Nurses usually apply some significant concepts during their practice to help patients respond to treatment positively. Nevertheless, various factors come into play to facilitate success of a concept in nursing practice. This paper focuses on the use of the concept of adaptation in nursing practice. The concept of adaptation is especially important because it helps nurses identify the current situation a patient may be in, and be able to account for patient’s response about a specific situation. Consequently, nurses can help them understand the necessary intervention that would alleviate the problem, and how they should respond to intervention.
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Roy’s study led the author to identify the areas of human functioning in which human behaviors can be linked (Patton, 2004). She coined these four functional areas as the four adaptive modes in her theory of adaptation. These modes are physiological, self-concept or group identity, interdependence and role function mode. All the modes focus on psychosocial needs of the patient except the physiological mode that focuses on the patient’s physical needs. It is within these modes that the nurse strives to assist the patient in recovering or maintaining adaptation. However, when assessing a patient having an acute form of psychosis, classifying the patient’s behavior into one of the modes may not always be possible. The practice of assigning behavior of patients to specific categories based on functions may evoke criticism.
The extent to which patients with an acute psychosis adapt to illness may vary considerably leading to equal variation in intervention. As such, Roy’s model of adaptation may provide insight into the most appropriate intervention in the illness. Nevertheless, this situation highlights the extent of the adaptability of the model that may manifest usefulness in the care delivery for patients with an acute mental disorder (Patton, 2004).
The fact that Roy deduced her model from the work of Harry Helson, indicates how nursing theorists borrow inspirations from theorists outside the profession of nursing meaning that Helson’s theory of adaption is the parent theory of Roy’s nursing theory.
Important Terms in the Concept
Focal stimuli denote those in the immediate reach of an individual. Contextual stimuli encompass all the stimuli involved in a situation. Residual stimuli are those factors that influence behavior, however, providers cannot validate their effects concerning these stimuli.
Physiologic mode involves the need of the system for physiologic stability (Roy & Andrew, 1999). The needs with respect to physiologic stability are protection, activity, rest, elimination, nutrition and oxygenation.
Roy’s model of adaptation depicts a person as a composite entity being in relevance to each of the adaptive modes and their subparts. The model embeds five scientific hypotheses and five philosophical hypotheses. The theorist states the philosophical assumptions in an abstract manner; applying the model in practice may seem complicated, and difficult to comprehend (Dixon, 1999). A clear understanding of the contents of the model and the way clinicians can apply to nursing practice in psychiatry can only be achieved through extensive study of the model. Nevertheless, according to Patton (2004), the complexity of the model may increase the resistivity of psychiatry nurses towards the model. Lack of knowledge in regards to the model may not only make nurses take a passive stance in its application, but also confuse patients making them less compliant to it.
In particular, difficulty in comprehending the concept of adaptation model may make patient reluctant to participate in formulating their plan of care and succeeding nursing intervention. In turn, this situation may affect the role of the patient negatively (Cahill, 1998 cited in Patton, 2004). Nurses in this situation may need to assist patients with mental health disease in orientating to the complexities of the model. Nonetheless, scholars have raised concerns whether it is right for nurses to attempt to orientate patients to the intricacies of the model when in state of acute mental illness. This act may worsen the mental state of the patients.
Roy’s model of adaptation applies to all the health concerns (Cunningham, 2002). This article reports on the study of the application of the model in guiding the evaluation, diagnosis, scheming, implementation and assessment of group care. The author pinpoints that the model is applicable in various health settings. It served as a structure for assessing and planning care for group of women patients for its holistic perspectives on people and adaptation process in the study. Cunningham (2002) explains that Roy’s model classifies the process of coping into two subsystems, namely, the regulator and the cognator.
According to Cunningham (2002), Roy’s model comprises stimuli forming the environment that influences adaptation, including focal, contextual and residual. Exposure to stimuli activates a person’s coping process via the cognator and regulator subsystems making him or her appear in one or more of the four adaptive modes in the model. The author goes a step further to describe the three psychosocial modes, in particular, interdependence mode, self-concept mode, and role function mode.
Farkas (1981) researched on the barriers to adaptation on elderly people and their families or friends in the context of a nursing home. The article postulates the four adaptive models as interdependence, role function, self-concept and physiological consistent with the study by the mentioned two authors. This study designated specific adaptation problems to specific adaptive modes. The results of the study connect the problems concerning adaptation with specific adaptive modes.
Samarel, et al. (1998) introduced a different dimension of the adaptation model. They assert that Roy and Andrew (1991) posited that intervention affected adaptation by increasing, reducing, maintaining, eradicating, or otherwise changing focal or contextual stimuli. Barone and Roy (1996, cited in Samarel, et al., 1998), on the other hand, posit that the mentioned stimuli are combined to shape the adaptation level of a person.
Criteria for Using the Concept
The criteria for adaptation model are not clear cut, although a nurse is regarded as being able to identify an important factor for helping the patient adapt to his or her current life experiences. In this light, the criteria for adaptation model involve determining the nature of the stimulus influencing the adaptation of the patient to their new state. The identification of the stimuli will help nurse place an individual into one or more of the four adaptive modes related to Roy’s model (Tolson & McIntosh, 1996).
A nurse must show an understanding of the model to assure the individual of the intervention he or she plans to give a patient. Importantly, the nurse must assess if the client understands the model to determine their corporation to a subsequent intervention.
Antecedents and Consequences
To establish a problem of adaptation to a specific medical state must be proceeded by identification of a specific disability state or impairment (Farkas, 1981). The existence of disability or impairment implied risk for the person to encounter greater adaptation difficulties. The study revealed that adaptation challenges associated with the physiological mode seem to drive the use of the nursing concept. Nevertheless, adaptation challenges in the rest of the three models emerge from and relate to conditions and challenges in the physiological mode.
Application of a nursing concept is important to help patients view nursing intervention positively in order to adhere to planned intervention. Nevertheless, if the nursing concept of adaptation is missing in a current health situation, various adverse effects may be manifested. The nurse may deliver a wrong intervention to a health state, achieve dismal results, as well as subsequent increase in cost of care. Both the nurse and the patient must collaborate for the model to have some effect. The nurse must explain to the patient the entire concept to motivate him or her to collaborate in the application of the model to their respective situation.
Approach of the Concept in Literature
Research articles address the nursing concept of adaptation in literature by highlighting the current health care context to establish the need for the use of the concept of adaptation. The authors explain the structure of the model to make the reader understand its relevance in any health situation.
Measurement of the Concept
Various researches used different tools to measure the adaptation model in specific health context. Fawcett and Tulman applied the Inventory of Functional Status After Birth (IFSAC) to assess the readiness of the new mother to take up infant-care roles as well as resume routine self-care, family, community and social, and occupational practice (1990, p. 722). In this scenario, virginal or ceasarian child birth signified the focal stimuli, while health variables and maternal demographics represented contextual stimuli. Importantly, the authors highlighted the relationship between the components of the model, the variables of the study, and IFSAC.
Another study by Samarel, et al., (1998) applied a different tool altogether. The authors used a structured interview plan to investigate the appplication of the model in breast cancer support groups. The instrument aimed to measure the capacity of women to adopt to psychosocial and physiological conditions secondary to the breast cancer.
Cunningham, D. A. (2002). Application of Roy’s Adaptation Model When Carinng for a Group of Women Coping With Menopause. Journal of Community Health Nursing , 19 (1), 49-60.
Dixon, E. L. (1999). Community Health Nursing Practice and the Roy Adaptation Model. Public Health Nursing , 16 (4), 290-300.
Farkas, L. (1981). Adaptation Problems with Nursing Home Application for Elderly Persons: An Application of the Roy Adaptation Nursing Model. Journal of advanced Nursing , 6, 363-368.
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Fawcett, J., & Tulman, L. (1990). Building a Programme of Research from Adaptation Model of Nursing. Journal of Advanced Nursing , 15, 720-725.
Patton, D. (2004). An Analysis of Roy’s Adaptation Model of Nursing as Used Within Acute Psychiatric Nursing. Journal of Psychiatry and Mental Health Nursing , 221-228.
Roy, C., & Andrews, H. (1999). The Roy Adaptation Model (2nd Ed.) Stamford; Appleton & Lange.
Samarel, N., Fawcett, J., Piacentino, J. C., Krippendorf, K., Eliasof, B., Hughes, P., et al. (1998). Women’s perception of group support and adaptation to breast cancer. Journal of Advanced Nursing , 28 (6), 1259-1268.
Tolson, D., & McIntosh, J. (1996). The Roy Adaptation Model: A Consideration of Its Properties as Conceptual Framework for an Intervention Study. Journal of Advanced Nursing , 24, 961-987.