Essay/Term paper: The roy adaptation model

Essay, term paper, research paper:  Science Research Papers

The Roy Adaptation Model


Roy began work on her theory in the 1960s. She drew from existing work
of a physiological psychologist, and behavioral, systems and role theorists. She
was keenly interested in the psycho/social aspects of the person from the start
and concentrated her education on this aspect of Person. Thus, the
language/thinking of psychology and sociology became second nature to her. The
need for intense study of the language and ideas behind Roy's Adaptation Model
is its biggest drawback in applying it to many clinical areas. The confusion in
the physiological mode's categories could be explained by her concentrating on
the psych social during her education.
In 1980, Roy and Reihl advocated a single unified model of nursing and
suggested this would insure stability of the discipline of nursing. They
maintained concepts and propositions of other models could be combined in
summary statements related to person, goals of nursing and the nursing process.
According to Fawcett, this position is a simplistic solution to a difficult
problem. Nursing, with its limited experience with metaparadigms and conceptual
models, is not ready for restrictions on its ways of thinking. It's my belief
that this act of advocating a single unified model was an act of multi-oppressed
thinking influenced by men, the Roman Catholic Church and the medical world.
During a 1987 conference of nursing theorists, Sister Roy made a number
of deferring remarks to a speech made earlier by a male Bishop.
Fawcett also says the Roy Adaptation Model has an extensive vocabulary
and that some familiar words (ie adaption) have been given new meanings in Roy's
attempt to translate mechanistic ideas into organismic ones.

Oppressed Group Behaviour:

-assimilating the values and characteristics of the Oppressors. -Nursing leaders
represent an elite group promoted because of their allegiance to maintaining the
status quo. -leaders of Oppressed Groups are controlling, coercive and rigid.

Oppressors:

-education is important to maintaining the status quo. -Roy's Model follows the
Medical Model and tends to be Totalitarian and therefore is familiar to Medicine
- they would want to encourage it. -behaviour preferred by Oppressors is
rewarded. -token appeasement (approval) is given to halt change or revolt.

The contributions of this conceptual model are that it will lead to more
systematic assessments of clients and an increased quality of nursing practice.
It could foster nursing knowledge through organized research and it could
provide a more organized curriculum.

Roy's definition of person

Roy defines the person as an Adaptive Open System. The Systems' Input
is: a) three classes of stimuli: focal, contextual and residual, within and
without the system and b) the systems' adaptation level or range of stimuli in
which responses will be adaptive. Inputs are mediated by the systems' Regulator
(psychological) and Cognator (Psych/social aspects of person) subsystems. The
system runs into difficulty when coping activity is inadequate as a result of
need deficits or excesses. System effectors (body organs that become active with
stimulation) are the four modes (physiological, self concept, role function and
interdependence) that the Cognator and Regulator can demonstrate activity
through. Output of the person as system may be adaptive or ineffective. Adaptive
responses contribute to the goals of the system ie: survival, growth promotion,
reproduction and self mastery. Ineffective responses do not contribute to the
systems' goals.
The person receives nursing care. Roy implies the client has an active
role in care and that he is a bio-psycho-social being who constantly interacts
with a changing environment.
The focus of nursing is the person. Roy in 1978, commented that although
the model may be applied to family, community in society it was developed
specifically for the person (medical model influence - Totalitarianism)
Perception links the Cognator and Regulator. Inputs to the Regulator are
transformed into perception. Perception is a process of the Cognator, responses
following perception are feedback into both the Regulator and Cognator.
Of the Cognator, there are three modes described by Roy. Self concept is
the need for psychic integrity and perception of worth.
Role function is the need for social integrity, and interaction with
others. Interdependence is the balance of dependence/ independence with others.
I like the concept of person as open systems and the concept of dividing
'stimuli' into focal, contextual and residual categories. There is definitely a
need for more emphasis and understanding of the person's: cognitive coping
mechanisms.
Again, Roy tends to imply that the person/adaptive system is reacting to
and trying to 'fit' into his surroundings - another manifestation of the Roman
Catholic fatalistic view of mankind.
Persons, family, communities are capable of affecting their environment
and letting it affect and expand their capabilities at the same time. It does
not have to be 'God's Will'. For example a person does not have to accept that
he and his will be struck down by bowel CA, or heart disease. A change in diet,
exercise, decreasing stress and not smoking will allow them to alter their
future. Because the medical model is so dependent and fixated on treating
pathologies, the public has gradually neglected or given up their ability to
protect themselves against disease.
Think of the health care system or the prevailing medical model as the
oppressor and the public as the oppressed. There is a clear understanding that
the content of education/information is just as crucial to an oppressed group as
access to it. Self esteem, or faith in their own ability to care for themselves
and make the right decisions; is low. The doctor or nurse always knows or is
right. For example, in the PACU, when we question some patients about their past
health and how they feel now, it's very common to hear 'I don't know, you
should ask my doctor.' When they are reassured that it is their opinion I want,
they will answer. If I express surprise that they have suffered so much, for so
long, they often say something to the effect of: "I figured if the doctor wanted
me to have more treatment/painkiller, he would have given it to me."
To paraphrase H. Jack Geiger, a civil rights worker: "Of all the
injuries inflicted on the oppressed people, the most corrosive wound within, the
internalized oppression that leads some victims, at an unspeakable cost to their
own sense of self, to embrace the values of their oppressors."

Roy - Health

Roy's original model says that health is on a health-illness continuum
from wellness to death. The degree of health or illness that the system
experiences is an inevitable dimension of a person's life. The Roman Catholic
Church, with it's fatalistic view of Human Life may have influenced Roy.
Currently, Roy defines Health as a process of becoming an integrated and
whole person and a process of being. Health is the goal of the person's
behaviour and the person's ability to be an adaptive organism.
Adaptation is a process of responding positively to environmental
changes. The person encounters adaptation problems in a changing environment
especially in situations of health and illness. Adaptive responses to pooled
effects of focal, contextual and residual stimuli are either positive ie:
promote integrity of the system re: goals of survival, growth, reproduction and
self mastery, or ineffective (do not contribute to goals). According to Chin and
Kramer, theoretical conceptualizations of health as a state of adaption implies
conforming or adjusting to environmental stimuli in order to "fit" within the
environment. This suggests that (fatalistic) events external to the person are
primary as a determinant of health and that person and environment are separate
entities. This follows the totality paradigm. Roy's categorization of systems
responses to a changing environment as adaptive or ineffective indicates health
is seen as a dichotomy (a process of dividing into two mutually exclusive or
contradictory groups). Unhealthy or healthy as seen by the medical model is
another example of totality or mechanistic paradigms. Fawcett says that no
explicit definition of health or illness is given by Roy so it must be inferred
that adaptive responses signify wellness and that inadaptive responses signify
illness.
My view of health is not based as firmly on the medical model or is as
fatalistic as Roy's. For example: Anesthesia prescribing Valium pre-op for a
normal response to impending surgery and the nurse administering it because it
is an accepted (and quick) way of dealing with pre-op jitters. In this case, the
doctor and the nurse have decided on a course of action for the patient in place
of providing pre-op answers to questions, different options and letting the
patient expand his ability to manage his state of health and himself.

Roy - Environment/Society

Environment/Society constantly interacts with the individual and
determines, in part, adaptation level. Stimuli originate in the environment. The
environment: refers to all the internal/external conditions, circumstances and
influences affecting the person, and his development and behaviour.
The internal and external environment provide input (or stimuli). The
environment is always changing and interacting with the person. The stimuli are
divided into focal; contextual and residual categories. Focal stimuli
immediately confronts the adaptive system ie: an M.I., a death in the family.
Contextual stimuli or "background stimuli" is genetic makeup, sex, maturity,
drugs, alcohol, tobacco, self concept, role function, interdependence,
socialization, coping mechanisms (Cognator and Regulator), physical and
emotional stress, culture, religion, environment. Residual stimuli are beliefs,
attitudes, experiences, traits which may be relevant but effects are
indeterminate and therefore cannot be validated.
Roy's general idea of the role Environment/Society play in the effects
on the person make it seem like the person is a fairly passive, adaptive system
- only reacting to stimuli from his environment, but not affecting it. My own
earlier comments on Environment/Society are basically the same. I's like to
emphasize that I've become more aware of the fact that Human
beings/families/community can also affect or alter their inner and outer
environment. That they don't have to accept the fatalistic view "that it's God's
Will.", or that Doctors/Nurses know best.
The best example is the use of the PCA pumps for pain control. When
instructed properly the patient has control over the amount of noxious, focal
stimuli in his inner environment. He does not have the stress of waiting to see
if the health care worker (Dr, Nurse, etc) is willing to alter his focal
stimuli/environment for him. I have found it best in the PACU to hand over the
control of the PCA pump as soon as possible as this ability to control this one
aspect of their environment has it's own positive analgesic effect on patients.
During a 1987 lecture at a nursing theorist conference, Roy made the
comment that although it might be the will of the client or the client's family
to turn off the ventilator, that "the affects on society as a whole had to be
considered, as the Bishop stated in his remarks this morning." To me, this
appears to emphasize the idea in Roy's work that the person, as a adaptive
system is only to be affected by external stimuli (in society, environment, R.C.
church) and is not affecting his environment/society equally, that he should
accept his fate.

Roy - Nursing

According to Roy, the Nurse using the Nursing Process, promotes
adaptation responses during health and illness to free energy from
ineffective/inadequate responses to increase health and wellness. Goals,
mutually agreed on and prioritized, are proposed to meet the global goals of:
Survival/Growth Promotion/Reproduction of race/society/attaining full potential
or mastery of self.
The nurse uses activities to increase adaptive and decrease ineffective
responses during illness and health. These activities alter or manipulate the
client's focal, contextual and residual stimuli and expand his repertoire of
effective coping mechanisms. Nursing focuses on the person (adaptive system) as
a biopsychosocial being at some point along the health-illness continuum. In
contrast, Medicine focuses on biological systems and the patient's disease. It's
goal is to move the patient along the continuum from illness to health.
Nursing's goal is to increase adaptation in four modes of physiological, self
concept, role function and inter-dependence. The nurse acts as an external
regulatory force to modify stimuli affecting adaptation of the system (person).
For example; instead of using the verbal analogue scale to assess whether I'll
continue with I.V. morphine, I prefer to let the patient decide his care. Is a
VAS of 4 O.K. for him, is he comfortable enough to rest, breath, move and cough?
My views are fairly similar to Roy's as far as the type of information
that needs to be gathered before setting goals. It's a good framework for
improving assessments of each patient. The emphasis on the Cognator (self
concept, role function, inter-dependence) is assuming that all nurses understand
the subtle differences between these modes and have the time to interview
patients in depth. This concept of nursing could be more easily applied to
psychiatric nursing, community nursing, or long term care facilities. Her
grouping of needs in the physiological mode are also a source of confusion and
frustration at Mt. Sinai where I work. For example: a state of hypervolemia or
hypovolemia could be under Oxygenation and/or Fluids and Electrolytes. The need
to do neurovascular checks could come under Oxygenation/Activity and Rest/or
Senses and Neuro functioning. Roy, herself, has said that in acute care areas, a
need to prioritize and focus on survival is necessary and that adhering to
closely to her model would be cumbersome in such settings.