you trying to fool?
You are a lifelong learner!

The number of personnel and services that describe themselves as person-centred is an ongoing theme of so many CVs, policies, SLAs, commissioning and consultant's presentations and lectures. ...

Whether in a ward, service, or organisation's philosophy, person-centred is a term that is being diluted to the extent that semantic inflation devalues what is supposed to be the main currency? Or are we admitting that this is the cost of the political games that people play? Whatever your view, there are insights of progress won, but also reminders on how much remains to be done.

Health and social care being multicontextual demands the existence of multiple currencies. One additional currency begs that we compare A, B, C with the evidence base.

If this is the crucible of our person-centred times then what is burning?

• Nursing ethics?
• Nursing education?
• Idealistic aspiration? (Yes, we will get there!)
• New Age incense?
• Policy initiatives?
• Funding allocations?
• Nursing activism (Or, are there any balls in the house)?
• Service infrastructures?

Although the media temperature is rising here in the UK, as health, itself economically recumbent is moved to ICU being so politicised; the Francis Report provides evidence of a dire lack of person-centred care. Recalling my basic nurse training: what can be more person-centred than ensuring that a patient has the necessary fluids and diet?

For women who suffer a miscarriage - where should they be nursed as debated in today's Guardian newspaper? What is person-centred care in maternity and gynaecology services?

In-patient provision and transitions from child-youth-adult provide other opportunities and major challenges for health and social care to demonstrate their person-centredness.

There are so many ways to be person-centred, so many levels, some may even be contradictory(?).


I wonder how many of those people highlighted in the Francis Report also had a form of dementia - whether diagnosed or not? Personhood and the need to acknowledge and sustain the person are not new.

Even if a service is person-centred in terms of the environment, meal choices, therapeutic options, belongings, personal space, proximity to home and relatives ... the crux at the center is the attitude of staff, and their having the time and space:

"to be"

person-centred

Additional links:

Mumsnet

Atkins, L. (2010) NHS 'must lessen trauma of miscarriages' Parents web forum Mumsnet calls for new code of practice to help women who lose their babies, The Guardian, Tuesday 2 March.

The paradox of Service Vs Person-Centred Care

Looking at Hodges' model and its basic structure of axes and care (knowledge) domains, I wrote a note to the effect that:

- the INTERPERSONAL (INTRA-) and SCIENCES domains are fundamental to individual care. 

This follows, of course, from the vertical axis.

Then I added, that the SOCIOLOGICAL and POLITICAL domains are fundamental to person-centred care.

 

Person-centredness is vested, is realised in and by the care domains that involve concepts mediated and related by the group, the collective.

 

There seems a (strong?) recognition of social justice and justice at work.

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

individualised	individualised
person-centred	person-centred

Perhaps this is the implicit origin of the call to new learners and professionals alike to 'Make a Difference', 'Be the Difference'?

Then I thought of the perennial duality of service-centred and person-centred care.

 

Accepting the idealised nature of these thoughts, when 'presented' with a case, health services - through their practitioners, focus on the individual. The individual may express personal choices, hopes, but the extent to which these garner a response, are acted upon, also depends on the SOCIOLOGICAL and POLITICAL domains. 

In terms of the ideals (that apply, and what I will call upon) there are two extremes - I have mentioned previously, consider:

In the triage situation, apart from establishing consciousness - communication and interpersonal are collapsed into seconds, and response to stimuli / pain, communication is not key. Task orientation, practice, procedure, events, rehearsal, stock and equipment checks are to the fore.

 

Alternately, there is the level of interpersonal skills that are exercised to communication with the patient, to learn of, recognise, and respond to their personal choices.

 

All of a sudden things seem to be reversed.

 

Short of being plain wrong (?) -

THIS seems powerful, essential and required medicine for the 21st century.

service	SERVICE
person	PERSON

It is even more nuanced, however, and I'm not trying to clever (mathematics and logic are definitely not my subject), but making the above easier to describe:

s	S
p	P

Above, I'm trying to suggest and represent:

1. A lack of regard and relative neglect of the humanistic domains [ s AND p ];
2. This is then reflected in the ongoing issues of parity of esteem for mental health, illness and psychological interventions [ s OR S ].

In #1, we can add the UK decade long, debacle of funding for social care and the status and recognition of the workforce; the legacy (lessons) of medical sociology and the potential of attention to the social determinants of health and the sustainable development goals (paper to follow mapping the SDGs to h2cm).

The [ S AND P] in the SCIENCES and POLITICAL domains - might (also) be indicative of the continuously espoused benefits of technology as part of health care delivery. While accessibility and improvements in this are emphasized, often Politically people are isolated due to lack of technology, or funds. There remains a SOCIO-technical divide.

The years to follow, will no doubt see the microscope from the SCIENCES placed in the humanistic domains and technology's impact - benefits examined there. Who knows: maybe a new instrument, simultaneously (transdisciplinary) qualified will be found?

Conclusion that might be drawn:

The bio-psycho-social model is insufficient for person-centred care (having an opportunity, then yes - I would say this).

The overall aim and objective of Hodges' model when applied, is not to tick boxes but to diffuse the disciplinary boundaries, to assure, and integrate.

More to follow... (a paradox?)

Review: iv Fundamentals of Person-Centred Healthcare Practice

Chapter 15 on 'Being sympathetically present' is a timely review of empathy, sympathy and compassion. As students learn and are exposed to experiences in practice and socialised (or not) in how these are practised this is very useful allied with exposure to the 6Cs. Mentioned in post iii: chapter 19 on Person-Centred Rehabilitation would benefit from the addition of reablement and resettlement. Given resort to a single chapter [22] on mental health it is understandable that the extreme form of trauma - physical and psychological experienced (but not necessarily wholly remembered) for people sexually assaulted points to forensic and Criminal Justice Liaison and Diversion Services. The authors here are to be congratulated on a feat of explanatory gymnastics. This just hints at the PSYCHO-dynamic* world that is mental illness, health and well-being (*physical and political).

Perusal of W2tQ reveals how readily Hodges' model can encompass the sciences and the arts (humanities). This is by design (the model's structure). The book stresses art with some (very well-balanced and executed) illustrations and prose. Once again (sorry) though, I thought of veterans, homeless, veterans, prisoners and newly released offenders and their circumstances. Being person-centred is very much attitudinal but this is physical not just cognitive and how we apply knowledge. Where this person is in space that is the centre of gravity. How best to approach, a person living with dementia and impaired senses, a homeless person lying under a bridge - even before we speak. 

 

I'm sure I read 'touch' in here, but it is not indexed. Post-COVID and in nursing as part of person-centredness this is an important part of communications skills, safeguarding and being safe. 

For the newly released prisoner, how prepared are they to be the person they can be, even before we are 'person-centred'?

"For the first time in 25 years the one-off payment given to adult prison leavers in England and Wales is to be raised. The Prison Discharge Grant will increase from £46 to £76, but what difference will that make?"

https://www.bbc.co.uk/sounds/play/m000y5sq

Released On: 24 Jul 2021  Available for over a year

 

The book identifies different interventions and models relevant to the respective practice area, i.e. rehabilitation. Chapter 33 presents a personal challenge in (being a lifelong learner) whether you have a fixed or growth mindset, which of four archetypes of self-awareness applies to you (pp.322-323)? It's worth reading for heutagogy (p.327). I was prompted to consider the ongoing journey here. If anyone would like to test the reflexive credentials of Hodges' model (p.328) please get in touch. Salience is a key concept in Hodges' model. What is important to the patient - person? What is now? Are we only person-centred dealing with conscious persons? Again, perhaps a missed opportunity - care of the unconscious patient? I enjoyed chapter 30 on critical thinking. I was reminded of (verbal) accounts of people applying the Tidal model in forensic care. This proved not exactly straight forward, whereas, once learned Hodges' model can function as an aide-mémoire. If shared then collaboration may be enhanced since as the latter sections of this book show specific concepts need to be identified, articulated, agreed and applied.

The final chapter's title made me laugh a little: A call to action. Sometimes you can't win on the periphery of academia (a privileged position nonetheless?). KISS (Keep it simple stupid) applies to Hodges' model, but whether simple, or deemed complex the model fails to be recognised as a vital tool for all health and social care practitioners. Especially learners taking their seats (in-situ or online) on course 101. I take heart in believing that Hodges' model has a very long tail in relevance and global potential.

Once again model/framework envy creeps in, as I have no evidence (yet). 

Paradoxically (or not) this book will have me try to take note of instances when an interaction calls for a suspension of person-centredness: for me, the patient, client, carer - for us simultaneously.

This is the 'take-away' for me from this book which I also heartily recommend.

I will refer to 'healthful' in another book review.

SPIRITUAL

 

individual - PERSON - patient
|

INTERPERSONAL : SCIENCES

SPIRITUAL  humanistic ---------------------------- mechanistic  SPIRITUAL

SOCIOLOGY : POLITICAL

|

family - group - population

 

SPIRITUAL

Mindset :: Parity - attitude aptitude (My choices*) Hodges' model - disassembly for care	- of esteem :: Touch aptitude attitude Hodges' model assembly of care
Culture Child - Parent - Guardian FAMILY- Social network Be the 'person' the Social Determinants of Health predict/dictate?	prisoner release grants and welfare *(Are you joking - without attending to the politics of health and social care? Diet, green spaces, identity, community (facilities), housing ...)

Many thanks to the publisher Wiley-Blackwell for the review copy.

Review i

Review ii 

Review iii

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.

Nurses - Ask 5 complimentary questions

I received an email from RCNi subject heading - 'Q. What questions are nurses asking?'

An invitation to sign-up and ask five free questions: https://rcni.com/ask 

Question 1

Is there a model of care, or nursing that encompasses the sciences, mental health, sociology and political domains of care?

Several models of care and nursing frameworks integrate diverse domains beyond purely biological aspects, encompassing scientific, mental health, sociological, and even political dimensions. These models emphasise a holistic approach to patient well-being, recognising the complex interplay of various factors in health outcomes.

• Social Model of Health: This model focuses on salutogenesis, examining what contributes to health rather than just illness, by considering broad social, economic, environmental, and cultural influences on an individual's well-being .
• Person-Centred Nursing Framework: This framework extends beyond individual biological health to include the person's intricate cultural context, family, spirituality, and life experiences, defining health as encompassing intellectual, social, and spiritual dimensions .
• Biopsychosocial Model of Care: This approach integrates biological, psychological, and social factors to address a patient's holistic needs, moving beyond the biomedical model's sole focus on physical illness .
• Dual Registration Degrees: Educational programmes for nurses and social workers combine life sciences with social work principles, law, and policy, preparing professionals to understand factors influencing health, social justice, structural inequalities, and anti-discriminatory practises .
• Multidisciplinary Team (MDT) Care Model: While not a nursing model itself, the MDT approach enhances patient care by integrating expertise from various professionals, including specialist doctors, nurses, psychology counsellors, dietitians, and pharmacists, to deliver individualised treatment plans and coordinate care .

Modern healthcare increasingly recognises the necessity of comprehensive care models that extend beyond traditional medical approaches. These integrated frameworks, including the social model of health, person-centred nursing, and the biopsychosocial model, provide a foundation for understanding and addressing the multifaceted nature of health, incorporating scientific, mental health, sociological, and policy-related aspects to improve patient outcomes. [Five references provided - hence poor formatting in transfer.]

Question 2

What model of care has the conceptual scope to critique parity of esteem in mental health nursing?

Critiquing the concept of parity of esteem in mental health nursing requires models that move beyond a purely biomedical focus to embrace holistic, person-centred, and culturally sensitive approaches. These models emphasise equality, social justice, and comprehensive care, addressing the historical imbalance between physical and mental health provision.

• Biopsychosocial Model: This model offers a conceptual framework to critique parity of esteem by considering biological, psychological, and social factors in a patient's health, aiming for holistic needs rather than just biological ones . It contrasts with the biomedical model, which has historically led to paternalistic decision-making in healthcare .
• Culturally Sensitive and Competent Care: Essential for critiquing parity of esteem, culturally sensitive care requires nurses to appreciate diverse cultures and adopt personalised, flexible approaches to mental health support . Culturally competent care, underpinned by equality and diversity principles, involves behaviours and attitudes that value patients' diverse backgrounds, improving satisfaction and outcomes .
• Person Centred Care: This approach is crucial for addressing the historical paternalism in healthcare, ensuring patients participate in decisions about their care and re viewed as individuals with unique experiences rather than just labels or symptoms . Recent mental health reforms, such as the Mental Health Bill 2025, aim to embed person-centred and equitable care further .
• Holistic Care: The Nursing and Midwifery Council (2024) emphasises assessing spiritual needs to provide effective holistic care, recognising that "seeing the whole person supports better care" . This aligns with the biopsychosocial model's aim to meet holistic needs and challenges the organisational and practice divisions between mental and physical healthcare .

Effective critique of parity of esteem in mental health nursing necessitates a shift towards models that integrate biopsychosocial, culturally sensitive, and person-centred approaches. These frameworks are vital for fostering equality, social justice, and comprehensive care, moving beyond traditional biomedical limitations to address the full spectrum of patient needs. [Eight references.]

I'll leave it there. I think. PJ

<>

My emphasis: In the spring I tried to engage and see if I could write a short article about Hodges' model for RCNi. After an online chat and following up by email, Hodges' model isn't for them apparently. It was kindly suggested that I try another journal.

I must improve my prompt writing.

I must improve my prompt writing.

I must improve my prompt writing.

I must improve my prompt writing.

Nurse, you must improve your prompt writing ...

Person centred care, wormholes, pesterers and care domains (ii)

Person centred care, wormholes, pesterers and care domains (i)

Mentor: Sorry my friend where were we up to?

Student: I am still puzzled as to how we can define and represent person centered care? Where does person centered care fit in h2cm (Hodges' health career model)?

The INDIVIDUAL-GROUP vertical axis places the person, the individual - at the top of the model. That could be a positive if we are thinking hierarchically, but shouldn't a model that is situated AND person centred be explicit and put the person at the center?

Mentor: This is a good question and you are right to ask it. As our previous discussions have illustrated our models are idealised and yet they should reflect the real world and experiences they seek to model and re-present for us:

Student: but in this case....?

Mentor: Well, not so quick...

As we noted the World's governments get the citizenry they deserve and vice-versa. If peace, political engagement, legitimate government and contentment are not a given but have to be earned then is person centred care any different?

Student: So, you are saying that peace, being a citizen, and mm... well-being I suppose are in a sense similar to person centered care?

Mentor: Perhaps?

Student: That seems quite a leap.

Mentor: Well your question prompts exercise - a certain gymnastics even - and with that a daily requirement we'll save this point for another time.

For now though... I know we don't necessarily need a precise definition of person centered care at the moment, but humour me and see what you can come up with in terms of this model of care. As you have mentioned it includes the INDIVIDUAL, the GROUP. And with the interpersonal and science domains the person's mind and body are literally in the frame.

Student: Well unless we are talking medical emergency then person centered care is about ensuring the individual is taken into account across all the domains of care.

That is - intra-interpersonal, physically - through the sciences, socially and politically. 

Oh - and spiritually too of course.

Mentor: So person centered or being person centered concerns domains of care?

Student: No. It's the content that matters. Take the interpersonal and myself as an example - what are my beliefs, previous experiences, writing skills and interests, my mood, disposition and attitude towards others. That only scratches the surface.

Mentor: I see. Can you go on from there...?

Student: Well I suppose each domain is visited according to various cues - and this is where context and situation come in. These supply the cues. They determine what is significant, what counts as information. For experienced nurses and health care practitioners this travel within and across the care domains comes as second nature.

Mm... I suspect that even if someone was not using h2cm explicitly their cognitive - conceptual movement could still be traced through the model, like passes on a football pitch.

Mentor: Very poetic! So if these care domains are being reflected upon does that mean person centered care is a consequence?

Student: Well I suppose it could if you take your mention of 'reflection' literally. Yes, picture the patient - the person - in the center of the h2cm matrix. We might even argue that our reflections place them there? Within the model what is the position of the person? If our deliberations could be measured - and practically that would be quite a task given patient engagement and dialogue - then is there an average across the domains? And is that the center - hence person centered?

Mentor: An interesting idea. And yet as you questioned initially the INDIVIDUAL in the model is at the top, at the top of an irregular continuum, so...?

Review: i Fundamentals of Person-Centred Healthcare Practice

This book is written for students and as per the title the focus is central to student's learning, knowledge, skills and practice through placement experiences. It needs to be pointed out that there is an underlying framework that the book's chapters refer to, this is the Person-Centered Practice Framework [PCPF]. While the editors have biographies the (non-editing) contributors are listed by affiliation. I would have liked to read a brief professional biography.

I was encouraged, but under no illusions, when I read that the authors: "show how the Framework interconnects with and fits with the approaches, concepts, models or principles relevant to their professions, roles, service users, students, colleagues, service contexts or learning environments." (Foreword). Clearly the PCPF has been fine-tuned and subjected to research nationally and internationally.

The book is thought provoking at the same time as being accessible with bite-sized chapters. I've often wondered about the meanings behind 'careful'. The introduction provides us with 'healthful' which I am still chewing over. I was encouraged too in the introduction as the book clearly needs to define many forms of care (e.g., person-centred, family, relationship) and concepts, such as, person, personhood and person-centred.

The text size, font and layout are modern and accessible. Some of the figures (p.5) while informative take a real effort to read and interpret, given the use of shades of green and grey. Here contrast - black on dark-green - is a problem. Each chapter begins with 'learning outcomes' and there are activities 'Who am I as a person?' in chapter 1. 

As we prepare for COP26 (fingers x'd) chapter 1 differentiates between person and non-persons. Now we see how the future and our ability to practice person-centred care depends on the viability, sustainability and hence protection of the biosphere.

Section 1 and the book as a whole is a marvellous primer for new learners. On pages 8-9 the discussion on 'the reflective person' and Sabat's three forms of self highlights the importance of the context and how person-centredness is situated:

Sabat, S. R. (2002). Surviving Manifestations of Selfhood in Alzheimer’s Disease: A case study. Dementia, 1(1), 25–36. https://doi.org/10.1177/147130120200100101
 

individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Self 1	Self 2
Self 3	Self 3*?

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

Review ii 

Review iii

Review iv

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.

Person-centred care: "Right! Down! Down! Riiggghhht again! Spot On!"

-|- Person-centred care is one of the Grails of health and social care. It is up there with holistic care, which it precedes since holistic care needs a subject (discuss?).

In terms of Hodges' model the 'person' (for me) is to the upper-left-of-centre. Why there? Well, you really understand why when helping people cope through dementia.

It is no surprise that the development of person centred care and personhood have been especially concentrated and emphasised in the care of people living with dementia.

They need to be and constantly refreshed too - everyone forgets - some of us more than others.

Physically of course 'person' translates to the upper-right quadrant. So there you have it - in the INDIVIDUAL-group axis the classic dichotomy-debate: MIND-BODY.

I have no argument with the need for person-centred care, but faced with a Grail and the bright light that can encompass it, safety and respect dictates we step back. From a distance we can then see that person-centred care is only part of a much bigger picture.

At the end of the day (and night!) we need to be centred full-stop.

If not then saying the words that count such as dignity, respect, choice, privacy will echo in the intra-INTERPERSONAL domain and make everyone feel good in the SOCIOLOGICAL domain. All very worthy but possibly without making an impact where it counts - in the POLITICAL domain.

By placing the person at the centre of Hodges' model ALL the
domains are ready to hand and mind.

Person centred care, wormholes, pesterers, care domains (iii)

Person centred care, wormholes, pesterers, care domains (i)

Person centred care, wormholes, pesterers, care domains (ii)

Mentor: Shall we re-turn to your question?

Student: OK. Good idea.

Mentor: So to recap how we can define and represent person centered care? Where does person centered care fit in h2cm (Hodges' health career model)?

The INDIVIDUAL-GROUP vertical axis places the person, the individual - at the top of the model. That could be a positive if we are thinking hierarchically, but shouldn't a model that is situated AND person centred be explicit and put the person at the center? Is that the nub of it?

Student: Yes.

Mentor: So can you suggest an avenue to pursue?

Student: No... but I was struck by the talk of movement.

Mentor: And that was your suggestion if I recall correctly. In a similar way you also mentioned ensuring that the individual is taken into account across all the domains of care. So it sounds like there is a theme there?

Student: Yes, but this may as well be a foreign language - ironically I am stuck - conceptually and physically.

Mentor: Mmm.. What do you do?

Student: Exactly!

Mentor: No sorry, really - what do you do?

Student: I study obviously. Mentor: And...? Student: Well I study and work as a nurse - a student nurse...

Mentor: So you should know the answer? I do not practise clinically as much as I used to, so you have an advantage over me in terms of finding the answer.

Student: If the answer lies in practice?

Mentor: For matters 'person centered' is there a better place to look?

Student: True. OK. So - movement... reasoning... 

Mentor: Is your job easy in practice?

Student: It varies of course, but in general - no it's not easy: it takes effort.

Mentor: Ah, now you may have something there!

Student: Oh well that's heartening [with a smile]. In terms of effort then - nursing - health and social care takes concentration and attention as per active listening. You finish a shift and you know you're spent - and there's that assignment and self-directed study to complete.

Mentor: So it sounds like nursing requires - demands even several forms of effort.

Student: Yes in thought and action.

Mentor: And the model - h2cm - can support you in your reasoning and action?

Student: Yes it can because the model encourages you to consider each of the care domains back and forth - and in so doing you move the individual from the top of the I-G axis to the center of the model. Right at the heart, the nexus!

Mentor: So if the model says something about person centered care what does it say?

Student: Well, it says that person centered care is not a given it has to earned. And there - clearly [smiling] is the effort!

Mentor: Well found. Yes, it takes a lot of effort on the part of individual practitioners to put the patient, carer, member of the public - the person - at the center and keep them there. Socio-political factors and lest we forget sometimes the individual themselves will sweep the center clear. What we find and place there are the constraints which are always many and can always be found, such as; location, finance, beliefs, politics... Nursing, health and social care is a constant struggle not necessarily against nature, but with nature and many other factors.

Student: You said something about the INDIVIDUAL-GROUP continuum being irregular and I'm sure there must be more to that?

It's almost as if there are the four pages - the care domains - through which we consider and write our care assessments, plans, evaluations and outcomes. And yet I'm intrigued regards the movement between these pages and the knowledge domains they give rise to.

 Mentor: That is another very worthwhile question and in the same way that we remember the fifth care domain - the spiritual; I am sure you will find a way with that question also in good time ...

-+-

"Riemann's cut, with two sheets are connected together along a line. If we walk around the cut, we stay within the same space. But if we walk through the cut, we pass from one sheet to the next. This is a multiply connected surface."

Kaku, Michio (1994). Hyperspace: A Scientific Odyssey Through Parallel Universes, Time Warps, and the Tenth Dimension. Oxford: Oxford University Press. Fig. 2.4, p. 42.

Person-centred care [PCC]: is it really happening? c/o National Voices

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

PCC = what’s important to the individual, is co-ordinated around their needs and involves them in decisions. "To be person-centred, that care needs to work together to wrap around all the needs of the individual in a holistic way. Sadly, our report found that neither the NHS nor adult social care can demonstrate co-ordination of care, despite ‘integrated care’ being a key goal of all national and local leaders over the past five to 10 years. The way health and care services work must change to reflect the needs of the population. It would be a start to recognise that co-ordination of care is an important factor, and that we need to be measuring whether it is happening."	(many) Definitions = 5 key indicators of pcc:  good information, good communication, involvement in decisions,  care co-ordination  and care planning. Service user reported data from 19 nat. surveys NHS:  in primary care, only 39% of patients said their GP was ‘very good’ at involving them in decisions. What’s more, personalised care planning doesn’t really happen. Only 3% of GP patients with one or more long-term conditions reported having a written care plan, suggesting that opportunities to deliver personalised care in the NHS are being missed.
"Personalisation of care is more advanced in adult social care than in the NHS, with 89% of adult social care users reporting that the care and support they received helped them to have control over their daily life. Similarly, 63% of people using a social care personal budget said that this had improved their ability to make everyday decisions. Participation and control of decisions is well-established in adult social care, with just over 90% of those using community adult social care saying they were involved in decisions about their care and support needs." (See original post - report for important additions)	20+ years policy  England Care Act 2014 National Voices coalition of health and care charities  report ‘Person-centred care in 2017' No National data on this... "It is clear from our report that a strategic overhaul of how care is measured is needed. Rather than single-service, single-setting, activity measures, more credence needs to be given to the experiences of the people who rely on services. Only then can we help local systems succeed in offering personalised, integrated and holistic care. Whilst there have been some advances in the delivery of person-centred care, there is still a long way to go before the policy rhetoric matches the reality experienced by people."

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.

 

iii Picking up sticks: when axes matter

It is one thing for us to break the stick, but quite another from a concept's perspective. They are accustomed to the dynamics at work, when as search terms they are exploded, or not. And, not just any concept but one that can be unique. Consider the concept, and how or where it finds itself [ in Hodges' or another model ]? Let us use the intra-INTERPERSONAL domain, as an example, and ask:

1. Is 'mood' fixed by the I-axis alone?
2. Does the humanistic axis have a role in where in the doomain the user of Hodges' model places 'mood'?
3. Acknowledging person-centredness, if the patient/client had a view, to what extent would this agree (with annonymity assured) with the professional's judgement, or a relatives / guardian?
4. What is as a result, 'mood' has become 'very low mood'? (To continue in this vein , invites complication, but we will continue.)
5. Introducing the 'Other' whatever their role and relationship, pushes us to the humanistic, but whether this is achieved in a person-centred manner (triage excluded) is a matter of opinion and judgement (evaluation).

If mood is fixed by the I-axis then if we determine the issue is 'low mood' are we introducing a combined quantitative and qualitative dimension, a continuum, at the selected point in the interpersonal domain? Writing previously about threshold concepts, I wondered, and proposed compound threshold concepts. There is a progression from the patient's subjective self-assessment, to in all likelihood of an objective measure being introduced, so spanning two domains. Definition of 'compound' aside; there is a compound structure at work.

What points 1-5 above reveal is triangulation. When it is argued that Hodges' model facilitates navigation as per my presentation on 21st April, this is a strategy from mixed-methods research in practice. Many years ago, Hodges' model was described as a 'cognitive periplus', reflecting the way ancient mariners initially charted the coastlines creating the first map, as per their culture and dispora. In the west more recently the value of social approaches and activities, especially in mental health. Care navigation is a role. Literally sign-posting to individually suited (which must be stressed) activities, resources, and agencies. So, in Hodges' model what are our three triangulation points? They are:

1. Axial;
2. Intra- InterDomain; 
3. Person-centred. 

Perhaps, we can describe 1-2 as conceptual anchors at least when dealing with a concept, while #3 is more about approach, values and philosophy. So, there is something of a 'cheat' going on, because each one is compound:

1. Axial: The axial is comprised of four points. The axes create a Cartesian plane (figure). And, as far as a patient is concerned, they mark off a point on the respective Individual and Humanistic-Sciences parts of the axes. This form of triangulation point can claim a general conceptual precision (language) in the applied terminal labels; but what happens in-between can be patently fuzzy. A mix of what may be objective and subjective.

2. Intra- Interdomain: This may be the most imprecise triangulation point. It appears the axes of Hodges' model are composite (figure). They have two-sides as a boundary. To be pedantic, in our example, one plays to the interpersonal domain, the other the sciences.

[The relationship between the axis and the domains in Hodges' model, is far from unique; but I wonder if there is something else here?]

2. Person-Centred: There is a paradoxical nature to person-centred(ness). It is also nebulous in nature, and yet in care it is definitive in practice (safety, purposes, values, professionalism, competency, ...).  It forms locus which can also be classed as a traingulation point, at the centre of the model. This is the point around which Hodges' model is built. This captures the individual's (life, care) context and situation, all influenced by their life chances as consequent health - and other - careers. Salience and our attention^ is key. Is it possible to frame our purpose(s)?

^A focus for [N] autumn.

Marrakech, Le Jardin Secret. 24th April. 1000-1830.

Inaugural Symposium on Person-centredness in the Curriculum May 2nd - 3rd

Dates
Thursday 2 May and Friday 3 May 2013
(starting at lunch time on 2 May with a full day on 3 May)

Venue
Loughview Suite, Jordanstown campus, University of Ulster, Northern Ireland

The School of Nursing at Ulster has a strong tradition of national and international leadership in the field of person-centred practice. The Institute of Nursing and Health Research at Ulster incorporates the Person-centred Practice Research Centre directed by Professor Brendan McCormack. Against this backdrop the School has been developing a programme of work with a focus on person-centredness in nursing education. It is our contention that in order to achieve maximum effect in practice, person-centredness should be embedded within and across all programmes of education for health care professionals.

This year the School of Nursing at Ulster will host its Inaugural International Symposium on Person-Centredness in Nursing Education. The one and a half day symposium will include presentations and workshops that will appeal to those involved in nursing education in academic and practice settings.

Symposium themes 
The three key themes of the symposium are:

• To explore ways of infusing a culture of person-centredness through effective, contemporary higher education
• To share innovative approaches to the facilitation of person-centredness in practice learning
• To reflect upon how the experiences of teaching teams and service users and to consider how these can shape educational approaches and teaching strategies

Target audience
The symposium will be of interest to colleagues who have an interest in promoting person-centred practice through education in practice or academic settings.

To reserve a place or for further information please contact:
Julie Cummins at the Institute of Nursing and Health Research

-----

I plan to attend this event on a topic central to h2cm.

ii 'Thinking outside the box ...' by Amber Javis

Second reply to a blog post by Amber Jarvis on The Mental Elf:

Thinking outside the box: alternatives to standard inpatient mental health care

Amber's post considers a study by:

Griffiths, J. L., Baldwin, H., Vasikaran, J., Jarvis, R., Pillutla, R., Saunders, K. R., … & Johnson, S. (2025). Alternative approaches to standard inpatient mental health care: development of a typology of service models. International Journal of Mental Health Systems, 19(1), 1-13: https://pubmed.ncbi.nlm.nih.gov/40247283/

Jarvis highlights concern within inpatient services of:

'use of coercive practices ... (Nyttingnes et al., 2018; Belayneh et al., 2024). These include physical restraint (physically holding a person), seclusion (holding a person in a locked room) and chemical restraint (the use of sedating medication to manage distress or behaviour, sometimes administered “as needed” rather than as part of any planned treatment). Poor relationships between staff and service users have also been noted, ...'

Reflecting since the previous post, I realise that I encountered efforts to prevent admission and treat in the community prior to going part-time. A short stay unit at a general hospital. Being a member of Intermediate Support for older adults; shifts ran 0800-2000 - early or late. Then working part-time, there were short-stay placements in the community that the recovery team would visit providing support.

Mental distress is distressing (a truism of course), both as lived experience (with or without self-awareness in-situ/crisis) and for others in the vicinity. Family, friends - who see a person they thought they knew, perhaps even thought they were a friend, a person who loved them; but now!? They present as distant, aggressive, subdued, agitated, unpredictable, inconsolable and possibly expressing thoughts of self-harm, threats to harm others, or totally bizarre, 'psychotic' ideas. This is not the person they thought they knew. For the person affected, familiars are strangers. A relational breakdown. We forget the severely mentally ill at our peril. A pervasive sense of helplessness is readily transferred: the reflex conclusion that help is needed - and fast.

To say we are creatures of habit, is to also acknowledge that change our environment results in a change in our behaviour. When relatives did arrive on the psychogeriatric ward I mentioned previously, they cried. Apologising for the environment, yes; efforts to reassure ensued and eventually family, friends were won over. They shouldn't have been. Unless we're in a game, play, or movie, who wants to find themselves in a Victorian era institution?

I've posted previously (or is it in draft?) on the importance of design in the design of care environments. It was a relative's visit to a care home, that resulted in a nursing home design business (Sunday Times). 

A person who is severely mentally ill needs service-centred care, not purely person-centred care. Person-centredness is key, but safety of self, and the public soon makes itself known. We also forget this at our peril. The problem is that control, and law literally take over. Plus, it's our place not yours. Loss of power the person struggling, ill, in crisis then follows. Amber continues:

'The concerns described above chime uncomfortably with modern mental health agendas of prioritising autonomy, compassion, trauma-informed and person-centred care. In light of these tensions, and the growing number of crisis alternatives – ranging from crisis cafes to intensive home treatment services – researchers  at the NIHR Policy Research Unit in Mental Health set out to map current alternatives to traditional inpatient care, both nationally and internationally. Griffiths and Baldwin’s findings raise important questions about how mental health services could evolve to better suit people’s needs, providing a valuable starting point for service planners considering developments in care.'

Hodges' model is ideal to help reflect and critique the relation-ship between 'a person' and 'the service'. I passed two gentlemen in London over the weekend. Clearly unkempt, standing but gesticulating, freely verbalising, incoherent on passing. Neither appeared intoxicated ( but I wasn't that close) or 'stoned'. That's the other question; passing-by what was I going to do? Does the 'community' care? On 'X' you encounter the extremes of debate. Anti-psychiatry, resort to and risks of dependence on medication - anti-depressants, anxiolytics; the damage from anti-psychotic drugs and atypical antipsychotics. The continuous debate about ECT. A dizzying stream of texts about mental health, over-diagnosis and wellbeing:

Medical prescribing has a partner. Social prescribing is well established, with organisations, events, publications and research emerging. People, have scoffed at the suggestion that gardening can help; or going for a run. Especially when you can't get out of bed. Chronic fatigue syndrome, long-COVID are seemingly monolithic in their resistance to change. A real challenge and so counter to the person's 'pre-morbid' personality and lifestyle.

For several years the state of mental health nursing as a specialty has been questioned. Is the mental health nursing curriculum being genericised? Enrollment of students nurses in learning disability has also dropped.

RCN questions separation of mental health nurse training (28 March 2025)

Medical prescribing has a partner. Social prescribing is well established, with organisations, events, publications and research emerging. People, have scoffed at the suggestion that gardening can help; or going for a run. Especially when they can't get out of bed. Chronic fatigue syndrome, long-COVID are seemingly monolithic in their resistance to change. A real challenge and so counter to the person's 'pre-morbid' personality and lifestyle. As a conceptual framework Hodges' model is ideal as a semantic net, to reflect and critique concepts that stretch and so disrupt (for a time) out norms. Concepts with a dual character. If social prescribing is one example, take crisis cafe mentioned by Jarvis above. If you think in physical - environmental terms where do you envisage a crisis occuring or playing out? What about a cafe? What is the ambience of these places?

I noticed a little visual game, an animation of characters running, jumping, climbing over an obstacle course. You focus on one figure and follow them for a time. This makes a difference, called distraction. In psychosocial intervention and managment of psychosis and anxiety audio - music, poetry, repetition has also bee used. The essence here must be when the intervention begins. Recognising relapse triggers, requires preparatory work. The Griffith reference is provided, but Jarvis begins to describe the results:

'Researchers identified 65 alternative service models to standard inpatient care. These were organised broadly organised according to the setting (e.g., community-based, hospital-based, or cross-setting) and the target population (e.g., adults versus children). Across these categories, ‘community-based alternatives’ were the most common category of alternative service models, followed by hospital-based and cross-setting approaches. We’ll explore each of these in more detail below.'

In post (i) and here I suppose I am advocating for mental health nursing as a distinct programme of study, practice and proven competence. For several years the state of mental health nursing as a specialty has been questioned. Is the mental health nursing curriculum being genericised? Enrollment of students nurses in learning disability has also dropped. 

RCN questions separation of mental health nurse training (28 March 2025)

There is a saying: 'You get what you pay for'. There is a sense that there are people who would like to ignore, deny, erase 'mental health'. After all, the truth really is that you can 'see' a broken leg. This isn't an issue if you can afford a private psychotherapist, or a psychoanalyst.

The elephant here (well, there always is one) is education and the literacies. For prevention: the ultimate change - this is where we must focus. But of course for the problem at hand - and mind it is too late.

(Post iii likely to follow.)

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

subjectivity          mental state - crisis - mind quality	objectivity hand - physical state - crisis quantity
Social prescribing Cafe	Housing - crisis Cost of living - crisis

See also: 'literacy' : 'prevention' : 'service' : 'severe' : 'change'

'Thinking outside the box ...' i

iii 'Thinking outside the box ...'