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Introduction
Traditionally, most nursing theorists failed to recognize the importance of the strengths within nursing practice to appreciate the value of working with strengths. Currently, there is the steady growth of recognizing the importance of a strengths-based against a deficit-based approach to nursing but it had been observed that very few nursing models have the concept of strengths as basis for care planning and execution. The McGill Model of Nursing has stood out. It has also been concluded elsewhere that the notion of working with strengths is closely integrated with the nature of the nurse family relationship. These include collaboration, situation responsive, and exploration; focus and goal of care such as health, coping, and development; and the construct of learning and sharing of information between them.
The practice of expert nurses has been noted to have demonstrated that nurses work with both strengths and deficits. Nurses were able to identify families strengths to promote the families ability to cope with life events, including illness at both the biological and psychological levels. Likewise, they were able to provide assistance to families in dealing with problems, deficits, and illness events by helping individuals and families capitalize on their strengths and resources. Empirical support for the importance of family strengths and resources, as they relate to health and health work, has also emerged as suggested in an empirical testing of the Developmental Health Model, Ford-Gilboe et al (1999). The study found that single mothers who reported higher levels of motivation were more actively involved in health work. In addition, mothers who reported greater strengths and resources were more effective in their problem solving and goal attainment, and they reported healthier lifestyle practices. Likewise, the same mothers reported higher levels of family functioning.
Discussion
It has been proposed that clinical practice in the helping professions has been dominated by the deficit, disorder, or problem-oriented approach for a considerable time focusing on what is wrong, missing, or beyond normal. However, this orientation toward deficits in clinical practice gave rise to two major problems: first, the clinician views the family primarily in terms of their problems or deficits, and this led to failure in seeing and appreciating the familys strengths and competencies. In addition, this approach labels or stigmatizes (Kaplan & Girard, 1994). Second, the families are seen as lacking the ability to solve problems and cope or achieve their goals without the help of the professional.
Consequently, the clinician attempts to solve the familys problems rather than work with the family to straighten things out. In this instance, the professional is perceived as the expert possessing the answer to their problem, solutions and the resources that the family do not posses. This make families feel alienated from the professionals who are trying to help them. To address these shortcomings, clinicians, theorists, and others in disciplines such as nursing (Allen, 1977), social work (Saleebey, 1992), and family therapy (Waters & Lawrence, 1993) have proposed that clinicians should focus instead on what individuals and families already know and what they can provide.
Nursing models such as Henderson (1966) and Orem (1988) have been based on a deficit approach even if other nurse theorists have encompassed the notion of strengths. This, however was viewed insignificant due to limited information of the construct and of when, where, and how it is used in nursing practice. But recent models like Erickson et als, (1983) Theory of Modeling and Role-Modeling, and the McGill Model of Nursing (Allen, 1977, 1999) have shifted the focus to strengths and have strengths as a core concept.
The McGill Model
Originally, the McGill Model emphasized working on strengths as critical in the planning of nursing care. Allen (1977, 1999) has devised the model contrasting the way in which nurses would plan care using a deficit approach with the way they would plan care using strengths or potentials approach. The deficit approach had the nurse base her or his plan on what may be lacking or failures underlying the persons problem. In contrast, the McGill Model of Nursing has the nurse recognize and use strengths and positive forces or the potentials in the individual-family situation as a basis of planning and action. Its goal is to help families use the strengths of the individual family members and of the family as a unit, including external resources beyond the family system, to cope, achieve their goals, and develop. As Warner (1981) suggested, developing and using strengths and resources is an important feature of health and healthy behavior.
Definitions
While all individuals and families possess strengths, potentials, and resources as understood in the McGill Model of Nursing, these constructs have been used interchangeably with unclear definition, differentiation, and hardly operationalized. The four types of strengths that enable individuals and/or families to cope with life challenges, to change as well as to develop are:
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Traits within an individual or a family such as optimism, resilience or even close knit;
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Assets that reside within an individual or a family such as financial resources or information or knowledge;
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Capabilities, skills, or competencies of which an individual or a family has developed such as care-giving, or problem-solving skills;
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More transient qualities in nature such as motivation.
Potentials, in contrast, are prior existence that could be developed into strength, although resources may vary and dependent on who the client is. As such, for an individual client, the resources are those assets that are external to the individual. This usually resides within the larger social network the most imminent of which is the family. Meanwhile, when the client is the family unit, then resources are those assets beyond or external to the family, such as organization they belong to, the social network or the services that exist in the community.
Using Strengths in Nursing
Karpel (1986) suggested that there are three aspects to using strengths in nursing as follows:
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Identification of strengths and provision of feedback this first and perhaps most important strategy is identifying strengths. Strengths need to be enumerated and recognized by both the professional and the family. This requires the clinician well-honed observational and listening skills to identify strengths. It entails the clinician to take note of strengths while listening to families narrate their story or when observing their behavior. The identification of strengths is a strategy that is relatively a simple technique but potentially produce many diverse beneficial outcomes. During the early stages of working with a client, identifying their strengths can be a strategy to develop an effective relationship with the family as well as engage them in health work. This also facilitates the development of a collaborative relationship between the clinician and the family. As the family learns about the assets that they may bring to work with the clinician, they are encouraged to appreciate their role in this partnership. In the end, mere identification of strengths can be a potent intervention that can bring about a significant change in the client or their perception of their situation. Wright and Leahey (1994) described this particular approach to working with strengths as offering commendations . or mirroring strengths as coined by Erickson et al (1983).
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Development of strengths Helping families develop strengths aims to facilitate coping and development as well as create change and help families meet their goals or solve their problems. The first approach to help families develop strengths is by helping them transfer the use of strength from a previous experience to another. Families may have strengths already identified that they have used in previous experience, and these strengths could be potentially useful in other, new situations. The second approach to help families develop strengths is through cognitive reframing. This is a strategy used to develop strength by turning what was possibly a deficit into a strength. The cognitive reframing process consists of statements or questions aimed at helping the family develop a different conceptual or emotional view of a situation, person, or behavior. Feeley & Gottlieb (1998) proposed that this usually involves sharing a perspective with the client that differs from their own. A third approach to develop strengths is to equip families with knowledge or competencies that enable them to cope and develop. Families can be assisted to access experiences or materials to augment their knowledge, taught new skills, such as assessment of their childs disease symptoms and decide when to take their child to the hospital.
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And calling forth strengths Allen (1977, 1999) proposed that the nurse recognizes and uses the familys strengths and potentials for the purpose of planning care. This entails that at every stage of the work with a family, the professional should consider how family strengths could be used to provide solutions or solve a problem. The strength is used to solve a problem already identified.
Working with Resources
Strengths are defined as assets that within the family unit in contrast with resources which are those assets external to the family such as extended family members, friends, neighbors, community agencies, and teams of professionals or even organization. This enables families to cope and develop in order to work with the professional towards achieving solutions. The three ways to use resources in a clinicians work with families are as follows:
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Identifying resources The several approaches of sensing, noticing, observing, questioning and researching that clinicians use in identifying strengths, are also applicable in identifying family resources. Likewise, Hartman (1978) pointed out that a valuable tool that can be used to explore families resources is the ecomap whish is a diagram depicting a familys network of contacts and involvement with others outside of their immediate family, as well as in the community. In this scenario, the quantity and the quality of the familys involvement with others outside the family system should be noted.
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Mobilizing and using resources Professionals including nurses usually provide information to their client about resources that exist in the community. Nevertheless, in helping families mobilize resources, providing information about existing resources is but an initial step as there are many steps in this process. After specific requirements are clearly established, resources are identified that might meet the familys needs. Processes are followed depending on requirement of systems such as health or social agencies, of which experienced clinicians are usually aware of and may provide adequate assistance to enable families access this resources in the community. These resources may include additional professional team or individual assistance and expertise, facilities, or medications that are previously beyond the reach of families in need.
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Regulating the input of resources After families have given access on resources external to their family system, it is very possible that they encounter difficulties in regulating the input of these resources. For instance, the resource may become a source of stress to the family or may be incapable of meeting the familys expectations or goals. In these cases, it becomes imperative for the clinician to assist the family in regulating the use of the resource. In assisting families regulate a resource involves a problem-solving approach where the clinician and the family cooperate to identify the problems associated with the use of the resource. They then generate strategies to minimize or halt problems and maximize the benefits of the utilization of the external resource.
Conclusion
By identifying the strengths and resources, as well as processes that nurses or professionals may capitalize on that lead to providing independence among families with incapable individuals, the McGill Model of Nursing becomes a step towards the betterment of health care.
There could be other models that compare or provide complementary insights or components towards the improvement not only of health care services by the professionals but also in empowering the client and their families, but the McGill Model serves as baseline towards achieving such.
For the time-being, professionals may benefit as their clients and families benefit from the identified model and maximization within the practice becomes an ultimate goal.
Reference
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Allen, F. M. (1999). Comparative theories of the expanded role in nursing and implications for nursing practice. Canadian Journal of Nursing Research, 30, 83-90.
Erickson, H. C., Tomlin, E. M.,&Swain, M.A.P. (1983). Modeling and role modeling: A theory and paradigm for nursing. Englewood Cliffs, NJ: Prentice Hall.
Feeley, N., & Gottlieb, L. N. (1998). Classification systems for health concerns, nursing strategies, and client outcomes: Nursing practice with families who have a child with a chronic illness. Canadian Journal of Nursing Research, 30, 45-59.
Ford-Gilboe, M., Berman, H., Laschinger, H.,&Laforet-Fleisser, Y. (1999, June). Testing a causal model of family health promotion behaviour in single-parent families led by mothers. Paper presented at the International Nursing Research Conference, Edmonton, Alberta, Canada.
Hartman, A. (1978). Diagrammatic assessment of family relationships. Social Casework, 59, 465-476.
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Saleebey, D. (1992). The strengths perspective in social work practice.NewYork: Longman.
Warner, M. (1981). Health and nursing: Evolving one concept by involving the other. Nursing Papers, 13, 10-17.
Waters, D. B., & Lawrence, E. C. (1993). Competence, courage and change: An approach to family therapy. New York: Norton.
Wright, L. M., & Leahey, M. (1994). Nurses and families: A guide to family assessment and intervention (2nd ed.). Philadelphia: F.A. Davis.
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