History of MRM: The Story
1957 – 1986:
Modeling and Role-Modeling originated as a practice model by Helen Erickson (1957-72); was conceptually validated by Mary Ann Swain, Director of Research, The University of Michigan (U-M) (1972-1974); was clinically validated by Evelyn Tomlin during joint graduate studies with Erickson (1975); and subsequently, was tested through the individual and joint work of Erickson, Tomlin, and Swain (1976-1986).
During the early years, Erickson created taxonomies of humans’ inherent needs and developmental processes. The first expanded upon Maslow’s theory of Basic and Growth Needs and the second expanded upon Eric Erikson’s Epigenetic Theory of Human Development. Erickson articulated and tested the Adaptive Potential Assessment Model (APAM) Model during her Master’s degree study and the concept of Self-Care Knowledge during her doctoral study.
After completing her education, Erickson joined the U-M nursing faculty. Nurses from many settings were increasingly interested in application of MRM theory in practice, research, and education. Major accomplishments during this time period included:
- Naming the theory, establishing the meaning of Modeling & Role-Modeling, and developing a logo representation of the theory;
- Implementation of MRM theory-based care in direct care settings;
- Initiation of programs of research including nationally-funded studies based on MRM theory by the faculty and students, particularly those at U-M;
- Incorporating MRM theory into educational programs and nursing textbooks;
- Publishing the first book delineating MRM theory; and
- Chartering a professional organization to support development and dissemination of the theory.
Meaning of “Modeling & Role-Modeling (MRM)”
The title MRM was coined during a discussion among interested U-M doctoral students. Erickson rejected the title, “Erickson’s Self-care,” and other similar suggestions. She stated that the work should be remembered for what it stands for—listening to the client, understanding the client’s worldview, and basing care on those understandings. She did not want the book to emphasize the author’s name, charisma, and so forth.
The language, Modeling and Role-Modeling was derived from an answer to a question posed by Helen Erickson to Milton Erickson (her father-in-law). She asked, Where should I start? He responded, “Model and then role-model” which was followed by a statement indicating that it was useless to do anything that matters if you don’t start by modeling their world. Only after modeling their clients’ (view of the) worlds, can nurses plan strategies that help them live the lives they want with meaningful roles—i.e. role-modeling.
The MRM Logo
The original logo of MRM, designed in 1981 by consensus among Erickson, Tomlin and Swain, shows nurse and client in an environment that exists in the universe, allowing for future growth and expansion of the paradigm.
Meaning of Logo:
- The two persons, arms interconnected, represent the human need for mutuality and reciprocity, or in simple language, connections with others without losing one's self (this is affiliated-individuation [A-I]).
- The hand represents the nurse's (or care provider's) role as a facilitator not a regulator. The nurse’s job is to help people heal and grow, at their own rate and in their own time.
- The arm represents the ability to facilitate another person across time and space. When we work with people, as described in MRM, we often "seed" growth that is not immediately observed; however, growth may occur secondary to that seeding. Thus, our ability to affect another person's life over time and space is extremely important. As Watzlawick (1967) says, "You cannot not communicate." Therefore, if the other member of the dyad perceives that you are communicating, you are (even when you don't intend to). In the long run this can be helpful or not, depending on the individual's perception. Thus, the logo has a long arm.
- Jenny James, Clinical Director of the Medical-Surgical units at The University of Michigan Medical Center, observed significant changes in students’ attitudes and nursing actions. She contacted Erickson for consultation. Soon after consultation, MRM was adopted as a framework for the Medical-Surgical units under the direction of James.
- Debra Finch, then head nurse on one of the units, adopted the entire model and initiated implementation. Finch, concurrently enrolled in graduate school, developed a clinical tool designed to assess developmental residual and tested it for her master's thesis.
- Together, Erickson and Swain tested the efficacy of the paradigm and theory through a NIH-funded demonstration study designed to reduce and control hypertension. It was followed by another NIH-funded study with persons who had Type-2 diabetes. Swain served as PI in both studies; Erickson was in charge of the MRM research protocol and data collection. Tomlin joined the research team as an additional clinician practicing from the MRM paradigm and theory.
- By the early 1980's, the original practice-derived model was expanded and tested through research, and ultimately took on a distinctive way-of-knowing and being-with-others. Klienbeck (1977) replicated Erickson's work on the APAM for her master's thesis.
- Other masters and doctoral students applied MRM in their graduate studies. Various constructs were explored and mid-range theories of MRM were developed. For example, Janet Barnfather ultimately created a program of study exploring the validity and reliability of the APAM.
- Early adopters of the paradigm and practice model were the Fundamentals of Nursing Faculty at U-M who taught using the framework before it was formally labeled as Modeling and Role-Modeling. This core of nurse educators published, Introduction to person-centered nursing (Lindberg, Hunter, & Kruzewski, Eds.). The editors introduced the concepts. Hunter wrote about the holistic person, describing the person as a system including a discussion of growth and development as well as exchanges of energy among the subsystems of the person, growth and development.
- In that same book, Tomlin wrote a chapter on Self-Care and referred to it as Helen Erickson's Concept of Self-care, stating, “At the heart of Erickson’s concept of self-care is the notion of the client-identified needs and goals. Each individual knows the kind of help he needs to mobilize his own strengths and resources...” She addressed Affiliated-Individuation; she described it as the relationship between interdependence and autonomy, outlined implications for nursing, and provided illustrations drawn from practice and research (pp. 51-59). This book, the first general nursing book to identify the paradigm and detail the significance of some of the individual foundational theories that were synthesized in MRM theory, was in press when Tomlin and Swain urged Erickson to write a book unique to MRM.
Publication of the “Classic” MRM Book
A cohort of faculty, students, and clinical personnel met weekly to discuss clinical, research, and educational issues as they related to MRM. By the early 1980's, it became apparent that sufficient interest existed to take the work to the next level. As Erickson states, I was running all over teaching nurses how to think about the paradigm and use it and the theory, and was constantly asked where they could get something to read about it. Although I’d written quite a bit, but struggled to get the writings published. In the meantime, the model had been adopted by units in the U-M hospital, and rudiments of it would soon be published in the book authored by the Fundamentals faculty. However, that work didn’t really describe the full intent and scope of MRM. So, I finally got tired of being embarrassed to say that there was minimal information published. I drafted most of the book in a couple of weeks. All in all, it took about 6 months to write the entire book.
The Modeling and Role-Modeling book was published by Prentice Hall in November 1983. The Fundamentals Department faculty book was published a few months later. Erickson learned from Milton Erickson that the connections between two people were key to establishing a relationship, and, by the late 1970s, had studied and adopted the work of those (Bentov, Watson, Rogers and Newman) who defined relations within the science of quantum mechanics.
But, Erickson was primarily concerned about healthcare providers’ lack of consideration for, understanding of, and ready dismissal of the client’s worldview; that is the clients’ subjective perspectives that explained what they needed to initiate and support normal healing processes. Therefore, the classic MRM book focused on the natural abilities of the human to grow, develop, and heal and the implications for caring processes. Energetic connections between two people were alluded to but not articulated in this work. (NOTE: Ellen Schultz and Carolyn Kinney advanced these connections in the second book via the alternative perspectives on how to describe nurse-client relations).
Other Modes of Dissemination
Carolyn Kinney, faculty at U-M, declared that MRM was sufficiently important so that efforts should be made to ensure its longevity.
Establishing the Society (SAMRM): In fall 1985, Kinney suggested a society for the Advancement of Modeling and Role-Modeling. In spring 1986, the Society for the Advancement of Modeling and Role-Modeling (SAMRM) was established at a chartering meeting of the original cohort of graduate nurses and clinicians. This was followed by the First National Conference on Modeling and Role-Modeling sponsored by SAMRM. Charter members included scholars such as Nancy Kline-Leidy, Janet Barnfather, Margaret Erickson, and others. (LEARN MORE)
Transitions among Founding Leaders: During fall 1985, Erickson submitted her resignation from U-M, and then relocated to assume the role of Associate Dean, Academic Affairs at the University of South Carolina (UofSC) in fall 1986.
A year later, Kinney accepted a faculty position at The University of Texas at Austin. Tomlin continued to teach Fundamentals at U-M for a few years and then retired and moved to Illinois. Swain accepted an Administrative position at U-M, and subsequently relocated and became Provost and Vice President for Academic Affairs at the New York State University System.
Concurrently, Jenny James became Vice-President for Nursing at Brigham and Women’s Hospital, Boston, MA. After her stint in Boston, she assumed other high level administrative roles at several other nationally recognized healthcare agencies in the U.S. At each agency, she consistently implemented either the MRM paradigm and/or the theory.
Other colleagues and former students relocated while simultaneously disseminating the philosophical underpinnings of MRM.
1987 – 2016:
In 1988, Erickson became Professor of Nursing and Chair of Adult Health Nursing at The University of Texas at Austin (UT Austin). Over the next several years, several neo-MRM scholars emerged at UT Austin and at other educational institutions. These persons developed new knowledge and models that were linked to MRM and expanded upon the basic MRM foundation.
Major accomplishments during this time period included:
- Dissemination of MRM theory in practice at other health care settings. One achieved Magnet status using MRM theory as the foundation for nursing practice.
- Expanding upon the basic MRM foundation to “grow the theory” through research conducted by neo-MRM scholars.
- Using MRM theory as a foundation for nursing curricula.
- Educating international audiences to MRM theory.
- Publishing two additional MRM theory books which addressed expansion and refinement of the theory’s foundations
- Carolyn Kinney extrapolated from the MRM paradigm and developed the Heart-to-Heart way of being with others, She launched and maintained a private practice until 2015.
- As previously mentioned, Jenny James was also influential in applying MRM in healthcare institutions. MRM was taught to nurses at multiple healthcare agencies nationwide.
- University Health System, San Antonio, TX adopted MRM theory as the foundation for nursing practice in 2006 and obtained Magnet status. See: https://nursology.net/practice-theory-exemplars/university-health-system-san-antonio-texas/
- Erickson tested and validated MRM constructs with healthy populations including those who attended health fairs and US Army soldiers stationed at a local army base.
- Several doctoral students participated in a three-year NIH-funded project (Erickson, PI and Kinney, Co-PI) studying the application effects of MRM on persons living with Alzheimer’s disease and their caregivers.
- Others studied aspects of MRM, expanded upon the nature and implications of concepts, and proposed mid-range theories. (See Reference Lists under MRM Resources). For example:
- Da’Lynn Clayton developed a clinical model specifically for children who were hospitalized or in outpatient clinics;
- Judith Hertz designed and tested the Perceived Enactment of Autonomy Scale as part of the self-care model for seniors;
- Dianne Bensen designed and tested the Group APAM Model;
- Linda Baas designed and tested an instrument to measure the construct of Self-care Resources and Actions with persons diagnosed with cardiac problems;
- Margaret Erickson designed and tested a way to assess type of relations (being or deficit) that teen-age mothers have with their newborns.
- Aspects of MRM were also adopted in several educational programs. One nursing program, under the leadership of administrator Noreen Frisch and senior faculty Susan Bowman, was at Humboldt State University in Arcata, California. It became the first to be nationally accredited with a MRM-based nursing curriculum.
- Helen Erickson was invited to visit Foo Yin Technical College in southern Taiwan and to present on MRM theory.
- Subsequently, in 1995-96, Barbara Irvin and Judith Hertz accepted an invitation to revisit Foo Yin for 6 – 12 months to teach faculty and others about MRM theory.
- Helen Erickson edited and published two additional books (2006, 2010) that expanded upon the “Classic” book. Chapter authors were many neo-scholars from across the U. S. who had expanded upon the basic MRM theory foundatons.
2017 - Present
While it is early in the current period of time, there have been several accomplishments. These will be updated as time passes. Thus far, major accomplishments include the following:
- Clearly, theoretical thinking has evolved to incorporate a realization that persons exist and are interconnected in a universe with constant energy exchange.
- University Health System, San Antonio, TX continues to base nursing practice on MRM theory. In 2018, they recognized Helen Erickson as their second Living Legend.
- Since 2018, there is a renewed interest in nursing theory and national theory conferences provide opportunities for SAMRM members to present new aspects of their research to broad audiences.
- SAMRM’s organizing MRM Theory Mandala was finalized at a retreat in 2019 and incorporated into education as a means for teaching about MRM theory.
MRM Evolution: From the Person’s Worldview to Universal Consciousness
Initially, the MRM premises addressed the significance of the client’s worldview as the focus of caring. The foundational sciences focused on how to think about the client’s worldview and implications for practice. Numerous philosophical assumptions provided the bases for defining the Principles and Aims of Practice.
Additionally, the MRM logo depicted nurse-client relations as a closed system but also something greater. However, the “something greater” was rarely discussed.
Today, the logo can be interpreted from both perspectives—micro (i.e., client’s worldview) to macro (i.e., “something greater”) and vice-versa. This requires learning to take a cosmic view—looking from the outer perimeters of a universal energy field while still valuing and using knowledge related to the micro cosmos of the holistic human being in relationship with the nurse.
The evolution away from solely the Person’s worldview to a more Universal Consciousness has occurred over time as a result of close ties among the SAMRM members (and others who learn about MRM) with lengthy discussions and revelations of alternative perspectives. Often, this has occurred when members have courageously peered around the edge of what is to suggest what might be. This has been the goal of the SAMRM retreats and conferences. (LEARN MORE)
Two persons played key roles in this evolution:
- Carolyn Kinney, who led chartering of SAMRM, developed a way to articulate Heart-to-Heart Connections. In her work, she explored the differences between Heart-to-Heart and Soul-to-Soul connections and how the first can merge into the second.
- Ellen Schultz attended the second MRM conference at Hilton Head, SC in 1988. Schultz joined SAMRM and, over the years, spoke to and vitalized the concepts of energy, energy fields, and energetic relations. Her work opened the door to expand the basic premises of MRM to include broader interpretations of person-centered caring and concepts, such as universal knowing and synchrony of all.
Erickson had spoken on several related topics, alluding to universal consciousness and energetic connections among all things (e.g. Compassion, Unconditional Acceptance, and the Cosmic View, 2014; Quantum Nursing and MRM, 2014; Spirituality: Is it the Art of Being? 2010). However, linking Universal Consciousness to MRM was not addressed until the spring of 2019. Nevertheless, in the second MRM book, published in 2006, writings addressed related concepts and suggested that holism had always been conceptualized as subsystems within systems; each had their own energy fields within sequentially larger fields.
This means that:
- At the micro cosmos of the human being, it is possible to see and understand the chemical intraconnections of brain and body;
- At the next level, it might be a mind-brain-body energy field that merges with a larger, faster vibrating field incorporating spiritual consciousness; and
- At universal consciousness, each higher and more complex field vibrates at a faster rate as described by Bentov and Newman.
- The first healthcare agency to be recognized with Magnet Status by ANCC and that used MRM was University Health System at San Antonio, TX. Erickson was honored as their second Living Legend in December 2018. Their work with MRM is summarized on the nursology.net website as a “Practice Exemplar”: https://nursology.net/practice-theory-exemplars/university-health-system-san-antonio-texas/
- Ten SAMRM members have attended and presented research at two national conferences since 2019: the Nursing Theory Conference at Case Western Reserve University (CWRU) in spring 2019 and the K.I.N.G. Collaborative Conference on nursing theory in late fall 2019.
- SAMRM has had representation on the planning committees for the fall 2019 collaborative conference and the planned spring 2020 2nd Annual Nursing Theory Conference at CWRU.
- The MRM Nursing Theory Mandala was incorporated into a nursing theories course as an educational tool for Entry-level Master’s nursing students at Metropolitan State University, St. Paul, MN in 2019. Dr. Ellen Schultz spearheaded this innovation and received positive feedback from students. This MRM application is highlighted on the nursology.net website as an “Education Exemplar”: https://nursology.net/education-theory/metropolitan-state-university-nursing-department/