KEYWORDS: Theoretical basis, Data structure, Diagram, Diagram-like, Representation, Popper, Physical, Information, Mental, Analogical representation, Information design, Cognitive structuring, Consilience, Objective - Subjective health, Triangulation

Citing this page:

Jones, P. (2000) Hodges' Health Career Care Domains Model, Assumptions Theory:

<>, Accessed

Introduction

The above heading is a misnomer. There is no exposition of theoretical rigour here, rather a search for the foundations upon which a valid theory might be built. As yet Brian and I have not had an adequate opportunity, or forum to examine even the most basic of hypotheses that may provide a theoretical basis for the HCM. Hence the role that this website and our visitors can play?

This page begins with a brief historical background of the use of signs, symbols, and definitions from the diagrammatic/visualization literature. Then questions are raised that highlight the theoretical chasm facing the HCM and its potential user community. The terrain is not featureless, much work has been completed. Tantalising peaks that tease, just rising above the fog. The conclusion of this page describes several established theoretical approaches that may have a role investigating the HCM. The key message of this page is the need to seperate theory and practice, uniting and validating the theory and practice of the HCM with an appropriate overarching philosophy.

History & Definitions

Long before integrated digital technologies, the problem of how to achieve shared understanding in a multilingual world were well recognized. Hansen (1999) lists three pioneers in the chapter 'Visualization in thinking, planning and problem solving', to which we can add the International Standards Organisation (ISO) and others.

Given the task here, crucial questions involve several themes:

1. DATA STRUCTURE
2. REPRESENTATION
3. DIAGRAMS
4. COGNITION
5. COMPUTATION

Some definitions and sources follow:

Myers & Konolige (1995) draw upon the frequent recourse to analogy in analogical representation. The authors differentiate between structures that are:

This distinction may be crucial in terms of the HCM and the thought that: 'two crossed lines do not make a diagram!' If this is true, then Myers & Konolige note that diagram-like representation structures are not easily defined, but they do share:

'the property of certain structural correspondence with the domain being modelled. It is precisely such correspondences that make analogical representations useful.' p.273

But how far does this apply to the HCM? These authors offer support for the aims and objectives of this website, by pointing out that the more general aspects of reasoning diagrammatically have been ignored, with attention focused on computationally oriented work, especially:

'the properties of particular classes of diagrams; and qualitative reasoning.' p.274.

The need to evaluate the existing and future potential of diagrammatic reasoning in other domains is reinforced in reports of the Advisory Group on Computer Graphics (AGOCG) (1997) & Orford, Dorling & Harris (1998). A key final piece of the AGOCG's work involved research into the application of visualization within the social sciences, to which Brian and I where able to contribute a small part.

It is important to note that the sources cited here refer to sentential representations in machine readable form, which is not necessarily equivalent to natural language or prose. Stenning & Inder (1995) help distinguish the relationships between the above definitions and points:

'A form of graphic that cannot express an abstraction necessary for some task will prove pathological, and will be better replaced by a more expressive language. But where a graphic can express the required abstractions, we predict that its weak expressiveness will make it a more efficient representation for performing the necessary inferences. This is so because weakly expressive systems are computationally tractable.' p.304

So diagrams are not a universal panacea. There are limits to what can be achieved and how tasks can be undertaken. The subtleties of the limits reside in 'about' and 'with'. Gilbert Ryle (1949) the philosopher (see also Magee (1987)), precipitated a profound shift in philosophy distinguishing 'knowing what' to 'knowing how'. Although not quite as profound, there is perhaps a similar important distinction for health professionals - with emphasis on 'professional'. How do health professionals use diagrams? For example, Myers & Konolige (1995) stress the activities of reasoning ABOUT diagrams, and reasoning WITH diagrams.

Castledine (2000) criticised the UKCC for declining to define nursing at a time when definitions are needed, no matter how difficult to grasp. Perhaps - as Castledine and other authors have highlighted - the keys to the definitional door must reside in a disciplines knowledge base, representational structures and reasoning? In the 21st Century, however, with collaboration the key requirement, it is not just the content that is crucial, but the way that a discipline's knowledge is articulated, disseminated, deployed and revised?

Historically, the use of space, to represent ideas, and communicate them to others is not new. An evolutionary path from 2D cave walls through to the latest virtual volumetric 3D forms can be traced. Abbott (1999) refers to Popper's 3 Worlds:

World 1 (PHYSICAL)
	World 2 (MENTAL)
World 3 (INFORMATION)

There is an interesting analogy between trying to map World 2 (which necessarily has to be done in World 3) and some of the work that has been done on the subjective perception of the environment, or on 'mental maps' as the subject is frequently called. p.78

It is possible to follow the emegence of theory on how people become experts and what differentiates the expert from their lay counterparts (Benner, 1984).

Exposure to World 1 and World 3 leads to the possession by individuals of a tacit groundbase of information and experience which becomes assumed as second nature and is essential for the meaningful transfer and receipt of more complex information. p.78

For an expert in a field, one would suspect that his World 2 picture would closely correspond to the World 3 model as generally accepted - however that might be derived - and perhaps also to relate reliably to World 1. This suspicion might be ill-founded. However, for someone without expertise, the picture would be very much more sketchy, or even totally empty of content. Large areas of World 2 will have no obvious correlates in Worlds 1 and 3, being the flux of transient and half-formed thoughts, the stream of consciousness, the continuous rollercoaster of minor emotions that make up so much of the mental life of any individual. p.78

Space in Health & Social Care

In health care Becker (1978) proposed the communication mosaic. John Clark's book A map of mental states, investigates how all the journeys of mental health can be plotted on a map. Figures detail a network of states, Patanjali's Yoga meditation procedure, enlightenment, Fischer's map, Freud's map, Popper's Three Worlds, box-shaped and cake-shaped maps of mystical states. Published in 1983, appendices include a computer graphics program in an early version of Apple™ BASIC, plus instructions on how to construct paper models of the map.

Eskin & Bull (1991) attempted to 'square a difficult circle' with their 'health care cube'. A means to assist general managers and public health physicians identify priorities in the contracting process. As noted elsewhere medical imaging already has an illustrious history with amazing benefits being realised, with the promise of more to come. In December 2000 Turley's paper 'Toward an Integrated View of Health Informatics' describes the 'communication cube' as a model of health informatics, noting that:

'.. it becomes clear that the approach we have taken in informatics in healthcare has been limited. Healthcare is complex; the result is that data is continuously repurposed and recycled within healthcare organisations. To the degree that we understand the multiple uses for data as it passes among disciplines, as it is used for purposes and is recycled at different time, there is need for data to be able to alter its level of granularity based on the purpose to which it is being put and the reason it is migrated to other disciplines and the way it is used within a single discipline at different times.' p.14

Jacobson's (1991) observations on the theoretical position of 'Information Design' serves as a pointer to the HCM's current situation. In many respects the above examples and the HCM are all about information design, which Jacobson claims exists as a 'unique design practice':

'Its purpose is the systematic arrangement and use of communication carriers, channels, and tokens to increase the understanding of those participating in a specific conversation or discourse.' Jacobson (1991) p.4

Information design is itself a matter of debate. Exemplary information design insights are displayed in the excellent series of books by Edward Tufte. Tufte is cited by Jacobson's contributors, to support their claim for the existence of information design as a discipline. Tufte (1997) displays clinical examples, how the status of patient's medical and psychiatric problems can be captured in 24 graphics (see also Powsner and Tufte, 1994)). Tufte writes:

'This architecture - blending quantitative multiples, narrative text, and images - may prove useful for monitoring other data-rich sources.' Tufte (1997) p.110-111

Hodges' Health Career Model as an example of information design?

Health care practitioners can readily relate to Jacobson and Tufte's respective mention of communication carriers, channels, tokens, conversations and dialogues; and monitoring of other [nursing, multidisciplinary, transdisciplinary?] data-rich sources. Copnell's (1998) analysis of two approaches to achieve synthesis of nursing knowledge concludes that nursing (and health care in general by implication) must search for tools to facilitate synthesis. The HCM must qualify as a tool to synthesize nursing knowledge, but how can we be sure? Copnell cautions that even before a tool is found, we need to be sure synthesis can be recognised.

Whatever the status of the HCM, for it to have meaning and clinical validity, there must be some basic rules; theoretical assumptions underpinning its construction, the resulting structure and application. A pivotal assumption behind Brian's work is surely the skill of assessment that training and experience imbues in health care professionals. Namely the ability to isolate, identify, select and place care concepts and other relevant data discretely onto a conceptual framework. (Synthesis in action?)

The skill of integrating theory and practice, a keystone for any bridge across the theory - practice gap, is certainly non-trivial and yet assessment is often reduced to a task involving a question and answer session directed by a checklist.

The HCM must make sense in terms of its:

continua quadrants (in two ways) the ability to relate concepts outside the HCM framework - i.e., thinking. and of course placement of these concepts within the HCM knowledge domains.

What basis can there be for these two assumptions?

Rainer Born and Ilse Born-Lechleitner use a diagram to begin their discussion of artificial intelligence. Their diagram is represented below, but the labels have been reversed to match the HCM. This rendition appears to match Brian's formulation. Brian's purpose differs from Born & Born-Lechleitner (1988) who note that:

'The choice of this system of coordinates can be taken as a quasi-empirical hypothesis. W, R, T and V therefore serve as undefined basic terms, their exact meaning is defined implicitly, i.e. by the relation of the terms to each other.' p.xii

So the formulation of the HCM grid could be assumed a quasi-empirical hypothesis. Born's world is the HCM's socio-political realm, which is the reality that humans create for themselves individually. Born et al. go on to build a systematic schema developing the definitions of initial concepts. Can clear definitions be made for the HCM's concepts? Are there related formulations?

There is another described by Fiandt, et al. (2003) and brought to my attention with many thanks - by John Bunzl: Wilber's - All-Quadrant/All-Level model (Wilber, 2000). The quadrants of this complex framework share much in common the HCM. A fact which enriches both schemes.

Consistency and Validity: Social structures, Social health care and Subjective health

Within the HCM or any other framework there must be consistency in how concepts are placed, and contexts can change this, as follows:

	There are many aspects of social care regarding which there is debate as to the 'ideal' source of service provision - vis-a-vis health versus social services - who, when, where, how and why?
A depression may be secondary to a physical problem, or vice-versa - where do priorities lie?
	How do we represent assertiveness skills possessed by an individual, and the exercise (or not) of those skills in social situations?
Where do we place treatment (drug) 'compliance' and 'concordance'?

This idea - that concepts have their 'place' is not novel. Osgood, et al. (1957) in The Measurement of Meaning outlined a way to map the psychological distance that individual's ascribe to concepts - the semantic differential method. Widely deployed in product studies (Hsu, et al., 2000), semantic differentiation is not limited to marketing, with Swallow & Sermet's (1969) study of dentally anxious children.

A further assumption concerns the actual domains that arise within the HCM and the exclusivity of these in terms of the problems to which they refer. For collaborative working there are key concepts and processes that may be very difficult to place confidently within the HCM grid. For example, screening, assessment, and intervention appear to involve all four domains to the same extent? Reproductive health cannot be restricted to any single quadrant, but arises in each and depending on context any quadrant could be said to be 'primary' as listed below:

	Sex as portrayed in the media.
How different forms of contraception work. Statistics and epidemiological studies.
	Attitudes and personal beliefs about sexually transmitted diseases. Personal behaviour, assessment of risk. Influence of culture and religious beliefs on the individual.
Funding for sex education and sexual health. Access to clinics. Sex education on the curriculum.

Due in part to limited resources, demands on services, case complexity and policy directions the push to integrate services demands questions .

Mobility, carer, and risk are among a diverse range of concepts subjected to analysis in the nursing literature (Rush & Ouellet, 1993).

To what extent this work shows that care concepts have a fixed position in the lexicon of the caring professions is debatable. Efforts to formalize the health care language must take account of the highly dynamic state of health care terminology. Concepts are not always fixed, either in their meaning or relationship with other concepts. Change in terminology is inevitable given the pace of change in health and social care.

This compounds our problem [trying to research the HCM] because different contexts may mean that distinct quadrants are used with different levels of granularity. Some concepts may be general spanning all four HCM quadrants, but others specific to a single quadrant, for example - the scientific. Could it be that the scientific quadrant itself may be divided into the four HCM quadrants. HCM quadrants within quadrants? (Oh dear!) This point seems damning in terms of trying to lay (or find!) the first brick of a theoretical foundation, but difficult questions must be asked.

The literature acknowledges the need for medicine and health care generally to seek out, represent, and reflect in outcomes the social dimension of care and the views of the individual patient. Recognition of the need to engage with people as autonomous beings, has not been realised in practice. It has to an extent, but encouraging patients to complain, and have raised expectations of the health care system, is not the same the same as according people their autonomy. If this were to be achieved, then perhaps less complaints would follow.

Sullivan (2003) argues that:

One function Brian Hodges intended for the HCM is curriculum development. From an educational perspective much of the above is bound up in values. From the expectations of patients and their carers, to the values held by novice health and social care professionals and their transformation into an expert. Weis & Schank (2002) aspire to ensure humanistic nursing care, identifying professional values as pivotal to this goal. Therefore, skills are needed in cognitive and psychomotor learning, plus affective skill learning. Although professional guidance stresses the role that values play in professional development, and examples such as the ANA cited by Weis & Schank include the nurse as advocate, others acknowledge the constraints that can operate on nurses in pursuance of this duty. To Weis & Schank's list it seems we must include political values, especially if education programs are to reflect health's contribution to the quality of future lives.

Divided we fall: United we find solutions...

What is needed are clear questions, followed by deliberation of which research methods may help to provide the best answers.

QUANTITATIVE

QUALITATIVE

In addition the combination of these approaches may open new doors via new questions:

Studies are now commonplace that combine quantitative and qualitative research approaches, using a method termed triangulation (Cowman, 1993). Ever since its initial application research methodology, triangulation has been the subject of intense ebate, that is still ongoing. Ongoing due to the complexity of the questions being asked, and presence of methodolatory - a term coined by Janesick (1994) for the researcher who defends and follows a research method potentially missing important facets relevant to the research subject.

The value of triangulation to the research community and its potential dangers extends across disciplines. For example, Decrop (1999) in tourism describes the four basic types of triangulation: data, method, investigator, and theoretical. aiding the possibility of researchers finding they have expertise in a research method in common with their colleagues in other fields (Rajagopal, 2002; Nolan and Behi, 1995).

As Shih (1998) discusses, debate continues as to the application and implications of each approach:

"the differences and similarities of these three perspectives have not been fully compared as either philosophies or methodologies." p.631

If however, answers are to be found to highly complex, confounding problems then hybrid methods must be adopted. The research community must be flexible and react to the environment they plan to enter. Heathfield et al. (1999) describe assessment of the electronic patient record in an multidisciplinary team environment - a projects set in the real world. There evaluation against theoretical, academic standards, or pure methods is plagued with difficulty. This paper also highlights additional problems in reporting results due to questions of interpretation, motivation and ownership.

There is a need for substantive and formal approaches. The brief review of the HCM quadrants above and that undertaken elsewhere on this site, highlight the need to integrate the quantitative and qualitative.

Facets and reflexions

Although the HCM is situation focused, validation of HCM would need to be tested from two person-centered perspectives:

1. All health care workers possess a cognitive template upon which they can map health/social care problems. This map is valid for that person.
2. There is a universal template (to be found in a 'nursing' text), a 'cognitive proforma' that learners acquire and experts use tacitly in their day-to-day work. This template acts as a repository and contains that profession's knowledge base and may become in an individual: static (non-learner); vulnerable to chaotic change; or enhanced by ordered change.

Serendipity sometimes comes to our aid. In Kramer (1995) I found a first reference to Facet Theory, which looks interesting in light of the above questions. A (casual) search via Google.com pointed to Rod Ward's (1993) paper, which expounds the case for Facet Theory in nursing research. Kramer's question concerned the classification of generic places:

'The criteria hypothesized to structure people's general place evaluation are not independent but mutually interrelated, and therefore imply a certain complexity which is thought to be accessible by Facet theory.' Kramer (1995) p.4.

Ward explains that:

'Research using Facet Theory relies on the construction of mapping sentences. ... The facets are conceptual categorizations underlying a group of observations: each facet can have a range of constituent values. What this means in practice is the labelling as a facet, of a conceptual categorization underlying a group of observations. For instance, one such facet might be gender with two constituent values; male and female. Another example would be to divide respondents into age groups, elements being 20-30, 30-40, 40-50, etc.' Ward (1993) p.550

Ward (1993) p.550-51 describes several diverse applications of Facet Theory: British universities to increase energy conservation following the 1970's oil crisis; prisoner and staff conceptualizations of prisons; individual perceptions of buildings; slimming and weight loss. In health facets have been developed mapping sentence in studies of nursing, areas of stress and coping. The examples are supported by five figures showing how:

'The analysis of results of Facet Theory relies on spatial mapping of results to provide a representation of individuals as points in space, and variables as ways of partitioning that space.' Ward (1993) p.552

A page introducing some themes on theories and avenues of enquiry that may further research of diagrammatic reasoning in health care / nursing will be replaced in 2006.

From Facets to Modes of Reasoning

Capturing the content of nursing knowledge is difficult, nursing (like other disciplines) requires explicit and implicit knowledge. Woolley (1990) cites Benner (1984) in describing the evolution of the nurse from novice to expert:

The 'Modes of Thought Questionnaire' (MOTQ) in Alwyn's (1985) 'Structure in Thought and Feeling,' provides a method to discern the associations between thoughts. Research of the HCM does not appear to be a question of knowledge acquisition as used in expert systems and artificial intelligence, but is more subtle. HCM researchers need a version of the MOTQ, one that can reveal the associations that health professionals (patients and carers too?), make in practice. Rosch's pioneering work in categorization and studies in nursing should help determine nursing and health care exemplars. Ultimately, research might also account for variations between disciplines.

A recurring debate centres on the basic knowledge domains a discipline identifies.

Are there three domains in nursing, as in 'biopsychosocial' (Biderman & Herman, 2002; Votava, 1985; Peplau, (1995); Nicassio & Smith, 1996; Meana, et al. 1997; McInnis-Dittrich, 2001; Moons, et al. 2003) or are there four - as per the HCM?

Ideally, a tool should be flexible, adapting itself to the information needs situationally and contextually. Whether in a patient's home, hospital, or international space station. Flexible in whatever context, for example - during a follow-up appointment, risk-assessment for self-harm; or genetic counselling. The question of whether to use three - biopsychosocial (Smilkstein, et al. 1984) or four domains (biological psychological sociological and spiritual), becomes less important. It is the associations between concepts and their significance that is of import.

In the field of information retrieval several concepts have been extensively researched, forming the basis of retrieval technologies. Concepts include aboutness, situation and context (

Twenty years ago, Smilkstein, et al. (1984) argued for in-depth biopsychosocial assessment of risk in pregnancy, to explain a larger share of variance in outcome. Concluding that more attention to structural modeling of the relationships among risk, resources and outcomes is needed. Since then the rise to prominence of political-autonomy aspects in assessment makes the struture of the HCM with its all encompassing theoretical scope ripe for in-depth research.

d

Tools to undertake conceptual modelling are needed that support the cognitive modelling undertaken within the professional carers, patient-carer community and the policy makers. This ongoing quest is acknowledged across all human problem solving activity. It is fundamental philosophically. In the figure above - jumping on the 3D bandwagon - some concepts may span all domains, while other concepts are restricted to only one or two of the four domains. The complexity is of course that these relationships depend on context, which varies constantly. It is at this point that the philosophical and much debated gap between our experience of reality and representation of it comes to the fore. For the professional team can they cope with the demands of the capturing, structuring and processing (priority, risk, discharge) the patient, the carer seperately?

Restructuring Stress

What does Bar-Tal et al.'s (1999) paper say of the application of the HCM? If people resort to cognitive structuring at times of stress, and the HCM could be assumed to be a tool to assist cognitive structuring, is its appeal (to me) evidence that I am continually stressed? Is the HCM acting as a negative reinforcer, the reduction in anxiety prompting the tool to be deployed repeatedly? Do other models act in this way? Could my use of HCM be fooling me into thinking that I can be comprehensive, when in reality short-cuts are being taken? Yet in defence, is it not a mark of a professional (or expert) that they can safely employ cognitive structuring to be efficient, effective? Surely, whether the HCM or some other cognitive resource, whatever is 'to-hand' in the cognitive toolbox will be reached for at times of stress. Experts and the rest of us experienced practitioners "do it by the book" - just? One definition of an 'expert' is someone who knows the corners that can be cut.

The above presupposes that clients are detached from the interactions, which of course cannot be the case, and must not. According to Bar-Tal et al (1999) and other authors they also engage in cognitive structuring at times of stress. What both client and therapist (of whatever discipline) strive for is "reflexive mapping" the process of making oneself as aware as we can at a particular point in time. For the client to achieve a better (therapeutic) understanding of their problems. For the therapist just prior to hypothesizing about the case at hand.

Both parties independently and conjointly need help with this task. In cognitive therapy the case formulation is the formulaic approach. Driven by time, behavioural development and feedback the act of producing case formulations can be aided through use of 'Mind Maps' (of which many people will be aware of, with mention of the Buzan Centres), described by Williams et al. (1997) and a website.

Both 'Mind Maps', the HCM and other tools can offer a staging post on the road to case formulation. Clients may be furtive about past early experiences and both strategies and others may be useful to elicit relevant material and insights. More complex formulations may be derived through the chaining of thoughts, feelings and behaviours, and within other specialist therapies such as, short-term cognitive analytical therapy - with the 'sequential diagrammatic reformulation'.

This is a danger in ICT, that the technology seduces us with feelings of power. The collection of data and the use of metaphor, especially powerful metaphors gives the illusion of control and predictability where there was none before. A 'health' warning given and reinforced by Hadwin (1996) who observes of sequential diagrammatic reformulation:

Consilience & Synectics (with a last word from John Venn?)

At the close of the 20th century Wilson (1998) provides added support for Brian's work in his book Consilience, together with an award winning rationale for why consilience is needed. (Further justification is provided in discussion on holism & information levels.) Wilson further demonstrates the use of lines and space to construct diagrammatic tools and their ubiquity.

I had been meaning to purchase Wilson's book since it topped the New Scientist book charts. The subtitle had immediate appeal: The Unity of Knowledge. Imagine the impact of my reading and seeing the following:

"The belief in the possibility of consilience beyond science and across the great branches of learning is not yet science. It is a metaphysical world view, and a minority one at that, shared by only a few scientists and philosophers. It cannot be proved with logic from first principles or grounded in any definitive set of empirical tests, at least not by any yet conceived. Its best support is no more than an extrapolation of the consistent past success of the natural sciences. Its surest test will be its effectiveness in the social sciences and humanities. The strongest appeal appeal of consilience is in the prospect of intellectual adventure and, given even modest success, the value of understanding the human condition with a higher degree of certainty." Wilson (1998) p.7

"Bear with me while I cite an example to illustrate the claim just made. Think of two intersecting lines forming a cross, and picture the four quadrants thus created. Label one quadrant environmental policy, the next ethics, the next biology, and the final one social science." Wilson (1998) p.7

It is so encouraging to see people trying to build bridges from both sides of the natural science/social science divide. Let us hope they meet in the right place? Wilson argues from a natural science perspective for the unification of knowledge. While, the HCM from a social science perspective uses health/social care as a context to unify concepts across multidisciplines.

Wilson continues his illustration by adding (p.8) concentric rings around the axes intersection. In the outer circles each discipline, social science, ethics, is 'comfortable' with itself. There, several aspects of ethics, for example, reside in close proximity. Move to the centre, however, 'where most real-world problems exist (p.8)' and there are fewer common concepts. The theoretical equivalent of real-world constraints perhaps? Why is consilience needed?

Every college student should able to answer the following question: What is the relation between science and the humanities, and how is it important for human welfare? Most of the human issues that vex humanity daily - ethnic conflict, arms escalation, overpopulation, abortion, environment, endemic poverty, to cite seven most persistently before us - cannot be solved without integrating knowledge from the natural sciences with that of the social sciences and humanities. Only fluences across the boundaries will provide a clear view of the world as it is, not as seen through the lens of ideologies and religious dogmas or commanded by myopic response to immediate need. Yet the that vast majority of our political leaders are trained exclusively in the social sciences and humanities, and have little or no knowledge of the natural sciences. The same is true of the public intellectuals, columnists, immediate interogators and think-tank gurus. The best of their analysis are careful and responsible, and sometimes correct, but the substantive base of their wisdom is fragmented and lopsided. Wilson (1998) p.11-12

Emery (2003) refers to a philosophical fitness landscape (PFL) which utilises a Master's thesis by Meece (1979). Emery combines Meece and Wilson's depiction of consilience, to provide a subjective measure of consilience. Emery and Meece note the polarity in scientific debate, to achieve a measure these differing views need to be represented and accommodated. Meece presented a 2D array of positions to represent views.

A useful PFL of Wilsonian consilience, I suggest, can be digitized for detailed analysis by reducing
the field to an array of pixels. The structure of such a topography would need to involve: (1) a digitized opinion survey to differentiate and translate these quadra-lateral attitudes, (2) a numerical weighting system to determine the relative magnitude of any philosophical position held within a quad, and (3) a system for summarizing the results as a locus, or a single-pixel identity of the user. p.220.

Emery explains how he came to Meece's approach:

One need not look far into psychological circles to find methods for analyzing mental attitudes and personality profiles. A popular one is the Myers–Briggs Type Indicator (MBTI) test that uses a bank of questions to measure “temperaments” of response. Then it differentiates them quadra-laterally into categories broadly defined as intuitional, thinking, feeling, and sensing, each one with its own bilateral characteristics. Some psychologists will say, with their own certitude, that if more people knew their MBTIs and shared them, they all might get along better. The mechanics of this however evade me. Scientists are bound to ask why this assumed benefit from ecumenism, as it were, would not just as easily break up into bunches of label-bearing separatists. It is a daunting concern,
and the only assumption that allows me to proceed is this: There must be some redeeming value relevant to the cause of consilience in this fraternal-order-of knowledge business. p.220-222.

[Meece's] bank of 33 statements seems more agreeable to our scientific “ temperaments.” The geometry of Meece’s method employs a useful kind of ambiguity, which should not be too offensive. He uses a subjective method to weight the responses according to how they fit into his own
digitized version of a PFL, approximated (by me) in Fig. 4. His method summarizes the results into a single pixel, of which there are 32, 8 within each quadrant. In my judgment, Meece has done well with the problems attendant to these subjective profiling techniques. He offers an honest and simple method of digitizing a PFL, useful perhaps as a starting place on our journey to the promising land of consilience. p.222.

Although Emery's focus is debate within biosystems and to populate the PFL he adopts fantasy as a methodology, together Meece, Wilson and Emery provide another definition of h2cm. A gymnasium for philosophical reflection. This journey is near its end, since to venture further demands a more philosophical approach, a necessary precursor to identifying possible research methodologies and methods - completion of a literature search.

While researching h2cm several ‘wow’ moments have occurred when a piece of work immediately resonates with h2cm. This is clearly evident in the diagrammatic formulations of (Wilson, 1998; Born & Born-Lechleitner, 1988) above, and more recently in Edwards (2004) whose images of Venn diagrams strike 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

Perhaps h2cm is an example of a maximal planar subgraph?

Future today

In terms of preparedness to cope with today's challenges and anticipate those of tomorrow, Begun and White (1995) appeal for movement from ingrained practices and approaches - to embrace:

• SHORT-TERM FORECASTING
• EMERGENT STRATEGIES
• SEARCH FOR NEW OPPORTUNITIES
• MULTIPLE SCENARIOS
• SELF-ORGANISING, TEMPORARY STRUCTURES
• STRUCTURAL INTERDEPENDENCE IN THE WORKPLACE
• LEADERSHIP TURNOVER
• INNOVATION, EXPERIMENT, DIVERSITY
• CO-OPERATION AND COMPETITION
• MARKETPLACE 'AGGRESSION'
• SELF-LEARNING

The clinical and informatics potential of h2cm is - like other care assessment-evaluation tools - predicated on the coincidental maturation of several factors, including:

• WORK-FORCE (recruitment, training, retention, attitude)
  
• REALISATION OF INFORMATION POLICY
  
• TRAINING PRIORITIES (instead of CLINICAL vs INFORMATICS; integrate INFORMATICS into the curriculum as befits the 21st Century)
  
• RESEARCH: methodologies & methods
  
• STANDARDS (clinical & information, social & ethical)

Interestingly, the success of Begun and White's (1995) appeal is also dependent upon these latter points, which are explored within this website.

"The entrepreneur is essentially a visualizer and an actualizer...
He can visualize something, and when he visualizes it he sees exactly how to make it happen."

Robert L. Schwartz

top : home

© Peter Jones 2000-2005

References:

Abbott, R. (1999) The World as Information, Intellect, Exeter, p.78

AGOCG (1997) Graphics, Visualization and the Social Sciences: Workshop Report, Advisory Group on Computer Graphics, Technical Report Series, #33,ISSN 1356-9066.

Alwyn, S. (1985) Structure in Thought and Feeling, Methuen, New York, App. C.

Bar-Tal, Y., Raviv, A., Spitzer, A. (1999) The Need and Ability to Achieve Cognitive Structuring: Individual Differences That Moderate the Effect of Stress on Information Processing, Jour. of Pers. and Soc. Pscyhol., 77,1,33-51

Becker, S.L. (1978) Visual stimuli and the construction of meaning, Randhawa BS et al. (Eds.) Visual Learning, Thinking and Communication, Academic Press, London, 39-60.

Begun, J.W., White, K.R. (1995) Alt. Nursing's Dominant Logic, Complexity and Chaos in Nursing, 2:1,10

Benner, P. (1984) From Novice to Expert: excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley.

Biderman, A., Herman, J. (2002) Did Weir Mitchell anticipate important concepts in ambulatory care and clinical epidemiology? J. Clin. Epidem., 55: 418–421.

Born, R.P., Born-Lechleitner, I. (1988) Introduction, Artificial Intelligence: The Case Against, Born, R.P. (Ed.) Croom Helm, London, vii-xxxv.

Castledine, G. (2000) We must all press to protect the title 'nurse', Br. J. Nurs., 8,(6),406.

Clark, J.H. (1983) A Map of Mental States, RKP.

Copnell, B. (1998) Synthesis in nursing knowledge: an analysis of two approaches, J. of Adv. Nurs., 27,870-874.

Cowman, S. (1993) Triangulation: a means of reconciliation in nursing research, J. of Adv. Nurs., 18,788-792.

Crow, R.A., Chase, J. et al. (1995) The cognitive component of nursing assessment: an anlysis, J. of Adv. Nurs., 22,206-212

Decrop, A. (1999) Triangulation in Qualitative Tourism Research, Tourism Management, 20, 157-161.

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

Emery, R. (2003) Could a “philosophical fitness landscape” foster Wilsonian consilience in biosystems debates? BioSystems, 72, 217–227.

Eskin, F., Bull, A. (1991) Squaring a difficult circle, HSJ, 101,5253,10 Jan., 16-19.

Fiandt, K., Forman, J., Erickson Megel, M., Pakieser, R.A., Burge, P. (2003) Integral Nursing: An Emerging Framework for Engaging the Evolution of the Profession, Nurs Outlook;51:130-7.

Goddard, J., Alty, A., Gillies, A. (2001) A case study in mental health informatics: barriers and attitudes to information support for integrated care pathways, ITiN, BCS-NSG, 13,3,12-15.

Hadwin, P. (1996) Brief Therapy in Mental Health Nursing Practice, MHN, 16,6,20-23.

Hansen, Y.M. (1999) Information Design, MIT Press, p.196.

Harrison, R.F. (1999) Visualisation of biomedical datasets by use of growing cell sructure networks: a novel diagnostic classification technique, The Lancet, 354,1518-21.

Heathfield, H., Hudson, P., Kay, S., Mackay, L., et al. (1999) Issues in the multi-disciplinary assessment of healthcare information systems, Information Technology & People, 12: 3, 253-275.

Hsu, S.H., Chuang, M.C., Chang, C.C. (2000) A Semantic Differential Study of Designers' and Users' Product Form Perception, Int. J. of Industrial Ergonomics, 25: 375-391.

Jacobson, R. (Ed.) (1999) Information Design, MIT Press, Cambs. Mass.

Janesick, V.J. (1994) The Dance of Qualitative Research Design: Metaphor, Methodolatory and Meaning, Denzin, N.K., Lincoln, Y.S. (Eds.) A Handbook of Qualitative Research, Sage, Thousand Oaks, 209-219.

Knafl, K.A., Breitmayer, B.J. (1989) Triangulation in qualitative research: issues of conceptual clarity and purpose, Qualititative Nursing Res., Morse, J.M. ed., Aspen, Maryland, 209-220.

Kramer, B. (1995) Classification of generic Places: Explorations with implications for evaluation, J. Env. Psychol., 15,3-22.

Laskin, J.H., Simon, H. (1995) Why a Diagram Is (Sometimes) Worth Ten Thousand Words, In Diagrammatic Reasoning: Cognitive and Computational Perspectives, (Eds.) Glasgow, J., Narayanan, N.H., Chandrasekeram, B., AAAI Press, MIT Press, London.

Magee, B. (1987) The Great Philosophers, BBC Books, London, 258.

McInnis-Dittrich, K. (2001) Social Work with Elders: a Biopsychosocial Approach to Assessment and Intervention, Allyn & Bacon

Meana, M., Binik, Y.M., Khalife, S., Cohen, D.R. (1997) Biopsychosocial Profile of Women With Dyspareunia, Obstetrics & Gynecology, 90,4,1,583-589.

Meece, E.A., (1979) Philosophy on a Circle: The Way of The Wisdom Wheel. Master’s Paper, San Jose State University [http://www.california.com/~eameece/questionnaire.htm].

Moons, P., Arnauts, H., Delooz, H.H. (2003) Nursing issues in care for the elderly in the emergency department: an overview of the literature, Accident and Emergency Nursing, 11, 112–120.

Morse, J.M., ed. Triangulation in qualitative research: issues of conceptual clarity and purpose, Qualititative Nursing Res., Aspen, Maryland, 209-220.

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

Nicassio, P.M., Smith, T.W. (Eds.) (1996) Managing Chronic Illness: A Biopsychosocial Perspective (Applications and Practice in Health Psychology), American Psychological Association.

Nolan, M., Behi, R. (1995) Triangulation: the best of all worlds? Brit. J. of Nursing, 4,14,829-832.

Orford, S., Dorling, D., Harris, R. (1998) Review of Visualization in the Social Sciences: A State of the Art Survey and Report, Advisory Group on Computer Graphics, JISC, ESRC, Technical Report Series, #41, ISSN 1356-9066.

Osgood, C.E., Suci, C.J., Tannenbaum, P.H., (1957) The Measurement of Meaning. University of Illinois Press, Urbana, 76-124.

Peplau, H.E. (1995) Some unresolved issues in era of biopsychosocial nursing, J. American Psychiatric Nurses Assoc., 1,3,92-96.

Powsner, S.M., Tufte, E.R. (1994) Graphical Summary of Patient Status, The Lancet, 344,386-389.

Rajagopal, P. (2002) An innovation—diffusion view of implementation of enterprise resource planning (ERP) systems and development of a research model, Information & Management, 40,87–114.

Rosch, E. (1975) Cognitive representations of semantic categories, J. Experimental Psychol: General, 104:3,192-233.

Rush, K.L., Ouellet, L.L. (1993) Mobility: a concept analysis, J. of Adv. Nurs., 18, 486-492.

Ryle, G. (1949) The Concept of Mind, Peregrine, Chap.II

Shih, F.J. (1998) Triangulation in nursing research: issues of conceptual clarity and purpose, J. of Adv. Nurs., 28, 631-641.

Smilkstein, G., Helsper-Lucas, A., Ashworth, C., Montano, D., Pagel, M. (1984) Prediction of pregnancy complications: An application of the biopsychosocial model, Social Science & Medicine, 18,4,315-321.

Stenning, K., Inder, R. (1995) Applying Semantic Concepts to Analyzing Media and Modalities, Diagrammatic Reasoning: Cognitive and Computational Perspectives, (Eds.) Glasgow, J., Narayanan, N.H., Chandrasekeram, B., AAAI Press- MIT Press, London.

Sullivan, M. (2003) The New Subjective Medicine: taking the patient's point of view on health care and health, Soc. Sci. & Med., 56, 1595-1604.

Swallow, J.N., Sermet, O. (1969) A Study of Dentally Anxious Children using the Semantic Differential Test, Journal of Psychosomatic Research, 13: 4, 357-362.

Trochim, W., Cook, J. Setze, R. (1994) Using concept mapping to develop a conceptual framework of staff's views of a supported employment program for persons with severe mental illness. Consulting and Clinical Psychology, 62, 4, 766-775.

Tufte, E.R. (1997) Visual Explanations: Images and quantaties, evidence and narrative, Graphics Press, Conn..

Turley, J.P. (2000) Toward an Integrated View of Health Informatics, Information Technology in Nurs., 12,4,10-14.

Ward, R. (1993) The search for meanings in nursing: could Facet Theory be a way forward? J. Adv. Nurs.,18, 549-557.

Weis, D., Schank, M.J. (2002) Professional Values: Key to Professional Development, J. of Prof. Nurs.,18,271-275.

Williams, C., Williams, S., Appleton, K. (1997) Mind Maps: An aid to effective formulation, Behav. and Cog. Psychotherapy, 25,261-267.

Wilson, E.O. (1998) Consilience: The unity of knowledge, Abacus.

Votava, Z. (1985) The Czechoslovak approach to biopsychosocial health, Social Science & Medicine, 21,12,1381-1382.

Wilber, K. (2000) Integral Psychology: Consciousness, Spirit, Psychology, Therapy, Shambhala Publications, ISBN: 1570625549.

Woolley, N. (1990) Nursing Diagnosis: exploring the factors which may influence the reasoning process, J. of Adv. Nurs., 15, 110-117.

top : home