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Stories From Practice

How the MRM Theory is being utilized in practice

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Where do our clients get support? “Sometimes the client will deplete energy stores trying to maintain a support system when instead he or she should be acquiring, building, and storing energy by interacting with the support system. An impoverished person does not have the energy to invest in maintaining others without further depleting his or her own internal resources… Nurses have seen many patients who have tried to allay the anxieties of their loved ones when the patients should have been receiving the interventions. There are other, however, who perceive their families as vital to their well-being. For example:

A 28-year-old male who, when confronted with open heart surgery to repair a septal defect and mitral valve insufficiency, requested that his wife (a nurse) have special visiting privileges after surgery. When the request was denied by the health care system, this man went off to surgery with great bravado. He had seemingly accepted his state of affairs. Imagine everyone’s surprise when he returned from surgery and refused to speak or understand his own language, but spoke Spanish instead, a language he and his wife had studied together. Since none of the nurses or doctors could understand him and he refused to understand them, his wife was allowed to spend the first 24 hours with him. This was substantially different from the typical five minutes per hour that the health care team had planned for him.”

Erickson, H. C., Tomlin, E. M., & Swain, M.A. (1983). Modeling and role-modeling a theory and paradigm for nursing. Englewood Cliffs, NJ: Prentice-Hall, Inc.

Modeling the Client’s World

E had moved to assisted living from a senior independent apartment, due to Alzheimer’s. Two of her life pleasures had been dancing and driving. She described trips where she drove and her husband sat in the passenger seat and worked or read. They regularly spent evenings at a local ballroom, dancing the night away. After he was gone, she was lonely without him, and besides needing a health care advocate, she also needed some outings that didn’t require the complexity of socializing. These outings gave us an opportunity to incrementally build a trusting relationship, a definite need for someone with no children and no family in the area. Partially because of her ‘aloneness’, Alzheimer’s understandably brought on some paranoid tendencies. This provided specific challenges in building a trusting relationship. Thus the outings had therapeutic value.

It was not easy to find outings that were meaningful to E. When she walked with a walker, and could no longer drive, how could I connect through dancing or driving? One day we drove past a huge empty church parking lot. Bingo! I pulled into the parking lot, put a tape in the tape deck, and turned up the music that she and her husband had danced to in their youth, the Big Band Sounds of World War II. I invited her to put both hands over onto the steering wheel. I told her we were going to dance the car. She rhythmically and slowly turned the steering wheel, closed her eyes, and allowed a huge smile to slowly spread across her face. She (we) danced the car safely in this huge empty parking lot. When she eventually opened her eyes and released the steering wheel, she was visibly relaxed and happy. This became a favorite outing, promoting connection and relaxation, practicing presence, and using relationship as intervention.

Ellen Swanson, RN, MA Do not reproduce without permission from Ellen Swanson

A Student Experience Modeling the Client’s World

A baccalaureate student nurse chose to do her senior practicum in public health with a focus on diabetic patients. She spent fall semester developing an assessment tool based on her chosen nurse theory, Modeling and Role-Modeling (MRM), and her focus area. This required a great deal of work studying the literature and research on both the theory and diabetes. Spring semester, she was assigned a woman with diabetes. The staff warned the student that the woman was considered “high maintenance”.

On the initial home visit, armed with her assessment tool, the student met with the patient fully intending to focus on the woman’s diabetes. However, to model the patient’s world, she first asked the patient to tell her about herself and what she felt she needed. The woman proceeded to tell her that she had her diabetes well under control. She reported that she had been a very social person and would have coffee with friends at least weekly, but was now incontinent and afraid to leave the house due to worry of accidents. The student was horrified to hear this as all her work had been on diabetes and her assessment tool was now useless. She admitted to her professor that she was tempted to disregard the patient’s concerns, because it would mean an immense amount of work to develop a new assessment tool based on incontinence. But, she said she realized that to be faithful to MRM, she needed to model the patient’s world. So, she developed a new assessment tool and, in addition, using her own money, purchased a variety of incontinence products for the patient to try. The patient found the products helpful and made her feel safe enough to go out and join her friends for coffee again. Not surprisingly, she no longer was “high maintenance”. When the student reported all of this to the public health agency staff, they were amazed and asked how she had found out this information. The student told them that she had simply modeled the patient’s world and that made all the difference.

Riki Scheela, PhD, RN Professor Emerita, Bemidji State University