Modeling and Role Modeling Theory

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 Syndrome.

The Modeling and Role Modeling Theory explains some commonalities and differences among people.

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.

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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
  her behaviors.
• 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 perspective.

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.
• Morbid grief is always related to need deficits.