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Carolandcarolineadaptationmodel

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  • 1.
    • When I consider your heavens,
    • The work of your fingers…
    • What is man that you are mindful of him,
    • The son of man that you care for him?
    • You made him a little lower than the heavenly beings
    • And crowned him with glory and honor
    • You made him ruler over the works of your hands
    • Psalm 8: 3-6
  • 2. Sister Callista Roy’s Adaptation Model and Application
  • 3. Person
    • -Person: adaptive system constantly interacting with external and internal environment
    • -Persons major task: Maintain personal integrity (wholeness) in face of environmental stimuli.
  • 4. Environment
  • 5. Adaptation
    • Integrated, Compensatory, or Compromised
    • Stimuli influence adaptation level
    4
  • 6. Roy’s Model Continued…
    • Coping mechanisms: Regulator and Cognator
    Control Processes: Stabilizer and Innovator ADAPTATION
  • 7. Four Adaptive Modes
      • 1. Physiological- oxygenation, nutrition, elimination, activity, rest, and protection
      • 2. Self Concept- Psychological and spiritual elements
      • 3. Role Function- primary,secondary, and tertiary roles the person performs in society
      • 4. Interdependence- coping mechanisms arising from close relationships
      • Goal: Promote integrated adaptation in all four modes = HEALTH
  • 8. Four Adaptation Modes
  • 9. Apply the Nursing Process to Each of the Four Adaptive Modes
    • 1. Assess Behavior
    • 2. Assess Stimuli
    • 3. Nursing Diagnosis
    • 4. Goal Setting
    • 5. Interventions
    • 6. Evaluation
    • ULTIMATE GOAL: Promote integrated adaptation in each of the Four Adaptive Modes
  • 10. Visual Aid
    • Roy’s Adaptation Model
    Person -open system Environmental Stimuli : Focal, Contextual, Residual Adaptation level : integrated, compensatory, or compromised . Health Nursing
  • 11.  
  • 12. Examples of Roy’s Model in Practice
    • Cancer patients -Cook(1999), Gerrish (1989)
    • Amputations - Dawson (1998)
    • Occupational Health -Doyle & Rejacich (1991)
    • Pt’s with Anxiety- Fredrickson (1993)
    • Hospitalized Children- Galligan (1979), Starn & Niederhauser (1990)
    • Coronary Care Unit- Hamner (1989)
    • Adolescents with Asthma- Hennessy-Harstad (1999)
    • Adult Hemodialysis patients- Keen et al. (1998)
    • Home care- Lankester & Sheldon (1999), Schmitz (1980)
    • Abused Women- Limandri (1986)
    • Patients with Kawasaki disease- Nash (1987)
    • Adolescents with bulimia nervosa- Pilote (1998a,1998b)
    • Elderly in apartment complexes- Smith (1998)
    • Patients with alzheimer’s disease- Thornbury & King (1992)
      • * List obtained from Fitzpatrick and Wall (2005)
  • 13. More recently...Suggested use in Community Health Nursing
        • Physical-morbidity/mortality stats, medical facilities, funding
        • Group identity-culture,morale
        • Role function-effectiveness and accountability of institutions (fire, police, hospitals)
        • Interdependence-relationships of community with outside organizations, quality of relationships within the community
        • * Dixon, E.L. (1999). Community health nursing practice and the Roy adaptation model. Public Health Nursing 16 (4), 290-300.
    13
  • 14. Use of Roy’s model to promote behavior change... - Helped women have a more accurate understanding of smoking addiction -Women were able to explain how stress affected their physical, mental, spiritual self and their relationships with others In conclusion: More accurate understanding of their addiction and their perceptions of stimuli that produced the desire for them to continue smoking. * Villareal, E. (2003). Using Roy’s adapation model when caring fpr a group of young women contemplating quitting smoking. Public Health Nusing, 20 (5), 377-384
  • 15. Helping Women through Menopause
    • Holistic approach to assessing and analyzing the menopausal transition
    • *Cunningham, D. A. (2003). Application of Roy’s adaptation model when caring for a group of women coping with menopause. Journal of Community Health Nursing, 19 (1), 49-60.
  • 16. Examples of Roy’s Adaptation Model in Research
    • Cross-cultural pain- Cavillo & Flaskerud (1993)
    • Caesarean birth- Fawcett (1990)
    • Child-bearing women- Fawcett & Tulman (1990), Tulman et al. (1998)
    • Cancer patients- Frederickson et al. (1991), Samarel et al. (1998)
    • Spinal cord injury patients- Harding-Okimoto (1997)
    • Abused women- Limandri (1986)
    • Well adolescents- Modrcin et al. (1998)
    • Breast-feeding women- Nyqvist & Sjoden (1993)
    • Spouses of surgical patients- Silva (1987)
    • Elderly persons- Smith (1988), Zhan (2000)
    • Persons with Alzheimer’s disease- Thornbury and King (1992)
      • * List obtained from Fitzpatrick and Wall (2005)
    16
  • 17. More recently...
    • Brooke Army Medical Center and U.S. Army Institute of Surgical Research- Series of studies based on Roy’s Adaptation Model
    • 1. Quality of life experienced by people with cancer. Findings: Military patients did not share with their healthcare provider about pain, sexual dysfunciton, ect. because they viewed these as expected.
    • 2 Investigate feasibility of exercise program and examine the effects on physiological and psychological parameters of health in Cancer patients. Findings: Improved exercise tolerance, activity, sleep patterns, and quality of life.
    • Excellent guide for Quality of Life outcomes in patients with long term illness
    • * Yoder, L. H. (2005). Using the Roy adaptation model: A program of research in a military research service. Nursing Science Quarterly 18 (4), 321-323.
  • 18. Adaptation in Children with Cancer
    • Used Roy’s model to guide in data collection in adaptation modes.
    • Different age groups will adapt differently
    • Age and physical maturity have significant impact on adaptation to cancer in pediatrics.
    • *Yeh, C.H. (2001). Adaptation in children with cancer: Research with Roy’s model. Nursing Science Quarterly 14 (2), 141-148.
  • 19. Examples of Roy’s model in Education
    • One of the most widely used models in the U. S. for nursing education
    • Geriatric Nurse-Practitioner Program
    • University of Ottawa School of Nursing, Canada
    • Mount Saint Mary’s College, Los Angeles
      • Students deliver care based on Roy’s model
      • http://www.msmc.la.edu/undergraduate-bachelor-programs/nursing/bachelor-of-science.asp
    *Source: Fitzpatrick & Wall, 2005
  • 20. Roy’s Model Applied to Administration
    • A research study explains how one hospital implemented Roy’s model to develop :
            • A Nursing Philosophy
            • Mission Statements
            • Standards of Practice
            • Job Descriptions
            • Performance Planning and an Appraisal System
            • A Quality Monitoring System
            • CONCLUSION: highly integrated system of nursing administration and practice
            • *Rogers et al.,1991
  • 21.
    • Caroline Gates RN
  • 22. Evaluation of Model
    • Adequacy
    • Model developed from belief based mainly on pediatric clinical observations
    • Use of Harry Helson’s adaptation theory
    • (Patton, 2004)
  • 23. Evaluation of Model
    • Clarity
    • Adaptation
      • -How is it defined?
      • -Who defines it?
      • -How is it evaluated?
    • Health
      • -Non-specific definition
      • (Lewis, 1988; Patton, 2004)
      • predictions
  • 24. Evaluation of Model
    • Clarity
    • Adaptive modes have unclear boundaries
      • -Interrelated by perception
    • Some use of theoretical jargon
    • Good assessment
    • method
    • (Lewis, 1988; Patton, 2004)
  • 25. Evaluation of Model
    • Complexity
    • Abstract and difficult to understand
      • Concept of Person as an
      • adaptive system
      • Cognator and regulator subsystems
    • Not easily operational for research
    • -stimuli create an extensive list of potential variables
    • Tolson & McIntosh, 1996
    • Adaptation
    • Coping Control
    • Regulator Cognator Stabilizer Innovator
    • Cognitive Emotional
    • Output processes
    • Central processes
    • Input
  • 26. Evaluation of Model
    • Completeness
      • Addresses all four concepts of a nursing model (metaparadigm)
      • Comprehensive and systematic assessment
      • - Observed behavior is reflective of the parts
      • Focus on the individual
      • -> More of a downstream approach
      • Smaller perspective
      • Person = adaptive system
    • -> Little room for humanistic
    • understanding
  • 27. Clinical Use of the Model for FNPs in primary care setting
    • Develops systematic and comprehensive ways of knowing reality
    • Promotes critical thinking
    • Focused on the Person
    • -rights, liberty, and independent actions
  • 28. Clinical Use of the Model for FNPs in primary care setting
    • Helps visualize the nursing process as a dynamic continuum -> the patient’s progress becomes the driving force within the process
    • Provides guidance for intervention that can enhance quality of life and enhance interaction of the person with the environment
        • Adaptation to chronic illness
        • Family functioning
  • 29. Clinical Use of the Model for FNPs in primary care setting
    • Limited by the perception of adaptation
      • -> need to identify client’s perception of the problem
      • The meanings attached to the experience
      • Then assist the client in forming realistic goals in coping with the problem
  • 30. Clinical Use of the Model with a Geriatric Population
    • Assess circumstances that might contribute to a premature admission to a long term care facility.
        • Role reversal
        • Powerlessness
        • Difficulty coping with
        • disability
        • Adaptation of significant
        • other
        • Farkas , 1981
  • 31. Clinical Use of the Model for Cardiac Health
    • Chest pain, decreased levels of activity, fluid overload, sleep disturbance (physiologic mode)
    • Fear, anxiety, body image disturbance due to bypass surgery (self-concept mode)
    • Increased dependency on others (role function)
    • Relationship needs unmet (interdependence mode)
    • Self-esteem issues (interdependence mode)
  • 32. Conclusion
    • Research supports Roy’s model as evidence based nursing process
    • Widely used in different settings and has enduring characteristics (based on system’s theory) (Alligood, 2010)
    • Updated as knowledge increases and trends change (Alligood, 2010)
    • In a world of globalization, the model is limited by an egocentric paradigm (Cody, 2006)
    • Limited by the view that the individual good is the highest good to be achieved (Cody, 2006)
  • 33. References
        • Alligood, M. R. (2010). Nursing theory: Utilization and application. Maryland
        • Heights , MO: Mosby, Inc.
        • Cody, W. (2006). Philosophical and Theoretical Perspectives for Advanced Nursing Practice. (4 th Ed.). Sudbury, MA: Jones and Bartlett.
        • Cunningham, D. A. (2003). Application of Roy’s adaptation model when caring for a
        • group of women coping with menopause. Journal of Community Health
        • Nursing, 19 (1), 49-60.
        • Dixon, E.L. (1999). Community health nursing practice and the Roy adaptation
            • model. Public Health Nursing 16 (4), 290-300
        • Farkas, L. (1981). Adaptation problems with nursing home application for elderly persons: an application of the Roy adaptation nursing model. Journal of Advanced Nursing (6), 363-368.
        • Fitzpatrick, J.J., & Whall A.L. (2005). Conceptual models of nursing: Analysis and application. Upper Saddle River, NJ: Pearson Education, Inc.
        • Lewis, T. (1988). Leaping the chasm between nursing theory and practice. Journal of Advanced Nursing (13), 345-351.
    20
  • 34. References Continued
        • Patton, D. (2004). An analysis of Roy’s Adaptation Model of nursing as used within acute psychiatric nursing. Journal of Psychiatric and Mental Health Nursing (11), 221-228.
        • Roders, M., Paul, L. J., Clarke, J., Mackay, C., Potter, M., Ward, W. (1991). The use of the Roy Adaptation Model in nursing administration. Canadian Journal of
        • Nursing Administration 4 (2), 21-26.
        • Tolson, D, McIntosh, J. (1996). The Roy Adaptation Model: a consideration of its properties as a conceptual framework for an intervention study. Journal of
        • Advanced Nursing (96), 981-987.
        • Villareal, E. (2003). Using Roy’s adapation model when caring fpr a group of young
        • women contemplating quitting smoking. Public Health Nusing, 20 (5), 377-384
        • Yeh, C.H. (2001). Adaptation in children with cancer: Research with Roy’s model.
        • Nursing Science Quarterly 14 (2), 141-148.
        • Yoder, L. H. (2005). Using the Roy adaptation model: A program of research in a
        • military research service. Nursing Science Quarterly 18 (4), 321-323.