12. ROY'S THEORY.ppt

theory

1. Sister Callista Roy’s
Adaptation Model
Presented By:
Mrs. Jagjit Kaur

2. Itistheframeworkfornursing
practiceandthedirectionfor
nursingresearch.
SistercallistaRoy’sadaptation
theory(RoyandObloy
1979,Roy 1980,1984,1989)
viewstheclientasanadaptive
system.
INTRODUCTION

3. BIOGRAPHICAL SKETCHOFTHENURSE
THEORIST
SistercallistaRoywasbornon
oct,14,1939.
Shedidherbachelorsofartsin
nursingfrommountst.Mary’s
college,losAngelesin1963
andmastersofsciencein
nursingfrom,Universityof
California,LosAngeles1966.

4. CONTD….
Shealsoreceivedhermastersofarts(M.A)in
sociologyfromthesameuniversityin1975andPh.D
insociology.
Roy was an associate professor and chairperson of
the department of nursing at mount Saint Mary’s
college until 1982.

5. CONTD….
From 1983 to 1985; she was Post Doctoral fellow at
Robert Wood Johnson at University of California, as a
clinical nurse scholar in neuroscience.
In 1988 Roy began the newly created position of
graduate faculty at, Boston school of nursing.

6. CONTD….
AccordingtoRoy’smodel,thegoalofnursingisto
helptheperson’sadaptivesystem.
AccordingtoRoy’smodel,thegoalofnursingisto
helpthepersonadapttochangeinphysiological
needs,self-concepts,rolefunctionand
interdependentrelationsduringhealthandillness
.

7. CONTD….
Allindividualmustadapttothe
followingdemands:
1.Meetingbasicphysiological
needs.
2.Developingapositiveself-
concept.
3.Performingsocialroles.
4.Achievingabalancebetween
dependence and
interdependence.

8. CONTD….
Itisroleofnurse:
Tofindoutdemandswhich
arecausingproblemsfora
client.
Toassesshowwelltheclient
isadaptingtothem.Nursing
careisthendirectedat
helpingtheclienttoadopt.

9. ORIGINOFTHEMODEL:
WhileastudentofM.sc.nursing,attheuniversityof
CaliforniasisterC.Roywaschallengedinaseminar
byanothernursetheoristDorothyE.JOHNSONto
developatheoryofnursing,subsequentlyin1970
the‘ROYADAPTATIONMODEL’wasbornasa
derivationofBertalanfty(1968)generalsystemtheory
andHarryHelson’sAdaptationleveltheory(1964).

10. ASSUMPTIONS OF
THEMODEL

11. CONTD….
1.Thepersonisabio-psycho-social
beingincludesbiologiccomponents
(Anatomy and Physiology),
psychological and social
components.
2.Thepersonisinconstantinteraction
withachangingenvironment
(interactionwithphysical,social&
psychologicalenvironmentchanges)

12. CONTD…
3.Tocopewithachangingworld,the
personusesbothinnateand
acquiredmechanismswhichare
biologic,psychologicalandsocialin
origin.
4.Healthandillnessarean
inevitabledimensionofthe
person’slife.
5.Torespond positivelyto
environmentalchanges,theperson
mustadapt(changingenvironment
demandspositiveresponse)

13. CONTD….
6.Theperson’sadaptationisafunction
ofthestimulus,heisexposedtoand
hisadaptationlevel,whichis
determinedbythecombinedeffectof
threeclassesofstimuli:
*focalstimuli
*contextualstimuli
*Residualstimuli

14. CONTD….
*Focalstimuliorstimulidemandingpromptattention.
*Contextualstimuliorstimulipresentina
surroundingandsituation.
*Residualstimulisuchasbelief,attitudeandhabits,
whichhaveanindeterminateonthepresentsituation.

15. CONTD….
8.Thepersonisconceptualizedas
havingfourmodesofadaptation:
psychologicalneeds
self-concept,
rolefunction,and
interdependencerelations.

16. Thefourprinciplesare
:
Theindividualisviewed
inthecontextofthe
purposefulnessofhuman
existence.
Unityofpurposeof
humankind
Activity&creativityfor
thecommongoods
Valueofmeaningoflife.

17. CONCEPTSOFMODEL
Roy’s model is a system model that focuses on
outcomes. the major features of the system models
are the:
-System and its environment
A system is a set of parts connects to function as a
whole for some purposes and are interdependence of
its parts.

18. CONTD….
Keys elements in the Roy
adaptation model are-
1. The person who is recipient of
nursing care
2. The goal of nursing.
3. The concept of health
4. The direction of nursing
activities.

19. CONTD…
Person:Royusespersoninhermodelasaconcept
toidentifytherecipientofnursingcare.criticaltothe
modelisthedescriptionofrecipientofnsgcareas
holisticadaptivesystems.
Personsaslivingsystemsareinconstantinteractions
withtheirenvironmentsbetweenthesystemandthe
environmentoccursonexchangeofinformation,
matterandenergy.

20. Goal-the goal of nsg. as the
promotion of adaptive responses
in relation to the four adaptive
modes (physiological, self
concept, role function and
interdependence)and contribute to
health.

21. Nsg activities-The nursing activities are
delineated by the model as those that
promotes adaptive responses in situation
of health and illness. The nsg activities are
identified as actions taken by nurses to
manipulate the focal, contextual residual
stimuli impringing on person.

22. CONTD….
The nsg processacc. to Roy’s
model consists of six steps-
(1)Acceptance of behavior
(2)Acceptance of stimuli
(3)Nsg diagnosis
(4)Goal setting
(5)Intervention
(6)Evaluation

23. Health-health has been defined as a “state and
process of being and becoming an integrate and
whole person’’ Health is a process where by
individuals are striving to achieve their maximum
potentials.

24. Environment-stimuli from within the person and
stimuli from around the person represents the
element of environment acc. to Roy.
Environment is specifically defined by Roy as “all
conditions, circumstances influences surrounding
and affecting the development and behavior of
persons and groups.

25. 6. THEPERSONASANADAPTIVE
SYSTEM
In addition to the concept of person,goal of
nsg,health and environment and nsg activities in
the model ,the theory of person as an adaptive
system employs additional concepts.

26. The person as an adaptive system

28. CONTD…
Contextual stimuli-observable, measureable and
reported by the person.
Residual stimuli-those make up characteristics of
the person that are present and relevant to
situation.

29. CONTD…….
Example:Mr.smithexperiencingthechest
pain,thestimulusimmediatelyconfrontingMr.
smith,thefocalstimulus,isthedeficitof
oxygensupplytohisheartmuscles.The
contextualstimuliincludethe90degreeof
temperature,thesensationofpain,Mr.smith’s
age,weight,bloodsugarlevel,anddegreeof
coronaryarterypatency.Theresidualstimuli
includehishistoryofcigarettesmokingand
workrelatestress.

30. CONTD….
Mechanisms are of 2 types:
(1)Regulatoris used primarily as a mechanism to
cope with physiological stimuli.
(2)Cognator used mainly as mechanism to cope
with psychological stimuli dealing primarily in area
of cognition, judgment and emotion.
-Regulator and cognator mechanisms are linked
through the process of perception.

31. CONTD….
Effectors: Roy has identified four adaptive modes;
Physiological
self concept
role function
interdependence.

32. 7. THEORYOFADAPTIVEMODES:
The theory of adaptive modes was developed in 1981,
consist of four parts:
physiological,
self concept,
role function &
interdependence.

33. CONTD…
Eachadaptivemoderepresentsagroupingof
behaviorsthatpromotetheindividualsmovements
towardsthegeneralgoals(survival,growth,
reproduction,mastery).

34. CONTD…..
(1)PHYSIOLOGICALMODE
Physiologicalwholenessisachieved
byadaptingtochangesin
physiologicalneeds.
Theregulatorcopingmechanismis
primarilyresponsibleforattainingand
maintainingthisintegrity.
othercomplex processthat
influencesregulator
activitiesarethesenses,fluidsand
electrolytes,neurologicalfunction&
endocrinefunction.

35. Five primary needs have been identified as
necessary for physiological integrity:
oxygen,
nutrition,
activity rest,
protection,
elimination

36. CONTD…
(2)SELF CONCEPT MODE
Selfconceptisoneofthe3psychosocialmodes,the
basichumanneedwithinmodesinpsychic
integrity,whichmeanspeopleneedtoknowwhothey
aresothatcanexistwithasenseofunity.

37. CONTD…..
Physicalself:isanappraisalofone’sphysical,
attributes, appearance, functioning,
sensation(feelingaboutself)sexuallyand
wellnessillnessstatus.
Personalself:isanappraisalofone’sown
characteristics,expectations,values&worth.
Personalselfhasbeendividedintothemoral
ethicalspiritualself,selfconsistency&selfideal,
selfexpectancye.g.IbelieveGodwillhelpme
throughthissurgery.

38. CONTD…..
(3)ROLE FUNCTION MODE:
The basic need in the role function adaptive model is
for social integrity. This means that people need to
know who they are in relation to others so that they
can act. All people have role in society. With each role
there are expected behavior .Role have been divided
into primary, secondary and tertiary.

39. CONTD….
(4)INTERDEPENDENCE MODE
Interdependence is a social adaptive
mode,needsaffection adequacy or the feeling of
security in nurturing relationships.
Interdependence means the close relationship of
people that involves willingness & ability to love,
respect & value others and to accept & responds
to love, respect and value given by others.
Loneliness as a common adaptation problem
resulting from a disruption in the modes.

40. Those currently identified
needs are listed below:
(a) Basic physiological needs-
Exercise and rest
Nutrition
Elimination
Fluid and electrolyte
Oxygen
Circulations
Regulations

41. CONTD….
(b)self concepts:
Physical self
Personal self
Interpersonal self
(c) role mastery:
-Role failure
-Role conflict

42. CONTD….
Natureofplanningandgoalsettingprocess
Thefocusofnsginterventionsduringthe
implementationofthensgcareplan
Thenatureoftheprocessofevaluatingthequalityof
effectsofthecaregiven.

43. NURSING PROCESS ACCORDINGTORAM
A problem solving approach for gathering data,
identifying the capacities and needs of the human
adaptive system, selecting and implementing
approaches for nursing care, and evaluation the
outcome of care provided.
oAssessment of Behavior:the first step of the nursing
process which involves gathering data about the
behavior of the person as an adaptive system in each of
the adaptive modes.

44. CONTD….
Assessment of Stimuli:the second step of the
nursing process which involves the identification of
internal and external stimuli that are influencing the
person’s adaptive behaviors.
Stimuli are classified as:
1) Focal-those most immediately confronting the
person
2) Contextual-all other stimuli present that are
affecting the situation
3) Residual-those stimuli whose effect on the
situation are unclear.

45. Nursing Diagnosis:step three of the nursing process
which involves the formulation of statements that
interpret data about the adaptation status of the person,
including the behavior and most relevant stimuli

46. GOALSETTING
the fourth step of the nursing process which
involves the establishment of clear statements of
the behavioral outcomes for nursing care.

47. Intervention:the fifth
step of the nursing
process which involves
the determination of
how best to assist the
person in attaining the
established goals

48. Evaluation:the sixth
and final step of the
nursing process which
involves judging the
effectiveness of the
nursing intervention in
relation to the behavior
after the nursing
intervention in
comparison with the
goal established.

49. DEMOGRAPHIC DATA


Name
Mr. NR
Age 53years
Sex Male
IP number ------
Education Degree
Occupation Bank clerk
Marital status Married
Religion Hindu
Informants Patient and Wife
Date of admission 21/01/08

50. FIRST LEVEL ASSESSMENT
PHYSIOLOGIC-PHYSICAL MODE
Oxygenation:
Stable process of ventilation and stable process of gas exchange.
RR= 18Bpm.
Chest normal in shape. Chest expansion normal on either side.
Apex beat felt on left 5th inter-costal space mid-clavicular line.
Air entry equal bilaterally. No ronchi or crepitus.
No abnormal heart sounds.
S1& S2 heard.
BP-Normotensive. .

51. CONTD….
Nutrition
He is on diabetic diet (1500kcal). Non
vegetarian.
Recently his Weight reduced markedly (10
kg/ 6 month).
He has stable digestive process.
He has complaints of anorexia and not
taking adequate food.
No abdominal distension. No tenderness.
Bowel sounds heard.
Percussion revealed dullness over
hepatic area.

52. CONTD….
Elimination:
No signs of infections, no
pain during micturation or
defecation.
Normal bladder pattern.
Using urinal for micturation.
Stool is hard and he
complaints of constipation.

53. CONTD….
oNow, activity reduced due to
amputated wound. Mobility impaired.
Walking with crutches.
Pain from joints present. No
paralysis.
ROM is limited in the left leg due to
wound.
No contractures present. No swelling
over the joints.
Patient need assistance for doing the
activities.

54. CONTD….
Protection:
Left lower fore foot is amputated.
Black discoloration present over the area.
No redness, discharge or other signs of infection.
Wound healing better now.
Pain form knee and hip joint present while walking.
Dorsalis pedis pulsation, not present over the left leg. Right
leg is normal in length and size.
All peripheral pulses are present with normal rate, rhythm and
depth over right leg.

55. CONTD….
Senses:
No pain sensation from the wound site. Relatively,
reduced touch and pain sensation in the lower
periphery; because of neuropathy. Using spectacle
for reading. Gustatory, olfaction, and auditory
senses are normal.
Fluids and electrolytes:
Drinks approximately 2000ml of water. Stable
intake out put ratio. Serum electrolyte values are
with in normal limit.No signs of acidosis or
alkalosis. Blood glucose elevated.

56. CONTD….
Neurological function:
He is conscious and oriented.
He is anxious about the disease
conditon
Touch and pain sensation
decreased in lower extrimity.
Endocrine function
He is on insulin. No signs and
symptoms of endocrine
disorders, except elevated blood
sugar value. No enlarged glands.

57. CONTD….
Personal self:
Self esteem disturbed because of financial burden and
hospitalization. He believes in god and worshiping Hindu
culture.
ROLE PERFORMANCE MODE:
He was the earning member in the family. His role shift
is not compensated. His son doesn’t have any work. His
role clarity is not achieved. INTERDEPENDENCE
MODE:
He has good relationship with the neighbours. Good
interaction with the friends relatives. But he believes, no
one is capable of helping him at this moment. He
says”all are under financial constrains”. He was
moderately active in local social activities

58. SECOND LEVEL ASSESSMENT
FOCAL STIMULUS:
Non-healing wound after amputation of great and
second toe of left leg-4 week. A wound first found
on the junction between first and second toe-4
month back. The wound was non-healing and
gradually increased in size with pus collected over
the area.
He first showed in a local hospital,referred to
medical college; During hospital stay great and
second toe amputated. But surgical wound turned to
non-healing with pus and black colour. So the
physician suggested for below knee amputation.
That made them to come to ---Hospital, ---. He
underwent a plastic surgery 3 week before.

59. CONTD….
CONTEXTUAL STIMULI:
Known case DM for past 10 years. Was on oral
hypoglycemic agent for initial 2 years, but switched
to insulin and using it for 8 years now. Not wearing
foot wear in house and premises.
RESIDUAL STIMULI:
He had TB attack 10 year back, and took complete
course of treatment. Previously, he admitted in ---
Hospital for leg pain about 4 year back. . Mother’s
brother had DM. Mother had history of PTB. He is a
graduate in humanities, no special knowledge on
health matters.

60. ASSESS. OF
BEHAVIOUR
ASSESSMENT
OF STIMULI
NURSING
DIAGNOSIS
GOAL
INTERVEN
TION
EVALUA
TION
Impaired
activity
inphysical-
physiological
mode
Focal stimuli:
During hospital
stay great and
second toe
amputated. But
surgical wound
turned to non-
healing with
pus and black
colour.
2.Impaired
physical
mobility related
to amputation
of the left
forefoot and
presence of
unhealed
wound
Long term
Objective:
Patient will
attain
maximum
possible
physical
mobility with in
6 months.
-Assess the
level of restriction
of movement
-Provide active
and passive
exercises to all
the extremities to
improve the
muscle tone and
strength.
-Make the
patient to perform
the ROM
exercises to lower
extremities which
will strengthen
the muscle.
-
Short term
goal:
Met: used
crutches
correctly on
22/4/08.
he is self
motivated in
doing minor
excesses
Partially Met:
walking with
minimum
support.

61. CONCLUSION
Mr.NR who was suffering with diabetes
mellitus for past 10 years. Diabetic foot
ulcer and recent amputation made his life
more stressful. Nursing care of this patient
based on Roy's adaptation model provided
had a dramatic change in his condition. He
studied how to use crutches and mobilized
at least twice in a day. Patient’s anxiety
reduced to a great extends by proper
explanation and reassurance.He gained
good knowledge on various aspect of
diabetic foot ulcer for the future self care
activities.

62. Scope
Grand theory RAM
Middle range theory evolved RAM:-
Caregivers’s effectiveness & well being.
Coping with pain & chronicity.
Coping with diabetes.
Gentle touch in preterm infants.

63. CONTD…
Significance
1987 –over 100,000 nurses have
graduated from program based on
RAM
Used by global scholars
Models used in research , curriculum
development, social issues , chronic
illness & development of research
instruments.

64. Utility
Research tool development
Describes responses to health illness.
Evaluates intervention
Measures perception of adaptation levels.
Measures perception of powerlessness & decision
making.
Measures health care outcomes of cancer patients.
Regaining functional abilities after delivery.
Used to identify adaptive and maladaptive behavior
to stimuli.
Lack of motivation to quit smoking.
Assessing & planning care of surgical patients.
Care of geriatric patients.

65. CONTD….
Obstetrical, peadiatric and neonatal settings.
Cardiac patients.
Elder care
Pshychiatric setting & organic brain syndrome.

66. 9. APPLICATION OFR.A.M INNURSING
(1) Nsg practice-R.A.M is a very useful method in nursing
practice specially in those setting where there are
convert psychological needs which are as essential as
physical one. Roy’s models are very effective in
pediatrics as well as community and rehabilatory nsg.

67. CONTD….
(2)Nursing Research-
R.A.M provide a conceptual model for
nursing process and this has been a
basis for number of research being
done.fore.gmeasuring functional
status after child birth,functionalstatus
during pregnancy.
If research is to affect practitioners’
behavior, it must be directed at testing
and retesting conceptual models for
nursing practice. Roy has stated that
theory development and the testing of
developed theories are nursing’s
highest priorities. The model must be
able to regenerate testable hypotheses
for it to be researchable.

68. CONTD….
(3)Education-
RAM useful in educational setting.Roy states that the model defines for
students the distinct purpose of nursing which is to promote man’s
adaptation in each of the adaptive modes in situations of health and
illness.

69. THANKS