Example Of Research Paper On Sister Callista Roy: Adaptation Model

Abstract

Sister Callista Roy’s adaptation model suggests that individuals and groups are systems interacting with and are integrated into their social and physical environment. Internal and external changes or occurrences referred to as inputs can pose threats to the system’s integrity or its ability to meet holistic needs. The effectiveness of responses or coping mechanisms known as outputs that may be physiologic or cognitive in nature determine the level of adaptation which can be integrated, compensatory, or compromised. The role of the nurse is to modify the inputs or outputs within the context of the nursing process to assist in system adaptation. The model is demonstrated in a case study of a child with acute asthma as an individual system and her family and community as group systems.
There are several key assumptions in Roy’s adaptation model. The first is that humans are adaptive systems continuously interacting with their social and physical environments (Roy & Andrews, 2008). The system consists of inputs, coping mechanisms, outputs, and feedback. Input consists of stimuli which can be focal, residual, or contextual. A focal stimulus is a situation that requires the greatest level of awareness and is influenced in a positive or negative way by contextual stimuli both internal and external. Such stimuli may relate to culture, developmental stages, and environmental factors.
Residual stimuli are also internal and external, but whether it exerts a positive or negative influence in not immediately known. The system’s level of adaptation is also an input and is categorized as integrated, compensatory, or compromised (Roy & Andrews, 2008). Integrated adaptation consists of processes that, in their entirety, meet system needs. If needs are not being fully met, compensatory processes are activated in attempts to restore adaptation back to an integrated level. However, adaptation can deteriorate to a compromised level when compensatory responses fail.
The human system can be an individual or consisting of social organizations including the family and community. Output pertains to individual or group behaviors in response to input that can be adaptive or ineffective (Roy & Andrews, 2008). The former pertains to responses that restore or enhance the human system’s integrity so that survival, growth and development, and reproductive goals are achieved. Human system integrity also pertains to meeting goals for mastering and transforming or improving the self, social interactions and relationships and the physical environment (Roy & Andrews, 2008).
On the contrary, ineffective or maladaptive responses at the individual or group level counter the achievement of goals for health and wellbeing. Such responses at the group level can even threaten the integrity of the individual system. Responses are also referred to as coping mechanisms which may be of the regulator or cognator type (Roy, 2011). Regulator mechanisms are physiologic responses such as when the immune system is activated during a bacterial infection, which is an external input, or when the sympathetic immune system is activated in response to cardiogenic shock, which is an internal input. These processes may operate within a positive or negative feedback system.
Cognator responses, meanwhile, relate to individual cognitive functions such as perception, learning, decision making, problem solving, and emotions (Roy & Andrews, 2008). Perception entails the processing of information that begins with attention to the stimuli, coding, and storage into short- and long-term memory. Learning pertains to the ability to accumulate knowledge, imitate skills, and generate insights. Decision making and problem solving are cognitive activities involving judgment while emotions relate to attachment, the feelings associated with input, and defenses that help attain relief from negative feelings (Roy & Andrews, 2008).
Regulator and cognator responses give rise to different adaptive modes, namely physiological-physical, role function, interdependence, and self-concept-group identity (Roy, 2011). When these modes are intact and functional, they result in behaviors that contribute to adaptation. The physiological-physical mode relates to meeting the oxygenation, elimination, nutrition, protection, and activity and rest needs as well as fulfilling fluid and electrolyte, neurologic, and endocrine needs. The self-concept-group identity mode pertains to self-image, social relationships, and culture. Role function is about fulfilling the expectations associated with a person or group’s position, while the interdependence mode pertains to interdependence among members of the group.
The second assumption pertains to the internal and external environment as consisting of circumstances, conditions, and influences framing and shaping the adaptive human system (Roy & Andrews, 2008). Previous assumptions on humans as a system and the environment shape the third assumption pertaining to health. It is defined by Roy and Andrews (2008) as “a state and a process of being and becoming an integrated and whole human being” (p. 54). It is attaining human system integrity through successfully meeting survival, growth and development, reproduction, mastery, and transformative goals.
Hence, the concept of health goes beyond the physical aspect or the absence of illness because individual and group responses to disease and personal, social or environmental changes are equally important in determining the degree that goals are met. Effective responses that promote system integrity can bring about successful adaptation even in times of acute and chronic illness or terminal illness and death. Based on the above assumptions, the objectives of nursing are clear. It is to promote adaptive responses in meeting needs and deficiencies, solving problems, and committing to goals as well as gaining resources, capabilities, knowledge, and skills (Roy & Andrews, 2008). Concurrently, nursing also aims to minimize actual or potential maladaptive responses.
The nursing process entails an assessment of behaviors or outputs in relation to the four adaptive modes through observation, interview, or measurement. Following an analysis of behavioral patterns, the nurse is able to identify adaptive and maladaptive regulator and cognator responses warranting nursing care administered with the participation of the human system involved (Roy & Andrews, 2008). As these responses are influenced by focal, contextual, and residual stimuli, the nurse works to obtain data on internal and external aspects posing challenges to the human system’s capacity to cope. The nurse consequently makes nursing diagnoses and engages the human system in the setting of goals. Nursing interventions aim to modify the magnitude or nature of the stimuli or strengthen the systems coping mechanisms to permit successful adaptation (Roy, 2011). An evaluation of the outcomes of care follows. The following case study demonstrates how the theory applies to the individual, family, and community.

Application to the Individual

An 8-year child presents at the clinic for wheezing and cough following an emergency department admission for the same symptoms two months ago. Measurements and an interview revealed the following data on the different adaptive modes. For physiological-physical mode, vital signs show the child’s respiratory rate is above normal, SpO2 is at 93%, peak flow is 50-80%, and HR is 117. She is using accessory muscles to breathe. Tight cough and expiratory wheezing were noted with a diagnosis of acute asthma exacerbation. There was a recent advisory on pollen, and the child also reports the symptoms began after exercises in PE class. The symptoms have affected the child’s sleep and appetite.
For self-concept-group identity mode, the child reported having difficulty keeping up with her classmates in physical education and had incurred so many absences that she also could not catch up academically requiring tutoring. She did not want to go to school anymore because of constant teasing. The diagnosis of ventilatory impairment is indicated by decreased peak flow, low SpO2, increased RR, and use of accessory muscles. A compensatory mechanism of the regulator type is an increase in HR but is ineffective in improving oxygenation. The focal stimulus is bronchoconstriction and contextual stimuli are a high pollen count coupled with intense physical activity and not taking prophylactic puffs of her inhaler medicine before PE class. She has also missed her bedtime anti-asthma medication. A residual stimulus is the need for tutoring.
She is in a compromised level of adaptation and will require interventions to address the internal and external stimuli. Treatment with oxygen, short-acting beta2 agonist, and inhaled corticosteroids promote bronchodilation and oxygenation (Cincinnati Children’s Hospital, 2010) that modify the focal stimulus. Keeping the patient in an upright position on the bed to ease breathing and monitoring vital signs and peak flow for treatment effectiveness and medication side effects are also warranted. The stimulus of non-adherence to medications is cognator response and is modifiable as compared to high pollen counts. Well-controlled asthma also permits children to participate satisfactorily in PE activities and medication compliance is a key. Related nursing interventions to promote adherence as an effective response will be implemented in the context of the family.

Application to the Family or Group

Considering that the patient is a child, the family plays a very important role in meeting her needs and enabling chronic disease self-management towards the achievement of adaptation. For the role-function mode, the mother who is 35 years old is the primary caregiver and has a part-time telecommuting job that enables her to care for the child at home as well as a younger one, aged 2. However, the demands of both work and child care had made it difficult for the mother to provide sufficient care to the older child. She admits forgetting to give the child’s daily maintenance medication, not giving nebulizations on time, and not taking peak flow measurements. She also could not bring the child in for scheduled follow-ups and does not remember the details of the child’s asthma care plan. These are ineffective responses.
For interdependence mode, the mother expressed her need for help in child care. She reports being very tired at the end of each day and difficulty sleeping. The husband is employed as quality control inspector at a bottling plant a 2-hour drive away and works six days a week. He often leaves the house early and comes home very late because of overtime work to make ends meet. He is the primary earner for the family. He is well besides hypertension which is well controlled. The mother’s parents live nearby, but she is hesitant to call on them because of a past disagreement and is an ineffective behavior as well. Nevertheless, they come to visit the children on Sundays after church. The mother’s two other siblings reside in other states.
The nursing diagnosis of ineffective adaptation relating to the family is indicated by capability deficits in providing child care. The adaptive level is compromised because physiologic and developmental needs of the child are not sufficiently met and the mother’s health is at risk. The focal stimulus is the child’s asthma which comes with medical costs for nebulizers and home peak flow meters which they buy out-of-pocket and non-medical costs such as private tutoring. It is the reason both parents cannot give up their jobs. The contextual stimuli include a limited social support system and having another child who also demands care. The child has also not been referred to the school nurse. The residual stimuli include the father’s demanding work schedule and current diagnosis of hypertension.
The goal of interventions would be to generate support towards meeting the need for adequate child care, better asthma control, and promotion of the caregiver’s health that enable family system integrity. Specific goals will be set in the presence of the parents and children that will alter the demand of the focal stimulus and bring about positive contextual stimuli. Family-focused asthma education is important in addressing capability deficits and generating effective behaviors (GINA, 2014). It will encompass the asthma care plan, the purpose of medications, the value of taking peak flow measurements, and the benefits of achieving optimum asthma control on the child’s respiratory functioning and quality of life as well as the demand on the family. It is also important to discuss with the mother about communicating with her parents to elicit their help on a more frequent basis. A referral will be made to the school nurse for asthma management in school that will facilitate coping.

Application to the Community or Population

Roy’s adaptation model also applies to chronic disease management at the community level (Roy, 2011). A high prevalence of asthma among young residents in the child’s community should be a focal stimulus that will prompt public health nurses to assess for contextual stimuli which may include a high level of particulate matter in the air because of urbanization or a high rate of smoking in the home. The absence of a collective action to improve air quality and reduce smoking is an ineffective response leading to a diagnosis of ineffective role functioning among concerned agencies contributing to a compromised adaptation level as risk factors remain. However, nurse-led coalitions can build awareness of the role of indoor and outdoor air quality in asthma exacerbations and initiates community actions for improving the environment leading to a decline in particulate matter levels. Doing so will reduce the prevalence of asthma in children and promotes cohesion and collective problem-solving among residents that aids in group system coping for current and future problems.

References

Cincinnati Children’s Hospital Medical Center (2010). Evidence-based care guideline for management of acute exacerbation of asthma in children aged 0 to 18 years. Retrieved from http://www.guideline.gov/content.aspx?id=24528
Global Initiative for Asthma (GINA) (2014). Pocket guide for asthma management and prevention (for adults and children older than 5 years). Retrieved from http://www.ginasthma.org/local/uploads/files/GINA_Pocket_2014_Jun11.pdf
Roy, C., & Andrews, A. A. (2008). The Roy adaptation model (3rd ed.). Upper Saddle River, NJ: Prentice Hall Health. ISBN-13: 978-0130384973.
Roy, C. (2011). Extending the Roy Adaptation Model to meet changing global needs. Nursing Science Quarterly, 24(4), 345-351. doi: 10.1177/0894318411419210.