The Modeling and Role Modeling Theory was developed by Helen 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.
The theory draws concepts from a variety of sources. Included in the sources are
Maslow's Theory of Hierarchy of Needs, Erikson's Theory of Psychosocial Stages,
Piaget's Theory of Cognitive Development, and Seyle and Lazarus's General Adaptation
The Modeling and Role Modeling Theory explains some commonalities and differences
The commonalities among people include:
Holism, which is the belief that people are more than the sum of their
parts. Instead, mind, body, emotion, and spirit function as one unit, affecting
and controlling the parts in dynamic interaction with one another. This means
conscious and unconscious processes are equally important.
Basic needs, which drive behavior. Basic needs are only met when the patient
perceives they are met. According to Maslow, whose hierarchical ordering of basic
and growth needs is the basis for basic needs in the Modeling and Role Modeling
Theory, when a need is met, it no longer exists, and growth can occur. When needs
are left unmet, a situation may be perceived as a threat, leading to distress and
illness. Lack of growth-need satisfaction usually provides challenging anxiety and
stimulates growth. Need to know and fear of knowing are associated with meeting
safety and security needs.
Affiliated Individuation is a concept unique to the Modeling and Role Modeling
Theory, based on the belief that all people have an instinctual drive to be accepted
and dependent on support systems throughout life, while also maintaining a sense of
independence and freedom. This differs from the concept of interdependence.
Attachment and Loss addresses the idea that people have an innate drive to attach
to objects that meet their needs repeatedly. They also grieve the loss of any of
these objects. The loss can be real, as well as perceived or threatened. Unresolved
loss leads to a lack of resources to cope with daily stressors, which results in
morbid grief and chronic need deficits.
Psychosocial Stages, based on Erikson's theory, say that task resolution depends
on the degree of need satisfaction. Resolution of stage-critical tasks lead to growth-promoting
or growth-impeding residual attributes that affect one's ability to be fully functional and
able to respond in a healthy way to daily stressors. As each age-specific task is negotiated,
the person gains enduring character-building strengths and virtues.
Cognitive Stages are based on Piaget's theory, and are the thinking abilities
that develop in a sequential order. It is useful to understand the stages to
determine what developmental stage the patient may have had difficulty with.
The differences among people include:
Inherent Endowment, which is genetic as well as prenatal and perinatal
influences that affect health status.
Model of the World is the patient's perspective of his or her own environment
based on past experiences, knowledge, state in life, etc.
Adaptation is the way a patient responds to stressors that are health- and growth-directed.
Adaptation Potential is the individual patient's ability to cope with a stressor.
This can be predicted with an assessment model that delineates three categories of
coping: arousal, equilibrium, and impoverishment.
Stress is a general response to stressful stimuli in a pattern of changes
involving the endocrine, GI, and lymphatic systems.
Self-Care is the process of managing responses to stressors. It includes
what the patient knows about him or herself, his or her resources, and his or
Self-Care Knowledge is the information about the self that a person has
concerning what promotes or interferes with his or her own health, growth,
and development. This includes mind-body data.
Self-Care Resources are internal and external sources of help for coping
with stressors. They develop over time as basic needs are met and developmental
tasks are achieved.
Self-Care Action is the development and utilization of self-care knowledge
and resources to promote optimum health. This includes all conscious and unconscious
behaviors directed toward health, growth, development, and adaptation.
In the theory, modeling is the process by which the nurse seeks to know and understand
the patient's personal model of his or her own world, as well as learns to appreciate
its value and significance. Modeling recognizes that each patient has a unique perspective
of his or her own world. These perspectives are called models. The nurse uses the process
to develop an image and understanding of the patient's world from that patient's unique
Role modeling is the process by which the nurse facilitates and nurtures the individual
in attaining, maintaining, and promoting health. It accepts the patient as he or she is
unconditionally, and allows the planning of unique interventions. According to this
concept, the patient is the expert in his or her own care, and knows best how he or
she needs to be helped.
This model gives the nurse three main roles. They are facilitation, nurturance, and
unconditional acceptance. As a facilitator, the nurse helps the patient take steps
toward health, including providing necessary resources and information. As a nurturer,
the nurse provides care and comfort to the patient. In unconditional acceptance, the
nurse accepts each patient just as he or she is without any conditions.
The basic theoretical linkages used in nursing practice for this model are: developmental
task resolution (residual) and need satisfaction are related; basic need status, object
attachment and loss, growth and development are all interrelated; and adaptive potential
and need status are related.
According to the theory, the five goals of nursing intervention are to build trust,
promote the patient's positive orientation, promote the patient's control, affirm
and promote the patient's strengths, and set mutual, health-directed goals.
Modeling refers to the development of an understanding of the patient's world, while
role modeling is the nursing intervention, or nurturance, that requires unconditional
acceptance. This model considers nursing as a self-care model based on the patient's
perception of the world, as well as his or her adaptation to stressors.
When it comes to research, the following are some theoretical propositions presented by the model:
The individual's ability to contend with new stressors is directly related
to the ability to mobilize resources needed.
The individual's ability to mobilize resources is directly related to their need deficits and assets.
Distressors are unmet basic needs; stressors are unmet growth.
Objects that repeatedly facilitate the individual patient in need take on
significance for that individual patient. When this occurs, attachment to the significant object occurs.
Secure attachment produces feelings of worthiness.
Feelings of worthiness result in a sense of futurity.
Real, threatened, or perceived loss of the attachment object results in morbid grief.
Basic need deficits co-exist with the grief process.
An adequate alternative object must be perceived as available in order for the patient to resolve his or her grief process.
Prolonged grief due to an unavailable or inadequate object results in morbid grief.
Unmet basic and growth needs interfere with growth processes for the patient.
Repeated satisfaction of basic needs is a prerequisite to working through developmental tasks and resolution of related developmental crises.