Monday, 30 December 2013

Le Ballet Mécanique (1924, Fernand Leger) & the axes of Hodges' model

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

Le Ballet ?

Le Ballet ?

Le Ballet ?

group - population

The Ballet mécanique faq

My source: Budick, A. (2013) Hymn to progress, Life&Arts, FT Weekend, 14-15 December. p.16.

Thursday, 26 December 2013

To-do list and challenges ... 2014 no particular order of priority or level of challenge presented...

Graduate study - distance learning, assignments, supervision, residential week
Research question
Role of simulations - games?

E-mail address (beyond yahoo and demon)

Video and Audio skills
 Drupal 8 (stable Windows install - Linux)
the Drupal stack (still)
Abandon/transition from this blogging platform to other

Complete and format recovery, recovery model and Hodges' model paper for submission to journal
Prioritise and relate conference attendance and presentations/workshops to post-grad studies
Complete remaining three books for review

focus, focus, focus...

Happy holidays a Healthy and Prosperous New Year to All!

Monday, 23 December 2013

SCNTST - Self Therapy

Self Therapy

"... Self Therapy 
is designed for the headphones
 not the dance floor, ..."

Hunter-Tilney, L., Life&Arts, FT Weekend November 16-17 2013, p.19.

group - population

Image source:

Sunday, 22 December 2013

mEDucator 3.0 | Open Linked Education - Melina+ (Drupal)
Checking through links yesterday I came across the mEDucator initiative and Melina+ which is part and noticed it is built using Drupal.

There is a thread on on science applications:

I posted in 2009 about the Science Collaboration Framework - SCF (for creating biomedical resources).

The link to SCF no longer works; there is an archive of this and other work that was part of Harvard's Initiative in Innovative Computing (IIC).

So it's important to consider these initiatives at least in terms of their longevity, their scale and number of participants, as examples of funded research and as Drupal projects.

Wednesday, 18 December 2013

Papers, *actual* post-grad studies and a visit to Brian Hodges

Early last month I posted about planned trips to Sheffield and Lancaster Universities.

On the 4th I visited Paula Procter at Sheffield Hallam University, spending two hours there. Paula and I have known each other through informatics conferences since the late 1980s or early 90s and the British Computer Society Nursing Specialist Group. (Sadly this group and its publications are not as active as they used to be.) I really appreciate Paula's time and her key conclusion that rather than thinking about Hodges' model I need to apply my knowledge and experience with the model and DO something with it. In doing something with the model in a certain community - most likely residential care and nursing homes - I would also have a potential community of users for the new website. This was quite something to hear as I'm at that stage of my career when, shall we say - other possibilities beckon.

In the afternoon I travelled the short distance to meet Brian Hodges at his home. It was great to meet with Brian again and his wife. It was a lovely sunny afternoon as per the welcome and some cake! We reflected on the respective changes over the past five years and current events. Hot-off-the-press of course was my sharing the discussion with Paula and the planned visit to Lancaster University.

We agreed to meet again and not leave it so long next time. Brian has a desire to write again and and a prospective topic in dependence - independence. I hope this is something Brian can do and forward a photo for the (still) promised site. Brian now has copies of the most recent papers and the latest draft on recovery in mental health and the model.

On the Wednesday, after work I drove to Lancaster to discuss their PhD E-Research and Technology Enhanced Learning (thesis and coursework) distance learning.

At the start of last week a reserve place - for January 2015 became an offer of a place next month.

So, as of next month I will make a start. There is a residential week to look forward to at the end of March. Three second hand books from the reading list are ordered. There is a recommended video link too that invites repeat viewing, Etienne Wenger on Communities of Practice:

- and in the Nursing Informatics book I'm reading for review, on page 189 box 11.1 is on the same topic and referenced source Wenger, E..

I predicted quite some time ago about the post count decreasing here ... now I have an excuse and I plan on this including Drupal.

Monday, 16 December 2013

Cognitive Informatics and other forms?

Over the past couple of months I've posted on topics that include an example of Hodges' model related to the post's particular theme. In McGonigle and Mastrian's Nursing Informatics and the Foundation of Knowledge, Second Edition (2012) on page 63 the editors cite Wang (2003):
Cognitive informatics attempts to solve problems in two connected areas in a bidirectional and multidisciplinary approach. In one direction, CI uses informatics and computing techniques to investigate cognitive science problems, such as memory, learning and reasoning; in the other direction, CI uses cognitive theories to investigate problems in informatics, computing and software engineering (p.120). 

I will leave it to you to consider the INTRA-INTERPERSONAL and SCIENCES domains, and not (just) how Wang's cognitive informatics 'fits' within Hodges' model, but what of the many other informatics fields. Here they seem like stepping stones, but taken together where do they lead to, from, ... about ...?

Wang, Y. (2003), Cognitive Informatics: A New Transdisciplinary Research Field, Brain and Mind: A Transdisciplinary Journal of Neuroscience and Neurophilosophy, Vol.4, No.2. pp.115-127.  

Saturday, 14 December 2013

H2cm - Beauchamp and Childress (1994) four principles of healthcare ethics

I'm clearing the decks of books at the moment, one of which is McGonigle and Mastrian's Nursing Informatics and the Foundation of Knowledge, Second Edition (2012). I notice a 3rd edition is in preparation.

A review will follow, but in chapter 5 on Ethical Applications of Informatics on page 73 (pb.) the four principles healthcare ethics of Beauchamp and Childress (1994) are mentioned in a very concise, informative discussion.

Although the exercise that follows involves 'putting concepts in boxes', doing so helps us to see beyond the boxes, to see the links between.

Although harm takes several forms it is physical harm (for nonmaleficence) that is most commonly thought of. This is the ethics concerning an individual so why have I placed beneficence in the sociology domain? Justice should be straight forward, but only if reinforced by law, and then only if that law is exercised. Autonomy should be straight forward. I must have the mental capacity, the insight to have choices. In the eyes of others these choices may be rationale or irrational. Although justice is place in the political (group / population) domain, rights are ascribed to individuals. This is useful property of Hodges' model the way that the individual and their mental life are diametrically placed (opposed?) and linked. It is others who are having determine the ethics of a given case, evaluating what is in the person's best interests; also having to take into account any advanced directives, or living wills.

What do you think? If you have some comments, can improve this or feel there is a correspondence here please let me know.


autonomy nonmaleficence
group - population

  • Respect for autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
  • Beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
  • Non-maleficence - "first, do no harm" (primum non nocere).
  • Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
Above text:

Wednesday, 11 December 2013

Critical Thinking - Gaining knowledge: Beginners + Experts = audience?

Clearing through books last month with several bound for the charity shops I came across Critical Thinking in Nursing: An Interactive Approach, by Rubenfeld & Sheffer, with the following table (p.30):

Ways of:

Gaining Knowledge Assigned readings and asking authoritiesMultiple written and verbal sources, and experience
Thinking DualisticRelativistic
Using rules Context freeSituation dependent
Looking at situations NarrowBroad

The table is not remarkable in its theme, but it is a useful prompt for Hodges' model and future studies. The concepts listed might help illustrate how Hodges' model can support learning. In addition to having an individual focus the model can consider any situation, hence the claim that the model is 'situated'. As stated previously person centeredness is not a given. It does not follow, nor is it achieved just because 'person centered' features several times in care philosophies and policies. The person must be put at the center of the model and then each of the domains considered together with the spiritual dimensions.

I'm also reading a nursing informatics book (posts and review to follow) that discusses casuistic ethics, that is case-based reasoning. While the utility of casuistry is debated in nursing, the need to consider the individual is always paramount. A prime example of the focus on the individual is the programme Inside the Ethics Committee on BBC Radio 4. Central to ethics are the frequent dilemmas that arise in health and social care, the difficult moral choices and dichotomies that must be faced. The model can be used in a context free way, that is considering rules in general; and also employed in specific contexts, such as a best interest meeting for a person recently moved into a residential care facility and distressed by the experience.

There are many dichotomies that can be identified in the basic model, and to a certain extent they reflect the dualistic thinking of the beginner as they build an understanding of particular fields of health care. As learners progress they integrate the concepts they encounter and are then able to associate these and relate them to prior learning, the current case and generate hypotheses that may also be predictive. Hodges’ model can frame and help represent student encounters be they narrow or broadening (recognising patterns). Gaining knowledge may need particular attention by the student (mentor and lecturer) in terms of the student's strategies for creating and protecting opportunities as a beginner and competent practitioner.

As a sign-off mentor I’ve become acutely aware – as required - of a learner’s level of skills and knowledge. What is their level of competence? What is their level of situational awareness? How are they progressing through their learning according to previous mentors and their own goals, learning objectives and evaluation? The concept of emotional intelligence is not new and still has the attention of researchers. Perhaps this could also inform questions for research into Hodges’ model as students elaborate their initial representations of nursing care, skills and knowledge through their course and ongoing as experts. Is emotional intelligence central to compassion in nursing? Encompassing all of these ‘ways’ in the table is reflection. This is not just for reflective practice but an ability to critique one's own practice and that of others.

The table is also helpful at this time considering future content and content types and the potential audience of a new website. The challenge is to emulate the table above in the way it reduces, simplifies very complex educational matters. Yesterday afternoon I was able to attend a very helpful two hour research clinic in Lancaster, following this I must (still) reduce the above questions and also recognise my own biases.

Rubenfeld & Sheffer (1994) Critical Thinking in Nursing: An Interactive Approach. 1st Edition, Lippincott Williams and Wilkins.

Sunday, 8 December 2013

Join the Revolution: For the Lady in the Corner (c/o ST4Health)


personal experience
one disease -
malaria, smallpox, leprosy, TB,

 emergency treatment, hospitals,
systems, capacity
society, community, village

gender, interactions,
humanitarian works,

policy, organisations,
population health improvement, global health, poverty,
economics, outcomes

group - population

My source:  HIFA2015 list

Saturday, 7 December 2013

Reading and writing the minutia of locked doors and windows (still a draught)

Couples, married or not, partners are the cards that frequently, if not by definition, lean on each other beyond the pale, to the n-th degree. Witness so many lessons of what love really is.

They bend and flex. Tested by history, timelines entwined, ties-that-bind, trying to persist in the hear and how.

Their psychological union is challenged as memories become eroded and physically frailty takes hold. Usually; mostly, on the one.

Eventually things, established relationships break and one or the other - should we say: finds themselves in - residential care.

Courtship enables us to become socialised to and with each other and respective families and in some instances other cultures and beliefs.

In this crucial transition sometimes there is learning through experience as respite care is sought.

In other cases health services wonder how this relationship has survived for so long. A crisis is a precipice for change. A chaotic invitation. Radical.

A sudden shift from what was home to a new world of corridors, r, ro, roo, room, rooms; my room? New noises and smells and altered routines and jumbled faces, touches, days and nights

The dolls of childhood are left behind, but may be picked up again literally as an emotional comforter. If not this then perhaps a ‘paper clad dol’ that is bound to be - ‘deprivation of liberty’.

In this new home, this person walks the corridor and inspects the minutia of the doors and windows. Staff pass by(e) waving by their walk - "so-busy-look-no-hands" while trying to be butterflies.

Butterflies that cannot say which way is ‘out’.

They are they. Difficult to follow with eye, head and a hand to catch. The individual recognises the whole of the comings and goings, the main thoroughfare. The strategic point, the nexus of comings and goings.

Something's not right though! I need to be somewhere else.

Sadly (or Usually), there is no going back.

Is there a pattern to this confused-coming-to-terms-with?

From asking repeatedly about being elsewhere, especially with the setting of the sun is there a shift in attempted reasoning? So correct, so responsible all those decades ago. Perhaps even months ago...

If no one will listen to me then perhaps if I have my wife/husband with me then they will see the importance of my cause, my mission.

See look - I have my wife, husband, partner with me now: we really need to go!

Can the residential care home support this person? Can they meet their care needs? They say they are ‘struggling’. Will they need to move – again?

How do they work through this transition? What do we know of how individuals negotiate this transition in their lives? How can we try to understand?

How do they make sense of what has happened, and where they now find themselves? Will their level of distress, agitation gradually extinguish as with their efforts to leave?

As they look to the windows, seek to traverse the doorway, cross the foreign threshold and venture to that somewhere that is not here, we know one thing.

Person centredness lies in the minutia of the life once lived through those locked doors and windows.

We can ‘open’ the doors and windows by travelling with them, together, sharing that journey, the sense of those times and upon returning help them adjust to this new listen and how. Clearly, deprivation of liberty is not a punishment here, yet it demands compensation by provision of high quality personalised care.

Wednesday, 4 December 2013

The EQUATOR Network: Support for “Declaration of transparency”

Following publication in the BMJ, in October 2013, of a proposed declaration of transparency a number of journals have now expressed their support for the transparency declaration and now ask lead authors to sign a declaration affirming that:
"this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained".

The following journals have now expressed their support:

BMJ Open
BJOG: An International Journal of Obstetrics and Gynaecology
Canadian Journal of Anesthesia
NIHR Journals Library

Reference: Altman DG, Moher D. Declaration of transparency for each research article. BMJ 2013;347:f4796 [free full text].

My source: equator network - newsletter December 2013

Monday, 2 December 2013

Book review: "Selfhood" vertical axis of Hodges' model denotes the individual and hence the self, the person and the group, the populous. As such when I came across Dr Terry Lynch's book Selfhood it was ideal as a book review candidate.

The book declares itself as a self-help book and clearly and quickly qualifies in this through its content. Section two of the book from page 51 through to page 272 (of 281 in total) is devoted to raising an individual's level of selfhood.

At first I wondered if this was going to be a fuzzy read that might also prove repetitious. I'll explain the latter shortly. The former does not apply, even though the 'self' is a very fuzzy concept especially in the hands of philosophers. Some of the content in section two may well overlap, but amongst self-awareness, self-talk, self-care, self-contact – these contributing components to selfhood are clearly explained.  The book utilises diagrams throughout, from page 3; and these support the text and are used to cross reference material.

Section one on basic principles and concepts fosters a sense of self-regulation for the self-help that the intended readership will pursue. The need to take one’s time with recovery of selfhood is stressed initially, the reader reminded of this through the actions, minimising the perception and occurrence of failure. There is no crash program and pacing is vital, small steps, return to some actions if necessary we are told early on. While not stated explicitly section one helps to foster hope. Although this is a self-help book, resort to a good therapist is mentioned on a couple of occasions. The central risk to the self of suicide is also examined and given due regard in terms of safety.

There is little new in a technical sense for a mental health professional, but the way the ideas are explained is very informative. The diagrams and the metaphors that are sometimes employed are very useful as teaching aids. If you are at the latter stages of your career then self-actualisation (p.258), as ever, and  creativity provides hope. I did wonder about the reading-grammar level and how this might exclude some people. Could this be another project? I enjoyed reading of the need to create a life-long solid level of selfhood (p.40), which also emphasizes the general need for life-long learning. Relating selfhood to overall 'health literacy' might be informative. You will not find assessment and methods here, which is liberating. Assessment is integral to the reflective process but not explicit and process bound as it is in mental health services. This may in itself provide a benchmark for the future progress of 'selfhood' and health literacy?

One thing I am still reflecting upon - is distinguishing between being able to have an overview of the route to selfhood and having a ‘big picture’ – holistic - perspective of ones situation (p.42). This concern resurfaced in the risk of being overwhelmed by the ‘big picture’ (p.45) and here am I wondering about the therapeutic uses of the big picture – as a summariser - ready reckoner for health, social care and recovery. 

As a champion for Hodges’ model I can also identify with the call for a flexible balance between the two poles of self and others and the call to reflect carefully. Action as harmony of action (p.54) amid the frequent chaos of our lives and health care systems is a very helpful definition. If you seek another perspective on self-efficacy there's a lead here. I was struck by the first case study about Craig and his initial wish for self-admission to hospital. I smiled somewhat ruefully at this, considering the changes in the number of NHS beds (-1700 HSJ) even in the brief years since Lynch’s book was written and published in 2011. This stresses the need for self-care and supports the advent of the 'recovery' movement in mental health. 

My previous note regards the literacy level of readers, is obviously a factor as users are encouraged to reflect upon each selfhood component and also write a diary/journal. The spatial definitions of selfhood also engaged me, given my preoccupation with cognitive spaces. This discussion of physical space, self, personal space and self-centredness and the notion of polluted environment in the context of emotions and feelings prompted much reflection.

At the end the reader is invited to read through the text again. I can see how a second pass and one that uses the book as a self-help manual could pay dividends. The self-help quality of the book is clear as after each attribute is described several actions are outlined. There are affirmations for the reader to utilise that are also listed in an appendix. The case histories should assist readers, who seeking to improve or recover their level of selfhood, may identify with at least one of several. The thought about repetition is not surprising as this is self-soup so to speak. There are just short of sixty instances of self-'  ' in the very helpful index.

Ultimately, this is not so much a statement about the book but perhaps the mental health challenge that faces the self in dealing with the other and the world at large. Overall the books 281 pages reveal the rich complexity of a vital concept and contributor to mental health and wellbeing. This is a very practical book which is to say it is an excellent self-help book.

Lynch, T. (2011) SELFHOOD, Limerick, Mental Health Publishing.