The Roy Adaptation Model - Term Paper Example

?Running Head: NURSING THEORY AND PRACTICE Nursing Theory and Practice BY YOU YOUR SCHOOL INFO HERE HERE Nursing Theory and Practice The Roy Adaptation Model The Roy Adaptation Model is one of the most viable nursing theories used in nursing practice. This model was developed by Sister Callista Roy in 1970, a practicing nurse holding an undergraduate degree in nursing from Mount St. Mary’s College and a doctorate from UCLA (Boston College, 2012). Roy was compelled to develop a new model of nursing practice and evaluation that recognized multiple variables of the human condition and tangible nursing activity in a way that had not been accomplished with previous nursing theories and models. With actual nursing practice, Callista Roy recognized that in order to provide effective care, there must be several specific factors taken into consideration. These include psychological constructs of human behavior, socialization, physiological care, and inherent evaluations related to nurse self-concept, role function and interdependence on systems and teams. Roy began to see not only better patient outcomes by adopting this rather holistic model and its principles, but more dedicated and devoted nurses with strong self-awareness and emotional intelligence to perform adequate nursing care practice. The Roy Adaptation Model (RAM) consists of a series of inputs referred to as stimuli, control processes that include coping mechanisms, effectors which relates to nursing and patient self-concept, and the establishment of a feedback system to achieve maximum positive outputs in nursing care and practice and to reduce ineffective responses learned through observation and direct experience with patients. Why RAM is so effective is that it is practical and realistic, taking into consideration the multi-dimensional characteristics of human needs and values that are critical components to how patients will respond to nurses and how nursing caregivers will respond to patients. What makes the Roy Adaptation Model so relevant is that it understands that nurses and patients are both adaptive and holistic in cognition and emotion, where health is more than physiological care, but also biopsychosocial taking into consideration more than just the patient (Shin, Park, & Kim, 2006). This is a transformational model of nursing care, in which nursing culture within the organization is considered both an input and an effector. Fairholm (2009) identifies that in order to build an effective culture within the health care organization, a nurse must be visionary, a teacher, and impart mission to others to reduce change resistance and also build inter-team loyalties. The Roy Adaptation Model recognizes the impact of de-motivated or highly motivated nursing agents within the organization as variables that can impact nurse self-concept and task importance impacting psychological and sociological condition of the caregiver. RAM provides an acknowledgement that nurses and patients are complicated and dynamic individuals that must be addressed according to their self-concept and ability to cope effectively with their health care provision while also developing positive inter-dependencies with other health care staff. This model does not negate the notion of servant leadership in which a nurse is able to provide effective service and care to others while also developing better emotional intelligence and self-betterment through cognition and self-evaluation (Farazmand, Green, & Miller, 2010). The feedback system is an evaluatory tool that assesses whether strategies in nursing practice have met with expected outcomes and also to assist in developing new strategies that were ineffective. This model therefore provides qualitative and quantitative analyses opportunities that explore tangible care actions and relationship-minded concerns that are best measured through interviews or direct observation rather than through statistical evaluation. This model, because of its ability to recognize subjective and deductive scenarios in nursing care, is more viable than many other theories and models of nursing as it does not limit the practicing nurse to only a single domain of understanding. It allows for intrinsic evaluation and extrinsic analyses occurring during patient interventions that are critical for establishing an effective model of nursing care. Rather than simply focusing on evaluation of patient needs, this model is realistic and valuable as it does not negate the importance of establishing a quality environment that is feasible to develop a more self-aware nurse practitioner and assist in building more competencies both practice-based and psychological. Kouzes and Posner (2012) iterate that in order to develop capable and effective teams, the individual must be considered credible and inspire a shared vision or mission. The Roy Adaptation Model puts significant emphasis on effectors of practice, such as the aforementioned establishment of positive inter-dependencies in team function, to build a more cooperative and adaptive team environment in health care. It should be said, based on the foundational knowledge of the importance and opportunities of this model, that Sister Callista Roy was a pragmatist, a down-to-earth realist who felt that other models of nursing practice simply did not maintain enough scope to genuinely impact patient care outcomes positively. Roy observed that existing models of nursing care tended to focus on singular concepts which limited the ability to assess and change the biopsychosocial characteristics so critical to nurse/patient interventions and strategies. The nurse is essentially, in this model, seen as a critical component to achieve effective patient outcomes rather than simply a variable within a patient-focused model. Total, holistic nurse health is considered essential for the establishment of successful and valuable patient relationships and practice. Practical Application of the Model Where this model is most viable and successful is when working with elderly patients who are oftentimes complicated interventions due to their stubborn, traditionalist and grounded values and principles, and often combative with nurses and family members attempting to promote self-healing and motivation. Older patients often are resistant to changes in their caregiving program, refusing to oblige with the identified steps required for self-motivation to achieve better health outcomes during their stay in the health care organization. Such complications can create de-motivated nurses, increase stress within the care environment, and erode relationships with the patient and family if the nurse does not use appropriate strategies and communications styles. Thus, to understand how the Roy Adaptation Model can be best utilized, one should consider a sedentary geriatric patient maintaining a heart condition that has put their health at significant risk. Further complicate the scenario by adding strong religious beliefs, such as those of the Seventh Day Adventist, where misplaced or challenged values and principles of divine healing are incorporated into the patient behavior profile. Rogers and Keller (2009) found the Roy Adaptation Model effective when working with sedentary geriatric patients, during care interventions where patients were resistant to therapeutic exercise and where patient followership to nursing direction was ineffectual. As an effector of quality patient care outcomes, Rogers & Keller found that building a sense of self-efficacy within the elderly patient sample built better motivation to achieve therapy goals and also build better social relationships with the nurse practitioner. Self-efficacy is established by recognizing the psycho-social characteristics that impact patient coping strategies and attempting to build trust between nurse and patient by increasing patient self-esteem and improve their perceptions about self-motivated competencies. Grieves (2010, p. 8) believes that change is a “negotiated order”, consisting of a variety of bargaining and collaborative strategies in order to build trust in the caregiver. In a situation where an elderly patient is refusing to follow the steps required to achieve better health outcomes and resists various medicinal treatments due to long-standing religious faith, the nurse must use multiple strategies that are in-line with spiritualism, conservativism, and emotional affection even if they conflict with their own personal values and religious conceptualizations. Thus, the Roy Adaptation Model becomes a trial and error model of practice whereby the nurse is constantly aware of patient psycho-social needs and principles and then uses adaptive strategies (effectors) to achieve a positive care outcome. The feedback systems in place, either quantitative or qualitative by design, will determine which strategies have met with negative patient outcomes and attitudes and then adjusting future strategies until an effectual care strategy is identified that can be used in like patient care situations. Patients with heart conditions that do not have an emotional support network from family or caregivers are at much higher risk of developing future cardiovascular events (Zambroski, Moser, & Bhat, 2005). Because of this, many patients with heart conditions must be taught self-care strategies (both physiological and psychological) to reduce these risks and improve their status through exercise or other appropriate treatment developed by physicians and carried out by nurse practitioners (Zambroski et al., 2005). The Roy Adaptation Model has been a successful system in situations where patients with cardiovascular problems do not have an adequate emotional support system, thus diminishing their coping capabilities and the establishment of trusting interdependence on nurses and the holistic health care environment (Bakan & Akyol, 2008). The nurse using RAM scans the care environment for the variety of stimuli (inputs) that are leading to resistant or de-motivated behaviors, which in the case of those with no support network might include family interference, traditionalism, emotional complications about the health care regimen prescribed, or even dislike of various nurses or other health care staff in the organization. Once these have been identified, the nurse then begins to regulate or control these input variables with biopsychosocial strategies that could include establishing social belonging under generic models of needs such as Maslow’s Hierarchy or common self-esteem development theories recognized under psychological models of emotional care. Essentially, under the Roy Adaptation Model, the nurse must become a multi-educated and multi-faceted environmental and social assessor to provide positive patient outputs while also not dismissing their own development and emotional needs during these interventions with difficult sedentary patients or resistant elderly patients maintaining cardiovascular problems. The nurse must recognize that his or her own control processes and effectors (such as self-concept) will play into these interactions with difficult patients and curb negative or frustrated thinking intrinsically. Starnes (2010) identifies that legitimate and valuable relationships are only built over time, starting with a series of small reciprocal acts that ultimately build trust and followership. This is why the Roy Adaptation Model is viable as it is not interested in short-run methodologies for improving patient relationships or fulfilling patient needs, it is a cyclical model with recurring feedback through trial-and-error with the ultimate goal of establishing legitimate followership as well as better patient care outcomes. This is why this model would be most relevant in health care environments where the patient is hospitalized for a significant period of time and thus forced to regularly interact with nursing staff or where ongoing, programmed interventions occur with multiple interactions occurring between patient and nurse during treatment. Implications for Nursing Practice Not all patient care scenarios are going to involve elderly, sedentary or patients with cardiovascular dysfunction, which is rather commonly understood in health care that diversity of patients create difficulty in establishing a streamlined model for use in every patient care situation. This is why the Roy Adaptation Model is so viable as it prepares the nurse for tackling patient diversity issues both social and psychological, making them aware of their surroundings, the clinical environment, and the patient as well as inputs stemming potentially from family members in their support networks. RAM allows the nurse to be a distinct and capable assessor, drawing on their previous education and experience in multiple domains of knowledge to provide patients with rewarding care and better relationship development. As a critical component in care, the nurse tackles their own deficiencies or embraces their own strengths (effectors) to improve task significance and also self-concept related to nursing care competencies. In no way is the nurse in a high volume care environment going to be able to operate, proverbially, within a vacuum without support from patient, coworkers and family members that are part of the care interactions. This is why the servant leadership and transformational leadership principles established by trusted models of leadership are included as variables in the Roy Adaptation Model as it relates to establishing effective nurse and patient coping and attempting to build strong inter-dependencies in the care cycle. What this model does is allow the nurse to ask his or herself what factors about their own emotions or attitudes and principles are impacting negative responses from patients or otherwise facilitating ineffective patient care outcomes. It would be highly impractical for the nurse to dismiss their own inherent attitudes that are absolutely going to manifest themselves during the patient interventions whether elongated or recurrent over time. Other existing models of patient-centered care do not allow for such self-examination, thus RAM provides a template by which to improve self-efficacy for the caregiver while always being mindful of what variables are acting as ineffective inputs. Thus, what the Roy Adaptation Model provides for personal nursing care is focus on better followership both internally and with the patient, establishing teamworking systems and better cooperative relationships that will provide a catalyst for better patient care outcomes. Team development as an input is highly relevant, measured through either interviews, observation or statistical analyses, identifying strengths and weaknesses in team members involved in patient interventions to enhance them or remove them from the care cycle when feedback systems identify complications from these inputs. As another example, in a care situation where conflict and challenge is routinely present, the Roy Adaptation Model provides a model for insight into the biopsychosocial attributes both inherently and involved with key actors in the patient care intervention to allow the professional to adopt the most viable strategy to gain cooperation and followership. The nurse essentially becomes a researcher that is ever-aware of the distinct psychological and sociological needs and principles of the self and the patient and family members. This model provides for personal understanding of the many unpredictable and assorted care scenarios that can occur as they relate to ethnic principles, elderly traditionalism, spiritual values, or generic defense mechanisms used by patients to avoid cooperative compliance to health care programs. Instead of always maintaining patient-centered focus, the nurse does not simply have to remove their own dissatisfaction or poor coping with these challenges from strategy development. It should be said, then, that the Roy Adaptation Model provides for a more well-rounded nurse that understands all of the dimensions of human behavior and tangible care practices that are going to impact patient behavior. Instead of limiting the nurse to narrow focus to achieve desired care outcomes, the nurse is one-third psychologist, one-third sociologist, and one-third transformational leader that understands vision and mission iteration as a key success variable in providing quality care. Using this model repetitively will show the nurse which strategies have the most statistical success rates in like patient scenarios and adopt what model of patient-focused care is most beneficial after identifying and improving self-efficacy and self-concept as caregiver. The model develops a nurse that is able to adjust the environment to better fit patient needs, establish a team-functioning methodology of care and practice, and one who is able to apply multiple strategies and critique them based on actual outcomes with patients. References Bakan, G., & Akyol, A. D. (2008). Theory-guided Interventions for Adaptation to Heart Failure. Journal of Advanced Nursing, 61(6), 596-608. Boston College. (2012). Sr. Callisa Roy PhD, RN, FAAN Professor and Nurse Theorist. Retrieved from http://www.bc.edu/schools/son/faculty/featured/theorist.html Fairholm, M. (2009). Leadership and Organizational Strategy. The Public Sector Innovation Journal, 14(1), 26-27. Farazmand, F.A., Green, R. D., & Miller, P. (2010). Creating Lifelong Learning Through Service Learning. Business Education & Accreditation, 2(1), 1-14. Grieves, J. (2010). Organizational Change: Themes and Issues. Oxford: Oxford University Press. Kouzes, J.M., & Posner, B. Z. (2012). The Leadership Challenge (5th ed.). San Francisco, CA: Jossey Bass. Rogers, C., & Keller, C. (2009). Roy’s Adaptation Model to Promote Physical Activity Among Sedentary Older Adults. Geriatric Nursing, 30(2), 21-26. Shin, H., Park, Y. J. & Kim, M. J. (2006). Predictors of Maternal Sensitivity during the Early Post-Partum Period. Journal of Advanced Nursing, 55(4), 425-434. Starnes, B. J., Truhon, S., & McCarthy, V. (2010). A Primer on Organizational Trust, ASQ Human Development and Leadership. Retrieved from http://rube.asq.org/hdl/2010/06/a-primer-on-organizational-trust.pdf Zambroski, C., Moser, D., & Bhat, G. (2005). Impact of Symptom Prevalence and Symptom Burden on Quality of Life in Patients with Heart Failure. European Journal of Cardiovascular Nursing, 4(3), 9-17. Appendix A: The Roy Adaptation Model Source: http://comunityapatis.blogspot.com/2011/01/application-of-roys-adaptation-model-in.html Read More