Keywords: Health Career, Conceptual Framework, Care Domains

Citing this page:

Hodges, B., Jones, P. (1997) Introduction: Hodges' Health Career Model:
<>, Accessed

Welcome to Hodges' Health Career Model (HCM) for Nursing Practice as conceived by Brian E Hodges. This page provides an introduction to the mdoel, its development and application. These details were obtained from an interview with Brian at The Manchester Metropolitan University on the (very warm!) afternoon of 28 May 1997. (What exactly is Hodges' model? Brian's notes I)

Introduction: A Description of the Health Career Model

First, I must explain that the HCM would not qualify as a 'model' as defined by nurse theorists in the literature. I see this as an advantage, not a problem. A view you will hopefully share once you have considered the information within the HCM website. Overall, the website has been produced to support the belief that the HCM warrants more exposure and should be the subject of research. Brian's model deserves an opportunity to flower, rather than gather dust on a shelf. Perhaps the model can benefit from developments in the cognitive and information sciences: if twenty years is a long time in academia it is an age in information sciences. Additionally, whilst not a sufficient rationale alone, assessment, collaborative working, care evaluation questions and issues from the seventies and eighties continue to perplex.

Development - origins

Brian conceived the HCM commuting between Sheffield and Manchester in 1983, on what was then the British Rail train service. His efforts were stimulated by the need to impose structure on the curriculum for a BSc Nursing Studies course. The search for tools to aid collaborative curriculum development is ongoing, as Van Neste-Kenny (1998) and colleagues reveal. Having defined the model in 1983, a scheduled teacher was unable to take a class, providing an opportunity for Brian to share the health career model with the students. Despite this impromptu start, within a short time academic colleagues recognized the value of HCM in curriculum design and development, in addition to clinical practice.

Ensuring comprehensive assessment remains a major problem for clinicians. The HCM facilitates assessment by acting as an aide-memoir, especially critical when faced with risk as per child care / abuse assessment and care evaluations. The HCM was adopted as an assessment tool for students on courses. Not surprisingly, health visiting was an initial area of application. Other early applications included case studies in post-basic nurse education, notably the Community Psychiatry Nursing Certificate; and what is now learning disabilities.

Key phases in development

The period 1983-7 comprised the main development work of the HCM. Due to illness in 1990 Brian was unable to continue in-depth development work. Hence Brian's bemused surprise at my contacting him. Although at that juncture in 1997 the HCM was "gathering dust", there remain many educators, clinicians and health care managers who have encountered Brian's work. They like myself, carry the HCM as part of their mental toolkit.

All ideas are built upon the work of others, and of course if the HCM can claim to be a type a graphical organiser then there are many pioneers in this field. Gordon's book in 1961 Synectics provides insight into creative thinking that can utilise techniques such as sketching, relating keywords, to draw relevant connections and conclusions.

The spaces created if they mirror a discipline can help students assimilate new information, integrate this or challenge existing thinking, and assist generating prose - such as case studies. Couch (1993) shows that synectics works well with all ages as well as those who withdraw from traditional methods, in this way these approaches can adapt to individual learning styles.

Categorization of the HCM?

This is difficult, as discussions on the Theory Development pages have revealed. HCM is descriptive rather than prescriptive. The model is situation not person focused. There are elements of grounding, in that the situation, or context(s) determine what data are significant in the assessment. The HCM then guides the health professional by highlighting the key subject domains for the assessor's attention. The HCM can be used in conjunction with a model of nursing, thereby providing a model of assessment rather than a model of care? So what is HCM? Is it a -

Please read through Brian's notes and decide for yourself. Let us know what you think.

Key influences - nursing; philosophical; ideological

Concept of Career

The concept of patient-health career (mentioned in the literature) highlights the fact that it is very difficult to prescribe and predict future outcomes, across all health care knowledge domains. This was translated by Hodges into a health career, taking into account the retrospective, prospective and here and now. The nurse (assessor) must take cognizance of the attributes the person brings with them in their current presentation (problem) and how this affects their future choices both in terms of ability to make them and the range of choices available.

Change in the focus of health care in the decade since I encountered HCM is evident in the work of Aneshensel (1995), who adds a further dimension to the concept. Citing Given and Given (1991); Wilson (1989), Lewis (1987); and listing three stages in the carers career.

1. Role acquisition
2. Role enactment
3. Role disengagement

Other influences include that of several medical sociologists for whom the concept of 'career' proved very valuable as per the contributions of Hughes (1958):

the moving perspective in which the person sees his life as a whole and interprets the meanings of his various attitudes, actions, and the things which happen to him (p.63).

A further quote reveals the historical position of Hughes' text 'Men and their work' which explores the professional development of a physician, but also reveals the longitudinal nature of career alluded to in Brian's work.

Of course much of what Hughes writes can apply to all individual members of society - both included and excluded. If 'professional world' is substituted for whatever 'world', we can reflect upon an individual's life chances and how the person has arrived at the point of a clinical encounter/episode/care spell.

CAREER

Initially, inclusion of career in the title has prompted some to suppose that Brian’s work and hence this website is literally concerned with a career in health. This explains, why in several instances, the HCM is listed under ‘employment’ or ‘career opportunities’. With the pressures on nursing and wider health care workforce globally, this may not be a bad thing; but as noted previously this placement is incorrect and a (fully understandable) misinterpretation. Brian’s use of career becomes obvious once the meaning of career in this context is understood.

In addition to Hughes (1957) there are a plethora of sources for the concept career and its application (McKinlay, 1971); Cowie, 1976; (Evers, 1981). These authors acknowledge their debt to the seminal work of Zola (1966). Much of this work was stimulated of course by the need to question institutional care delivery systems.

For example, Evers used the term career to compare the type of care prescription delivered in elderly care environments with the idealised care prescriptions promoted in policy statements, professional manifestos and introductory texts on geriatrics. Evers compared the idealised care prescriptions with actual care prescriptions, using the labels minimal warehousing and a personalised warehousing career. These labels in themselves suggest the negative non person-centred nature of the care. These idealised care prescription derived from Activity Theory assumptions embody three important prescriptions for the organization of geriatric care in hospitals 1) active intervention and therapeutic optimism; 2) Patients’ physical and psychological independence should be promoted and encouraged; 3) Patients’ feelings of self-esteem, and quality of life, are best sustained, restored or enhanced through engagement in purposeful activity.

If it is possible - Brian's use of career includes and extends these applications. The HCM simultaneously acknowledges the influence of the care environment, the educational, sociopolitical and cultural milieu from which the individual enters the care economy. Whilst in prose this may seem like Brian wanting his cake and eating it, a survey of the HCM figure above, hopefully forces the viewer to accept all that this intersection of continua brings forth.

Health and especially learning disabilities contexts certainly invites use of career and the associated idea of life chances. These concepts are well represented in the literature and no doubt influenced Brian's studies and teaching and that of his peers.

Brian's background in learning disability comes to the fore in relating and contrasting terms in the Health Career Model:

The concept of career in a health care context is not as archaic as Hughes might suggest.

Cowie (1976) writes about the career of cardiac patients, how they perceive their illness. Cowie cites the work of several medical sociologists, Mechanic (1962) who identified four dimensions along which one may perceive illness. The first two dimensions, commonality and familiarity of symptoms he referred to as illness recognition; the other two, predictability of outcome and threat from the illness he referred to illness danger. There is an undeniable similarity in the way a good education, good parenting or guardianship, can enhance the career prospects of a given individual.

The figure here seeks to emphasise that contemplation of career involves time in the sense of past, present and future. Cowie's paper is person-focused being concerned with how patients perceive and interpret the coronary event itself:

I became aware of the process of retrospective reconstruction in an attempt to normalise the heart attack when patients, in responding to my general question ‘Why are you in hospital?', did not begin with the event itself, but always placed it in a historical context of anything from a few hours to one year. Analysis of the data showed that there were no consistent variations by age, sex or socio economic status. Variations depended on individual biographies and career contingencies such as whether or not the patient smoked, was overweight and what his GP, the hospital staff and fellow patients told him. Patients compared themselves with fellow patients using age, number of previous attacks, the nature and degree of symptoms, and perceived progress in the medical regimen as checks on the validity of their perception and interpretation of their heart attack. p.87

Evers (1981) researched the careers of acutely ill geriatric patients. Focusing on care prescriptions In the same that people have varied careers so too can patients. Evers revealed variations in the patient careers of long stay patients.

Before proceeding, a definition of patient career is needed. As used here the term refers to the sequence through time of recurring and non-recurring events and interactions involving the patient, which take place in a particular environment - the ward - and a particular set of social relationships”.

A key change in focus was the need to accept the patients pre-admission

Two distinct sub-types of long stay career can be identified, one of which is less discrepant from the care prescriptions than the other. It can be argued that contrasts in the structure of social relationships amongst doctor, nurse and patient are the key to understanding how the two types of long stay career are created. Moving on from this analysis, it is possible to suggest an alternative organizational arrangement for delivery of long stay geriatric care.

How times change: from continuing care in the public sector and the patient career; to private sector residential and community care and the career of care assistants.

Brian has been and remains interested in the way by which people come into contact with health services and practitioners.

Nursing care

The move to a situation focused position, is validated by Hodges assertion that nurses have their own agenda. Thus far, individual nursing care is a nonsense. A point I have raised previously myself - as a student on each ward, a question at the time would be the model used. One model - many patients, so does one model match the needs of all the patients?

Perhaps there is a hint of some link with Orem's self-care model here? Another attribute to assist in categorization.

Author's critique - comments

A constant difficultly from Hodges point of view is the nature of the nurse's contact with the patient. The terms we use - 'person', 'individual', 'client' and 'service user' more recently, 'patient' for want of a better term. The nature of contact is problematic because of our definitions of health. In Orem's model we would encourage (nurse) the patient so that they are able to clean their own windows. In the past under some models (Roper, Logan, and Tierney - Activities of Living), it could be argued that the nurse would clean the windows, given that this constitutes a 'health deficit'? This has been a constant source of frustration.

Reception / application - Nationally

Unfortunately, the HCM has not been widely publicized. Enquiries were received nationally from:

• Teesside - models of nursing - degree course
• Middlesborough
• Reading
• North Wales - School of Nursing
• Scotland
• Regional - Community Mental Health Teams

In December 2003 a student nurse informed me that Kemple View Psychiatric Services, Blackburn, UK, are using the Health Career Model as an aid to assessing individual needs.

If you know of other services using the health career model please let us know.

Conferences / Papers / Other Publications

There is only one reference to the HCM, the result of attendance at an English National Board conference in Cardiff, Wales.

Why a lack of published work I hear you ask?

Well, during the nineties models of nursing were no longer 'flavour of the month'. Although in the USA and elsewhere nursing theory has retained its currency, in the UK this has never really been the case. Reasons for this have been much discussed. The nursing process once much in the nursing media has also taken a back seat - while primary nursing, integrated care pathways, and evidence based care (each admittedly quite different from the other) have center stage. This is to be expected, as health care policy and society at large are very dynamic.

Despite Brian's efforts, his papers on the Health Career Model were not accepted for publication. This is a shame beyond any personal disappointment Brian may have experienced, as there are not many models of nursing that originated in the U.K. and were created by a male(!) (as Francis Biley pointed out). It does make you wonder how many worthy ideas - deserved of attention and debate - have suffered this fate before? The single reference (please note that you need the 1st Edition) is:

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

In March 2003, Trevor Adams contacted me, enquiring if an article he had written in 1987 is the first reference to the HCM. Well this certainly does seem to be the case, which is excellent news, and once I obtain a copy of Trevor's paper we will furnish more details here on the website.

Looking forward - further development?

As far as Brian and I are aware, apart from these pages and my own occasional use of the HCM in my clinical work there is nothing happening in the development of the HCM. Reflections explains my ongoing interest in the HCM. The HCM retains a currency, a significance that meets many of the demands that nursing theory meets in practice. To me Brian's approach has applications that extend beyond health care, a proposal this website seeks to support. Nursing theory and practice must enter the so-called 'information age'.

References

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

Aneshensel, C.S. (1995) Profiles of care giving: the unexpected career, Academic Press London, 21.

Couch, R. (1993) Synectics and Imagery: Developing Creative Thinking Through Images. In: Art, Science & Visual Literacy: Selected Readings from the Annual Conference of the International Visual Literacy Association (24th, Pittsburgh, PA. September 30 - October 4, 1992). (ERIC Document Reproduction Service No. ED 363 330).

Cowie, B. (1976) The Cardiac Patient's Perception of his Heart Attack, Soc. Sci. & Med. 10: 87-97.

Evers, H.K. (1981) The Creation of Patient Careers in Geriatric Wards: Aspects of Policy and Practice, Soc. Sci. & Med. I5A: 581-588.

Gordon, W.J.J. (1961) Synectics. New York: Harper & Row.

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

Hughes, E. (1958) Men and their work. New York: Free Press.

Mechanic, D. (1962) The concept of illness behaviour. J. Chron. Dis. 15: 189.

McKinlay, J.B. (1971) The Concept "Patient Career" as a Heuristic Device For Making Medical Sociology Relevant to Medical Students, Social Sciences & Medicine, 5, 441-460.

Van Neste-Kenny, J., Cragg, C.E., Foulds, B. (1998) Using concept maps and visual representations for collaborative curriculum development, Nurs. Educator, 23(6),21-25.