Slides: Workshop on Hodges' model at 5th Threshold Concepts Conference Durham 11 July 2014

See also previous post:

http://hodges-model.blogspot.co.uk/2014/07/h2cm-workshop-at-threshold-concepts.html

H2CM workshop at Threshold Concepts Conference 11th July 2014 Durham

Prior to the workshop I did not know how many people would be interested. In the end I had four attendees. With the session located in a large dining hall I had to improvise. I explained the model on paper sat in the middle. The presentation worked on the laptop, with a little swapping of seats for vision. As always with Hodges' model (I believe) the questions and discussion that ensues is primary engagement and this can mitigate environmental limitations. This is also why I believe Hodges' model is applicable to the global community.

I had twenty 2-sided A4 templates to hand-out. The format was as follows:

• What is Hodges’ model?
• A concept sorting exercise
• A case study exercise
• Some examples of links to threshold concepts
• Q & A - discussion
• Feedback

The exercises appeared to go very well, prompting, as hoped, people to think about the model as presented, their own work and threshold concepts. The case study seemed quite realistic and yet it is of course fictional.

Where did I slip up? In at least three ways: I did not have my own feedback form. This is frustrating as I've used these routinely in sessions delivered in residential and nursing homes. I did not complete all the slides. We ran for 85 minutes starting 5 minutes later than intended. On reflection I could have attended for the two days as there were, some really relevant presentations on the Thursday also. I'm really grateful to the people who took part in the workshop. Their work included computer science, law, migration and mathematics.

Durham from TC2014 website

They suggested I identify existing threshold concepts from the health and social care literature and relate these to Hodges' model. Another suggestion pointed to a pre-populated conceptual space using Hodges' model that can act a guide. I've wondered about this before in terms of how to avoid the care reduced to a checklist critique. Although lists play an evidence-based role in assuring safety and situational awareness, the check box mentality is viewed as undermining nursing and high quality personalised care? There is definitely scope for a paper combining #h2cm and threshold concepts.

The TEL course at Lancaster is proving a challenge as anticipated, because I do not have first-hand access to learning management systems and the more formal educational context. I am working on this with an ongoing secondment application, but I never hold my breath.  Doing the TEL course is (also) a test, it forces me to focus and produce small studies and very quickly too. I had wondered about using the workshop to this end, but in light of very helpful supervision and discussion with peers online I directed attention to a semi-structured questionnaire and the reflective content of LMSs used by local students.

Significantly, the four participants in Durham is more than needed for a 4000 word study, so the workshop is a great experience and further 'demonstrator'.

I am still reflecting on the workshop and will be in touch with several people as a result. I would also like to thank the organisers for my being able to contribute. The slides will also be posted online soon. I will add some notes to act as instructions.

In 2016 the conference will be in Nova Scotia, when available I will add the updated link in the sidebar.

h2cm - Latest paper published in International Journal of Person Centered Medicine

The latest paper on Hodges' model is now published online:

Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination

Abstract

The concept of recovery is widely applied within service delivery in the field of mental health. The dimensions of recovery were explored using a singular conceptual framework known as Hodges’ model, which is shown to be suited to this particular task. This arises from the model’s structure, in that it encompasses the individual-group and a care domain specific to the political aspects of both health and social care. The evidence was found by relating recovery to the model’s care domains, which is also relevant to the experience of mental health service users and developments over the past decade in mental health service provision. Particular attention is given to the ‘Recovery Star’. This can be used as a key-working and outcomes tool. The discussion is also placed in a context of the current socio-economic climate, notably the ‘politics of recovery’ at a time of austerity.

With thanks to the editors, referees and to Gerry Bennison and Dawn Talbot for assisting in the beginning of this paper including their directions on the Recovery STAR; and for very helpful advice on the final drafts provided by Dr. Andrew Shepherd, and Prof. George Kernohan.

Making learning visible dodging bullet points

Since January and the start of the course in Technology Enhanced Education there's been - and still is - a lot of reading to do. I've gained new and renewed insights into possible research methods and I'll share some of this in the next few weeks. The figure below is from:

Hay, D., Kinchin, I., Lygo‐Baker, S., 2008. Making learning visible: the role of concept mapping in higher education. Studies in Higher Education. 33, 295–311. doi:10.1080/03075070802049251

Figure 4 from Hay.

Over the years I've noticed and been rewarded when after a session on the care domains model some audience members have commented that the exercise made them think. There's nothing special in that of course, simple maths makes me think. Perhaps, people felt relief for a change from the passive absorption of facts, images, acting as static targets for a slew of bullet points. What comes across though is that there was some effort involved. In the figure above we can imagine the energy needed to not only create new and maintain existing concepts, but reject others. This might also constitute one front of the theory - practice gap?

This in a way reflects my thinking that although we refer to person-centred care in theory, practice and policy, this does not automatically follow. Person-centredness should take effort, work and energy. If that is the case, it also needs time.

Over Here 2: Smart Thinking or Who do you think you are?

Of all the things that tend to merge, overlap, then appear discrete only to dissolve again we can see illness, health and well-being. To these we can add - self-help, intelligent self-help, various forms of literacy (3R's, emotional, economic, information, visual, health) and self-care.

I am sure that Hodges' model can help improve health literacy and general reflective abilities. There are some really difficult-to-reach audiences, clients and communities out there. The challenge is not just spreading the word:

A crude but generally accurate definition of what makes a smart thinking book is anything you could easily imagine being the subject of a TED talk. The recipe is to find a leading expert and get him (alas, still more often than her) to write about an idea in his field that is interesting to a wider audience and which he believes - or at least claims - can help us change our lives for the better. It has been called intelligent self-help, but since most potential readers would not appreciate the implied association with the dumber varieties, "smart thinking" has a certain advantage. ... FT Weekend. p.8

- but demonstration too.

My source: Julian Baggini, Wisdom set to work, Life & Arts, Financial Times. March 8-9, 2014, p.8.
Online: http://www.ft.com/cms/s/2/70365226-a3c1-11e3-aa85-00144feab7de.html#axzz2wiUqgpuw

A book chapter: Spatial semantics - definitions...

This book would appear to be an essential reference in respect of h2cm, the following is from chapter 13:

Spatial semantics is the study of the meaning of spatial language, but what is to be regarded as ‘spatial language’? A moment’s reflection suffices to show that the answer to this question is anything but trivial, since SPACE is not a self-contained ‘semantic field’, but rather constitutes an important part of the background for all conceptualization and meaning (Kant [1787] 1964). Furthermore, the term ‘space’ has been used all too often in an extended, metaphorical sense in Cognitive Linguistics and Cognitive Science, e.g., ‘Space Grammar’ (Langacker 1982), ‘Mental Spaces’ (Fauconnier 1985), ‘Conceptual Spaces’ (Gärdenfors 2000). Hence, an unrestricted interpretation of the term ‘space’ might lead us to think that ‘all semantics is spatial semantics’, a conclusion that not even cognitive linguists would find too attractive. Therefore, the scope of spatial semantics needs to be restricted, and this can and has been done in at least three different ways: by form class, by semantic category, and by communicative function. The three definitions based on these restrictions do not coincide, however, and each leaves something to be desired.

Jordan Zlatev (2007) Spatial Semantics, Chapter 13. In. Hubert Cuyckens and Dirk Geeraerts (eds.) Handbook in Cognitive Linguistics. Oxford, Oxford University Press.

and a 1 [ Empirical - Tabula Rasa ] 2, 3, 4...

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

Hodges' model: another blank slate

2 a blank slate...	1 Empirical - Tabula Rasa (4th album)
4 and here?	3 as dictated here

group - population

Wikipedia: Tabula rasa

Image: Israbox

Part II: Pensioners, 'Health students' and Children

For decades the reactive health care system has been founded, loved and sustained through the primary care - secondary care hospital system, together with its complex range of referral systems and processes.

Now demographic trends and economic pressures have seen the emergence and ongoing development of the virtual hospital. Call centers and teams that deliver nursing and medical care in the home to prevent admission and facilitating early discharge are still basically reactive.

What is needed is a cognitive hospital.

A form of hospital that acknowledges the health care system but can finally progress the preventive agenda on an individual, educational basis, fostering self-efficacy, health literacy and if necessary self-care.

Review: Philosophical And Theoretical Perspectives For Advanced Nursing Practice

http://www.jblearning.com/catalog/9780763765705/

If you are a miner for insight, a pearl diver for knowledge or seeking blue sky wisdom this book can deliver and sign-post in plenty through its references. In summary: this book is a history book that nods at futurology.

I had high expectations for the text, also anticipating an exacting read. After all, as a 5th edition this is a well established text. The expectations were not wholly realized, however; many of the papers are quite dated being published originally in the 1990s.

The book is an important collection and can certainly be regarded as essential reading for advanced nursing practitioners and those pursuing post-graduate nursing studies. Several chapters hail from the same journal publisher and perhaps - as a positive - this contributes to the readable and accessible style throughout the book. The text format and size are also easy to read. I found one spelling mistake within the index entry for 'diagnosis' p.387. In addition to the historical development in part 1 the book's division into five parts - 31 chapters in total - acknowledges the reliance on the past and from it appears from a previous edition the arrival of the 21st century. Apart from the current date of issue 2013 I cannot accurately place the most recent additions to the volume. The contents listing and preface are limited in this respect. Judging from the references they are not that recent. 2010 is one of the most recent references I could find, and this, the 75ed of Toby & Mariner.

Many of the papers are seminal and include an overview of particular aspects of nursing thought - analysis and synthesis. Unsurprisingly, there is philosophy and ethics in great abundance, together with ecocentricism, several forms of feminism, aboriginal peoples and their world views, evidence, health, beliefs, art, professionalism, research, patterns, advanced practice, theory and much more. The distinction between evidence based theory and evidence based practice is something of which all nurse students should be aware.

There is specific reference to Advanced Nursing Practitioners. There could obviously be some variation in how this professional group are considered as opposed to Advanced Nursing Practice. Having just returned from Belfast and the University of Ulster there is ongoing currency in McCormack's chapter 17 A Conceptual Framework for Person Centered Practice with Older People. While dated 2003 McCormack's work was emphasized at a recent conference in Ulster I was able to attend (and there are plans for another). I am sure other chapters may be enlivened by such reviewer found co-incidences as this.

I wonder if the scope of the book and acknowledgement of the passing of time seems to shout for a two-volumed approach. As suggested above, the previous acknowledgement of the future seems to have hailed from the 20th century and got lost. We are now after all more than a 1/10 of the way into the 21st century.

Having started my nursing career in the RN, chapter 22 on military metaphor in nursing and the need for another. A researcher contacted me several years ago about using Hodges' model (a conceptual framework) in a study on bullying in nursing. I've never heard anything since, but Hodges' can help in such research in two respects. The inclusion of a political domain and the organization of groups of people, emphasizes process, procedure, protocol, routine, and may proceed to regimentation, discipline, hierarchy so to a degree language games will follow. As this chapter notes, several professions, including nursing are said to eat their young. A commentary after the chapter provides a useful balance and makes this point. The chapter is nonetheless a reminder of the role of language and how professionalism arises and is sustained (disciplines too?). The proposal of frontier as a new metaphor is fitting as Hodges' model identifies five conceptual fronts - frontiers that must be integrated. 

As a frontier - Chapter 21 on rapture and suffering with technology in nursing holds many lessons and insights. Heidegger's "standing reserve", the human-technology interface, what it means to live like a human being and the distinction of being a human being. Mobile technology, m-health, e-health are making a huge contribution to global health and need a place here. I found Macurdy's four principles 326-327 on what patients need to assume power and control over their care very illuminating, especially in highlighting information access and the importance of health literacy.

In the text and the index I could not find specific reference to capacity, as in mental capacity, informatics, global health, information (access), justice, law, legal, management, human rights, literacy, mental, political, psych-, long-term medical conditions and recovery. While the book would become incoherent if a disease/diagnosis-based approach was adopted, we might ask: does dementia deserve specific inclusion? This is an interesting (and potentially vociferous) debate in itself - to what extent should such a book record change through several decades? Of course the book is not an encyclopedia and it is easy to critique according to omission. These are pressing times demographically, however; while there is a population focus: global communities and aboriginal communities in chapter 23 and 24, this merely scratches the surface of very large world.

This book is a valuable asset and has stimulated many ideas here (and potential blog posts). I am very pleased to have read it and would recommend it to students and practitioners alike. I am grateful to the publishers for the review copy.

Cognitive continua ( ... just a sentence of promise)

The idea of a cognitive continuum has much to offer nurses and its potential has yet to be fully exploited. p.136.


Thompson, C. (2001) JAN Forum: Clinical decision making in nursing: theoretical perspectives and their relevance to practice - a response to Jean Harbison. Journal of Advanced Nursing, 35(1), 134-137.

Every incredible view...

The Shard, London, UK

Every incredible view, whether achieved 

by natural, artificial or conceptual means
relies upon a structure, a framework.

Image source: The view from The Shard
http://www.theviewfromtheshard.com/

HealthTap: Invited to add their widget... I asked a question...

No doubt it was a bulk email, but I received an invitation from HealthTap to add their widget here on W2tQ. The widget provides the means to access their service, that of putting questions to medical experts.

I have minimized the side bar content, stripping out buttons and other media paraphernalia and yet suitably intrigued I asked a question - ;-)

Q. Is there a conceptual framework that can help

 assure holistic (physical - mental, social) and integrated care 

that is also person-centered? 

Fourteen hours later news of an answer duly arrived by email:

Holistic Medicine
I believe that Holistic Medicine, when properly practiced, assures all of that. For the principles delineated by the American Holistic Medical Association see http://www.holisticmedicine.org/content.asp?pl=2&sl=22&contentid=22

Also see http://www.abihm.org/general-public


I greatly appreciate Dr. Randy S. Baker's response and the above links. This is helpful in several respects despite not exactly being the answer I was hoping for.

The answer is itself holistic in a sense in wrapping the question up in an organisational wrapper. That's a safe response, with medicine in there for wholistic measure. Who ever said medicine is reductionist! Judging from his profile holistic medicine is Dr Baker's forte.

Also interesting in the answer is the way the hook in the question was deemed to be the reference to 'holistic' and not the conceptual framework element.

Another point in Dr Baker's reply that reflects on Hodges' model and the health news media in England (UK) next week* is the bit about when properly practiced.

The adoption of Hodges' model is no guarantee of 

person-centered, 

integrated, 

holistic care.

Although the term conceptual framework (Hodge's model !) is not given in the answer: assure is.

What ever conceptual framework (care model, care philosophy...) is adopted to deliver health care, they must contribute towards the assurance of high quality care - that which ultimately positively engages the patient, carer, family and communities.

My question still remains and is usefully extended, passed to the above organisations.

So does the AHMA and the American Board of Integrative Holistic Medicine have a conceptual framework that helps support their holistic objectives and assurance of care? I will contact them to see if I can obtain a further response.

Thanks again to Dr Baker and HealthTap.

* The Francis Inquiry Report is anticipated on Wednesday.

Dialectics in therapy, case formulation, h2cm and a tree

Kuyken et al. (2009) propose three dialectics that are useful in an evaluation of their model for case conceptualization, these are:

Released today - 28th Jan 2013

nomothetic – idiopathic; 
simple – complex; 
and subjective – objective.

This act of identifying polarities can be described as a diagrammatic formulation in itself.

These dialectics and many others can be readily incorporated into h2cm: for example;

socio – technical,
macro – micro.
...

Kuyken, W., Padesky, C., Dudley, R. (2009). Collaborative case conceptualization. New York, The Guilford Press.

The Enormous Theorem meets The Enormous Conceptual Framework

with Best Wishes for the Season and 2013...

Hodges' Health Career - Care Domains - Model is not a theory of health and social care.

It can however encompass the conceptual space that comprises not only health and social care, but the lived experience of individuals, and the existence of corporate and political entities (notably policy).

So while mathematicians have The Enormous Theorem, in Hodges' model we can at least reflect on what might be the enormous conceptual framework.


Prize awarded for largest mathematical proof. New Scientist, Sept 10 2011, 211, 2829. p.5.

Conferences and studies (what's the date?!)

I don't know about 21.12.12 being a date of note. 12.12.12 has brought another addition to a string of  disappointing conjunctions this past week.

I posted in the summer - here - about the ICN Congress in Melbourne next May. My submission did not make it, being placed on the reserve list. If this journey was going to happen then I would need to make arrangements now. So a desire to visit Australia and share Hodges' model with the ICN community and possibly some academic centers there will have to wait for another time. The original idea of a symposium would have been marvellous, so perhaps there are partnerships still to be forged.

Next up: another possible speaking opportunity for April, admittedly provisional has not been confirmed. Quite a disappointment this as I would have repeated a workshop approach I've used.

And finally ... finding an avenue to study Hodges' model at a postgraduate level (part time PhD) is proving far from straightforward. I knew this would be the case, so I will continue to refine my preparations and make further enquiries and applications.

As this year comes to a close I'm pleased to have done the presentations to date. Great experiences and communities all. I understand that the preoccupations with the Mayan calendar and the end of the World are mistaken. It is the start of a new calendar - a new age. That sounds good to me.

Two recent references informing my studies: Concept maps & Threshold concepts in mental health

These two references inform my study of Hodges' model:

Zubrinic, K., Kalpic, D., Milicevic, M. (2012). The automatic creation of concept maps from documents written using morphologically rich languages. Expert Systems with Applications. 39. 12709–12718.

Stacey, G., Stickley, T. (2012). Recovery as a threshold concept in mental health nurse education. Nurse Education Today. 32, 534–539.

I will post again soon with some thoughts on the above. If you can suggest other recent resources please get in touch.


And on a personal note ALL THE BEST TO DAN, KAREN & little ANNA too. 10.11.12 a day to remember.

Slides from IPH Conference Belfast 11 Oct 2012

Here are the slides from the IPH Open Conference in Belfast. There were several very helpful questions from the floor. With fifteen minutes for the presentation and ten for questions, the 23 slides were ambitious but they were delivered in the allotted time. Many aspects could be developed further and emphasized. In particular the way that public health policy and practice has switched from needs based approaches to assets. This also reflects the trend in self-care and the recovery model in mental health. (I have added needs-assets to one slide.)

If any public health - public mental health practitioners are interested in exploring the possibilities then please get in touch. After several presentations the issue here is to extend this work so as to be able to test and apply existing and found knowledge to say something new... 

A Framework to facilitate Integrated Public Health from Peter Jones

I greatly appreciate the votes received for the abstract, the organisers for what was a free event to attendees, and the support and hospitality of Prof. Kernohan. 

Additional link: The Health Well

World Mental Health Day & Hodges' model

Today is World Mental Health Day. Here are some mental health related concepts mapped to Hodges' model that I have encountered over the past few weeks (I could list many more of course).

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

depression, suicidal ideas, motivation, beliefs, agitation, assessment tools, understanding of treatment, communication skills, confusion, aggression, lability of mood, loss, disorientation, orientation, concordance, stress and vulnerability, observation, distress	risk assessment, electroconvulsive therapy benzodiazepines, anti-depresssants, side-effects, gait, pain, care environment,  diagnosis of depression, anxiety, dementia, records - behaviour charts, electronic health record, security
carer under stress, reassurance, counselling skills, respite care, family therapy empathy and rapport with residents (colleagues...), patient and relative engagement, activities, distraction, engagement, life history, touch, care strategies and recommendations, smiles, companionship	commissioning, funding of services, consent, integrated working effectiveness, referral-on, care vouchers, advocacy, service access, compliance, use of Mental Health Act, staff survey, gatekeeping - access to beds, work allocation, health & nursing in the media

See also: Hodges' model - indicative content

Book review: Nursing Knowledge: Science, Practice, and Philosophy

Searching for an up-to-date nursing theory book I wanted something different from the usual fare. The usual fare being a description of the various nursing theories, models and frameworks to date. I needed a text that would help me in two ways: firstly, deal with and critique the foundations of nursing theory; secondly, to provide some insights that would inform my own study into Hodges' model. I quickly found a book with a bonus: it is written by a philosopher.

Mark Risjord's - Nursing Knowledge: Science, Practice, and Philosophy (Wiley-Blackwell, 2010).

This is not a large book considering the literature within its potential purview at just 246 pages in total. The text is very readable both visually and in style. Even if points need to be re-read this isn't a chore. Evidence of structure and discipline runs from paragraphs to the overall division into seven parts, with the usual reference listing and index. As a nursing student of the late 70s and early 80s this book needed to reframe this subject for lifelong learning student of the 2010s. Risjord starts by examining the history - prehistory no less - of the problem. 

Key questions that have arisen in nursing and directed thought are discussed. The influence of what was happening simultaneously in the philosophy of science and culture is also related. The writing is succinct (as already suggested) on page 18 we have an explanation for the appearance of the relevance gap, how this gap endures and how it might be closed.

Central to the demographic, media and political challenges that nursing faces part II covers values. This brings in nursing's standpoint and more direct reference to cultural influences on nursing knowledge in particular feminism. This discussion is again brief, standpoints are very relevant for me. The combination of depth of analysis, brevity with a clear focus are a great achievement. A lesson in how to write, how to argue, how to communicate. You can only do this if you know your subject.

If I missed anything it is technology and information, but the book is probably all the better for this whether considered an omission or diversion. Seeing specific reference to multidisciplinary in the index and a discussion of nursing knowledge in relation to other disciplines would be helpful. Risjord's purpose for this book is however, clear from start to finish. It's there in the title. The book is no glossary, or dictionary, and yet the treatment of many concepts here, such as; axioms, borrowed theory, coherence, context, grand theory, and paradigm (a chapter)... will help reader's appreciate their definition and use. Seminal papers from the literature are identified and re-examined. Much of the book is devoted to research and methods with illustrative examples.

There is much to inform my studies, in particular chapter 15: Conceptual models and the fate of grand theory. Here I can conclude from Risjord that Hodges' model creates an orientation picture rather than an abstraction picture:

On this understanding, nursing models are expressions of the philosophical background to nursing research. Conceptual models orient research and practice by guiding the selection of problems or making phenomena salient. They make no theoretical pronouncements. A conceptual model can guide research and practice only in the light of some values and goals. Nursing values and goals are thus crucial components of the conceptual model on the orientation picture. They set the agenda for nursing research by articulating what is important. p.173.  

I've long considered Hodges' model to be a map. Initially, a blank map - a space within which values can be deliberated. In pedalling this particular bike since 1998 I know how tired nursing theory is. Now students don't need to get on the bike, they stand on one pedal and freewheel the short distance that represents the curricula space devoted to nursing theory (and philosophy). A packed curriculum provides the momentum for the (values) by-pass. Mark Risjord concludes with new questions about nursing theory, new maps and new directions. I've outlined other points from the text for future reference. This book will remain a companion for quite some time: a great compass.

Acknowledgement: Many thanks to Wiley-Blackwell for the review copy.

Your help needed to develop an instrument to measure ‘e-health literacy’

Researchers from the University of Copenhagen, Denmark and Deakin University, Australia are developing an instrument to measure ‘e-health literacy’ in current and future users of healthcare.

To develop this instrument they are undertaking a comprehensive consultation with a wide range of stakeholders. This includes the perspective of users of the healthcare system, as well as the perspective of ‘experts’, i.e. researchers, healthcare professionals, managers and policymakers.

They are looking for help with this task to ensure that the research is comprehensive, asking for your views and observations on what a person needs to be able to do in order to use digital health services (e-health). To do this there is an online survey, which takes about 3 to 5 minutes to complete.

Please complete the survey no later than Wednesday, 1 August 2012. The researchers will collate statements from all respondents over the next month or so. In a second e-mail, they will ask you to group and rank individual statements in terms of importance.

The output will be a comprehensive map of the key elements of e-health literacy. This information will be integrated with data generated from workshops with both health care users and professionals. The final goal is the production of an internationally relevant tool to measure e-health literacy.

If you wish to receive a copy of the results of this research, please indicate this on the last page of the survey.

Please follow this link to the survey:www.survey-xact.dk/LinkCollector?key=DCXCFD3F3N36

My source: Patient Information Forum via twitter