Sr. Callista Roy Adaptation Model of Nursing PDF

Sr. Callista Roy: Adaptation Model of Nursing Marie Josephine J. Serra, RN, MAN "When push comes to shove, we will seldom disappoint ourselves. We all harbour greater stores of strength than we think. Adversity brings the opportunity to test our mettle and discover for ourselves the stuff of which...

Sr. Callista Roy: Adaptation Model of Nursing Marie Josephine J. Serra, RN, MAN "When push comes to shove, we will seldom disappoint ourselves. We all harbour greater stores of strength than we think. Adversity brings the opportunity to test our mettle and discover for ourselves the stuff of which we are made." -Sister Callista Roy Overview: The RAM provides a useful framework for providing nursing care for persons in Roy health and in acute, chronic, and terminal illness The RAM views the person as an Adaptation adaptive system in constant interaction with an internal and external environment. Model The RAM provides an effective framework for addressing the adaptive needs of individuals, families, and groups. Overview: Johnson's nursing model was the impetus for the development of Roy's Roy Adaptation Model. Roy also incorporated concepts from Helson's adaptation theory, von Bertalanffy's Adaptation system model, Rapoport's system definition, the stress and adaptation theories of Dohrenrend and Selye, and Model the coping model of Lazarus. ASSUMPTIONS 1. SCIENTIFIC ASSUMPTIONS 2. PHILOPSOPHICAL ASSUMPTIONS MAJOR A stimulus is any entity that provokes a response and that serves as the point of interaction between the person and the environment. CONCEPTS The environment is the source of a variety of stimuli that either threaten or promote the person's unique wholeness. Environmental stimuli either threaten or enhance an individual's ability to adapt. Stimulus As an example, loving supportive behavriors from a parent enhance a child's ability to successfully adapt, or whereas a hostile, abusive parent poses a threat to a child's adaptation. MAJOR Roy categorizes these types of stimuli as focal, contextual, or residual. FOCAL is defined as the internal or external CONCEPTS stimulus most immediately challenging the person's adaptation. The focal stimulus is the phenomenon that attracts the most of one's attention. CONTEXTUAL STIMULI are all other stimuli Stimulus existing in a situation that strengthen the effect of the focal stimulus. RESIDUAL STIMULI are any other phenomena arising from a person's internal or external environment that may affect the focal stimulus but whose effects are unclear. MAJOR The three types of stimuli act together and influence the adaptation level, which is a person's "ability to respond positively in a situation." CONCEPTS EXAMPLE: SMOKING Stimulus MAJOR A person's adaptation level may be described as integrated, compensatory, or compromised. A person does not respond passively to CONCEPTS environmental stimuli; the adaptation level is modulated by a person's coping mechanisms and control processes. Roy categorizes the coping mechanisms into either Coping the regulator or the cognator subsystem The coping mechanisms of the regulator subsystem occur through neural, chemical, and Mechanisms endocrine processes. The coping mechanisms of the cognator subsystem occur through cognitive-emotive & Control processes. Processes MAJOR Roy has identified two control processes that coincide with the regulator and cognator subsystems when a person responds to a stimulus. CONCEPTS The control processes identified by Roy are the stabilizer subsystem and the innovator subsystem. The stabilizer subsystem refers to "the established structures, values, and daily Coping activities whereby participants accomplish the primary purpose of the group and contribute to common purposes of society." Mechanisms The innovator subsystem refers to cognitive and emotional strategies that allow a person to change to higher levels of potential. & Control Processes MAJOR Adaptation refers to "the process and outcome whereby thinking and feeling persons, as individuals or in groups, use conscious awareness and choice to CONCEPTS create human and environmental integration." Rather than being a human system that simply strives to respond to environmental stimuli to maintain integrity, every human life is purposeful in a Health and universe that is creative, and persons are inseparable from their environment. ADAPTIVE or INEFFECTIVE RESPONSES result from Adaptation these coping mechanisms. ADAPTIVE RESPONSES promote the integrity of the person and the goals of the human system, that is, survival, growth, reproduction, mastery, and personal & environmental transformation. INEFFECTIVE RESPONSES neither promote integrity nor contribute to the goals of adaptation. MAJOR CONCEPTS Four Modes of Adaptation Physiological "is associated with the physical and chemical processes involved in the function and activities of Mode living organisms" five needs are identified relative to the basic need of physiological integrity: 1 oxygenation 2 nutrition 3 elimination 4 activity and rest 5 protection complex processes that contribute to physiological adaptation senses fluid, electrolyte, and acid-base balance neurological function endocrine function the basic need of the physiological mode is physiological integrity Self-concept "it focuses specifically on the psychological and spiritual aspects of the human system" Mode the basic need underlying the individual self- concept mode has been identified as psychic and spiritual integrity, or the need to know who one is so that one can be or exist with a sense of unity, meaning, and purposefulness in the universe "self-concept is defined as the composite of beliefs and feelings about oneself at a given time and is formed from internal perceptions of others' reactions" its components include: 1) the physical self, which involves sensation and body image 2) the personal self, which is made up of self- consistency, self-ideal or expectancy, and the moral-ethical-spiritual self Role Function "is one of two social modes and focuses on the roles the person occupies in society Mode a role - defined as a set of expectations about how a person occupying one position behaves toward a person occupying another position basic need underlying the role function mode has been identified as social integrity - the need to know who one is in relation to others so that one can act persons perform primary, secondary, and tertiary roles  primary role - determines the majority of behavior Role Function engaged in by the person during a particular period of life; determined by age, sex, and developmental Mode stage secondary roles - those that a person assumes to complete the task associated with a developmental stage and primary role tertiary roles - related primarily to secondary roles and represent ways in which individuals meet their role associated obligations; are normally temporary in nature, freely chosen by the individual, and may include activities such as clubs or hobbies these roles are carried out with both instrumental and expressive behaviors instrumental behavior - "the actual physical performance of a behavior" expressive behavior - "the feelings, attitudes likes, or dislikes that a person has about a role or about the performance of a role" Interdependence focuses on close relationships of people (individually and collectively) and their purpose, structure, and development Mode interdependent relationships involve the willingness and ability to give to others and accept from them aspects of all that one has to offer such as love, respect, value, nurturing, knowledge, skills, commitments, material possessions, time, and talents basic need of this mode - relational integrity two specific relationships are focus: with significant others, persons who are the most important to the individuals with support systems, others contributing to meeting interdependence needs two major areas of interdependence behaviors receptive behavior and contributive behavior - "receiving and giving of love, respect, and value in interdependent relationships" METAPARADIGM NURSING Broad: "health care profession that focuses on human life processes and patterns and emphasizes promotion of health for individuals, families, groups, and society as a whole" Specific: Roy defines nursing according to her model as the science and practice that expands adaptive abilities and enhances person and environmental transformation. nursing activities as the assessment of behavior and the stimuli that influence adaptation METAPARADIGM PERSON Humans are holistic, adaptive systems "As an adaptive system, the human system is described as a whole with parts that function as unity for some purpose. Human systems include people as individuals or in groups, including families, organizations, communities, and society as a whole." main focus of nursing, the recipient of nursing care, a living, complex, adaptive system with internal processes (cognator and regulator) acting to maintain adaptation in the four adaptive modes METAPARADIGM HEALTH "Health is a state and a process of being and becoming integrated and a whole person." It is a reflection of adaptation, that is, the interaction of the person and the environment." METAPARADIGM ENVIRONMENT "all the conditions, circumstancs, and influences surrounding and affecting the development and behavior of persons or groups, with particular consideration of the mutuality of person and earth resources that includes focal, contextual, and residual stimuli" "It is the changing environment [that] stimulates the person to make the adaptive responses." is the input into the person as an adaptive system involving both internal and external factors Critical Thinking in Nursing Practice with Roy's Model The nursing process a goal-oriented, problem-solving approach to guide the provision of comprehensive, competent nursing care to a person or groups of persons "relates directly to the view of the person as an adaptive system" Roy has conceptualized the nursing process to comprise the following six simultaneous, ongoing, and dynamic steps: 1. Assessment of behavior 2. Assessment of stimuli 3. Nursing diagnosis 4. Goal setting 5. Intervention 6. Evaluation  Behavior Assessment an action or a reaction to a stimulus may be observable or non-observable of Behavior observable: pulse rate, blood pressure non-observable: feeling experienced by the person and reported to the nurse Exploration of behaviors manifested in the 4 adaptive modes allows the nurse to achieve an understanding of the current adaption level and to plan interventions that will promote adaptation At the beginning of the NPR, a thorough assessment of behavior must be performed and the assessment must be ongoing.  In this level of assessment, the nurse Assessment analyzes subjective and objective behaviors and looks more deeply for possible causes of of Stimuli a particular set of behaviors Nursing The diagnostic statement specifies the behaviors that led to the diagnosis and a Diagnosis judgment regarding stimuli that threaten or promote adaptation. "judgment process resulting in statements conveying the adaptation status of the human adaptive system  focuses on promoting adaptive behaviors Together, the nurse and the client agree on Goal Setting clear statements about desired behavioral outcomes of nursing care The outcome statement should reflect a single adaptive behavior, be realistic, and be measurable. The goal statement should include the behavior to be changed, the change expected, and the time frame in which the change in behavior should occur  focuses on the manner in which goals are attained Intervention any action taken by a professional nurse that he/she believes will promote adaptive behavior by a client arise from a solid knowledge base and are aimed at the focal stimulus whenever possible any nursing approach that is intended "to promote adaptation by changing stimuli or strengthening adaptive processes  consists of one question: "Has the person moved toward adaptation?" Evaluation requires that analysis and judgment be made to determine whether those behavioral changes stated in the goal statement have, or have not, been achieved by the recipient of nursing care the nurse judges the effectiveness of the nursing interventions that have been implemented and determines to what degree the mutually agreed upon goals have been achieved.  Representation of Individuals Representation of Human with Anorexia Nervosa as Adaptive Systems Adaptive Systems