Contributors: Ellen Swanson and Ellen Schultz
January 12, 2020
See also related Practice/Theory Exemplars

Education/Theory Exemplar (Modeling and Role-Modeling)

Location – St. Paul, Minnesota, USA

Framework title – Nursing Theory Mandala based on Modeling and Role Modeling Theory

Year Curriculum initiated – 2018

Key Faculty –

Developer: Ellen E. Swanson, MA, RN, BSN, PHN, HNB – BC (Retired)
Implementer: Ellen Schultz, PhD, RN, HTCP, AHN – BC

Description of theoretical framework

In the hierarchical organizational chart, energy flow is linear and vertical. It is about power over, superior/inferior ways of relating. A new circular mandala model, based on holism, is available to help move us beyond the boxes that limit us and into twenty-first century concepts. These concepts include interdependence, mutuality, collaboration, and synergy. In the circular model, energy flow is circular and self-perpetuating due to the synergy that results from energy flowing throughout the model in all directions. This can be deeply healing, and for deep healing to occur, compassion is necessary. When compassionate, we are able to dance beyond the box step.

The following visual is the mandala template that offers a holistic alternative way to organize information.

The template features four rings and a center. Each ring has a suggested definition for application. Examples will follow these definitions.
Ring 1: Outer rainbow ring – seven resources or sources of energy for the chosen application topic.
Ring 2: Teaching and learning ring – what each resource or source teaches or contributes.
Ring 3: Inner resources ring – resources available from or applied to the body, mind, and spirit either literally or figuratively (ancient cultures included emotions in the mind arena).
Ring 4 and center: Manifestation ring — based on the Feng Shui Ba-Gua system and its life aspects.

The next visual is the mandala application to Holistic Nursing and uses the ring definitions above.

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Description of the curriculum

An application of the mandala template was made to a specific nursing theory, Modeling and Role-Modeling (MRM), by the Society for the Advancement of Modeling and Role-Modeling. The MRM theory mandala was initially introduced to teach MRM theory in a graduate nursing course, Nursing 601: Nursing Science.  Students were enrolled in the Entry-Level MSN Program at Metropolitan State University. This course introduced a broad range of nursing theories.

The Society for the Advancement of Modeling and Role-Modeling adjusted the ring applications as follows, including the addition of a definition of the white space in the visual:

White space: Universal consciousness or energy particles, vibrating at the highest level throughout all aspects of the universe. Universal consciousness simultaneously affects and effects surrounding energy particles and contains all knowledge.

Ring 1: Spiritual consciousness, synthesized knowledge, derived from the Universal Energy Field that guides the MRM practice model. Energy particles in this field vibrate at a slightly lower level.
Ring 2: Specific knowledge that informs and guides nurses using MRM. Links all aspects of the human being.
Ring 3: Specific MRM nursing knowledge, skills, and attitudes based in MRM knowledge and beliefs: Body (Acting), Mind (Knowing), and Spirit (Connecting).
Ring 4: Manifestation in the client. Anticipated outcomes for growth, development, and healing in humans.
Center: Health/Balance (Yellow/White Energy); symbolizes mind-body-brain-spirit synergy.

This next mandala shows the application to MRM Theory and uses the adjusted ring definitions above.

Working in small groups, students were given the option of writing a paper on a given theory or applying the mandala to that theory. All the groups chose the mandala option. Using the MRM theory mandala as a guide, the groups chose a theory and used the mandala to demonstrate the components and interrelationships among the theory components.

Evaluation

The nursing theory mandala assignment relates to the course outcome: Evaluate selected nursing philosophies, models and theories, including their relevance to diverse client populations.

Faculty evaluation of the students’ application of the mandala was through use of a grading rubric. Success of this assignment in meeting the course objective, combined with students’ enthusiasm, led to converting this to a required assignment.

Evaluative comments from the students included the following:

1.  “Learning in this way facilitates better understanding and ability to recall.”
2. “…our group agreed that we did not think about this theory in the aspect of mind-body-spirit until we started working on the Mandala together.
3.  “Overall, our group believes using the mandala was a more helpful tool compared to writing the paper on our theory. We believe this tool helps us evaluate relationships within the theory and developed meaningful learning. Since the mandala is not as elaborate as the paper, we were left with opportunity to be creative and create critical thinking between our views…”
4. “It was a creative way to facilitate learning about theoretical concepts specific to culture and diversity….Another advantage of the mandala is its visual orientation to social structure phenomena which provide broad, comprehensive, and unique factors influencing care expressions and meanings. The limited space of a circle helped us stay focused on the theoretical concepts and prevented us from going astray. We also found out that while coming up with ideas to make the mandala, we had opportunities to share and learn from one another. Finally, before filling in the rings in the mandala, we learned to self-reflect and be self-aware about the topic before we made decisions.”
5. “By systematically examining each of the template’s levels, a theory can be gradually analyzed and broken down into a set of more readily understood concepts. It helps us deduct the true essence of the theory in a structured way.”
6. “We were better able to unearth the main theories that became its foundational stones…it helps with looking at a concept in a micro and macro focus, a duality that is hard to achieve without a skillful approach. Its mind-body-spirit core helps develop a better understanding of the theory explored. It also helps deduct the main concepts of the theory by peeling off the layers of conceptualization.”
7. “Overall, our group believes using the mandala was a more helpful tool compared to writing the paper on our theory. We believe this tool helps us evaluate relationships within the theory and developed meaningful learning.”
8. “Overall, this has been a very rewarding and at the same time challenging experience. We felt that by using [the] Mandala with Orem’s theory made us understand it a lot more clearly than if we were to analyze it without this fascinating tool.”

Challenges

The students of Dr. Shultz also listed their challenges with using the mandala.

1. “The only disadvantage about [using the] mandala is the fact that it might not be useful for every nursing theory because the concepts may not be able to be divided up into such an organized way.”
2. “One disadvantage of the mandala is the limited space for the writer to use when describing each section of the rings. The writing sections in each ring are meant to have a short description. Someone who was looking at the mandala for an explanation of our theory may not fully understand each ring’s information because it is meant for brief descriptions. For example, ring one has short descriptions of the resources Barker used to form the middle range theory. Someone may not know each of the individual resources and will need to do further research to understand parts of Barker’s theory.”
3.  “Despite its striking usefulness, we have also encountered a few difficulties utilizing the Mandala. As a group, we struggled in unanimously identifying and matching concepts to the plentiful sections of the [mandala]. We felt we each could have filled out the template a little differently if left to our own vises [sic]. Therefore, we felt we could not necessarily guarantee the correct application of the Mandala. It was, however, re-assuring to know that this tool was more subjective and open to personal interpretation, which is still a very useful approach to theory analysis and understanding. Last, but not least, as a group, we thought that each concept could fit more than one life aspect, therefore introducing slight confusion in applying the tool.”

Rewards

1. This project has created a new application for the mandala.
2.  A new strategy for teaching nursing theory has emerged.
3. An opportunity has been provided for students to see nursing theory in a new light.
4. The student enthusiasm for the project provides more energy needed for transforming the linear/hierarchical to the circular/collaborative way of being to this profession, community, society, and mankind.
5. Our profession is invited to dance beyond the box step by creating mandalas for every nursing theory.
6. Our profession is invited to dance beyond the box step by creating and applying mandalas in all nursing educational opportunities.

About the Contributors

Ellen E. Swanson, MA, RN, BSN, PHN, HNB-BC (Retired) had a 46 year career that included ortho-rehab, mental health, operating room, management, teaching, care managing, and consulting. For fifteen years she had a private practice in holistic nursing, focusing on health and wellness teaching and counseling. She served on the leadership council for the Minnesota Holistic Nurses Association for ten years.

 

Ellen Schultz, PhD, RN, HTCP, AHN-BC is Professor Emerita and Community Faculty at Metropolitan State University Department of Nursing in St. Paul, MN. For more than 30 years she has taught holistic nursing and nursing theory. She is certified in Advanced Holistic Nursing, labyrinth facilitation, Healing Touch, and Feng Shui. She is past-president and board member of the American Holistic Nurses Credentialing Corporation.