Discussion theory 7

 nurse theorist, writer, lecturer, researcher and teacher

 Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill

 Born at Los Angeles on October 14, 1939.

 Bachelor of Arts with a major in nursing - Mount St. Mary's College, Los Angeles in 1963.

 Master's degree program in pediatric nursing - University of California, Los Angeles in 1966.

 Master’s and PhD in Sociology in 1973 and 1977.

 Worked with Dorothy E. Johnson  Worked as f faculty of Mount St.

Mary's College in 1966.  Organized course content

according to a view of person and family as adaptive systems.

 RAM as a basis of curriculum at Mount St. Mary’s College

 1970 - The model was implemented in Mount St. Mary’s school

 1971- she was made chair of the nursing department at the college.

 Roy’s Adaptation Model for Nursing was derived

in 1964 from Harry Helson’s Adaptation Theory – adaptive responses are a function of the incoming stimulus and the adaptive level

 Roy combines Helson’s work with Rapport’s definition of system and views the person as an adaptive system.

 After the development of her theory, Roy developed the model as a framework for nursing practice, research, and education.

 According to Roy, more than 1500 faculty and students have contributed to the theoretical development of the adaptation model.

 The model uses concepts from AH Maslow to explore beliefs and values of persons. Roy’s holistic approach to nursing is based in humanism.

 A pilot research study and a survey research study from 1976 to 1977 led to some tentative confirmations of the model.

 From this beginning, the adaptation model has been supported through research in practice and in education.

 A set of units so related or connected as to form a unity or whole and characterized by inputs, outputs, and control and feedback processes.

 A constantly changing point, made up of focal, contextual and residual stimuli, which represent the person’s own standard of the range of stimuli to which one can respond with ordinary adaptive responses.

 The occurrences of situations of inadequate response to need deficits or excesses.

 Seen not as nursing diagnosis, but areas of concern for the nurse related to adapting person or group (Within each adaptive mode)

 Focal Stimulus – the degree of change or stimulus most immediately confronting the person and the one to which the person must make an adaptive response, that is, the factor that precipitates behavior

 Contextual Stimuli – all other stimuli present that contribute to the behavior caused or precipitated by the focal stimuli

 Residual Stimuli – factors that may be affecting behavior but whose efforts are not validated

Regulator – subsystem coping mechanism which responds automatically through neural- chemical-endocrine processes.

Cognator - subsystem coping mechanism which responds to complex processes of perception and information processing, judgment, and emotion.

Adaptive Responses – responses that promote integrity of the person in terms of goals of survival, growth, reproduction, and mastery

 Ineffective Responses – responses that do not contribute to adaptive goals, that is, survival, growth, reproduction, and mastery

1. Physiological Mode – involve the body’s basic needs and ways of dealing with adaptation in regard to fluid and electrolytes; exercise and rest; elimination; nutrition; circulation and oxygen; and regulation, which includes the senses, temperature and endocrine regulation

2. Self-Concept Mode – the composite of beliefs and feelings that one holds about oneself at a given time. It is formed from perceptions, particularly of other’s reactions, and directs one’s behavior. (physical self and personal self)

3. Role Performance Mode – role function is the performance of duties based on given positions in society.

4. Interdependence Mode – involves one’s relations with significant others and support systems. In this mode one maintains psychic integrity by meeting needs for nurturance and affection.

 The person is a bio-psycho-social being.

 The person is in constant interaction with a changing environment.

 To cope with a changing world, person uses both innate and acquired mechanisms which are biological, psychological and social in origin.

 Health and illness are inevitable dimensions of the person’s life.

 To respond positively to environmental changes, the person must adapt.

 The person’s adaptation is a function of the stimulus he is exposed to and his adaptation level

 The person’s adaptation level is such that it comprises a zone indicating the range of stimulation that will lead to a positive response.

 The person has 4 modes of adaptation: physiologic needs, self- concept, role function and inter- dependence.

Nursing • A “theoretical system of

knowledge which prescribes a process of analysis and action related to the care of the ill or potentially ill person.”

• Roy differentiates nursing as a science from nursing as a practice discipline.

Person • A “biopsychosocial being in constant

interaction with a changing environment.”

• The recipient of nursing care, as a living, complex, adaptive system with internal processes (cognator and regulator) acting to maintain adaptation in the four adaptive modes (physiological needs, self- concept, role function, and interdependence.)

• The person as a living system is “a whole made up of parts of subsystems that function as a unity for some purpose.”

Health • A “state and a process of

being and becoming an integrated and whole person. Lack of integration represents lack of health.”

Environment • “all the conditions, circumstances,

and influences surrounding and affecting the development and behavior of persons or groups. ”

• The input into the person as an adaptive system involving both internal and external factors (may be slight or large, positive or negative)

• Any environmental change demands increasing energy to adapt to the situation. Factors in the environment that affect the person are categorized as focal, contextual, and residual stimuli.

Outcome Theory - well articulated conception of man as a nursing client and of

nursing as an external regulatory mechanism.

 Both deductive and inductive

 Deductive – derived from Helson’s Theory. Helson developed the concepts of focal, contextual, and residual stimuli, which Roy defined within nursing to form a typology of factors related to adaptation levels of persons. Roy also uses other concepts and theory outside the discipline of nursing and relates these to her adaptation theory.

 Inductive – she developed the four adaptive modes from research and practice experiences of herself, her colleagues, and her students. Roy built on the conceptual framework of adaptation and as a result developed a step-by-step model by which nurse use the nursing process to administer nursing care to promote adaptation in situations of health and illness.

 Useful for it outlines the features of the discipline and provides direction for practice

 The model considers goals, values, the client, and practitioner interventions

 Using Roy’s six-step nursing process, the nurse: 1. Asesses behaviors 2. Asseses stimuli 3. Diagnosis 4. Sets goals to promote adaptation 5. Nursing interventions 6. Evaluation

 The model is a valuable tool to analyze overlap and distinctions between the professions of nursing and medicine.

 Throughout the 1970’s and 1980’s, Roy’s model has been implemented as a basis for curriculum development in associate degree diploma, baccalaureate, and higher degree programs in many countries.

 The model does generate many testable hypothesis related to practice and theory.

Middle range theories have been derived from RAM

› Samarel, N., Fawcett, J., Krippendorf, K., Piacentino, J.C., Eliasof, B., Hughes, P., Kowitski, C., and Ziegler, E. (1998). Women's perception of group support and adaptation to breast cancer. Journal of Advanced Nursing. 28(6), 1259-1268.

› Yeh, C. H. (2001). Adaptation in children with cancer: research with Roy's model. Nursing Science Quarterly. 14, 141-148.

› Zhan, L. (2000). Cognitive adaptation and self-consistency in hearing- impaired older persons: testing Roy's adaptation model. Nursing Science Quarterly. 13(2), 158-165.

 Clarity - logical; claims to follow a holistic view but leaves out “spiritual, humanistic, and existential aspects of being a person”

 Simplicity – has several major concepts and subconcepts and numerous relational statements; complex

 Generality – generalizable to all settings in nursing practice, but is limited in scope because it primarily addresses the concept of person-environment adaptation and focuses primarily on the client

 Empirical Precision – Testable hypothesis have been derived from the model

 Derivable Consequences – has a clearly defined nursing process and can be useful in guiding clinical practice; capable of generating new information through hypothesis-testing

 www.currentnursing.com

 Tomey, A.M., (1994). Nursing Theorists and Their Work. 3rd ed. Missouri: Mosby