| © Brian Hodges' original course notes on the HCM I |
Keywords: Health Career, Conceptual Framework, Care Domains
Citing this page:
Hodges, B. (1997) Hodges' Health Career Model
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Welcome to Hodges' Health Career Model (HCM) for Nursing Practice, conceived by Brian E Hodges, who retains copyright of the original course notes, reproduced here with permission. |
Introduction
The health career model is essentially concerned with the person in a social context. The notion of career derives from the intervention of the nurse being future orientated, increasing the health choices, health chances or health prospects of individuals or groups (including families) taking cognisance of the biography of the person or persons being helped. The person already has a biography that has been influenced by their physical and psychological make-up, the kinds of families and social networks they have experienced and the culture or geographical location in which they live. The health career is influenced by personal factors of the individual of physical or psychological origin and factors relating to the social world and the policies that govern daily life. The model is in effect situation focussed rather than person focussed requiring that all the possible contributing factors to the current situation and possible futures be examined if only to be discounted.
The nature of nursing
Nurses work with individuals and with groups. The word individual was preferred as Person is a social construct. The care of the elderly and the mentally handicapped as highlighted in the reports of the 1960's and 1970's may have been different for example if we had treated them as people rather than as objects. The activity of Nursing involve different kinds of knowledge some of which is impersonal, mechanical, objective in nature - from chemistry to procedures and decision making - and whilst other aspects of the nurses role requires more personal knowledge (of both nurse and client); such things as an appreciation of feelings, the development of self esteem or of personal growth.
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These attributes: Individual
to
Group AND
- were placed on intersecting continuums. Then having identified four key subject disciplines of nursing Brian placed a key discipline in each of the four quadrants formed by the intersecting axes, this comprises the subject disciplines level of the health career. |
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Together these axes and aspects of nursing can be combined as follows: So in our assessment we consider the client/patient's
interpersonal or psychological situation. Also how science
impinges on the individual. So the patient may suffer depression
and insomnia, due to pain and anxiety, caused by cancer affecting
the bowels. In this crude example we see how the sciences are
introduced - anatomy and physiology; disease processes; and
psychological aspects - mood, sleep. |
At the start of this section I questioned the status of HCM as a 'model'. If this seems harsh it was not meant to be. On the contrary it is a fact that Brian openly admits to. You see the HCM says nothing about the model of nursing that should be used, or how care, treatments should be delivered. The HCM is not prescriptive, advocating that a particular model of nursing/health care must be used. This could be considered a strength rather than an academic failing? A debate introduced in reflections.
In the sections below the contents of these quadrants are suggested, the lists are those Brian recorded in his notes.
1.2 The Health Career Matrix (Simple Form)
The contributions of the various quadrants of the health career model although not of equal importance occur in all nursing situations.
Aspects of Nursing
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Consideration of science applied to nursing recognizes that to care for another person as a nurse requires an understanding of science and the scientific principles mediated through nursing activity. |
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| “An enquiry into the causes and conditions which determine the character of the phenomena observed” Wyle (1960) |
(Learning disabilities) practitioner to use headings that they feel to be relevant, i.e.
- Previous health career - past medical history
- Presenting physical condition - biological features
- Physical handicaps
- Sensory handicaps (i.e. five senses)
- Medication
- Nutrition
- Genetics
- Growth
- Other headings?
Some possible areas of interest:
Science in nursing
Applied physiology Diet Medication Physical attributes Impairment / abnormalities Abilities Disabling factors Normal development Normal Age related changes Metabolism Pathology Forms of disease Infection process Response to disease Response to insult Hypothermia Accidents Falls House safety Physiology Age Gender Pharmacology Systems / senses Growth and development Homeostasis Genetics Exercise Epidemiology Demography Cause / Distribution Age related health Research Morbidity Science foundation Bacteriology Physics Biochemistry Nutrition Mechanics Technology Procedures Rules
Aspects
of Nursing
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In caring for another person nurses undertake activities that have been closely studied by psychologists. An understanding of individual and group psychology should enhance the quality of care given to patients either individually or in groups. The nurses should consider how the knowledge of psychological principles can be used to promote health. |
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| "That branch of philosophy which examines and treats the growth functions and processes, conscious or subconscious, of the mind in relation to sensations, feelings, emotions, memories, will and conduct, whether examined introspectively - or from the behaviour of others under specified conditions" Wyle (1960) i.e. |
Child |
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| (i) | Psychological history | Adolescent |
| Adult | ||
| Neighbours | ||
| Interactive processes | Friends | |
| Groups | ||
| Verbal/Non Verbals | ||
| (ii) | Individual processes | Perceptions - hallucinations |
| Thought content - delusions | ||
| Cognitive - Day, date, time, orientation | ||
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(iii) |
Family dynamics | |
| (iv) | Sexuality - conflict | |
| (v) | Self awareness/self esteem |
coping style - dominant/submissive |
| (vi) | Spirituality |
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| vii) | Other headings |
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Some possible areas of interest:
Interpersonal Aspects
Individual Psychology Personhood Behaviour Dominant / Submissive Security / Insecurity Self-awareness Self-esteem Gender differences Decision making style Coping style Confidence Beliefs - true / false Sexuality Needs Belongingness Personal space Communication Personal autonomy Leisure Expectations Psychology of aging Stress Bereavement Processes of grief Pathology Confusion Depression Disorientation Processes of individual change Initiative Motivation Education Learning Memory Life skills Reality Orientation Occupation Developmental tasks Perception Group Psychology Family dynamics Marital relationship Group Membership Networks Interactive Processes Relationships Encounters Disengagement Integration / Isolation Loneliness (maybe relative) Submission to carers Child rearing practices Counselling
Aspects of Nursing
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Medical sociology can similarly be viewed as having components involving caring for and caring about. An understanding of sociological concepts should enable the nurse to adapt the care in accordance with the requirements of the situation. |
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"Scientific and systematized study of mankind considered as social beings, living in organized communities; the study of human society; social science" Wyle (1960) i.e. |
(i) Family unit/structure
(ii) Area in which family live - pollution i.e. chemical, noise
(iii) Living conditions - warm, dry
(iv) Roles/norms
(v) Values/beliefs
(vi) Social Class
(vii) Language/culture
(viii) Religion
(ix) Extended family - support given
(x) Other headings?
Some possible areas of interest:
Sociological Aspects Sociology Norms / Normative control Values Deviance / stigma / disvalued status Beliefs Status Power Socialization Significant others Roles Family structure Work Employment / unemployment Life chances Living conditions Amenities Patterns of daily life Organizations Leisure Social activities Social stratification Independence (as valued) Medical Sociology Social causes of disease Use of health services Institutionalization Sick role Patient career Ward culture Health beliefs Social context of health care Alternative medicine Acupuncture Homeopathy Folk medicine Informal carers Cross cultural health issues Cultural determinants Subculture (e.g. travelling folk) Cultural behaviour Sickness and death rituals Diet Language Ethnomedicine
Aspects of Nursing
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Nurses are beginning to become more politically aware as they recognize that to provide nursing care it is essential to have a knowledge of the social structures and the policies that shape our environment. An understanding of the politics of health care and the politics in nursing are essential. |
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"The management conduct of private affairs or motives, aims, interests which inspire public or private action" Wyle (1960) i.e. |
(i) Benefits - financial input into family
(ii) Employment
(iii) Service agents involved - Nurse involvement/Social Services
(iv) Education - (General education combines with social policy - Cognitive access to services.)
(v) Social Policy - Physical, and economic access to Health Centre/G.P.; distribution; rural communities.
(vi) Family politics/decision making
(vii) Ethics of intervention - client too submissive - professionals imposing power/control.
(viii) Other relevant headings?
Some possible areas of interest:
Political Awareness Legal aspects of care Patients rights Decision making Ethics of intervention Resource allocation [including own time] Power relationships Teams (nurse/patient/doctor/others) Social Administration Benefits Welfare Provision - source of help Social Policy Voluntary sector Community organizations Pressure groups Politics of health care provision Hospital policies Resource allocation Inequalities in health provision Access to public transport Public buildings Public amenities (including shops) Sources of Information Media As leisure As source of information Housing Effects on health Policies
These concerns in nursing, which are indicative rather than prescriptive, have correspondence in the subject disciplines that support the activity of nursing. Once a comprehensive assessment is completed the nurse (and wider health care team) must consider:
| NURSING INTERVENTIONS | CLIENTS PERCEPTION OF PROBLEMS VITAL |
| Instrumental? Interpersonal? Education? Organizational? Which quadrant? |
Helps to dilute power/ control which can compound low self-esteem. Client to prioritize own problems if possible. This may be formalized i.e. S.O.A.P. format S = Subjective O = Objective A = Assessment P = Plan |
© Brian E Hodges 1997
This completes this set of Brian's notes, but this is far from the end. The application of the HCM depends, of course, upon our purpose. Whether the purpose is curriculum development, care planning, identifying unmet need, brainstorming study ideas or service development the range of phenomena that occupy the knowledge domains obviously varies.
There are many assumptions contained in Brian's notes, for example - what of the structural and theoretical basis for the HCM?. The rest of this website identifies and explores these assumptions and link the HCM to clinical practice today in the informatics age. To learn more about how Brian related the Health Career Model to curriculum development and practice, please click the bridge below.
Wyle H.C., (1960) Universal English Dictionary, 13th Ed.
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Brian's notes II: |