title 1
title 2

© 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

<>, Accessed


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.

These attributes:

Individual to Group AND
Mechanistic to Humanistic

- 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.

Hodges model axes with labels
Image of Hodges' model axes and subject domains

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.

It is easy then to see how an individual's sleep problem could affect the family - a carer for example, hence we move from the individual to the group side of the vertical axis - the patient and family. Illness can involve loss of earnings (for carers too), dependence on welfare and care, this then takes us into the political subject realm. Future updates to these pages will include actual examples of assessments using this format.


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.


Ruler

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.

Science title Aspects of Nursing

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.

caduceus
“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.

  1. Previous health career - past medical history
  2. Presenting physical condition - biological features
  3. Physical handicaps
  4. Sensory handicaps (i.e. five senses)
  5. Medication
  6. Nutrition
  7. Genetics
  8. Growth
  9. 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

Interpersonal titleAspects of Nursing

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.

Brain, psychology, neurology, cognition image.
"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
(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

(iii)

Family dynamics
(iv) Sexuality - conflict
(v)

Self awareness/self esteem

coping style - dominant/submissive
(vi)

Spirituality

vii)

Other headings


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

Sociology title Aspects of Nursing

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.

City image, society, social groups.

"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

Political title Aspects of Nursing

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.

Politics, law, power.

"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

rule

© 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.

A bridge - theory to practice}

References

Wyle H.C., (1960) Universal English Dictionary, 13th Ed.

Move to top of this document HCM Home page

 !  See also

Welcome

HCM Introduction

Brian's notes II:
Theory-Practice

HCM & Multicontexts

My reflections


Interpersonal Links

Science Links

Sociology Links

Political Links


Home