Brian Hodges

Peter Jones


Jones, P. (2005) Introduction for Patients & Carers
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Introduction to Hodges' Health Career Model for Patients & Carers


Welcome to two pages introducing h2cm.

As a patient or carer you already appreciate why clinicians and policy makers refer to the patient's journey. If you are reading this as a patient or carer Brian and I hope you are not that seasoned a traveller. I will make this assumption though as I try to explain what h2cm is and why it may help you and the services you are in contact with.

Why do we need something called h2cm?

Referring to the patient's journey is a very appropriate start. Travellers have always needed help. How far must I travel? What route must I take? Are there signposts along the way? Is there a map, or must I find my way from landmark to landmark? Is there someone to act as a guide, or must I act as pilot and navigator, and who is in charge? Will it hurt if I 'bump' into something on this journey? What happens upon arrival - will I be a complete stranger in a strange land?

Brian Hodges created h2cm to help with these questions. h2cm can act as a guide or prompt, not just for you to use, but for all with a vested interest in health and social care. Rather than this being another thing that is done for you, or to you, the health career model can be used by you alone. h2cm can help ideally when used together with your healthcare professional, or advocate should you have one.

Several problems prompted Brian to create the health career model.

Firstly, students often need help to remember and connect all the various facts and pieces of knowledge they come across in their studies and practice. When I say students, this applies to qualified staff too, as we are all life-long learners.

The second follows from the need, acknowledged previously, to link theory and practice. This concerns what does the health care team need to know in order to provide 21st century care for you, your family and wider community. This is not just about your doctor, nurse and what they know about the human body, diseases, drugs and treatments. This clinical knowledge is very important, but there is also the small matter of the team and how their knowledge is shared? How does the team function, in order to provide seamless care? Once determined, how can they check that this knowledge is up-to-date and proven, and how can they put this knowledge into practice?

The third point combines 1 and 2 with a most vital ingredient: you! On the internet in health forums you may come across people complaining of lack of attention to physical needs in mental health and vice versa. How can the professionals - who are human themselves - remind themselves that you the patient (or carer) are much more than a diagnosis, much more than a machine that has broken down. Brian's model can literally help us to see more...

Once upon a time ...

If you were writing a story, then you would start with a blank document. What you need first of course, is ideas, something to write about. As a patient you do not suffer from writer's block, you have a story to tell. A story filled with pain, discomfort, plus change - the contant stream of new drugs, treatments, new ways to book appointments, several opinions, uncertainty and possibly fear too.

h2cm can help reduce this uncertainty, guide your thoughts and your priorities and make these accessible to others. You may already have been given a copy of a care plan. h2cm can complement this, not replace it. You would not set out on a journey without an atlas (either in paper or electronic form).

You might expect that a consultant would be unsettled when a patient walks into the consulting room bearing more than their out-patient appointment card. We are not talking about lists on toilet rolls. When you think about it, the healthcare team may actually be impressed to see that a patient has invested their time in preparing to assist themselves and the team to maximise the time available. Busy staff are becoming increasingly aware of the value of self-assessment, so frequently it comes as no surprise that you arrive with more than a card. Not only has this patient turned up (which helps), but they are keen and motivated to help themselves.

I suppose it may help you at this point to learn just what h2cm is....

What is h2cm? Brian's questions...

The best way to explain Hodges' model is to revisit the questions Brian originally posed. (At the time Brian was teaching nursing students, but h2cm applies to all health & social care professionals.)

To begin: who do nurses care for?

Individual people first and foremost, of all ages, races, and creed, but also groups of people, families, communities, and populations.

Cartoon of nurse giving an injection into frightened man's arm, with over-sized syringe.

Then Brian asked:

What types of things - tasks, duties, treatments - do nurses carry out?

Nurses do things according to strict rules and policies, they use equipment dictated by specific treatments including drugs, investigations, even minor surgery. A good example is an injection. Have you ever wondered - if nurses care so much - how can they stick needles in people? Well the questions posed by Brian explain this in part. Nurses do many things by routine, remember the stereotypical matron, working with machine-like efficiency? What patients and carers want, however, is to be treated as an individual. To have their individuality and value as a human being - their humanity - recognised and respected by another.

If tasks like injections, intravenous fluids are classed as mechanistic, then there follows those activities when healthcare workers give of themselves, developing rapport and engaging therapeutically with you as a person. This is opposite to mechanistic task and is described as humanistic. This is what the public usually think of as the caring nurse.

Putting this all together Brian came up with the diagram below:

Hodges' Health Career - Care Domains - Model axes and domains

Brian's model can take a snapshot of a situation and the various points of view that need to be addressed. This is possible because h2cm helps to shine a light on things that might otherwise be missed. As you can see in the diagram above, the simple questions that Brian asked give rise to a very broad and inclusive range of subjects or what we call here - care domains. While fairly self explanatory, the subjects cover:

Interpersonal - Individual Psychology, Mental Health, Cognitive Science (mind), Expectations, Awareness, Understanding.

Sciences - Anatomy & Physiology, Chemistry, Physics and other Sciences, Informatics (computing).

Sociology - Group dynamics, Social and Cultural studies, History, Self-help groups, Community Informatics

Political - Political Science, Economics, Governance, Human Rights, Health Policy, Legislation - Data Protection, Freedom of Information, Professional regulation, Patient Forums, Service Provision: Nationally and Locally.

Interesting: Tell me more - how does this diagram relate to me?

In the listing that follows are the four care domains, with the particular types of information that would be recorded under that subject. Under the sciences - which emphasises physical measurement, analysis and testing - we might find such information as your height, weight, temperature, blood group and pulse rate.

Combining the two axes or continua, creates four quadrants creates four knowledge or care domains.

  1. Interpersonal (you as an individual, your interests, values, your understanding, fears, beliefs, coping strategies, your mood, problems you face);
  2. Sociological (your family, friends and community);
  3. Empirical (the physical world, the sciences, diagnosis, treatments & drugs, what research says);
  4. Political (waiting times, access to care, funding, benefits, rules, freedom of choice and information).

In addition to being a patient, you are a unique individual with a medical, surgical or other clinical problem you are also (usually) a member of a family, with certain roles and duties to fulfill. In work, out of work or retired you have not only health status, but economic status. Perhaps you are unable currently or occasionally to make decisions for yourself, relying on someody else, who may accompany you on appointments. All of these things and more contribute to the total number of information sources you and the health & social care team must manage. Not all are relevant, hence the importance of initial consultations and communications.

The figure below seeks to reveal h2cm and selected aspects of its relationship to patients and carers. Perhaps, you can fill in the gaps depending on your situation, advocacy workers, self-help, patient forums, support organisations...

Using Hodges' model to present the patient's and carer's situation.
click on image above to enlarge it

If you would like to try h2cm for yourself, our resources page includes a template which you can use.

Part two is not essential in terms of introducing you to h2cm, but develops these themes further....

four pearls, one with earth superimposed - read page 2

Thank you for your interest which is greatly appreciated.

Whether a patient, carer, advocate everybody needs:

help-2c-more - help-2-listen - help-2-care

Copyright © 2005 Peter Jones

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