The Application of Roys Adaptation Model in Nursing Practice - Essay Example

The Application of Roy’s Adaptation Model in Nursing Practice In the nursing profession, the development of theories is an essential element in clinical practice. The purpose of which is to guide and support nurses to ensure the deliverance of safe and quality nursing care to clients (Clement, et.al 1983). Roy (1984) in her work explicated in her adaptation model the five hallmarks of a nursing theory that are interrelated to the concept of adaptation: person, environment, goal of nursing, nursing activities and health (Stein, 2006). Roy (2000) claims “the model provides a way of thinking about people and their environment that is useful in any setting. It helps one prioritize care and challenges the nurse to move the patient from survival to transformation.” In Roy’s Adaptation Model (1976), she notes that the person is a biopsychosocial adaptive system. It is an open system that repetitively interacts with the environmental changes through the series of adaptation. These needs are divided into four different adaptive modes: physiologic, self-concept, role function and interdependence (Stein, 2006). Roy (1976) also stressed that as the internal and external stimuli or changes occurs, the development and behavior of the person adapts to protect and maintain his physiologic, psychic and social integrity. She also asserts that the person has different levels of adaptation, which could either result in a positive response called adaptation or a negative response called maladaptation (Roy, 1984). Although in Roy's model, the person is referred to an individual client, her model can also be applied to family, groups and communities (2). An early important concept of Roy's model drew on the work of Harry Helson, a physiologic psychologist (Roy,1984), who defined adaptation as a process of responding positively to environmental changes and described three types of stimuli that influence an individual's ability to cope with the environment: focal, contextual and residual (Fawcett, 1984). Those that directly deal with the individual in a particular situation are focal stimuli. Other agent or factors that influence the situation presently are contextual stimuli. Residual stimuli consist of the individuals thinking, attitude and personal view of something that may influence the situation (Ross et.al.1990). An early important concept of Roy's model drew on the work of Harry Helson, a physiologic psychologist (Roy,1984), who defined adaptation as a process of responding positively to environmental changes and described three types of stimuli that influence an individual's ability to cope with the environment: focal, contextual and residual (Fawcett, 1984). Those that directly deal with the individual in a particular situation are focal stimuli. Other agent or factors that influence the situation presently are contextual stimuli. Residual stimuli consist of the individuals thinking, attitude and personal view of something that may influence the situation (Ross et.al.1990). The environment as Roy (1976) viewed it is in dynamic relationship with the person. The concept of environment is both internal and external in relation with the person. All conditions and situations comprising the environment is in constant change affecting the behavior of the person that threatens his integrity. Roy (1976) describes health as a state and process of being and becoming integrated reflecting a successful and positive adaptation of person to the stimuli from the environment signifying person and environmental mutuality. A healthy person is one whose integrity is intact because of his ability to adapt. Illness, on the other hand, is a condition when a person's integrity is endangered due to his maladaptive response to stimuli (Meyers, 2005). To assist the person in his adaptive capabilities, the goal of nursing in Roy’s Adaptation Model, thus contributing to health, improve quality of life, maintain his productivity and protect his integrity (Meyers, 2005). Illness prevention and health maintenance is also a concern in nursing by broadening the person's zone of adaptation (Roy, 1976). Many nurses have embraced the Roy Adaptation Model as a framework and guide for nursing practice on the care of individual patients (Ross, et.al., 1990). They use this model to map out the plan of care of patients and create nursing interventions. In clinical nursing, the person in the model is the recipient of care. The nurse has a professional obligation to work collaboratively with the client to promote, review and assess adaptive strengths in all four adaptive modes that will promote health (Hanson, 1984). The nursing process is a problem solving approach. It includes gathering data, categorizing needs of the adaptive system, selecting and implementing approaches for nursing care and evaluation the outcome of care provided (Meyers, 2005). In Roy's Adaptation Model, the nursing process consists of six steps: First level assessment, Second level assessment, Problem Identification, Goal Setting, Intervention, and Evaluation (Roy, 1976). The Roy 's Adaptation Model provides a new way of looking at the person in providing care in acute medical/surgical acute care setting.(Meyers, 2005). Nursing care starts with the assessment process of the behaviors of the four adaptive modes. The person is assessed on two levels as in the case of Mrs. Smith, diagnosed with pancreatitis. First level is the assessment of client behaviors which involves gathering of data about the behavior or the presence and presence of maladaptation of Mrs. Smith in each of the four adaptive modes. Behaviors of the physiologic mode are assessed such as oxygenation, nutrition, elimination, activity, rest, fluid and electrolyte balance, neurological function and endocrine function. Behaviors of the self-concept mode are assessed by seeking out beliefs that Mrs. Smith has about herself. Need is psychic, self-consistency, self-ideal, body image and spiritual integrity so that the person can exist with a sense of meaning and purposefulness. In the role function mode, how Mrs. Smith sees herself in relation to others is determined. Sustaining equilibrium between independence and dependence in the person's relationship with others is involved in the interdependence mode. Dependent behaviors include seeking for affection, help and attention. Independent behaviors include mastery of obstacles and initiative taking (Roy, et.al., 1999) The second level of the assessment process includes the determination of stimuli influencing the person's maladaptive behaviors (Roy, 1984). In the case of Mrs. Smith, the types of stimuli that form her environment causing her behavior are assessed and classified as focal, contextual and residual. Mrs. Smith's focal stimulus includes premature activation of pancreatic enzymes. Her feeling of uncertainty of her disease is the contextual stimulus. The establishment of a nursing diagnosis or problem identification in the Roy model is the third step of the nursing process. This is the formulation of statements that interpret the data that has been evaluated in the second level assessment. Roy suggests that statements contain the adaptation status of the person as well as the most relevant influencing stimuli (Roy, 1976). The fourth step of the nursing process is Goal Setting. It is the formulation of a behavioral outcome statement of nursing care that will promote adaptation. The general goal is to change maladaptive behavior, underpin adaptive performances and improve the person's ability to cope. Goal statement should not just include behavior, but should indicate the time frame in which the goal will be met. It is a collaborative effort between the nurse and the person in deciding the outcomes of the person (Roy, 1984). An example of a goal statement for Mrs. Smith would be "the patient will exhibit ability to care for his pancreatitis within two weeks." Intervention is the fifth step of the nursing process according to Roy. Once the stimuli are identified the nurse selects management interventions. The focal point of nursing care is on modifying the stimuli or reinforcing adaptive behaviors. There are two approaches to help the person in attaining the goals established. In the first approach, the focal stimuli is managed skillfully to achieve a positive adaptive response. While in the second approach, the person's zone of adaptation is broadened so that the stimuli fall within it so that the person can adapt positively (Roy, 1976). Evaluation is the final step in the nursing process which entails judging the effectiveness of the nursing interventions in meeting the goals set in relation to the behavior of the person. The intervention is successful if the outcome behaviors met the stated goals maintaining the integrity of the person. If the behaviors are still maladaptive after the nursing intervention, then further appraisal of the nursing action needs to be done (Roy, 1976). An example of a statement indicating effective intervention for Mrs. Smith would be "patient demonstrates proper pancreatitis care behaviors." Adaptation is an outcome of responding positively to changes in the environment to restore need for satisfaction. Adaptive behavior is a positive response and is analogous to adaptive health that promotes integrity of the different facets of the human system, that is, survival, growth, reproduction and personal transformation. And a healthy person is one whose integrity is intact and maintained as a result of his ability to adapt. Behaviors which are ineffective do not result in goal attainment and are unacceptable to society (Roy, 1984). Roy's Adaptation Model has an impact in nursing education, practice and research. An advantage of the Roy Adaptation Model is that it provides answers to question as to how nursing care should be given to the patient. The model clearly delineates the nursing process and serves as guide in clinical practice. It takes into account the client, goal and interventions for reaching the identified goal (Meyers, 2005). Another gain of using the model in clinical practice, is that it directs the nurse to rank care to be given to the client in the hope of altering the patients coping and adaptation (Roy 1976). It leads the nurse to problem-solving approach in promoting the best adaptive strategies and ways if the adaptation of the client to the stimuli are not health promoting. The nurse can therefore maneuver the environment in order to promoter adaptation (Roy, 1980). To apply the Roy Adaptation Model to nursing practice, the nurse works in partnership with the client in assessing and planning the client’s abilities to deal with health. An advantage in using the model is that together, both the nurse and the client can work collaboratively in finding ways in facing and handling challenges that will work for the patient both in the present and future (Stein, 2006). Lopes, et.al., (2006) argued that “Roy is the author of one of the most diffused nursing conceptual models.” The Roy Adaptation Model is slowly evolving and changing. The conceptual model began in 1960. And in 1976, Roy clearly described the four basic concepts of her model. In addition, Roy continued and persevered to improve her model in 1981, 1984, 1986, 1991 and 1999 (Lopes, et.al., 2006). In this light, one disadvantage of using the Roy Adaptation Model as a framework in providing care in practice, is that constant revisions in its application in practice is needed to keep up to the new changes that might be incorporated by Roy in the future. The very fundamental idea of the Roy adaptation model is that the person is constantly adjusting, coping, adapting or changing to stimuli. Helson (1964) defined the model as “a system that functions as a result of the interdependence of its parts.” A drawback on using this model in practice is that since its an organized unit of several factors that form a network, failure of a part of the system, could mean the failure of the whole system (Lopes, et.al., 2006). In summary, nurses play a key role in individual patient care by facilitating adaptive behaviors in response to environmental influences. For a nurse to be effective in the delivery of quality nursing care, theoretical basis are needed to guide practice in the care for the person and meet client goals. The nurse should be able to assess how the person responds to certain stimuli in each mode leading to positive coping and adaptation to the focal stimuli. If coping and adaptation are not health promoting, the nurse may need to manage the environment based on the response of the person in order to promote adaptation to maximize health (Roy, 1980).   References Clement, I, & Roberts, B. (1983). Family health: A theoretical approach to nursing care. New York: Wiley. Fawcett, J. (1984). Analysis and evaluation of conceptual models of nursing. Philadelphia: F.A. Davis.   Hanson, J. (1984). The family. In S. C. Roy (Ed.), Introduction to nursing: An adaptation model (pp. 520-537). Englewood Cliffs, NJ: Prentice-Hall. Meyers, K. (2005). Frequently Asked Questions The Roy Adaptation Model. (2005). Boston College. Ross, B., & Cobb, K. (1990). Family nursing: A nursing process approach. Redwood City, CA: Addison-Wesley Nursing. Roy, C. (2000). The visible and invisible fields that shape the future of the nursing care system. Nursing Administration Quarterly, 25(1), 119-131 Roy, C. (1984). Introduction to nursing: an adaptation model. (2nd ed.). Englewood Cliffs, N.J.: Prentice Hall, Inc.   Roy, S. C., & Roberts, S. (1981). Theory construction in nursing: An adaptation model. Englewood Cliffs, NJ: Prentice-Hall.   Roy, S. C. (1980). The Roy adaptation model. In J. Riehl & S. C. Roy (Eds.), Conceptual models for nursing practice (pp. 60-69). New York: Appleton-Century-Crofts.   Roy, C. (1976). Introduction to Nursing: An Adaptation Model. New Jersey: Prentice - Hall.   Stein, R. W. (2006). A Comparison And Contrast of Nursing Models by Roy and Neuman. http://www.scielo.br/pdf/rlae/v14n2/v14n2a16.pdf (Lopes et al 2006)   Read More