Post doctoral fellow Clinical nurse scholar Chair of the Department of nurses Adjunct professor of the graduate school

ool program, school of nursing Acting director and nurse consultant of Saint Marys Hospital A Doctorate in sociology Active in many nursing organizations NANDA specifically An author and co author of a number of books

Conceptualizing the theory

 Her theory was first conceptualized in 1964 (date of inception)

pediatric patients
First a part of her graduate work it was then adopted as a conceptual framework of the undergraduate nursing curriculum

 Recipient of care Maybe the person, family, group, community or a society Each considered by the nurse as a HOLISTIC ADAPTIVE SYSTEM

 Source of stimuli Defined by Roy as all conditions, circumstances and influences that surround and affect the development and behavior of persons and groups

External

internal

 Defined by Roy as a state and process of being and becoming an integrated and whole person AIM OF THE NURSE in practicing Roys model is : promote the health of the person by promoting adaptive responses

Health is achieved if the person has positively adapted

SURVIVAL

GROWTH

INTEGRITY OF THE PERSON

REPRODUCTION

MASTERY

 Roy defines goal of nursing as the PROMOTION of ADAPTIVE RESPONSES in relation to the FOUR ADAPTIVE MODES.
NURSING seeks to reduce ineffective responses and PROMOTE adaptive responses as output behavior of the person

CONCEPTS OF THE THEORY

INPUT
CONTROL PROCESSES

OUTPUT

INPUT

STIMULI

external

internal

focal
contextual
residual

Most immediately confronting Greatest degree of change impacting on the person

all other stimuli of the persons internal and external environment having an influence on the situation
Those internal and external factors who current effects are unclear

SEVERE PAIN :damage to cardiac muscle (angina / MI)

Unfamiliar surroundings and people

OLD AGE
Smokes 2 packs of cigarettes a day over 20 years

A number of activities / interventions carried out in the immediate environment (ER) Attached to devices and had undergone several tests since arrival Has not seen his wife since he was in the ambulance, has been told that she is in the waiting room

Sedentary lifestyle with no exercise

No previous history of hospitalization

focal

contextual

residual

INPUT
CONTROL PROCESSES OUTPUT

COPING MECHANISMS / SUBSYSTEMS OF THE PERSON

AS AN ADAPTIVE SYSTEM

REGULATOR
TRANSMITTERS OF THE REGULATOR SUBSYSTEM:

COGNATOR
Related to higher brain functions:

NEURAL AUTONOMIC REFLEXES CHEMICAL ENDOCRINE

PERCEPTION LEARNING JUDGMENT EMOTION

IDENTIFY

REGULATOR OR COGNATOR MECHANISM

Children listening attentively to their teacher and imitating what the teacher does.

Deep breathing

When a family decides for the mode of treatment for their father who has been diagnosed with cancer stage 4

SECRETION OF INSULIN BY THE PANCREAS WHEN THE BODY NEEDS ENERGY

A burning house

A fireman comes for rescue and he is running with all the needed equipment to stop the fire

He tries to put out the fire

The fireman was able to rescue a child in the midst of a fire

INPUT
CONTROL PROCESSES OUTPUT

response OUTPUT

BEHAVIOR OF THE PERSON

ADAPTIVE RESONSES
Promotes integrity of the person

INEFFECTIVE RESPONSES
Do not contribute to integrity
NURSE INTERVENES

ADAPTIVE RESONSES

INEFFECTIVE RESPONSES

ADAPTIVE RESONSES

INEFFECTIVE RESPONSES

ADAPTIVE RESONSES

INEFFECTIVE RESPONSES

The FOUR modes of Adaptation

 Basic needs

Psychological & spiritual aspect

Psychic integrity

Performance of duties based on a given position

social integrity

Ones relations with others

Covers the basic needs of the human person:

Oxygenation Nutrition Elimination Activity and rest Skin integrity Intact senses Fluid and electrolyte balance Intact neurologic function
GOAL: PHYSICAL INTEGRITY

Focuses on the psychological and spiritual aspects of the individual

Beliefs and feelings that one holds about himself

GOAL PSYCHIC INTEGRITY that one needs to know who one is so that one can be or exist with a sense of unity

Set of expectations about how a person is expected to behave based on her position or role

Basic need-social integrity, the need to know who one is in relation to others
GOAL : SOCIAL INTEGRITY

Focus on the close relationships of people and their purpose. Balance results in feelings of being valued and supported by others. Basic need - feeling of security in relationships Nurse must give more importance or particular attention to dying patients.

stimuli
Adaptive response Coping mechanisms/ subsystems FOUR adaptation modes

HEALTH

Ineffective response

DISEQUILIBRIUM

is to enhance life processes through adaptation in four adaptive modes.

- guidelines of the nurse in the application of

the nursing process

The six elements of the Roys nursing process parallel the five phases of the nursing process

ASSESSMENT OF BEHAVIOR

Assessment of the client in the four adaptive modes enhances a SYSTEMATIC AND HOLISTIC APPROACH
In this phase the nurse collects data about the FOCAL, CONTEXTUAL, RESIDUAL stimuli affecting the client This process thus clarifies the etiology of the clients problems

ASSESSMENT OF STIMULI

NURSING DIAGNOSIS

Use of a typology of diagnoses developed by ROY related to the four adaptive modes

GOAL SETTING
PLANS FOR

Identify expected client behaviors after management of focal or contextual stimuli

IMPLEMENTATION

Nursing interventions are planned with the purpose of managing the FOCAL OR CONTEXTUAL STIMULI May also focus on BROADENING THE PERSONS ABILITY TO ADAPT
Goal behaviors are compared to the persons actual output responses Movement toward or away from goal achievement is determined Readjustments to goals and interventions are made based on the evaluation data

EVALUATION

 Use of Roys six step nursing process in the clinical setting

By manipulating the stimuli and not the patient, the nurse enhances the interaction of the person with their environment thereby promoting health Disadvantage: nursing process was lengthy and that it took much time to complete Advantage: useful in inpatient settings, except in intensive care units Easier to use in clinics and physician offices, outpatient settings Major strength of the model : provide a system that accounted for physical needs and psychosocial needs Roys model is useful when patients receiving care could participate in care planning and problem solving

 The RAM was used for curriculum development, application of the model resulted in decreased anxiety in the students and provided a framework to give direction to the education of practitioners. Nursing process can be utilized as a guide for the students in their clinical area exposure Enhance the theory and practice of the students The model allows increasing knowledge in the areas of both theory and practice The RAM defines the distinct purpose of nursing students, which is to promote adaptation of person in each of the four adaptive modes in situations of health and illness.

 The model distinguishes nursing science from medical science by having the content of these areas taught in separate courses. Roy believes that curricula based on this model help in theory development by the students, who also learn how to test theories and recognize new theoretical insights. Roy suggests that the model is advantageous for integrated curricula and that it clarifies objectives, identifies content, and specifies patterns for teaching and learning. Throughout 1970s and 1980s, the Roy model was implemented as a basis for curriculum development in associate-degree diploma, baccalaureate, and higher-degree programs in many countries.

 The model is able to generate many testable hypotheses that need to be researched. A group of graduate students at DePaul university tested the model in a number of practice situations, the students concluded that the model provided a good framework for ordering a variety observations and was flexible enough to be used in both episodic and distributive settings. Roys model have been used in many quantitative and qualitative researches and for the development of adaption research instruments and researchers were satisfied with the outcome of their researches for it has provided face validity for its usefulness as a framework to guide their study. The model does generate many testable hypotheses related to both practice and nursing theory.

 Roy defines goal of nursing as the PROMOTION of ADAPTIVE RESPONSES in relation to the FOUR ADAPTIVE MODES. NURSING seeks to reduce ineffective responses and PROMOTE adaptive responses as output behavior of the person Nursing is dealing with person, not only as a biological organism but as a holistic adaptive system. Therefore, Roy attempts to describe ADAPTATION as a process involving holistic functioning to affect health positively.

END