MRM, Selected Definitions
Barbara L. Irvin, RN, PhD
Written
January 1997
All people are alike in some
ways and different in other ways. Some commonalities exist among
people as holistic beings, including their basic needs,
developmental stages and drive for affiliated-individuation.
Differences among people include their genetic endowment, unique
model of the world and how they adapt to stress.
Similarities Among
People
Holism:
Belief that people are more than the sum of their parts; that
body, mind, emotion and spirit function as one unit, affecting
and controlling the parts in dynamic interaction with one
another; thus, conscious and unconscious processes are equally
important.
Basic Needs:
Based on Maslow's hierarchical ordering of basic and growth
needs which drive behavior. Basic needs are only met when person
perceives they are met. According to Maslow, when a need is met,
it no longer exists, and growth can occur. Anxiety is secondary
to unmet needs; thus when basic needs are unmet, a situation may
be perceived as a threat, and physical or psychosocial distress
and illness may occur. 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:
Concept unique to MRM theory based on belief that all people
have instinctual drive to be accepted and dependent on support
systems throughout life, while also maintaining sense of
independence and freedom. Differs from concept of
interdependence.
Attachment and Loss:
People have an innate drive to attach to objects that repeatedly
meet their needs and they grieve the loss of any of these
objects. Loss can be real, perceived or threatened. Unresolved
loss leads to lack of resources to cope with daily stressors
resulting in morbid grief and chronic need deficits.
Psychosocial Stages:
Based on Erikson's theory, task resolution depends on degree of
need satisfaction. Resolution of stage critical tasks lead to
growth-promoting (trust) or growth-impeding (mistrust) residual
attributes that affect one's ability to be fully functional and
able to respond in a healthy way to daily stressors. As one
negotiates each age-specific task, he or she gains enduring
character building strengths and attitudes (virtues) such as
self-control or willpower.
Cognitive Stages:
Based on Piaget's theory, thinking abilities also develop in a
sequential order and it is useful to understand the stages to
determine what developmental stage the client might have had
difficulty with or need to work on. Thus, with client education,
keep information simple for a client in stage of concrete
operations (develops age 7-11).
DIFFERENCES AMONG PEOPLE
Inherent Endowment:
Genetic as well as prenatal and perinatal influences that affect
health status.
Model of the World:
A person's perspective of his or her own environment, based on
past experiences, knowledge, state of life, etc.
Adaptation:
The way a person responds to stressors that is health and
growth-directed.
Adaptation Potential:
Individual ability to cope with stressor; i.e., to mobilize
resources; can be predicted with an assessment model (APAM)
which delineates three categories of coping: arousal,
equilibrium and impoverishment. Resources may be internal or
external. Arousal reflects anxiety and tension. Equilibrium is a
relatively steady state of balance and may be either adaptive or
maladaptive. Whereas adaptation is positive, a maladaptive state
is one in which the person is coping with stressful stimuli, but
only at the cost of draining energies from another subsystem.
Impoverishment is a state in which people have diminished or
depleted resources to draw upon.
Stress:
A general response to stressful stimuli in pattern of changes
involving the endocrine, GI and lymphatic systems which Selye
identified as the general adaptation syndrome (GAS). The three
phases of the GAS are the alarm reaction, stage of resistance
and stage of exhaustion. Stimuli may be perceived as threatening
or challenging (Lazarus); stressful or distressful (Selye).
Engle identifed psychological reactions to stress as with the
flight or fight response. MRM theory synthesizes all of these
into a more holistic view.
Self-Care:
The process of managing responses to stressors. Self-care
includes what we know about ourselves, our resources, and our
behaviors.
Self-Care Knowledge:
Information about self a person has concerning what promotes or
interferes with his or her own health, growth and development;
what has affected an illness or contributed to a current
problem; and what is needed to promote fulfillment,
effectiveness in a situation, or optimal health. Includes
mind-body data.
Self-Care Resources:
Internal and external sources of help for coping with stressors.
Developed over time as basic needs are met and developmental
tasks achieved.
Self-Care Action:
Development and utilization of self-care knowledge and resources
to promote optimum health. Include all conscious and unconscious
behaviors directed toward health, growth, development and
adaptation.
NURSING ROLES
Facilitation:
Helping client identify, mobilize and develop personal strengths
in moving toward health.
Nurturance:
Gently supporting and encouraging client to integrate all
biophysical, cognitive and affective processes in movement
toward health
Unconditional
Acceptance: Using
empathy to fully accept person as worthy with no strings
attached.
AIMS OF INTERVENTION
Build Trust:
Through nurse-client relationship; keep promises, meet basic
physical and safety needs through being truthful and
trustworthy; use touch and boost esteem needs, through affirming
comments about strengths.
Promote Positive
Orientation: In
other words, accept client as worthwhile and facilitate ability
to project oneself into a positive future through making
comments about events that might occur next week, etc.
Promote Control:
In other words, perceived control is the key; ask what client
needs and how you can help; offer options in plan of care;
recognize small accomplishments such as breathing evenly,
control bleeding.
Affirm and Promote
Strengths: Comment
on small strengths, e.g., strong pulse, ability to void, to walk
from bed to chair.
Set Mutual,
Health-Directed Goals:
Involve client in developing health directed interventions that
fit within his or her model of the world
------------
Reference
Erickson, H.C., Tomlin, E.M., & Swain, M.A. (2005) (8th
Printing). Modeling and role-modeling: A theory and paradigm
for nursing. Cedar Park TX: EST Company. (Original printing
by Prentice Hall, 1983).
Erickson, H. (Ed). (2006) Modeling and role-modeling: a
view from the client’s world. Cedar Park TX: Unicorns
Unlimited.
Erickson, H. (1990). Theory based nursing. In H. Erickson &
C. Kinney (Ed). Modeling and role-modeling: theory, practice
and research. Vol 1(1), pp. 1-27. Cedar Park TX: The Society
for the Advancement of Modeling and Role-Modeling.