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8/3/2019 Power Point Ram

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Post doctoral fellow

Clinical nurse scholar

Chair of the Department of

nurses

Adjunct professor of the

graduate school program,

school of nursing Acting director and nurse

consultant of Saint Marys

Hospital

A Doctorate in sociology

Active in many nursingorganizations NANDA

specifically

An author and co author of a

number of books


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Conceptualizing the theory


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Her theory was first conceptualized in 1964(date of inception)

pediatric patients

First a part of her graduate workit was thenadopted as a conceptual framework of theundergraduate nursing curriculum


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Recipient of care

Maybe the person, family, group, community or a society

Each considered by the nurse as a HOLISTIC ADAPTIVE

SYSTEM


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Source ofstimuli

Defined by Roy as all conditions, circumstances and

influences that surround and affect the development andbehavior of persons and groups

External internal


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Defined by Roy as a state and process of being andbecoming an integrated and whole person

AIM OF THE NURSE in practicing Roys model is :

promote the health of the person by promoting

adaptive responses

Health is achieved if the

person has positively adapted


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SURVIVAL GROWTH

REPRODUCTION MASTERY

INTEGRITY

OF THE PERSON


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Roy defines goal of nursing as the PROMOTION of

ADAPTIVE RESPONSES in relation to the FOURADAPTIVE MODES.

NURSING seeks to reduce ineffective responses and

PROMOTE adaptive responses as output behavior of the

person


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CONCEPTS OF THE THEORY


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INPUT

CONTROLPROCESSES

OUTPUT


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INPUT STIMULI

Most immediately confronting

Greatest degree of change impacting on thepersonfocal

all other stimuli of the persons internaland external environment having an

influence on the situationcontextual

Those internal and external factors whocurrent effects are unclearresidual

external

internal


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SEVERE PAIN :damage to

cardiac muscle (angina / MI)

Unfamiliar surroundings

and people

Sedentary lifestylewith no exercise

Smokes 2 packs of

cigarettes a day over

20 years

OLD AGE

No previous history

of hospitalization

A number of activities /

interventions carried out in theimmediate environment (ER)

Attached to devices and had

undergone several tests since

arrival

Has not seen his wife since he was

in the ambulance, has been told that

she is in the waiting room


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INPUT

CONTROLPROCESSES

OUTPUT


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COPING MECHANISMS /

SUBSYSTEMS OF THE PERSONAS AN ADAPTIVE SYSTEM

REGULATOR COGNATOR

TRANSMITTERS OF THE REGULATOR

SUBSYSTEM:

NEURALAUTONOMIC REFLEXES

CHEMICAL

ENDOCRINE

Related to higher brain functions:

PERCEPTION

LEARNING

JUDGMENT

EMOTION


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IDENTIFY

REGULATOR OR COGNATOR MECHANISM


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Children listening attentively to their teacher

and imitating what the teacher does.


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Deep breathing


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When a family decides for the mode of treatment for

their father who has been diagnosed with cancer stage 4


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SECRETION OF INSULIN BY

THE PANCREAS WHEN THE

BODY NEEDS ENERGY


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A burning house

A fireman comes for rescueand he is running with all

the needed equipment to

stop the fire


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He tries to put out the fire


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The fireman was able to rescue a

child in the midst of a fire


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INPUT

CONTROL

PROCESSES

OUTPUT


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OUTPUTBEHAVIOR OF

THE PERSON

ADAPTIVERESONSES

Promotes integrityof the person

INEFFECTIVERESPONSES

Do not contributeto integrity

response

NURSE INTERVENES


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ADAPTIVE

RESONSES

INEFFECTIVE

RESPONSES


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ADAPTIVE

RESONSES

INEFFECTIVE

RESPONSES


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ADAPTIVE

RESONSES

INEFFECTIVE

RESPONSES


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he FOUR modes of Adaptatio


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Onesrelations

with others

Performance ofduties based on

a given position

Psychological& spiritualaspect

Basic needs

Psychic integrity

social integrity


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Covers the basic needs of thehuman person:

Oxygenation

NutritionElimination

Activity and rest

Skin integrity

Intact senses

Fluid and electrolyte balance

Intact neurologic function

GOAL: PHYSICAL INTEGRITY


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Focuses on the psychological andspiritual aspects of the individual

Beliefs and feelings that one holds

about himself

GOAL PSYCHIC

INTEGRITY

that one needs to know who

one is so that one can be or

exist with a sense of unity


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Set of expectations about howa person is expected to

behave based on her position

or role

Basic need-social integrity, the

need to know who one is in

relation to others

GOAL : SOCIAL INTEGRITY


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Focus on the close relationships

of people and their purpose.

Balance results in feelings of

being valued and supported byothers. Basic need - feeling of

security in relationships

Nurse must give moreimportance or particular

attention to dying patients.


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stimuli

Coping mechanisms/

subsystems

FOUR adaptation

modes

Adaptive response

Ineffective response

HEALTH

DISEQUILIBRIUM


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- guidelines of the nurse in the application ofthe nursing process

The six elements of the Roys nursing

process parallel the five phases of the

nursing process


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Assessment of the client in thefour adaptive modesenhances a SYSTEMATIC ANDHOLISTIC APPROACH

ASSESSMENT

OF

BEHAVIOR

In this phase the nurse collectsdata about the FOCAL,

CONTEXTUAL, RESIDUAL stimuliaffecting the client

This process thus clarifies theetiology of the clients problems

ASSESSMENT

OF STIMULI

Use of a typology of diagnosesdeveloped by ROY related tothe four adaptive modes

NURSING

DIAGNOSIS


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Use ofRoys six step nursing process in the clinical setting By manipulating the stimuli and not the patient, the nurse

enhances the interaction of the person with their environment

thereby promoting health

Disadvantage: nursing process was lengthy and that it took

much time to complete

Advantage: useful in inpatient settings, except in intensive care

units

Easier to use in clinics and physician offices, outpatient settings

Major strength of the model : provide a system that accounted

for physical needs and psychosocial needs

Roys model is useful when patients receiving care could

participate in care planning and problem solving


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The RAM was used forcurriculum development, application

of the model resulted in decreased anxiety in the students and

provided a framework to give direction to the education of

practitioners.

Nursing process can be utilized as a guide for the students intheir clinical area exposure

Enhance the theory and practice of the students

The model allows increasing knowledge in the areas of both

theory and practice The RAM defines the distinct purpose of nursing students,

which is to promote adaptation of person in each of the four

adaptive modes in situations of health and illness.


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The model distinguishes nursing science from medical

science by having the content of these areas taught inseparate courses.

Roy believes that curricula based on this model help in theory

development by the students, who also learn how to test

theories and recognize new theoretical insights.

Roy suggests that the model is advantageous for integrated

curricula and that it clarifies objectives, identifies content, and

specifies patterns for teaching and learning. Throughout 1970s and 1980s, the Roy model was

implemented as a basis for curriculum development in

associate-degree diploma, baccalaureate, and higher-degree

programs in many countries.


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The model is able to generate many testable hypotheses that

need to be researched. A group of graduate students at DePaul university tested the

model in a number of practice situations, the students concluded

that the model provided a good framework for ordering a

variety observations and was flexible enough to be used inboth episodic and distributive settings.

Roys model have been used in many quantitative and

qualitative researches and for the development of adaption

research instruments and researchers were satisfied with the

outcome of their researches for it has provided face validity for its

usefulness as a framework to guide their study. The model does

generate many testable hypotheses related to both practice and

nursing theory.


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Roy defines goal of nursing as the PROMOTION ofADAPTIVE RESPONSES in relation to the FOURADAPTIVE MODES.

NURSING seeks to reduce ineffective responses andPROMOTE adaptive responses as output behavior of theperson

Nursing is dealing with person, not only as a biologicalorganism but as a holistic adaptive system. Therefore,Roy attempts to describe ADAPTATION as a processinvolving holistic functioning to affect healthpositively.


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END

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