Roy Adaptation Theory is a nursing theory developed by Sister Callista Roy that views humans as adaptive systems. The theory proposes that people constantly interact with a changing environment and strive for adaptation in four modes: physiological, self-concept, role function, and interdependence. Nursing aims to promote positive adaptation through assessing a patient's behaviors and environmental interactions to enhance coping and remove ineffective responses.
Dr. Roy also had a opportunity to be a clinical nurse scholar two year post doctoral program in neuroscience Nursing at University of California.
she selected this field to develop her understanding of the holistic person especially as an adaptive system and because of her familiarity with this clinical area as the result of her own neurological illness.
Dr. Roy also had a opportunity to be a clinical nurse scholar two year post doctoral program in neuroscience Nursing at University of California.
she selected this field to develop her understanding of the holistic person especially as an adaptive system and because of her familiarity with this clinical area as the result of her own neurological illness.
Orems theory ppt for M.Sc. nursing 1st yearShweta Kumar
Introduction: Orem defines self-care as a learned, goal oriented activity directed towards the self in the interest of maintaining life, health, development and well being. The goal of Orem’s theory is to help the client perform self-care.
Biography of theorist Dorothea E Orem: Dorothea E Orem was born in Baltimore, Maryland on July 15, 1914. She was a nursing theorist and creator of the ‘ Self-care deficit ’ nursing theory, also known as the Orem model of nursing.
Orem’s General Theory Of Nursing: Orem (1991) states her general theory. Orem developed the Self-Care Deficit Theory Of Nursing, which is composed of three interrelated theories: 1) Theory of self-care: Self-care, self-care agency, basic conditioning factors, the therapeutic self-care demand, self-care requisites- Universal (Activities of daily living [ADL]), Developmental, Health deviation
2) Theory of self-care deficit, 3) Theory of nursing systems: Wholly compensatory system, partly compensatory system, supportive educative system.
Orem’s theory and nursing metaparadigm:Definition of metaparadigm- “ the concept that identify the phenomenon of central interest to a discipline ; the prepositions that describe those concepts and their relationships to each other.”
Nursing metaparadigm concepts: *Nursing,* Health, *Environment, *Human being.
Orem’s theory and nursing process:
Nursing process- 1)Assessment, 2)Nursing diagnosis, 3)Plans with scientific rationale, 4)Implementation, 5)Evaluation
Orem’s nursing process- 1)Diagnosis and prescription ; determine why nursing is needed. Analyze and interpret- make judgements regarding care. 2)Design of a nursing system and plan for delivery of care. 3)Production and management of nursing systems.
Orem’s work and the characteristics of a theory:- *Theories must be logical in nature,* simple yet generalizable,*basis of hypothesis that can be tested,* assist in increasing the general body of knowledge,* practitioners to guide and improve their practice,* consistent with other validated theories , laws and principles.
Strengths of Orem’s theory:-
Limitations of Orem’s theory:-
Application of Orem's Self-Care Deficit theory: Evaluation of the application of self care deficit theory:
Summary: Orem presents her general theory of nursing, The self care deficit theory of nursing , which is composed of three interrelated theories of self care, self care deficit and nursing systems. This theory is used as basis for nursing school curriculum and base of nursing information system.
Martha Rogers’s Science of Unitary Human Beings...simplified...with a case sc...Karen V. Duhamel
This PowerPoint is a comprehensive overview of Martha Rogers's abstract conceptual model of the Science of Unitary Human Beings, with a simplified description of her model, including a case scenario illustrating key conceptual principles.
Among the many models of health related quality of life, Pender’s Health promotion behavior model helps to identify factors influenced the decisions and actions of individuals that were made to prevent disease and promote a healthy lifestyle.
This is the Roy Adaptation Model presented by Callista Roy.
This presentation includes assumptions of the theory, major concepts,meta paradigms and theory's strengths and weaknesses. It also includes the types of stimuli and coping systems of theory.
The Roy Adaptation Model sees the person as a biopsychosocial being in continuous interaction with a changing environment. The environment includes focal, contextual and residual stimuli. A focal stimulus is the confrontation with one's internal and external environment.
1. To be able to differentiate, apply and identify the various models of nursing theories and approaches in all phases of life.
2. To know the essential value of formal nursing conceptual models and understand the provision of a shared view of the metaparadigm concepts (person, environment, health and nursing).
3. Be able to focus on nursing's role: to work with patients to manage their health problems/life processes.
Orems theory ppt for M.Sc. nursing 1st yearShweta Kumar
Introduction: Orem defines self-care as a learned, goal oriented activity directed towards the self in the interest of maintaining life, health, development and well being. The goal of Orem’s theory is to help the client perform self-care.
Biography of theorist Dorothea E Orem: Dorothea E Orem was born in Baltimore, Maryland on July 15, 1914. She was a nursing theorist and creator of the ‘ Self-care deficit ’ nursing theory, also known as the Orem model of nursing.
Orem’s General Theory Of Nursing: Orem (1991) states her general theory. Orem developed the Self-Care Deficit Theory Of Nursing, which is composed of three interrelated theories: 1) Theory of self-care: Self-care, self-care agency, basic conditioning factors, the therapeutic self-care demand, self-care requisites- Universal (Activities of daily living [ADL]), Developmental, Health deviation
2) Theory of self-care deficit, 3) Theory of nursing systems: Wholly compensatory system, partly compensatory system, supportive educative system.
Orem’s theory and nursing metaparadigm:Definition of metaparadigm- “ the concept that identify the phenomenon of central interest to a discipline ; the prepositions that describe those concepts and their relationships to each other.”
Nursing metaparadigm concepts: *Nursing,* Health, *Environment, *Human being.
Orem’s theory and nursing process:
Nursing process- 1)Assessment, 2)Nursing diagnosis, 3)Plans with scientific rationale, 4)Implementation, 5)Evaluation
Orem’s nursing process- 1)Diagnosis and prescription ; determine why nursing is needed. Analyze and interpret- make judgements regarding care. 2)Design of a nursing system and plan for delivery of care. 3)Production and management of nursing systems.
Orem’s work and the characteristics of a theory:- *Theories must be logical in nature,* simple yet generalizable,*basis of hypothesis that can be tested,* assist in increasing the general body of knowledge,* practitioners to guide and improve their practice,* consistent with other validated theories , laws and principles.
Strengths of Orem’s theory:-
Limitations of Orem’s theory:-
Application of Orem's Self-Care Deficit theory: Evaluation of the application of self care deficit theory:
Summary: Orem presents her general theory of nursing, The self care deficit theory of nursing , which is composed of three interrelated theories of self care, self care deficit and nursing systems. This theory is used as basis for nursing school curriculum and base of nursing information system.
Martha Rogers’s Science of Unitary Human Beings...simplified...with a case sc...Karen V. Duhamel
This PowerPoint is a comprehensive overview of Martha Rogers's abstract conceptual model of the Science of Unitary Human Beings, with a simplified description of her model, including a case scenario illustrating key conceptual principles.
Among the many models of health related quality of life, Pender’s Health promotion behavior model helps to identify factors influenced the decisions and actions of individuals that were made to prevent disease and promote a healthy lifestyle.
This is the Roy Adaptation Model presented by Callista Roy.
This presentation includes assumptions of the theory, major concepts,meta paradigms and theory's strengths and weaknesses. It also includes the types of stimuli and coping systems of theory.
The Roy Adaptation Model sees the person as a biopsychosocial being in continuous interaction with a changing environment. The environment includes focal, contextual and residual stimuli. A focal stimulus is the confrontation with one's internal and external environment.
1. To be able to differentiate, apply and identify the various models of nursing theories and approaches in all phases of life.
2. To know the essential value of formal nursing conceptual models and understand the provision of a shared view of the metaparadigm concepts (person, environment, health and nursing).
3. Be able to focus on nursing's role: to work with patients to manage their health problems/life processes.
Roy conceptualizes the human system in a holistic perspective, as holism stems from the underlying philosophic assumption of the model. Holism is the aspect of unified meaningfulness of human behaviour in which the human system is greater than the sum of individual parts.
This Slide Submitted in Partial Fulfilment of the Philosophy Subjects for the Degree of Master of Nursing (International Program) Prince of Songkla University 2020
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
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CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
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The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
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2. ‘ADAPTATION IS VIEWED AS THE PROCESS
AND OUTCOME WHEREBY THINKING AND
FEELING PERSONS AS INDIVIDUALS OR IN
GROUPS, USE CONSCIOUS AWARENESS AND
CHOICE TO CREATE HUMAN AND
ENVIRONMENTAL INTEGRATION.’
SISTER CALISTA ROY.
3. About the Theorist
Sister Callista Roy is a nursing theorist, professor and author.
She was born on October 14, 1939 at Los Angeles, California.
She majored in nursing in 1963 from Mount Saint Mary's
College, Los Angeles.
She received Master's Science in Pediatric Nursing from
University of California.
She was a postdoctoral scholar in Neuroscience Nursing at
University of California.
4. About the Theorist
Worked as a Pediatric Nurse, Nursing Instructor and in many different capacities.
She was Professor and Nurse Theorist at the Boston College of Nursing.
Dorothy E. Johnson mentored her to develop this adaptation model while pursuing her
Master's Degree.
Roy's Adaptation Model was implemented in Mount Saint Mary's School in 1970.
The Roy Adaptation Model was first published in Nursing Outlook in 1970 entitled
“Adaptation : A Conceptual Framework for Nursing”.
5. About the Theorist
At present, she is a Professor at School of Nursing
at Boston.
She has many Honorary Doctorate Degrees and
awards in excellence in fostering professional nursing
standards.
Sister Callista Roy has also been recognized as a living
legend in 2007 by American Academy of Nursing.
6. Theoretical Sources
Roy credits Harry Helson’s Adaptation Theory (1947) for playing
a key role in her early thinking and development of the model.
She credits Rapoport’s Definition of systems as well as concepts
regarding Theory of stress from Lazarus and Selye (1984).
Roy acknowledges the contribution made by other faculty and
students to the development of the model.
7. SCIENTIFIC
Consciousness is constructed of individual and environment
integration.
Awareness of self and environment is rooted in thinking and feeling.
Thinking and feeling mediate through human actions.
Relationships include acceptance, protection, and fostering
of interdependence.
Integration of human being and environment results
in Adaptation.
8. PHILOSOPHICAL
Individual has mutual relationships with the world and
God.
God is revealed in the diversity of creation
Individual use human creative abilities of awareness,
enlightenment, and faith.
Individual are accountable for the processes of deriving,
sustaining, and transforming the universe.
9. CULTURAL
Experience within a specific culture will influence how each
element of the Model is expressed.
Within a culture, central culture will influence the elements of
the Roy Adaptation.
Cultural expressions of the elements of Model may lead to
changes in practice activities like nursing assessment.
Due to multi-cultural perspective, implication and research
may differ from the experience in the original culture
10. Statement of the Theory
“The goal of nursing is to promote adaptation
for individuals and groups in each of the four
adaptive modes; i.e. physiological needs, self-
concepts, role function and interdependent
relations, thus, contributing to health quality
of life and dying with dignity.”
11. PERSON
Human beings are in constant interaction with their environment
which brings both internal and external changes.
They respond to the environmental stimuli they experience.
The characteristic of openness in human allows a person to adapt
in constantly changing environment.
Human is as an adaptive system.
12. ENVIRONMEN
T
According to Roy, environment means "The conditions, &
circumstances affecting the development and behavior of
persons”.
A person exists in an open relationship with the
environment.
The internal and external stimuli affect the
person.
13. NURSING
The goal of nursing is the promotion of adaptation for
human beings by four adaptive modes leading to health,
quality of life and dying with dignity.
Nurses assess the client's behaviors, promote positive
adaptation by enhancing environment interactions and
helps clients react positively to stimuli.
Nurses eliminate ineffective coping mechanisms.
Leads to better outcomes for the clients.
14. HEALTH
Roy defines health as, “A state or process of being or becoming an
integrated and whole person.”
Health is not freedom from the inevitability of death, disease,
unhappiness, and stress, but the ability to cope with them.
If human being can adapt holistically, they will be able to
maintain health to reach completeness. If persons cannot adapt, the
integrity of the person is affected negatively.
Health is the state where human can adapt to
stimuli.
15. Major Concepts of Roy's Adaptation Model
System: Parts which are interconnected and interdependent to form a unity.
The system is characterized by inputs, outputs, control and feedback processes.
Adaptation: Adaptation is the process and outcome where by thinking and
feeling individuals or groups use conscious awareness and choice to create human
- environmental integration.
Adaptation problems: Adaptation problem means the occurrence of a state
due to inadequate responses to meet deficit.
16. Major Concepts of Roy's Adaptation Model
Stimuli: A person’s adaptation is influenced by stimuli from the environment.
Categories
- Focal stimuli: The internal or external stimuli which immediately confront
the individual’s awareness and consciousness.
- Contextual stimuli: Contextual stimuli are all other stimuli that contribute to the
effect of the focal stimuli. Stimuli influence how people deal with the focal
stimuli.
- Residual stimuli: Residual stimuli are environmental factors within or outside
the human system. These factors though effect on behavior.
17. Major Concepts of Roy's Adaptation Model
Coping Processes: It includes both innate and acquired coping mechanism.
Innate mechanisms are inborn, genetically determined, common to the species
and are automatic process. Acquired coping are learned or developed
responses.
The process of coping is further categorized by Roy as “The Regulator &
Cognator Subsystems are applied to individuals; whereas Stabilizer and
Innovator Subsystems are applied to groups”.
18. Major Concepts of Roy's Adaptation Model
Levels of Adaptation: Adaptation level of an individual represents the condition of life
process.
- Integrated process: The modes and subsystems meet the needs of the environment
forming a stable process (e.g. spiritual realization, breathing, successful relationship).
- Compensatory process: The cognator and regulator are challenged by the needs of the
environment, but trying to meet the needs (e.g. starting with a new job, grief,
compensatory breathing).
- Compromised process: The various modes and subsystems are not sufficiently meeting
the environmental challenge (e.g. unresolved loss, hypoxia, abusive relationships).
19. Major Concepts of Roy's Adaptation Model
Levels of Adaptation
Integrated to Compensatory
An integrated life process may change to compensatory process
where attempt is made to re-establish adaptation.
Compensatory to Compromised
If the compensatory process are not adequate then result is
compromised.
20. Major Concepts of Roy's Adaptation Model
Internal processes or Subsystem
o Regulator: It is Physiological Coping Mechanism of an individual through
which the body attempts to cope through Neural, Chemical and Endocrine coping
channels.
oStimuli from environment act as inputs through the senses to the nervous system.
oIt affects the fluid, electrolyte, acid-base balance and endocrine system.
oThis information is all channeled automatically.
o The body produces an Automatic – Unconscious Response to it.
21. Major Concepts of Roy's Adaptation Model
Internal processes or Subsystem
o Cognator: Major coping process for individuals.
o It involves 4 Cognitive-Emotive Channels:
a) Perceptual & Information processing: It includes activities of
selective attention, coding and memory.
b) Learning: It includes imitation, reinforcement and insight.
c) Judgement: It includes problem solving and decision making.
d) Emotion: It includes effective appraisal and attachment.
22. Major Concepts of Roy's Adaptation Model
Adaptive Modes: Through the adaptive modes the responses to
& interaction with the environment can be carried out and adaptation can
be observed. There are 4 adaptive modes:
a) Physiologic – Physical Mode
b) Self-concept – Group-identity Mode
c) The Role Function Mode
d) The Interdependence Mode
23. Physiologic Physical Mode
It is the Manifestation of Physiologic Activities of all cells, tissues,
organs and systems that make up the body. It includes 5 basic needs of:
Oxygenation: Patterns of oxygen use related to respiratory and cardiovascular
physiology and pathophysiology.
Nutrition: Patterns of nutrient used to maintain effective human functioning and how
the nutrient help for growth and repairing injured tissue.
Elimination: Patterns of elimination of waste products.
Activity & Rest: How the pattern of activity and rest takes place in an individual.
Protection: Skin integrity and immunity.
24. Physiologic Physical Mode
In addition, four processes are involved in Physiologic Adaptation:
a) Senses: Sensory-perceptual information
b) Fluid, Electrolyte, Acid-Base Balance: How the fluid and electrolyte
balance maintained in the body.
c) Neurologic Functions: Relationship of neural function to regulator and cognator
coping mechanism
d) Endocrine Functions: How the endocrine system act in conjunction with nervous
system to maintain control of the body process.
25. Self-concept - Group-identity mode
The basic need underlying the self-concept mode is psychic and
spiritual integrity that is the need to know who one is so that one can
exhibit a sense of unity.
This mode includes :
a)Physical self (body sensation & body image)
b)Personal Self (self-consistency, self- ideal & the moral ethical-
spiritual self)
26. Self-concept - Group-identity mode
Body Sensation: How the individual experiences the physical self.
Body image: How the individual views the physical self.
Self-consistency: Individual’s efforts to maintain self-organization.
Self-ideal or expectancy: Represents what the individual expects to be and to do.
Moral-ethical-spiritual self: Represents individual’s belief system and self-
evaluation.
27. Role Function Mode
It focuses on the role of the person in the society and group within.
The basic underlying need is Social Integrity. It includes:
a) Primary role: It determines the majority of individual's behaviors and is defined by
the individual's sex, age, and developmental stages.
a) Secondary role: It includes to carry out the tasks required by the stages
of development and primary role.
a) Tertiary role: These roles are temporary, feely chosen, and may include activities
related to hobbies.
28. Interdependence Mode
It includes behaviour towards interdependent relationships like giving and receiving of
love, respect and value.
The basic underlying need is relational integrity and feeling of security in the
interdependent relationship.
It includes 2 specific relationships:
a) Relationship with significant others
b) Relationship with support systems
29.
30.
31. Propositions of Roy Adaptation Model
Stimuli from internal and external environment serves as inputs to the nervous
system which produces automatic unconscious response.
Stimuli and adaptation level serve as input to human adaptive systems.
One must make adaptations to accommodate new environmental requirements.
The internal and external stimuli influence behavioural responses.
Human beings are described as adaptive systems that are constantly
growing and developing within changing environments.
32. Propositions of Roy Adaptation Model
Health for human adaptive systems are reflections of adaptation.
The Goal of Nursing is the promotion of adaptation there by contributing to
health, quality of life, dying with dignity.
Nursing intervention is to maintain the adaptive behaviour and to change
ineffective behaviour to adaptive.
Nurse’s role is to promote adaptation in health and illness by
enhancing the interaction of human systems with the environment.
33. Application of the Theory
Nursing Practice
The Roy adaptation model is one of most frequently used conceptual frameworks
used to guide nursing practice.
Senesce (2003): This model can be used by individual nurse to understand, plan
and direct nursing practice in the care of individual patients.
Villarreal (2003): applied this model in caring of young women who were
contemplating smoking cessation.
Newman (1997): used the model to caregivers of chronically ill family members.
34. Application of the Theory
Nursing Education
Roy suggests this model helps to clarify objectives, identifies content
and specifies patterns for teaching and learning.
This model provides nursing educators a systemic way of teaching students to
assess and care for patients within the context of their lives rather than just as
victims of illness.
In the early 1980's the School of Nursing at the University of
Ottawa experienced a major curriculum change by incorporating this model as
base to their new curriculum.
35. Application of the Theory
Nursing Research
This model is used in knowledge development.
Young-McCaughan (2003) by using Roy's Adaptation Model studied the effect of
a structured aerobic exercise tolerance, sleep patterns and quality of life in
patients with cancer.
Bournaki (1997) by using Roy's adaptation model studied Pain related
responses to venipuncture in school-age children.
36. Nursing Process and the Roy Adaptation Model
Roy specifically stresses that the nursing process is ongoing and continuous.
Roy states regarding nursing process that ‘Nurses rely on intuitive skills to assess and
initiate interventions.”
A nurse's role in the Adaptation Model is to manipulate stimuli by
removing decreasing, increasing or altering stimuli so that the patient can
adapt effectively.
37. Assessment
Assessment of behaviour
Nurse must identify the behaviours hinder adaptive process.
In the First Level Assessment, the nurse assesses the behaviors manifested from the
four adaptive modes.
The nurse uses observational skills, intuition, accurate measures and interviewing
skills to systematically gather data.
In the Second Level Assessment, the nurse assesses the stimuli; categorize them as
focal, contextual, or residual leading to identification of internal and external stimuli
which influences individual's adaptive behaviors.
38. Nursing Diagnosis
Analysis of data of both levels of assessment results in formulation of a nursing
diagnosis that reflects the patient’s adaptive state.
Goal Setting
It involves clear statement of the behavioural outcomes of nursing care.
The goal is to promote client's adaptation process through nursing care.
Roy also suggests to provide time frame in which the goal is to be attained.
39. Implementation
The nurse chooses interventions to promote the desired adaptation through
either changing stimuli or strengthening adaptive process.
The nurse and patient in collaboration identifies the desirable or undesirable
consequences.
Once the appropriate nursing intervention has been selected, the nurse initiate
steps that will enhance coping.
40. Evaluation
Evaluation focuses on judging the effectiveness of the nursing intervention in
relation to the behaviour of the individual.
To determine if the adaptive goals have been met, the nurse uses the same skills
as were employed in the assessment phase of the process – observation,
intuition, measurement and interviewing.
41. Clinical Application of the Theory
Mr. Kumar, a 58 years old patient has been admitted to the
hospital with complaints of non-healing wound in his right leg
since 6 weeks. He is a known case of Diabetes Mellitus since
last 12 years and has been on insulin regimen. He was admitted
after various ineffective treatment for the non-healing wound.
He works in bank and is the sole earning member of the family
of 6. On admission he has been planned for amputation of toes
of right leg and a long hospital stay.
42. Clinical Application of the Theory
Demographic Date of the Client
Name : Mr. Kumar
Age : 58 years
Sex : Male
IP number : M2863
Education : Post graduate
Occupation : Bank officer
Marital status : Married
Religion : Hindu
Informants : Client and Wife
Date of admission : 04/04/2015
Diagnosis : Diabetes mellitus
43. First Level Assessment
Physiologic-Physical Mode
Oxygenation
- His capillary refill time delayed and Dorsalis pedis pulsation of affected limp is not
palpable.
Nutrition:
-On diabetic diet, complaints of anorexia since admission.
Elimination:
- He complaints of constipation since 3 days.
Activity:
- Activity reduced now due to wound in right leg, walking with the help of crutches,
complaints of pain, needs assistance in activities.
44. First Level Assessment
Physiologic-Physical Mode
Senses:
-Because of neuropathy, he has reduced touch and pain sensation in the lower periphery.
Fluids and Electrolytes:
-Serum electrolyte values are within normal limit, RBS is 300 mg/dl.
Neurological Function:
-He is very anxious about the disease condition and his family’s future.
Endocrine function:
-Due to DM he is on insulin since 9 years.
45. First Level Assessment
Self- Concept Mode
Physical Self
-He is very anxious about body image changes, but he is accepting treatment and
trying to cope with the situation.
Personal Self:
-Because of financial burden and hospitalization, self-esteem disturbed.
Role Performance Mode
-He was the only earning member in his family. His role shift is not compensated.
Interdependence Mode
-Maintains good relationship with the family, neighbors, friends and relatives.
46. Second Level Assessment
Focal Stimulus
- Non-healing wound leading to amputation, which is the cause of
hospitalization.
- Repeated hospital stay.
- Suffering from non-healing wound since considerable period.
- Ineffective treatment regimen.
47. Second Level Assessment
Contextual Stimuli
He is a known case diabetes mellitus for past 12 years.
He is not in habit of wearing footwear in house and premises.
Residual Stimuli
- He suffered from Tuberculosis 5 years back. His mother was diabetic. He is a
graduate in economies, so no special knowledge regarding health matters.
48. Nursing Process
ASSESSMENT NURSING
DIAGNOSIS
GOAL PLANNED
INTERVENTION
EVALUATION
Focal Stimuli:
Alteration in Physical
self of self control mode
due to change in body
image.
Contextual Stimuli:
He is a known case of
DM. He is aware of the
planned reconstructive
surgery.
Residual Stimuli:
As a student of
economics, he possesses
limited health related
knowledge.
Anxiety related to
change in body
image, hospital
admission,
unknown outcome
of the disease and
financial constraints
as evidenced by
complaints of
insomnia,
vocalization and
facial expressions
of the patient.
To reduce
anxiety.
- Allow and encourage
him to ask questions.
- Allow him and to
verbalize their anxiety.
- Provide comfortable
and quiet environment
for the patient.
- Possible increased
interaction with family.
- Identify his
stressbuster and allow
such activity.
- Music Therapy.
Coping through Cognator
Subsystem
Goal Met:
-Able to take rest, uninterrupted
sleep for considerable time.
-Asking less question. Looking
less stressed.
Unmet:
-He is not totally free from
anxiety due to financial
constraints.
-Continue plan, re-evaluate
goal and interventions.
49. Critique of the Theory
Clarity: The concept is logical, but the development of definitions are inadequate.
Simplicity: It is complex due to several major concepts, sub concepts.
Generality: It is generalizable to all settings in nursing practice. It addresses the concept
of person-environment adaptation and focuses primarily on the client.
Empirical precision: Testable hypothesis.
Derivable consequences: It has a clearly defined nursing process which is useful in
clinical practice. It generates new information through hypothesis testing.
50. Limitation
Theory is very conceptual.
It is difficult to understand.
Four adaptive modes have unclear boundaries.