Keywords: Diagrams; Classification; Purpose of diagrams; Application; Health care recording functions

Citing this page:

Jones, P. (2000) Hodges' Health Career Care Domains Model and Diagrams:

<>, Accessed

Introduction

Further insight into the HCM can be gained from enquiry into what other types of diagram (visualization) are in use generally and specifically in health care? Before proceeding, however, what does the literature say?

Defining terms

Walker & Chaplin (1997) review the literature in chapter 9 of Visual Culture, devoted to 'modes of analysis'. They initially differentiate between modes of analysis that focus upon content and those that focus on form. Of special interest here are definitions of iconography and iconology - quoted in the table below:

'Icons are graphic symbols that can be used to represent actions or operations and that are designed to convey ideas or information in a non-verbal manner.' (Garcia, et al., 1994) p.191

'Developing a taxonomy of classification of icons is important because it helps determine which dimensions are relevant in the interpretation of those icons. This will lead to strategies for choosing icons for a particular task.' (Garcia, et al.)

Walker & Chaplin (1997) also cite the work of Pierce (1839-1914), an American philosopher who classified and named dozens of different kinds of signs, the best known being:

Two key fields of academic research are also identified:

'Any process of communication or experience of meaning involves signs; consequently semiotic research encompasses such diverse phenomena as gestures and facial expresssions, clothes, diagrams, comics, films, photographs, buildings, etc., etc. As a result, some theorists have maintained that semiotics is the 'science' best qualified to disclose 'the logic of culture'. p.137-138

'... the art or 'science' of interpreting and understanding texts and works of art is called 'hermeneutics'. p.142

Areas of study other than semiotics and hermeneutics often take much for granted. It is left to philosophers of science, religion, nursing, etc., to draw attention to problems and issues. A question here might be what sort of diagram is the HCM? It was noted elsewhere how Myers & Konolige (1995) differentiate between structures that are:

New toolbox - new tools?

For every day purposes we certainly do not make such distinctions, and yet people rely on a variety of 'toolboxes' as Novick (2000) shows. Both physical and cognitive tools depending on whether the problem is home maintenance, or a pictorial representations of thought. To reveal 'types' obviously demands some sort of organisation, but which is it to be? Three possibilities stand out immediately:

Classification usually suggests some form of hierarchy. Where to start then, the top or bottom of the hierarchy, or is there a way in in the middle? using the table above can we begin from media, purpose or refer to examples of graphical data designs, as per Tufte (1983). Tufte cites the following as fundamental graphical data designs:

• DATA MAPS
• TIME-SERIES
• SPACE-TIME NARRATIVE DESIGNS
• RELATIONAL GRAPHICS p.15

These obviously concern data presentation and statistical reporting. A much broader scheme is needed to incorporate the above and the rich selection of cognitive tools in health. The most basic of lists demonstrates the required scope: anticipated recovery pathways; collaborative care plans; critical care pathways; care management maps; and dementia care mapping all highlight the visual metaphor at work in health care recording/planning.

Health care practitioners rely heavily on cursive recording (written text). How might the use of the health career model be phrased? Perhaps a form of words could inform a classification?

The HCM is a conceptual tool used to elucidate relationships that inform a professional's clinical practice and that of the wider multidisciplinary team.

We must acknowledge, however that the HCM can include human relationships, as well as conceptual. So:

The HCM is a conceptual tool used to elucidate conceptual and humanistic* relationships that inform a professional's clinical practice and that of the wider MDT.

[Humanistic relationships here could include those with animals - pets. Patients/Clients and their carers may also use the HCM.]

Implicit within the above statements is Brian's reference to the HCM being situated. The figure below is one formulation of the statement above, with some additions.

Using the terms 'function', 'title / type' and 'application' the diagram above can be read as follows:

The HCM is a conceptual tool used to elucidate conceptual and humanistic* relationships that inform a professional's clinical practice and that of the wider MDT.

The organisational chart is included, as this also informs us about human relationships. Not included are genograms, nomograms, time-lines, and a plethora of other graphical tools. Depending on the objective, the above examples of tools assigned to informing the user about human relationships, could also be placed under conceptual. The classification developed here is not meant to be definitive or comprehensive. The interplay between 'function', 'title / type' and 'application' are highly dynamic. Within our minds the selection of tools is a dynamic process, which paper and present web media cannot represent, except as a snapshot.

In the example above the selection of 'inform' as a function was arbitrary to a degree, and a difficulty resides in the fact that there are many synonyms for a given term, and there are a plethora of other functions that diagrammatic thinking tools could be said to cover. Out of these possible terms, e.g., 'inform', 'represent', illustrate', 'instruct', etc. which - as Rosch (1976) would have us ask - are the exemplars from a health care perspective? This trail to the work of Rosch (and beyond?) ties together questions about:

• a nursing (health care) language;
• ontology - especially structuring;
• reasoning and tacit knowledge;
• granularity of representation for purpose.

Perhaps, however, the levels in the above chart are not compatible in the sense that when further additions are made to the classification it may work horizontally, but not vertically? That is to expect more than this particular categorization will allow?

Have toolbox - will travel (care)?

As the title suggests Law Encoding Diagrams (LEDs) are concerned with empirical phenomena [Mechanistic-Science based], in systems that display formal rules. These systems may have two, three or more variables which make for complex interactions. LEDs help to explain these interactions and render them palpable. Cheng (1999) provides interactive examples at his website, and explains thus:

Staying in the empirical-scientific quadrant, nomograms are used by researchers and statisticians, with an interactive example provided by H.R. Roussais. The example link reveals the question of risk reduction and number needed to treat.

Moving to interpersonal and sociological territory, lexis pencils represent a visualization tool to record and represent historical, social, economic, and demographic information. The sequential diagrammatic reformulation (SDR) spans the social and interpersonal quadrants.

Even at the level of literature search, it is marvellous to discover work that resonates and adds support to ones own. This occurred in the diagrammatic formulations of Wilson’s consilience and Born & Born-Lechleitner.

More recentl, Edwards’ images of Venn diagrams struck a cord. Edwards asks: What exactly is a Venn diagram?

What problem does it solve? What is it really trying to tell us? Well, solving problems in the propositional calculus is no longer a very lively field of research, but computer science is, and it is here that the fundamental nature of the diagram becomes clear. The dual of a Venn diagram is a maximal planar subgraph of a Boolean cube. In this chapter I explain this statement and show how it justifies the assertion that a Venn diagram is trying to tell us as much about a cube in n dimensions as we can represent on a piece of paper. It is a two-dimensional map of an important object in many-dimensioned space, the Boolean cube. (p.77) Is h2cm an example of a maximal planar subgraph?

Beyond the day-to-day health care experience Anders (1999) defines not so much specific diagrammatic forms as whole computer based representations. These can be found under the heading of structure, but include such prosaic sounding terms as 'cybrids' and cyberstructures. There are some fascinating developments and tools to look forward to(?). Diagrams offer so much as a tool, so this section will end with a diagram. A diagram that includes an initial listing.

© Peter Jones 2005

References:

Anders, P. (1999) Envisioning CyberSpace, McGraw-Hill, NY.

Cheng, P. (1999) Representational Analysis and Design: Law Encoding Diagrams: http://www.psychology.nottingham.ac.uk/research/credit/projects/law_encoding_diagrams/ (Accessed Oct 2000).

Edwards, A.W.F. Cogwheels of the Mind: The Story of Venn Diagrams, John Hopkins Univ. Press, 2004.

Garcia, M., Badre, A.N., Stasko, J.T. (1994) Development and validation of icons varying in their abstractness, Interacting with Comp., 6,2,191-211

Myers, K., Konolige, K. (1995) Reasoning with Analogical Representations, In Diagrammatic Reasoning: Cognitive and Computational Perspectives, (Eds.) Glasgow J Narayanan NH Chandrasekeram B, AAAI Press- MIT Press, London.

Novick, L.R. (2000) Spatial Diagrams: Key instruments in the toolbox for thought, The Psychology of Learning,40.

Rosch, E. et al. (1976) Basic objects in natural categories. Cog. Psychol., 8, 382-439.

Tufte, E.R. (1983) The Visual Display of Quantitative Information, Graphics Press, Conn.

Walker, J.A. Chaplin S (1997) Visual Culture: An introduction, Manchester Univ. Press, Man.