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Paper wrote for National University, NSG 403 Nursing Theories and Models, describing Sr. Roy's Adaptive Model case study
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APPLICATION OF ROY’S ADAPTATION MODEL 1
Application of Roy’s Adaptation Model
br. Jose Francisco Pereira, OSGC
National University San Diego
January 29, 2012
APPLICATION OF ROY’S ADAPTATION MODEL 2
Nursing Theory Models are co-related in between theory, education, research, and
clinical practice, working as a guide in all areas with this interaction assuring that the nursing
profession stay relevant and continuous positively influencing the patient’s health.
Many Nurses have developed theories to define or explain various aspects of the nursing
profession, and becoming a step-by-step set of ideas and “concepts that hold true as a constant
and can be used to treat patients, describe and explain illnesses and their subsequent cures,
predict facets of cause, reaction and outcome, and prescribe a healing course of action. Nursing
theories can be viewed as the field establishing its professional boundaries as the main
component of caring is impossible to measure. The theories also seek to define what it is that
nurses know and do as a separate autonomous discipline that is only recently being granted its
autonomy.” (Topnursingcolleges.com. n.d.)
Sr. Roy’s, encouraged by Johnson’s nursing model, in 1976 developed the Roy’s
Adaptive Model (RAM) which incorporate concepts from, Helson’s adaptation theory, Von
Dohrenrend and Seyye, and Lazarus’s coping model (Philips, 2002). RAM understands a person
as an interrelated system, biological, psychological, and social.
Understanding Roy’s Adaptive Model
RAM describes a person as “an adaptive system with cognator and regulator subsystems
acting to maintain adaption in the four adaptive modes” (Roy, 2009): physiologic-physical, self-
concept-group identity, role function and independence (Figure 1). It also takes in consideration
an interdependency between person and resources, where the person is a whole in the family,
groups, community, society, organizations, and nation, with their environment been related to
“all conditions, circumstances, and influences surrounding and affecting the development and
behavior of persons and groups, with particular consideration of mutuality of person and earth
APPLICATION OF ROY’S ADAPTATION MODEL 3
resources” (Roy, 2009).All of those are divided in three kinds of stimuli: focal with an
immediate effect, contextual is a contributory circumstance, and residual which is related to
residual beliefs or attitude from a past experience (Alexander, Fawcett, & Runciman, P. J. 2006).
Health is “a state and process of being and becoming an integrated and whole that reflects
person and environment mutuality” (Roy, 2009), where health, wellbeing, and illness can co-
exist (Phillips, 210) in a continuum. Nursing is “to promote adaptation for individuals and groups
in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by
assessing behavior and factors that influence adaptive abilities and to enhance environmental
factors” (Roy, 2009).
Figure 1: Sr. Roy’s Adaptation Model (RAM)
Source: Roy & Andrew, 1999.
RAM, defined adaptation as "the process and outcome whereby the thinking and feeling
person uses conscious awareness and choice to create human and environmental integration"
(Roy, 1997) through a “creation spirituality” concept, which understand that the “person and the
APPLICATION OF ROY’S ADAPTATION MODEL 4
earth are one, and that they are in God and of God” (Roy, 1997). Moreover the person and the
environment as sources of stimuli and both needs modification to promote adaptation in four
modes - physiologic, self-concept, role function, and interdependence - to obtain health
behavioral results, with each patient’s adaptation model being unique and in constant change.
Roy’s Adaptive Model Nursing Process
RAM nursing process is a problem solving approach where in each of the four adaptive
modes, where the RN will need to:
1. Assess the Behavior “of the person as an adaptive system in each in each of the
adaptive modes.” (Marinquez, D. J. S., 2009)
2. Assess and identify the internal and external stimulus, “that are influencing the
person’s adaptive behaviors. Stimuli are classified as: 1) Focal – those to most
immediately confronting the person; 2) Contextual – all other stimuli present that are
affecting the situation and 3) Residual – all other stimuli present that are which
descripts the adaptive system; internal and external stimulus influencing patient’s
adaptive behaviors for each of the adaptive modes.” (Marinquez, D. J. S., 2009)
3. Nursing diagnosis “involves the formulation of statements that interpret data about
the adaptation status of the person, including the behavioral and the most relevant
stimuli.” (Marinquez, D. J. S., 2009)
4. Goal Setting “involves the establishment of clear statements of the behavioral
outcomes for nursing care.apply interventions based on patient center care plan
(implementation).” (Marinquez, D. J. S., 2009); “Goals need to be realistic and
attainable and are set in collaboration with the person.” (Andrews & Roy, 1991)
APPLICATION OF ROY’S ADAPTATION MODEL 5
5. Intervention “involves the determination of how best to assist the person in attaining
the established goals” (Marinquez, D. J. S., 2009); adapt “the principles of the model
and the development of multi-modal training tools for your learners, including just-in-
time training and use of adult learner principles; attending to issues of authority,
leadership style and communication.” (Senasec.2010)
6. Evaluation is “final step of the nursing process which involves judging the
effectiveness of the nursing intervention in relation to the behavior after the nursing
intervention in comparison with the goal established.” (Marinquez, D. J. S., 2009).
During this phace, if any ineffective behaviors are observe, the RN will start all
process again.
Practical application of the model in a case study (Attachment)
When a nurse is applying RAM to her daily life is difficult to separate person, health,
environment, and nursing since they are all interrelated, see figure 1.
Sr. Roy’s model is been apply to case study 4, which describes a new patient to the clinic
who is coming to see the RN Certified Diabetic Educator (CDE). Being the first nursing
consultation, the CDE is evaluating Ms. Brown medical data, coping strategies (adaptive),
knowledge of her medical condition, the ability to recognized personal habits, internal and
exterior stressor, which collaborate towards preventing her to obtain optimum health. The goal of
the nurse is to assist Ms. Brown developing an effective adaptive system towards her health and
illness.
In the clinical setting the CDE, review clinical data from the Ms. Brown chart notice that
she is 45 years-old African-American female with a family history of type 2 diabetes and a
history of with mild hypertension which is under control with medication, and dyslipidemia in
APPLICATION OF ROY’S ADAPTATION MODEL 6
the past 2 years. Ms. Brown has a body mass index (BMI) of 30kg/m2, with a waist
circumference of 40 inches. Her most recent blood work shows A1C level as at 7.3% and fasting
glucose levels average between 140 and 160mg mg/dl; no others blood work are available at this
time.
During nursing interview, the CDE noted that Ms. Brown has recently become divorced
and is a single mother of an age eight years old son and a five years old daughter; recently move
to a new area in the same apartment complex as her mother who can provide after school care for
her children; unable to lose the weight gained during both pregnancies; lives a sedentary live due
to working as an administrative assistant; unable to have free time to herself due to working and
family obligations. She also stated feeling frequent tiredness and some paresthesias in her lower
extremities, mainly burning sensations that come and go in her calf muscles and the top of her
feet.
The nurse recognized that Ms. Brown is dealing with three major life changing events,
recently divorce, becoming sole care giver of two young children, and her new residential status
which create new stresses such as how to: 1) effectively provide economically for her family,
which may require more time at work or even obtain a part-time job; 2) to find new ways to care
for her children, being a single mother there is not a partner to share this obligation and her
mother may become ill or may will have personal schedule conflicts with the aftercare for the
children, and children adaptation of having only one parent at home; 3) new residential status,
which can create sense of insecurity related to new area adaptation for her and the children,
transportation to and from work, and finally the children adaptation to new school which can
direct influence theirs behavior. Each of these factors can provide internal and external stressors,
creating an imbalance to previous coping strategies that Ms. Brown used to deal with her
APPLICATION OF ROY’S ADAPTATION MODEL 7
Hypertension, dyslipidemia and maybe is causing her type 2 diabetes to be out of acceptable
parameters.
The CDE goal following RAM is to understanding how Ms. Brown life use to be and
how she use to feel before her divorce, how she is feeling with her new family system and
residential situation, meals choice and preparation, what she knows about type 2 diabetes, the
correlation between type 2 diabetes with cardiovascular disease, and exercises. After these
understanding is gain, the nurse can develop a nursing care plan with Ms. Brown towards assist
her to obtain control of her type 2 diabetes, maintain her hypertension and dyslipidemia under
control, make better meals choices, increase physical activity, and prevent depression. This goal
can be obtain by Listening With the Heart (Hwoschinsky, 2002) to Ms. Brown, answer her
question in a non-judgmental way, referral to dietician and social-worker consultation, and start
an open line of communication with clinic nurse case manager to answer any further question
that she may encounter. Moreover provide reading and visual materials developed by the
American Diabetes Association related to diabetes, cardiovascular disease, depression, food
choices and labels, and finally trustful website links.
Before ending the consultation, the CDE review with Ms. Brown all the subjects covered
during the section by requesting Ms. Brown to explain what they have spoken; this will insure
patient understanding. Provide Ms. Brown with all future schedule appointments, and finally
reinforce by telling her that if she has any further question a clinic case manage will be able to
assist during clinic working hours.
The nurse finalize her notes to make possible for the next RN caring for Ms. Brown to be
able to identify and reinforce working adaptive mechanisms, to identify new internal and
external stimuli, and identify coping mechanisms needing adaptation.
APPLICATION OF ROY’S ADAPTATION MODEL 8
Conclusion
Sr. Callista Roy Adaptive Model has been proving effective in all patient care settings,
from intensive care units to home health care. RAM dynamic contour has the capability to assist
patient, family, community, and any others social groups towards a mutual learning,
understanding, and supporting patient and nursing wellbeing. Moreover help nursing staff to
develop their only personal coping mechanism when dealing with negative stimuli, as well
helping them to realize their own potential.
RAM was used with Ms. Brown to assist her understand her physical health and coping
mechanism in use, identify external stimuli, provide inside in how to cope with old stimuli in her
new life cycle, and also identify new stimuli. It will assist Ms. Brown to stay whole as an
individual in her surrounds and an integrated part of the collective.
We do understand that every second stimuli change and or a new stimuli is introduce, and
coping mechanisms are continuous process of body, mind and soul doing what nature does best
maintain homeostasis continually trying to stay / be one with God.
APPLICATION OF ROY’S ADAPTATION MODEL 9
References
Alexander, M. F., Fawcett, J. N., & Runciman, P. J.. 2006. Roy’s adaptation model. In Nursing
practice: hospital and home: the adult (3rd ed.). pg. 1085. China: Elsevier Health
Sciences.
Andrews, H., & Roy, C. (1991). The Adaptation Model. Norwalk, CT: Appleton & Lange.
Hwoschinsky, C.. (2002). Listening with the heart (3rd ed.). Indianola, WA:
Compassionate Listening Project.
Manriquez, D. J. S.. (2001). Sister Callisto Roy theory on adaptation [PowerPoint slides].
Retrieved on 01/26/2012 from http://www.slideshare.net/davejaymanriquez/callista-roy-
presentation
Phillips, K. D. (2002). Roy’s adaptation model in nursing practice. Nursing theory: Utilization
& application (pp. 289-314). St. Louis: Mosby.
Phillips, K. D.. 2010. Sister Callista Roy: Adaptation model. Nursing theorists and their work
(7th ed). pg. 342. Mosby, Maryland Heights, MO.
Roy Adaptation Association. 2010. Boston College. Retrieved on 01/14/2012 from
http://www.bc.edu/schools/son/faculty/featured/theorist/Roy_Adaptation_Association.ht
ml
Roy, C.. 1997. Future of the Roy model: Challenge to redefine adaptation. Nursing Science
Quarterly, 10 (1), 44 - 46. doi:10.1177/089431849701000113
Roy, C., & Andrews, H. (1999). The Roy Adaptation Model. Stamford, CT: Appleton & Lange.
Roy, C.. 2009. The Roy adaptation model. 3rd ed. Pearson. Upper Saddle River, NJ.
Senasec, P. (2010). Implementing the Roy adaptation model: from theory to practice. Boston
College. Retrieved on 01/26/ 2012 from
APPLICATION OF ROY’S ADAPTATION MODEL 10
http://www.bc.edu/schools/son/faculty/featured/theorist/Roy_Adaptation_Model/
Practice.html
APPLICATION OF ROY’S ADAPTATION MODEL 11
Appendix
Case Study 4
Ms. Shanell Brown is a 45-year-old African American woman diagnosed with type 2
diabetes 4 years ago. She is being seen today by the RN Certified Diabetic Educator (CDE) for
evaluation on how she is managing her diabetes. Ms. Brown is a new patient, having recently
moved to the area. An initial review of her electronic health record indicates that she has a family
history of type 2 diabetes and cardiovascular disease. Ms. Brown was recently divorced and is
now a single mother with two children, a son age eight, and a daughter who is five. She recently
moved to a new apartment so they could be close to her mother who also lives in the same
complex. Her mother provides after school care for her children.
During the interview with the CDE, Ms. Brown states, “I haven’t been able to lose the
weight I gained during pregnancy with both my kids”. She leads a sedentary lifestyle mainly due
to her work as an administrative assistant for a local university. “I wish I had more time to
exercise but by the time I get home and take care of the children, there just doesn’t seem to be
any time left for me.” She was also diagnosed with mild hypertension and dyslipidemia during
this past year, which is something that is expected with type 2 diabetes. Ms. Brown confides she
feels well except for frequent tiredness and some paresthesias in her lower extremities, mainly
burning sensations that come and go in her calf muscles and the top of her feet.
Other information noted in her record show her blood pressure is under good control with
medication. She has a body mass index (BMI) of 30 kg/m², which is obese. Her waist
circumference is 40 inches. Her fasting glucose levels average between 140 and 160 mg/dl. Her
most recent A1C level is at 7.3%. The goal for the visit today is to help Ms. Brown understand
APPLICATION OF ROY’S ADAPTATION MODEL 12
the importance of diet and exercise in controlling the progression of diabetes. Other factors that
may be considered are stress related to changes in her family situation.
APPLICATION OF ROY’S ADAPTATION MODEL 13
Theory Paper Point Assignment
STUDENT NAME:
Criteria Points
Earned
Thoughts are expressed clearly and concisely using correct sentence structure 3Paragraphs are organized with an introductory sentence, discussion sentences and transition sentence to the next section 2Paper is organized with an introduction, discussion (with headings), and summary/conclusion 3Grammar and spelling errors are limited to less than 3 per document
2Paper correctly conforms to the latest edition of APA format:
Title page1
Double spacing1
Running head and pagination1
Citing sources within paper1
Reference list (matches citations in paper)1
Paper reflects integration of thoughts, feelings, beliefs, and values2
Paper reflects the ability of the student to think, analyze, and synthesize complex information from a variety of sources 3Total Points
20COMMENTS:
APPLICATION OF ROY’S ADAPTATION MODEL 14
Course Instructor