I want to hold your hand: from the McGill Model to Strengths-Based Nursing and the evolution of patient-centred care

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Paula Jofre (Photo: Allen Mcinnis)

Patient-centred care has become something of a buzz term in medicine in the past decade. But what many in the field might not know is that a patient-centred care model was pioneered by McGill nurses back in the 1950s.

The McGill Model of Nursing promoted the idea that nurses, patients and families are equal partners in providing support, information, and advocacy. Patients and families are treated with respect, and listened to as individuals with personalities, preferences and histories of their own. It is difficult to grasp now just how revolutionary these ideas were at the time.

“I thought everyone thought like this, but it was really radical,” says Dr. Laurie Gottlieb, Flora Madeline Shaw Chair in Nursing and Professor at the Ingram School of Nursing. Dr. Gottlieb worked with Dr. Moyra Allen, to describe and evaluate McGill’s nursing approach that Dr. Allen called Situation-Responsive nursing. This work became the foundation for the McGill Model of Nursing. It was the mid 1970s, and Dr. Allen, who joined the faculty in 1954, could see that with the introduction of universal healthcare in the 1960s and the rapidly evolving field of medicine, the time was ripe for an expanded role for nurses.

Dr. Gottlieb recalls this era when nursing in Canada was at a crossroads. Some in the field were advocating for a replacement role, whereby nurses would take over many tasks performed by doctors, others preferred the existing assistant-to-the-physician role. “At McGill, we said no, the expansion has to be different,” says Dr. Gottlieb. “We have to expand into being nurses for families. Our focus was not just on diagnosis and treatment. We were looking at how people responded to their diagnosis and how they were recovering from their illness and how we were promoting their health in the community.”

A generation of nurses trained under the McGill Model of Nursing went on to become leaders who trained the next generation of nurses. The model was adopted by hospitals across Canada, as well as internationally. Dr. Gottlieb then spearheaded the evolution of the McGill Model by developing Strengths-Based Nursing, a philosophy and value-driven approach to guide clinicians, leaders, and educators. Strengths-Based Nursing and Strengths-Based Care, referring to the strengths that nurses, patients and families are encouraged to recognize and foster in themselves and others to promote health and facilitate healing.

Prof. Catherine Gros—Assistant Professor at the Ingram School of Nursing at McGill, who studied under Dr. Allen—argues that in the face of the rapidly expanding specialization, the advent of new technologies and the sheer volume of medical knowledge, the relational aspects of nursing have somewhat lost ground to other duties in recent years. There was, and sometimes still is, precious little time to stop and hold someone’s hand, interact with families, or just listen.

But there has been a noticeable return to the original tenets of patient-centred care in recent years, notably with the publication of Dr. Gottlieb’s expansive overview, Strengths-Based Nursing Care, which came out in 2013. The book has been translated into several languages and uses the stories and voices of nurses in the trenches of the Canadian healthcare system—mostly here in Montreal—to help articulate a philosophy and a value-driven approach as it has evolved today and is a widely-used textbook.

“This fall we will be implementing a revised undergraduate curriculum using the Strengths-Based Nursing approach as the underlying philosophy,” says Maria Di Feo, Faculty Lecturer and Clinical Placement Coordinator at the Ingram School of Nursing. Ms. Di Feo says the next step is to inspire the clinical instructors and preceptors working with students in the clinical settings to use the Strengths-Based approach. “It would be ideal, if the School and the clinical settings shared a common philosophy of nursing.” In a joint venture with their clinical partners, the Ingram School of Nursing is now in the process of developing online modules for nurse preceptors on the Strengths-Based Nursing approach, and on how the values and principles underlying the approach can be used to guide the teaching of nursing students in the clinical settings.

Dr. Gottlieb says that McGill’s nurses are uniquely placed to help guide the medical community’s newly rediscovered interest in patient-centred care, because they’ve been at it for decades. On top of that, as Prof. Gros notes, research has demonstrated what proponents of the McGill Model of Nursing and the now Strengths-Based Nursing have long known: that this kind of relational care approach improves patient outcomes and satisfaction, as well as job satisfaction for nurses. “McGill has been a real leader in teaching patient-centred care,” Prof. Gros says.

 

May 12, 2017

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