World Mental Health Day 2014: or...

https://www.time-to-change.org.uk/WMHD

http://www.mentalhealth.org.uk/our-work/world-mental-health-day/world-mental-health-day-2014/

or - World Parity of Esteem Day 2014?

Mental health & Psychology resources
(Links I - Hodges' model)

Bleeding holism

Holistic, integrated and 

person centered care

 is what happens when 

 respect and empathy 

bleed.

Psychiatric Bulletin - Letter: Psychiatry for medical students: need for a more holistic approach to teaching?

From: Psychiatric Bulletin -

http://pb.rcpsych.org/content/38/3/138.2.full

Kristina Rodney and Laura Wilkinson

Kristina Rodney and Laura Wilkinson are both ST4 medical students, Newcastle University, Newcastle, UK, email:k.rodney AT newcastle.ac.uk.

We are two medical students who wish to offer a perspective on undergraduate education and psychiatry.

During our student placement, we attended the old age psychiatry module at the Northern Deanery MRCPsych programme focusing on dementia and ethics. This was aimed at trainees and not specifically medical students but we were surprised to find that this was not above our level of knowledge. This prompted discussion of undergraduate psychiatry training more broadly, which we felt focused too heavily on the diagnosis of mental illness and less so on the holistic approach to the patient and their presentation as covered by the MRCPsych course. From our experience of undergraduate psychiatry we feel that the assessment by means of a logbook of conditions encourages students to find patients with a certain diagnosis, and in doing so overlooks the true essence of psychiatry. To our mind this incorporates the ability to consider all aspects of a patient’s life and formulating these, while demonstrating compassion for another person at a time of most need.

Through choosing a 6-week placement in old age psychiatry we have been able to explore the specialty more thoroughly and broadly than facilitated within the standard undergraduate programme, and we have realised how little of psychiatry we have been exposed to as undergraduates. We have become more aware of the importance of considering the patient’s personal and social circumstances alongside their diagnosis, and how these can influence each other. Specifically, the importance of a sound ethical approach to practice has been highlighted through the higher-level teaching we experienced, where the Mental Capacity Act was discussed in detail.

We believe that it would benefit undergraduates to experience a more realistic and rounded placement in psychiatry and truly consider the social implications of mental illness. As it currently stands, undergraduate education in psychiatry is oversimplified to focus on diagnosis and does not acknowledge the capabilities of medical students to adopt a holistic approach. An opportunity to consider all aspects of a psychiatrist’s role may encourage more students to consider a career in this field.

<>

I have contacted the authors of this letter to inform them of Hodges' model and its scope in assuring holistic and integrated care. The model could also facilitate curriculum development. The authors of the letter are not endorsing Hodges' model, I am seeking to highlight the need for such a resource.

Thanks to:

Lucy Alexander
Rights and Permissions Manager
Royal College of Psychiatrists

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.

If you must rumple the care domains - rumple them together

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

group

'A Man’s body and his mind, 
with the utmost reverence to both I speak it, 
are exactly like a jerkin, and a jerkin’s lining; – 

rumple the one	– you rumple the other.’ 1

¹ Sterne L. The Life and Opinions of Tristram Shandy, Gentleman (1761), vol. 3, ch. 4 (eds M New, J New). University of Florida Press, 1978.

Source: Royal College of Psychiatrists (2013) Whole-person care: from rhetoric to reality Achieving parity between mental and physical health. Occasional Paper 88, March 2013. p.2.

The limitations of the healthcare sector

4

many

decades there 

have been recurring 

issues, austerity measures, 

requirements, policy challenges, 

policy initiatives, gaps between theory 

and practice, a crisis in compassionate care, 

rising waiting times and a plethora of other concerns.

All these then and much more 

affect the

 healthcare

 sector

Clearly, there is no 'magic wand', but there must be a way to address some of the difficulties? 

Within health and social care, locally, nationally and globally we need a tool to help improve interprofessional reflective practice, to support person-centered, holistic care across physical, emotional, social, political and spiritual domains of care. 

The future demands a resource (free, open, easy to learn) that can also facilitate self-care, health literacy and the many carers within families and communities.

 

So, how big is your picture?

Resistence is futile: give in to the obvious need for the 'nhm'

INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

nhm	ohm + nhm
nhm	nhm (+ ohm!)

group - population

ohm: The ohm (symbol: Ω) is the SI derived unit of electrical resistance, named after German physicist Georg Simon Ohm. (Wikipedia)


nhm: The nhm (symbol: +).

However, the principles do not extend to problems posed by cognitive impairment as a result of the illness and the ever present danger of wandering, seeking old and familiar surroundings, or acting on memories from years gone by. Some patients become aggressive at times; the service must have mechanisms for managing patients effectively in ways that recognise their inherent worth and humanity. The stigma and abbreviated autonomy that is implied in managing people with dementia requires a new holistic method of managing their care that relates the care to the patients'/service users' values. p.80. [my emphasis]

Heginbotham, C. (2012) Values-Based Commissioning of Health and Social Care, Cambridge, CUP. (Review to follow).

TO: EU -omics research community; if you are seeking a holistic approach for personalised medicine...

The relevance of Hodges' model as a resource in 21st century health care and research can be found within personalised medicine.

This is in addition to the need to assure holistic bandwidth within existing health care delivery, when it is person centered care that is the concern. Personalised medicine brings with it further challenges as it emphasizes the scientific, the inevitable reductionist work can potentially increase the distance between the humanistic and the mechanistic. The working document from the European Commission -

Brussels, 25.10.2013 SWD(2013) 436 final COMMISSION STAFF WORKING DOCUMENT. Use of '-omics' technologies in the development of personalised medicine
http://ec.europa.eu/health/files/latest_news/2013-10_personalised_medicine_en.pdf

on page 7 we read:

The figure is instructive as it shows that a holistic approach is needed to fully appreciate the challenges and opportunities presented by personalised medicine. 

'Holistic' is a much maligned word, with its fuzzy, new age connotations. Especially when the word count = '1'. Another related document also picks up the holistic call:

IMI2 will deliver tools, methods and prevention and treatment options (directly or indirectly) that will progress the vision of personalised medicine and prevention. Through providing the framework required to support collaboration between scientists, regulators, HTAs, patients and healthcare providers, IMI2 will ensure that research is translated into implementable solutions to current healthcare challenges. Solutions that are not purely focussed on the development of new medicines, but that provide a holistic personalised healthcare package as well as maintain people healthy and productive through out their lifetime. Reclassification of diseases based on their root cause and not symptoms will help addressing unmet needs even in areas where a range of options exist but patients do not respond, because their symptoms are misleading therapy choices.
[ IMI - Innovative Medicines Initiative ]

Outline Strategic Research Agenda for a biomedical research public private partnership under Horizon 2020: (draft) The right prevention and treatment for the right patient at the right time. 08 July 2013http://www.efpia.eu/uploads/Modules/MCMedias/1373296554546/IMI2%20Strategic_Research_Agenda_v%208%20July%202013.pdf

On page 10:

A sustainable healthcare system is a holistic one in which the patients are responsible for their wellness and quality of life; physicians, therapists, nutritionists, community carers, and all other actors in the value chain are motivated to this goal; delivery of care takes into account patient beliefs, values and both rational and irrational behaviors; the care is affordable to both public and private payers and promotes health; sustainable businesses can thrive; and the education, prevention and management of chronic conditions are aligned to achieve this goal.

The focus of these documents is -omics and the development of new medicines. By its very nature this research, data and knowledge lies deep within many sciences: new sciences no less. This recognition of the need for holistic approaches and perspectives is still very encouraging. As the first document on personalised medicine notes, future treatments must be from "bench to bedside". We can equate this as "mechanistic to humanistic", but only as long as the patient in that bed is a person and not just viewed as a diagnosis with an associated -omic profile.

Have a look also at the figure on page 7, the medical innovation cycle. As discussed previously on W2tQ patient safety needs situated awareness and holistic perspectives.

My original (and seemingly incomplete) source:
http://www.researchresearch.com/index.php?option=com_news&template=rr_2col&view=article&articleId=1339313

Zero, One, Fifteen, (Thirty, Sixty...?)

SOCIETY

care-S S-cares

context: UK news media 15 minute carer visits to elderly clients

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

Reflecting on Social Care with Hodges' model

The one, self, me, a person. Carers: ethics (and common sense? when is 15 minutes of 'fame' enough?), demonstration of rapport, empathy, dignity, loneliness, independence. Carer stress. Job satisfaction. Staff knowledge and skills. Observation. Mental state. Mood. Choices - personal preferences. Personal - carer's values. Cognition - Re-cognition. Case review. Individualized care? Expressed concerns (wither...?)

theory: task vs. person-centered care mechanistic aspects of care, travel, geography, arrival, tasks, plan, recording, constraints - esp. time, practical problems encountered. Number of carers involved. Safety. Protective clothing. Seasonal factors. Evidence base? Best practice? Relapse rates? Telecare role? Physical mobility - movement. Systems, processes, logistics and scheduling. Degrees of freedom - flexibility. Data, information, datasets. Admissions - depth of data?

practice: task vs. person-centered care Caring relationship building, trust - very personal - intimate care, subjective: time with someone I like / don't like? Relatives experience. Social care infrastructure - community centers. Ability to go out shopping with a carer. Media: BBC 2 Newsnight 7/10/13; The Times; C4 News. Social contact. Social mores (time?)

Policy, professionalism, recording, outcome measures. Agreement - care plan. Care reviews. Ban on 15 minute visits? Management. Standards. Supervision. Zero hour contracts. Pay and conditions. Staff turnover. Vulnerable adults. Personal development, training. Risk of organization's reputations being damaged. Corporate responsibility, values. 'Value for money'. New commissioning systems. Advocacy (position significant). Whistleblowing. 'Francis effect' increase in nursing posts. HSJ, 25 Oct 2013, p.6. 'Funded establishment'.

group - population

Discount the contract, you can then 'discount' the individual worker and the client.

Care Relationship = Care Transaction

Wikipedia: "15 minutes of fame"

Listening to Jay-Z

Listen to Jay-Z's Magna Carta Holy Grail:

- but if it is care fundamentals you seek ...

Manet & the art of nursing - never unresolved: (and The Francis report)

Yesterday I travelled to London for a nurse related meeting and used the opportunity from 8pm - 11pm to take in the Manet exhibition at the Royal Academy of Arts. Brilliant! It is a great event. There really is no comparison apart from the very high resolution close examination that our technology makes possible; but then that is a difference experience, a different purpose.

Manet's work at the RA includes paintings that do appear unfinished. Areas of the canvas being unresolved brings home the relationship and dependency of the artist with the subject, and the artist's approach to portraiture. Manet was quite demanding on his subjects apparently and while not completely averse, he did not routinely rely on the new opportunities that photography afforded. Here are some thoughts from the Art Fund website:

'Summer' or 'The Amazon', by Edouard Manet

Manet was a great risk-taker and critics of day rallied against his inconsistent approach, as you will see many of the works seem 'unresolved' or 'unfinished' but one of Manet's great skills was this ability to stop painting at the right moment, and it is this technique which gives the works a sense of movement and life.

Manet once said to his friend Antonin Proust, 'I must be seen whole. Don't let me go piecemeal into the public collections; I would not be fairly judged.' This exhibition, which brings together the largest selection of works by the artist to be exhibited together in a UK museum, is a great opportunity to judge Manet's extraordinary talent as a 'whole'.

In nursing we are accustomed to impatient patients. Many though have no choice but to 'sit' and 'lie'. They are static, not able to walk or run away.

Unconscious patients - we speak to them: redrawing the outlines. Searching verbally where we cannot go, reaching for the centers of personhood. We sculpt them back to their optimal health. Sometimes the brush strokes are urgent, sometimes we improvise with touch.

All the time an ideal: a portrait of care. No matter how busy we are basic nursing care should never remain unresolved.

That part of the canvas is always completed. The outline is integrated. The horizon, foreground, middle and background may be sketchy in the extreme cases, but the real mission critical bases are covered.

What we should never countenance, collude, or indirectly sanction are the cutting of those bases.

If we do the work of art is not just unfinished: it is corrupt.

The Francis Report

Anagram graphic c/o Wordsmith

Manet's 'The Amazon' from: Reproarte.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.

In orbit*: Where a model of global health care should be

What platform are you using 

to monitor and positively impact 
the minutiae of care 

and the whole picture?

* and in mind.

On 25 May, NASA's Phoenix lander was 10 kilometres above the surface of Mars and less than three minutes from landing when it was captured passing in front of Heimdall crater by the HiRISE camera on the Mars Reconnaissance Orbiter (MRO).

http://www.nature.com/news/2008/080604/full/453712a/box/1.html
Published online 4 June 2008 | Nature 453, 712-713 (2008) Eric Hand

Additional link:
Phoenix: A tribute

Health in the Round - A paper Griffiths et al. ...

The quote below from Griffiths et al. highlights what might be described as health in the round. As the authors address: the rapid growth of online social networking for health, health care systems are experiencing an inescapable increase in complexity - they contrast disease-centred health care with patient-centred. In so doing they distinguish the mechanistic tendencies in health care systems with the humanistic. For me reading this section of the paper was a circumnavigation of health and social care domains of Hodges' model:

Good communication between doctors and patients has been widely recognised by professional bodies in North America (AAMC, 1999) and Europe (GMC, 2009) as essential to the delivery of health care and appears to contribute to healing (Street, Makoul, Arora, & Epstein, 2009). Stewart (2001) has argued for a shift away from disease-centred biomedicine to a more holistic patient-centred alternative. This approach encompasses: exploring the patient’s reason for consulting; developing an understanding of their context; finding common ground in problem characterisation and management; supporting health promotion; and enabling the doctor-patient relationship to continue (Stewart et al., 2003). Patient-centred practice reflects (Bensing, 2000) a set of social and political ideas about the nature of the doctor patient relationship (Mead & Bower, 2000), which, it could be argued, forms a complex system (Situngkir, 2004). p.2237.

Griffiths, F., Cave, J., Boardman, F., Ren, J., Pawlikowska, T., Ball, R., Clarke, A., Cohen, A. (2012). Social networks - The future for health care delivery. Social Science & Medicine. 75: 2233-2241.

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.

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

A question. An answer - in response to recent media (HSJ Ack.)

Here are a couple of quotes from HSJ Roundtable meetings:

"What I hear around the country is that we have masses of information but we need to turn that into something that is intelligible and can be used for strategic decision making."...

"We need to look at how information links together to get a holistic picture of the situation." p. 20.

Dr Shahid Ali, (2012) Commissioning Information. Full Measures. HSJ, June 28, 20-23.

 "I don't think we should be integrating systems, we should be integrating around patients."  p. 20.

Dr Shahid Ali, (2012) Integrated Care. Let the Data Flow. HSJ, June 21, 20-25. 

"There's no integrated view of integrated care. The danger is that you have an integrated care system and everyone says, 'I will do one as well', and you end [up] with six of them." p. 22.

Owen Powell, (2012) Integrated Care. Let the Data Flow. HSJ, June 21, 20-25.


A question or two, or three ...

Is there a generic framework that can be shared and utilised across all health and social care?

A free resource that can be deployed in imagination, in solo on paper, in tandem and within a group potentially shaping collaboration, innovation, change and transformation. Applied in the clinical environment, the home, the lecture theater, the sports field...

A tool that can help support reflective practice not only at a strategic level, but the tactical and operational. What is happening on the ground floor? A framework that can help represent not only processes and policy, but practice, individual and group purposes.

Yes, policy maker and CEO meet with your information manager ... and discuss strategy.

But what is data, information, knowledge ....? What is 'health care' for it appears above we do not know?

Is there really no integrated view - even at a basic level that deserves further study?

Yes, health care practitioner meet your patient (client), their carer, your other partners (social enterprise...) and pursue what really counts: the best quality of care you can deliver given several constraints.

What is the outcome to be?

For the majority of the population (those not living with a long term medical condition) the transformation must be self-efficacy:
if 'shift happens' it must be from ill-health to health through education.

One answer:
The health care system cannot do this alone.

A World Record for Health Care: The 4 minute reflection

Of all the things that can be done within 4 minutes one of the most significant in the history of sport is undoubtedly who would be the first to run a mile in under four minutes:

In health care four minutes is both an age and an instant in someone's health career.

If we took four minutes to reflect upon a person's care across the care domains what difference might that make?

Just one minute per care domain to help deliver - personalised care, self-care, carer support, integration, health promotion and how to stay well. ...

In healthcare we are constantly seeking GOLD.

Wherever you are have an amazing Olympics!

Reflections on: Designing for Self-Care - the home-clinic difference

As much as I might like to I will not be able to attend Copenhagen and the workshop details of which I posted yesterday. Reading the call for papers prompted the following reflections - many of which may not be relevant to the actual workshop content, but hopefully help illustrate Hodges' model:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

literacy - health literacy, cognitive access, insight, memory, education, communication, attitudes, motivation*, beliefs, BEFORE-AFTER holistic measures, mental health, mood, context, therapeutic modalities, self-recording, person-al purposes - process reconciliation, coding / classification, self data capture, expectations, general health perception, sleep, leisure, independence level (self-efficacy), individual 'clinic' need / attendance, rating of existing clinical relationships, DOO - (presence of) differences of opinion*

physical interface modalities: touch, gesture, eye movement, video interviews; clinical diagnoses (primary), observations, assessment-measures, data capture, medications, lab tests, pain, 'distances' (several not just home-clinic); treatment/drugs - training, mobility (room count, vistas), info prescription, other media - learning materials, self-care tasks (granularity, number, complexity, ...), clinic-al purposes - process reconciliation, evidenced interventions, coding / classification, home adaptations?, experience of telecare? mobile apps? home IT / comms, chronological:pathological age definitions: long term- / chronic

life story, narrative medicine, quality of life, care history - duration / exposure to care systems, domestic relationships, primary care / nursing (multidisciplinary care) relationships, perceived integration of care, social network, access to day care / respite care, definitions - shared vocabulary, self-care folksonomy? (virtual) community creation (outcomes)? affordances, meaning of 'clinic' attendance, 'CKO-X' Carer's Knowledge of

autonomy, power in the home: My space?, service interfaces, available specialist services, responsiveness, support, best interests, privacy, budgets (self), protocol - referrals, political emphasis: physical-mental health? predefined benefits, economic impacts, savings, policy reach, implications for commissioning

As the workshop concerns home - clinic difference and designing for self-care this prompted me to a more detailed consideration of the 'distances' involved. Not just in the physical geographical sense of home-clinic travel (car, walking, public transport, disabled transport) but when last the citizen (patient) visited various locations.

There are many other dimensions of course ... the final context reduces the above to something manageable.

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.