MODELING AND ROLE MODELING THEORY Helen c. Erickson MODELING AND ROLE MODELING THEORY

Timothy Amborski James Furstenau Kim Karwowski Kimberly Miller Presented by: Timothy Amborski James Furstenau Kim Karwowski Kimberly Miller Ferris State University Nursing 324 Nursing Theorist Group 7 Presentation February 26, 2012

The University of Michigan Saginaw General Hospital School of Nursing Helen C. Erickson HELEN C. ERICKSON The University of Michigan PhD, Educational Psychology 1976 – 1984 MS, 1974-76; BSN, 1972-74 Activities and Societies: Sigma Theta Tau, Rho Chapter Saginaw General Hospital School of Nursing Diploma in Nursing, Nursing 1954 – 1957

Erickson's Modeling and Role Modeling Theory Introduction Erickson's Modeling and Role Modeling Theory   The Modeling and Role Modeling Theory was developed by Helen C. Erickson, Evelyn M. Tomlin, and Mary Anne P. Swain. It was first published in 1983 in their book Modeling and Role Modeling: a Theory and Paradigm for Nursing. The theory enables nurses to care for and nurture each patient with an awareness of and respect for the individual patient's uniqueness. This exemplifies theory-based clinical practice that focuses on the patient's needs(Helen C. Erickson, 2011).

Helen C. Erickson credentials Clinical Background ER and Medical - Surgical Nursing Director of Health Services; San German, Puerto Rico Independent Psychiatric Nurse Consultant Current Activities Actively researching Modeling and Role-Modeling Theory Professor Emeritus; University of Texas at Austin Faculty Consultant for MRM; Various Schools of Nursing & Service Agencies Board of Directors; American Holistic Nurses Certification Corporation (The Society for the Advancement of Modeling and Role Modeling, 2011).

Historical Background Maslow's Theory of Human Needs was used to help label and articulate Helen Erickson's observations the unmet basic needs interfere with holistic growth whereas satisfied needs promote growth. The MRM Theory was written over several years. Culmination of work published in the book, "Modeling and Role-Modeling: A Theory and Paradigm for Nursing", in 1983 (The Society for the Advancement of Modeling and Role Modeling, 2011).

Influence of Philosophy Helen Erickson credits Milton H. Erickson in the formulation of Modeling and Role- Modeling, when he told her to "Model the client's world, understand it as they do, then role-model the picture the client has drawn, building a healthy world for them."(The Society for the Advancement of Modeling and Role Modeling, 2011).

Influence of Philosophy According to Sappington & Kelley: The Theory of Modeling and Role-Modeling enables the nurse to care for and nurture each client with an awareness of and respect for the individuals uniqueness. This type of care giving exemplifies theory-based clinical practice that focuses on the clients needs. Care is offered that recognizes that clients have the knowledge and the ability to understand what has made them sick, as well as what will make them well (1996).

Modeling and role-modeling Theory MRM provides a paradigm and theory for nursing. MRM is best depicted as a grand theory encompassing numerous mid-range theories. MRM has been applied in a variety of clinical practice settings, educational programs, and research (The Society for the Advancement of Modeling and Role Modeling, 2011).

Influences on theory creation The Modeling and Role Modeling Theory is unique to nursing in its inclusion of the concepts from: Maslow’s theory of hierarchy of needs Erickson’s theory of psychosocial stages Piaget’s theory of cognitive development General Adaptation Syndrome (GAS) by Selye and Lazarus Retrieved from http://nursingplanet.com/theory/modeling_and_role-modeling_theory.html

Theory premise: all people have Commonalities Differences Holism basic needs affiliated-individuation attachment and loss psychosocial stages cognitive stages Inherent endowment model of the world, adaptation and its potential stress self-care and its knowledge, resources, and action

Global Concepts Modeling: The nurse seeks to know and understand a patient’s unique model of their world in order to appreciate its value and significance to the patient. The nurse uses the information to develop an image and understanding from the patient’s perspective. Role Modeling: The nurse’s role is to facilitate and nurture the individual in attaining, maintaining, and promoting health. It accepts the patient unconditionally and allows for unique individual interventions. According to this concept, the patient is the expert in their own care and knows the best how they need to be helped.

Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8708346 Client-focused The theory enables the nurse to care for and nurture each client with an awareness of and respect for the individual’s uniqueness. It’s based on the client’s needs. Clients have the ability and knowledge to understand what has made them sick. It empowers the patient to grow to heal. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8708346

Holistic nursing

Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17544676 Holistic nursing According to Erickson: Holistic nurses believe that the human being, composed of a mind, body and soul integrated into an inseparable whole that is greater than the sum of the parts, is in constant interaction with the universe and all that it contains. Health and well-being depend on attaining harmony in these relationships. Healing is the journey toward holism. Using presence, intent, unconditional acceptance, love, and compassion, holistic nurses can facilitate growth and healing and help their clients to find meaning in their life experiences, life purpose, and reason for being (2007). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17544676

Encourage independence Establish trusting patient/nurse relationship Holistic View Encourage independence Establish trusting patient/nurse relationship Focus on the clients’ strengths Establish goals focused on the clients’ view of effective recovery Provide patient opportunity to be involved

Modeling and role-modeling Foundation of care The five goals of nursing intervention include: Promote client control Build trust Affirm and promote client’s strengths Promote clients positive orientation Set health directed goals Retrieved from http://nursingplanet.com/theory/modeling_and_role- modeling_theory.html

Modeling and role modeling theory It’s UNIVERSAL! Care focused on the client’s needs and can be used in all area’s of nursing. It involves an “open/holistic view” and applies to all aspects of nursing care.

Why use this Theory? Walsh, VandenBosch, and Boehm state, “this theory has drawn together previously developed knowledge and added new ideas and ways of looking at nursing. It describes the scientific bases useful for our profession and our unique contribution to clients via the art and science of nursing practice,” (1989). “It is a complex theory because of the integration of several theories and ways of looking at man. Although the theory contains many levels of meaning, its basic concepts make sense, and can be readily applied to nursing practice,” (Walsh, VandenBosch, and Boehm, 1989).

Disadvantages to theory usage Time consuming: when a nurse has multiple patients and limited time, it may be difficult to fully implement MRM. Patients are coming into the hospital setting with several co- morbidities and issues. A patient might be private in nature, thus not divulging all the information needed to implement MRM. MRM works on the premise that each patient is knowledgeable about their needs and their wants, which may not be the case.

Nursing Case Study Health History: Mr. Smith is a 55 year old obese male who has been admitted to the medical/surgical unit this morning, after presenting to the emergency department last night. Mr. Smith’s wife found him lying on the floor and mildly confused, when she came home from work yesterday evening. Mr. Smith has been diagnosed with diabetes mellitus, after his blood test results at the emergency department indicated his glucose level was 620 mg/dl. He has no history of a diagnosis of diabetes, however, states that his father has been a diabetic for the past twenty years. Mr. Smith lives with his wife and has a son that lives nearby. His wife and son have been at his bedside at the hospital. Mr. Smith and his wife state they have no knowledge about diabetes, and are anxious about it, but are willing to learn. Mrs. Smith reports that the patient has been having episodes of extreme thirst, irritability, and sweats for the past month, but did not want to go to the doctor. Mr. Smith’s health history also includes hypertension and hyperlipidemia.

Nursing Case Study Continued page 2 Diagnostic Measures: At this time, his vital signs are as follows: B/P 128/72, Pulse 88, Respirations 18, and Temp 97.2F. His oxygen saturation is 98% on room air. His blood glucose level in the E.D. at 8 p.m. last night was 620 mg/dl. All other labs were within normal limits. Mr. Smith denies any pain. He presented as confused and slightly agitated in the E.D. but is now alert & oriented x 4, calm, and cooperative. His heart sounds are a regular rate and rhythm without any murmurs. Lung sounds are clear to auscultation. Bowel sounds are active in all four quadrants. No edema present, and pedal pulses are palpable. He has a peripheral IV placed in the dorsal left hand. His skin was cool and clammy in the E.D. but is now warm and dry. He has a superficial abrasion on his right elbow, which he and his wife attribute to his fall. Mucous membranes are pink but tacky.

Nursing case study Continued page 3 Diet: Once Mr. Smith was admitted to the hospital, he was ordered to follow a special diet, incorporating ADA guidelines. He and his wife state that they are unfamiliar with carbohydrate counting, calorie counting, and diet terms, such as “concentrated sweets”. It is also important for him to have adequate hydration, because he is showing mild signs of dehydration.

Nurse case study Continued page 4 Drug Therapy: Mr. Smith has been ordered to start a long-acting insulin to be taken at bedtime, and a short-acting insulin as needed following a sliding scale. He is also being started on an oral diabetic medication to be taken daily with his breakfast. He is going to continue on his daily oral anti-hypertensive medication and his daily bedtime cholesterol medication. Mr. Smith has been ordered to monitor his blood sugar before each meal and at bedtime, and keep a log of his results to report to his primary care physician. He has been ordered to attend outpatient diabetes diet teaching classes to learn calorie counting and carbohydrate counting upon discharge from the hospital.

Promote patient’s positive orientation. Promote patient’s control. Nursing case study Continued page 5 Nursing Care Plan: Helen C. Erickson’s Modeling/Role Modeling theory emphasizes facilitation, nurturing, and unconditional acceptance. She uses 5 goals in her theory: Build trust. Promote patient’s positive orientation. Promote patient’s control. Affirm and promote patient’s strengths. Set mutual, health-directed goals. How can you utilize her theory to educate this newly diagnosed diabetic patient and his wife on blood sugar monitoring and insulin use?

Answer key to case study Please see separate attachment. Thank you!

References Alligood, M. R. (2009). Nursing Theorists and Their Work. Maryland Heights, MO: Mosby Elsevier. Erickson, H. C., (2011). Retrieved from Nursing theory: http://nursing- theory.org/theories-and-models/erickson-modeling-and-role-modeling- theory.php Erickson, H. (2007, June). Philosophy and theory of holism. Nurs Clin North Am, 42 (2). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17544676 Modeling and Role Modeling Theory. (2012, January 28). Retrieved from http://nursingplanet.com/theory/modeling_and_role-modeling_theory.html

References Nursing-theory.org (2011). Biography and Career of Helen C. Erickson. Retrieved from http://nursing-theory.org/nursing-theorists/Helen-C-Erickson.php Sappington, J., & Kelley, J. (1996, June). Modeling and Re-Modeling Theory. Journal of Holistic Nursing, 130. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8708346 The Society for the Advancement of Modeling and Role Modeling. (2011, February 14). Retrieved from http://www.mrmnursingtheory.org Walsh, K., Vandenbos, C., and Boehm, S. (1989). Modelling and role-modelling: integrating nursing theory into practice. Journal of Advanced Nursing 14, 755. Retrieved from http://deepblue.lib.umich.edu/bitstream/2027.42/74308/1/j.1365- 2648.1989.tb01640.x.pdf