<ul><li>When I consider your heavens, </li></ul><ul><li>The work of your fingers… </li></ul><ul><li>What is man that you a...
Sister Callista Roy’s Adaptation Model  and Application
Person <ul><li>-Person: adaptive system constantly interacting with external and internal environment </li></ul><ul><li>-P...
Environment
Adaptation <ul><li>Integrated, Compensatory, or Compromised </li></ul><ul><li>Stimuli influence adaptation level </li></ul>4
Roy’s Model Continued… <ul><li>Coping mechanisms: Regulator and Cognator </li></ul>Control Processes: Stabilizer and Innov...
Four Adaptive Modes <ul><ul><li>1. Physiological-  oxygenation, nutrition, elimination, activity, rest, and  protection </...
Four Adaptation Modes
Apply the Nursing Process to Each of the Four Adaptive Modes  <ul><li>1. Assess Behavior </li></ul><ul><li>2. Assess Stimu...
Visual Aid <ul><li>Roy’s Adaptation Model  </li></ul>Person -open  system Environmental Stimuli : Focal, Contextual, Resid...
 
Examples of Roy’s Model in Practice  <ul><li>Cancer patients -Cook(1999), Gerrish (1989) </li></ul><ul><li>Amputations - D...
More recently...Suggested use in Community Health Nursing <ul><ul><ul><li>Physical-morbidity/mortality stats, medical faci...
Use of Roy’s model to promote behavior change... -  Helped women have a more accurate understanding of smoking addiction -...
Helping Women through Menopause <ul><li>Holistic approach to assessing and analyzing the menopausal transition </li></ul><...
Examples of Roy’s Adaptation Model in Research  <ul><li>Cross-cultural pain- Cavillo & Flaskerud (1993) </li></ul><ul><li>...
More recently... <ul><li>Brooke Army Medical Center and U.S. Army Institute of Surgical Research- Series of studies based ...
Adaptation in Children with Cancer <ul><li>Used Roy’s model to guide in data collection in adaptation modes.  </li></ul><u...
Examples of Roy’s model in Education  <ul><li>One of the most widely used models in the U. S. for nursing education  </li>...
Roy’s Model Applied to Administration <ul><li>A research study explains  how  one hospital implemented Roy’s model to deve...
<ul><li>Caroline Gates RN </li></ul>
Evaluation of Model <ul><li>Adequacy </li></ul><ul><li>Model developed from belief based mainly on pediatric clinical obse...
Evaluation of Model <ul><li>Clarity </li></ul><ul><li>Adaptation </li></ul><ul><ul><li>-How is it defined? </li></ul></ul>...
Evaluation of Model <ul><li>Clarity </li></ul><ul><li>Adaptive modes have unclear boundaries </li></ul><ul><ul><li>-Interr...
Evaluation of Model <ul><li>Complexity </li></ul><ul><li>Abstract and difficult to understand </li></ul><ul><ul><li>Concep...
Evaluation of Model <ul><li>Completeness </li></ul><ul><ul><li>Addresses all four concepts of a nursing model  (metaparadi...
Clinical Use of the Model for FNPs in primary care setting <ul><li>Develops systematic and comprehensive ways of knowing r...
Clinical Use of the Model for FNPs in primary care setting <ul><li>Helps visualize the nursing process as a dynamic contin...
Clinical Use of the Model for FNPs in primary care setting <ul><li>Limited by the perception of adaptation </li></ul><ul><...
Clinical Use of the Model with a Geriatric Population <ul><li>Assess circumstances that might contribute to a premature ad...
Clinical Use of the Model for Cardiac Health <ul><li>Chest pain, decreased levels of activity, fluid overload, sleep distu...
Conclusion <ul><li>Research supports Roy’s model as evidence based nursing process </li></ul><ul><li>Widely used in differ...
References <ul><ul><ul><li>Alligood, M. R. (2010).  Nursing theory: Utilization and application. Maryland  </li></ul></ul>...
References Continued <ul><ul><ul><li>Patton, D. (2004). An analysis of Roy’s Adaptation Model of nursing  as  used within ...
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Carolandcarolineadaptationmodel

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Carolandcarolineadaptationmodel

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

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