Demonstrating Theory in
Practice: Examples of the
McGill Model of Nursing
Alice P Gaudine, RN, PhD
ABSTRACT
An important test for a model of nursing is its
usefulness in practice. One-hundred and forty-
seven nurses in one hospital attended a 2-day work-
shop on the McGill Model of Nursing. An evalua-
tion of this workshop showed the usefulness of the
McGill model. Self-efficacy for performing the
model increased, as did behaviors and performance
The professional practice of nursing requires the
use of a nursing theory or a model of nursing to
guide practice for several reasons. First, nursing prac-
tice not guided by nursing theory is apt to be centered
on medical and psychosocial concerns. In such cases,
nurses may lack a distinct professional identity and
may not feel satisfied. The use of a nursing model
may help nurses identify and act on nursing prob-
lemrs, and thus enhance nursing satisfaction (Fitch, et
al., 1991). Second, if nurses have difficulty answering
the question "What is nursing," othler professionals
also may have a poor understanding of the role and
potential role of nurses-leading to suboptimal use of
nursing in interdisciplinary practice.
The 1970s and 1980s saw proliferation of new nurs-
ing theories, while the current era presents a shift
from theory development to theory utilization
(Alligood & Marriner-Tomey, 1997; Fawcett, 1995).
Demonstration projects are needed to show the effects
of nurses' use of theory on nursing behaviors, nurses'
satisfaction, and patient and family outcomes. A n-um-
ber of authors have stated that one of the most impor-
tant tests of nursing theory is how useful practicing
Alice P Gaudine, RN, PhD is Assistant Professor, School of Nursing,
Memorial University of .Newfoundland, St. John's, NVewfoundland, Canada.
'fhis article is based on research done for the authors doctoral dissr-
tation inder the guidance of A. Saks. The authur thanks the nurses, mian-
agers, and instructors who participatedin this study, and the anonymious
reriewers of this articlefortheir helpfil coimments.
Address reprint requests to Alice P Gaudine, RN, PhD, Assistant
Professor, School of Nursing, Memorial University of Newfoundland, St.
John's, Ntwfoundland, AIB 3V6 Canada.
The Journal of Continuing Education In Nursing
related to nursing by this model. Self-reports and
supervisor reports measured these increases 6
months after the workshop. Further, the implemen-
tatlon of the model led to staff nurses initiating bot-
tom-up changes in the nursing department.
Boundary conditions or factors outside of the work- j
shop content that enhanced the adoptation of the
model are described. l
nurses find the theory (Barnum, 1994; Martin,
Forchuk, Santopinto, & Butcher, 1992; Torres, 1990).
One way to begin implementing a nursing theory
in an organization is by offering training on the the-
ory. To be effective, nurses must transfer what they
learn during training into their workplace-a
process referred to as "transfer of training" (Baldwin
& Ford, 1988). The fact that employees frequently do
not implement what they learn is an important detail
to remember when planning workshops designed to
teach a theory of nursing. Nurses who have been
practicing successfully for a number of years may
not wish to change the way they practice. They may
believe nursing theory is unrealistic for practice-
that it is something only nurse academics use in their
ivory towers. Nurses may resent attempts to have
them conceptualize their nursing, believing this
implies that their current practice was lacking in
some way.
This article discusses a 2-dav educational program
on Allen's McGill Model of Nursing (Allen, 1977).
This model teaches that the role of nursing is to
develop and maintain family health, where health
includes the ability to cope, to leam new ways of
problem solving, and to develop over time. Allen
defines family broadly to include individuals who
live together or have significant relationships with
each other Timing is important, and nurses assess
families' readiness for receiving information or for
working through issues. The nurse works in collabo-
ration with families, structuring learning environ-
77
DEMONSTRATING THEORY IN PRACTICE

TABLE 1
DESCRIPTIVE STATISTICS OF MEASUREMENT VARIABLES
Measure Mean Standard Deviation Range Sampis Size
Pro-Training
Self-efficacy 6.55 1.22 6.34 147
Motivation to learn 3.80 .50 2.67 147
Behavior, self-rated 3.08 .61 .61 144
Post-Training
Self-efficacy 7.40 1.06 5.50 146
Reactions 4.09 .47 3.33 147
Behavior, supervisor-rated 2.15 .75 2.97 105
Performance, supervisor-rated 2.32 .79 4.13 105
2-Month Follow Up
Self-efficacy 7.46 1.13 7.24 117
Behavior, self-rated 3.45 .63 3.38 118
Behavior, supervisor-rated 2.84 .69 3.45 97
Performance, supervisor-rated 2.95 .71 3.11 97
6-Month Follow Up
Self-efficacy 7.58 1.10 6.24 93
Behavior, self-rated 3.39 .68 3.45 94
Behavior, supervisor-rated 3.26 .68 2.79 62
Performance, supervisor-rated 3.38 .78 2.78 63

ments, and helping families explore issues and devel-
op over time. Nurses help families attain their own
goals, not the goiLs nurses feel the family should
have. Rather than focussing on weaknesses and defi-
ciencies in individuals, nurses help them cope with
issues by using their strengths.
The main purpose of this article is to present an
evaluation of the effectiveness of a workshop on the
McGill Model of Nursing, thereby contributing to
the demonstration of the utility of this model for
clinical nurses. A second purpose is to discuss
"boundary conditions" or factors outside of the
workshop content contributing to the success of
this workshop.
EVALUATION
One hundred and forty-seven staff nurses working
in 11 different departments of a community hospital
attended a 2-day workshop on Allen's McGill Model
of Nursing. The workshop was repeated 12 limes,
wvith a maximum attendance of 20 nurses per work-
shop. Two months following their attendance at the
workshop, nurses attending the same session of the
workshop met with their instructor and discussed
their efforts to practice nursing using the model.
The mean age of the nurses attending the work-
shops was 42.5 years (SD = 9.3), and the mean num-
ber of years working at their current hospital was 12.4
(SD - 6.9). One-hundred and nineteen of the nurses
had a nursing diploma, 12 niurses had a bachelor's
degree in nursing, 15 nurses had a bachelor's degree
in a non-nursing discipline, and I nurse did not pro-
vide her educational background. This sample repre-
sents a relatively senior, clinically experienced group
of nurses prepared at the diploma level. The nurse
managers of this hospital knew that although the hos-
pital's nurses were very skilled at implementing med-
ical aspects of care, they lacked a framework or a
vision for inmplementing nursing aspects of care.
To evaluate the workshop, nurses were asked to
complete questionnaires at the beginning of the work-
shop, at the end of the workshop, and at 2 and 6 months
following the workshop. In addition, nurses were
asked to give a questionnaire to their supervisor to
complete at the time of the workshop and at 2 and 6
months following the workshop (Gaudine, 1997).
Nurses identified their cuestionnaires with a code
number known only to them. Table 1 shows tle
descriptive statistics of the measures, and Table 2 shows
the Cronbach alphas and correlations of the measures.

78 Volume 32, Number 2, March/April 2001

 GAUDINE

TABLE 2
CRONBACH ALPHAS AND PEARSON CORRELATIONS FOR STUDY VARIABLES
i
I
i t ~~ ~
i9 90 tJ
0V e0Ea
50

1: 1
iE
2 0 I 9S. sE I111!cf)
N ' MOw
D m i
om,

Self-efficacy, pre .95

Self-efficacy, post 55* 97
Self-efficacy, .56' 70* .98
2 months
Self-efficacy, .52* .55 .70* .98
6 months
Motivation .12 .18* .20' .28* .83
Behavior, self, pre .51* .29' .44* .40* .26' 95
Behavior, super, post .18 .08 .19 .28* -.02 .40' .98
Behavior, self, .37* .41 * .61* .32' .31 ' .65' 29' .96
2 months
Behavior, super, .17 .21* .33* .18 .16 .39* .25 .40* .98
2 months
Behavior, self, .42' .24' .48* .44' .47' .72* 34* .76' .39* .96
6 months
Behavior, super, .31* .36' .52* .50' .42* 45* .44* .55* .72* .55* .98
6 months
Reactions, post .14 .43 .40* .11 .46' .14 -.14 .31* .12 .17 .23 .86
Performance, super, .14 .04 .17 .26' -.09 .41* .91* .25' .37* 35* .56' -.21' .93
post
Performance, super, .16 .24' .29' .17 .16 .38* .31* .46' .83' .40* .64' .04 43* .31' .93
2 months
Performance, super, .31 ' 34* .47* .49* .31 * .44* .44' .45* .64* .45* .91* .26' .57* .49* .69' .30* .96
6 months

p< .05

Motivation to Learn successful in increasing the nurses' motivation to learn.

Motivation to learn was measured by a nine-item
scaile, with eight items from a previously used motiva-
hon to learn scale (Saks, Haccoun, & Laxer, 1995). An
example of an item on this scale is "The material in this
workshop will be useful to me in my job." Immediately
prior to thc start of the workshop, nurses were asked to
respond to these itemts using a five-point scale ranging
from (1) "strongly disagree" to (5) "strongly agree.'
Nurse managers had been concerned that nurses would
negatively anticipate the implementation of a model of
nursing, but the mean score for the motivation to learn
mneasure was 3.80 (Table 1). This may indicate that plan-
ing around factors not related to the workshop con-
tent or planning around "boundary conditions," was
Alternatively, it may indicate that the nurse managers
were incorrect in assuming nurses would not be moti-
vated to attend a workshop on a nursing theory.
Reactions to Training
The success of developing a workshop nurses
would find relevant and enjoy was evaluated by a
nine-item reactions ro training scale administered
immediately after the completion of the second day of
the workshop. The nine items for this scale were
reviewed by two researchers. Examples of items are:
"The content of this workshop is applicable to the nurs-
ing department where I work," and "I would recom-
mend this workshop to others." Nurses were asked to

The Journal of Continuing Education in Nursing 79

DEMONSTRATING THEORY IN PRACTICE
10
8 E2 3
5'
_ 4,
X) 3I
2 l
12
pre-workshop post-workshop 2 months 6 months
Time
Figure 1. Self-efficacy over time. Using repeated measures
ANOVA, self-efficacy pre-workshoD is significantly different (p <
.01) from self-efficacy post-workshop, 2 months and 8 months.
respond to nine items using a five-point scale ranging
from (1) "strongly disagree" to (5) "strongly agree.'
The mean score of 4.09 (Table 1) signifies that the nurs-
es found the workIshop relevant and enjoyable.
Evaluation of the Implementation of the Model
The nurses' transfer of training or implementation
of the model was evaluated by measuring:
* The nurses' self-efficacy for performing the
McGill Model of Nursing, or their belief that they
could perform the McGill Model of Nursing.
* Self-ratings and supervisor ratings of behaviors
related to this model, or how frequently nurses exe-
cuted actions related to the model.
* Supervisor ratings of perfornance or how well
they performed this model.
Self-efficacy was measured at the beginning of the
first day of the workshop, at the end of the second day
of the workshop, and at 2 and 6 months following
training. Self-ratings of behaviors were taken at the
beginning of the first day of the workshop, and at 2
and 6 months following training. Supervisor ratings
of behaviors and performance were taken within a
few days of the training and at 2 and 6 months fol-
lowing training.
Self-efficacy. Because self-efficacy refers to an individ-
ual's belief in his or her capacity to successfully perform
a spedfic task, Bandura (1986) argued that measures of
self-efficacy should be specific to the behavior being
investigated. To develop the self-efficacy measure, the
two workshop instructors and two nurse experts were
asked to list the skills and content knowledge required
80
5 -
o4
03
CZ
L
!L
ow
Workshop 2 Months 6 Months
Time
Figure 2. Self-rated behavior over time. Using repeated measures
ANOVA, self-rated behavior is higher (p < .01) at 2 and 6 months
than at the time of the workshop.
to practice nursing using the McGill Model of Nursing.
The two instructors confirmed they planned to cover all
of the skills and content identified on this list. This
process resulted in 29 items on the list which were
developed into the 29 items for the self-efficacy scale.
Examples of items are:
* Collaborate with patients in planning their nurs-
ing care.
* Create a collaborative reiationship with your
patient's family.
* Identify the strengths of a family.
* Assess the health of a patient where health is
defined by coping and development as opposed to the
absence of illness.
* Assess how a patient usually copes with a stress-
ful life event.
* Assess how family members usually cope with
stressful life events.
* Assess a patient's readiness to change.
* Facilitate a patient's learning of new ways to cope.
Nurses were asked to rate their level of confidence
that they could perform each of these items on a 10-
point scale ranging from (1.) "not at all confident" to
(10) "totally confident.'
Self-rated behavior. Behavior related to the McGill
Model of Nursing was measured by asking nurses to
rate how frequently they performed each of the func-
tions identified by the 29 items on the self-efficacy scale.
Participants rated their frequency of behavior on a five-
point scale, ranging from (1) "never' to (5) "always."
Supervisor-rated behavior. At the end of the 2-day
workshop, nurse participants were given a copy of the
Volume 32, Number 2, March/April 2001

5-
0
"4-
Em _V
0
.I
0o1- _ ,
Worshop 2 Months 6 Msnths
Time
Figure 3. Supervisor-rated behavior over time. Using repeated
measures ANOVA, supervisor-rated behavior is higher (pc .01) at
2 and 6 months than at the time of the workshop. There is no sig-
nifcant difference between 2 and 6 months.
questionnaire for supervisors. The nurse participants
were asked to give this questionnaire to their supervi-
sors, who were to mail it directly to a researdc assis-
tant at a local university. Supervisors rated each
nurse's frequency of behavior using the same 29 item
behavior scale the nurses completed.
Supervisor-ratedperformance. Performance was mea-
sured by nine items designed to indicate how well the
nurse was able to implement the McGill Model of
Nursing in the workplace. The items were reviewed
by two supervisors for their ability to appraise staff
using the items. Supervisors were asked how well
nurses could perform tasks, (e.g., writing nursing care
plans that reflect concepts of the McGill Model of
Nursing, using a collaborative approach, as opposed
to directive, with his or her patients and their fami-
lies). Supervisors rated each nurse's performance of
these nine items on a five-point scale with anchors
from (1) "unsatisfactory" to (5) "very good.'
Analysis. Using repeated measures ANOVA, the
researcher found that self-efficacy immediately post-
training was higher than self-efficacy pretraining, and
this increase in self-efficacy was maintained during six
months, as illustrated by Figure 1. Similarly, self-rated
behavior, supervisor-rated behavior, and supervisor-
rated performance were higher at 2 months than at the
time of training, and remained higher at 6 months fol-
lowing training, as illustrated by Figures 2, 3, and 4.
Discussion. Nurses refocused their care from
patients to patients and their families. Nurses were
assessing strengths, coping styles, and readiness to
learn and change. Rather than forming nursing care
plans without consulting patients and families, these
plans were developed in collaboration with them.
Further, planning attempted to build on strengths, to
The Journal of Continuing Education in Nursing
GAUDINE
gs-]
4
E4
ao
V3 _ -
t2
02 - - _ _ _ _ _ _
m~~~~~~Tm
Figure 4. Supervisor-rated perfbrmance over time. Using repeated
measures ANOVA, supervisor-rated performance is higher (p <
.01) at 2 and 6 months than at the time of the workshop. There is
no significant difference between 2 and 6 months.
use previously learned coping strategies, as well as to
facilitate new coping strategies, and to recognize
readiness to learn and change.
Nurses found the workshop relevant and enjoyable.
The workshop was effective in increasing nurses' self-
efficacy for performing the McGill Model of Nursing,
nurses' behaviors related to the model, and the quality
of nurses' performance of the model. The evaluation of
the workshop to implement the model has four signifi-
cant strengths. First, unlike a number of evaluations
limited to a time near the completion of the workshop,
this evaluation looked at the implementation of the
model up to 6 months following the workshop. Second,
the evaluation looked at different outcomes-nurses'
reactions to the workshop, nurses' self-efficacy for per-
forming the model, nurses' behaviors related to the
model, and the quality of nurses' performance of the
model. Third, outcome measures were developed for
this study because self-efficacy measures need to be
domain specific (Bandura, 1986), and because measures
for behaviors and performance related to the McGill
Model of Nursing did not exist. Consequently, the mea-
sures consisted of items sensitive to what was intended
to be measured. Relying on existing tools sometimes
results in a reliable and valid measure of something that
is not the construct of interest. Finally, both self-reports
and supervisor reports were used to measure nurses'
behaviors and performance related to the model.
The evaluation is limitated because although the
response rate of the 2- and 6-month follow-up ques-
tionnaires was high, not all of the nurses and their
supervisors completed these questionnaires, as indi-
cated in Table I. It is possible that nurses who did not
complete the questionnaires or give the questionnaires
to their supervisors made fewer efforts to implement
a1
DEMONSTRATING THEORY IN PRACTICE
the model of nursing. Further, it is possible that both
the self-reports and the supervisor reports at 2 and 6
months were inflated, because the nurses and their
supervisors felt compelled to indicate that they were
making progress. Therefore, the followhig section of
this article supplements the quantitative evaluation of
the implementation of the McGill Model of Nursing
with a description of some changes initiated by staff
nurses in the hospital following the workshop. This
section provides additional support for the effective-
ness of the workshop in changing nursing practice.
Bottom-Up Change in Nursing Practice
Nursing educators and administrators who try to
implement change in nursing practice are often frus-
trated by their lack of success, frequently citing "resis-
tance to change" as a reason. The adoption of a model
of nursing may provide nurses with a framework for
their practice, leading to changes in individual nurses'
behaviors. In the case of the workshop in the McGill
Model of Nursing, 147 nurses from the same hospital
received the same knowledge about the model. This
led to a common knowledge base among nurses
working in the same department. Their shared enthu-
siasm for nursing by this model facilitated the nurses'
ability to identify and implement different nursing
procedures within their departments.
IMPLEMENTATION OF METHODS
TO SHARE PATIENT-RELATED DATA
BASED ON THE MODEL
Following attendance at the McGill Model of
Nursing workshop, nurses working in the
Emergency Department noted that the assessment
tool they were using did not allow documentation of
assessment data related to tne model. They noted that
although they frequently had access to patient infor-
mation such as patient living arrangements and
patient and family strengths, this information usual-
ly was not passed on when the patient was admitted
to the hospital. They worked with nurse managers to
revise their documentation tool and began including
such information in their reports to inpatient nurses
when a patient was admitted.
Inpatient nurses receiving reports from Emergency
Department nurses currently learn not only a patient's
medical history and prescribed treatments, but also
such information as a patient's strengths and
resources, including family and living arrangements,
and a patient's coping strategies. Nurse managers of
inpatient departments noted that nurses used this
information in their work with patients, reducing the
82
time between the admission of a patient and the devel-
opment of a patient care pian. Discharge planning
began earlier and was performed not by the nurse
working with other health care professionals, but by
including the patient or the patient's family.
Sharing and acting on information related to the
McGill Model of Nursing concepts helped give nurs-
es in medical and surgical departments an under-
standing of how their role differed from nonregis-
tered nurses' role. Nurses were heard voicing with
pride that they practiced by the McGill Model of
Nursing. The fact that nurses gained in their profes-
sional identity was evidenced when nonregistered
nurses began championing for their right to attend
the McGill Model of Nursing workshop. Nurses
began acting more frequently as patient advocates, a
result of their learning more about the treatment
choices for patients and their families. As a result
several doctors began questioning the director of
nursing whether nurses in the hospital should be
using a model.
The Emergency Department's nurses' inclusion of
assessments based on the McGill Model of Nursing
led to changes in the Intensive Care Unit nurses' prac-
tice. The Intensive Care Nurses decided to begin shar-
ing the Emergency Department's nurses' assessments
as well as their own assessments. To accomphsh this,
they changed the format of their morning report.
Instead of focusing the report on what happened on
the previous shift a brief morning conference was
held so each day-shift nurse could "present" his or her
patients. AThis type of forward focusing morning con-
ference, as opposed to a backwards looking report,
was already in place at another hospital in the same
city. This practice was brought to the Intensive Care
nurses' attention by nurses familiar with these meet-
ings at the other hospital.
Morning presentations began by reviewing the
patient's diagnosis, physiological status, planned
medical interventions, and information necessary for
safe patient care. However, information based on the
McGill Model of Nursing (e.g., patient and family
strengths and coping styles), was also communicat-
ed. Nurses began developing skills at planning inter-
ventions in collaboration with patients-interven-
tions that would use patient and family strengths
and coping style. Increased communication with
patients and families led to nurses feeling more
empowered in their role of patient advocates. Thus,
report became a time of sharing nursing ideas, and
formed the framework for continuous learning
among the nurses.
2Volume 32, Number 2, March/April 2001

A FAMILY NURSING APPROACH
FOR OPERATING ROOM AND
PERIANAESTHESIA NURSES
Operating Room and perianesthesia nurses recog-
nized their role in facilitating family coping by aug-
menting their efforts to provide family members with
information before, during, and imnmediately foDlowing
surgery. Perianesthesia nurses began allowing a parent
to come into the area and be with his or her child who
had undergone surgery, as soon as the child awoke and
was medically stable. Day Surgical nurses began to
phone patients a few days prior to scheduled surgery,
as well as a day or so following surgery, in an attempt
to address patient concerns and need for information.
What is noteworthy is not that these program changes
occurred, but that these changes were initiated by staff
nurses-staff nurses who refocused their role from a
medically-oriented model to include functions they see
as their separate nursing role.
Families and Visiting Hours
Visiting hours in the hospital were limited to sever-
al hours in the afternoon and several hours in the
evening. Prior to the workshop, nurses sometimes
formed confrontational relationships with patients'
family members, arguing with them when it was time
to leave the hospital. Following the workshop, nurses
recognized the importance of family in patients'
recovery and saw the role of nurses as working with
families. Rather than viewing the family as getting in
the way of nursing care, they encouraged family
members to become involved in care, with the
patient's permission. It became accepted practice for a
nurse to ask a coworker to observe the nurse's
patients while he or she met with a family. Nurses
acted to have the hospital visiting policy revised to
enable families to be together to support each other.
IMPLICATIONS FOR RESEARCH
This evaluation is limited because the workshop
conducted to implement a nursing model was per-
formed in one hospital, with fairly experienced nurs-
es. While reactions to the workshop were measured,
subsequent job satisfaction and professional commit-
ment following practice of the model were not mea-
sured. This study provides anecdotal support for an
increase in both job satisfaction and professional com-
mitment following the workshop, but it is recom-
mended that future evaluations measure both of these
variables. Moreover, future evaluations of the imple-
mentation of nursing models should consider patient
and family outcomes.
The Journal ot Continuing Education in Nursing
GAUDINE
BOUNDARY CONDITIONS THAT ENHANCED THE
ADOPTION OF THE MODEL OF NURSING
1. Credibility of need for training
The need for education ina nursing theory came from a
respected and credible source, the provincial professional
nurses association.
2. Participation
A model of nursing was not imposed on the nurses.
Instead, a committee of staff nurses reviewed various
models and selected the model they felt was useful as
well as consistent wih their values, beliefs, and
assumptions.
3. Union and coworker support
The education coordinator dscussed the budget to be
spent on the workshop with representatives of the nurses'
union.
4. Supervisor support
Nurse managers attended a workshop on the model in
order that they would be supportive of nurses' efforts to
use the model.
5. The workshop
The nursing coordinators who presented the workshop
made efforts to relate the model to the nurses' practice.
The workshop was offered to small groups of nurses,
enabling nurses to discuss the model's concepts and plan
nursing care based on the model.
6. Follow-up session
At the end of the workshop, nurses were told they would
be discussing situations where they had used the model
of nursing at a two-month follow-up session. At the folbw-
up session, nurses shared their success stories with
other nurses.
BOUNDARY CONDITIONS FOR SUCCESSFUL
IMPLEMENTATION OF NURSING MODEL
Prior to implementing the McGill Model of Nursing
in the hospital, nurse managers and educators felt that
nurses may not be interested in learning about a model
and would find what they learned too theoretical to
use in their practice. Because of this, much planning
occurred around factors outside of the actual training
content or around boundary conditions for the work-
shop (sidebar on this page). Recognizing and coping
with these boundary conditions contributed to the
success of the workshop.
Credibility of Need for Training
The impetus for implementing a model of nursing
in the hospital came from a routine professional
inspection report of nursing practice in the hospital
conducted by the provincial nursing professional asso-
ciation. The report indicated that nurses in the hospi-
tal were not using a model of nursing and recom-
mended that nurses in the hospital practice using a
83
DEMONSTRATING THEORY IN PRACTICE
shared model. While the nursing policy and procedure
manual did outline the hospital's model of nursing
(Allen's McGill Model of Nursing), nurse managers
recognized that virtualy none of the staff nurses were
aware of this or had any knowledge about this model.
Thus, the need for education in a nursing theory
came from a respected and credible source, as the
provincial nurses' professional association is widely
respected in this province of Canada. Nurses attending
the workshop were asked to volunteer to evaluate the
effectiveness of the workshop by completing question-
naires immediately prior to and immediately following
training and at 2 and 6 months following training. They
were aware that the hospital's director of nursing
would analyze these questionnaires as part of her doc-
toral dissertation, and therefore realized that the direc-
tor of nursing felt the workshop was important.
Participation
Although the hospital had adopted the McGill
Model of Nursing approximately 10 years earlier, the
nurses questioned why this model had been selected.
Approximately half of the hospital's nurses were
French-speaking, and they expressed the desire to
consider a model developed by the French communi-
ty. Rather than imposing a model on the nurses, the
director of nursing suggested that a committee of staff
nurses, chaired by the associate director of nursing,
review various models. This committee was asked to
select the model they felt was useful as well as consis-
tent with their values, beliefs, and assumptions. After
approximately 1 year of study, the committee decided
to stay with Allen's McGill Model of Nursing. The
staff nurses on the committee shared the process for
selecting a model and their reasons for the selection
with the nurses on their respective units. Thus, the
nurses felt that the dedsion to address their profes-
sional association's recommendation to adopt a
model and the choice of the model were both deci-
sions they made themselves to improve nursing care.
Union and Coworker Support
Following the decision to adopt the McGill Model of
Nursing, the nursing education coordinator began
plans for a 2-day workshop to familiarize nurses with
the model. She prepared her budget for all nursing
workshops occuring in the hospital that year, designat-
ing the majority of the budget for the McGill Model of
Nursmg workshop. Because the large expenditure for
this workshop reduced the number of nurses that could
attend other workshops, she shared her budget with the
nurses' union. When the nurses' union recommended
84
some reduction in the budget for the McGill Model of
Nursmg, the nursing education coordinator worked
with the union to arrive at a mutually agreed on plan
for the next year's nursing continuing education.
Supervisor Support
The hospital's director of nursing recognized that
front-line supervisors would have to feel at ease with
the model if they were to support the nurses' efforts to
use this model. Therefore, a 3-day workshop was
offered to train nurse managers prior to the imple-
mentation of the 2-day workshop for staff nurses. At
the managers' workshop, managers were encouraged
to discuss ways the workshop content could be pre-
sented so it would seem realistic and valuable to the
staff nurses. The managers also thought of ways to
facilitate the implementation of the model on their
units. They identified the need to develop a new nurs-
ing history form to facilitate assessments based on the
McGill Model of Nursing. A committee including staff
nurses was given this task.
The Workshop
The nurse managers at the hospital were concerned
that nurses might find a workshop on nursing theory
too academic and unrelated to the realities of their
everyday practice. For this reason, every effort was
made to make the workshop relevant.
Two of the hospital's nursing coordinators devel-
oped and presented the workshop. Both were familiar
with the current practice of the hospital's nurses, as
wel as the various situations these nurses faced. Thus,
there was a high degree of connectedness between the
workshop leaders and the participants. The workshop
was designed for groups of no more than 20 nurses
because it was interactive. Nurses discussed the
model's concepts and responded to patient videos by
developing further assessment plans as weUl as plan-
ning nursing care based on the model of nursing.
The workshop was designed to increase the nurses'
self-efficacy (i.e., their belief that they could success-
fully implement this model). According to Bandura
(1986), knowledge of one's self-efficacy comes from
four sources of information:
* One's actual performance attainments.
* Vicarious experience or models
* Verbal persuasion.
* Physiological feedback.
Therefore, practice sessions in which nurses per-
formed assessments and wrote care plans, video mod-
els, and group discussion, and interactive sessions
designed to make nurses feel empowered to nurse by
Volume 32, Number 2, March/Apnl 2001

the model were incorporated into the workshop.
Some of the sessions included discussion at the end of
the workshop about how to facilitate nurses using the
theory in their practice.
The workshop was also designed to recognize the
nurses as adult learners (Garrison, 1994; Peters &
Jarvis, 1991). Adult learners are motivated to learn
when they perceive a need for learning. Therefore, the
nurses were reminded that their professional associa-
tion had recommended the implementation of a nurs-
ing model. Further, the nurses discussed situations
where they felt chalenged to provide good nursing
care and would feel a need for learnig. Adult learners
have much to share with other adult learners.
Instructors asked nurses to share examples of their
nursing, and together they discussed how the McGill
Model of Nursing could be applied in these situations.
Follow-Up Session
At the end of the 2-day workshop, nurses were
informed that they would have a 1-hour, follow-up
session in approximately 2 months time. Nurses were
aware that they would be discussing situations in
which they had used the McGil Model of Nursing at
the follow-up session. Approximately half of the nurs-
es were not scheduled to work on the day of their fol-
low-up session, and instructors met individually with
these nurses. Thus, nurses left the 2-day workshop
knowing there was an expectation of them to transfer
what they had learned into their nursing. Further, the
2-month follow-up session served to reinforce key con-
cepts of the model, as well as to allow nurses to share
their success stories with other nurses.
CONTRIBUTIONS AND IMPLICATIONS
FOR PRACTICE
This artide makes two main contributions: 1) nurses
in this hospital found the McGiU Model of Nursing
helpful, and used it to enhance their practice, and 2)
boundary conditions for maximizing transfer of train-
ing were defined. Nurses' enthusiasm for nursing using
this model was demonstrated by bottom-up changes in
nursing practices. An important test of nursing theory
is how practical nurse clinicians find the theory
(Barnum, 1994; Martin, et al., 1992; Torres, 1990). The
McGiU Model of Nursing is currently used in a number
of health care organizations in the province of Quebec,
The Journal of Continuing Education in Nursing
GAUDINE
as well as in other provinces in Canada, and its sphere
of influence continues to grow. Nurse educators and
administrators wishing to enhance nursing practice
and patient outcomes should consider implementing a
shared model of nursing.
Nurse managers at the hospital felt that nurses
might find a workshop on nursing theory not relevant
to their practice. To help counteract this, a year of plan-
nig took place before the workshop was offered.
During this year, boundary conditions for enhancing
transfer of training were identified and addressed.
Nurses working m administration and continumg edu-
cation should consider the importance of front-end
planning prior to offering a workshop, and should
delay the implementation of a workshop until they
have identified and addressed the boundary conditions
for enhancing transfer of training for their workshops.
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TITLE: Demonstrating theory in practice: examples of the McGill

model of nursing
SOURCE: The Journal of Continuing Education in Nursing 32 no2
Mr/Ap 2001
WN: 0106002465004

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