Developed in the UK during the early 1980s, Hodges’ model is a conceptual framework that is person-centred and situation based. In structure it combines two axes to create four care (knowledge) domains (as per figures 1 and 2). Academics and practitioners in many fields create models that help support theory and practice (Wilber, 2000). Models act as a memory jogger and guide. Whereas in health education theoretical frameworks are discipline related with specific and generic uses, community informatics emerged from university, corporate and governmental environments without a model (Clement, et al., 2004). In health care generic models can encourage holistic practice directing the user to consider the patient as a whole person and not merely as a diagnosis derived from physical investigations. Exposure of h2cm is limited to a small (yet growing) cadre of practitioners; several published articles (Hinchcliffe, 1989; Adams, 1987; Jones 2004a, b). In addition to a website (Jones, 1998) there is a blog and an audio presentation both first published in 2006.
The best way to explain h2cm is to review the questions Hodges originally posed. To begin, who are the recipients of care? Well, first and foremost individuals of all ages, races and creed, but also groups of people, families, communities and populations. Then Hodges asked: what types of activities – tasks, duties, and treatments – do nurses carry out? They must always act professionally, but frequently according to strict rules and policies, their actions often dictated by specific treatments including drugs, investigations, and minor surgery. Nurses do many things by routine according to precise procedures; as per the stereotypical matron with machine-like efficiency. If these are classed as mechanistic, they contrast with times when healthcare workers give of themselves to reassure, comfort, develop rapport and engage therapeutically. This is opposite to mechanistic tasks and is described as humanistic; what the public usually think of as the caring nurse. In use this framework prompts the user to consider four major subject headings or care domains of knowledge. Namely, what knowledge is needed to care for individuals – groups and undertake humanistic – mechanistic activities? Through these questions Hodges’ derived the model depicted on the main website:
– and blog associated with the model ‘Welcome to the QUAD’:
http://hodges-model.blogspot.com/ (please see the tags for posts since April 2006)
Initial study of h2cm on the website has related Hodges’ model to the multicontextual nature of health, informatics, consilience (Wilson, 1998), interdisciplinarity, and visualization. H2cm says nothing about the study of knowledge, but a great deal about the nature of knowledge is implied in figures 1 and 2. This prompted two web pages devoted to the structural and theoretical assumptions of h2cm (Jones, 2000a, b.). Although the axes of h2cm are dichotomous, they also represent continua. This duality is important as an individual’s mental health status is situated on a continuum spanning excellent to extremely unwell. There are various states in-between affected by an individual’s beliefs, response to stress, coping strategies, epigenetic and other influences. H2cm was created to meet four educational objectives:
- To produce a curriculum development tool.
- Help ensure holistic assessment and evaluation.
- To support reflective practice.
- To reduce the theory-practice gap.
Since h2cm’s formulation these objectives have grown in relevance. The 1980s may seem remote, but these problems are far from archaic as expansion of points 1-4 reveals. Student life is preparation for life-long learning. Curricula are under constant pressure. Despite decades of policy declarations, truly holistic care (combining physical, mental and pastoral care) remains elusive. The concept and practice of reflection swings like a metronome, one second seemingly de rigour, the next moment the subject of web based polls. H2cm can be used in interviews, outlining discussion and actions to pursue, an agenda – agreed and shared at the end of a session. The model is equally at home on paper, blackboard, flipchart and interactive whiteboard. Finally, technology is often seen as a way to make knowledge available to all practitioners; the means to bridge theory-practice gap through activities such as e-learning, governance and knowledge management.
The axes within h2cm create a cognitive space; a third axis projecting through the page can represent history; be that an educational, health or other ‘career’. It is ironic, that an act of partition can simultaneously represent reductionism and holism. Reductionism has a pivotal role to play, which h2cm acknowledges in the sciences domain. What h2cm can do is prompt the expert (single domain) practitioner that there are three other pages to reflect and write upon.
Adams, T. (1987). Dementia is a Family Affair. Community Outlook, Feb, pp. 7-8.
Clement, A., Gurstein, M., Longford, G., et al. (2004). The Canadian Research Alliance for Community Innovation and Networking (CRACIN), Journal of Community Informatics, 1, 1, pp. 7-20.
Cunliffe, B. (2001). The Extraordinary Voyage of Pytheas the Greek, Penguin.
Hinchcliffe, S.M. (Ed.) (1989). Nursing Practice and Health Care, [1st Edition only], London, Edward Arnold.
Hughes, E. (1958). Men and their Work. New York: Free Press.
Jones, P. (1996). Humans, Information, and Science. Journal of Advanced Nursing, 591-598.
Jones, P. (1998). Hodges’ Health Career Care Domains XE “Domains” Model.
Retrieved May 12, 2007, from HYPERLINK “http://www.p-jones.demon.co.uk” http://www.p-jones.demon.co.uk
Jones, P. (2000a). Hodges’ Health Career Care Domains XE “Domains” Model, Structural Assumptions. Retrieved May 12, 2007, from
HYPERLINK “http://www.p-jones.demon.co.uk/theory.html” http://www.p-jones.demon.co.uk/theory.html
Jones, P. (2000b). Hodges’ Health Career Care Domains XE “Domains” Model, Theoretical Assumptions. Retrieved May 12, 2007, from
HYPERLINK “http://www.p-jones.demon.co.uk/struct.html” http://www.p-jones.demon.co.uk/struct.html
Jones, P. (2004a). Viewpoint: Can Informatics And Holistic Multidisciplinary Care Be Harmonised? British Journal of Healthcare Computing & Information Management, 21, 6, 17-18.
Jones, P. (2004b). The Four Care Domains XE “Domains” : Situations Worthy of Research. Conference: Building & Bridging Community Networks: Knowledge, Innovation & Diversity through Communication, Brighton, UK.
Retrieved May 7, 2007, from HYPERLINK “http://www.comminit.com/healthecomm/planning.php?showdetails=318” http://www.comminit.com/healthecomm/planning.php?showdetails=318.
Wilber, K. (2000). Integral Psychology: Consciousness, Spirit, Psychology, Therapy. Shambhala Publications.
Wilson, E.O. (1998). Consilience: The Unity of Knowledge, Abacus.
KNOWLEDGE – CARE – Domain link resources: