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

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

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

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

RESPONSE: [updated 21st June 2026]

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

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

Are the Four Domains Comparable or Asymmetrical?

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

1. Differences in Scope and Focus

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

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

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

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

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

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

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

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

2. Differences in Methodology

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

3. Differences in Practical Application

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

4. Theoretical Foundations

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

Is There an Essential Asymmetry?

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

Sources and References

1. Conceptual Overview of Hodges’ Model:

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

2. Theoretical Foundations:

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

3. Discussions on Asymmetry and Complementarity:

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

Summary Table: Asymmetry in Hodges’ Model Domains

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

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

 

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

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

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

1. Scope and Focus

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

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

2. Epistemological Differences

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

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

3. Practical Application in Care

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

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

4. Hierarchy of Integration

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

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

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

Conclusion: Essential Asymmetry

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

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

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

Threshold Concepts, Professionalism & Scope of Practice

Amongst the chaos of self-directed study, vapourware, writing and starting a PhD program one writing project still in draft form concerns Hodges' model and what is termed the 'scope of practice'. As a generic and multidisciplinary conceptual framework Hodges' model can, I believe, assist in demarcating and differentiating the following:

• knowledge - in all its forms;
• a curriculum;
• interprofessional working;
• activity, tasks, actions;
• responsibilities;
• expected competences;
• procedures;
• assistant, associate, general registered, specialist - advanced practice;
• existing policies, law, rules and standards;
• records

Another draft paper (closer to completion I think) and which I've referred to before (see - chaos is the word!) relates Hodges' model to threshold concepts and definitely bears revisiting.

Scope of practice is different from professionalism but invites comparison. For example, the professionalism that is hopefully exercised when a practitioner recognises that their scope of practice is being called into question.

Searching the literature once again below is a new paper that combines professionalism and threshold concepts. I will see if I can add another paper of note and extend this post later in the week.

Hilary Neve, Helen Lloyd & Tracey Collett (2017) Understanding students’ experiences of professionalism learning: a ‘threshold’ approach, Teaching in Higher Education, 22:1, 92-108,
DOI: 10.1080/13562517.2016.1221810

To link to this article: http://dx.doi.org/10.1080/13562517.2016.1221810

Scope, Space, Nursing, Informatics: Fusion II (care)

After Paolo Perrotta (see post January 20, 2012):

and Paolo Perrotta, (2010). Metaprogramming Ruby, The Pragmatic Bookshelf. p.75.


Imagine being a care coordinator making sense and sense making (Dervin, 2005) your way through a new health and social care referral: here is the care program(me) approach. You jump from care problem, to strength, to further assessment question ... until the care domain priority is resolved. A decision point. That's the initial scope (and in an urgent / crisis situation this is resolved in an instant).

The scope is not defined in a single program, but several in parallel. This is why health and social care is often described as complex. You find yourself in a complex. At this decision point you are at the center of a range of local variables.

You can see bindings all over the scope. p.75.

There are assumptions, hypotheses and bits of data yet to be fully apprehended. It's hard but vital to be aware of what is objective and what is subjective. Why?

Raise your head, and you see that you're standing within an object,

[ a very special object ]

with its own methods and instance variables; that's the current object, also known as self. p.75.

To your immediate left and forward there are instance variables: beliefs, choices, motivation, aspirations, memories ... and the unique ability of this self to use its methods to communicate and interact with other selves, the world and future. You notice a problem. Many of the methods you might expect are not intact. There is a problem with the capacity of memory. Where there should be several parameters in sequence: there is. One. This may even then be lacking. Reading and writing is a problem here.

To the right and forward there is a monthly weight chart, a medication administration chart, BP and pulse are also recorded. There is a history of falls, a fractured femur, and bruising. There is a diagnosis - an inguinal hernia. Two postcodes have you momentarily perplexed. Ah, one is static 'home'; the other is current location and that's a close to home telecare mediated match.
 
Turning first to your right and over your shoulder there is an issue with care management and wandering at night: a vulnerability for this person. Another instance variable then flags mental capacity for a that hernia which needs repair. Respite care vouchers have been issued, but the year's allocation remain unused.

Next, turning around to your left there are details of next of kin and the fact that the carer involved is under a great deal of stress.

Further away, you see the tree of constants so clear that you could mark your current position on a map. p.75.

You are in fact encircled by a series of official identifiers. First at 10 o'clock two first names - these are the names that are given. The names for the person, the individual who is the focus of the referral. At two o'clock a key event for this individual their DOB - date of birth. At four o'clock the digits of the NHS number and a local case record number are captured. Completing the "Full name" at 8 o'clock you find a surname, the family name. It's double-barreled too. An explicit effort to preserve and extend family history and lineage.

Squint your eyes, and you can even see a bunch of global variables off in the distance. p.75.

Global variables.

What lies behind them?

It sounds strange to describe the person as an object, even if the context alludes to informatics.
To confirm this object is special. When you think about it though this object, the patient, the person, the individual, this self has a partner: the healthcare professional.

When we say that positive, high quality care values are global that makes sense. They should be: globally. To say they are variable seems to invite poor quality care, slack standards, inequality, inequity. Acknowledging that standards do vary can help ensure vigilance and that high quality care remains the key aspiration for new learners and experts alike. Nursing and other values are then a global variable that need constant attention and governance.

"Model hospital": Where to find 5mins per shift? (footprints - transformation?)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Mental health	8,500 beds blocked costing NHS providers around £900m per year 5 mins
Social care	Operational productivity and performance in English NHS acute hospitals: Unwarranted variations £280m delayed transfers of care independent sector expenditure costs £482m lack of data (still!) Stepdown facilities

"On staff rosters, Lord Carter said he found cases in which trusts were squeezing nurses on to weekday shifts in order to make up their weekly hours, and said 

 improving productivity by five minutes per shift could save as much as £280m." (p.11)

<>

Model - hospital : Model - community care : Model - self-care?

Scope of disciplines

Scope of nursing... (draft paper)

Scope of footprints

Scope of transformation?

Additional link:
NHS England (March 2016) Sustainability and Transformation Plan footprints, Ref: 04902.

My source: 

Dunhill, L. (2016) Carter: be masters of your fate, Health Service Journal, 10 February, 126: 6475, 10-11.

The Scope of Nursing::And other things

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

"Scope Resolution Operator (::) 

The Scope Resolution Operator (also called Paamayim Nekudotayim) or in simpler terms, the double colon, is a token that allows access to static, constant, and overridden properties or methods of a class.

When referencing these items from outside the class definition, use the name of the class.

As of PHP 5.3.0, it's possible to reference the class using a variable. The variable's value can not be a keyword (e.g. self, parent and static). 

Paamayim Nekudotayim would, at first, seem like a strange choice for naming a double-colon. However, while writing the Zend Engine 0.5 (which powers PHP 3), that's what the Zend team decided to call it. It actually does mean double-colon - in Hebrew!"

Source: http://php.net/manual/en/language.oop5.paamayim-nekudotayim.php 

Scope of Nursing: (Interpersonal, Sciences, Sociology, Political & Spiritual)  actions, procedures, responsibility, accountability, governance, whistle-blowing, transparency, competency, candour, quality, safety....

Self-care?

Spot image: http://iridia.ulb.ac.be/~cpinciroli/extra/h-414/one_spot.png

Disciplines in Disarray - Scope of Practice, Disciplinary boundaries

To be in a state of disarray, is to be disarmed, without access to resources, or at least having an impaired ability to organise strategically for reasons of defence, disputation or argument. Constructive debate will be hard to achieve and so the confusion continues.

Prior to 2013 ideas for a paper with a would-be co-author began. Early that year there were 5000 words. There's probably mention of (another!) project on these pages – somewhere/when? The focus was using Hodges' model to explore 'scope of practice' in nursing. As the conceptual gift that keeps giving, Hodges' model can encompass all health disciplines, curricula, and professions, informal caring and social care too.

This post is prompt-ed (human ‘intelligence’ needs a nudge too) by ‘discussion’ on what was twitter, and currently on ‘X’. So in turn I can reflect on how relevant this paper would be today.

I still have that draft of over 5000 words. It is now woefully out-of-date. Out-of-date? Well the available job postings across the health and care sectors, have always changed. If you scan the paper copies of  Nursing Times, Nursing Standard, Nursing Mirror (anyone?) and the BMJ, The Lancet, Health Service Journal over three-four decades the evidence is clear. Then try the e-media, (and with it AI!)?

Now, for several years the impacts of  policy and change in advanced nursing practice, plus associate roles, that have also been applied in medical training and education are coming home to roost. Depending on your corner, and position in the debate there's a position called 'Noctor' (Vaughan and Kar, 2026).

I find it regrettable that consultants and 'senior' nurses have taken corners, as policy results in grossly negative examples with potentially safety consequences. There has always been a 'distance' to be bridged between health disciplines. In the past any sense of competition was usually, and so constructively patient-centred - grounded in the delivery and quality of care. The contest was tempered through mutual respect and dignity, and recognition of respective roles, knowledge, abilities and contribution to what is (and remains?) the multidisciplinary team?

Now with technology and AI in the mix, maintaining goodwill, common-sense and keeping the patient, public and future generations in sight will need a degree of diplomacy as yet not called-upon.

This made me think of the unions in the 1970s and more recent examples of work-to-rule. 

As health professionals argue between themselves, what is the cost of distraction?

Yes, that paper using Hodges' model on 'scope of practice (and theory!)' would be timely now.
In fact, it is urgently needed.

Vaughan L, Kar P. Vexatious complaints are being weaponised to discourage debate BMJ 2026; 394 :e100697 doi:10.1136/bmj-2026-100697 

Previously: 'scope' : 'publications'

Hodges' model - the pros ...

Having posted the cons, here are the pros with part of the initial twitter thread once again:

If it is not too confusing, by another - Peter Jones @innov8tor3

4 #h2cm can be a generic conceptual framework for all disciplines: health, education,
contexts: development, edtech, socio-tech*
So scope *global* (utopic?) – more pragmatically - a utility across communities of practice.
*Plus other domain 'bridges': https://t.co/SqzQQnYuKz

— Peter Jones (@h2cm) February 14, 2021

A further query followed:

"can be", but is it?

What would you say has stopped that from happening?

— Peter Jones (@innov8tor3) February 15, 2021

The short answer is clearly that Hodges' model isn't the generic conceptual framework, it follows that is not global either. The reasons why are many and I've posted about several over the years, indirectly and more recently in a more direct manner:

My Moon Mission? "The Stack"

Hodges' model and trial by vampires ... 

Continuing the post on 'cons' here are the 'pros' outlined again along the INDIVIDUAL - GROUP axis (some re-ordering may be needed). To state from the outset that research on Hodges' model is limited, but there is hope for a basic resource for all:

INDIVIDUAL

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP - COMMUNITY - POPULATION

h2cm complements mind-mapping 1. - a cognitive tool: the model has individual utility - formulating the - h2cm provides learners with a scaffold - h2cm can help integrate, understand forms of (health, reflective) literacy/informatics - overvalued? h2cm can encompass value & values - seek pilot study res care / student well-being - ownership: use 'health career model'? - reflection and critical thinking still vital - generation of ideas/associations IS the idea - situation/context bounds model use and scope of inferences - h2cm can be used for lifelong learning - h2cm's application changes with user's vocabulary - Peter's ready to pass this 'baton' - Yes, Nurse 1st -

- h2cm is easy to explain, best via workshop - there is a small bibliography [sidebar] - - 2020 two new independent papers (2. below) - research question is ongoing [ dhyb 3.] - there are ideas/theories h2cm can draw upon - invented here: NW could celebrate - literature still reflects on reflection - student nurses do 'hear of' models & theory - h2cm: as simple/complicated as needed? - - measure of holism, integration ...? - - can encompass all 'spaces' - h2cm remains a response to legacy issues - - person-centred care - - holistic care/ ['holistic bandwidth'] - - integrated care - 'exposure' to Drupal ongoing - learning+ - - Drupal distributions also an option? - 'Peter' is in 'Persistence' (Go Perseverance!)*

h2cm can assist in 1-1 collaboration - care planning - - case formulation - - and small group work - - re. ownership: more 'cost of adoption' not high - there is interest - Yes, time to stop blogging/tweeting - we need a tool to bridge lifespan, healthspan, health career, career span - many dialogues remain contested, patiency, recovery: try this 'space?' - h2cm can help represent the 'hidden' value of labour social, relationships, psychological -

- Safety via Assurance role? - - Spans Quality::Quantity of Care - sense of ownership - make it 'yours' - COVID-19 reveals need & role for h2cm - the model is CC [power to your elbow?] - funding for research would be a bonus - - partnership / studies always welcome - carry the model f/w to 'LeaveNoOneBehind' - - address SDGs at 'home' too - h2cm can also outline the scope of a discipline - an original purpose was in curriculum design - h2cm useful in evaluation/regulation - still seeking benefits: [yes] policy instrument? - reflection/r. practice stressed for nurse re-validation

Further additions / revisions may follow and to the cons post.

To expand on Drupal: the question of its appropriateness to build a new website/platform is not an omission. Drupal 9.0 - 10.0... appear to make the update process and overall experience for non-developers much more user-friendly. I'm looking f/w to a virtual DrupalCon North America in April.

A co-authored paper is on its third journal transfer. Then to address the two-part draft well advanced, related to a conference in July.

1. 

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

2.

Hayward, B.A. (2020), Mental health nursing in bushfire‐affected communities: An autoethnographic insight. Int J Mental Health Nurs. doi:10.1111/inm.12765

Iris Lohja, Yves Demazeau, Christine Verdier. A multi-agent system approach to dynamic ridesharing for older people: State-of-the-art work and preliminary design. 18èmes Rencontres des Jeunes Chercheurs en Intelligence Artificielle, RJCIA’20, Jun 2020, Angers, France. pp.52-59. ⟨hal-02897446⟩ 

3. Don't hold your breath!

*... and yes, at times my head hurts. 

⁺ ... I think and yes to be demonstrated. If not, I do have a 'requirement' and there may be value in that..?

Scope, Space, Nursing, Informatics: Fusion I

Paolo Perrotta writes:

Imagine being a little debugger making your way through a Ruby program. You jump from statement to statement until you finally hit a breakpoint. Now, catch your breath and look around. See the scenery around you? That's your scope.

You can see bindings all over the scope. Look down at your feet, and you see a bunch of local variables. Raise your head, and you see that you're standing within an object, with its own methods and instance variables; that's the current object, also known as self. Further away, you see the tree of constants so clear that you could mark your current position on a map. Squint your eyes, and you can even see a bunch of global variables off in the distance. p.75.

Paolo Perrotta, (2010). Metaprogramming Ruby, The Pragmatic Bookshelf.

"Models, Theories and Concepts" c/o Smith (1994). Plus ça change ...

"Whilst the impracticality of unified approaches has been noted for some time (McFarlane, 1976), it is still considered that many theories, in their efforts to explain everything, succeed only in explaining nothing (Draper, 1990). Therefore, as Kenny (1992) points out, the use of theories and models in nursing has resulted in sweeping generalizations which 'are not always personally, culturally or contextually appropriate'.

In overcoming this difficulty many authors advocate that theories of lesser scope and abstraction are considered (McFarlane, 1976; Clarke, 1986; Draper, 1990; Moore, 1990; Ingram, 1991; Reid & Bond, 1991). Such theories have been termed 'mid-range' and address a more limited number of variables in particular situations (scope), whilst being empirically grounded and focusing on practical problems (abstraction) (Rogers & Shoemaker, 1971; Walker & Avant, 1983; Fawcett, 1984; Lowenberg, 1984). According to Clarke (1986), mid-range theories should appeal to practitioners as being more directly accessible conceptually and linguistically. Reed & Robinson (1991) contend that, given the diversity of nursing practice, the search for grand theory is inappropriate and nursing would be better served by developing mid-range theories that are 'more precisely stated, more easily treated and produce more specific indications for practice'." pp. 59-60.

Smith, J.P. (1994) Advanced Nursing Series - Models, Theories and Concepts. Oxford: Blackwell Scientific Publications.

While the structure of Hodges' model is global - 'grand' in scope, the model, as a template is blank and open to whatever conceptual content follows in the practice situation, or context. 'Precision' can be assured using Hodges' model as it can facilitate person-centred care, integrated care, reflection, critical thinking and conceptual development. 

Delivery of high-quality health care is not a given. 

Safe, effective and equitable care is variously dependent upon staffing, the skills and attitudes of individual nurses, staff numbers, skill-mix, team effectiveness and resource allocation. Hodges' model can also assist users to recognise and call-out unmet needs, deficits in the quality of care, and risks to the safety of patients, the public, staff and the profession.

At risk of sounding grand if not grandiose ...

Change will and must follow - in respect of models and theories, not just of and for nursing but health and care at scale.

Papers in process, book reviews and volcanoes

There are three papers currently in process. There is some good and bad news; plus some similarity with volcanoes. This is in the sense of active, dormant and extinct.

The papers are - with no prizes for guessing the common feature:

1. The Scope of Nursing and Hodges' model
2. Case Formulation (Conceptualization), Diagrams and Hodges' model
3. Recovery and Hodges' model

Two papers are active, that's Case Formulation and Recovery. On the stove is Recovery and it's cookin. I've two co-authors providing invaluable input.

I've just read Terry Marks-Tarlow's Clinical Intuition in Psychotherapy The Neurobiology of Embodied Response and a review will follow my recommending this book right now.

There's a review copy of another book in the post that I believe can inform the recovery paper:

Values-Based Commissioning of Health and Social Care (thanks CUP)

I'm sure the concept of values-based commissioning is a gift to Hodges' model and the recovery paper. A theme to return to on W2tQ. The paper includes the Recovery STAR and relates this to Hodges' model.

The case formulation effort is with my co-author, and after a meeting in Manchester one early evening may incorporate risk formulation too.

The good news is none of these projects are extinct. The first nursing scope paper was rejected. The nursing scope paper is dormant, but is stirring following the symposium on person centredness in nursing early in May 2013.

There are two other books to get to grips with and a project that is in danger of extinction. The sight of Vesuvius next month may help: shift matters.

Seeds in 'architecture' iii

Prof. Younés describes 'three essential dualities': 

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

IMAGE and WORD 

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

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

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

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

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

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

TYPE and MODEL 

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

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

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

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

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

IMITATION and INVENTION 

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

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

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

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

interior individual	exterior individual
interior collective	exterior collective

 

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

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

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

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

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

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

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

By David Rieff

See also: 

Seeds in 'architecture' i 

Seeds in 'architecture' ii

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

End of Life Care (Pathways), Nursing and Thresholds

There is a controversy (was in Telegraph) that has been growing for some time, concerning the Liverpool Care Pathway for end of life care. This is a very demanding and yet rewarding aspect of nursing. I have experience of end of life nursing care in a non-specialist capacity, having worked on wards for older adults and being involved with people who have mental health and life-threatening physical health problems.

It pains me greatly not just as a scouser that something with 'Liverpool' in it should become a cause of distress, a center for debate and review. Is the pathway green and shady? Is it comprised of stepping stones, with room for two, and with time granted for your next step? Or is there a danger in some instances the path can become tarmac clad, without the succor of a services stop for basic sustenance? Can a pathway become a motorway? What does that sign say? "DON'T HOG THE MIDDLE LANE!"

What pains me seriously is that what can be a invaluable, evidenced based palliative care resource can be undermined due to the complexity of the generic and palliative care situation.

If we truly practice person-centered care then there are no care pathways.

Or, to put it another way: there are as many care pathways as there are patients and carers.

Whether you believe in social medicine, or private; whether you are laissez-faire, or leave such matters to a higher power there is no escaping the need for organisation - for order.

The mix and concentration of people, knowledge, resources and time dictates that tasks, roles and processes be delineated and assigned. We need to assure a given level of quality, and to predict things, not everything is as difficult as the weather: or death. Pathways can assist in specific contexts.

Is there scope for personalisation on a pathway? ...

Steps and pace can vary and to the left and right of center. There are many pathways though: some valid - evidenced, award winning; while others might be broad, narrow, twisted - to become a disorientating ethical loop...

Being placed on a pathway denotes a decision point, a threshold. We need to remember in all fields of health and social care practice that there are multiple thresholds to be taken into account, communicated effectively and revisited:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

'me' - existence, resilience, assets, personhood, ethics, personal values, mood, personalised care, understanding of treatment, communication skills, self-expression, loss, orientation, observation, distress, psychological assessment, sedation, beliefs, choices, :theology PURPOSE	'me' - existence, feeding, nutrition, fluids,  evidence base, Liverpool care pathway, quality of life measures, referral thresholds, prediction, resilience, reductive - holistic assessment, medication, distance, where: home-hospital-hospice? pain management, decision locale, specialism, basic nursing care, resilience PROCESS
memories, good-byes, love, compassion, carer under stress, reassurance, counselling skills, meetings with family, empathy and rapport, patient and relative engagement, life history, relative's recognition that loved one is dying, care strategies,  patient experts, patient - carer experience, communities of PRACTICE	consent, advocacy, mental capacity,  integrated working, effectiveness, independent autonomy, service access, bed availability, health & nursing in the media, scope of nursing, scope of medicine, law, medicolegal issues, whistleblowing, complaints, formal review, appeals, organisation, argumentation, professionalism, ageism, POLICY (re-PURPOSED)

The relative position of concepts above does not indicate priority.

"The LCP is not the answer to all our needs for care of the dying but is a step in the right direction."

Marie Curie Palliative Care Institute
Liverpool Care Pathway for the Dying Patient (LCP)

Update on new papers: 1. Case formulation & 2. Scope of Nursing

At present, with the support of a co-author, I am editing a paper on Hodges' model and the scope of nursing. The text some 6000 words was submitted to a journal last April and rejected, but as ever feedback is golden and the comments are being used to revise. The referees have set a challenge as amongst several points I tease out where the inherent theoretical perspectives lie in Hodges' model and how their identification within h2cm helps to define the scope of nursing.

Another paper in final draft - 4400 words - concerns the model and case formulation. At last I've arrived at this topic. Hodges' model is basically a simple drawing with care concepts superimposed. Cognitive behavioural therapy [CBT] and cognitive analytical therapy [CAT] make use of case formulation and CAT utilizes what are called sequential diagrammatic formulations.

The old website pages were written rather on the fly. They almost comprise a 'to-do-list' of thoughts and findings to revisit and check. Of two old pages one dealt with possible ideas and sources that might inform the structure of Hodges' model; the other page theory.

On the latter page I learned of SDRs - the sequential diagrammatic reformulations used in CAT and related this to the care domains of h2cm -

It feels good to be able to address this theme at long last.

In just over a week I'm looking f/w to a three day break in the Lakes. Weather permitting some  walking and a few runs, a bike ride, writing and Drupal - which I have put down of late...

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

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

 'Please provide sources and references.

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

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

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

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

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

1. Scope and Focus 

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

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

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

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

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

2. Epistemological Differences

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

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

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

3. Practical Application in Care

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

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

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

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

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

4. Hierarchy of Integration

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

This is interesting in itself.

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

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

'For example:

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

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

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

CfP International Journal of People-Oriented Programming (IJPOP)

********************* CALL FOR PAPERS *********************
(edited here for length)
*** INAUGURAL ISSUE ***

SUBMISSION DUE DATE: 1st May 2010

International Journal of People-Oriented Programming (IJPOP)

Official publication of the Information Resources Management Association
http://www.igi-global.com/IJPOP

Co-Editors-in-Chief: Steve Goschnick & Sandrine Balbo
Published: Semi-annual (both in Print and Electronic form)

Mission of IJPOP:

The International Journal of People-Oriented Programming (IJPOP) is cross-discipline in range yet singularly focused on empowering individuals to conceptualise, design, program, configure and orchestrate Internet-powered mashups, game mods (modifications), aggregate and structure personal media and build standalone cloud-based and client-side applications (on smartphones, netbooks, laptops, desktops, home network and novel appliances) – into self-fashioned tools and products that ultimately suit the user's own unique needs and aspirations. Other individuals may well take up such apps, mods and mashups for themselves, further customising, enhancing and embellishing them, or they may in part be used in a social or family context (to the benefit of the collective aspirations of those Social Worlds of which the individual is a part) – nonetheless, the focus of composition, development and customisation is on a product for oneself, upon theory, concepts, techniques, methodologies and ultimately tools that service a market of one. Our mission is to be the first journal that comes to mind to academics and practitioners alike and remain the best with regard to all aspects of People-Oriented Programming. Our papers and reviews will be insightful and compelling to both educators and researchers, and often to a wider audience too – the people for whom this paradigm of software development has come about.

SCOPE:

People-Oriented Programming requires high-level tools to empower both the technical and non-technical user, which in turn calls upon research into meta-models that inform design and construction, that aid comparisons of these tools, and facilitates the interchange of content between them. The meta-models of most interest to POP initially, are drawn from two disparate disciplines – the Task Analysis (TA) and Agent-Oriented (AO) paradigms– both of which often have models with representations of entities matching the needs of POP, e.g. goal, task, object, agent, individual, role, intention and communication. Several AO architectures and methodologies have called upon branches of Psychology to formulate AO meta-models that incorporate mentalistic notions such as perception, motivation and intention, but which are most often aimed at constructing artificial humans and the like. In POP we too call upon those same Psychologies and similarly enhance and formulate meta-models and methodologies influenced by them, but with the intention of augmenting and empowering the individual human, in areas where they themselves desire aid or have identified a gap in their own abilities or resources, which they want to enhance.

From Sociology, POP draws upon ethnography with a focus on self-ethnography using tools such as cultural probes, life blogs and life logs to capture aspects of the individual's own life, themselves (or through a life coach), from which they draw the desire and/or frame the need for new technological artefacts to be used in their own lives. Interactivity, with respect to facilitating and streamlining a regular user's intention to build their own artefacts, and situatedness in terms of the individual's current location and activities, are two other facets of HCI (human computer interaction) that POP encompasses.

Video gaming is the first application area where large numbers of everyday users have been able to envisage and then developed their own innovations within existing games. So-called game mods are working examples of POP where players have appropriated userfriendly tools, usually built into the game engines by the vendors (e.g. The Sims, World of Warcraft, etc.). Video games have joined other media (e.g. movie, novel, comic) in the new genre of transmedia storytelling (e.g. franchises such as Tomb Raider, The Matrix, Harry Potter), allowing the player to enter the story 'so far', extending it in the 'now', constructing their own individualised narratives and increasingly, with the capability to enhance and extend the realm of the game itself. These individual constructed game mods allow players to extend virtual realms and narratives in real-time, in directions often unforeseen by the game engine makers. Such activities are increasingly a part of an individual's entertainment and education. Game modding as described, and the engines and tools that enable it, are within the scope of POP.

Internet-based mashup tools (e.g. Google Wave) have opened up a second application front beyond game mods, where POP is likely to gain mass adoption and occasionally produce radical user innovation. The selection and orchestration of disparate distributed services (e.g. web services; information feeds; the Cloud) by an individual within a user-friendly toolkit or framework, is also in the scope of POP. While the formal protocols and the technical enactment of such specific services are of little interest here, the quality, access, usage, aggregation and orchestration of them by the individual themselves, into a personalised synergy of capability made available through some enacting technology, are of acute interest to POP. Modeling techniques and people-friendly notations that bridge and coordinate distributed services together with local resources within POP tools – ones that the layperson can understand and use in conceptualising their designs - encompasses another cross-discipline facet of POP.

RECOMMENDED TOPICS:

Topics to be discussed in this journal include (but are not limited to) the following:

* Activity theory and modeling
* Agent meta-models, mental models
* Alert filter and notification software, automated task assistance
* Augmented reality, augmented interaction
* Automating personal ontologies, personalised content generation
* Client-side conceptual modeling
* Computational models from psychology
* Context-aware systems, location-aware computing, ubiquitous computing
* Cultural probes, self-ethnography
* End-user composition, end-user multi-agent systems
* Game development support tools
* Game mods, game engines, open game engines
* Home network applications
* Human-centred software development
* Interface generators, XML-based UI notation generators
* Interface metaphors
* Life logs, life blogs, feed aggregators
* Mashups, mashup tools, cloud mashups
* Model-driven design, didactic models, model-based design and implementation
* New generation visual programming
* Personal interaction styles, touch and gestures
* People-Oriented Programming (POP)
* People-Oriented Programming case studies
* Personal ontologies and taxonomies
* Personalisation, individualisation, market of one
* Personas and actors
* Real-time narrative generation engines
* Role-based modeling
* Service science for individuals
* Situated computation, social proximity applications
* Smart-phone mashups, home network mashups, home media mashups
* Software analysis & design, software process modeling
* Software component selection
* Speech and natural language interfaces
* Storyboarding, scenarios, picture scenarios
* Task flow diagrams, Task-based design
* Task models, task analysis, cognitive task models, concurrent task modeling
* Use case models, user interface XML notations
* User-centered design, usage-centered design
* User interface tools, XML-based UI notations
* User modelling, end user programming, end user development
* Wearable computing, bodyware
* Web-service orchestration, web-service co-ordination

SUBMITTING TO IJPOP:
Prospective authors should note that only original and previously unpublished articles will be considered. INTERESTED AUTHORS MUST CONSULT THE JOURNAL’S GUIDELINES FOR MANUSCRIPT SUBMISSIONS at:
http://www.igi-global.com/Files/AuthorEditor/guidelinessubmission.pdf

PRIOR TO SUBMISSION. All article submissions will be forwarded to at least three members of the Editorial Review Board of the journal for double-blind, peer review. Final decision regarding acceptance/revision/rejection will be based on the reviews received from the reviewers. All submissions must be forwarded electronically to: stevenbg AT unimelb.edu.au

All inquiries and submissions should be should be directed to the attention of:

Steve Goschnick
Co-Editor-in-Chief
International Journal of People-Oriented Programming
E-mail: stevenbg AT unimelb.edu.au

Additional links:

Goschnick, S. (2009). People-Oriented Programming: from Agent-Oriented Analysis to the Design of Interactive Systems, In. J.A. Jacko (Ed.): Human-Computer Interaction, Part I, HCII 2009, LNCS 5610, pp. 836–845.