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Sister callista roy
- 1. Sister Callista Roy:Adaptation Model Jill N Meyokovich, RN BSN
- 2. Sister Callista Roy Born 1939-present Member of the Sisters of Saint Joseph of Carondelet BSN, MSN, Masters and Doctorate of Sociology Professor, clinical nurse scholar, nurse theorist, author
- 3. Becoming of the Model While working on masters, was mentored by Dorothy Johnson Challenged to develop a conceptual model Roy noticed the resiliency of children and change Intrigued by adaptation becoming the eventual framework
- 4. Becoming of the Model cont 1968: Operationalization 1970: Literature debut 1977: Model presentation
- 5. Basis of Adaptation Model Harry Helson Rapoportdefinition Combination became definition of a person as an adaptive system Dohrenwend, Lazarus, Mechanic, and Selye Biological, and behavioral sciences Underpinnings Johnson’s behavioral model
- 6. Statement of theory “The goal of nursing is to promote adaptation for individuals and groups in each of the four adaptive modes, thus contributing to health quality of life, and dignity with dying” (Roy 1999, p. 19)
- 7. Main premise of theory “When push comes to a shove, we will seldom disappoint ourselves. We all harbour greater stores of strength than we think. Adversity brings the opportunity to test our mettle and discover for ourselves the stuff of which we are made.Do not underestimate the power of a person to cope. He may be dependent now but deep within him lies the energy to adapt” http://nursingtheories.blogspot.com/2008/07/sister-callista-roy-adaptation-theory.html
- 8. My view of the RAM I believe the adaptation model as a framework used to see a person who is constantlyinfluenced by their environment; people have the chance to positively respond to their environment and adapt, or fail at adapting. It is the nurse who guides us in the succession of adaptation.
- 9. Metaparadigm Person Environment Health Nursing
- 10. Terms Environment Stimuli Health Adaptation Ineffective responses Adaptation level Nursing
- 12. Assumptions Major assumptions Scientific Philosophical Implicit Humanism Veritivity
- 13. Propositions Nursing promotes adaptive responses Nursing decreases ineffective responses Nursing enhances interaction which promotes adaptation
- 14. Main concepts Two internal mechanisms for adaptation Regulator Cognator Four adaptive modes physiological-physical needs self concept group identity role function interdependence
- 15. 4 modes Physiological Self-concept/group identity Role function Interdependence
- 16. Diagram RAM
- 17. Nursing Implications Goal is directed to establishing adaptation Contribute to health, quality of life and dying with dignity Roy Adaptation Model Nursing Process Assessment of behavior Assessment of stimuli Nursing diagnosis Goal setting Nursing intervention Evaluation
- 18. Internal criticism Adequacy Clarity Consistency Logical Development Level of Theory Development
- 19. External Criticism Complexity Discrimination Reality Convergence Pragmatic Scope Significance Utility
- 20. Tools/Instruments Used to measure perceptions of powerlessness in decision making Health care outcomes for cancer patients Framework for adult survivors of multiple traumas Describe relationship between nursing intervention and interpretation of results Used as a basis for checklist for problematic behavior prediction
- 21. Application of theory to practice Middle range theory areas Caregiver well being Coping with pain Coping with chronicity
- 22. Practice reflection/problem This is not the first situation that came to mind as I was reflecting this question, but this is the most appropriate situation, I believe for this exercise. There was a woman in her 40s who presented to the ED with a c/c of assault. She was pregnant, had been vomiting, and was assumed to have taken some type of psychoactive medication due to her erratic behavior. She was uncooperative with her nurse and was yelling, crying, refusing to take her medication, and refusing a urine specimen. After about one hour of trying to coerce compliance with the woman, my colleague desperately came to me and asked if I could “try to talk some sense into this lady”. “Therapeutic communication is not my strong point Marian, you know that”, was my response. However, we have a very tight nit bond of nurses in our department, and I felt my obligation to help. I proceeded into the room with a plan to place myself in an inferior position as to elicit a feeling of safety and comfort. I said nothing as I entered the room and immediately turned the lights taking a blanket from the shelf for her. I sat down in the chair next to her and said absolutely nothing for what felt like an eternity. Finally, I asked her how I could help her. She did not respond and I sat there for yet another eternity. When I stood up to walk out she told me to sit back down. Finally she began to talk, and might I add, for a VERY long time agreeing to comply with the treatment plan. I was thoroughly convinced that I was not going to be able to help this woman, but I was determined to try. I believe that all patients, even the most difficult ones, want help. Some people have great difficulty relinquishing control and giving trust to others. Therefore, I believe that by turning the lights off, I created a safety ground for her because she did not have to look at me. With the blanket, I showed compassion and offered her comfort. With my silence, I offered a willingness to help without saying so. By sitting in the chair, I made myself an equal instead of a superior. This was one of “proud” moments in my nursing career. I touched someone that was untouchable by others. And my fellow nurses were so shocked when I came back to the nursing station with a urine specimen they thought I voided in the cup myself! Although this was a difficult situation for the both the patient and I, I would have wanted the nurse to treat my mother or my sister just as I had treated her. I slept quite well that night.
- 23. Practice reflection/problem Moreno, M., Duran, M., & Hernandez, A. (2009). Nursing care for adaptation. Nursing science quarterly. Jan, 67-73.
- 24. Research articles Wright, P., Holcombe, J., Foote, A., & Piazza, D (1993). The Roy adaptation model used as a guide for the nursing care of an 8 year old child with leukemia. Journal of Pediatric Oncology 10(2), 68-74. Sercekus, P. & Mete, S. (2009). Effects of antenatal education on maternal prenatal and postpartum adaptation. Journal of Advanced Nursing Dec, 999-1010.
- 25. Conclusion RAM is a complex theory RAM lends many applications to education and research RAM theorizes that people are adaptive systems constantly influenced by stimuli Nursing is used to increase adaptive behaviors Nursing is used to decrease maladaptive behaviors
- 26. References Alligood, M, & Tomey, A. (2010). Nursing theorists and their work: 7th ed. Maryland Heights MO: Mosby. Meleis, A. (2007). Theoretical nursing:4th ed.. Philadelphia: Lippincott William & Wilkins. Moreno, M, Duran, M, & Hernandez, A. (2009). Nursing care for adaptation. Nursing Science Quarterly, 22(1), 67-73. Peterson, S, & Bredow, T. (2009). Middle range theories application to nursing research: 2nd ed. Philadelphia: Lippincott William & Wilkins. Roy, C, & Andrews, H. (1999). Roy adaptation model. Stanford CT: Appleton & Lange. Roy, S.C. (1988). An Explication of the philosophical assumptions of the roy adaptation model. Nursing Science Quarterly, 1(26), 26-34. Sercekus, P, & Mete, S. (2009). Effects of antenatal education on maternal prenatal and postnatal adaptation. Journal of Advanced Nursing, Dec, 999-1010. Sister callistaroy. (2008, July). Retrieved June 1, 2010 from http://nursingtheories.blogspot.com/2008/07/sister-callista-roy-adaptation-theory.html Wright, P, Holcombe, J, Foote, A, & Piazza, D. (1993). The Roy adaptation model used as a guide for the nursing care of an 8 year old child with leukemia. Journal of Pediatric Oncology Nursing, 10(2), 68-74.
Notes de l'éditeur
- -Sister Callista Roy was born in October 1939 in California-She is a member of the Sisters of Saint Joseph of CarondeletShe received undergraduate degrees in nursing, has both a masters and doctorate in sociology-She held professor status at Mount St Mary’s College and was a postdoctoral fellow at University of California-Roy has authored many books and articles and has received numerous personal and professional achievement recognitions
- - Roy was challenged by Johnson to create a model for nursing; Roy, a pediatric nurse at the time, had great interest in children and their ability to adapt especially in the face of great physical and psychological changes
- First operationalizedat Mount St Mary’s college as foundation of nursing school; 1977 model was presented Nurse Educator Conference
- Roy used HerryHelson’s adaptation theory as a basis for her her own model, which statrs that an adaptive response is a function of stimuli; he further defines a stimulus as anything that can elicit a response; this may be internal or external; his work defined the “adaptation zone” which defines whether the response is perceived with a positive or negative outcome; if it is a positive outcome, the person is considered to have adapted to the stimulusWith Helson’s work and Rapoport’s definition of system, the person is now considered an “adaptive system”Dohrenwend, Lazarus, Mechanic and Syle further outline self integrityOther sciences were cited to help to understand persons
- Roy’s theory states that a person is constantly interacting with a changing environment; when he or she cannot respond effectively, nursing is needed; when nursing has allowed the person to respond effectively, and therefore has adapted, nursing is no longer needed.
- I would like to take this opportunity to reflect on my practice problem from earlier in the semester. I believe the RAM fits this situation quite well. My problem was a patient who presented to the ED with a c/o of assault and had been previously uncooperative and noncompliant with the recommended treatment plan. It was through my nursing care and interventions, that I was able to help her realize that I was, in fact, aiding her to comply with the treatment plan to help her. The RAM states that nursing is used to help the patient change maladaptive behaviors into positive adaptation.
- Person is an adaptive system made of parts; Environment is internal or externalHealth is the process of becoming wholeNursing is a function to achieve adaptation
- -environment refers to all conditions and circumstances that affect the behavior of people-stimuli may be focal, contextual or residual-health is a state/process of becoming wholeAdaptation- positive response to stimuli which creates integration of human and environmentIneffective responses- negative response to stiumuli which do not contribute to the goals of peopleAdaptation level- integrated, compensatory, compromisedNursing- practice which aids in expanding adaptive abilities; goal of nursing is to help in achieving the 4 adaptive modes
- -According to Alligood, human systems are complex and adapt to many different stimuli to achieve adaptation; furthermore, these systems work together to achieve a purposeA few of the scientific assumptions believe that awareness of self and environment is based on thinking and feeling which go on to mediate hman action. Acceptance, protection and independence are system relationships, and that the integration of human and environment result in adaptationPhilosophical assumptions believe that we have relationships with God and others; God is the creator, and that we as humans are responsible for the universe.Implicit assumption believes that people can be reduced to parts for study and care, nursing is based on causality and that people’s opinions and values should be respected; A quote from Roy “Individual persons, their perceptions and their experiences are the starting point of nursing”Humanism states that people are essential to knowing- the principles include holism, purposefulness, activity and activityAlligood text states that veritivity “affirms in the belief of the purpose, value and meaning of all human life” According to Roy, (2008) her own meaning of veritivity “refers to the principle of human nature that affirms a common purposefulness of human existance”.
- -Regulator mechanism is recognized as the autonomic nervous system to respond to stimuli and the environment; this includes the nervous and hormonal systems; mechanical responses are a result of the input of stimuli-Cognator system- applies a meaning to the stimuli to attach feeling to a behavior; parts of the cognator mechanism inclue coding, memory, learning, judgement, and emotion. Because these concepts cannot be measured directly, the resultant behaviors are evaluated. These are then classified into one of the four adaptive modes. -Input is sent through the internal mechanisms and produces an expected response
- Physiological mode includes the basic necessities to maintain the physical integrity of a being; includes nutrition, elimination, activity rest, protection, fluid/electrolytes-Self concept- beliefs and feelings about oneself; the underlying needs are spiritual; self is broken into the physical self and the personal self; physical self includes concepts such as appearance ,attributes and sexuality; personal self includes values, worth and the moral-ethical-spiritual self. -Role function- social integrity and the need to know how to act-Interdependence- need to feel secure in nurturing relationships.
- Circular diagram of the RAM. On the left hand side, you see the incoming stimuli. The stimuli are affecting the physiologic, selfconcept, interdepedence, or role function modes. Each of these modes are interrelated and share similar circles. The coping process is superimposed on the mode circles. Pointed outward from the coping process is the behavior which has been processed and ends in the adaptation circle. The fact that the diagram is circular and not linear represents, the constant fluid and dynamic movement of incoming stimuli and resultant behaviors.
- Roys’ six step nursing process is similar to the 5 step nursing process we are familiar with; an added exception to the assessment of stimuli which is affecting the particular behaviorBehavior- is judged as being adaptive or ineffective; Stimuli- nurse identifies the stimuli and the eliciting response of the effect on the behavior. Based on the assessment, nursing diagnoses are made and goals are set. It is through the intervention step that the stimuli are manipulated. In the evaluation stage, ineffective or maladaptive behaviors are reassessed in an attempt to reach a common goal of adaptive behavior. According to Roy (2008) the processes of each adaptive mode is viewed as the middle range theories that make up the knowledge of how integration takes place.
- Internal criticism according to Peterson and Bedrow concerns the fit of the internal components of the theory and their relationship to each other.Royswork is a conceptual model which describes the theory that the person is an adaptive system; it is an abstract model.-Adequacy: systematic model which is synthesized from other models in different disciplines; Clarity: Roy clearly defines the metaparadigm concepts and the four adaptive modes; philosophical concepts are difficult to understand; Consistency: physiological mode is concrete which lacks congruency from the other three modes; Logical Development- central concept of adaptation is shown to be true; however the philosophical assumptions that the model is based upon does launch into unproven territoryLevel of Theory Development- Meleis describes it as being “exemplary” and has been used to develop middle and situation specific theories. Has been used as a framework to describe adaptation and nursing interventions in achieving adaptation.
- External criticism according to Peterson and Bedrow “considers the fit between the theory and external criteria”; the evaluation of these concepts is dependent on the perceptions of the person evaluating the theoryRoy’s adaptation model is a grand theory model and is quite complex which includes several concepts, sub-concepts and four modes; because there are many different concepts and modes, it is a complex and difficult theory to understand.Complexity- this is a complex grand theory and according to Meleis, the complexity of the theory has slowed the operationalization of the theory for research project but lends itself well to education.Discrimination- Roy adaptation model is unique as it uses both scientific and philosphical assumptions to predict adaptive or ineffective behaviorsPragmatic- RAM is used and operationalized in the description of adaptation of chronic pain and caregiver effectiveness; it has been applied to the realm of pediatrics, oncology and psychology; has been used in the construction of checklists Scope- RAM is a broad range theory with a wide level of abstractness that can be applied to a number of settingsSignificance- the research has definite impact on nursing and interventions and can provide a framework for predicting adaptive or maladaptive behaviors and guide nursing interventions to assist the patient in achieving their maximum potentialUtility- has been used to describe phenomena such as functional return after delivery, healthcare outcomes for cancer patients, planning care for surgical patients;
- Roy’s theory has been used in two main areas to include caregiver effectiveness and well being and coping with pain and chronicity; it has been used to develop and describe the adaptation to chronic pain; ; the theory has been translated and supported in different cultures.
- This was my submission to the practice reflection/problem earlier in the semester. As I re-read my problem I realized that the RAM was appropriate to describe my nursing situation. I will give a few moments to reflect the reading.
- Practice reflection dealing with the nursing situation narrated earlier. Through the Duran et al (2009) article, the RAM outlines the necessity for the nurse to make an effort to become familiar with the patient’s lives. Attention to their context allows the person to be recognized as an individual. The RAM asserts that each nurse-patient interaction is individualized and unrepeatable. The nurse knows that in order to achieve adaptation the patient must recognize and be an active participant in their own environment. By “reducing” myself to the patients level (sitting in a chair silently) I recognized key facts outlined by Moreno et al : the power in the nurse-patient relationship is mutual, each recognize the influence each has on the other, and decision making is shared.
- The RAM uses as a guide for the nursing care of an 8 year old, specifically utilizes the framework of the RAM to guide nursing care for an 8 year old with leukemia. Using the 6 step nursing process, the RAM was able to correctly identify maladaptive behaviors in the child as well as the causative stimuli, use nursing interventions to aid in correcting the behaviors and manipulating the stimuli thereby adjusting the child’s behavior of loneliness to positive adaptive behaviors regarding hospitalization. Effects of antenatal education on maternal prenatal and postpartum adaptation used the RAM to hypothesize that manipulating the stimuli (education) would predict more effective postpartum behaviors (i.e. adaptation) in the education group vs the control group./