Keywords: Health Career, Nursing, Health, Conceptual Framework, Care Domains, Knowledge, Interventions

Citing this page:

Hodges, B. (1997) Hodges' Health Career - Care Domains - Model, Bridging Theory & Practice

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Health Career and the Curriculum

Some questions to facilitate both care and curriculum planning

• What possible interventions would enhance the health career?

• What knowledge would support the possible intervention?

• What knowledge of the NATURAL SCIENCES/ PSYCHOLOGY/ SOCIOLOGY/ HUMAN ENVIRONMENT will illuminate the nursing observations?

• What knowledge of the NATURAL SCIENCES/ PSYCHOLOGY/ SOCIOLOGY/ HUMAN ENVIRONMENT will support the nursing interventions?

Possible Nursing Interventions

The essential feature of the health career model is the person in a social context. The person having physical attributes that are explained by the natural sciences, and behaviour that is explained by psychology. The social context was considered to consist of the social world explained by sociology and the policies that structure the social and physical world.

The model consists of three layers: health career on the top, subject as the base, with nursing being the intermediate and mediating layer between the person in terms of the Health Career and the Subject disciplines.

d The base layer comprises four subject disciplines:

• natural science;
• psychology;
• sociology;
• and politics.

Nursing is quintessentially future orientated and concerned with the person in social context. Intervention including education, counselling or information needs to take account of the physical attributes of the person - the presence of for example physical disabilities or aberrations and other attributes that may impinge on health - or psychological attributes in terms of education, motivation, beliefs, attitudes, personality of the person or in terms of group psychology - relationships the dynamics of the family or network of friends.

In social terms the nurse needs to take cognisance of the norms, values roles and social pressures that relate to such things as social class and the influences of particular cultures and sub-cultures on the concept of health the approaches to health measures and the use of health services.

Health care without politics is simply not possible. Nursing occurs within a framework of policies that need to be understood if not challenged. Accessibility of clinics, provision of materials, the ethics of any intervention and the general allocation of resources, including the practitioners own time, all fall within the political arena of policies that shape the human environment.

All nursing situations are essentially concerned with a particular person within a particular social context of geography, time and culture. That the biography of the person (and the family) need to be taken into account in the planning of the intervention makes the health career model particularly apt.

An examination of the contributing factors in various nursing situations has been undertaken.

Health Visiting

In public health nursing or Health Visiting it is possible to consider, for example, the contributing factors to immunization practice, they physiology of immunity and the biological effects (or possible effects) of non-compliance, the beliefs people hold about immunization or the motivation to participate in health programmes, the social factors that influence uptake - social class, social press, values, norms - and the effects of culture and the political arena of who is immunized, the policies that dictate control immunization programmes, the power utilized by nurses who expect compliance, and the ethics of immunization programmes.

Similarly it is possible to examine the physiological psychological, sociological and political aspects of health education, child abuse, screening well man clinics, family visiting or other public health nursing activities.

Intensive Care Nursing

In intensive care for example the nursing situation is complex involving a patient, significant technological presence, and a `family'. The family (and the machinery for that matter) are not mere appendages to the patient but constituent parts of the total nursing situation. The model states that at the time of the nursing intervention the person already has a biography that has a controlling influence on the health status, future pattern of health and, importantly, the nature of the nursing intervention.

The biographical health career extends backwards in time at least as far as conception up until the now moment relating to the personal and social factors that impinge on health, they physical and psychological dimensions of the person and the social and political aspects of the world in which the person lives. In the Intensive Care Unit the immediate concern is with the recent Renal Transplant.

Both of these situations are related to the persons biography. Although the full health career will need to be examined by nurses at some time before the patient is discharged from nursing care the nurse in the Intensive Care Unit is required to consider in particular those aspects of the career that impinge on the current nursing demand; considering and discounting rather than overlooking those areas of the model not of direct relevance. The immediate social context is the intensive care situation itself, the intermediate social context would be the 'family' (or immediate caring network) and employment; the wider social context being the personal geography social networks, political scenario and the contemporary state of knowledge. The patient (or client which may not be the same) is thus set within a particular space-time framework. Some nursing activities have priority in terms of time or in terms of proximity.

District Nursing

In District Nursing the contributing factors to incontinence, ageing, handicap and disability, the problems of sensory impairment, bereavement, or even the ubiquitous leg ulcer could be undertaken.

The use of the Health Career Model for the nursing care of the elderly not only indicates the usefulness of the model but, importantly, clearly shows what nurses in this speciality have always know; that care of the elderly is intrinsically interesting. Care of the elderly is interesting from a physiological, psychological, social and political point of view as is evidenced by the quantity and range of research undertaken in this arena.

The elderly are of special interest as they have a longer pre-nurse contact health career. By virtue of their age they have had longer to acquire particular beliefs, values and habituated behaviours. Similarly they are likely to have experienced a number of changes in the explanations for disease and other processes, and to have been exposed to varieties of health care provision.

Community Mental Health Nursing

Community Mental Health Nursing [CMHN] is essentially concerned with the person in a social context. The nature of persons and the specific social context may require further exploration but there is in essence no disagreement between the role of the CMHN and the Health Career Model. Whilst there may be different goals for nursing interventions and different solutions to the same nursing problem, there is no disagreement that nursing is future orientated and positively directional. Consideration of the Health Career Model should assist the Community Psychiatric Nurse in the selection and evaluation of intervention strategies.

Alcohol related problems are a common reason for referral to the CMHN. Alcohol has recognized and well documented physiological effect, moreover, physical methods of treatment are possible. To be in a position to help people with alcohol related problems the nurse needs to be aware of the physiological effect of alcohol and to be an effective advocate of the patient the nurse requires a working knowledge of the physical methods of treatment their uses, abuses, advantages and shortcomings. Additionally the nurse should be able to speak with authority on the debate concerning physiological dependence on alcohol. This would accord with the 'scientific aspects of nursing' as set out in the Health Career Model.

Where physiological explanations are eschewed psychological determines may be substituted. Personal inadequacies, personality, social skills shortfall, or family dynamics may be used to explain the difficulties that result in the excess use of alcohol. The solution to the problem may be sought by behavioural therapy, individual or group psychotherapy, social skills training, family therapy, counselling or health education. The interpersonal aspects of nursing corner of the model would cover both the explanations and the interventions and assist the nurse in identifying the knowledge that would support the nursing strategy.

'Sociological aspects of nursing' are an important consideration from the norms and values that surround the use of alcohol in different cultures, social classes or occupations to the medicalization of alcohol related problems, the attribution of patient status and measures of social control. Such knowledge should assist the nurse in the adoption of appropriate nursing care or the elimination of inappropriate strategies where the most useful form of intervention is uncertain.

The remaining quadrant of the nursing component of the Health Career Model is `political awareness'. In relation to the situation under consideration, alcohol related problems, `political awareness' takes into account the services provided for people with such problems, the benefits to which they are entitled or perhaps should be receiving, the ethics of intervention, the power relationships that occur between professionals, the family and the client, and the legal aspects of nursing care. In addition the nurse should consider the relationship between the `alcohol industry', the consumption of alcohol and the role of the Government who takes taxes whilst at the same time promoting a campaign to combat the undesirable effects of alcohol consumption. The debates surrounding the campaigns about alcohol abuse and drinking and driving are illustrative of the need for nurses to be politically aware.

The Health Career Model could be used to illustrate other nursing situations that are the concern of the Community Psychiatric Nurse. The model has been used in the planning of nursing are in community settings and in the production of a curriculum based upon the English National Board Course Number 811, 'Nursing Care of Mentally Ill People in the Community' and subsequent courses.

Occupational Health Nursing

The model is concerned with the life of the person and how the various components of that life are organised and interwoven. This requires a knowledge of the culture including (especially for the Occupational Health Nurse) a knowledge of the nature of work patterns and practices. The reflexive nature of the Health Career Model, together with the health orientation, makes its use in the very different working environments likely to be encountered by and Occupational Health Nurse particularly apt.

An examination of the contributing factors in various Occupational Health Nursing situations may be undertaken. It is possible to consider, for example, the contributing factors to accidents including scientific aspects - age, gender, physiological explanations, use of equipment, control procedures or shift patterns - psychological aspects, in terms of education, specific training, predisposing behaviours or group membership. The sociological dimension of accidents could be examined in terms of values (risk of injury versus possibility of bonus), traditional working practices or group norms. The political aspects would involve a consideration of such things as rules, procedures, design and legislation that are intended to reduce the incidence of injury.

The Health Career Model facilities the setting of priorities as it does not demand specific information. Nor does it demand the prior identification of problems or needs, asking only that the situation be examined in terms of what the nurse needs to do to enhance the health career and what knowledge the nurse is required to possess in order to act.

The importance in all cases is to examine the nursing situation rather than the medical diagnosis.

The Health Career Model is essentially concerned with the person in a social context. The model differs from other conceptual models of nursing in the consideration of the situation as a whole rather than the person as a whole adding a new dimension to the term holistic. The model being situations in which other models appear to have limitations.

The Health Career model does not differentiate between the knowledge a nurse requires to act (commonly called theory) and the act of nursing (commonly called practice); the curriculum model should also be the practice model. Neither does the model demand the acquisition of another language but instead requires a questioning reflexive approach to nursing care.

© Brian E Hodges 1997

You can also explore how the HCM can assist capture of the multicontextual nature of health and nursing care delivery.

E-mail: Brian E. Hodges

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