Callistra roy

THIS PPT CONTAIN INFORMATION ABOUT ROYS ADAPTATION THEORY WITH SUITABLE EXAMPLE

1. CALLISTA ROY THEORY prepared by : M rs. Pinky A ntony Presented by Mrs. Arockia Mary Associate Prof

2. INTRODUCTION Sister Callista Roy began her nursing career in 1963 after receiving her Bs in Nursing from Mount Saint Mary’s college, Los Angels. In 1966, she received her Ms in Nursing, and in 1977, her Doctorate in sociology from the University of California, Los Angels. In 1964, Roy began work on her model when professor Dorathy .E. Johnson, a behavior model theorist, challenged her during a graduate seminar class to develop a conceptual model for nursing .

3. cont In 1968, Mount Saint Mary’s college, Los Angels adopted Roy’s Model as framework for its UG nursing curriculum. In 1976, Roy published Introduction to nursing: an Adaptation Model . In 1984, after further clarification and refinement of the model through research and testings , she published a revised version.

4. SYSTEM GENERAL INFORMATION: ARE A SET OF ORGANIZED COMPONENTS RELATED TO FORM A WHOLE; REACT TO AND INTERACT WITH OTHER ENVIRONMENT HAVE BOUNDERIES THAT ARE FLEXIBLE AND OPEN TO PERMIT INTERACTION WITH OTHER SYSTEMS. EMPLOY A FEEDBACK CYCLE OF INPUT, THROUGHPUT, AND OUTPUT

5. INPUT Input is identified as STIMULI, which can come from the environment or from within a person. Stimuli are classified as FOCAL (immediately confronting the person CONTEXTUAL (all other stimuli that are present), or RESIDUAL (non specific such as cultural beliefs or attributes about illness) Each person’s adaptation level is unique and constantly changing

6. THROUGHPUT Throughput makes use of a person’s processes and effectors Processors refer to the control mechanisms that a person uses as an adaptive system. Effectors refer to the physiologic function, self-concept , and role function involved in adaptation.

7. OUTPUT Output is the outcome of the system; when the system is a person, output refers to the person’s behaviors. In Roy’s system, output is categorized as adaptive response (those that promote a person’s integrity) or ineffective responses (those that do not promote goal achievement; for example, not taking antihypertensive medication)

8. Cont., Adaptive responses are used when person demonstrates behaviors that achieve the goals of survival, growth, reproduction, and mystery These responses, or output, provide feedback for the system.

9. COPING MECHANISM Are the processes or behavior patterns that a person uses for self-control Can be inherited or learned Are of two types: the regulator and the cognator ; these two mechanisms are subsystems of the person’s adaptive system Must act together to maintain the integrity of the person as an adaptive system

10. REGULATOR The regulator subsystem consists of input, internal processes, and output. input stimuli can come from the external environment or from within the person internal processes – including chemical, neural, and endocrine – transmit the stimuli, causing output, a physiologic response the regulator subsystem controls internal processes related to physiologic needs (such as changes in heart rate during exercise)

11. COGNATOR the Cognator subsystem consists of input, internal processes, and output it regulates self-concept, role function, and interdependence the cognator subsystem controls internal processes related to higher brain functions, such as perception, information processing, learning from past experience, judgment, and emotion F or example, a client with diabetes who decides to increase insulin intake based on symptoms of high blood glucose.

12. Adaptive modes are part of the internal processes and act as system effectors Are categories of behavior to adapt to stimuli Include physiologic function, self-concept, role function, and interdependence; the regulator and the cognator act within these modes

13. Cont.. Can be used to determine a person’s adaptation level; this level, which is exhibited by a person’s behavior, reflects the use of adaptive modes and coping mechanisms. Can be used to identify adaptive or ineffective responses by observing a person’s behavior in relation to the adaptive modes

14. PERSON AS AN ADAPTIVE SYSTEM

15. 1.Physiologic- Physical Mode . Physiologic function Involves the body’s basic needs and ways of adapt .Includes a person’s patterns of oxygenation, nutrition, elimination, activity, and rest; skin integrity; sense; fluids and electrolytes; and neurologic and endocrine function .Is less abstract than the other three adaptive modes PHYSIOLOGIC ADAPTATION

16. 2.Self Concept -Group Identity Mode: . Self- concept- Refers to beliefs and feelings about oneself .Comprises the - physical self (includes sensation and body image) - personal self (includes self-consistency and self-ideal)and - moral and ethical self (includes self-observation and self-evaluation)

17. ROLE FUNCTION Involves behavior based on a person’s position in society Is dependent on how a person interacts with others in a given situation Can be classified as primary (age, sex), secondary (husband, wife), or tertiary (temporary role of a coach)

18. 4.Interdependance Mode .Involves a person’s relationship with significant others and support systems .Strikes a balance between dependent behaviors (seeking help, attention, and affection) and independent behaviors (taking initiative and obtaining satisfaction from work) .Meets a person’s needs for love, nurturing, and affection

19. PERSON Is the recipient of nursing care; Roy implies that a client has an active role in the care Is a BIOPSYCHOSOCIAL BEING who constantly interacts with a changing environment Is an adaptive system who uses innate and acquired coping mechanisms to deal with STRESSORS Can be an individual, family, group, community, or society

20. ENVIRONMENT is defined by Roy as all conditions, circumstances, and influences surrounding and affecting the development and behavior of person and groups Consists of internal and external environments, which provide input in the form of stimuli Is always changing and constantly interacting with the person

21. HEALTH 1. Was originally described by Roy as health-illness continuum, with one end of the continuum being death and the other end wellness; health and illness considered an inevitable dimension of the person’s life 2. is currently defined by Roy as a process of being and becoming an integrated and whole person; 3. health is viewed as the goal of the person’s behavior and the person’s ability to be an adaptive organism

22. NURSING 1. is required when a person expends more energy on coping, leaving less energy available for achieving the goals of survival, growth, reproduction, and mastery 2. uses the four adaptive modes to increase a person’s adaptation level during health and illness 3. employs activities that promote adaptive, not ineffective, responses in situations of health and illness 4. is a practice – centered discipline geared toward persons and their responses to stimuli and adaptation to the environment 5. includes assessment, diagnosis, goal setting, intervention, and evaluation.

23. THE NURSING PROCESS RAM offers guidelines to nurse in developing the nursing process. The elements : First level assessment Second level assessment Diagnosis Goal setting Intervention evaluation

24. Demographic data Name Age Sex Education Occupation Marital status Religion Informants Date of admission Mr . NR 53 years Male Degree Bank clerk Married Hindu Patient and Wife 21/01/08

25. 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 5 th inter-costal space mid- clavicular line. Air entry equal bilaterally. No ronchi or crepitus S 1 & S 2 heard. No abnormal heart sounds. Delayed capillary refill+. Apex beat felt- normal rhythm, depth and rate. Dorsalis pedis pulsation of affected limp is not palpable. All other pulsations are normal in rate, depth, tension with regular rhythm. Cardiac dull ness heard over 3 rd ICS near to sternum to left 5ht ICS mid clavicular line. BP- Normotensive . . Peripheral pulses felt-Normal rate and rhythm, no clubbing or cyanosis.

26. 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. Soft on palpation. No tenderness. No visible peristaltic movements. Bowel sounds heard. Percussion revealed dullness over hepatic area. Oral mucosa is normal. No difficulty to swallow food

27. 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.

28. ACTIVITY AND REST: Taking adequate rest. Sleep pattern disturbed at night due unfamiliar surrounding. Not following any peculiar relaxation measure. Like movies and reading. No regular pattern of exercise. Walking from home to office during morning and evening.

29. Cont.. Now, 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.

30. PROTECTION: Left lower fore foot is amputated. Black discoloration present over the area. No redness, discharge or other signs of infection. Nomothermic . Wound healing better now. Walking with the use of left leg is not possible. Using crutches.

31. Cont.. 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. Several papules present over the foot. All peripheral pulses are present with normal rate, rhythm and depth over right leg.

32. 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. olfaction, and auditory senses are normal.

33. 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

34. NEUROLOGICAL FUNCTION He is conscious and oriented . He is anxious about the disease condition. Like to go home as early as possible. Showing signs of stress. Touch and pain sensation decreased in lower extremity. Thinking and memory is intact.

35. ENDOCRINE FUNCTION He is on insulin. No signs and symptoms of endocrine disorders, except elevated blood sugar value. No enlarged glands.

36. SELF CONCEPT MODE- Physical self He is anxious about changes in body image, but accepting treatment and coping with the situation. Belongs to a Nuclear family. 5 members. Stays along with wife and three children. Good relationship with the neighbours . Good interaction with the friends. Moderately active in local social activities

37. PERSONAL SELF Self esteem disturbed because of financial burden and hospitalization. He believes in god and worshiping Hindu culture.  

38. 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.

39. 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

40. 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. From there, they referred to ---- medical college; where he was admitted for 1 month and 4 days. 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.  

41. 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.

42. 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.

43. 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. 

44. Wound started healing and he planned to discharge on 25th april . 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.