Nursing Theory related to Adaptation:

In 1984, an extensively revised edition of Introduction to Nursing: An Adaptation Model was published.

Elements of the Roy Adaptation Model

The five essential elements of the Roy Adaptation Model are:

1. The person 2. The goal of nursing3. The concept of health 4. The concept of environment5. The direction of nursing activities

PersonThe recipient of nursing care may be the person, a family, a group, a community, or a society. Each is considered by the nurse as a holistic adaptive system. The concept of a system as applied to an individual. The individual aspects of parts act together to form a unified being. Persons are in constant interaction with their environments.

Each person is seen as an integrated whole with biological, psychological & social components & in constant interaction with the surrounding environment. In order to maintain homeostasis or integrity, the person must adapt to any changes that occur either from internal or external stimuli. Roy refers to 2 sub systems of adaptation within the person: the regulatory system & cognator system.

Adaptation Stimulilevel

Coping mechanism:CognatorRegulator

Physiological function Self-conceptRole-functionInterdependence

Adaptive / ineffective responses

Feedback

Input Processors Effectors

Output

Person as an Adaptive System

The regulator system refers to endocrine & autonomic nervous system. The cognator system refers to thoughtful responses of the person to stimuli.

Input: Stimuli & Adaptation LevelAccording to Roy, the adaptive system of a person

has inputs as stimuli coming from the external environment & internally from person. These stimuli are focal, contextual & residual. The focal stimuli are the person’s immediately confronting stimuli & constitute the degree of change impacting upon the person. Contextual stimuli are other entire stimuli of the person (internal & internal) that influence the situation & are observable, measurable or subjectively reported by a person.

Residual stimuli are characteristics of the person that are present & relevant to the situation but are difficult to measure objectively. Along with stimuli, the adaptation level of person acts as input to the person as and adaptive system. Person’s adaptation level is a constantly changing aspect which influenced by coping mechanisms of that person.

Processors: Coping Mechanisms: Regulator & Cognator.

Roy has used the term “Coping Mechanism” to control processes of the person as an adaptive system. Coping mechanisms may be genetic: WBC or learned: use of soap for hand washing. Roy’s Model considers 2 subsystems of coping mechanisms: regulator & cognator.

• The regulator subsystem: It has also input, internal process & output. Input stimuli may originate externally or internally to the person. These stimuli are transmitted through chemical, neural or endocrine systems. Autonomic reflexes are generated as output behaviors of regulator subsystem.

The cognator control processes are related to higher brain function: perception/information processing, judgment & emotion. Perception/information processing is related to the process of imitation, reinforcement &insight. Problem solving & decision making are the internal process related to judgment & emotion has the internal processes of defense to seek relief, affective appraisal & attachment.

The regulator & cognator are acting together. The adaptive level is influenced by the individual’s development & use of coping mechanisms. Maximal use of coping mechanisms broadens the adaptation level of the person & increases the range of stimuli to which the person can positively respond.

Effectors: Physiological function, self-concept, role function & interdependence

In internal processes of the person as an adaptive system, Roy defines the system effectors or adaptive modes: physiological function, self-concept, role function & interdependence. The regulator & cognator mechanisms are viewed as acting within these four modes. All people have certain needs to maintain integrity.

Roy divides these needs into 4 modes:1. Physiological function mode: oxygenation, nutrition,

elimination, activity & rest, skin integrity, senses, fluids & electrolytes, neurological function & endocrine function.

2. Self-concept mode: values, beliefs & emotions. (physical self, personal self & moral-ethical self).

3. The role function mode: social interaction (role identity & role mastery).

4. Interdependence mode: human value, affection & affirmation.

Output: Adaptive or Ineffective responses:Outputs of the person as a system are the behaviors of

person. Behaviors may be observed, measured or subjectively reported. Behaviors become feedback to the system. Output of the system may be either adaptive responses or ineffective responses.

Adaptive responses promote the integrity of the person, which is behaviorally demonstrated when the person is able to meet the goals in terms of survival, growth, reproduction & mastery. Ineffective responses do not support these goals.

Each person has an individual adaptation zone that is concerned with his/her capacity to respond to stimuli. All the stimuli that affect an individual fall within that zone, the positive responses are seen as the person can maintain his integrity. If the stimuli are too greater than the adaptive zone, the person will not be able to maintain integrity &responses are seen as maladaptive or negative. The size of an individual’s adaptive zone varies from person to person.

Adaptation level

Stimuli

Adaptation level

+R/Adaptation

stimuli

--R/Ineffective response

e.g. For pending examinations, one individual may adapt by following a pre-planned revision schedule. This response is a positive adaptation within the personal zone. Another person may respond by sleeplessness, poor concentration & loss of appetite, a negative adaptation outside his/her personal zone.

The concept of Health:

Health is the state & process of being & becoming an integrated & whole person. The integrity of the person is expressed as the ability to meet the goals of survival, growth, reproduction & mastery.

The concept of Environment:

All circumstances, conditions or changes which challenge the person as an adaptive system are considered as the environment. The person is constantly interacting with the continuously changing environment. Both external & internal factors are identified as stimuli that affect people’s behavior or development.

Stimuli are categorized into 3 groups: focal, contextual & residual.

The goal of Nursing:The main goal of nursing is to promote person’s

adaptation in physiological needs, self-concept needs, role function need & interdependence needs. If the person’s adaptation level is viewed as a line, the zone of adaptation is the distance above & below that line that sets the limit of the person’s adaptation capacity.

When the total stimuli (focal, contextual & residual) fall within the person’s zone of adaptation, an adaptive response results. When the total stimuli fall outside the individual’s zone of adaptation, ineffective output behaviors occurs, where nursing requires.

Nursing Activities:

Nursing activities are delineated by the model as those that promotes adaptive responses in situations of health & illness. Nursing activities include the manipulation of focal, contextual & residual stimuli with patient’s zone of positive coping.

By making these adjustments, the total stimuli fall within the adaptive zone of the person. When ever possible, in the first, the focal stimulus is manipulated. When the focal stimuli cannot be altered, the nurse promotes an adaptive response by manipulating contextual & residual stimuli. Besides this, the nurse may anticipate that the person has a potential for ineffective responses secondary to stimuli likely to be present in a particular situation.

Major Concepts:

Human being: Human being functions holistically, highest possible fulfillment of human potential.

Nursing Client:

A person, family, group or community. Biopsycho-social adaptive systems with 2 processors subsystems that are mechanisms for adapting or coping-regulator & cognator. The system has 4 affectors of adaptation or adaptive modes: physiological needs, self concept, role function & interdependence. A holistic adaptive system.

Environment:Internal & external stimuli: focal, contextual &

residual. In other words: it is a conditions, circumstances, & influences surrounding & affecting the development & behavior of persons & groups.

Health:A state of adaptation that is manifested in free

energy to deal with other stimuli. A process of promoting integrity.

Nursing: Nursing focuses on persons, groups……. with

ineffective behaviors & on manipulation of stimuli, so that they would fall within the patient’s adaptive zone.

Application of Roy’s Adaptation Model in Nursing Process

The elements of the Roy’s nursing process include first & second level assessment, diagnosis, goal setting, intervention & evaluation.

Situation: Mrs. Priyanka is 45yrs old woman is receive d from abdominal hysterectomy. Before surgery, her heart rate was 80/min, BP is 120/80mmHg, respiratory rate was 16/min. after 45min in recovery, her Heart Rate is 150/min, BP is 80/60mmHg & respiratory rate is 32/min.

• Assessment (1st & 2nd Level Assessment)First Level Assessment:

Behavioral assessment, it is considered the gathering of output behaviors in relation to each 4 adaptive modes: physiological function, self-concept, role function & interdependence. Information collected includes subjective, objective & measurement data. E.g. in Priyanka’s condition, 1st level assessment is done after collection of vital signs before operation & during recovery time. Nurse has found increased regulator output behavior is signaled by sympathetic nervous system stimulation of heart in response to decreased BP.

Second Level Assessment:After 1st level assessment, the nurse analyses the

emerging themes & patterns of client behavior to identify ineffective responses or adaptive responses requiring nurse support. When ineffective behaviors requiring support are present, the nurse conducts the 2nd level assessment. The nurse collects data about the focal, contextual & residual stimuli impacting on the client. This action clarifies the etiology of the problem & identify significant contextual & residual factors. Adaptation problems are indicated when survival, growth, reproduction or mastery goals of the person are impeded or when the integrity is threatened.

For Priyanka, the nurse decides that an ineffective response is occurring need, she needs 2nd level assessment. The focal stimulus is low BP is secondary to unknown underlying cause. Contextual stimuli are: 45yrs old, cool extremities, NPO for 12hrs, IV infusion 100ml/hr, 200ml fluid infusion during operation, 10ml urine excreted in first 45min, 1 ½ hrs of G.A., 500ml blood loss, no operation site bleeding. The residual stimuli includes history of renal infection.

• Nursing Diagnosis:

Roy describes 3 methods of making nursing diagnoses: use a typology of diagnosis developed by Roy in 4 adaptive modes/make diagnoses by stating the observed behavior with the most influencing stimuli /summary behaviors in one or more adaptive modes related to the same stimuli. For Priyanka’s condition, the nursing diagnoses is a decreased BP secondary to fluid volume deficit. A fluid volume loss is suggested both by contextual data & by the changes in the baseline HR, BP & Urine output.

• Goal Setting:Goals are set mutually with the person.

Goals are end point behaviors that a person is to achieve. Long term goals would reflect resolution of adaptive problems & availability of energy to meet the goals of survival, growth, reproduction & mastery. Short term goals identify expected client behaviors that indicate cognator or regulator coping. For Priyanka, nursing goal is to maintain a BP ±20mmHg of baseline levels within 15min can set.

• Plans for Implementation & intervention:

Nursing actions are planned with the purpose of altering/manipulating the focal, contextual or residual stimuli. Nursing actions may focus on broadening the person’s coping ability (adaptation zone), so that the total stimuli fall within that person’s ability to adapt. For Priyanka, plan nursing interventions and then takes the following interventions as follows: increased IV fluid rate to 300ml/hr, elevate foot of bed, give 40% oxygen by mask & give verbal & tactile stimulation to take slow deep breaths.

• Evaluation:

Goal behaviors are compared to person’s output behaviors & movement toward or away from goal achievement is determined. Readjustments to goals & interventions are made on the basis of evaluation data. For Priyanka, evaluation criteria would include: urine output more than 30ml/hr, mental alertness, BP±20mmhg, HR ±20/min & RR ±5/min of presurgery levels.

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