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In healthcare settings, nurses play a critical role in service delivery as they interact with patients in every stage of the treatment process. As a result, they need to have theories and models that guide their thoughts when they execute their duties at work. Though previously nursing relied on the arguments from the related fields, today, numerous nursing theories focus on the existing nursing knowledge. This knowledge includes grand-range nursing theories that provide broad views on the nursing process. Even though they come from different theorists, nursing models aim at promoting health through appropriate nursing actions. This paper examines Roy's Adaptation Model by providing a background assessment of Sister Callister Roy. Furthermore, it provides an analysis as well as an evaluation of the theory and examines its application in nursing and also in the intensive care unit.
Nursing Theory Analysis
The nursing practice draws from various theories and frameworks formulated to help guide the practice. However, in the past years, nursing has started to rely on methods from other closely related fields, such as medicine. It is only after the realization that for nursing to develop as a discipline, it requires theories specific to the area, that the scholars started formulating nursing theories. These approaches help in defining the nursing practice, identifying and defining principles that guide this practice, identifying nursing goals, as well as clarifying the scope of nursing. Nursing theories provide a creative and rigorous way of formulating ideas to provide a systematic evaluation of an occurrence. The application of these nursing theories guides nurses in their work as they follow a tested and verified hypothesis. Some models offer holistic approaches to nursing while others are specific to certain areas or practices. Roy's Adaptation Model is one of the grand-range nursing theories applicable in intensive care unit settings.
Theory/Author Name and Background
Roy's Adaptation Model is one of the theories applicable to intensive care units. First published in 1970, the concept was then developed by Sister Callister Roy (Henderson, 2012). Born in 1939, Sister Callister started working in a hospital at the age of 14 as a pantry girl, and she worked her way up as a nurse aide. The theorist had a background in nursing and was a registered nurse. Roy received her first degree from Mount Saint College in 1963 (Henderson, 2012). She later obtained a Master's degree in nursing and sociology. The theorist developed the model while in graduate school, after being challenged to create a conceptual model for nursing (Henderson, 2012). Her background in nursing and sociology shaped her thought process, leading to the development of the Adaptation Model that offers a holistic adaptation approach.
When devising this concept, Sister Callister relied on and made references to previously existing adaptation models. The roots of the model involve Johnson's nursing model that acted as an inspiration for the formulation of Roys's Adaptation Model. Some of the other ideas included in the adaptation model are Helsons adaptation theory, Rapoport's system definition, von Bertalanffy's system model, and Dohrenrend and Selye's stress and adaptation theories (Henderson, 2012). Sister Callister also included concepts from Lazurus coping model in her approach (Henderson, 2012). Including ideas from other models not only helped her improve the model but also assisted the theorist in bridging gaps that existed in the previously formulated adaptation concepts. Roy's Adaptation Model seeks to guide nurses in the application of the nursing process rationally. The theory tries to address the need for the adaptation process in health outcomes. It focuses on three types of stimuli that affect a patient's modes of functioning. The three stimuli are circumstances, conditions, and influence, while the four modes of operation are self-concept, physiologic needs, inter-dependence, and role function. In its totality, the model provides a holistic adaptation model in which a person is in constant contact with the internal and external environment.
In formulating the model, the theorist uses deductive reasoning where she starts with general statements and proceeds to make a logical conclusion. Roy presents the model as a grand level nursing theory based on a collaborative process centered on the notion that health is an evaluation and that a range of well-being differs from maximum level wellness to illness (Naga and AL-Khasib, 2014). The theory goes ahead to define five aspects of the argument that include the person identified as a bio-psycho-social being with four different modes of adaptation. It also claims that the environment acts as a stimulant, one that affects people's health. The next aspect entails the exploration of health itself. According to the theorist, a person's health depends on their ability to adapt to the environment (Henderson, 2012). Lastly, Roy defines the goal of nursing as comprising six steps that help patients adjust to their surroundings, ultimately improving their health and overall well-being. The author, therefore, takes a deductive approach where she starts with the general statement, and then she defines various aspects and demonstrates how they relate to one another, ultimately concluding how nurses can help improve patients' health.
The major concepts outlined in the model include adaptation. They also include metaparadigm concepts of person, environment, health, and nursing. According to Roy, adaptation is a process that influences the outcomes of people who make use of awareness, creating integration between humans and the environment (Naga and Al-Khasib, 2014). According to this model, that is the aim of nursing. The theory defines humans as adaptive systems that are seen as a whole made of parts that complete a person. Another significant concept outlined in this framework is the environment that involves both internal and external environments. According to Roy, the environment affects the progress and behavior of people in adaptive processes. Health, as defined in Roy's Adaptive Model, is the outcome of adaptation to the environment while nursing is the process that promotes this adaptation.
Roy defined the terms theoretically, describing the concepts by showing their interconnectedness. They are a part of the deductive process that ultimately leads to conclusions drawn from the theory. Throughout the framework, the author consistently uses these terms as defined. Also, the theorist is consistent in the use of words in the argument. The theorist is explicit in her descriptions and definitions the terms are not implied since instead, she defines them openly and does not leave room for questions on the defined terms. She also shows how the major concepts of her theory affect human health and how it is possible to improve this well-being through her definition of the concepts (Naga and al-atiyyat, 2013). Roy's Adaptation Model shows the relationships between the major concepts in the framework. A person is one of these significant ideas that, according to the author, need to adapt to the environment. The environment contains the stimuli that the person needs to adjust to. A person's health depends on their ability to adapt to internal and external situations. However, when the person's health deteriorates, and the person is in a hospital, the nurse has a role in helping the patient adapt to the environment by improving their health in the long run. Therefore, in Roy's Model of Adaptation, the principal concepts are related to one another and directly influence healthcare outcomes.
Roy's adaptation model has various assumptions, both implicitly and explicitly defined in the model's framework. Among the explicit assumptions, there are the person's feelings and thoughts that dictate the person's actions (Naga and Al-Khasib, 2014). The theory also assumes that a person's awareness of the environment is rooted in these feelings and thoughts. Furthermore, the theorists state that individual and environmental transformations have roots in the conscience of people and that by integrating with the environment, the individuals adapt to it. Roy also claims that within cultures, there are elements that force the application of the model to evolve in activities such as nursing assessment. Also, she maintains that human beings have a mutual relationship with the world and with God-figures. Among her implicit assumptions is that experiences in different cultures determine how the elements of the model get interpreted. Also, she assumes that people and earth share common integral patterns.
The theory takes into account the four nursing meta paradigms people, health, nursing, and the environment. Roy takes these four paradigms as the central concepts of her approach. According to her, a person is an adaptive system with cognitive regulative systems that work together to enhance the adaptability of the four human adaptation modes (Naga and al-atiyyat, 2013). Also, she sees the environment as conditions that influence the growth and actions of individuals and groups mainly through the establishment of mutual relationships between people and nature's resources. According to Roy, health is the process by which the individuals integrate into the environment, which both makes the person whole and conveys mutuality between a person and their surroundings. Additionally, Roy defines nursing by stating that the goal of nursing is to promote the adaptation of the four adaptive modes that help improve health, quality of life, and promote dignity in death. Nurses achieve this by assessing the conduct and conditions that support people's adaptive abilities and environmental factors. Roy explains the meta paradigms as the interrelated concepts that influence one another. She explains her theory clearly and concisely, claiming that the person's ability to adapt to the environment affects their health and that by assessing the factors promoting adaptability, nursing can help improve the nursing outcome.
Roy explains her concepts theoretically, systematically, and logically, allowing the readers to judge the legitimacy of the definitions as well as that of her work. She creates strong theoretical linkages within the ideas, providing a rational account of the variables while at the same time linking them to one another, making the theory believable (Naga and al-atiyyat, 2013). The adaptive framework has logical organization and has a simplified form, establishing a basis for formulating and testing the hypothesis.
Throughout the approach, Roy consistently uses concepts and valid statements. The system and structure are holistic and complete, allowing for practicability, leading to an improved focus in the nursing practice (Naga and al-atiyyat, 2013). Additionally, the theory makes use of diagrammatical representation illustrating the four adaptation modes of people, forming the basis for the model and its background evaluation. The interpersonal accounts linked to self-concept, physiologic-physical, purpose, and interdependence help in clarifying and understanding the model.
Roys theory is congruent with nursing standards and practices. It provides an accurate and comprehensive assessment that facilitates the formulation of detailed nursing plans promoting health in patients. According to Roy, nursing is a six-step process with evaluation being the first step (Henderson, 2012). The stages closely relate to one another, and in some instances, they intertwine. These six steps are first-level assessment, second-level assessment, diagnosis, planning, implementation, and evaluation. These criteria, according to her, form two categories the first level that assesses the behavior and the second level that looks at the stimuli. This assessment guides nursing activities by advocating for a detailed evaluation of the patient's condition through examining their four adaptive modes and also by assessing the stimuli for their behavior. It requires the use of observations, interviewing, measurements, and other methods of obtaining data to receive the related data systematically. Additionally, the nurse must differentiate between the internal and external stimuli that affect the behaviors that require the collaboration of the nurse and the patient. The nurse then analyzes the data, leading to an accurate diagnosis within Roys's model.
After the diagnosis, the nurse can then make a plan on how to promote adaptation to the environment. In this stage, both the nurse and the patient work together to establish a statement of behavioral outcomes expected from the actions directed at promoting adaptation. This step guides nurses in devising treatment plans for their patients. It leads them to formulate activities that help patients change their behavior in a way that helps them cope with the illness (Henderson, 2012). By identifying the factors that shape a patient's actions, the nurses can make accurate plans to manage the condition. In the next step, Roy advocates for the implementation of the plan. Here, the nurse selects the best method to help the patient attain the desired adaptation goals by either changing the stimuli or promoting adaptation. Achieving this requires the nurse to make a list of the stimuli and then identify the best method by either changing or encouraging adaptation. The nurse is also expected to determine the outcome of enhancing the coping process as high, moderate, or low. Additionally, the nurse should allow the patient to participate in choosing the best option.
Once the appropriate option gets identified, the nurse takes the necessary actions to alter the stimuli and enhance the coping process. Roy's implementation advocates for patient inclusion, which is vital in improving health outcomes, and she also calls nurses to apply critical thinking when devising accurate clinical decisions that will promote positive health outcomes. The next stage involves an evaluation of the intervention measure adopted in the implementation stage (Henderson, 2012). Here, the nurse uses methods such as observation, intuition, interviewing, and measurement to evaluate whether or not the set adaptive goals are met. This stage reminds nurses that they have to conduct frequent follow-ups on the patients to determine whether the treatment plan is working for them.
Roys model can be applied in various hospital settings, including the intensive care unit. Her Adaptation Model offers a systematic and conceptual nursing model for nurses to evaluate the patient's bio-psycho-social adaptive aspects (Huang, Xie, and Wu, 2015). It further provides six steps that act as a guide to nurses on how to restore or enhance the four adaptation modes. In the ICU setting, the model is a comprehensive framework for the detailed assessment of patient's different aspects. In the ICU, I would use Roy's theory to critically assess the patient's condition, paying attention to their behavior and the stimuli that have led to this situation. Through this assessment, I would understand why the patient is reacting the way they are, which would help me in the selection of the appropriate methods to help the patient cope with the stimuli. Also, I would conduct frequent checks on the patient to evaluate their condition. The focus would be on whether their health situation is improving. In the intensive care unit, my primary focus would be on ensuring that the patients are functioning normally or close to normal by ensuring that they get everything required and that the prescribed medication is administered as per the prescription.
Nursing theories shape the nursing profession by providing a framework for nurses to follow. Roy's Adaptation Model is a good example of points of view, offering a holistic approach to nursing. First published in 1970 by Sister Callister Roy, the theory is applicable in various medical practices. The theorist's educational background in nursing and sociology influenced the formulation of the framework. Roys Adaptation Model offers to demystify the influence of adaptation to internal and external stimuli of health. The models are deductive and significant concepts that are explicitly defined. The proponent also creates close linkages between the main ideas. Furthermore, the theory has both explicit and implicit assumptions, on which the argument gets its foundation. Moreover, Roy is consistent in using terms throughout her approach, and she describes her model clearly and concisely, thus making it believable. In nursing, the model guides nursing actions by providing a six-step model that is in line with the nursing standards. These are first and second-level assessment, diagnosis, planning, implementation, and evaluation. By following these steps, nurses can help patients improve their coping process by first identifying behaviors and corresponding stimuli, making a diagnosis, formulating a treatment plan, implementing the program, and finally, evaluating its effectiveness. I would use the model in ICU to support lives and promote the adaptation process.