Hodges' Model: Welcome to the QUAD: Search results for reflect

Hodges' model is a conceptual framework to support reflection and critical thinking. Situated, the model can help integrate all disciplines (academic and professional). Amid news items, are posts that illustrate the scope and application of the model. A bibliography and A4 template are provided in the sidebar. Welcome to the QUAD ...

Showing posts sorted by relevance for query reflect. Sort by date Show all posts
Showing posts sorted by relevance for query reflect. Sort by date Show all posts

Friday, April 10, 2020

Reflection, Revalidation, RCN Congress and Research

Thinking Out Loud: Journal 'Regulars'

Like many people I looked forward to experiencing RCN Congress again in June. Now of course Congress itself is a casualty of COVID-19.

Last May as already posted, I picked up several nursing journals too. Having time(!) I've read about reflection, I submitted the required reflective accounts to complete my revalidation last month (so good through to March 31 2023) and I've time to reflect now.

Reading some of the papers and browsing through the journals I notice one has "CPD reflective questions" which are specified for full-length article submissions. Here are some examples from one journal issue:
"If a patient presents with red flag signs of impeding airway obstruction, consider the aspects of the 6Cs in nursing and reflect on the care, compassion, and communication required to the patient and family.
Consider the different dimensions of a person-centred climate of a long-term care setting.
Reflect on the nurse's role in the provision of person-centred care in an older adult residential setting.
How could you make the care of patients in your setting more person-centred?
Reflecting on the case study, what do you consider may help nurses in recognising the condition early and minimise the need for investigations?
Reflect on how the time perspective [can] be an indicator of health and quality of life in people with HIV or another patient group.
Consider how the time perspective can be incorporated into the health care of people with HIV.
Think about how nurses can assess the time perspective in people with HIV."
If you understand Hodges' model then you will appreciate how the model can facilitate reflection on all of the above.

The contents page of many publications usually differentiate between 'features', or 'special focus' and pages listed as 'regulars'.

For quite a while I've not only worked on papers (two advanced drafts at present) but (quietly) wondered about those 'regular' pages and what would it take for journals to adopt Hodges' model as a common resource?

Of course, this begs questions of legitimacy, evidence-base, standards ... and as I have acknowledged Hodges' model is no panacea for a practitioner's or a health system's limitations. Hodges' model itself may constrain the adopted perspectives of readers; as opposed to as I believe, liberating them? If all the posts here were analysed, what is the holistic bandwidth of the content?* If Hodges' model was adopted what trends, if any, would be revealed? If students used Hodges' model to reflect on their own well-being in year 1 - year 3 what would they learn? Are there wells of reflection about which reader's reflections would congregate? Would this in turn be influenced by other recognised biases in publishing and the way the above questions are selected?

It would still be amazing to see Hodges' model as a regular and universal prompt. Even as a research project - the aide-mémoire it is intended to be. The journal would then actively engage with its readership and provide invaluable CPD.

My new folder is already open for the next three years ...

Be Well :: Be Safe All

*I admit that there are topics I have avoided posting, as they are potentially fraught 'politically' or in other respects.

British J. of Nursing, 28,9. 2019 (9 May, Congress Bumper Issue!).

Tuesday, January 27, 2026

c/o Intima 'Reflect on the World' . . .

CARE/of Intima:

REFLECT ON THE WORLD WITH US EVERY FRIDAY AT NOON.

No pressure, but we want to remind you that every Friday, around noon EST, we post a Crossroads blog—a short reflection that contributors from our current issue do on something from our archives.

Think of “Friday at noon” as a blip in your busy life where you take time to yourself to reflect on our small part of the universe. Pause and spend 5 minutes reading one each Friday — it’s the equivalent of a deep-breathing exercise, a short yoga stretch, a tiny palate cleanser of lemon sorbet between the complex courses served up to us every day, or a moment stolen between patients or in a waiting room when you step out of your routine. Read the titles of recent ones below, then go and read a few. If you like what you read, set up a reminder alert.

INDIVIDUAL
|
    INTERPERSONAL    :     SCIENCES               
HUMANISTIC --------------------------------------  MECHANISTIC      
SOCIOLOGY  :   POLITICAL 
|
GROUP


 
 
 





My source: Intima (and image) - mail list.

See also: 'reflect' : 'crossroads'

Sunday, April 01, 2018

Paper: How social workers reflect in action and when and why they don’t [Mapped to h2cm]

individual
|
INTERPERSONAL : SCIENCES
humanistic ---------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group

The self - personhood

Reflection (as core concept)
has value and limitations

Non-reflection to protect the self

Unbearable anxiety

psychoanalysis - findings

defended nature of the self

thinking & non-thinking
'suspended self-preservation'
Self - Two perspectives - Service User

emotional intelligence
internal supervision
intuition - improvisation
Reflexive

Helicoptering - metacognition

Sexuality (form of bracketing-off of oneself)*
lived experience of the senses
RATIONALE

Theories of reflection

Frameworks for reflection (reflective practice)

physical / somatic effects of anxiety

ethnographic study

audio recordings



Reflective practice demands that
you learn from experience.
It requires you to be self-critical.
It expects you to analyse
what you think, feel, and do...

#When is it better NOT to reflect?

'Containment'

'splitting'

risks (being completely non-reflective)

experiences and the (mobile) body
TECHNICAL
*limits capacity of some aspects of relational work

 Social Work Practice

Home visits

Family home children and parents
'tacit knowing-in-action'
Reflection in Practise

Fieldwork - home, car

SW composed when service users in distress, absorb their sadness, shame, fears,
and at times their joy #

Face-to-Face interviews

Relationships: sexuality, gender

offloading informally - office

Social Work / Clinical Case Supervision

 offloading formally

Two Local Authorities

Management Supervision and Governance

Child protection

Power

Organisational risk management

Policies, Procedures

Lone working...

Influence in 'advocacy'
[comment on twitter - see below]
(as a Professional or 'Independent'?)


Harry Ferguson (2018): How social workers reflect in action and when and why they don’t: the possibilities and limits to reflective practice in social work, Social Work Education, DOI: 10.1080/02615479.2017.1413083

My source: Twitter
 

Sunday, March 10, 2013

Space to reflect

2013 could be quite a year for comets, at least in the northern hemisphere.

As we reflect in our studies and at work it is vital to take a breathe and reflect when we can on things otherwordly - Comet PanSTARRS:


Weather permitting after work  I will visit Parbold Hill to get a good view of the western horizon.

I've tried on two evenings - 12th - 13th - to spot PanSTARRS without success. There's still time as it moves north. The new moon was quite a sight last evening. Through the binoculars a jet very low down looked like a rocket - the shuttle taking off. Between the low clouds I watched the sun set: cue reflection

APOD archive southern appearance: comets Lemmon & PanSTARRS

Image source: NASA.

Thursday, January 02, 2020

"Nurses' ability to reflect on their practice is vital to the profession" Is it?

I beg to differ with the title of this editorial, as I wonder how vital reflection really is; and not just to nursing, but to the profession. I wonder from the rather detached perspectives of:

  • Wigan Pier - and the parochial view this engenders (#globalhealth - where on Earth do I think I am?);
  • As a 'local' nurse practising in Bolton;
  • As a mental health nurse practising in the community within the NHS
  • As a champion of a pivotal* resource for reflection and critical thinking (where is everyone?);
  • and several others ...
Nursing Management
Quinn notes how "Nursing continues to develop to meet the needs of the society in which it operates." Plus: "A core part of revalidation is the ability to reflect on, and learn from, our interactions with others." My reading of Kinchin (and others over the years) suggests that reflection needs to be more a practice and revalidation based. I understand this is not what Quinn is saying in this issue on "Reflection as part of revalidation". Reflection using Hodges' model can be preemptive and anticipatory. We need to get beyond introspection and the retrospective important as this is.

As to where people are, it seems they are elsewhere, maybe reflecting in the sciences domain seeking theories and evidence. Perhaps, current teaching and exposure to models and theories of nursing and healthcare has them reaching for 'pure' models of reflection - Boud, Gibbs et al. when necessary. As we talk about the legacy issue that is integrated care, in Hodges' model here is a tool - a 'freebie', a 'takeaway' yes an Ubercare, that can grow with students, newly qualified nurses and experienced staff as lifelong learners.

Now that is vital to me. When reflection is hard-wired**, a part of a practitioner's cognitive apparatus and their educational toolkit to share with the public explicitly or implicitly as the context and engagement demands.

*Pivotal? Yes, and of course in light of the above, I'd be pleased to explain and even argue the case. The irony here is the current (ongoing!) focus upon recruitment and retention. Hodges' model is 'just' a tool, I recognise this; but could the application of Hodges' model energise, inoculate and so prime students for their course of education and practice placements?

**soft-wired too - humanistic

Quinn, B. Nurses' ability to reflect on their practice is vital to the profession, Nursing Management, April 2019. 26:2, p.5.

Thursday, September 12, 2019

8th Biennial Threshold Concepts Conference 2020

Threshold Concepts in the Moment

The 8th Biennial Threshold Concepts Conference, 2020 is taking place at University College London from July 8-10, 2020 and we are inviting submissions from across all academic disciplines. The closing deadline for submission of abstracts is Friday 6th December, 2019.
"After almost two decades of research on threshold concepts that stemmed from Myer and Land’s seminal publication in 2003 it is time to reflect and take stock. As an idea it has generated significant interest and has become a world-wide phenomenon that has captured the interest of researchers and practitioners across the globe. 
The promise it offers as a lens to consider curriculum design, approaches to pedagogy and a way of reimagining learners has already had significant impact as the Flanagan website attests… But its full potential remains as yet unrealised. Is it time for an honest appraisal of where we are and where we want to go? If we want to continue to develop the ideas then we need to ask ourselves some potentially troublesome questions:
  • Has threshold concepts become synonymous with learner difficulty?
  • Have we become entrenched in a slavish adoption of the framework? Or do we apply the framework too loosely?
  • How do we avoid thresholds becoming seen as a panacea that can explain all learner difficulty? 
In considering these and other questions the conference offers an opportunity to reflect on the achievements thus far and encourages us to consider where we think work in the area needs to go next. There will never be a single solution to support all learners master the same threshold but an awareness of threshold concepts and their associated complexities allows us to become more informed practitioners." ...
For more details please visit the conference website:

https://thresholdconcepts.home.blog/biennial-threshold-concepts-2020/biennial-conference-2020-threshold-concepts-in-the-moment/

... and see the discussion list:
https://www.jiscmail.ac.uk/TCS

Best wishes
Julie

Dr Julie Rattray SFHEA
Associate Professor of higher Education and Director of Education
School of Education
Durham University
Leazes Road
DURHAM
DH1 1TA

Email: julie.rattray AT durham.ac.uk
Twitter @joolsled
Web: https://www.dur.ac.uk/education/staff/profile/?id=1964

(The original message from Julie has been modified above with text from the conference site and mention of the discussion list.)

Friday, December 06, 2019

TC2020: 8th Biennial Threshold Concepts Conference 2020

Bentham House, University College London
London, UK, July 8-10, 2020
After almost two decades of research on threshold concepts that stemmed from Meyer and Land’s seminal publication in 2003 it is time to reflect and take stock. As an idea it has generated significant interest and has become a world-wide phenomenon that has captured the interest of researchers and practitioners across the globe.

The promise it offers as a lens to consider curriculum design, approaches  to pedagogy and a way of reimagining learners has already had significant impact  as the Flanagan website attests… But its full potential remains as yet unrealised. Is it time for an honest appraisal of where we are and where we want to go? If we want to continue to develop the ideas then we need to ask ourselves some potentially troublesome questions:
  • Has threshold concepts become synonymous with learner difficulty?
  • Have we become entrenched in a slavish adoption of the framework? Or do we apply the framework too loosely?
  • How do we avoid thresholds becoming seen as a panacea that can explain all learner difficulty?
In considering these and other questions the conference offers an opportunity to reflect on the achievements thus far and encourages us to consider where we think work in the area needs to go next. There will never be a single solution to support all learners master the same threshold but an awareness of threshold concepts and their associated complexities allows us to become more informed practitioners.

Conference Sub-themes

  • Disciplinary retrospectives: transforming the disciplines;
  • Practice based thresholds: embedding thresholds within professional practices;
  • Liminality: knock knock knocking on transformation’s door;
  • Thresholds and curriculum design: new horizons;
  • Troublesome not tricky: not all that challenges is a threshold;
  • Avoiding swampy ground: acknowledging the pitfalls and planning for the future.

Submission Guidelines

We are inviting the following submissions:
  • Full paper: 20 minutes presentation, 10 minutes Q&A (max 300 word submission);
  • Lightning Talk: 5 minutes presentation, grouped questions (max 150 word submission);
  • Roundtable: 1 or 2 to lead a discussion, perhaps outlining a planned project or exploring an interdisciplinary collaboration (max 300 word submission).
The deadline for submissions is 6pm GMT 16 December (was originally end of Friday 6th December) 2019.

Conference sub-themes

  • Disciplinary retrospectives: transforming the disciplines;
  • Practice based thresholds: embedding thresholds within professional practices;
  • Liminality: knock knock knocking on transformation’s door;
  • Thresholds and curriculum design: new horizons;
  • Troublesome not tricky: not all that challenges is a threshold;
  • Avoiding swampy ground: acknowledging the pitfalls and planning for the future.

Organising Committee

  • Jason Davies (UCL)
  • Julie Rattray (Durham)
  • Anne Tierney (Heriot-Watt)
  • Susannah McGowan (Georgetown, USA)
  • Abel Nyamapfene (UCL)
  • Elia Gironacci (Warwick)
See also:
https://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=TCS

Monday, February 10, 2025

Book review: Handbook on the Ethics of AI #2

Well, I am sold. So, encouraging again to read 'reflect -ion' on the first page and throughout chapter 1:

'... why the very idea of AI gives rise to (or should give rise to) ethical reflection.' (p.21), and I'm sure the book as a whole.

Most readers may pass this by, but to me this matters. Ethics scholars however will see how important and conjoint reflection is to deliberation and argumentation of ethics. Especially, as noted in post #1 the five part division of the text Foundations and Context; Responsibilities; Rights; Politics and Power; and Thinking Otherwise. 

Tables break up and inform the text. I like the way for many tables the source is: Author's own elaboration.
Given the subject matter, yes, the authors have the literature but they are also formulating their chosen theme against the present, near future, socio-political scenarios and much more. So, reflection - this should be expected. With Hodges' model I'm often asked why are those concepts placed in that particular domain? Perhaps that is a question for general artificial intelligence? Subjectivity is a key challenge, and its effective communication.

If I say, chapter 1 is a great primer on What Is This Thing Called the Ethics of AI and What Calls for It? I'd sell the book short, the whole text fulfills this purpose. The definitions and responses to What is A.I. are very helpful, taking into account ancient to more recent history. I've a book in a box by David Chalmers (sorry Prof.) - one day - which helps here discussing intelligence and consciousness.

I'm primed to pick up on 'gaps' (Theory-Practice) and in human experience they are inevitably legion. The responsibility gap (and meaningfulness!) c/o Sven Nyholm is a place to return to, to debate why A.I. raises such a broad range of ethical issues. Patiency is never far away. Here, the patient is stark: in  moral agents and moral patients (p.20 and 89). This blog is littered with posts on Drupal, which to date I have never mastered. I remember sitting in DrupalCon presentations, in the midst very skilled professional coders. A member of the community stood at the podium recounting their lived experience of impostor syndrome. In November with a presentation of my own, I had my own encounter. Well into reading this book, it really did help. The conclusion of chapter 1 contrasts the frequent need for a big-picture overview and reflection on more specific issues. That's quite fitting for me.

I am biased in the encouraging kernels I find: as seek them I do. Yes, as chapter 2 AI Ethics before Frankenstein begins: 'there remains work to be done in charting the long-range conceptual development of  AI in the history of political thought.' (p.27, my emphasis). And much more I hope. Chapter 2 combines literature, myth and I enjoyed the discussion on techne, Prometheus, Hobbes, the interdisciplinary bridge of techno-politics and articulating the mechanistic in our lives. Focussed recently on thresholds and threshold concepts in revising two papers: Hunt writes, 'Frankenstein is a "threshold" text for "modern political science fiction" (p.31). 

This  resonated - especially 'for its prediction that the nascent Enlightenment-era sciences of chemistry, anatomy, and electricity could be used to artificially make a human being' (p.31). The exploration of bad education and bad governance through Shelley and social history is other-worldly in itself. Hunt's conclusion which includes 'Wollstonecraft was the pivotal figure in the process of refracting ideas of AI from Hobbes to Shelley, ...' left me wondering about the refactoring of code. 

Chapter 3, Smith's Faith, Tech, and Ethics of AI brings more reflect -ion with the bonus for me of Descartes. On faith, the human situation is also repeatedly stressed. Delving into creation too, this is detailed on forms of theology - Augustine, Bede, for example, and philosophy Bacon, Hume, Kant and their role in diminishing the influence of religious thought and epistemology (p.39). How long a push was that? Surely it is ongoing - in some quarters? Medieval thought is discussed, and I recall this broad period also being regarded as misunderstood [Medieval Philosophy - Bryan Magee & Anthony Kenny (1987)] . 

On a personal level, I've always placed belief in the intra- interpersonal domain of Hodges' model. In psychosis, depression, anxiety, phobias in short mental health, beliefs can be disrupted, and influenced of course when all is well. Religion I have framed at the individual and socio-political level. Clinically, it is the individual patient's beliefs, if they follow a particular religion that we also need to be cognizant of as health personnel. Machine, or human; object or being as Smith asks:

SELF / INDIVIDUAL  -  OBJECT / THING
|
      INTERPERSONAL    :     SCIENCES               
HUMANISTIC  --------------------------------------  MECHANISTIC      
 SOCIOLOGY  :    POLITICAL 
|
GROUP

the human -

the machine -


- can become machine

- can become human



socio-


-political

There is depth of discussion too: in AI and Power; a Christian response to AI ethics. This handbook is not just for quick reference. There is indeed redemption (p.43) to be found:

'It is easier to cover a blemish than examine why it resulted in the first place: genetics, diet, stress, or lack of self-care.'

I argue for Hodges' model as a tool to identify, (re)present, and relate the determinants of health: all of them. The points and paragraphs on theology, mind, body and self are well worth revisiting.

Johnson's chapter 4, What are Responsible AI researchers really arguing about? provides support for my ongoing belief in the value of sociotechnical theories and approaches, and another book on enactivism. Given the ethics of the global south (and technological/electronic colonialism) more could perhaps be made of LMIC, but the point is made in Table 4.1 (Examples of functionalist evaluations of AI models, p.52). Constructivism 2.2 is a rich seam for me. Table 4.2 touches on medical diagnosis and socio-technical. Johnson notes that in seeking answers to AI ethics problems, scientists see constructivist approaches and '.. constructivism as a metaethic, holding a rich space for more research into pluralistic AI-Alignment', (p.53). And, the potential for much more. This is suggested (for me) in reference to the need for a holistic view of AI model's genesis, and 'two sides of one coin' - dichotomy, polarity, oppositions, binary reductions ... ? 

Johnson's conclusion is an indirect thumbs up (cue Arnie style - of course) to Hodges' model as a project. Conceptual frameworks can indeed:
'... offer unique perspectives on the methods commonly employed and to understand and mitigate the risks and dangers of AI.' (p.62).
If ethics gets 'technical' then the book's full title is well-earned. Two case studies demonstrate functionalist and constructivist debates in responsible AI. I don't remember Capt. Kirk et al. stating to a malign alien 'intelligence' "The trophy doesn't fit in the suitcase because it's too large (small)," (p.58). The writer's put other solutions to the characters lips. Spock, however, would find the discussion here on 'Artificial General Intelligence, 4E Cognition and Enactivism' - "Fascinating!"

Much more to follow ...

Handbook on the Ethics of Artificial Intelligence. David J. Gunkel (ed.). Cheltenham, UK: Edward Elgar Publishing Ltd. ISBN: 978 1 80392 671 1245
https://www.e-elgar.com/shop/gbp/handbook-on-the-ethics-of-artificial-intelligence-9781803926711.html


Related previous posts: 'general + AI'

Saturday, September 05, 2026

UN votes to adopt new world map to reflect Africa's true size | BBC News

UN tells the world: Stop making Africa look small

'By 164 votes to one, Member States on Friday endorsed a resolution promoting map projections that more accurately reflect the true size of continents – the culmination of an African-led campaign against the 16th-century Mercator projection, still the most widely used map in the world. 

The United States cast the sole vote against, dismissing the initiative as part of a “radical ideological project.” 

Six countries – Estonia, Georgia, Lithuania, Moldova, Serbia and Ukraine – abstained. 

The resolution does not ban the Mercator projection or impose a replacement. Instead, it encourages governments, schools, international organizations and technology companies to use the Equal Earth projection and other so-called equal-area maps when relative size matters, and to teach the limitations of any flat map in representing a spherical planet.'

Continued ... UN



Previously: 'cartography'

Wednesday, April 17, 2024

Policy Dialogue - Water, Conflict and Peace in the Middle East: online

Dear colleagues,

I am delighted to invite you to the next Policy Dialogues from the JHU-UPF Public Policy Center:

Water, Conflict and Peace in the Middle East
Thursday 25th April, 6pm CEST
Online via Zoom (registration required)
Language: English

The Middle East is a region of both severe water problems, and acute political instability. But what is the relationship between these two things? This Policy Dialogue will provide an opportunity to reflect on this question and its implications. It will overview the region’s water problems, and consider how these problems are – or are not – contributing to conflict. It will also examine, conversely, how war and violence are affecting patterns of water resource degradation and water insecurities, and will reflect on opportunities for water-related peace-building, including on how water for peace initiatives might best be pursued.

We are delighted to invite Natasha Carmi (Water Peace Programme Manager at the Geneva Water Hub) and Jan Selby (Professor of International Politics and Climate Change at the University of Leeds, UK) to share their expertise during this session.

We invite you to join us and explore the complexities of this extremely important issue. You can register here. Please also share this invitation within your networks.

Best regards,
Aeve

Aeve Ribbons
she/her

Educational Projects Manager of JHU-UPF Public Policy Center (UPF-BSM)
Managing Editor of the International Journal of Social Determinants of Health and Health Services (IJSDOHS)

My working days are Monday-Thursday / Mis días laborables son de lunes a jueves.

Website: http://www.upf.edu/jhu-ppc/

Twitter: https://twitter.com/pubpolcenter


My source:

Politics of Health Group Mail List Messages

Visit the PoHG website for lots of interesting links and publications: http://www.pohg.org.uk/

Visit PoHG on Facebook: https://www.facebook.com/282761111845400

Follow us on Twitter: @pohguk

Saturday, July 15, 2017

c/o Marschalek (2017) Public Engagement in Responsible Research and Innovation

This blog often features EU research initiatives and conferences and a European project (2014-2016) to build a Responsible Research and Innovation (RRI) Toolkit also has a conference series and various publications. Marschalek's dissertation is a invaluable resource on RRI, drawing on the need for reflection, reflexivity, critical thinking and highlighting many models within sciences and participative methods. Reading the following you will hopefully glean the basis for my interest in the document and what might follow the project overall.

1.2 The Relevance of (Self-)Reflection and Reflexivity  
Scientists are not typically asked to anticipate future societal effects of their work. ...  
... But reflections, particularly on non-intended effects, are rarely undertaken. Reflection is not (yet) viewed as an integral part of scientific work. Many other more important issues need to be addressed within a scientific career. ...  
... Studies like this and others have revealed that researchers are rarely encouraged to self-reflect. ... 
... What is needed is to »step into the helicopter« (Schuurbiers, 2011, p. 784) to look at one’s own work from a distance. A look from the outside and feedback also help reflection. »Researchers are not accustomed to viewing their decisions from a normative perspective or discussing the normative aspects of decisions explicitly. ... 
... Unfortunately, not many reflection tools are available as yet. Quality standards and codes of conduct should »stimulate the reflection of the relation between one’s own values and that of external parties« (Asveld, Ganzevles & Osseweijer, 2015, p. 585) and there are self-reflection initiatives to motivate individuals to reflect on the impact of their work, e.g. a »Hippocratic Oath for individual scientists« (Sutcliffe, 2011), but even fewer ask organisations for self-reflection. Marschalek (2017) pp.15-16.

Marschalek, Ilse. (2017). Public Engagement in Responsible Research and Innovation.
A Critical Reflection from the Practitioner’s Point of View. University of Vienna, Vienna.
https://www.zsi.at/object/publication/4498/attach/Marschalek_Public_Engagement_in_RRI.pdf


My source and with thanks:
International Science Shop Contact Point
Norbert Steinhaus
Wissenschaftsladen Bonn - Bonn Science Shop
Reuterstr. 157 - 53113 Bonn – Germany

Responsible Research & Innovation: RRI Tools
www.rri-tools.eu
www.facebook.com/RRI.Tools.Project
Twitter: @RRITools

Saturday, August 30, 2025

Revisiting "patient career"

Almost a decade ago I posted:

Medical Sociology: The Importance of 1894....2015 patient career - health career

- which was prompted by:

McKinlay, J.B. (1971) The concept “patient career” as a heuristic device for making medical sociology relevant to medical students. Social Science and Medicine, 5(5), 441-460.
https://pubmed.ncbi.nlm.nih.gov/5160599/

McKinlay's abstract reads:
Abstract

Increasingly it is being suggested that the behavioural sciences can contribute to medical education and should be incorporated into the medical curriculum. Evidence for the development of this view in Great Britain can be found in the recommendations of the recent Royal Commission on Medical Education and the submissions of various bodies to it. Given that the behavioural sciences in general and medical sociology in particular, can contribute in a positive way to the medical curriculum this paper attempts to: (a) draw together and crystallize some of the major problems inherent in past attempts to organize and include the behavioural sciences in the medical curriculum; (b) devise some criteria for determining the behavioural science content of the medical curriculum; (c) outline and discuss one possible course in medical sociology utilizing, as an organizing framework, the concept “patient career”.
Brian Hodges created his eponymous model with curriculum planning, design and development as a key purpose. In the early-mid 1980s nursing was looking forward to becoming a degree, undergraduate course of study.

McKinlay's use of 'patient career' (and others) can obviously be associated with the impact of life chances upon a person's health career

Individual
|
      INTERPERSONAL    :     SCIENCES               
HUMANISTIC  --------------------------------------  MECHANISTIC      
 SOCIOLOGY  :    POLITICAL 
|
Group






'While discussing the relationship between the medical and social sciences, and the role of the social scientist in teaching and research in medicine, Butler groups the range of medical topics which have been studied sociologically into four main categories [l4]. These are,

the sociology of illness,
the sociology of health,
the sociology of medical care
and the sociology of healing.' p.443.^



McKinlay sees these categories as too comprehensive. Although within the SOCIOLOGICAL domain of Hodges' model this is a 'start'? McKinlay proceeds to identify specific difficulties presented to educators, which include (in summary and with my emphasis):
'(a) The failure to identify needs, specify objectives and devise criteria
(b) The failure to distinguish between perspectives

'Very generally, the behavioural sciences can be said to be conccrned with the description and explanation of the health and illness behaviour of groups and social categories, whilst medicine (especially clinical medicine) aims at the understanding and successful treatment of individual patient cases. By working exclusively on the basis of (or failing to take account of) these separate perspectives, meaningful dialogue between behavioural scientists and medical students has been made extremely difficult.'

(c) The failure to distinguish the audience
(d) The failure to take account of temporal location
(e) The failure to provide a conceptual framework

Most courses in the behavioural sciences either offered or proposed, to a greater or lesser extent, tend to ressemble a sort of shopping list. For example, the courses offered by Badgley, Martin et al., and those proposed by the Society for Social Medicine and the Royal Commission all reflect this "'shopping list" charactcristic. After working down the list it is assumed that students will have the technical goods required. It is, of course, difficult for students undertaking these "shopping list" courses to reflect on where they have been, appraise their current position, or consider where they may be going.
Two further general problems seem to be inherent in many of the attempts to systematize the field of medical sociology, and to some extent are associated with some of the problems already outlined. 
(f) The problem of trying to cover too much [Which lists 18 topics for 2nd year students.]
 (g) The problem of omitting important areas' pp.443-445.
McKinlay then, is similarly preoccupied with the curriculum (for medical students):
'This section is concerned primarily with devising criteria which, given the finite amount of teaching time available, will offer some guidance in determining what aspects or areas of medical sociology should be given priority for teaching in the medical curriculum.' p.445.
This work from the 1970s surely invites reflection upon the meaning of 'progress'? 

^My formatting.

More to follow...?

Thursday, September 06, 2007

SOCIOLOGY links: Holistic Bliss or Tristram Shandy ... IV

I've introduced the rationale behind the content of the INTERPERSONAL and POLITICAL links pages. Let's now look at SOCIOLOGY: Although the ticking of the clock has a mechano-quantum constancy, people are collectively nudged forward through the 7 AGES that characterise our personal and social lives. These two lives beg a question in terms of Hodges' model and its four care (knowledge) domains. From what I've already said chronological age is mechanistic; but if that is the case in which domain does pathological age reside? Perhaps it is not just one domain, but a matter of span ;-). If for you this means or includes traversing the SCIENCE and SOCIOLOGY domains; that is quite a journey, so better prepare...

Following this on the SOCIOLOGY links page - can that be HEALTH PROTECTION & PROMOTION? Again!

Well yes it is and this is not a mistake. Just an effort to emphasise the need to direct our attention and resources at health promotion and prevention at a community AND individual level. Visiting Assen in the Netherlands last month you hear of the Dutch love of bicycling. Seeing is believing though and all ages were out and about. Marvellous to behold.

If health and communities are about support then there are a multitude of groups and networks dedicated to the task for PATIENTS and CARERS. The emphasis now is also to engage the public in service and policy development. They also need to be involved in public health, health and social care research and not just as 'subjects'.

In terms of Hodges' model contrast this journey - SOCIO-POLITICAL with the SOCIO-SCIENTIFIC referred to above. Another post perhaps....?

Similarly, there are PROFESSIONAL and other associations across all disciplines. This includes the notion of integrated services, still a long way to go. These professional groups are 'political' in the [ORGANISATIONAL] sense, but I wanted to reflect the social - socialisation - aspect. (What! You've done one row! Come on Jones hurry up!)

The phrase COMPUTER SUPPORTED COLLABORATIVE WORKING (CSCW) is not used as widely these days, but it captures a key purpose in HEALTH, SOCIAL & COMMUNITY INFORMATICS whether at an international, national or local level. Although I have placed it on the INTERPERSONAL page EDUCATION is all about 'socialisation' and an ongoing debate.

SOCIOLOGY I & II speak for themselves and in there you should find medical sociology and narrative medicine. Surely, the SOCIOLOGY listings should have pride of place here? The position of SOCIOLOGY on this links page is not intended to reflect examples of various socio-political concepts such as demotion, loss of status, alienation... It is true, these can reach over the INDIVIDUAL-GROUP axis and pummel the individual; but -

No. As with the other links pages SOCIOLOGY sits on the 2nd row due to the needs of health and social care learners (ALL staff!), patients and carers (the Public) to have speedy access to the relevant links.

QUALITATIVE RESEARCH is next and the ongoing quest for more effective methods and tools to help unravel the phenomenological world. As with QUANTITATIVE RESEARCH in the SCIENCES listing, I've included some examples of software tools.

The final row presents ANTHROPOLOGY in which medicine and SCIENCE will find their earliest roots. Fittingly then HISTORY is right alongside. Two listings are devoted to ART, CULTURE, MEDIA and TECHNOLOGY; a realm I could really get lost in if I had the chance. I've tried to include some of the best examples of various genres, but they change so quickly. Please let me know (through the website) if you've a gem or two.... to share - or if you notice any broken / outdated links. I use tools to check, but they are digital and of course on this [HUMANISTIC] side of h2cm everything we touch is 'analogue'(?).

As you may have noticed this SOCIOLOGY domain is the smallest with just 12 listings. Perhaps here with the POLITICAL domain in the lower half-group hemisphere of Hodges model more (people) really does mean less? Yet, another post perhaps...?

Although ARCHITECTURE seems to epitomise -

  • the physical world with its presence (whether loved or abhorred);
  • the notion of artefact on a grand and detailed scale
  • the mix of mechanism and material
  • ....
Architecture is also associated with the human spirit, the ephemeral. I have wondered about including the subject here. It is a truly colossal micro-macro subject and also a profound factor in the health and well-being of all of us.

Like health it touches all the knowledge domains....

Next! Last but not least SCIENCES...

Wednesday, January 17, 2024

Book review iv. General Psychotherapy: Principles and Common Theoretical Aspects - Rediscovering Humanity

   General Psychotherapy

My late teens - early twenties coincided with the emergence of chaos, fractals and yes - emergent phenomena. Consequently, I had to refer back to Chapter 3, as Hartmann-Kottek writes:

"If we imagine a fractal that encompasses all categories similarly to a quantum in this regard, all cells, organs, particularly the human brain, the entire person, groups of people, races, nature and the earth would also be in field and structure at the same time. This does not appear to be an abnormal notion. Several experiences with field phenomena of the relationship level would consequently gain their natural allocation.

Indeed, we are familiar with notions that cross categories with regard to states of matter: Water as ice, snowflakes, liquid, vapour, mist and clouds are normal aspects of daily life."p.215.

This resonates at present with reading on categories, seeking theory and to what extent can mathematics and logic be applied to Hodges' model and more importantly, to the humanities? There is some toing-and-froing in the book, but for me having read the book - it works. If a student asked me what is a good subject to study at high school. It would be Social and Economic History, especially if you are thinking of pursuing mental health nursing, psychiatry, or psychology. General nursing too, I would add, acknowledging the need for holistic and integrated theory, practice and management. 

Chapter 7: is a regular rollercoaster in terms of history and cultures:

The Spirit of the Times and Cultural Epochs as Reference Systems Along with Their Transformation of the Ideal Level of Human Development – A Historical Journey Into the Past to Learn for the Future

In healthcare we need to constantly ask (it's called mandatory training) about the protected characteristics, the various literacies, including emotional, spiritual, cultural; and all the determinants of health. And we need to be cognizant of all of them: individual, environmental, commercial, educational, social, and educational (hence why 'categories' are salient).

The discussion of non-European cultures are particularly rewarding - Africa, Australia, Polynesia, Ancient far East, Native Americas, Egypt, Yoruba and others. Page 437 brings Martial arts, where synergy between mind, body and spirit is central. Reflecting culture and the association between health, well-being, the human condition and pastoral care chapter 7 covers the main religions and relationships between several. The influence of aesthetics in certain cultures is also introduced. The book is a springboard for further reading. Section 7.1.2 on an Integrative, Holistic Stance as a Countermovement provides the names and dates of  more than fifteen personalities: Alexius Meinong (1853-1920) ... Wilhelm Witte (1915-1985). Through the history described, it is interesting to reflect on the significance of the holding of knowledge and power imbued through its use. The end of chapter is an effort to take stock of social development - a non-trivial task given the dynamic world we try to exist within. 

 I found I was rolling together chapters 6,7 and 8 even as they hold-their-own in content and placement. As a community mental health nurse I still reflect upon:

  • There is no overarching theory of health communication.
  • Gatekeeping is alive and well.
  • The current often vociferous 'debate' between psychiatrists, psychologists, patients/clients, carers and nurses too.
Chapter 8 returns to the integration of psychotherapy with the politics of research, or how the exercise of power within psychotherapy research has resulted in crises. I wished I'd paid more attention, but I do recall at some events, conferences instances of animosity between different therapeutic camps. Hartmann-Kottek does not labour the final chapter. There are positive messages here too. A page and a half overview informs us that globally there is research attending to the knowledge and not the interests of particular therapeutic organisations and associations. Statistics, evidence, fake science are discussed, the history in psychotherapy and how this frames the future. When I started reading the book behavioural science was in the news for the wrong reasons. 

Chapter 8 reminds me of the proverb 'Reap what you sow'. Now across health and social care how many gates and gate-keepers are there? Outside of 'emergency' triage: how many are legitimate, needed? How as the original role - processes changed? In England there is ongoing debate about IAPT - Improving Access to Psychological Therapies. Fascinating and troubling the apparent increase in diagnosis of autism and attention deficit hyperactivity disorder (ADHD). Still many questions to be asked, especially on access to therapy within  the auspices of universal health coverage.

Here on the blog and in my application of Hodges' model, it may seem that the POLITICAL domain is the constant elephant. The thing to be climbed over, circumvented, accepted for all its ills (no pun intended). Politics, the political is a tool. It is, in Hodges' model, an essential domain in terms of care delivery and knowledge. The idea of that "Competitive constellations happen." (p.465) is of course a reality. In championing and studying Hodges' model this is well recognised. Chapter 8 is a mélange of socio-political concepts which briefly reveal what must be better resolved not just in psychotherapy, but health and social care: all the determinants.

Hodges' model = a natural home for contextual research?

 "At long last, 'contextual research' (Wampold et al.) has put an end to the belief solely in standardised and manualised treatment programmes." p.345.

While the above gives me great encouragement - a note in book: "Generalising partial perspectives only ever lead to impasse." (p.458) reminds me to take nothing for granted.

Chapter 8 places an emphasis on balance.

Hartmann-Kottek uses the term '(r)evolutionary' in chapter 8. This is fitting as the chapter begins with history - with or without the Dodo. Perhaps quantum descriptions can be found by (necessarily) and paradoxically increasing the theory-practice gap. Taking 'theory' even further away from the noise, complexity of practice. We often consider theory, as an opportunity to be idealist. How often (in the past?) have nurses found the nursing theory - model they are trying to apply ungainly as the day-to-night pressures of care delivery make themselves known? Perhaps ironically by venturing further into theory new vistas will appear, with timely and much needed perspectives given the demands of health in the 21st Century.

 'I' - 'Individual' 'SELF' 'Patient' 'Client'
  |
    INTERPERSONAL    :     SCIENCES               
HUMANISTIC --------------------------------------  MECHANISTIC      
SOCIOLOGY  :   POLITICAL 
|
dyad / couple  family  GROUP community population
PSYCHO -
PSYCHO -

... experience-related, 
mind and 

- TECHNICS^
- MECHANICS^

confrontational connections in the
physiological patterns ... (p.480).


foundational collective context i

dyad, triad, couples, families,
small and large groups

foundational collective context ii

gates, gate-keepers, gate-keeping
access, accessibility


Many thanks to Prof. Hartmann-Kottek and Springer for the review copy. I will add the related posts below soon.

An enjoyable, informative read and a great contribution to my CPD. There are many more points to highlight and I may do so in the future.

Hartmann-Kottek, L. (2022). General Psychotherapy, Principles and Common Theoretical Aspects - Rediscovering Humanity. Springer. https://doi.org/10.1007/978-3-030-87466-7.

^Used in the text.

Monday, July 08, 2019

Inaugural Scottish Threshold Concepts Conference: TCs in Action [ii]

After Prof. Land's keynote and the previous post on 'work-as-X' I can see the value of the academically agnostic - neutrality of Hodges' model in terms of the spaces it affords. It can be used to reflect as a safe space or problematic, troublesome or unsafe. As an example, consider the task of reflecting upon the current state of residential and nursing home care?

individual - self
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group- population











Next reflect upon residents and sexuality within these care environments. This could be from any perspective, or even work through several: resident, a new care worker, other team members, staff nurse, home manager, family member, GP, or inspector. ...













#UoDthresholdconcepts2019
Prof. Land raised the matter of extreme vulnerability and experience of Syrian refugees. Individual and Population are forced through a threshold that is catastrophic: that of identity. The scale of this event is being stressed as an urgent issue that must be accorded attention in parallel with physical relief

Perhaps, it is not just individuals who must encounter and pass through a threshold in their learning, their liminal journey. The problems we face demands that disciplines must find the disciplinary bridges that will enable them to solve the interdisciplinary and even transdisciplinary problems we face.

Geopsychiatry is a key bridge here. Research has determined that trauma can be intergenerationally transmitted. Governments, aid organisations and policy makers must take this into account and not just respond with physical relief. Unfortunately, the imbalance that is a lack of parity of esteem in general physical and mental health has its global-scale analogue in humanitarian crises and conflicts, especially those that displace populations.

Prof. Land referred to eduChaos and this is where 'lived experience' is found: not just in 'real time'.

#UoDthresholdconcepts2019

Uncertainty, kept repeating itself Prof. Land describing the work of Ilgen et al. (2018) and the need in (and through) education to find comfort with uncertainty. The challenge of this is acute in medicine and mental health care as Ilgen's work highlights. The previous post's nod to box-ticking and elsewhere the quest that is the 'comprehensive record' stresses at point of initial encounter - the initial assessment, perhaps to the detriment of an outcome oriented approach?

The question posed of "how professionals can manage the uncertainty arising from complex, ill-defined problems with conflicting assumptions, evidence and opinion" [another slide] is not just concept-bound as I tend propose. The terrain of Hodges' model can be used to map wells of uncertainty that help make the more certain, concrete data - information stand out. It helped me to see the situatedness of this discourse repeated. The definitions of 'uncertainty' and 'certainty' attributed to Ilgen et al. (2018) are a helpful adjunct to information science based sources.

In subsequent parallel sessions I switched rooms in  trying follow what was most relevant. First was,
'Where have all the empathetic professionals gone? An exploration of empathy as a threshold concept for the helping professions'. This provided a multidisciplinary insight into social work education, with overlaps that included safeguarding and child protection. Jayne Lewis's format had us engaged, well me clearly as I've no notes or photos. The talk of empathy made me recall twitter and student nurses remarks on their placements (accepting too that 'No news is good news') and student-mentor-placement relationships. If the practice/placement environment is stressed/contested for a variety of reasons, to what extent does this influence empathy role models, student experience and study of TCs? Do researchers need to record the emotional and political 'temperature' as a baseline measure?


#UoDthresholdconcepts2019


Next, on the programme; TCs, medical students and population health learning. From an acute angle (I was late arriving) Hothersall explained a study with a small sample, and yet findings that (as ever) call for more study, with implications for teaching in the lecture theatre, as a whole, in practice and relevance for me.

I'm sure there are many threshold concepts in public health and public mental health (to ensure inclusion). Even if specialty posts in public health are filled 2013-2016 (and amid recruitment pressures) I wonder if there is an issue for students (generally) in the perception of  'public health' and their respective discipline? Is there something in the old debate of pure - applied disciplines? Do medical and other students feel they must focus attention on the 'hard' learning rather than the 'soft' fuzzy concepts that public health encompasses? What has been the impact of the most recent series of re-organisations?



 #UoDthresholdconcepts2019

Of course, given the big themes identified, for me, the first lecture 101 should include a conceptual framework that can readily incorporate the (socio-)technical, (psycho- socio-) political, conceptual and much more.


The presenter also informed us that a paper is in press: 'The Clinical Teacher'. These findings of concepts that were troublesome for students appears to support my '101' role for Hodges' model - but then I would say that ...


Tierney's Exploring threshold concepts in the scholarship of teaching and learning was a rich source on a model of scholarship (Trigwell, et al. 2000) with tables also drawing on Perkins (1999, 2006) that I must try to follow-up as with Visual Art as navigation of affective thresholds: implications for the classroom.



The afternoon keynote discussed The dual development of professional identity as physicians and mentors, with Profs Hokstad and Kvernenes. Using a narrative reading (Reismann, 2008) the content and findings to me call for simultaneous duality in identity, the medical and the non-medical (practitioner - interaction with the patient and their family), clinician and mentor.

Being struck by the thought (on science, knowledge, holism - whole / part distinctions) of Goethe in the past it was a marvellous to attend Jonathan Code's session; Mind the Gap - Ontological discontinuity as threshold concept. I imagined Hodges' model and several leaves in various stages of growth.

It creates an overhead for conference organisers, but video recordings would be a great help. I think there is one more short post on this conference.


Ilgen, J.S., Eva, K.W., de Bruin, A., Cook, D.A., Regehr, G. (2018). Comfort with uncertainty: reframing our conceptions of how clinicians navigate complex clinical situations.
Adv Health Sci Educ Theory Pract. Nov 2. doi: 10.1007/s10459-018-9859-5.


See also:
Inaugural Scottish Threshold Concepts Conference: TCs in Action [i]

Friday, May 12, 2017

What does professionalism mean to you? c/o NMC - #IND2017


Dear Peter

We are writing today to wish you a happy International Nurses’ Day – a chance to celebrate the exceptional professional contributions of nurses across the world.
The professionalism of nurses and midwives has always been essential to good care. We all know professionalism when we see it – but there’s never been a single definition for what it means in nursing and midwifery.
So we wanted to use the opportunity of International Nurses’ Day to tell you about a new tool we have developed, Enabling professionalism in nursing and midwifery practice, which defines professionalism in nursing and midwifery for the first time.
We hope it will help you to explain and strengthen your own professional contribution as a nurse or midwife, as well as being a tool you can use to reflect on your practice when you revalidate.
We have each shared what professionalism means to us, and we would love to hear your stories too. Share your views on what professionalism means to you through this form or through the NMC’s Twitter account @NMCnews using #professionalism.
Best wishes, and happy International Nurses’ Day.
Jane Cummings, Chief Nursing Officer, England
Charlotte McArdle, Chief Nursing Officer, Northern Ireland 
Fiona McQueen, Chief Nursing Officer, Scotland
Jackie Smith, Chief Executive and Registrar, Nursing and Midwifery Council
Jean White, Chief Nursing Officer, Wales

----------------------------------------------------------------------------------------------------------------
I will investigate this tool and reflect - post about it in the near future as appropriate.
To nurses and carers the world over Very Best Wishes for #IND2017.
Please look after yourselves too!!*

*The 1st rule of 1st aid.