This document discusses Hodges' model, a conceptual framework for organizing healthcare knowledge into five domains. It was created in the 1980s as a way to support holistic care, direct curriculum, bridge theory and practice, and facilitate reflection. The document provides background on the model and outlines exercises applying it to a case study about a student struggling after family issues. It also discusses potential research directions for the model, such as exploring its relationship to threshold concepts and how it could be adapted for new purposes in the 21st century healthcare system and interdisciplinary fields.

1. Hodges’ Health Career –Hodges’ Health Career –
Care Domains – Model*Care Domains – Model*
Threshold Concepts in Practice
5th Biennial International Threshold
Concepts Conference
9th – 11th July 2014, Durham, England
https://www.dur.ac.uk/education/cap/conferences/thresholds2014/
Peter JonesPeter Jones
*Hodges’ model created by Brian Hodges*Hodges’ model created by Brian Hodges

2. My background:My background:
Community Mental Health Nurse Older AdultsCommunity Mental Health Nurse Older Adults
Intermediate Support Team Older AdultsIntermediate Support Team Older Adults
Ribbleton Hospital, Preston, Lancashire, UKRibbleton Hospital, Preston, Lancashire, UK
RMN, RGN, CPN(Cert.) BA(Hons.) Comp./Phil.RMN, RGN, CPN(Cert.) BA(Hons.) Comp./Phil.
PG(Dip.)COPE, PGCEPG(Dip.)COPE, PGCE
Graduate student, Technology Enhanced Learning, LancasterGraduate student, Technology Enhanced Learning, Lancaster
University.University.
1.1. Nursing Mental health, General, Community MH.Nursing Mental health, General, Community MH.
2.2. Informatics – ZX81, BBC micro – computer-aided learningInformatics – ZX81, BBC micro – computer-aided learning
3.3. Hodges’ model - 1998Hodges’ model - 1998

3. Aims and ObjectivesAims and Objectives
1. To introduce Hodges’ model
2. Apply Hodges’ model
3. Research directions
4. Tentative links to Threshold Concepts
5. To learn from this community!

4. Hodges’ model is…Hodges’ model is…
 A conceptual frameworkA conceptual framework
 Combines two axes to create five domains ofCombines two axes to create five domains of
knowledgeknowledge
 HISTORY: Created in the 1980s Brian E HodgesHISTORY: Created in the 1980s Brian E Hodges
(Senior Lecturer, Ret.) at MMU.(Senior Lecturer, Ret.) at MMU.
 Not widely published.Not widely published.
 No evidence base.No evidence base.
 Simplistic in appearance.Simplistic in appearance.
 Worthy of research!?Worthy of research!?

5. The need for research…The need for research…
2020thth
– 21– 21stst
CenturiesCenturies
ORIGINAL PURPOSES:
 to support holistic practice and person-
centred care
 to help direct curriculum development
 to help bridge the theory – practice gap
 and to facilitate reflective practice

6. StructureStructure
In this and the next slide the structure and
content – care domains - are explained in the
workshop. This includes the purposes of Hodges'
model and other background.

7. Content:Content:

8. Exercise 1Exercise 1 Conceptual sorting
[ A4 template provided ]
Mobility Infection Fluid intake Subjective
Agitation Sleep Mood
Feeling safe & secure Data Law Freedom
Smartboard Body
Emotional Contentment Eyesight & Hearing
Friends Dignity Respect Spiritual activities Family
Statistics Discuss (speaking) Belonging
Choice Attitude
Policies Advocacy Consent Staffing numbers
Community of Practice Nutrition Pain
Tablet (computer) tablet (medicine) Culture Thought
Accreditation Government policy Insight Autonomy
Process Qualitative Objective
Time Curriculum Lecturer Weight Community
Hope Aspiration Personality Inspiration
Military Engineering Therapy Software
Who What Funding When Where Why How
Moodle (LMS) Equality Organisation Activism Virtual
International Identity

9. Exercise 1Exercise 1 Conceptual sorting – suggested…
Agitation
Subjective Sleep Mood
Feeling safe & secure Emotional
Contentment Choice Attitude
Thought Insight Hope Aspiration
Personality Inspiration
Therapy Who What
When Where Why How
Identity
Body Mobility Pain Fluid intake
Infection Data (digital!)
Nutrition Smartboard
Eyesight & Hearing
Tablet (computer) tablet
(medicine) Process Software
Engineering Statistics Time
Virtual
Weight Qualitative
Discuss (speaking)
Community of Practice Family
Culture Community Belonging
Friends
Spiritual activities Respect Dignity
Policies Advocacy Consent
Staffing numbers
Curriculum Equality Law
Military Freedom Organisation
International
Funding Autonomy Government
policy
Accreditation Lecture Objective
Activism Moodle (LMS)

10. Exercise 2Exercise 2 case studycase study
 James is a first year student at Durham (Earth Sciences) from the Midlands who is
living in a shared flat. His flat mates are concerned for his welfare. Greg and Amy
say his appearance, behaviour and studies are suffering.
 He has often kept to himself in that he visits his grandmother a lot who lives locally.
Apparently his father turned up 11pm two weeks ago last Friday. The news: his
parents are splitting up. A fellow student who answered the door also thought his
dad had been drinking and driving. Since this news James has been late, or missing
lectures. He was reliable with the flat rota but this has lapsed. He was due to move
to his grandmothers who is local to help her. Last w/e James was smoking
something ‘special’ and ended up getting upset, and wet near the river. While upset
James told a friend trying to help him that his gran has dementia. James has been
expressing some odd even paranoid ideas but won’t seek some help thus far.
Ordinarily he is studious and was making good progress.
 Using Hodges’ model can you outline some of the key aspects of the information
provided and next steps.

11. Exercise 2Exercise 2 Case study – suggested…
Low mood, stress, risky
behaviours
Family expectations? Sleep
Mental impact of cannabis –
motivation, being organised,
concentration, attention
Which substance?
Physical health status
Nutrition, Weight, Hygiene
Physical risks
Away from home, Parental
problems
Grandmother – does James need
help with her care?
previous history
Student counselling. Moving into
grandmothers – his choice?
Friends
Confidentiality, Referral to
student support
Engagement, Choice, Consent
Grandmother – access to
services?
James' access to services?
Father’s behaviour
James - disciplinary procedures?

12. The need for research…The need for research…
2020thth
– 21– 21stst
centuriescenturies
ORIGINAL PURPOSES:
to support holistic practice and person-centred care
to help direct curriculum development
to help bridge the theory – practice gap
and to encourage reflective practice.
NEW PURPOSES:
Political dimensions of health care
Self-efficacy, responsibility
To integrate the literacies
Highlight socio-technical perspectives
E-learning...!

13. Research influences - directions 2 –Research influences - directions 2 –
interdisciplinaryinterdisciplinary…?…?
 SituatednessSituatedness
 MulticontextualMulticontextual
 EmbodimentEmbodiment
 LiteraciesLiteracies
 InformaticsInformatics
 Visualization – mind mappingVisualization – mind mapping
 ArgumentationArgumentation

14. Research influences - directions 3Research influences - directions 3
specificsspecifics……
 Michel Serres – philosophical-critiqueMichel Serres – philosophical-critique
• InformationInformation
• ComplexityComplexity
• EcologyEcology
 Conceptual spaces (Gärdenfors, 2000)Conceptual spaces (Gärdenfors, 2000)
• Adapting ‘quality dimensions’... +?Adapting ‘quality dimensions’... +?
 Threshold concepts (Meyer and Land, 2003)Threshold concepts (Meyer and Land, 2003)
• TCs in health literature and here!TCs in health literature and here!
• OtherOther thresholdsthresholds in healthcare?in healthcare?
• Reflection, interrogative wordsReflection, interrogative words

15. Threshold concepts within Hodges' model?Threshold concepts within Hodges' model?
Student's thought, reasoning, cognition
Ontological – 'Being' Transformative (Not just
the concepts - Context dependent – not
forgetting – sundowning phenomena?)
Authentic?
Troublesome: situational awareness.
Engagement in psychosis
Troublesome, 'Complex concepts', maths,
technical, programming, formal languages.
Iatrogenesis
Bounded – balance: standing sitting,
swallowing: dementia, anti-psychotics, (also
specific instances – exceptions) levels of
distress: risk
Integrative titration of meds; bloods-infection-
behaviour
Communities of practice,
Languages
– Discursive – patient, client, service user...?
Jargon
Troublesome, integrative: Cost as a means of
control re. Public health: Alcohol, substance
misuse, sugar, smoking.
'Welfare state' Individual as 'citizen'.
Self-care, 'recovery'.
Professional values (where are they?)
Measure & Outcomes:
'holistic bandwidth'? Complexity?

16. Threshold concepts – discussionThreshold concepts – discussion
(thoughts only…)(thoughts only…)
 Transformative:Transformative: Caring for the other. Rapport-Empathy.Caring for the other. Rapport-Empathy.
One context – several domains of care OR one conceptOne context – several domains of care OR one concept
across several contexts, e.g.across several contexts, e.g. consent, mental capacity, ill-consent, mental capacity, ill-
advised decisions.advised decisions.
 Troublesome:Troublesome: Axial in terms of Hodges’ model?Axial in terms of Hodges’ model?
Individual-group. Ethics. Positive risk management.Individual-group. Ethics. Positive risk management.
Interplay of process – practise, e.g. deprivation of liberty,Interplay of process – practise, e.g. deprivation of liberty,
risk in the community, progression of dementia.risk in the community, progression of dementia.
 Irreversible:Irreversible: Values!?* Not taking things personally, notValues!?* Not taking things personally, not
‘retaliating’, unconditional positive regard.‘retaliating’, unconditional positive regard.
 Integrative:Integrative: Could this also be in part the process ofCould this also be in part the process of
socialisation into a profession?socialisation into a profession?
*But what of POLITICAL factors?*But what of POLITICAL factors?

17.  Bounded:Bounded: Constraints, data reduction, (role of domains /Constraints, data reduction, (role of domains /
disciplines?) context dependent as in person centered care?disciplines?) context dependent as in person centered care?
Communication skills, e.g. silences.Communication skills, e.g. silences.
 Discursive:Discursive: Demonstrated in vocabulary 1-3 yrs, recordDemonstrated in vocabulary 1-3 yrs, record
writing and case discussion/presentation.writing and case discussion/presentation.
 Reconstitutive:Reconstitutive: 'Windows of opportunity' for (care)'Windows of opportunity' for (care)
delivery an individual living with dementia, student’sdelivery an individual living with dementia, student’s
learning about resources – care in the community – (peoplelearning about resources – care in the community – (people
being socialised into care) and ‘political realities andbeing socialised into care) and ‘political realities and
rhetoric’.rhetoric’.
 Liminality:Liminality: Student’s own (dynamic) conceptual space.Student’s own (dynamic) conceptual space.
Threshold concepts – (thoughts only…)Threshold concepts – (thoughts only…)

18. The future … discussionThe future … discussion
Five Ws and ‘H’ Reflective Frameworks
(Gibbs, Johns)
Threshold Concepts
What, Where, When,
Who, Why & How
Nursing,
Interprofessional?
Nurse education, Social
care sector
Conceptual Spaces Hodges’ model Visual tools – mind mapping
Quality dimensions,
domains, regions?
Domains, nursing’s values,
quality dimensions, ‘holistic
bandwidth’?
Software packages
Drupal: content management
system
Visual tools – mind mapping SVG, RDF, dedicated content
types?
Quality dimensions,
domains, regions (re-
factored for h2cm?)
Buzan  early influence!
SW in LMS?
For Hodges’ model?

19. Thank you for your participation!Thank you for your participation!
Blog: Welcome to the QUAD –Blog: Welcome to the QUAD –
http://hodges-model.blogspot.co.ukhttp://hodges-model.blogspot.co.uk//
Since 2006…Since 2006…
Includes a bibliographyIncludes a bibliography
http://hodges-model.blogspot.co.uk/2014/07/h2cm-workshop-at-threshold-concepts.htmlhttp://hodges-model.blogspot.co.uk/2014/07/h2cm-workshop-at-threshold-concepts.html
h2cmuk@yahoo.co.ukh2cmuk@yahoo.co.uk
 Work: +44(0)1772 773496Work: +44(0)1772 773496
 Mob: +44(0)7753222286Mob: +44(0)7753222286
@h2cm@h2cm