Nursing Theory Application

Introduction

The Roy adaptation model is based on the premise that a human being is both a psychological and biological being. Consequently, their external environment has a large impact on their well being because they are always interacting with it. (George, 2002) In light of these, a person's ability to cope can be impeded by some external stressors. This is the point at which nursing interventions are necessary. Nurses ought to assist patients to deal with these stressors hence promoting their overall health. The paper shall apply this nursing theory in a case study.

Description of the model

There are four major concepts that can be used to analyze the Roy adaptation model and these are:

• Environment
• Adaptation
• Health
• Nursing

Under the adaptation concept, a patient is regarded as a system that adapts to its environment. Here, there are four modes that facilitate this adaptation. The interdependence mode recognizes the fact that patients need relationships and affection from others while at the same time, those parties also need to receive affection from the former. Additionally, the physiological mode inculcates a view of the human being as a system that needs to be physiologically and physically upright. Additionally, Roy believes that in the adaptation concept, one must consider the role function mode because this relates to the way individuals play their functions in accordance with their positions. Conversely, the self concept mode looks at the way personal and physical beliefs intertwine within any individual. In this case, body sensations and body images reflect one's physical belief while spiritual and moral beliefs reflect the personal. In this mode, nurses can either respond adaptively or ineffectively. Ineffective responses occur when the responding individual fails to promote the integrity of the human adaptive system. On the other hand, adaptive responses occur when the nursing practitioner promotes all the values associated with the human system such as environmental systems, growth and survival. (Young et al, 2001)

Under the environmental concept, a patient can either be affected by internal or external stimuli. Here, a situation may be focal where an individual has to cope with that environmental factor immediately. In other situations, it may be contextual where the environmental factor has caused a certain situation. In other circumstances, it may be residual in that those environmental factors cannot be defined. The environmental concept is quite crucial in nursing practice because it provides an explanation for stressors within the system. According to the model, one is only subjected to stress when their coping mechanisms have been ineffective in the process of adapting to environmental stimuli. In other words, there are three particular systems that need to be considered here; the first is the process of taking in the external factor. The second is the adaptation of the system to the external stimulus and the third is the presence of stress as a result of poor adaptation to the system. It should be noted here that an individual can either respond to their environment through biological systems such as endocrine or neurological (this is referred to as the regulator subsystem). In other instances, an individual can respond to their environment through the learning process (this is referred to as the regulator subsystem)

The third concept incorporated in the model is health where one can only be considered healthy when the patient is integrated and whole. It should be noted that there is a distinct difference between the model and medicine. Medicine is restricted to the treatment of disease while the adaptation model covers other wider issues such as growth, adaptation and survival. (Tulman and Fawcett, 2003)

Nursing is the last concept in the health model and involves the promotion of adaptation concepts. Through nursing, patients can be able to improve their lives, health and well being.

In order for the model to work effectively, one needs to first observe all the four modes mentioned earlier, thereafter, it becomes necessary for one to look at all the Environmental Features surrounding a given case. Then, one should diagnose the patient. This is then followed by setting goals for healthcare which will then be followed by a rationale for treatment or some possible interventions. Lastly, one ought to examine the overall effectiveness of the model. (Davis, 2005)

Application of the Roy adaptability model to the case of a patient with heart failure and care plan

Consider the case of patient known as Maria. She is a Russian immigrant who has been living in the US alone. She was admitted into the hospital with heart failure. The patient had visited other hospitals severally, because of related symptoms.

The first step in the Roy adaptation model is to conduct an assessment of the patients' adaptation levels under the four modes.

Physiological mode: the patient could stand up, walk, and express herself well. Consequently, one could deduce that the patient's neurological functioning was in order. However, the patient could not perform any aggressive physical activities; there was some level of hemodynamic instability. Additionally, the patient could not sleep properly.

Interdependence; since Maria was an immigrant who had no relatives with her in the country. She was very isolated and only had her colleagues at work for support. However, the latter could only visit once in a while as they were busy attending to their obligations.

Self concept mode; Maria seemed very depressed. Due to the fact that there was no family near her, she felt so lost and thought that she would not do anyone any good by living. Consequently, she demonstrated a minimal concern for medical interventions as she seemed wary of it.

Functional mode: Maria felt that there was very little use for her as her family had forgotten her in Russia

The second step is an analysis of the Environmental Features surrounding this case study. The focal stimulus relating to this patient is with regard her left ventricle functions. The patient was suffering from heart failure owing to the fact that she could not perform aggressive physical activities. Additionally, the patient's condition affected her vital signs and her cardiac output. An analysis of the contextual stimulus reveals that the patient was having a defeatist attitude due to the frequency of the illness and also due to her level of social isolation. Besides this, other stimuli that could be affecting Maria include her frequent hospitalization and her personality; perhaps she is not very aggressive or does not easily cope with hard situations.

The third step in the adaptation model is conducting a diagnosis of the problem. In Maria's case, the problem of poor left ventricle functioning that has minimized cardiac output. The problem was as a result of subsequent injuries related to the myocardial system. (Sitzman and Eichelberger, 2004) Consequently, interventions ought to revolve around this aspect.

The fourth step is setting goals for intervention. The first treatment objective is to improve adaptation by dealing with focal stimuli. In this case, hemodynamic medicine (Dopamine drip) will be given in small doses until the patients' vital signs have been revived. The other issue is improving the patient's cardiac output. This will be achieved through the use of Milrinone, Lasix and Dobutamine. The latter interventions only deal with the physiological. However, other modes such as self concept also have to be tackled. In this case, Maria was depressed and she also had very low self image. It was necessary to teach the patient that becoming inactive was not the end of the road. Besides this, it is also necessary to deal with role modes where the patient will be taught that she is still relevant to her former work colleagues and her friends. It will also be necessary to teach Maria how to live with her disease rather than giving up. Maria was also encouraged to talk about her prevailing circumstances.

The fifth step is an examination of treatment rationale. The reason why Dopamine drip was used was because if titrated in the right manner, it could increase the patient's blood pressure to 90mmHg. Additionally, it was necessary for the patient to be put on Milrinone and Dobutamine infusions because the latter have been used by many practitioners to facilitate cardiac output improvement. Additionally, Lasix was utilized in order to cope with duresis hence eliminating the heart failure issue. The reason why it was necessary to deal with Maria's self concept was that this was affecting her overall well being.

The last step is an examination of the effectiveness of the model. (Tomey and Alligood, 2002) This model was effective because Maria's heart failure was eliminated and her blood pressure went back to the normal level. However, the self concept mode did not improve substantially, because Maria was still not able to express her feelings about her condition. However, she realized that her work colleagues still cared for her and this enhanced her functional mode.

Conclusion

In summary, the Roy adaptation model looks at the patient holistically in that the role of the nursing practitioner is to act as a resource coordinator where one looks at all the needs of the patients and the appropriate resources required to solve them. Besides that, the model also brought out the fact that the nursing practitioner was solving problems. There was a rigorous step of diagnosis and goals created to solve the problem. Additionally, the adaptation model also brought out the fact that the nurse is in fact a care giver and this is depicted through the four aspects of diagnosis. The effectiveness of the model in the treatment of the patient is adequate proof that the model does work.

Reference

Young, A., Gebhardt , S. and McLaughlin, K. (2001):Connections: Nursing Research, Theory, and Practice; Mosby Publishers

Davis, P. (2005): Evaluation and Analysis of Nursing Models and Theories: Contemporary Nursing Knowledge; Springer Publishers

George, J. ( 2002): Nursing Theories: The Base for Professional Nursing Practice; Appleton & Lange Publishers

Tomey, A. and Alligood, M. (2002): Nursing Theorists and Their Work; Mosby Publishers

Sitzman, K. and Eichelberger, L. (2004): A Creative Beginning: Understanding the Work of Nurse Theorists; Bartlett and Jones Publishers

Tulman, L. and Fawcett, J. (2003): Women's Health During and After Pregnancy; Springer publishers

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