The McGill Model, 30 years in

Nurses strive for partnerships with patients and their families

Catherine Gros, a nursing professor at McGill, wants her students to look up from their medication sheets and take closer notice of whether their patient went for a walk through the hospital corridors, finished every item on their lunch tray, or visited with family.

According to the McGill Model Gros teaches, the big picture rules.

The McGill Model of Nursing – a health care approach developed in the 1970s in the Faculty of Nursing under Professor Moyra Allan – privileges the relationship between nurses and families, and takes a holistic look at patient care. According to the McGill School of Nursing web site, the McGill Model of Nursing encourages patients and their families to participate more actively in treatment.

“Nurses are caregivers and families are caregivers, so we have a natural connection…. If we can see the strength in [the family], we can see the strength in our profession,” Gros said in an interview.

This family-centric ideology of the Model is why Gros invited Simon Boyer, a 12-year-old boy diagnosed with an ulcerative colon condition, Crohn’s, this past summer, to give a presentation at her Practice of Nursing Part 1 class last Wednesday.

Crohn’s disease, a chronic auto-immune disorder of the digestive tract, usually manifests itself as an inflammation of the bowels. Although management of symptoms is possible through treatment, there is currently no known cure.

While hospitalized at the Montreal Children’s Hospital, Simon worked on a Powerpoint presentation called ‘’Me and My Crohn’s,’’ which he presented to the class of 21 male and female students.

The students, who were floored by Simon’s presentation, queried him, his ten-year-old brother Ethan, and his mother Genny about how their lives changed when a family member got sick. From their questions, it was clear the students were raised on the McGill Model, and believed strongly in the power of active family support to heal patients.

Simon mentioned that when diagnosed, he wondered if Crohn’s was fatal, a topic the class took particular interest in during the question-answer session.

“[The possibility of dying] was the first thing that went through my mind – ‘I have a disease.’ They said I could die and that made me really nervous. But the doctors told me I’d die only if I don’t take meds, which gave me motivation to take the meds,” Simon said.

A student later told Gros how inspiring it was to listen to Genny and Ethan’s stories of coping with Simon’s illness. It was difficult for Genny to watch Simon in so much pain when doctors performed a colonoscopy on the ulcerated part of his bowel. It was an exhausting and invasive procedure that required Simon to stay on clear fluids and take vile-tasting laxatives. Every time Simon was hospitalized, Ethan was scared it was that the last time he’d ever see his brother.

Gros thanked the family for their responses, letting them know that this sort of insight into their personal feelings was exactly the kind of information her students needed so that they could learn to become more effective nurses.

Gros then led the class in acknowledging the strength of the Boyer family in a time of crisis. Positive feedback on family caregiving is central to the McGill model and sometimes lacking in traditional doctor’s visits, which focus on medical strategies or unsatisfactory test results.

Looking back on her 24 years in the McGill nursing faculty, Gros pointed out that it’s taken a long time for the health-care community to recognize the value of the McGill Model. McGill itself resisted establishing a PhD program that would allow nurses to develop and refine their own theoretical approach. The nursing PhD program was finally approved in 1994.

“[The McGill] School of Nursing fought very hard to get a PhD program because we wanted the ability to direct research and develop the theory [of the McGill Model]” Gros said.

She attributed the resistance of the academic community to a nursing PhD program to the way society sees women and nurses.

“The biggest hurdle is still society’s view of women. Unfortunately, nursing has not always been valued by society – it’s related to women’s work, mothering and nurturing,” she said. “Under the hierarchy of the health-care system, nurses were always seen as assistants who carried out the doctor’s orders, handmaids for the doctors, mini-doctors. But we are doing something completely different.’’

The McGill Model, as a dynamic, ever-expanding model, is a result of the reevaluation of the nurse’s role in health provisioning. A study performed soon after the PhD program’s establishment showed that patients treated with the McGill Model have more favourable health outcomes.

In explanation of it’s growing acceptance over the past 30 years, Gros offered that members of the health-care community have become increasingly accepting of more holistic care. She mentioned the recovery-based model in psychiatry, which values patient goals over those of the system, as another example illustrating how patient-based care is gaining momentum.