An Evaluation of the Theory of Modeling and Role-Modeling

Abstract

The purpose of this paper is to explore Erickson, Tomlin, and Swain’s theory of Modeling and Role-Modeling. This paper evaluates the validity, usefulness, congruence with current nursing standards, and applicability to the nursing profession.

Modeling and Role-Modeling: A Theory and Paradigm for Nursing

, was the main source of information used in evaluating this theory. Other books and articles, along with online sources were also utilized. This paper applies modeling and role-modeling to current nursing issues with the example of how it can be used to combat nurse burnout. In conclusion, this paper sheds light on out importance of this theory to nursing research, education, practice, and future development of the theory to promote holistic nursing.

Keywords:

Modeling and Role-Modeling, nursing, theory

An Evaluation of the Theory of Modeling and Role-Modeling

Helen Erickson, Evelyn Tomlin, and Mary Ann Swain developed the theory of Modeling and Role-modeling, forever impacting the nursing profession. Erickson et al

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originally published their work in 1983 in the book,

Modeling and Role-Modeling: A Theory and Paradigm for Nursing

. Because of it’s continued relevance to the nursing profession this theory has been used as a framework for a multitude of research studies and nursing education curriculums. These theorists believed in the empowerment of the individual to promote and maintain health. They developed a guide to providing holistic nursing care that is easy to follow. In the following paper the major concepts, validity, and relevance of modeling and role-modeling is presented.

The holistic nursing theory of Modeling and Role-Modeling is categorized as a middle-range theory and paradigm. Inspiration was taken from personal experiences of the theorists as well as from the works of Erik Erikson, Maslow, Milton H. Erickson, Piaget, Selye, and Engel to develop a holistic theory for nursing practice. (Alligood, 2018, p. 400). Erickson et al. (2009) described a person as a holistic being made up of multiple interrelating subsystems. (p.44). The goal of modeling and role-modeling is to achieve and maintain a state of equilibrium of these various subsystems, which is defined as health. The subsystems that make up a person are identified as cognitive, psychological, biophysical, and social. (Erickson et al., 2009, p.45). In this theory the nurse is able to facilitate equilibrium with an understanding of the following concepts.

The first major concept to understand is environment. Environment, in this theory, is made up of a person’s support systems and life stressors. In understanding environment, the understanding of affiliated-individuation is necessary. This is the belief that a person has the instinctual need to be both dependent on and independent of support systems. (Erickson et al., 2009, p. 47). When the nurse identifies and understands a person’s environment he or she can then accurately empower them to achieve and maintain health. Other central concepts significant to this theory are self-care promotion and its relation to the facilitation of the nurse, nurturance, and adaptation. According to Erickson et al. (2009) health occurs when a person learns how to effectively mobilize internal and external resources to achieve a state of well-being. In other words in order to achieve and maintain health, a person needs to learn how to cope or adapt to stressors in his or her life. The nurse’s role is then to become the facilitator in mobilizing internal and external self-care resources. Examples of self care resources include, internal which are a person’s inner strengths embedded in their personality and external, which consist of a person’s surrounding support systems. By mobilizing these self-care resources the nurse promotes self-care action. Self-care actions are the interventions implemented to meet a person’s basic needs that are unique to the individual. Adaptation then occurs when a person effectively responds to internal and external stressors bringing about health or equilibrium by using self-care resources. (Erickson et al., 2009, p.47). Nurturance and unconditional acceptance are key methods the nurse can use to be guide the patient to adaptation. Nurturance is described as the nurse searching for the patient’s

“

personal model of his or her world

”

and then appreciating the importance of it from the patient’s unique perspective. (Erickson et al., 2009, p. 49). In addition to utilizing nurturance, it is important for the nurse to give the patient unconditional acceptance, which is accepting the patient themselves as unique and valued. (Erickson et al., 2009, p.49). In using nurturance and unconditional acceptance the nurse creates a safe place for the patient to be honest about the stressors affecting their health. This then brings about an increase in positive patient outcomes because the interventions used are specific to their individual needs. In accordance with the central concepts explained above, the theorists developed their own definition of nursing. Erickson et al. (2009), describe nursing as “the holistic helping of persons” with self-care actions and an “interactive, interpersonal process” in which the nurse nurtures strength through identifying, and mobilizing resources to ensure coping with one’s environment or life stressors affecting health. (p.49). Due to their beliefs in these central concepts, the theorists developed the holistic theory of modeling and role-modeling.

The modeling and role-modeling theory can be thought of as consisting of two different stages. The first stage is “modeling.” The nurse “models” for his or her patient when he or she develops an understanding of the patient’s world from their perspective. This requires communication with the patient as well as analysis of the patient’s world. Modeling is always done first. It is necessary to carry out the next step of this theory, which is “role modeling”. Role modeling is the facilitation and implementation of purposeful interventions in accordance to the data collected in the modeling stage. (Erickson et al, 2009, p.95).  In other words, this step in the theory consists of the nurse planning and implementing nursing interventions tailored to the individual patient. The main focuses of this theory are self-care, nurturance, and adaptive coping. The nurse promotes all of these focuses with the patient’s unique model of the world in mind. Below is a schematic model depicting the major concepts of modeling and role-modeling.

Figure 3-1 Concepts in our philosophy (Erickson et al., 2009, p. 44).

In addition to analyzing the major concepts and assumptions of a theory, one needs to determine that the theory is logical, valid, testable, and useful to the nursing profession. Determining if this theory is organized logically is easiest to evaluate. Erickson et al. published their theory in the form of a book. The book was written in language that was clear, concise, and easy to follow. It also included real life examples that made it easy for the reader to emulate in everyday nursing practice. Because the theorists presented a logical, well-organized theory, there is a plethora of research studies found that use modeling and role-modeling as a theoretical framework. These studies have been conducted in many classifications of people, of different diagnoses, and of all ages, making this theory diversely applicable. In addition to research, many universities have used modeling and role-modeling as inspiration for their nursing curriculums. Some of these universities include, St. Catherine’s University, University of Texas at Austin and Brownsville, Lamar University, Joanne Gay Dishman Department of Nursing at Beaumont, State University of New York, University of Tennessee at Knoxville, Capital University of Ohio, and Foo Yin College of Nursing and Medical Technology in Taiwan. (Alligood, 2018, p. 408).  McEwen and Wills (2019) thought that “the major attraction” to this theory is that it is practical and is an easily applicable model in guiding nursing research, education, and practice. (p.168). Because this theory can be applied in so many areas of the nursing profession, it can be concluded that the theory is testable, useful, and valid.

To further evaluate the validity of this theory, application to a current practice problem facing the nursing profession is necessary. An example of a current practice problem that the theory of modeling and role-modeling can be used for is nurse burnout. Nurse burnout is a huge issue facing the nursing profession. A study by Mary Elaine Koren,

Mindfulness Interventions for Nursing Students: Application of Modelling and Role Modelling Theory

, applies the concept of self-care promotion to nursing students’ stress. Traditionally this theory is applied to the nurse-patient relationship, but, in this study, the author shows that it can also be applied to a relationship with self. Nurses can take an inventory of their own self-care knowledge and resources and then plan and carry out self-care actions. This study suggests mindfulness training as a form of coping or self-care action. According to Koren (2017), mindfulness training enables a person to reflect on stressors affecting them and in turn promote self-care actions. This study can be applied to practicing nurses easily and has the potential to help decrease burnout. The modeling and role-modeling theory is so generalized that it can be applied to many different areas of the nursing practice, not just patient care.

In addition to evaluating validity and usefulness of a theory, one should evaluate the congruence of the theory with current nursing standards. In comparison to the American Nurses Association (ANA) Code of Ethics for Nurses and Scope and Standards of Practice, there is a direct connection of the theory to these provisions and standards. One example includes ANA Code of Ethics provision 1 which states: “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person”(2015). The theory of modeling and role-modeling is congruent with this provision because it calls for the nurse to collect data from the patient’s world (modeling) and to convey unconditional acceptance of the patient in order to develop a therapeutic relationship to promote self-care action (role-modeling). The theory is also congruent with the ANA Nursing: Scope and Standards of Practice specifically in standard 1 (assessment), standard 4 (planning), and standard 5 (implementation). (Bickford and Gazaway, 2015). The nurse assesses the patient’s needs and self-care knowledge (knowledge of their internal and external stressors) in the modeling stage and then plans and implements interventions in the role-modeling stage. Lastly, it is congruent with standard 8: Cultural congruence. Cultural congruence is when the nurse demonstrates “respect, equity, and empathy” in all interactions and actions of a culturally diverse patient population. (Bickford et al., 2015). Modeling and role-modeling is culturally congruent because it calls the nurse to learn about the patient’s background and environment, which includes his or her culture. This theory guides the nurse to view all people in their uniqueness and recognize how the concept of culture plays a major part in how a person will cope under certain stressors. The nurse is to consider the patient’s worldview and appropriately tailor interventions to promote health.

Finally, in evaluating a theory one must determine its capacity for future development. For modeling and role modeling an entire society was founded for this purpose called the

Society for the Advancement of Modeling and Role-Modeling

. (Alligood, 2018, p.408). Society members meet biennially to provide a forum for nurses to discuss the relationships between and among holistic nursing practice, research, theory, and education. (Alligood, 2018, p.408). Alligood (2018) believed that this theory “guides research, directs practice, and generates new ideas” which makes the theory of modeling and role-modeling invaluable to the nursing profession. (p.409). It has become integral to holistic nursing in the practice setting as well as in education and research.

In conclusion, the theory of Modeling and Role-Modeling by Erickson, Tomlin, and Swain, has made amazing contributions to the nursing profession. This is shown in the vast amount of research studies that utilize the theory and the multiple nursing education programs that mimic the theory in their curriculum. This theory is valid, logical, applicable to current nursing issues, and congruent with ANA code of ethics and standards of practice. It is transcultural and can be applied to all people from different backgrounds with different health issues across the life span. The importance of this theory is proven in the fact that the Society for the Advancement of Modeling and Role-Modeling was founded to ensure future development of the theory. Nurses across all specialties can use this theory to connect with their patients and empower them to do the work necessary to promote and maintain health.

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