Journal of Advanced Nursing, 1997, 26, 138–145

Theory-based nursing practice

Barbara M. Raudonis PhD RN
Assistant Professor, Harris College of Nursing, Texas Christian University, Fort Worth

and Gayle J. Acton PhD RN

Assistant Professor, School of Nursing, The University of Texas at Austin, Austin, Texas,
USA

Accepted for publication 5 June 1996

RAUDONIS B.M. & ACTON G.J. (1997) Journal of Advanced Nursing 26, 138–145
Theory-based nursing practice
Theory provides nurses with a perspective with which to view client situations,
a way to organize the hundreds of data bits encountered in the day-to-day care
of clients, and a way to analyse and interpret the information. A theoretical
perspective allows the nurse to plan and implement care purposefully and
proactively. When nurses practice purposefully and systematically, they are
more ecient, have better control over the outcomes of their care, and are better
able to communicate with others. Health care agencies can designate a specific
nursing theory to guide the nursing practice within the entire organization. The
critical component in choosing a nursing theory for an organization is the ‘fit’
between the philosophical assumptions of the organization and the theory.
Modelling and role-modelling, a theory and paradigm for nursing, can be
implemented in any setting. Hospice is a concept of care, not a place. Hospice
care illustrates the excellent ‘fit’ between an existing philosophy of care and
theory-based nursing practice. The ‘fit’ is based on the similarity of the
philosophical assumptions of hospice and the nursing theory of modelling and
role-modelling.

Keywords: nursing theory, hospice, modelling and role modelling

ting aside unimportant data. Theory directs interpretation

I NTRODUCTI ON
Nurses are being called upon to care for clients with
increasingly complex needs. The ability of nurses to care
for these clients necessitates a way to organize the hun-
dreds of data bits that are encountered in the day-to-day
care of clients. Theory provides a logical way to organize
this information, resulting in purposeful and proactive
practice.
Theories provide the practitioner with a way to view
client situations and thus serve as a vehicle for the
interpretation and organization of information. Theory
allows nurses to focus on important information while set-
Correspondence: Barbara M. Raudonis PhD RN, 4200 Eagle Ridge Drive,
Arlington, Texas 76016, USA.
of the relationships among the data and predicts outcomes
necessary to plan purposeful and systematic care.
Discourse concerning the nature and utility of theory
can be easily documented. Dicko
and James (1968), Ellis
(1968) and Hardy (1974) all state that theory must be useful
for and give direction to nursing practice. When nurses
use a theory as a base for their practice, they are able to
systematically identify, label, aggregate and synthesize
phenomena. Nurses need a theoretical perspective to help
them understand which data are important, how these data
relate, what can be predicted by these relationships, and
what interventions are needed to deal with specific
relationships. In short nurses need to know what they will
do with the data after they are collected in order to collect
meaningful data. Without this understanding data are

138 © 1997 Blackwell Science Ltd


often collected and left uninterpreted or never collected
at all.
Nurses are very busy and have little time to spend on
activities that do not convey specific meaning. Nurses do
not have time to learn everything there is to know about
a client; thus, they collect data, interpret, analyse, diagnose
and plan care based on their perceptions of what is import-
ant. A theoretical perspective helps the nurse to focus in
on the important and meaningful data. This gives nurses
a way to understand the data, to interpret the relationships
among the phenomena, to predict outcomes given these
relationships, and to plan and implement care purpose-
fully and proactively. When nurses practice purposefully
and systematically, they are more ecient, have better
control over the outcomes of their care, and are better able
to communicate with others. Purposeful, systematic care
requires that practice be based in theory.
The purposes of this paper are to: (a) define theory-based
nursing practice; (b) discuss the ‘fit’ of the Modelling and
Role-Modelling (MRM) nursing theory and hospice
nursing; and (c) illustrate the significant outcomes of
theory-based practice through a brief case study.
M ODELLI NG AND ROLE-M ODELLING
THEORY
Modelling and Role-Modelling (MRM) (Erickson et al.
1983), a theory and paradigm for nursing, assumes that
people have continuous mind–body interactions that are
both inherent and learned. MRM theory also proposes that
persons have the potential and inherent drive to grow and
develop across the lifespan. These theoretical propositions
represent a synthesis of concepts from theories of stress
adaptation, humanistic psychology, psychosocial and cog-
nitive development, object relations, and attachment and
loss (see Table 1).
MRM theory maintains that nursing is an interpersonal
interactive process occurring between the nurse and client.
Modelling is defined as the application of theoretical
knowledge to client information in order to understand
how the client views his or her world. Role-modelling
employs nurturance and facilitation by using client-
centred interventions that are acceptable within the
Table 1 Theorists and theoretical formulations
Maslow: Basic and growth needs/self-actualization
Erikson: Psychological development
Piaget: Cognitive development
Bowlby, Winnicott & Klein: Attachment and loss
Lindemann: Morbid grief
Engel & Selye: Adaptive responses and potential for response
Erickson et al. (1983).
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 138–145
Theory-based nursing practice
client’s view of the world and designed to assist the client
towards optimal growth, health and well-being.
Major concepts
Major concepts of the theory which explain human
nature include holism, health, adaptation, aliated-
individuation and self-care. Concepts relating to the nature
of nursing include facilitation, nurturance and uncon-
ditional acceptance. These concepts provide the foun-
dation for understanding people and the role of the nurse
in assisting clients towards optimal health and well-being.
Holism implies that the whole is greater than the sum
of the parts. Human beings are holistic with multiple inter-
acting subsystems. Dynamic interaction characterizes the
relationship among the subsystems. Thus, a stressor in one
subsystem might result in stress in that or another sub-
system. Each subsystem is dependent on, and interacts
synergistically with the other. Body, mind and spirit are
a total unit and interact to function as one.
Health is seen as a state of physical, mental and social
well-being. It is not merely the absence of disease or ill-
ness. In fact, well-being may be present in the gravest of
infirmities.
The concept of aliated-individuation maintains that
persons have an inherent need to be able to be dependent
on support systems while simultaneously remaining inde-
pendent from these support systems. That is, persons need
to be both dependent (supported) and independent (in
control) and feel comfortable in either situation.
Inherent to adaptation is an innate drive towards health,
growth and development. This drive is instinctual, despite
the ageing process, disability or disease. Stressors are a
part of everyday life and have both positive and negative
e
ects on a person. One person may perceive the stressors
of life as a threat, thus potentiating the negative e
ect of
stressors. However, another person may view these same
stressors as a challenge, finding opportunity for growth
and self-realization.
Responses to stressors are moderated by resources that
persons may draw upon. Resources are developed from
basic need satisfaction. All persons have basic needs.
These needs include the physiological needs such as food,
water and oxygen. They also include the needs for safety/
security, love/belongingness, esteem/self-esteem and self-
actualization. As needs are met repeatedly, need assets are
developed. Need assets translate into resources which stay
in reserve to be used in response to stressors.
Persons use stressors to move forward in life. However,
a person may tax one subsystem in order to cope with a
stressor in another. This continued taxing of one subsys-
tem to support another may result in physical illness
(Barnfather et al. 1989). Health and well-being depend on
learning to cope with stressors by mobilizing resources.
Adaptation occurs as the person responds to stressors by
139
B.M. Raudonis and G.J. Acton
mobilizing resources to propel the person in a health and
growth-directed manner, thus achieving optimal well-
being.
Self-care
Self-care is a complex concept that encompasses three
levels: knowledge, resources and actions. In regard to self-
care knowledge, MRM theory contends that, at some level,
a person knows what has made him or her ill or interfered
with growth. Similarly, the person also knows what will
optimize health and well-being.
Self-care resources are those things that persons can
draw upon in times of stress in order to facilitate coping
and adaptation. Resources are not static. Each person has
varying levels of resources, depending on the need satis-
faction state of the individual at any given point in time.
Self-care action is the development and utilization of
self-care knowledge and self-care resources. Through self-
care action the healthy, growth-oriented person mobilizes
resources and acquires additional resources that will help
him or her gain or maintain optimal health and well-being.
Concepts relating to the role of the nurse include facili-
tation, nurturance and unconditional acceptance. MRM
views the nurse as a facilitator, not an e
ector. The nurse
does not try to control the client’s behaviour, but acts to
facilitate the client in his or her e
orts to move towards
adaptive well-being.
Nurturance is defined as the supportive assistance of a
person in a growth-producing direction. People know what
they need and the role of the nurse is to discover these
needs, from the client’s model of the world, and nurture
the client towards optimal well-being. The nurse provides
information and guidance in order to help the person to
go forward in a growth-producing direction.
Being accepted as a worthy and important human being
is the basic premise of unconditional acceptance. The use
of empathy is an important aspect of unconditional accept-
ance as the nurse strives to show the client that he or she
is accepted, valued and respected.
Theoretical linkages or propositions are those state-
ments that link together the concepts of the theory and
make the theory applicable to potential users. Table 2
identifies the major theoretical propositions from MRM
theory.
Data collection
Using MRM in client situations always begins with data
collection. There are three sources for data collection: the
client (primary), the family and nurse (secondary), and all
other health care providers (tertiary). Table 3 provides an
overview of the data collection process. Data are collected
in all categories from all sources; they are then aggregated,
interpreted and analysed. Organization of the data occurs
140 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 138–145
Table 2 Theoretical propositions
1. Basic need satisfaction is a prerequisite for developmental task
resolution
2. Unmet basic needs interfere with growth processes
3. Persons become attached to those objects that satisfy basic
needs
4. Secure attachment produces feelings of worthiness
5. Feelings of worthiness result in a sense of futurity
6. Real, threatened or perceived loss of the attachment object
results in grief
7. Individual’s ability to contend with stressors is directly
related to the ability to mobilize resources
8. Individuals’ ability to mobilize resources is directly related to
their need deficits and assets
Erickson (1990).
within four categories: description of the situation, expec-
tations, resource potential, and goals and life tasks.
After data collection is completed the task is to develop
interventions that are acceptable within the client’s model
of the world. Table 4 presents the basic principles of inter-
vention, intervention aims and intervention goals.
HOSPICE CARE
MRM theory-based nursing practice can be implemented
in any setting. Hospice care is an example of the excellent
‘fit’ between an existing philosophy and concept of care
and theory-based nursing practice.
Hospice is a concept of care, not a place. Hospice is
based on a holistic philosophy of living and dying. An
interdisciplinary team of health care providers o
er palli-
ative and supportive care to meet the physical, psychologi-
cal, social and spiritual needs of the family facing death.
Although the primary goal of intervention is symptom con-
trol and relief of the distress caused by the disease process,
care is planned so that clients maintain control of
decisions regarding their care, spiritual-emotional com-
fort, and preparation for death (Saunders et al. 1981, Blues
& Zerwekh 1984, Petrosino 1986, National Hospice
Organization 1994).
In hospice nursing, dying persons and their families are
the unit of care and the focus of nursing interventions,
which are provided in the context of interdisciplinary care.
The key component of hospice nursing is the interaction
between the nurse, the terminally ill person and the
family. Nursing interactions that demonstrate trust, caring
and acceptance establish a therapeutic relationship
between the nurse and the client/family. Such relation-
ships enable the nurse to provide individualized care that
meets the unique needs of each hospice client (Petrosino
1986). A study by Raudonis (1993) found that for some
clients receiving hospice care, interaction with their hos-
pice nurse meant being acknowledged as an individual
 Theory-based nursing practice

Table 3 Categories, subcategories and purposes of data collection nursing practice. The key to the ‘fit’ is the similar philo-
sophical assumptions of MRM theory and hospice nursing.
Category & subcategory Purpose of data collection The underlying philosophy of MRM theory views nursing
as a dynamic and interactive ‘process between the nurse
Description of the situation
and the client and requires an interpersonal nurse-
1. Overview of the 1. To develop an overview of the
client relationship…’ (Erickson et al. 1983 p. 43–44).
situation client’s situation from the
Philosophical foundations of MRM theory include:
client’s perspective
holism; lifetime growth and development; adaptation,
2. Aetiology 2. To identify the aetiological
factors involved aliated-individuation; self-care knowledge, resources
Stressors and actions; facilitation; nurturance; and unconditional
Distressors acceptance as described in an earlier section of this paper.
3. Therapeutic needs 3. To identify possible MRM theory defines nursing as:
therapeutic interventions
the holistic helping of persons with their self-care activities in
Expectations relation to their health. This in an interactive, interpersonal pro-
1. Immediate 1. To develop an understanding cess that nurtures strengths to enable development, release, and
of the client’s personal channeling of resources for coping with one’s circumstances and
orientation in terms of the environment. The goal is to achieve a state of perceived optimum
client’s expectation for the health and contentment.
present and future (Erickson et al. 1983 p. 49)
2. Long-term
Much like MRM’s theoretical assumptions, hospice is
Resource potential founded on a holistic philosophy of living and dying. The
1. External 1. To determine the nature of the tenets or assumptions of hospice care include: (a) recogni-
external support system zing and building on the patient’s and family’s inner
Social network strengths; (b) use of technology and individualized plans of
Support system care to achieve and maintain pain and symptom control as
Health care system
well as the highest level of comfort and well-being possible
2. Internal 2. (a) To determine the client’s
for the patient; and (c) use of the patient’s/family’s decision-
strengths and virtues
making skills to enhance the quality of life of the patient
Strengths
Adaptive potential (b) To determine the client’s
(Amenta 1986). These philosophical assumptions lead to
currently available the goal of seeking an appropriate death for each hospice
internal resources patient. An appropriate death assumes a warm relationship
Feeling states with family, friends and caregivers, a context of open aware-
Physiological data ness and communication, and belief/values that allow for
the discovery of meaning (Grady & Wilson 1981).
Goals & life tasks Because of the compatible philosophical assumptions of
1. Current 1. To determine the current MRM and hospice care, we believe that MRM theory is a
developmental status in order
systematic way to view hospice patient situations,
to understand the client’s
organize patient data, interpret relationships among the
personal model and to utilize
data and predict outcomes needed to plan purposeful and
maximum communication
skills
systematic care for hospice patients and their families.
2. Future
CASE STUDY
The following case study is an excerpt from an interview
person. The outcome of these relationships was the from a naturalistic field study of the nature, meaning and
improvement and maintenance of the client’s physical and impact of empathy from the hospice patient’s perspective
emotional well-being, that is, their quality of life. (Raudonis 1993, 1995). All names used in the presentation
have been changed.
Bob was a 78-year-old Caucasian male. He and his wife
‘FIT’ BETWEEN MODELLING AND ROLE-
did not have any children. Bob had been a widower for
M ODELLI NG AND HOSPI CE
16 years. He only had 2 years of a college education due
In the following section we will discuss why we believe to World War II. Bob worked as a piano tuner and tech-
that MRM theory and hospice nursing are a good ‘fit’ and nician in the music department of a local university.
therefore an appropriate model for theory-based hospice Bob was diagnosed with colon cancer 4 years ago. He

© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 138–145 141
B.M. Raudonis and G.J. Acton

Table 4 Basic principles,

intervention aims and
intervention goals
Basic principles
1. The nursing process
requires a trusting
relationship between
nurse and client
2. Aliated-individuation
is dependent on a
person perceiving that
he or she is an
acceptable,
respectable, and
worthwhile human
being
3. Human development is
dependent on the
person’s perception
that he or she has some
control over his or her
life, while
concurrently sensing a
state of aliation
4. There is an innate drive
toward holistic health
that is facilitated by
consistent and
systematic nurturance
5. Human growth is
dependent on
satisfaction of basic
needs and facilitated
by growth-need
satisfaction
Intervention aims
1. Build trust
2. Promote client’s
positive orientation
3. Promote client’s
control
4. Arm and promote
client’s strengths
5. Set mutual goals that
are health directed
Intervention goals
1. Work to develop a
trusting relationship
between yourself and
the client
1. Facilitate a self-projection
that is futuristic and
positive
3. Promote aliated-
individuation with the
minimum degree of
ambivalence possible
4. Promote a dynamic,
adaptive, and holistic
state of health
5. Promote and nurture
coping mechanisms that
satisfy basic needs and
permit growth-need
satisfaction

had undergone several operations over the years. When
the cancer metastasized to his bones he underwent the
maximum radiation allowed. At the time of this interview,
Bob had been a home care hospice patient for 5 months.
Authors’ note Hospice services include the assignment
of a volunteer to the hospice patient and family. The hos-
pice team provides the hospice volunteer with information
regarding the plan/goals for the patient/family, patient’s
interests, etc. Volunteers establish a supportive relation-
ship with the hospice patient and family. The volunteer
assists with a variety of activities such as letter writing,
telephoning, reading, providing emotional support to the
patient and family as well as respite for the family.
Bob: I was a loner, I’ve been a loner practically all of my life and
don’t have a lot of people that I could call friends, and so
forth. I spend a lot of time alone, reading and pursuing
what I would enjoy or what I want to do. They [hospice
nurses] were a little concerned about that, of course. That
maybe I should have someone come out and talk to me and
I told them after awhile, that really [Bob’s emphasis]
wouldn’t help me because friends really try to help but
quite often they do more harm than good because when
they help, well they have to help at their [Bob’s emphasis]
convenience and maybe the patient would be waiting one
day and they’ll call and say well I can’t do it today and
that’s disturbing to a patient. So, after they realized how I
felt about it, why then, they stopped. Decided that I didn’t
need for anyone to, for people to come out and talk to me
quite a lot. Because I had been alone and get along pretty
well by myself. But that doesn’t mean that I don’t enjoy
having someone to talk to once in awhile, like my sister-
in-law. But she is about my limit as far as being able to take
care of something like that. Anything else that would,
except a casual visit or something would be I think, detri-
mental to me.
R: Well, that sounds like it was very important that the hospice
nurses could finally recognize…
Bob: Yes, they did, very, very soon. And they were patient with
me and I was patient with them. So, now, they say that
they [chuckled] fight over who’s going to get to come out
and talk with me. It kind of inflates my ego a little. Maybe
they’re just kidding, I don’t know. But no, no, they’re not,
really. They really like to come out and talk with me, too.

142 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 138–145

The interview continued:
Bob: Life still has its good points. I’ve never reached the point
where life hasn’t had some value. I suppose if pain was so
acute that I couldn’t think about anything but pain, well
then, I don’t suppose life would have too much value. But
I still have things that I do such as studying my Spanish
and reading, keeping my mind busy and concentrating and
all that type of thing… Well, I can always adjust to what
happens. In fact, the whole deal [having colon cancer]
never has been really bad for me. It developed, so I just
went on from there. Now, I understand that some people
can’t do that very well, but as I was saying, I have my
Spanish and I concentrate and get my mind on that instead
of my troubles and that may be one reason that things
haven’t worked like they thought… my attitude may have
had something to do with me living longer than they had
anticipated [longer than the original 6-month prognosis].
Case analysis
In order to implement MRM theory with the case study
presented in this paper, four fundamental areas must be
assessed. These include: (a) description of the situation;
(b) expectations of the client; (c) resource potential of the
client; and (d) goals and life tasks (see Table 2).
In assessing Bob’s situation a nurse implementing MRM
theory would need to get a description of the situation
from Bob’s perspective. The first step in this process would
be to ask Bob to describe himself and his life over the last
few months. Bob’s response would undoubtedly reveal the
data contained in this case description and perhaps much
more than is contained in the brief case study presented
in this paper.
After Bob has been given the opportunity to describe his
personal situation, the MRM nurse could explore data
related to stressors and distressors potentially present in
Bob’s life. This could be accomplished by asking Bob about
the things that are happening in his everyday life that are
worrisome or concerning to him. Data available from the
case study suggest that Bob perceives himself as a ‘loner’
and that he has spent much time alone doing what he
enjoys or what he wants to. As a nurse practising MRM
theory we could take that data at face value, but perhaps
a better avenue would be to ask Bob, ‘Could you tell me a
little more about your life as a loner?’ Probes from data
collection might include statements such as, ‘That is very
interesting, I’d like to hear more about that’. This would
allow Bob the opportunity to expand on his life and any
worries or concerns that might be applicable to the
situation.
It also appears from the case study data that Bob may
interpret the visits from the volunteers as distressors,
evidenced by Bob’s statement:
© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 138–145
Theory-based nursing practice
‘They [hospice nurses] were a little concerned about that [spend-
ing time alone]… and maybe I should have someone come out
and talk to me and I told them after awhile that really [Bob’s
emphasis] wouldn’t help me because friends really try to help but
quite often they do more harm than good…
It appears from the above statement that Bob tolerated
the volunteer visits awhile before telling the hospice
nurses that the visits were not very helpful. This is a classic
case of intervention based on the professional’s model of
the world rather than on the client’s model of the world.
In other words the hospice nurses assumed that someone
who states that they spend a lot of time alone would surely
benefit from volunteer visits. Bob seems to be saying that
such is not the case. Therefore, careful consideration of
Bob’s information is extremely important.
The nurse implementing MRM theory would make a
thorough assessment of Bob’s statements and strive to col-
lect more data regarding spending time alone. Additional
data would have enabled the nurse to determine whether
being alone was a normal adaptive pattern for Bob and
whether support of this life pattern was in order or facili-
tation of change would be a more appropriate course of
action.
Factors related to the current situation are also helpful
when implementing MRM theory. The nurse could ask
Bob if he has ever been in a similar situation and if so,
what was happening to him at that time and how did he
handle the situation. This additional data would give the
nurse a much clearer picture of Bob’s world and how nurs-
ing intervention might best facilitate Bob’s present
situation.
The next area of data collection is aimed at eliciting
Bob’s expectations about the situation. The MRM nurse
would ask Bob what he thinks is going to happen over
the next few months, weeks, days, hours, minutes (as
opposed to what he would like to have happen which is
asked later when assessing goals). The case study indi-
cates that Bob’s life pattern is one of spending time alone
and that he expects to continue this pattern. MRM theory
would indicate that Bob’s expectations should be hon-
oured, with supportive actions from the nurse. These
actions could include reassurances that the nurses or
volunteers would not force visits and that Bob would be
encouraged to contact a nurse or volunteer any time
assistance or human connection was needed. In addition,
a possible strategy would be to ask Bob if it would be
acceptable to him to receive phone calls from a nurse or
volunteer on a regular basis just to check on him. Perhaps
even a weekly or bi-weekly visit might be scheduled,
with reassurance to Bob that the nurse or volunteer
would call before coming and Bob would always have
the option of cancelling the visit. Such actions might
reassure the nurse as well as respect Bob’s need for
independence.
143
B.M. Raudonis and G.J. Acton
Resource potential
The third area to assess is that of resource potential. The
nurse implementing MRM theory would ask Bob where he
seeks or finds support in his life. In the case study Bob
gave a couple of clues about his external resource poten-
tial. The first clue came in these words:
… wouldn’t help me because friends really try to help but quite
often they do more harm than good because when they help, well
they have to help at their [Bob’s emphasis] convenience and
maybe the patient would be waiting one day and they’ll call and
say well I can’t do it today and that’s disturbing to a patient. So,
after they realized how I felt about it, why then, they stopped.
These data indicate that, from a social support perspec-
tive, Bob may be fairly isolated. Thus, that assumption is
probably the basis from which the volunteers to visit Bob
were dispatched. But further examination of Bob’s data
reveals even more about his social support situation.
Consider this datum:
But that doesn’t mean that I don’t enjoy having someone to talk
to once in awhile, like my sister-in-law. But she is about my limit
as far as being able to take care of something like that.
This statement indicates that Bob considers his sister-
in-law his main source of support. Therefore, the MRM
nurse would investigate the nature of this supportive
relationship in more depth. For example, the nurse might
ask Bob, ‘How do you feel when you are talking with your
sister-in-law?’. Nursing actions might be directed towards
a visit with the sister-in-law to elicit her perspective of the
situation and how the nurse might facilitate her (Bob’s
sister-in-law) in meeting Bob’s support needs.
To assess Bob’s internal strengths and adaptive poten-
tial, the MRM nurse would ask Bob to describe what he is
good at or what he sees as his strengths. It appears from
the case data that Bob has a need to be in control of his
life patterns. The data also suggest that he has an ability
to assess a situation that may be detrimental to his well-
being and take action to correct the situation. But further
assessment data are needed to thoroughly evaluate this
area.
Goal and life tasks
The last area of assessment is that of goals and life tasks.
The nurse implementing MRM would ask Bob what he
would like to see happen over the next few days, weeks,
months. The case study does not directly describe Bob’s
goals and the tasks that he wishes to accomplish. However,
there are clues that Bob wants his pain under control.
E
ective pain management will allow him to continue to
do the things he enjoys and values: studying his Spanish
and reading. His goals are consistent with the hospice
144 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 26, 138–145
philosophy which emphasizes living and facilitating the
fulfilment of the patient’s goals.
Bob also implies that his attitude has been instrumental
in surviving beyond the 6-month prognosis. Consider the
following datum:
… I never reached the point where life hasn’t had some value…
I have my Spanish and I concentrate and get my mind on that
instead of my troubles.
To assess Bob’s goals and life tasks yet to be completed,
the nurse would specifically ask Bob: what do you need
to accomplish in the next days, weeks or months? This is
giving control back to the individual and allows him to
identify and establish his agenda. Bob’s statement ‘But I
still have things I do such as studying my Spanish and
reading, keeping me busy and concentrating and all that
type of thing…’ informs us of what he does with his time,
but does not identify his needs or ‘unfinished tasks’. Once
this information is obtained, the nurse would follow-up
with further questions regarding what needs to happen in
order to achieve Bob’s goals. Finally, the nurse would ask
Bob how the hospice team members could help him com-
plete his tasks.
Based on this additional data the hospice nurse would
develop interventions that would assist Bob in bringing clos-
ure to his life. Bob, however, has outlived the original prog-
nosis of 6 more months to live. He attributes his survival to
his attitude and the hospice care he has received. Further
assessment is needed to thoroughly evaluate this area.
CONCLUSI ON
Using a case study and analysis we demonstrated how a
nursing theory provided a logical way to organize client
information, guide our interpretation of the information,
and identify areas in need of further assessment. The
theory-based assessment provided the foundation for the
development of meaningful, individualized interventions.
The case study also illustrated the good ‘fit’ between the
theory of MRM and hospice nursing care. MRM is a model
for theory-based hospice nursing practice. Similar philo-
sophical assumptions of MRM and hospice nursing were
the critical link.
Individual hospice nurses can use MRM on a daily basis
in their own nursing practice. Hospice agencies can for-
mally choose MRM as the theory base for their agency. All
nursing care, documentation and plans of care would be
based on the theory. The future challenge is the implemen-
tation of MRM as theory-based practice in hospice nursing.
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