Rich Pictures - rich pickings?

Seeking conceptual anchors I've often thought of Hodges' model as a rich picture. Reading to complete my latest module and add to the threshold concepts draft I came across:

Berg, T., Pooley, R. (2013) Contemporary Iconography for Rich Picture Construction. Systems Research and Behavioral Science 30, 31–42. doi:10.1002/sres.2121

There are several points with implications for h2cm and future work. From the abstract:

The RP is a diagrammatic means of identifying differing world views with the aim of creating shared understanding of the organization. The RP has predominately been used as a freeform, unstructured tool with no commonly agreed syntax.

Our research suggests that the RP requires structure to become a contemporary knowledge elicitation device. p.31.

The application of rich picture is quite specific within soft systems methodology [SSM], but there is much to learn here. Let's use the abstract as a template:

Hodges' model could be a diagrammatic means of identifying differing personal care needs, with the aim of creating shared understanding of person-centred care aims and co-created health literacy which whenever possible includes the patient and carer.

Hodges' model provides a structure but one that is nonetheless freeform. You could say the coastline is mapped, but only to a degree. I have already likened Hodges' model to a cognitive periplus. A coastline is clearly definable: initially (it is also fractal). For a ship as in years of yore where can it go? Can it turn inland, to new discoveries (and disciplines)? Is this an estuary with a navigable river? Can the ship find a way out to a new sea through this strait? Even if the ship hugs the coast navigating potentially treacherous waters when newly found? Does this flexibility in Hodges' model arise because it is in effect templatized (axialised)? I have often wondered about my concluding that the user of Hodges' model wants to have their cake and eat it too. By this I mean h2cm is simplistic and so it is dismissed by many, but it can serve complex purposes once populated. By deriving the care domains from the structure, h2cm provides conceptual spaces within which users can orchestrate the concepts pertaining to a particular situation, or context.

Back to paper: there is no syntax as yet since there are no designated icons for Hodges' model. There are many sources and libraries including possibly a subset of RPs, the Noun Project too.

Berg and Pooley write that: RP requires structure to become a contemporary knowledge elicitation device. There is a problem here in what we mean by contemporary, given how long RPs have been around. Of course the same applies to h2cm, hence my efforts. Can we, dare we be more ambitious?

From the paper itself:

This holistic methodology [SSM] uses the rich picture (RP)... p.31

Hodges' model is a holistic methodology that combines threshold concepts, conceptual spaces...!?

More specifically Berg and Pooley write:

Avison and Fitzgerald propose that there is an unwillingness to engage in the rather lengthy requirement gathering process of the RPs and further suggest that management want to avoid political issues that could arise. In certain hierarchal organizations, it is suggested that the RP does not appear ‘business like’, and there is a lack of credibility with the approach (Daellenbach, 1994). p.32.

Judging from the graphics in the paper much of the 'political' may be interpersonal-relationships, but this will inevitably also refer to interdepartmental and interdisciplinary wrangling. Hodges' model gets^# politics. H2CM includes into its structure a POLITICAL domain. If we expand Berg and Pooley's observation could this account in part for the failure of so many IT projects and the need for socio-technical approaches? Computers feature quite highly as one of the most repeated icons in RPs (graph on p.35). There is also a striking similarity between Hodges' model and RP in the simplicity I referred to previously. Within the 'organization' and the hierarchy (even if levelled to pubescent bumps) there remains a need for efficiency (accounting for time), formality and being 'business-like'.

I suspect that for some people, depictions of RPs and Hodges' model are fine on the training room flipchart paper. Once the turn-is-given and the evidence is there to see on the A1 page then to expect more: time for drawing, reflecting, concept mapping, meeting of hearts and minds, problem solving... is a stretch of credibility for some. It may be that as Berg and Pooley do not refer to vocabulary, so often this is the stumbling block as there is no shared vocabulary. It may be close, but differences remain and technology waits for no organization.

Hodges' model attests that meaning comes from several sources and we need to listen in quadrophonic at least, and all before any pencil is licked.

<>

# Gets is used here in two senses: The model (I mean of course the user) gets politics  in terms of access to the political ramifications of whatever... This bare structure may not be doing anything but it has potential. Concepts, such as, consent, capacity, deprivation of liberty, 7-day follow-up, safeguarding, information sharing... can then be encountered in practice, learned and eventually integrated.
Students (and others) can get political as an activist; be that as a critical thinker, advocating for healthcare, or within union and professional bodies.

See also (a dated paper and still an excellent read):
Shaw, Mildred L.G., & Gaines, Brian R. (1989) Comparing conceptual structures: Consensus, conflict, correspondence and contrast. Knowledge Acquisition, 1(4), 341-363.

The SSM - RPs community should look f/w with relish to the advent of VR. This can surely overcome many of the difficulties highlighted in Berg and Pooley (2013) and address the point above about contemporaneity. Icons will be ready-to-hand (gesture, look, thought!...): the challenge then becomes shared VR, but then this is central to its purpose.

Book for review: iv "Philosophy of Care - New Approaches to Vulnerability, Otherness and Therapy"

Don't worry this is not a chapter-by-chapter review. Having cast the stone that is Hodges' model we will skip a few times.

The use of footnotes varies from chapter to chapter. They inform the text, in several instances being quite illuminating. Beside the footnote (1/3 of a page) I noted - 'baby, cacophony, perception - brain - not overwhelmed but can't ignore' (p.41). Stoicism is the focus in chapter 3; perception, fields, manifold, circles of care, self, time, situation! We have field, subfields, domains.

"Perception is always about a diagnosis of the situation in which the living being finds itself. ...

... perception is always about finding one's "whereabouts" or one's "location" in life's journey." p.42.

On the features of perception, 4/4: "might be termed the breadth or width of the perceptual field." p.42. 

"As pointed out above, all perception has the structure of a compact, continuous, and uninterrupted manifold. In other words, it forms what we have termed a field. But the perceptual field  could contain nothing but the "bare bones" of "inert" qualia, (a manifold of simple qualities impinging themselves upon the perceiver)." p.42. 

The author, Jorge de Carvalho continues another view of qualities that take place in "each given moment". This is the challenge of salience, what is significant? How to 'read' in care: the spoken, the unspoken? 

Developing notes on Hodges' model as a mathematical object, Hodges' model in its basic form as a template, I'm proposing as an empty set. The structure of Hodges' model, its two axes instantiate the "bare bones". In programming/instruction terms ... Hodges' model provides INITIALISATION. A reset. This can act as a prompt for learners to acknowledge the person - the other and consider 'unconditional positive regard'. There's polarity too (p.46) and each living being lives in its own global field, in its own global 'map' - in its own geography" (p.49). Physical geography and the change 'there' is giving rise to cogeographical (a neologism?) disruption - eco-anxiety and climate-angst. 

Psycho-geography: the polarity of our times?

Previously: NHS data breaches: the 'cogeography' of who and where?

Another note, amongst Hierocles' circles is 'reflex arc'. So many feedback loops, cascades to worry about. 

As Jorge de Carvalho writes: 'what we are talking about is a very complex field of fields. ... described both as a compass rose and as a framework of concentric circles" (p.51). [There's a relay race, a torch relay in ancient terms p.54. Care is the object that is passed on. I've a dual-shaped baton to pass on.]

Care is more than perception (p.52), care presupposes a degree of activity or action. I like the acknowledgement of 'vigilant waiting' too. For me this draws in the importance of communication; Watzlawick's Five Axioms of Communication. After all, what happens to all these perceptions? There's vulnerability, fragility and care for the sheer existence and the whole content of a given being (p.56). Jorge de Carvalho, deploys a series of numbered points which helps reading. Page 60's footnote had me drawing circles, unborn at the centre: as one. But the collective unborn in another rough circle. Eachtimeness: I like this Stoic formulation through circles. Fourthly, we arrive at pure care. I'm still pondering on ".. there is no absolute either/or dichotomy between care and its opposite" (p.61). Integration is also here, an issue for modern times, a legacy problem from ancient times?

Luis Mendes's chapter I must read again. The abstract includes:

"Three fundamental aspects will be identified: (a) the need to consider self-existence from a global point of view; (b) the need for an axis for that life-view; (c) the need for correspondence between self-existence and life-view. Apparently, this structure is formal and arbitrary. Secondly, I will analyse the structure of despair. Three fundamental aspects will be analysed: (α) the requirement for a life-view which can be applied to the totality of subjective existence; (β) the requirement for an unconditioned instance of meaning; (γ) the requirement for the exclusion of the possibility of failure." p.79.

I'm sure Kierkegaard has featured in Philosophy Now, and The Philosophers' Magazine. Mendes' focus is arbitrariness. The hypothesis is well explained (p.80) structure of care. There's much for me here: care, life-view (health career - life chances), "a global understanding maps the world" (p.81), existential map, fulfilment, meaning (of course!). Reading -

"So, a life-view needs to be stabilized, to have unity. It needs an instance that works as an axis and as a point of support. We need something to support our life" (p.83).

I could have jumped up, waved and shouted "OVER HERE!" Would Kierkegaard have been pleased? Perhaps I should have read Kierkegaard, not Michel Serres (please see bibliography in the sidebar)? Still time (fingers x'd); especially if there's any interest in the form of co-author(s)? Care is full of ideals. Mendes through Kierkegaard gives my  project encouragement: "Truth is to live for an idea." p.84. Not necessarily truth but the idealism in care, including identity. It is helpful in care to be reminded of the ideal as a calling, hence motivation (intrinsic and extrinsic) is still key. If you're intrinsically motivated, devoted to your chosen vocation, is your pay that important - to the government/organisation that employs you? A shame this is so often lost to political leaders; who, given their chosen vocation, exhibit a markedly short memory.

Braga, J. & Santiago de Carvalho, M. (Eds.), (2021) Philosophy of care: New approaches to vulnerability, otherness therapy. Springer. 

Many thanks again to Springer for my copy, especially given a follow-up request, well post-publication date.

Individual

|

      INTERPERSONAL    :     SCIENCES                   

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

 SOCIOLOGY  :    POLITICAL 

|

Group

personal courage relational - (emotional) care despair - fulfilment motivation ideals	unity - stability maps compass - orientation models - frameworks geography
life as a whole society - community of practice external validation extrnisic motivation	sustainable development goals policy accountability failure (courage here - political convictions?)

See also:

body & soul - Book: Philosophy of care: New approaches to vulnerability, otherness therapy

Book for review: ii "Philosophy of Care - New Approaches to Vulnerability, Otherness and Therapy"

Book for review: iii "Philosophy of Care - New Approaches to Vulnerability, Otherness and Therapy"

Leapspace? Why not ...?

Referred to a paper in an email: https://doi.org/10.1016/j.jclinepi.2026.112401.

- I noticed an invitation to try Leapspace. 

So I leapt (with much editing - for formatting here). ...

 

Copilot steps

Creating a plan to respond to your query

Performing search for foundational documents
Performing keyword search
Using data from Scopus
("Hodges' model" OR "Hodges model" OR "Hodges' health career model" OR "health career model" OR "care domains model") AND (nursing OR healthcare OR "health care" OR education) AND (domain* OR component* OR framework OR concept* OR definition*)

Performing natural language search
Using data from Scopus
What are the conceptual definitions, domains, and components of Hodges' model in nursing and healthcare education?

Performing keyword search
Using data from Full text
("Hodges' model" OR "Hodges model" OR "care domains") AND (diagram* OR figure* OR visual* OR schema) AND (teach* OR education OR curriculum OR learning) AND (critique OR adaptation* OR application*) AND (method* OR framework OR discussion)

Performing natural language search
Using data from Full text
How is Hodges' model represented, taught, and adapted in nursing or healthcare education, including diagrams and critiques?

Performing keyword search
Using data from Scopus
("Hodges' model" OR "Hodges model" OR "care domains framework") AND (application* OR use OR implementation OR practice) AND (critique* OR limitation* OR adaptation* OR evaluation*) AND (nursing OR healthcare OR "health care")

Performing natural language search
Using data from Scopus
What applications and critiques of Hodges' care domains framework have been reported in nursing and healthcare practice?

Done

Generated by LeapSpace, Thu Jul 09 2026

Hodges' health career - care domains - model

Hodges’ Health Career – Care Domains – Model is a generic, practice-based conceptual framework for health and social care that organizes thinking into four knowledge/care domains: science, political, sociology, and interpersonal. It is presented as broadly applicable across healthcare contexts and is used to structure reflection, critical thinking, and care planning. [1] [2] [3]

Core domains

Domain	What it covers	How it is used
Science	Cause and effect, evidence, costs, benefits, and trade-offs	Helps frame the “hard” evidence side of care and service decisions. [1]
Political	Policy, systems, and structural influences on care	Helps connect care to wider health and social policy contexts. [1] [4]
Sociology	Social context, culture, stigma, and relationships	Helps explain how social factors shape health and illness experiences. [1] [5]
Interpersonal	Therapeutic relationships, patient/carer engagement, and human interaction	Supports person-centred and relational practice. [1] [2] [6]

What the model is for

• It is described as universal in structure and adaptable to many healthcare settings, including informatics, dementia/palliative care, forensic mental health, and oral health. [2] [3] [4] [7] [8]

• It helps practitioners map concepts into domains, build a mind-map-like structure, and support reflective practice and critical thinking. [3] [9]

• In forensic mental health nursing, it is proposed as a way to guide assessment, decision-making, and recovery-oriented practice. [2]

Bottom line

Hodges’ model is best understood as a four-domain lens for integrating clinical evidence, policy, social context, and relationships into one framework for care and reflection. Its main value is not in prescribing a single care process, but in helping users think more holistically and systematically about health problems and care systems. [1] [2] [3]

Confidence level: High — multiple sources consistently describe the model’s four domains, generic structure, and broad healthcare applications.

References

1. Fox, Siobhán, FitzGerald, Carol, Harrison Dening, Karen, (...), Timmons, Suzanne (2017) Better palliative care for people with a dementia: summary of interdisciplinary workshop highlighting current gaps and recommendations for future research. BMC Palliative Care. https://doi.org/10.1186/s12904-017-0221-0

2. Doyle, M., Jones, P. (2013) Hodges' Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/j.1365-2850.2012.01961.x

3. Jones, P., Wirnitzer, K. (2022) Hodges' model: The Sustainable Development Goals and public health - Universal health coverage demands a universal framework. BMJ Nutrition, Prevention and Health. https://doi.org/10.1136/bmjnph-2021-000254

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

5. Jones, P. (2008) Exploring serres' atlas, Hodges' knowledge domains and the fusion of informatics and cultural horizons. Social Information Technology: Connecting Society and Cultural Issues. https://doi.org/10.4018/978-1-59904-774-4.ch007

6. Merritt, M.K., Procter, N. (2010) Conceptualising the functional role of mental health consultation-liaison nurse in multi-morbidity, using Peplau's nursing theory. Contemporary Nurse. https://doi.org/10.5172/conu.2010.34.2.158

7. Jones, P. (2009) Socio-technical structures, 4Ps and hodges' model. Nursing and Clinical Informatics: Socio-Technical Approaches. https://doi.org/10.4018/978-1-60566-234-3.ch011

8. Jones, P. (2011) Socio-technical structures, 4Ps and hodges' model. Clinical Technologies: Concepts, Methodologies, Tools and Applications. https://doi.org/10.4018/978-1-60960-561-2.ch215

9. Jones, P. (2025) A Generic Model and Conceptual Framework to Prime Curiosity Across Health and Social Care Disciplines to Facilitate Lifelong Learning. Journal of Evaluation in Clinical Practice. https://doi.org/10.1111/jep.70252

Follow-up Suggestions 

What are the key components of Hodges' health career care domains model?

How does Hodges' model apply to interdisciplinary health care practices?

What are the implications of Hodges' health career care domains model for patient-centered care?

Feedback on Hodges' model in 'mathematical' terms

Through HIFA, I noticed an introduction by a new subscriber - Mr James Twahirwa; and noted a maths-oriented skillset:

'HIFA profile: James Twahirwa works on Research and data analysis in Rwanda. He is deeply interested in contributing to the global effort to improve health equity through reliable, accessible information. His background in statistics, data analysis, and research methods equips him to support evidence-based decision-making and strengthen health systems.

By email, I got in touch seeking an independent reading of the draft h2cm-maths paper (part 1).

Prior to this, Mr Twahirwa kindly made the following observations on Hodges' model which he is happy for me to post here:

==============

Dear Peter Jones 

I find your work interesting and really well-positioned.

Overall impression

Your work is intellectually ambitious and unusually well-positioned. You are attempting something that many disciplines struggle with: creating a unifying conceptual framework that can bridge practice, theory, and abstraction without collapsing into reductionism. The fact that Hodges’ model originates in nursing and has sustained relevance across decades already gives it credibility as a practice-informed epistemic structure, not just a diagram.

Your effort to reinterpret it through mathematics and category theory is especially interesting, because health economics often suffers from exactly the fragmentation your work seeks to address: disconnected models of behavior, outcomes, ethics, and systems.

1. The 2x2 structure aligns naturally with health systems thinking

Health economics constantly balances dualities such as:

• Individual vs population
• Clinical outcomes vs social value
• Quantitative evidence vs lived experience
• Efficiency vs equity

A 2x2 framework provides a powerful way to hold these tensions without collapsing them into a single metric. This is one reason cost-effectiveness frameworks often feel incomplete. Hodges’ model appears capable of holding multiple dimensions of value simultaneously.

2. Conceptual clarity over mathematical dominance

Health economics has increasingly recognized that mathematical rigor alone does not guarantee insight. Your attempt to treat Hodges’ model as a conceptual object rather than a predictive algorithm is aligned with modern critiques of over-formalization in economics and health policy.

Where your work could be strengthened

1. Clarify the “mathematical” claim carefully

From a health economist’s perspective, the risk is not that the model lacks mathematics, but that readers may misunderstand what kind of mathematics is being invoked.

You may want to explicitly distinguish between:

• Mathematics as computation or formal proof
• Mathematics as structural reasoning (relations, mappings, constraints)

Making this distinction early will help avoid criticism that the model is “not really mathematical,” while still defending its rigor.

2. Connect to applied decision-making

To attract health economists and policy researchers, it may help to show how Hodges’ model could:

• Frame health technology assessment decisions
• Structure evaluations of complex interventions
• Support mixed-methods research designs

Even one concrete example (e.g., health service redesign, chronic disease management, or resource allocation) would strengthen its practical relevance.

3. Position the work in relation to existing frameworks

Your work resonates with, but is distinct from:

• Systems thinking in health
• Capability approach (Sen, Nussbaum)
• Complex adaptive systems
• Multi-criteria decision analysis

Explicitly stating how Hodges’ model complements or improves upon these will help readers locate it intellectually.

I hope this feedback may be of help

Happy festive season.

=================

Thank you Mr James Twahirwa. These comments are very helpful. You have identified the many strengths of Hodges' model and its uses. On the mathematics, you make many points for me to address and balance in terms of the overall intent and content of this 'project'.

Mr Twahirwa is now in possession of the draft paper. Any further thoughts are always welcome. While rather remote from clinical practice (a debate in itself) health economics is ultimately grounded in health services and health systems development. So this perspective provides a critical counterbalance to my clinical (business) as usual approach.

Point #1 is a primary motivating factor for this 'project'. I'm sure I can use structure as an anchor, while acknowledging that Hodges' model is a conceptual model, an idealisation. Additional feedback regards reasoning, decision making and Bayes also apply here:
[ ii Learn your lines and the hyperplanes will follow ].

In Point #2 I may be able to leverage research, drawing from #1:

'Mathematics as structural reasoning (relations, mappings, constraints)'.

Point #3 will be considered in-part through April's complexity conference; and revisiting former work on systems.

Both points #2 and #3 may find their home in a second paper (part 2), but this is fine, as it may support a step-wise workflow, and something akin to a logical progression(?).

As posted before any assistance greatly appreciated.

Interesting ... 'Incidence structure(s)'

Unsurprising, in studying 'Hodges' model, I've been aware of Wilfrid Hodges and model theory for many years.

Now, trying to look at (Brian) Hodges' model using maths, I've wondered about possible connections with Wilfred Hodges' work.

Dr W. Hodges was listed in searches on lines, axes, and structure:

'Algebraists and geometers like to classify structures by the laws which they obey. A typical law for incidence structures reads:

"For any two different lines L and M, there is exactly one point which lies on both L and M."'

My imagination may be getting the better of me, but there seems something profound in the intersection of the model's two axes and the care - knowledge domains that are created (proposed - adopted..)?

So, is Hodges' model a form of 'incidence structure', or does it contain several incidence structures? 

Hodges, W. (1985). Truth in a Structure. Proceedings of the Aristotelian Society, 86, 135–151. http://www.jstor.org/stable/4545041

Questions in eclipse

 Last Friday 9th I had a Zoom chat for 30 mins, regards Hodges' model with faculty in the USA.

We touched upon:

• background to Hodges' model
• courses taught across the water and interests
• overlaps, inc. person-centered care - socio-technical
• informatics & literacies
• maths/logic

As an outcome it was suggested I forward some questions I'm currently of Hodges' model. Questions that for me, are challenging, put me in the dark, and may not even be valid?

Going through my draft notes I picked out 20, beginning with the working title:

Hodges’ Model as a mathematical object and relational ontology:
category theory or category mistake?

1. Can it be argued there is what amounts to a care locus - that can 'locate' person-centredness?
   
   
2. Can the model's domains be seen as functions?
   
   
3. Are the domains placeholders?
   
   
4. Is there a case to test, and if logical implement co-domains (e.g. parity of esteem)?
   
   
5. Are there other 'structures' in Hodges' model,  for example L-shaped forms, that is relations that involve three domains and (seemingly) omit one?
   
   
6. Are there practical - case studies - that can be associated with such structures?
   
   
7. Can Hodges' model be considered as a single conceptual space (Gärdenfors), or a series of four? (blog posts)
   
   
8. Can Hodges' model be used to identify and apply threshold concepts (Meyer & Land)? (blog posts)
   
   
9. Can we argue that the structure of Hodges’ model as defined by the axes extent, provides and invites inverse relations?
   
   
10. Is Hodges' model as a structure only (a template) equivalent to an empty set (empty set as an initial object)?
11. Is this a mathematical analogue (being neutral) to a practitioner's unconditional positive regard?
    
    
12. Taking its axes and four (care/knowledge) domains can Hodges' model be reduced to a graph?
    
    
13. If Hodges' model acknowledges/incorporates Cartesian duality, are there Cartesian products?
    
    
14. In these Cartesian products are critical operations, e.g. relating to psychotropics - physical health; eating disorder - physical/mental health; complex emotional needs - policy (evidence-based care)?
    
    
15. If the model is inverted, mirrored ... what follows: is the structure - function - consistency retained?

    
    
16. Is Hodges' model 'closed' in comparison with Buzan's (open?) approach to mind-mapping?
    
    
17. There is an 'equation of time': is there an 'equation of care'?
    
    
18. Thought experiments: (semantic distance... cognitive linguistics)
    
    

    Which concept (INTERPERSONAL :: SCIENCES) is closer to the ‘INDIVIDUAL’ axes; which is closest to the ‘GROUP’ (SOCIOLOGY :: POLITICAL)?

    
    

    Which concept (SOCIOLOGY :: INTERPERSONAL) is closer to the HUMANISTIC axes; which is closest to the MECHANISTIC (SCIENCES :: POLITICAL)?

    
    
19. Role of 'types' in Hodges' model - that is, patient / model as a whole as objects (with identity)?
    
    
20. What significance can be gleaned given commonality between several mathematical terms, e.g. group, object, (co-)domain and Hodges' model?

I can no doubt structure - group these questions, and I've not picked out many concerned with Hodges' model as a set, or, as yet, those venturing into category theory. I am wondering, what the commutative law might tell us about holistic, integrated care, and parity of esteem when applied through Hodges' model? Also refining 3-4 case examples to explore and illustrate the same?

While it is maths that prompts this diversion, perhaps ultimately health care disciplines can determine its own formal approach that can produce its own context-sensitive rules, that straddle mathematics/logic and the humanities?

In initial emails, I'd noted the forthcoming eclipse across the USA. Checking, my interlocutor is just N of the path of totality (I wish!) for April's total eclipse. I'm enjoying the darkness here too.

https://science.nasa.gov/eclipses/future-eclipses/eclipse-2024/where-when/

#TotalEclipse2024 #SolarEclipse2024

International Nurses Day - Closing the gap: My Project for a Global Conceptual Framework for Nursing

As International Nurses Day is celebrated tomorrow on the 12th May the emphasis and work here at W2tQ lies with Hodges' model. The project is to publicise h2cm's international potential in providing an avenue to help unify nursing theory, practice and assure future research.

Fawcett wrote of the metaparadigm of nursing - namely the inclusion of the concepts of person; environment; health; and nursing.

These concepts are incorporated into Fawcett's criteria on model validation which are listed in bold-italic below.

I have also ventured some reflections on the current status of h2cm when compared against these criteria.

Assumptions underlying the conceptual model are made explicit.

It is not sufficient, but the structure of Hodges' model renders the assumptions within the model explicit. The structure identifies eight initial key concepts:

INDIVIDUAL, GROUP (population); HUMANISTIC, MECHANISTIC; SCIENCES, POLITICS, SOCIOLOGY, INTERPERSONAL

A complete description of all four concepts of nursing's metaparadigm are presented.

Reflection soon reveals that several environments are suggested:

PHYSICAL, ORGANISATION, COMMUNITY, HOME, RESIDENCES, DWELLINGS, COGNITIVE (conceptual), SYMBOLIC, ABSTRACT, VIRTUAL, FORUMS, COLLEGES

Propositions of the conceptual model completely link the four meta-paradigm concepts. 

This is feasible, reasoning from the foundation of the model's structure.

The internal structure of the conceptual model is logically congruent.

This does need to be demonstrated. Initial recognition of logical congruence might be found through the conjoining of disciplines, that is frequently taken for granted: PSYCHO-SOCIAL; SOCIO-TECHNICAL; SOCIO-ECONOMIC.

The conceptual model is socially congruent, socially significant, and socially useful.

I have claimed on numerous occasions that the model is agnostic, universal, accessible, and has educational potential. These and other qualities need to be critically examined.

Empirical evidence in support of the model has accumulated from many derived theories.

The two final criteria are the most challenging. Empirical evidence supporting Hodges' model is available, but again must be tested through research. If someone has time - could you please compare the frequency of a set of political concepts in the nursing literature since 1985?* The emergence of health literacy and self-efficacy, threshold concepts, conceptual spaces, the rise of the semantic web and developments in software can all potentially support h2cm. Producing a roll-call of some of the latest trends in contemporary education, research and culture is not good enough, specific studies are needed.

The total contribution of the conceptual model to nursing knowledge. 

There is a long, long way to go, but the contribution has begun ... every journey ...

Of course, it is almost 20 years since publication of Fawcett's criteria. Has the concept of congruence changed in that time? What is socially significant and useful now? What should the social and political weighting of evaluative criteria be in 2012...? There is a body of critique upon Fawcett's and other evaluative tools within nurse education.

Perhaps a new set of criteria could be defined using h2cm itself? For a model of nursing (health and social care) to be fit for purpose, acceptable and viable across the globe, there are new concepts to be represented. While that would certainly close a gap, it does not seem a rigorous or valid way to proceed. I will seek out other more recent criteria and present them here at some point.

Fawcett J. Analysis and Evaluation of Conceptual Models of Nursing, 3rd ed. Philadelphia, Pa: FA Davis; 1995.

*Many thanks - if someone should pick this up, which ever axes, concept or issue.

Come on Healthcare: catch up will you!

Within philosophy it is recognised that Immanuel Kant provided a means by which the rationalists and empricists can be reconciled. Some background:

In philosophy, rationalism is the epistemological view that "regards reason as the chief source and test of knowledge"[1] or "the position that reason has precedence over other ways of acquiring knowledge",[2] often in contrast to other possible sources of knowledge such as faith, tradition, or sensory experience. More formally, rationalism is defined as a methodology or a theory "in which the criterion of truth is not sensory but intellectual and deductive".[3]  https://en.wikipedia.org/wiki/Rationalism

In philosophy, empiricism is an epistemological view which holds that true knowledge or justification comes only or primarily from sensory experience and empirical evidence.[1] It is one of several competing views within epistemology, along with rationalism and skepticism. Empiricists argue that empiricism is a more reliable method of finding the truth than purely using logical reasoning, because humans have cognitive biases and limitations which lead to errors of judgement.[2] Empiricism emphasizes the central role of empirical evidence in the formation of ideas, rather than innate ideas or traditions.[3] Empiricists may argue that traditions (or customs) arise due to relations of previous sensory experiences.[4]

Historically, empiricism was associated with the "blank slate" concept (tabula rasa), according to which the human mind is "blank" at birth and develops its thoughts only through later experience.[5] https://en.wikipedia.org/wiki/Empiricism

If health and social care, must be evidence-based, then as far as Hodges' model is concerned we are then duty-bound to use the most readily available 'evidence' to us, including (while taking liberties?):

• The structure of national health and social care organisations (NHS, DHSS ...)
• Physical infrastructure
• Human Resources Organisation
• Unions and Labour relations
• Texbooks, journal papers, conferences
• Organisational structures from the regional to the local
• Professional bodies and governance of licensing/registration
• Curricula that students follow^
  
• Models, frameworks, teaching and learning tools and methods
• Data, statistics, information and reporting (national, international)
• Research projects ongoing (whatever scale, methods, methodology)
• Accounts from lived experience of patients, carers and public (^and students)
• Policy
• Funding
• Law relating to Health and Social Care
• Public (Mental) Health? Discuss
• Media (Social) Control, Advertising
• . . .
  

Hodges' model: Structure and Content

Using this evidence, we still see the Cartesian divide, the mind-body distinction writ large in health and social care. The continuing impact is evident in theory, practice, (hence) lived experience, policy and managment. Since its creation in the 1980s, Hodges' model mirrors (literally) this philosophical, epistemological and ontological legacy, thereby acknowledging the ancient history of medicine, and 'modern' development of healthcare and nursing. Through this device, Hodges' model can facilitate debate, critique, reflection, and critical thinking; to encourage progress in our thought, motivations, action and subsequent evaluation.

This explains the structure of Hodges' model and predicts the range (contextual signature) of content when the model is applied.

Evidence permitting of course!

See also: BBC The Great Philosophers:

Series 1: 4. Descartes

Series 1: 5. Spinoza and Leibniz

Series 1: 8. Kant

n.b. I video taped this marvellous series when first screened. When studying for my BA(Hons), audio taped, they also provided a great learning resource in the car. The programmes are on BBC 4 (UK) once again, but are readily accessible.

Hodges' meta-model...?

In combination the empty foreground and background brings us simultaneously to what is 'now': the situation, the context. The personal, social, political and physical are constantly re-presented in the health:ill-health duality. Our focus remains: ill-health. We still lack the depth of vision to resolve this duality. Focus needs structure: only from simplicity may we travel to complexity. 

The need for simplicity, structure, meaning and recording can be found, accomplished and apprehended through the conceptual framework known as Hodges' model. Its cruciform span is coincidental, and yet can be interpreted as four ways. Four ways of looking - seeing, learning and knowing. Five ways and even. As the model and the user reflects the innumerable perspectives that can be found as these conceptual spaces breathe: waxing and waning. Always from that initial state. Emptiness with structure.

Hodges' model: a blanc space, neutral for structure & content

On twitter today I mentioned the discovery of the book Panaesthetics by Daniel Albright. It was a buy in the end. A great discovery saddened to then learn that its author is no longer with us. Although I have not read it there will be much to draw from it: literally. I have often written about Hodges' model being initially a neutral space, a blank sheet. What is a starting position is always political as with Hodges' model. Its structure regiments the paper it is drawn upon. The presence of a political care - knowledge domain makes a statement. Structurally and in content the sense of neutrality is broken. Albright points to historical support as he discusses "What is painting?".

"White, said Superville, is an innocent peaceful color, calming us in the way that pure snow or moonlight calms. Black implies "silence and solitude, sadness, death, and oblivion"; red is "the hieroglyph of life and movement . . . the excess of luminous rays, just as the colour black is its absorption and annihilation." But this correlation of color with emotional state is less original than Superville's belief that color and lines are "the identical signs of one invariable language, and the associations of the one automatically imply the associations of the other" - every color corresponds to a linear pattern, every linear pattern presupposes a certain color. Superville provides a diagram to prove his point: red throws its arms into the air; black is stooped, submissive; "white , an invariable, pure sign, like the horizontal line, occupies the middle space between two extremes" (fig. 27)." p.102.

This is not the exact figure from the book but the meaning is relayed (I think).

A contact from the OU and 'The Difference that Makes a Difference' Conferences David Chapman kindly commented on this post on Facebook:

David Chapman "White is an innocent, peaceful, color". Except when it is the colour of the KKK, colonialism and slavery? I like the use of the shapes and can see that there may be ideas you can use in the quad, though.

Unlike · Reply · 1 · March 4 at 8:44am

I've expanded on my Facebook response below:

Thanks David, Yes I realise there's a potentially racist tone to this "white as pure". It is of course about the ideas, structure and form. I still refer implicitly to Michel Serres' work and the significance of 'blanc' and in previous posts. There are many ethnocultural connotations as to how black, white, greys and colours are interpreted and what they mean. As a tool it is important that Hodges' model conveys neutrality. In this case no emotional, value-based stance is taken.

Another thought from the past I recall is the BBC micro wordprocessor View and its appearance on a monochrome (Phillips) screen. Green on black (the new 'blanc'?) worked best. The penultimate blanc is the night sky...?

Albright, D. (2014) Panaesthetics On the Unity and Diversity of the Arts. New Haven: Yale University Press.

Diagram: http://www.dezenovevinte.net/obras/av_rc_baile_en.htm

The symbol '+'

Apart from a multitude of symbolic meanings the figure below also provides the structural foundation for Hodges' model and as symbols.com notes:

The cross with arms of equal length is an extremely old ideogram used in most cultures. It is also one of the basic gestalts in Western ideography (as opposed to the basic elements, which are derived entities). The cross is found in every part of the world, in prehistoric caves and engraved on rocks.

In my interview with Brian Hodges' over 10 years ago in May 1997, Brian provided an account for how he arrived at this structure (summarised below). As mentioned elsewhere on this blog, the website, symbols.com and other sources - the cross, or 2x2 matrix is a common device to explain and structure. The four elements, the four humours (or humors) yellow bile, black bile, phlegm and blood, the seasons; there are so many things that can be characterised in this way.

With '+' as a starting point for me to reflect on Hodges' model I see each line as an individual. This agent or subject could include patient (person) and health care worker; lecturer and student and many other examples.

The act of cros-sing, the intersection of the axes represents two human beings being in a situation.

Space and time brings people together:

and also forces us apart - physically and temporally.

Adding an arrow to one end of these axes creates the dynamic of communication.

The angular distance in the alignment of those arrows offers hope -

• in our common humanity we are never in 180 degree opposition;

and yet acknowledges:

• the isolation of the individual -
  
• and the challenge.

The work that must done. Hence the primacy of communication skills and values; in order to bridge individual being, ti:me and space.

Perspective is helpful here as an extension:

While we may get close to another person, through relationships that entwine the lines - be they spun by professional obligations, friendship, family ties, or intimate sexual relationships - the two lines are always distinct: part of an elaborated knot.

Is it just the special ties that must forever seek to be one+

---

The best way to explain h2cm is to review the questions Brian Hodges originally posed.

To begin, who are the recipients of care? Well, first and foremost individuals of all ages, races and creed, but also groups of people, families, communities and populations. Then Hodges asked: what types of activities - tasks, duties, and treatments - do nurses carry out? They must always act professionally, but frequently according to strict rules and policies, their actions often dictated by specific treatments including drugs, investigations, and minor surgery. Nurses do many things by routine according to precise procedures, rather like the stereotypical matron with machine-like efficiency? If these actions are classed as mechanistic, they contrast with times when healthcare workers give of themselves to reassure, comfort, develop rapport and engage therapeutically.

This is opposite to mechanistic tasks and is described as humanistic; what the public usually think of as the caring nurse. In use this framework prompts the user to consider four major subject headings or care domains of knowledge. Namely, what knowledge is needed to care for individuals - groups and undertake humanistic - mechanistic activities? Through these questions Hodges’ derived the model axial structure.

Dramatherapy ii - from Sociometry, Sociogram to Sociatry

Individual

|

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :    POLITICAL 

|

Group

A personal journey

"... Moreno soon began to seek ways of measuring the form and structure of relationships in groups. The techniques of sociometry which he invented have since been widely and successfully adopted by his successors, becoming an accepted field of social research in their own right. At its simplest, this approach relies on asking of the social grouping under investigation to indicate their relationship to each other so that, for example, a pattern of dominance (vertical structure) or affinity (horizontal structure) can be discerned. These measures may be committed to paper in diagram form (a sociogram) or expressed by the individuals arranging themselves in positions symbolising their relationships (an action sociogram)". p.106.

"More complicated interconnections and patterns can be demonstrated and the group asked to explore alternatives in order to recognise sources of conflict and misunderstanding and to modify them. Moreno foresaw a new discipline for which he coined the name 'sociatry' in which the social organisation rather than the individual is the object of the healer's endeavours, a truly 'group' psychotherapy". p.106.

Anticipating future theory-practice policy and education change. Could the reduction in the options for student mental health nursing placements be compensated in-part by addressing the concurrent change in the range of therapeutic (modalities) interventions available?

Davies, M.H. Dramatherapy and Psychodrama, Chap. 5. pp.104-123. In Jennings, S. (Ed.), (1987) Dramatherapy. Theory and Practice for Teachers and Clinicians. Routledge, London. p.106.

Previously: theatre , space , diagram

Care & Information Architecture in Drupal 7 and h2cm

At Drupalcon Paris this morning webchick provided an overview of Drupal 7. Amongst the feature laden slides was the way an information architecture emerged and was used to review the usability of version 6 and the soon to be released 7th version of Drupal. The list - comprising several contexts:

• appearance
• configuration
• content
• people
• structure

- had me reaching for Hodges' model and the care (knowledge) domains. This is a very informal rendering of an information architecture and yet very useful. As explained elsewhere h2cm is a very high level tool and resource and I have often viewed Hodges' model as a care architecture. Placing the above list on to Hodges' model then -

content	appearance structure
people	configuration

The rationale for this is fairly straight forward:

CONTENT: in creating content we are - as Dries stressed with Drupal - reaching out to a global audience, but content needs to fire in the mind of individual users. The site must have meaning for that person.

APPEARANCE: Style and design are physical in the sense that properties abound, even though appearance is subjective at the end of the day. Despite this there are guide lines and rules that help us avoid "what sucks".

STRUCTURE: Again even if conceptual on paper, in menus, or database tables; our models and frameworks span the divide between physical and abstract or virtual as representations. They enable communication and interaction.

CONFIGURATION: Well here the decisions are political. They may vary in the degree of left - right and centre, but they are nonetheless political.

PEOPLE: Last, but not least is people - COMMUNITIES! Built around users and the practical implementation of things they want to do - their purposes.

When we think of people it reminds me of the way people sometimes confuse social inclusion and exclusion and in placing 'people' here we cannot ignore the constant interplay between the interpersonal and political domains with roles, permissions, policy, security and other related issues.

Hearing about Drupal 7 on the first full day of Drupalcon means that the winter and indeed 2010. ... sounds a busy and lucky time here! The plans for code freeze and move towards the final release were also outlined this morning. With the announcement of Drupalcon 2010 in San Francisco more to follow: including three days in Paris....

Reflections [IV] Conceptual Spaces At Work: Parthemore, Unified Conceptual Space

In my notes on Hodges' model, nursing theory and conceptual spaces I've referred to Rosch, Gärdenfors and there is much of note in my copy of The Big Book of Concepts. There are gaps to fill, key sources to find and digest including the history of concepts. In Empirical Investigations in Conceptual Spaces Theory and the Unified Conceptual Space Joel Parthemore really helped this effort. His presentation began with: What is a concept? Which (for me) begs the question: What is a concept within Hodges' model? Is it a single entity?

Joel's slides included the following:

In the Beginning Was...

• Classical definitionism: concepts are like entries in a dictionary.
• Classical imagism: concepts are like pictures in the mind.

And then came their descendants:

• Prototype and exemplar theories (Rosch)
• Informational atomism (Fodor)
• Proxytypes theory (Prinz)
• Conceptual spaces theory (Gärdenfors)

Listening to Joel introduce his work on unified conceptual spaces I can relate several points to Hodges' model especially the following.

• Attempt to describe how all of an individual conceptual agent’s conceptual spaces map or weave together into a single unified space, a “space of spaces” describable along certain common axes.
• By extension, how all of the individual conceptual agents’ unified spaces map together, in linguistic human society, into a single, common unified space.
• Unlike CST, UCST is explicitly enactive: concepts are located not in the agent nor in the environment but in the interaction of agent and environment.

A couple of speakers brought up the question of a 'space of spaces'. Centeredness also preoccupies us in health and education. We are desperate to pick up the patient and the student and put them at the center of things. I keep wondering (see link below) about the extent to which structure and a theory of cognition are interdependent in terms of the resulting conceptual spaces? Since the late 1980s Buzan's mind-mapping has struck me as not being 'grounded'. This may not be an issue in many applications, but for a generic conceptual framework some underlying structure (dimensions) seems essential.

Joel also considered this:

• One major shortcoming of currently available mind-mapping software is the lack of any well-defined theory of cognition (let alone theory of concepts) underlying the application.

I hope I can make contact with Joel and return to this. He indicated papers and further projects with colleagues and a piece of software.

Additional link (Hodges' model - nexus, structure):

http://hodges-model.blogspot.co.uk/search?q=nexus

ii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

I didn't have time to finish reading Frankel et al. before WCCS26. This book has an index which was very useful, to efficiently check certain points. It is amazing the number of books without an index.

Chapter 1 is 'Guiding Principles' and links really well with the index. At two pages it is brief and yet also constitutes Part 1. 

Part II The Clinical Situation, continues an introductory thread. Chapter 2 The “Clinical Situation”: An Introduction to Its Structure and Complexity is what attracted me to the book. At five pages, there was more in this vein. I looked ahead and found that the chapters all seemed short. Checking the book's web page, 50 chapters in 270 pages, so just over 5 pages and well referenced too.

Initially, you might feel short-changed, of course, I didn't with a review copy. But don't worry. You are in patient- person-centred hands here. Sometimes content matters. The three authors work and are researchers in psychiatry. For me, the guiding principles and part II provide a handshake with the index. The person here then, is given a literary hug. Immediately, there is a link between the variables of care and the structure of a case (or caseness). 

'But importantly that "structure" is dynamic changing over time. We classify variables as "clinical" as they are brought into play for the purpose of treatment, i.e., the goal of healing.

The clinician is not just challenged to unravel this complicated situation but also to represent the patient accurately, including his or her "human" elements as represented by temperament and personal attitudes. What are the patient's essential needs. tolerances, preferences? Yet, there is even more to know about each patient. Does she have children? What is her financial status, her ethnicity? What are her attitudes about medical professionals. Does she believe in medicine, or even in science?

Beware! None of these factors are dispensable when trying to understand a patient. Just try to leave out a few and you are left with a gutted rendering of that person, not a living human being.' p.7. 

(and continued in fragmented form below ...)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

'The result even when this level of detail, is available may still be an anemic version of the patient.    Traditionally a medical patient is subjected to an extensive workup that includes a mental status examination, in addition to a detailed past and present history, ...	... and an extensive "review of (organ) systems.
Now add the multiplicity of problems, psychiatric and systemic medical, from which the patient suffers. ...	Multiplicity may include systemic medical, psychiatric, social, financial, and lack of access to health providers.' p.7.

'From this description it seems logical that complex patients presenting with mixed medical-psychiatric disorders be managed with an ongoing collaborative approach delivered by a multispecialty team. Included may be a primary care physician, psychiatrist, and/or psychotherapists. One or more of the collaborating professionals may be a nurse practitioner and/or a physician's assistant.' p.7

I will return to the 'logical' in the final quoted paragraph above. The author's declare their intent from the outset, and by the literature-to-date they achieve this (may I please add? 'in spades!').

 

Over the years and as raised on W2tQ, several colleagues and contacts have asked "Where is the book on Hodges' model?" Not to sound weird, but this book asks that same question through some challenges to the usual 'medical' text. There are several lessons to take away here, even if only to keep a dream alive. While the physical size of a textbook, its practical appeal and stance makes it appear as something to pop in your top shirt/jacket pocket. A pocket guide: quite an impression just 10-20 pages in, and in this digital age.

 

As you would expect from mental health practitioners - psychiatrists - psychotherapists, interpersonal, subjective-objective and intersubjective factors are integral to how complexity is defined and measured. In Chapter 2, pp.11-12 there is mention and reference to the Value-Based Integrated Case Management Complexity Assessment Grid:

Specker, S., Andrew, R., Drexler, E., Koithan, E., Thurber, S., & Frankel, S. (2026). Development of the Self-Administered Health Complexity Screening Instrument. Professional case management, 31(2), 81–89. https://doi.org/10.1097/NCM.0000000000000845

I will check this instrument as I complete this review. As noted on April 9th this book was published in 2023, so I remain grateful to Daniela and colleagues at SpringerNature for the review copy (which also enjoyed WCCS!).

Previously: 'complex' : 'holistic bandwidth' : 'mental health' : 'person(-centred)'

More to follow ...

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

Combining h2cm, Informing Science and informatics on the Rainbow Bridge

Thor

As a boy one of my favourite superheroes and subjects of myth was Thor and his retinue - Loki, Odin, The Rainbow Bridge. These remain tantalizing escapes for young minds should a corner shop sell comics.

As I mentioned previously in posting about the informing science journal, a paper currently in preparation makes use of holistic bridges and I have had in mind Thor and his ilk and Rainbow Bridge between worlds. In Hodges' conceptual framework the domains of knowledge that make up the model could almost be disparate worlds. This disciplinary repulsion presents several challenges at a time when disciplinary in-fusion is needed (demanded by our problems):

Integration of health and social care in the form of:

• physical - emotional health;
• applied socio-technical informatics
• personalised and service centred care

Academic cross-disciplinary working, e.g. informatics -

• clinical
• urban
• e-governance

Last summer I posted a suitably colourful mix of holistic bridges that included the image below. These hyphenated cross-disciplines conjoin the four care or knowledge domains of Hodges' model.

My interest in ICT began with the ZX81 in 1981 and ever since I've been intrigued as to how we can integrate the above. Why does this matter? It matters not just because of the complexity of the problems we face in in our work and home lives. The real challenge lies in communication.

To take one problem the application of ICT in health care. Here the technical world, the mechanistic butts up against - clashes with - the humanistic. The paper published in spring focused upon socio-technical structure in nursing informatics.
Structure whether virtual, conceptual framework, mythical rainbow is one thing; but what purposes can arise from structure?

In highlighting communication (critical in health care) our purpose is -

using information technology to help convey
the meaning of information in order to inform.

The two axes (or hammers?) in Hodges' model are:

HUMANISTIC - MECHANISTIC [H-M]
and
INDIVIDUAL - GROUP [i-g]

These axes provide the bridge to link informing science and Hodges' model. In the act of communicating, imparting information we may be concerned with the concept of information from its mathematical formulation, the channel, noise through to the semantics and meaning from a sociocultural perspective. This seems to match with the (horizontal) axis [H-M], while the task of informing is concerned with the agents that is the (vertical) axis [i-g].

So what is the relevance of Thor? Well that role of engaging clients (patients, carers, managers, service users....) in communication sees a group communicate with an individual and vice-versa. The processes involved are not necessarily discrete as might be captured 'on paper'. The axes of Hodges' model labelled 'information' and 'informing' become blurred.

We are constantly reminded of the multi-contextual nature of healthcare. Now, I don't know if care is suddenly more complex on a Thursday, I just figure that when Thor starts to swing his hammer there is suddenly not one axis, but a great many. We are not just aware of multiple contexts we are forced to consider the multi-dimensional too.

Additional links:

Informing Science Journal

Thor image and interesting discussion:
http://afewshotstoshaman.blogspot.com/search?q=thor

Thor - movie 2011?

ii Seeds in 'architecture'

There is something seductive in architecture, the imagination of ideas on paper, the promise of the cornerstone, the reality of the construction, the space it grasps and the space it bestows.

Arriving at Younés paper, the history and reference to Valéry's Eupalinos ou l'architecte, Socrates and Phaedrus had me captured. 

Healthcare is dialogue. Spoken and unspoken. Discourse. Dialectic. Perspective: One : Shared : (the) Many.

What is said, gestured, and unsaid. Valéry's dialogue sounds worthy of follow-up, appreciating Plato and this form of theatre and learning. There is a latent architect in us all. Patiency too - but not yet - let us build first. Every day and night we construct (hopefully). When necessary we know when to disassemble, de-construct, to initiate change.

Reading Younés I can readily relate the paper to nursing, Hodges' model, and healthcare generally. The paper's three main questions concern (of course) architectural theory:

1. the causal relation between building and theory;
2. the necessary mental conditions that precede theory;
3. a definition of theory in its scope, discourse, and nature.
   

There are many points of note (reading my yellow highlighter) here. 

'Reflection precedes realization, but theory does not necessarily precede practice'. p.234.

'Theory however, is a systemic elaboration that operates based on definitions and concepts, in the sense that definitions build concepts, and concepts in turn build a theory, but not the reverse of the sequence.'

'Theory, then, comes 'late', only because it is the synthesis of a content that was already present'. It is constructed after a prolonged reflection over many experiences, based on common, comparative, or contrasting sets of criteria.

Younés focus is specific the development of theory in architecture, but as he writes: 'there is some element of reflection which can be termed the building's efficient cause' p.234. I wonder about Nursing Theory and the nurse's theory based on the person - in-person: reflection of care, assessed, planned, delivered, evaluated and recorded. There are nurses still preoccupied with Q.1, even if the (primary) focus is within academia(?).

Q.2 seems an invitation for philosophy (as per the journal's title!). Being non-judgemental, if not starting to build nursing Theory, then especially for the nurse co-constructing, co-designing a theory of care with the patient/family. Hodges' model is not just a series of set squares, facilitating design; it is an empty set. Never completely empty, due to the structure. A structure that contradicts. A structure paradoxical as it constrains and releases, records and forgets.

Q.3? Did someone call - continuity? Yes, (and how!) we can carry on from Q.2. Scope - yes. See the space? Listen to all the dimensions. Reduced to those that count, in discourse and nature, by nature.

Person-centred? New patient. RESET. Re-build - but remember humanistically.

See also:

Seeds in 'architecture' i

Seeds in 'architecture' iii

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