Sister Callista Roy: Roy Adaptation Model: Sister Callista Roy: Roy Adaptation Model Image: Image Mid 1960’s through the 1970’s Caring Stereotypes Evolving Image: Evolving Image The Female Liberation Movement Feminism Empowerment Professionals Slide 4: Personal Image Sister Nurse Nurse Scholar Callista Roy-time line: Callista Roy-time line October 14, 1939 Callista Roy Born 1963 BA (Nursing) 1966 MS (Nursing) 1966-83 Dept. of Nursing (MSMC) 1964-66 Conceptualization of Model 1968 Model put into practice 1971-74 Chair, Dept of Nursing (MSMC) 1971 Integration of Psychiatric Concept 1973 MA (Sociology) 1977 PhD (Sociology) 1978-79 Study, Project Director 1978 Award, Fellow of American Academy of Nursing 1981 Founder’s Award 1991 Award, National League for Nursing 1987 100,000 (est.) nursing students graduated with knowledge of RAM 1991 Research, Measurement of…adapting to situations… 1987-Present Professor, and Nurse Theorist. School of Nursing, Boston College Metaparadigm: Person: Metaparadigm : Person Humans are holistic, adaptive systems A whole with the parts that function in unity for some purpose Not limited to just the individual can include; groups, families, organizations, communities, and society as a whole Metaparadigm: Environment: Metaparadigm : Environment Includes all the conditions, circumstances, and influences surrounding and affecting the development and behaviours of the person. Stimuli include can be categorized as focal, contextual and residual. Internal and External Metaparadigm: Health: Metaparadigm : Health A state and a process of being and becoming integrated as a whole person Reflection of adaptation that is the interaction of the person and the environment Metaparadigm: Nursing: Metaparadigm : Nursing Acts to enhance the interaction of the person with the environment to promote adaptation A science and practice that expands adaptive abilities and enhances person and environmental transformation. Metaparadigm: Adaptation: Metaparadigm : Adaptation Added by Roy Process and outcome whereby thinking and feeling persons use conscious awareness and choice to create human environment integration “every human life is purposeful in a universe that is creative and persons are inseparable from the environment” (Dr. Callista Roy). Roy Adaptation Model (RAM)-Terms: Roy Adaptation Model (RAM)-Terms System-a set of parts connected to function as a whole for some purpose Stimulus-something that provokes a response, point of interaction for the human system and the environment Focal Stimuli-internal or external stimulus most immediately affecting the system Contextual Stimulus-all other stimulus present in the situation Residual Stimulus-environmental factor, that effects on the situation that are unclear Slide 12: Regulator Subsystem-automatic response to stimulus (neural, chemical, and endocrine) Cognator Subsystem-responds through four cognitive-emotive channels (perceptual and information processing, learning, judgment, and emotion) Behaviour-internal or external actions and reactions under specific circumstances Adaptive Responses-promote the integrity of the human system Ineffective Responses-neither promote not contribute to the integrity of the human system Slide 13: Copping Process-innate or acquired ways of interacting with the changing environment Innate-genetically determined, automatic process Acquired-developed through learning, deliberate and conscious 4 Modes of Adaptation: 4 Modes of Adaptation 1.Physiologic-Physical Mode Behaviour pertaining to the physical aspect of the human system Physical and chemical processes Nurse must be knowledgeable about normal processes 5 needs (Oxygenation, Nutrition, Elimination, Activity & Rest, and Protection) Slide 15: 2.Self Concept-Group Identity Mode The composite of beliefs and feelings held about oneself at a given time Focus on the psychological and spiritual aspects of the human system Need to know who one is, so that one can exist with a state of unity, meaning, and purposefulness 2 modes (physical self, and personal self) Slide 16: 3.Role Function Mode Set of expectations about how a person occupying one position behaves toward a person occupying another position Basic need-social integrity, the need to know who one is in relation to others Slide 17: 4.Interdependance Mode Behaviour pertaining to interdependent relationships of individuals and groups Focus on the close relationships of people and their purpose Each relationship exists for some reason Involves the willingness and ability to give to others and accept from others Balance results in feelings of being valued and supported by others Basic need-feeling of security in relationships Slide 18: Roy Adaptation Model Feedback Stimulus Responses Physiologic Mode Self Concept Mode Role Function Mode Interdependence Mode Human System Goal of Nursing: Goal of Nursing Roy defines the goal of nursing as the promotion of adaptive responses in relation to the four adaptive modes: physiological-physical, self-concept-group identity, role function and interdependence. Adaptive responses are those that positively affect health, that is, support the integrity of the human adaptive system. In the perspective of RAM, human responses include not only problems, needs, and deficiencies, but also capacities, assets, knowledge, skills, abilities and commitments. Slide 20: The nurse may anticipate that the human system has a potential for ineffective responses and secondary to stimuli and likely to be present in a particular situation. The nurse acts to prepare the human system through anticipatory guidance. Nursing actions suggested by the model include approaches aimed at maintaining adaptive responses Nursing Diagnosis : Nursing Diagnosis A nursing diagnosis is an interpretative statement that represents a judgement that the nurse makes in relation to the adaptation status of the human adaptive system. The method suggested by roy is stating the observed behaviour along with the most influential method . The Roy Nursing Process Applied to Nursing Practice: The Roy Nursing Process Applied to Nursing Practice Individual Situation. In a recovery room, the RAM can be applied to nursing assessment and interventions in various clinical situations. The roy model is applied to a person during the period of immediate recovery from surgery and anesthesia . By applying the RAM, significant behaviours can be conceptualized as regulator output responses. Regulator output responses that vary from baseline values determined for the person may be the first warning of an ineffective response to postoperative stimuli Slide 23: Key baseline values are the person’s presurgery measures of heart rate, blood pressure, and respiratory rate. Goals are set with the basic survival of the person as a priority. Interventions are taken so that focal and contextual stimuli are altered and adaptation is promoted. The evaluation of goal achievement is made, and further actions are taken as necessary. 6 Step Nursing Process: 6 Step Nursing Process Assesses the behaviours manifested from the four adaptive modes Assess the stimuli, and categorize them into type of stimuli Create a nursing diagnosis of the person’s adaptive state Set goals to improve adaptation Implement interventions to achieve goals Evaluate if goals have been met Slide 25: Assess. Of Behaviour Assess. Of Stimulus Nsg. Dx. Set Goals Intervention Evaluation -5 basic needs -Nsg. background -norms to compare against -helps looks at particular modes -identify stimuli -consult with client -assess. for –ve/+ve adaptation -relate behaviour to most relevant stimulus -3 part statement 1.behaviour to be observed 2.change behaviour 3.time frame -change stimulus -appropriate, with the highest probability of achieving goals -agreed upon with client -assessment of behaviour response, in relation to goal -may cause negative feedback and have to set new goals Six Step Nursing Process STRENGTHS AND WEAKNESS OF THE ROY ADAPTATION MODEL: STRENGTHS AND WEAKNESS OF THE ROY ADAPTATION MODEL The RAM offers a variety of strengths for all areas of nursing. First, is the focus on, and inclusion of, the whole person or group. The four modes provide an opportunity for consideration of multiple aspects of the human adaptive and support gaining an understanding of the whole system. The importance of the spiritual aspects of the human adaptive system, often omitted from nursing assessment, is included in a manner that allows for incorporation of spirituality without imposition of the nurse’s beliefs . Slide 27: It is evident from the amount of research using the RAM reported in the literature, and through the formation of BBARNS, that research is supported. Due to this research connection, the RAM is evolving rather than static. It is logically organized and draws on the nurse’s observational and interviewing skills. Weaknesses have been identified in relation to research and to practice. One is the need for consistent definitions of the concepts and terms within the RAM, as well as for more research based on such consistent definitions. Slide 28: Also, in a practice arena that is increasingly challenged with time constraints, the amount of time required to fully implement the two areas of RAM assessment may be viewed as insurmountable. This is particularly true as one begins to use the RAM; a nurse more experienced in the use of the RAM may find the time constraints less compelling Our personal philosophy: Our personal philosophy The positive energy exchange that occurs between a nurse and the client results in a true, caring, therapeutic relationship, conducive to a healing environment.