roys adaptation

8/7/2019 Roys Adaptation

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PREPARED BY MR. ARUN JOSE

INTRODUCTION

y Sister Callista Roy began her nursing career in 1963 after receiving her Bs inNursing from Mount Saint Marys college, Los Angels.

y In 1966, she received her Ms in Nursing, and in 1977, her Doctorate insociology from the University of California, Los Angels.

y 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.

y In 1968, Mount Saint Marys college, Los Angels adopted Roys Model asframework for its UG nursing curriculum.

y In 1976, Roy published Introduction to nursing: an Adaptation Model. In 1984,after further clarification and refinement of the model through research andtestings, she published a revised version.

GENERAL INFORMATION:

y ARE A SET OF ORGANIZED COMPONENTS RELATED TO FORM AWHOLE;

y REACT TO AND INTERACT WITH OTHER ENVIRONMENTy HAVE BOUNDERIES THAT ARE FLEXIBLE AND OPEN TO PERMIT

INTERACTION WITH OTHER SYSTEMS.

y EMPLOY A FEEDBACK CYCLE OF INPUT, THROUGHPUT, ANDOUTPUTINPUT

y Input is identified as STIMULI, which can come from the environment or fromwithin a person.

y Stimuli are classified as FOCAL (immediately confronting the personCONTEXTUAL (all other stimuli that are present), or RESIDUAL (nonspecific such as cultural beliefs or attributes about illness)

yEach persons adaptation level is unique and constantly changing

THROUGHPUT

y Throughput makes use of a persons processes and effectorsy Processors refer to the control mechanisms that a person uses as an adaptive

system.


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PREP RE BY MR AR J E

y Effect efert t e physi l ic functi n, self-concept , and role functioninvolved in adaptation.

OUTPUT

y Outputis the outcome ofthe system; when the system is a person, output refersto the persons behaviors

y In Roys system, outputis categorized as adaptive response (those that promotea persons integrity ) orineffective responses (those that do not promote goalachievement; for example, nottaking antihypertensive medication)

y Adaptive responses are used when person demonstrates behaviors thatachievethe goals of survival, growth, reproduction, and mystery

y These responses, or output, provide feedbackforthe system.COPINGMEC ANISM

y Are the processes or behavior patterns that a person uses for self-controly Can be inherited orlearnedy Are oftwo types:the regulatorand the cognator;these two mechanisms are

subsystems ofthe persons adaptive system

y Must acttogetherto maintain the integrity ofthe person as an adaptive systemREGULATOR

y The regulator subsystem consists ofinput, internal processes, and output.y input stimuli can come from the external environment or from within the

person

y internal processes including chemical, neural, and endocrine transmitthestimuli, causing output, a physiologic response

y the regulator subsystem controls internal processes related to physiologicneeds (such as changes in heart rate during exercise)

COGNATOR

y the Cognator subsystem consists ofinput, internal processes, and output y it regulates self-concept, role function, and interdependencey the cognator subsystem controls internal processes related to higher brain

functions, such as perception, information processing, learning from pastexperience, judgment, and emotion


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PREPARED BY MR. ARUN JOSE

y For example, a client with diabetes who decides to increase insulin intakebased on symptoms of high blood glucose.

y Adaptive modesy are part of the internal processes and act as system effectorsy Are categories of behavior to adapt to stimuliy Include physiologic function, self-concept, role function, and interdependence;

the regulator and the cognator act within these modes

y Can be used to determine a persons adaptation level; this level, which isexhibited by a persons behavior, reflects the use of adaptive modes and copingmechanisms.

y Can be used to identify adaptive or ineffective responses by observing apersons behavior in relation to the adaptive modes

1.Physiologic- Physical Mode

.Physiologic function

Involves the bodys basic needs and ways of adapt

.Includes a persons 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


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2.SelfConcept -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)

ROLE FUNCTION

y Involves behavior based on a persons position in societyy Is dependent on how a person interacts with others in a given situationy Can be classified as primary (age, sex), secondary (husband, wife), ortertiary

(temporary role of a coach)4.Interdependance Mode

.Involves a persons relationship with significant others and support systems

.Strikes a balance between dependent behaviors (seeking help, attention, andaffection) and independent behaviors (taking initiative and obtaining satisfaction fromwork)

.Meets a persons needs forlove, nurturing, and affection

Mateparadigm

Person

y Is the recipient of nursing care;Roy implies that a client has an active role inthe care

y Is a BIOPSYC OSOCIAL BEING who constantly interacts with a changingenvironment

y Is an adaptive system who uses innate and acquired coping mechanisms todeal with STRESSORS

y Can be an individual, family, group, community, or societyEnvironment

y is defined by Roy as all conditions, circumstances, and influences surroundingand affecting the development and behavior of person and groups


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y Consists ofinternal and external environments, which provide inputin the formof stimuli

y Is always changing and constantly interacting with the person

Health

y 1. Was originally described by Roy as health-illness continuum, with one endofthe continuum being death and the other end wellness; health and illnessconsidered an inevitable dimension ofthe persons life

y 2. is currently defined by Roy as a process of being and becoming anintegrated and whole person;

y 3. health is viewed as the goal ofthe persons behavior and the persons abilityto be an adaptive organism

Nursing

is required when a person expends more energy on coping, leaving less energyavailable for achieving the goals of survival, growth, reproduction, and mastery

2. uses the four adaptive modes to increase a persons adaptation level during healthand illness

3. employs activities that promote adaptive, notineffective, responses in situations ofhealth and illness

4. is a practice centered discipline geared toward persons and their responses tostimuli and adaptation to the environment

5. includes assessment, diagnosis, goal setting, intervention, and evaluation.

THE NURSING PROCESS

RAM offers guidelines to nurse in developing the nursing process.

The elements :

y Firstlevel assessmenty Second level assessmenty Diagnosisy Goal settingy Intervention


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y evaluationFIRST LEVEL ASSESSMENT(PHYSIOLOGIC-PHYSICAL MODE)

Oxygenation:

y Stable process of ventilation and stable process of gas exchange.y RR= 18Bpm.y Chest normal in shape. Chest expansion normal on either side.y Apex beat felt on left 5th inter-costal space mid-clavicular line. Air entry equal

bilaterally.

y No ronchi or crepitusy S1& S2heard. No abnormal heart sounds.y Delayed capillary refill+.y Apex beat felt- normal rhythm, depth and rate.y Dorsalis pedis pulsation of affected limp is not palpable.y All other pulsations are normal in rate, depth, tension with regular rhythm.

Cardiac dull ness heard over 3rd

ICSnear to sternum to left 5htICSmidclavicular line.

y BP-Normotensive. . Peripheral pulses felt-Normal rate and rhythm, noclubbing or cyanosis.NUTRITION

y He is on diabetic diet (1500kcal). Non vegetarian. Recently his Weight reducedmarkedly (10 kg/ 6 month).

y He has stable digestive process.y He has complaints of anorexia and not taking adequate fo od.y No abdominal distension.y Soft on palpation.y No tenderness.y No visible peristaltic movements.y Bowel sounds heard.


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y Percussion revealed dullness over hepatic area.y Oral mucosa is normal.y No difficulty to swallow food

Elimination:

y No signs of infections, no pain during micturation or defecation.y Normal bladder pattern.y Using urinal for micturation.y Stool is hard and he complaints of constipation.

ACTIVITYAND REST:

y Taking adequate rest.y Sleep pattern disturbed at night due unfamiliar surrounding.y Not following any peculiar relaxation measure. Like movies and reading.y No regular pattern of exercise.y Walking from home to office during morning and evening.y Now, activity reduced due to amputated wound.y Mobility impaired.y Walking with crutches.y Pain from joints present.y No paralysis.y ROM is limited in the left leg due to wound.y No contractures present.y No swelling over the joints.y Patient need assistance for doing the activities.

PROTECTION

y Left lower fore foot is amputated.y Black discoloration present over the area. No redness, discharge or other signs

of infection.


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y Nomothermic.y Wound healing better now.y Walking with the use of left leg is not possible.y Using crutches.y Pain form knee and hip joint present while walking.y Dorsalis pedis pulsation, not present over the left leg.y Right leg is normal in length and size.y Several papules present over the foot.y All peripheral pulses are present with normal rate, rhythm and depth over right

leg.

SENSES:

y No pain sensation from the wound site.y Relatively, reduced touch and pain sensation in the lower periphery; because of

neuropathy.

y Using spectacle for reading.y Gustatory, olfaction, and auditory senses are normal.

FLUIDSAND ELECTROLYTES

y Drinks approximately 2000ml of water.y Stable intake out put ratio.y Serum electrolyte values are with in normallimit.y No signs of acidosis or alkalosis.y Blood glucose elevated.

NEUROLOGICAL FUNCTION

y He is conscious and oriented.y He is anxious aboutthe disease condition.y Like to go home as early as possible.y Showing signs of stress.y Touch and pain sensation decreased in lower extremity.


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y Thinking and memory is intact.ENDOCRINE FUNCTION

y He is on insulin.y No signs and symptoms of endocrine disorders, except elevated blood sugar

value.

y No enlarged glands.SELFCONCEPTMODE-Physical self

y He is anxious about changes in body image, but accepting treatment and copingwith the situation.

yBelongs to a

Nuclear family. 5 members.

Stays along with wife and threechildren.

y Good relationship with the neighbours.y Good interaction with the friends.y Moderately active in local social activities

PERSONAL SELF

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

ROLE PERFORMANCE MODE

y He was the earning memberin the family.y His role shiftis not compensated.y His son doesnt have any work.y His role clarity is not achieved.

INTERDEPENDENCE MODE

y He has good relationship with the neighbours.y Good interaction with the friends relatives.y But he believes, no one is capable of helping him atthis moment.y He says all are under financial constrains.y He was moderately active in local social activities


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SECOND LEVEL ASSESSMENTFOCAL STIMULUS:

y Non-healing wound after amputation of great and second toe ofleftleg- 4week.

y A wound first found on the junction between first and second toe-4 monthback. The wound was non-healing and gradually increased in size with puscollected overthe area.

y He first showed in a local (---) hospital. From there, they referred to ----medical college; where he was admitted for1 month and 4 days. Duringhospital stay great and second toe amputated. But surgical wound turned to

non- healing with pus and black colour. So the physician suggested for belowknee amputation. That made them to come to ---Hospital, ---. He underwent aplastic surgery 3 week before.

CONTEXTUAL STIMULI

y Known case DM for past10 years.y Was on oral hypoglycemic agent forinitial2 years, but switched to insulin and

using it for 8 years now.

y Not wearing foot wearin house and premises.RESIDUAL STIMULI

y He had TB attack10 year back, and took complete course oftreatment.y Previously, he admitted in ---Hospital forleg pain about 4 year back.y Mothers brother had DM. Mother had history of PTB.y He is a graduate in humanities, no special knowledge on health matters.

CONCLUSION

y Mr.NRwho was suffering with diabetes mellitus for past10 years.y Diabetic foot ulcer and recent amputation made his life more stressful.y Nursing care ofthis patient based on Roy's adaptation model provided had a

dramatic change in his condition.

y Wound started healing and he planned to discharge on 25th april.y He studied how to use crutches and mobilized atleasttwice in a day.


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y Patients anxiety reduced to a great extends by proper explanation andreassurance.

y He gained good knowledge on various aspect of diabetic foot ulcer forthefuture self care activities.

roys adaptation

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