Keywords: Health, Career, Philosophy, Care Philosophy, Care Domains

Citing this page:

Jones, P. (2006) Searching for the Middle: h2cm

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Hodges’ Model: A cognitive periplus for life long learning

Developed in the UK during the early 1980s, h2cm is person-centred and situation based, combining two axes to create four care (knowledge) domains (figures 1 and 2 combined). Academics and practitioners in many fields create models that support theory and practice. Models act as a memory jogger, a guide for all life-long learners. Generic models encourage holistic practice directing the user to consider the patient as a whole person, not just a physically derived diagnosis. Exposure of h2cm is limited to a website since 1998, a very small cadre of ‘cognitive’ practitioners and several published articles (Hincliffe, 1989; Adams, 1987; Jones, 2004a,b).

The best way to explain Hodges’ model is to review the questions Brian 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 Brian 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, the stereotypical matron - machine-like efficiency? If these 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. Through these questions Hodges’ derived the model depicted in figures 1 and 2 below.

	Initial (and ad-hoc) study of h2cm encompasses the multicontextual nature of health, informatics, consilience (Wilson, 1998), interdisciplinarity, and visualization.
H2cm says nothing about the study of knowledge, but a great deal about the nature of knowledge is implied in figures 1 and 2.

This prompted two web pages devoted to the structural and theoretical assumptions of h2cm (Jones, 2005). Although the axes of h2cm are dichotomous, they can also represent continua. This duality is important as an individual’s mental health status is situated on a continuum spanning well and unwell, with various states in-between; an individual’s beliefs, response to stress, coping strategies, epigenetics and other influences.

h2cm was created out of the need to meet four educational objectives:

1. To produce a curriculum development tool.
2. Help ensure holistic assessment and evaluation.
3. To support reflective practice.
4. To reduce the theory-practice gap.

Since h2cm’s formulation these objectives have grown in relevance. The 1980s may seem remote, but these problems are far from archaic as expansion of points 1-4 reveals. Student life is preparation for life-long learning. Curricula are under constant pressure. Despite decades of policy declarations, truly holistic care (combining physical, mental and pastoral care) remains elusive. The concept and practice of reflection swings like a metronome, one second seemingly de rigour, the next moment reflection is the subject of web based polls. In application h2cm can be used in interviews outlining discussion and actions to pursue, an agenda - agreed and shared at the end of a session. H2cm is equally at home on blackboard, flipchart, or interactive whiteboard. Finally, technology is often seen as a way to make knowledge available to all practitioners; the means to bridge theory-practice gap through activities such as e-learning, governance and knowledge management.

The axes within h2cm create a cognitive space; a third axis projecting through the page can represent history – health career. In h2cm what happens when we create the individual – group and humanistic-mechanistic continua, when they overlap? It is ironic, that an act of partition can simultaneously represent reductionism and holism. Reductionism has a pivotal role to play, which h2cm acknowledges in the sciences domain. What h2cm can do is prompt the expert (single domain) practitioner that there are three other pages to reflect and write upon. This depends on the extent to which the axes and domains are logical and how the model can be tested.

Health practitioners have for millennia debated the status of ‘caring’ as a science or art. H2cm demarcates the boundaries of disciplines, but they are permeable. Being person and situation centred, h2cm does not prescribe the (nursing) theoretical stance of the user. This is determined by the user of Hodges’ model. For example, in early intervention in psychosis, the model can help capture the priorities of patient, family and how these equate with education and treatment needs. Plans and responsibilities can be listed, agreed and copies made available. The h2cm political domain encourages consideration of control, compliance, concordance and advocacy from medication through to care policy. Further political issues for the UK includes work towards members of the public having secure access to a summary of their care record, across national boundaries and public involvement in service development. The quest for timely, accurate, secure delivery of health and social care information remains a holy grail locally, nationally and internationally.

Intro : Serres : You are here : Fused : Info2Care : Art-Science : Lang2Care : Global Reach & Close

References:

Adams, T. (1987) Dementia is a family affair. Community Outlook, Feb, 7-8.

Hinchcliffe, S.M. (et al.) 1989 Nursing Practice and Health Care, 1st Edition only, London, Edward Arnold.

Jones, P. (2000) Hodges' Health Career Care Domains Model, Structural Assumptions;
[http://www.p-jones.demon.co.uk/struct.html] Accessed: Mar 30 2006.

Jones, P. (2000) Hodges' Health Career Care Domains Model, Theoretical Assumptions;
[http://www.p-jones.demon.co.uk/theory.html] Accessed: Mar 30 2006.

Wilson, E.O. (1998) Consilience: The Unity of Knowledge, Abacus.