Roy’s Adaptation Model: Care for Patient with Cerebrovascualr Accidents

1. Cebu Normal University
Graduate School
Osmeña Blvd., Cebu City
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Roy’s Adaptation Model: Care for Patient
with Cerebrovascualr Accidents
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In Partial Fulfillment in MSN 4001
PHILOSOPHICAL-THEORETICAL NURSING
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Dave Jay S. Manriquez RN.
October 2008

2. INTRODUCTION
Nursing is a scientific way of providing care to a client in any health care setting.
Man as the client is the recipient of all the nursing care activities in an effort to assist
him adapt to the changing environment and maintain an optimal level of functioning.
Today inspite of modernization in the medical field, CVA still plays a major role in
the morbidity of the Filipino population. This could be attributed to the highly stressful
living environment we are in, plus the westernized dietary habits we have come to
acquire as well as man’s indulgences in these modern times.
Cerebrovascular Accident (CVA) or stroke is the most common disease of the
nervous system, ranking third among the leading causes of death in the United States.
CVA refers to the sudden and dramatic development of neurologic deficits that result
when cerebral blood vessels are occluded or ruptured causing interruption of blood
supply to a portion of the brain.
Man is a biopsychosocial being who has the innate capacity to adapt to agent
and environment stimuli. In order to promote health, the nurse and members of the
health team facilitate man’s favorable adaptation to the multifactorial stimuli through
their caring and curing interventions.
Armed with these facts, the investigator would like to know how best to assist his
client, who had Cerebrovascular Accident, adapt to the changes occurring both within
himself and in his immediate environment. Utilizing Sr. Callista Roy’s Adaptation Model
is the most appropriate in the care of the client with Cerebrovascular accident.

3. SUMMARY OF LITERATURE
This study explores and utilizes Roy’s Adaptation Model of Nursing as a
theoretical approach in caring for a client with Cerebrovascular Accident.
Roy’s view man as biopsychosocial being in constant interaction with a changing
environment. To cope with the changing environment, man has certain innate and
acquired mechanisms which are biologic, psychologic and social in origin. Some are
genetically determined, some are common to the species while some are acquired
through such processes as learning. Man’s positive response to a changing
environment is known as the process of adaptation. Man’s ability to respond positively
or to adapt depends upon the degree of the change taking place and the state of the
person coping with the change. There are eight basic assumptions of the Roy
Adaptation Model.(Riehl and Roy, 1974).
1. Man as a bio-psycho-social being.
2. Man is in constant interaction with a changing environment.
3. To cope with a changing world, man uses innate and acquired mechanisms,
which are biologic, psychologic and social in origin.
4. Health and illness are one inevitable dimensions of man’s life.
5. To respond positively to environmental changes, man must adapt.
6. Man’s adaptation is a function of the stimulus he is exposed to and his
adaptation level.
7. Man’s adaptation level is such that it comprises a zone which indicates the
range of stimulation that will lead to a positive response.
8. Man is conceptualized as having four modes, physiologic needs, self-concept,
role function and interdependence relation
The researcher adopted Sister Callista Roy’s concept of the nursing process
while assessing, observing, collecting, organizing, identifying, delineating, analyzing and
validating the health needs and teaching guide of stroke patients.

4. The four essential elements of the Roy Adaptation Model are of the following: the
person who is the recipient of the nursing care; the concept of the environment; the
concept of health; and the concept of the goal of nursing.
The Concept of Adaptation. The adaptation system has input of stimuli and
adaptation level, outputs as behavioral response that serve as feedback and control
processes known as coping mechanisms. The inputs o stimuli are classified into three
focal, contextual and residual stimuli. These three stimuli combile and create a widw
range of responses of the individual at a particular point in time.
Outputs of the person as system are the behaviors of the person. Output
behaviors can be both external and internal. Roy categorized these outputs into
adaptive and ineffective responses.
Adaptive responses promote the integrity of the person and the goals of
adaptation, which are survival, growth, development and mastery. Ineffective responses
neither promote integrity nor contribute to the goals of the adaptation response to
change by the person maybe processed predominantly in a simple adaptive model.
More often, the response is processed simultaneously in more than one mode.
According to Roy” Health is state and process of being and becoming an
integrated and whole person.” Health is the reflection of how successfully an individual
has adapted to environmental stimuli. The nurse manipulates the stimulus response
process in the four adaptive models.
The goal of nursing therefore, is to help the person achieve adaption by helping
the person survive, grow, reproduce and master. Adaptation leads to optimum health,
well-being to the highest quality of life possible and to die with dignity. Adaptation
enables the person to find meaning and purpose in life and to become an integrated
whole.

5. SUMMARY:
The foregoing case study is about a 60 year old, male, married, patient who is
diagnosed as post-infarct seizure, status post Cerebrovascular Accident. The case was
an attempt to apply the concepts of Roy’s Adaptation Model in the case of Mr.B.E.
The case study sought to answer the specifically the following questions: using
Roy’s theory what alterations in the adaptive modes were evident in Mr.B.E’s case in
terms of physiologic mode, self-concept mode, role function mode, and
interdependence mode and what factors influence the adaptive modes of Mr.B.E. in
terms of focal stimuli(immediately confronting the client); contextual stimuli (all other
stimuli present; and) residual stimuli (such as beliefs, attitudes or traits which have a
indeterminate effect on the present situation
FINDINGS:
Utilizing the nursing process, the nursing history and assessment showed the
following alterations in the adaptive modes –
A. Physiologic Mode
1. Activity and rest
1.1 Impaired physical mobility
1.2 Activity intolerance
1.3 Self-care deficit- bathing, hygiene, toileting, grooming
2. Neurologic function
2.1 Knowledge deficit
3. Senses
3.1 Altered sensory-perceptual ability
B. Self-concept Mode
Disturbance in self-esteem
C. Role Function Mode
Altered Role Performance

6. D. Interdependence Mode
Dysfunctional independence
CONCLUSION:
Mr.B.E. , over fifty years old, hypertensive, diabetic and over stressed, this
is the scenario presented in this case study. Person fittinginto the above characteristics
among others are the likely candidates to suffer from stroke or CVA wherever one refers
it to.
The case study further revealed that Cerebrovascular Accident patients
like Mr.B.E. will have adaptive problems affecting the physiologic needs, self-concept
mode, role function and the interdependence mode.
A prompt management, emphasizing prevention of complication and
planned early rehabilitation may make it possible for some patients who survived CVA
to return to productive work. Roy’s Adaptation Model provides a good support system in
helping these patients return to normal life in their respective community.
The use of Roy Adaptation Model of Nursing enhances nursing care on a
CVA patient. Implementing this model in practice is perceived as having a positive
impact on personal sense of nurses as well as on the image of nursing profession as a
whole. The model is found effective in providing direction towards achieving patient
outcomes. According to the writer, the introduction of the model on a CVA patient made
a positive difference in quality of patient care, primarily due to the comprehensive
approach to assessment and planning. In the clinical care setting, the model concepts
were more easily incorporated in to practice than the actual language of the model. A
several stimuli which are affecting the person from the internal and external
environment in four different modes of adaptation are being managed by nursing
interventions. The stimuli are shown as aiming to affect person’s equilibrium, but with
appropriate nursing interventions, they are diverted away from the patient, and effective
adaptation is achieved. Overall, this model provides a structure for focusing, organizing,
and directing thoughts and actions related to patient care and for achieving, desired
patient outcomes efficiently and effectively
RECOMMENDATION:

7. Promoting Adaptive responses in situations of health and illness is the goal of
nursing. From this standpoint, the researcher strongly recommends the utilization of
Roy’s Adaptation Model to guide nurse practitioners in the care of clients in any health
care settings.
Further nursing research and field utilization of Roy’s Adaptation Model is also
recommended to continually adjust and validate the model for the improvement of
nursing practice

8. BIBLIOGRAPHY:
Black, Joyce M. and Jacobs, Esther M.,1993, Luckmann and Sorensen’s
Medical-Surgical Nursing: A Psychophysiologic Approach , 4th
Edition,
Pennsylvani: W.B.Saunders Co.
Roy, Callista,Sr.,1976, Introduction to Nursing: An Adaptation Model,
New Jersey; Prentice Hall, Inc.
Tomey, Ann.,1994, Nursing Theorists and Their Works, 3rd
Edition
Missouri; Mosby.
Lancaster, J. (1992). Conceptual Models of Nursing. MO: Mosby-Year Book.
Mitchell, J. and Pilkington, B. (1990). Theoretical Approaches in Nursing
Practice: A comparison of Roy and Parse. Nursing science quarterly, (5)1, 81-87.
Roy, C. (1991). An explication of the philosophical assumptions of Roy’s
adaptation mode. Nursing Science Quarterly, 1(1), 26-34.
Tiedman, M.(1996). Roy’s Adaptation Model. Conceptual models of nursing,
analysis and application (Third edition). Norwalk, Conn: Appleton-Century-Crofts.
Tolson, D. and McIntosh, J. (1996). The Roy Adaptation Model: A consideration
of its properties as a conceptual framework for an intervention study. Journal of
Advanced Nursing, 24(5), 981-987.