Dr.Rebecca Samson PCON-Bangalore 4.2.

10

Introduction
Professional nursing practice is grounded in a theoretical foundation. In effect ,practice suggests theory which ,when scientifically validated returns to guide practice by way of conceptual models.(Mc Far lane 1986) Conceptual models attempt to explain the nursing paradigm, or overall scheme, which relates the nursing client to the context or environment of care; to the health or illness situation; & to the practice of nursing.

 A Theory is logically interconnected set of confirmed hypotheses or propositions (McKay 1986). A Hypothesis or proposition specifies the relationship between two or more concepts or ideas. A Conceptual model can be thought of as a symbolic map or structure which integrates the concepts or ideas of a theory in to a meaningful configuration. A conceptual models therefore explains theory & the ideas which comprise it.

 Conceptual models are of value to nursing in that they represent a tool to link theory and practice. They help to clarify thinking about the elements of practice situation and their relationship to one another, They help practitioners of nursing to communicate with one another in a meaningful way. They serve as guide to practice ,education and research.

The choice of model determines the kind of information that will be gathered the way it will be organized and interpreted.

Definitions
Theory: An abstract statement formulated to predict, explain, or describe the relationships among concepts ,constructs or events. Theory is developed and tested by observation, and research using factual data. Frame of reference: The personal guide lines of an individual ,taken as a whole. An individual frame of reference reflects the individual persons social status ,cultural norms and concepts.

Defi.
Model: A symbolic representation of the interrelations exhibited by a phenomenon within a system or a process.

The model is presented as conceptual frame work or a theory that explains a phenomenon and allows predictions to be made about a patient or a process.

Theories
In order to establish the links between your study and nursing theory , a theoretical or conceptual frame work for investigating the study should be chosen. This may require a further search of the literature to clarify the fit' between the theory and your question. Example; several theoretical frame works could be used for a study of alternative birthing. From Orems self care theory it can be posited that alternative ,possibly home birth ,would increase a family s self care agency. Alternatively ,within the frame work of systems theory ,child birth would be seen as a natural event contributing to homeostasis in the family system.

Theories In Specific ..

Lydia Halls CARE, CORE, CURE Theory/Model

History
Lydia Hall was born in New York City on September 21, 1906 and grew up in Pennsylvania. She was an innovator, motivator, and mentor to nurses in all phases of their careers, and advocate for the chronically ill patient. She promoted involvement of the community in health-care issues. She derived from her knowledge of psychiatry and nursing experiences in the Loeb Center the framework she used in formulating her theory of nursing. These experiences might have given her insight in on the distinct roles of nurses in providing care for the patients and how the nurses can be of utmost importance in caring for these patients.

 The theory of all, as they say, contains of three independent but interconnected circlesthe core, the care and the cure. But what do these terms mean? According to the theory, the core is the person or patient to whom nursing care is directed and needed. The module has mentioned that the core has goals set by himself and not by any other person, and that these goals need to be achieved. The core, in addition, behaved according to his feelings, and value system. The cure, on the other hand is the attention given to patients by the medical professionals. The module has been explicit in stating that the cure circle is shared by the nurse with other health professionals. These are the interventions or actions geared on treating or curing the patient from whatever illness or disease he may be suffering from. Some interventions I can think of in relation to this are the surgeries performed to treat a tumors or other malignancies, prescribing pharmacologic therapies and performing diagnostic tests.

Hist

About Lydia hall's core, care and cure model?

what can you say about this theory's simplicity, generality, empirical precision and derivable consequences? Can this model also be called "three interlocking circle's theory"? YES

Lydia Hall CARE, CORE, CURE

Care: The body (intimate bodily care)
Core: The person (therapeutic use of self) Cure: The disease (seeing the patient & the family through medical care)

The 3 interlocking circle theory.

1.Care 2.Core 3.Cure

 It is shown you in a diagram that there are 3 circles which are interlocked with the words Care, Core and Cure. So you could call it the 3 interlocking circle theory.

It is simple
It is simple yet is needed in the practice of the profession. 1. We treat our patient's as a holistic body (Care). 2. We implement interventions and treatment regimens with consideration of the patient as a human being . (Core). 3. We look at their disease and response to treatment. (Cure)

Care, Core, and Cure: Lydia E. Hall

Objectives
1. Describe the historical background of the development of Halls care, core, and cure 2. Identify what is unique about Halls theory 3. Explain the meaning of, and who is involved in, care, core, and cure 4. Present the relationship between Halls work and concepts in nursings metaparadigm 5. Provide an example of use of care, core, and cure in clinical practice

Objectives
6. Identify strengths and weaknesses of care, core, and cure for clinical practice 7. Discuss the appropriateness of qualitative and quantitative research methods for testing Halls work 8. Relate care, core, and cure to critical thinking, therapeutic nursing interventions, communication, and outcomes 9. Cite examples of the contagiousness of Halls work

Care, Core, and Cure: Lydia E. Hall

Requires Critical
Thinking

Theory Overview - Care, Core, and Cure: Lydia E. Hall

Lydia E. Hall believed that patients over the age of 16, who were past the acute stage of illness, required a different focus of care than did the acutely ill.

She demonstrated the effectiveness of her theory in practice at the Loeb Center.
The three components of her theory are care, core, and cure.

Care is based in the natural and biological sciences, includes the intimate aspects of bodily care, and is exclusive to nursing.

Core is based in the social sciences, involves the therapeutic use of self, and is shared with other members of the health care team. Cure is based in the pathological and therapeutic sciences, involves working with the patient and family in relation to the medical care, and is shared with other members of the health care team.

The highlight, however is the care model.

This is the part of the model reserved for nurses, and focused on performing that noble task of nurturing the patients, meaning the component of this model is the motherly care provided by nurses, which may include, but is not limited to provision of comfort measures, provision of patient teaching activities and helping the patient meet their needs where help is needed.

The high light

That means that if all three circles exhibit harmony and balance, the patient will be the one to benefit from it all since his needs are being put into priority but the meeting of it depends on which circle of the model is responsible for meeting such activities.

It was hard not to see that in all of the circles of the model, the nurse is always presents, but the bigger role she takes belongs to the care circle where she acts a professional in helping the patient meet his needs and attain a sense of balance.

THE THEORY AT WORK: APPLICATION TO OUR INDIVIDUAL PRACTICE

ELOISE ENCARNACION AND ROSE DE LEON, Operating Room Nurses: The theory can be applied in all the phases of the operative experience. The CARE can be utilized when providing patient care and teaching at each phase of the surgery, providing comfort both physiologically and psychosocially. The CORE model can be realized when he patient is able to express his feelings about the procedure and participates in exploring these feelings, helping him towards a faster recovery. The CURE model is used when we provided medication therapy to the patient, nurses assuming our roles as either scrub or circulating nurse.

 The patient with congestive heart failure usually has health problems related to the ineffective pumping mechanism of the blood, pooling of the blood in the lower extremities and a vast array of systemic symptoms. The cure model can be applicable in this case when the nurse would perform assessment and formulate care plans based on the patients needs and against limitations set by the physicians. The cure model will also require the nurse to closely monitor the patients response to the treatments and any untoward symptoms and relay these with the other members of the health team.

CAYE ELLIMA, Critical Care/NICU Nurse:

Critical Care/NICU Nurse.

In the care model, the nurse can help the patient or the family in accepting and adapting to the emotional and other stresses the condition may bring. It will be the nurses task to open channels of communication to allow expression of feelings and help the patient/family work out through it. It is also in this model that health teachings are imparted.

Critical Care/NICU Nurse.

The core model dominates when the patient and/or family are able to address the emotional concerns and issues related to the perception of the effects of the disease process such as activity restrictions. It will be, therefore, the sole role of the nurse to help the patient/family maintain or achieve his sense of balance.

NHINA SANDEEP DE ROSAS, Nursing Education/Clinical Instructor:

The core, care and cure model can be applied into nursing education by utilizing its concepts in the mode of instruction given to students. The care model can be materialized in education by having clinical instructors provide real-world learning experiences to students. This would provide the students more opportunities for learning and encourages feedbacks about learning topics. Doing this would institute measures to further explore learning needs and help students develop confidence in assuming their roles as nurses.

Nursing Education/Clinical Instructor.

The cure model can be used by nursing educators when they plan for learning activities for their students. This can be done through implementation of diagnostic examinations to ascertain the students learning needs not only on nursing practice but also on other fields of science affecting the practice of nursing. The core model can be fully realized only when the clinical instructors are successful in helping the student meet his learning needs and thus providing him with an increased sense of accomplishment in terms of knowledge.

RANDULF ERGUIZA, Community Health Nursing/Clinical Instructor:

Care becomes effective when we show sincerity and genuineness in our approach not only towards students but also to patients. We listen, we communicate and we make them feel a part helping the patients. Core is strengthened when we make them (students and patients) realize their potentials as individuals by reflecting not only on things that they can do but also on things that they were not able to do, and what things they still can do. Cure is provided when measures such as encouraging people in the community to utilize the services offered by the health centers and; and teaching them compliance to treatment regimens.

JAN STANLEY DIARESCO, Dialysis Nurse

Lydia Halls Care, Core and Cure theory can also be seen and identified in this kind of setting. Patients undergoing hemodialysis experiences problems such as physical vulnerability, feeling of being a burden to the family and being hopeless. Being a nurse one should use therapeutic communication when dealing with the patient, and family, provide proper care to the client as he or she undergoes dialysis and create an environment that would promote holism as the procedure is being done.

Dialysis Nurse
As soon as the patient arrives in our unit we explain the treatment and how would it benefit her and the risks involve so that he/she would be ready once the consent is being explained to her the physician. The therapeutic use of self of a nurse is shown here. As a practitioner in the Kidney Unit, we perform dual responsibility, one as nurse and the other as a technician. Being a nurse technician, we provide care to our clients by understanding the concept of dialysis with the use of the machine, how to troubleshoot technical problems, understanding water treatment, cannulation and priming the machine When priming the machine we wash out the renalin and residues present in the dialyzer to protect the client from its harmful effects that could lead to anaphylactic shock. Injecting innohep and heparinizing the tubings makes it safer for the client since clotting will be prevented, which could cause blood loss or wastage.

Dialysis Nurse
Monitoring vital signs of the client 15 min for the first hour and 30 min thereafter to check for hypotension or hypertension (common complications during HD) would easily alert the nurse to provide initial interventions such as positioning, flushing and notifying the physician for medications to be given or any procedure to be carried out. Upon removal of the cannulas from the patient site, the nurse should properly apply pressure dressing on the site so as to prevent blood loss and promote healing of the site. Educating the client not to scratch the site, exercise her are so that the fistula site would be bigger and prevent any injury to the site would be ways of preventing future complications to the site.

Lydia Hall 1926 - 1969 Summary

Lydia Hall was a rehabilitation nurse and one of the Columbia University/Teachers College school. Her "Care, Core, and Cure Model" was an early model of nursing practice used at the Loeb Center for Nursing and Rehabilitation in Westchester County, New York. The Loeb Center was nurse directed, developed to prevent the fragmented care common in the 1950's and 1960's.
According to the Care, Core, and Cure" model, nurses work in three arenas: care (hands on bodily care), core (using the self in relationship to the patient), and cure (applying medical knowledge). Hall was another nurse to the delineate the practice of nursing from the practice of medicine.

Group Activity
Care of the Congestive Heart Failure Patient: The Care, Cure, and Core Model : Mary L. McCoy RN BSN(c), Case Management, Plymouth, Indiana Introduction Congestive heart failure patients have decreased physical endurance and emotional concerns resulting from significant changes in their quality of life. Congestive heart failure patients perception of quality of life depends on individual health status and limitations in caring for themselves. Programs with a focus on patient education and disease management can improve quality of life and decrease hospital readmission rates for congestive heart failure patients (Chelho, Ramos, Prata, Bettercourt, Ferreira & Cerqueira-Gomes, 2005). Congestive heart failure is a chronic disease that progressively decreases patients abilities of self-care due to significant weakness that is experienced as a result of compromised cardiac and respiratory systems. This disease is present in 10% of elderly over the age of 70. Congestive heart failure patients readmission rate to hospitals due to poor disease management is an ongoing problem. The cost of congestive heart failure admissions to the hospital ranges from 8 to 15 billion dollars a year (Quaglletti, Atwood, Ackerman, & Froelicher, 2000). Current patient care models focus on the physical, social, emotional, and educational needs of patients. Congestive heart failure patients may have physical, social, emotional and/or education needs depending on the severity and stage of their disease process, knowledge of the disease, and current social support systems. It is imperative to evaluate and analyze various patient care models, and to choose one that best meets the particular patients needs because care plans are the essential framework through which nurses work to provide the care a patient needs (Anderson & McFarlane, 2004).

Grp work
Lydia Halls Care, Cure, and Core Model refers to patients as having three needs of care: the physical, the medical, and the social needs. Nurses can easily provide the Care, Core and Cure model of nursing to meet the needs of patients with chronic disease (Touhy & Birnbach, 2001). Nurses using Lydia Halls model, assist with education, medical management, and provide physical, emotional, or social support for congestive heart failure patients. T The medical management and education offered by nurses increases patients knowledge and ability to manage their disease and prevent exacerbations and reduce hospital readmissions (Quaglietti et al., 2000). Development of the nurse and patient relationship is critical in problem solving and providing care and education to promote effective health management for the congestive heart failure patient. Open communication and trust is necessary to facilitate care, provide education, and arrange discharge planning (Touhy & Birnbach, 2001).

Framework
Lydia Halls model for nursing provides a framework to encourage open communication between patients and nurses. The model has three interrelated circles that represent medical and clinical management nurses give to patients.

The care circle is the intimate care nurses provide to patients to assist in bathing, dressing and assistance with daily activities. The disease management and treatment of the patient is addressed in the cure circle of the framework. The core circle symbolizes the emotional and social structure of the patient. The model is not static, but rather the patient can be in an individual circle or the circles can overlap depending on the needs of the patient during management of their disease. Patients who have their care, cure, and core needs met have improved self-esteem and awareness of the importance of disease management and improved quality of life. The care, cure, core model provides an opportunity for Patients to develop trust and communicate their fears and concerns in relation to disease management (Touhy & Birnbach, 2001).

Care Model

Grp wk.

The care model dominates when Nurses provide hands on care to congestive heart failure patients. Hands on care for patients produces an environment of comfort and trust and promotes open communication between nurses and patients. Open communication encourages expressions of thoughts and fears and decreases anxiety. Patients develop feelings of security and verbalize concerns of disease management, emotional, and/or social issues in relation to the lifestyle changes they are experiencing secondary to congestive heart failure (Touhy & Birnbach, 2001). Patient education and discharge planning begins in the care model. During this phase, nurses have the primary role of answering questions and address concerns in relation to disease process, disease management. Congestive heart failure patients needs are addressed as nurses and patients develop both interpersonal and professional working relationships (Touhy & Birnbach, 2001). Cure Model The cure model (Figure C) dominates when nurses perform physical assessments and care management plans for congestive heart failure patients. During this phase, nurses assess patients ability to perform activities of daily living based on physical changes that occur during walking, talking or bathing (Touhy & Birnbach, 2001). Nurses monitor patients fatigue level, respiratory status, blood pressure and oxygen saturation to determine patients tolerance level and need for supplemental oxygen. Lung sounds are osculated for diminished breath sounds or crackles for signs of fluid congestion. Congestive heart failure patients pulse strength, edema, and temperature are assessed to monitor circulation status secondary to decrease cardiac output and potential of pooling of fluid in the lower extremities (LeMone & Burke, 2004). Education to congestive heart failure patients is essential to increase their understanding of their disease process and to improve medication compliance. It is important that nurses review medications and stress the importance of compliance to medication schedules. Improved compliance can improve the quality of life for the congestive heart failure patient and result in decreased hospital readmissions (Coelho et al., 2005). Diet compliance also improves the status of congestive heart failure patients. Patients who understand their ordered diet understand the importance of compliance to prevent weight gain due to fluid overload. Patients who recognize the symptoms that accompany their disease understand when to notify the physician of weight gain, increased shortness of breath, fatigue, or dizziness (LeMone & Burke, 2004).

Grp wk
Core Model The core model (Figure D) of the framework dominates when nurses and patients are able to discuss emotional concerns and distress to physical and mental changes due to patients disease process. Patients address emotional concerns and distress due to their perceived ability or inability to manage their disease, living alone, and general fear of their disease process. These emotions and concerns effect compliance to the medical plan and quality of life (Touhy & Birnbach, 2001). An essential role of nurses in the healthcare plan is to assist with management of congestive heart failure patients by providing medical, physical, and social care. The framework of Lydia Hall is used in the following care plan to assist in meeting the personal, medical, and social needs of congestive heart failure patients (Touhy & Birnbach, 2001).

Congestive Heart Failure Plan of Care

Care:
Problem 1: Potential for inability to care for self related to weakness and decreased mobility Intervention Asses patients ability to bathe and dress self Assist with activities of daily living as needed for personal care Teach importance of rest when bathing and dressing

Goal
Patient will have increased strength to bathe and dress self Patient will have assistance as needed for personal care Patient will verbalize and demonstrate the importance of rest when bathing and dressing

Problem 2: Potential for decreased social interaction secondary to fear, anxiety, and trust Intervention
Identify cause(s) of stress/anxiety Provide comfort and support Encourage open communication Identify strengths

Goal
Patient will verbalize stress and anxiety issues and have decrease fear Patient will feel comfort and support during care Patient will communicate openly Patient will verbalize strengths in ability to care for self

Congestive Heart Failure Plan of Care

Cure: Problem #1:

Activity intolerance secondary to decrease cardiac output and weakness

Intervention Assess vital signs Monitor respiratory status Encourage rest periods during activity Assess need for oxygen and stress importance of compliance of oxygen use

Goal
Pulse, blood pressure and respiratory rate will be within patients limit Respiratory effort, oxygen saturation will be within patients normal limit Patient rest during activity and verbalizes importance of rest

Problem #2: Fluid volume excess secondary to decreased circulatory status/cardiac output Intervention
Teach patient to monitor daily weight, pulse, edema and respiratory effort Teach patient medication protocol and importance of medication compliance Teach importance of diet compliance Teach importance of notifying the physician of status change

Goal
Patient will verbalize the importance of monitoring weight, pulse, edema, and respiratory effort Patient will verbalize medication schedule and importance of compliance Patient will verbalize importance of diet compliance Patient will verbalize the importance of notifying the physician

Congestive Heart Failure Plan of Care

Core: Problem #1: Ineffective coping secondary to disease process Intervention Assess patients image of body/health changes Identify patients strengths in caring for self Assess patients ability to care for self Goal Patient will understand and begin to accept changes related to disease process Patient will verbalize strengths and weakness Patient will have care needed to promote optimal health

Problem #2: Potential for non-compliance secondary to knowledge deficit and low self esteem Intervention Assess patients knowledge of disease process, treatment and medication schedule Assess patients feelings of ability to care for self Promote patients strengths and self esteem Goal Patient will understand disease process, treatment and medication schedule Patient will verbalize feeling of ability to care for self and assist in discharge planning of disease process Patient will increased self esteem in ability to care for self and disease management (RN Central, 2005)

Discharge Planning
Discharge planning during the core phase provides patients with essential emotional support and serves to decrease anxiety and fear (Touhy & Brinbach, 2001). Social isolation and the fear of dying affect the survival of cardiac patients. Patients may not have access to quality care or support needed to manage their disease. During this phase, nurses can provide emotional support and assistance by arranging home health care that best suits the needs of patients when they are discharged to home (Asadi-Lari, Parkham, & Gray, 2003).

Conclusion
Nurses work with the medical team to assist in evaluating congestive heart failure patients understanding of symptoms of their disease, compliance to diet and medication regimens, and the importance of informed follow up with their physician or nurses. Nurses can promote trust and facilitate open communication with patients when providing hands on care (Touhy & Brinbach, 2001). Licensed Practical Nurses have an important role in management of congestive heart failure patients assessment and education. Lydia Halls Framework of Care, Cure, and Core provide a model for nurses to follow when evaluating congestive heart failure patients physical, medical, and social needs (Figure E). The individualized care offered by nurses promotes improved quality of life and decreased hospital readmissions for congestive heart failure patients (Touhy & Birnbach, 2001).

References
Asadi-Lari, M., Packham, C., & Gray, D. (2003). Unmet Health needs in Patients with Coronary Heart Disease: Implications and Potential for Improvement in Caring Services. Health Quality of Life Outcomes, 1(26), 1-8. Retrieved January 10, 06, from http:www.pubmedcentral.gov Web Site: http://www.hqlo.com/concent/1/1/26 Coelho, R., Ramos, S., Prata, J., Bettercourt, P., Ferreira, A., & CerqueiraGomes, M. (2005). Heart Failure and Health related Quality of Life. Clinical Practice and Epidemiology in Mental Health, 1(19), 1-13. Retrieved January 16, 2006, from http://www.pubmedcentral.gov LeMone, P., & Burke, K. (2004). Heart Failure. In P. LeMone & K. Burke (Eds.), Medical Surgical Nursing: Critical Thinking in Client Care (3rd ed., pp. 870-888). Upper Saddle River: Prentice Hall, Inc. Paris, M. (2002, February 5). National Quality Management Program. Retrieved July 30, 2005, from http://www.jcaho.org/pms/core+measures.htm Quaglietti, S., Atwood, E., Ackerman, L., & Froelicher, V. (2000). Management of The Patient with Congestive Heart Failure using Outpatient, Home, and Palliative Care. Progress in Cardiovascular Diseases, 43, 259-274.Retrieved RN Central. (2005). RN Central. Retrieved January 10, 06, from www.rncentral.com/careplans/main.html Touhy, T. A., & Birnbach, N. (2001). Lydia Hall, The Care, Core, Cure Model. In M. E. Parker (Ed.), Nursing theories and nursing practice (pp.135-137). Philadelphia: F.A. Davis Company.

The Roy Adaptation Model

ASSUMPTIONS

Scientific Systems of matter and energy progress to higher levels of complex selforganization Consciousness and meaning are constitutive of person and environment integration Awareness of self and environment is rooted in thinking and feeling Humans by their decisions are accountable for the integration of creative processes Thinking and feeling mediate human action System relationships include acceptance, protection, and fostering of interdependence Persons and the earth have common patterns and integral relationships Persons and environment transformations are created in human consciousness Integration of human and environment meanings results in adaptation

Philosophical
Persons have mutual relationships with the world and God Human meaning is rooted in an omega point convergence of the universe God is intimately revealed in the diversity of creation and is the common destiny of creation Persons use human creative abilities of awareness, enlightenment, and faith Persons are accountable for the processes of deriving, sustaining, and transforming the universe

PERSONS AND RELATING PERSONS

An adaptive system with coping processes Described as a whole comprised of parts Functions as a unity for some purpose Includes people as individuals or in groups (families, organizations, communities, nations, and society as a whole) An adaptive system with cognator and regulator subsystems acting to maintain adaptation in the four adaptive modes: physiologic-physical, selfconcept-group identity, role function, and interdependence

Adaptive Modes
1. Individual 2. Group 1.Physiologic-physical Five needs - oxygenation, nutrition, elimination, activity and rest, protection Four complex processes-senses; fluid, electrolyte, and acid-base balance; neurologic function; endocrine function Operating resources: participants, capacities, physical facilities, and fiscal resources. 2.Self-concept-group identity Need is psychic and spiritual integrity so that one can be or exist with a sense of unity, meaning, and purposefulness in the universe Need is group identity integrity through shared relations, goals, values, and coresponsibility for goal achievement; implies honest, soundness, and completeness of identifications with the group. 3.Role function Need is social integrity; knowing who one is in relation to others so one can acct; role set is the complex of positions individual holds; involves role development, instrumental and expressive behaviors, and role taking process Need is role clarity, understanding and committing to fulfill expected tasks so group can achieve common goals; process of integrating roles in managing different roles and their expectations; complementary roles are regulated. 4.Interdependence Need is to achieve relational integrity using process of affectional adequacy, i.e., the giving and receiving of love, respect, and value through effective relations and communication Need is to achieve relational integrity using processes of developmental and resource adequacy, i.e., learning and maturing in relationships and achieving needs for food, shelter, health, and security through independence with others

ENVIRONMENT
All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources Three kinds of stimuli: focal, contextual, and residual Significant stimuli in all human adaptation include stage of development, family, and culture

 Health: a state and process of being and becoming integrated and whole that reflects person and environmental mutuality .

HEALTH AND ADAPTATION

Adaptation: the process and outcome whereby thinking and feeling persons, as individuals and in groups, use conscious awareness and choice to create human and environmental integration .
Adaptive Responses: responses that promotes integrity in terms of the goals of the human system, that is, survival, growth, reproduction, mastery, and personal and environmental transformation . Ineffective Responses: responses that do not contribute to integrity in terms of the goals of the human system .

Adaptation levels represent the condition of the life processes described on three different levels: integrated, compensatory, and compromised

NURSING Nursing is the science and practice that expands adaptive abilities and enhances person and environment transformation Nursing goals are to promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity This is done by assessing behavior and factors that influence adaptive abilities and by intervening to expand those abilities and to enhance environmental interactions

NURSING PROCESS

A problem solving approach for gathering data, identifying the capacities and needs of the human adaptive system, selecting and implementing approaches for nursing care, and evaluation the outcome of care provided

NURSING PROCESS..

Assessment of Behavior: the first step of the nursing process which involves gathering data about the behavior of the person as an adaptive system in each of the adaptive modes Assessment of Stimuli: the second step of the nursing process which involves the identification of internal and external stimuli that are influencing the persons adaptive behaviors.

NURSING PROCESS..

Stimuli are classified as: 1) Focal- those most immediately confronting the person; 2) Contextual-all other stimuli present that are affecting the situation and 3) Residual- those stimuli whose effect on the situation are unclear.

NURSING PROCESS

Nursing Diagnosis:step three of the nursing process which involves the formulation of statements that interpret data about the adaptation status of the person, including the behavior and most relevant stimuli Goal Setting: the forth step of the nursing process which involves the establishment of clear statements of the behavioral outcomes for nursing care.

NURSING PROCESS

Intervention: the fifth step of the nursing process which involves the determination of how best to assist the person in attaining the established goals Evaluation: the sixth and final step of the nursing process which involves judging the effectiveness of the nursing intervention in relation to the behavior after the nursing intervention in comparison with the goal established.

 An Explication of the Philosophical Assumptions of the Roy Adaptation Model Sister Callista Roy, RN, PHD School of Nursing, Boston College, Boston, MA

The Roy Adaptation Model

History
The Roy Adaptation Model for Nursing had its beginning when Sr. Callista Roy entered the masters program in pediatric nursing at University of California Los Angeles in 1964. Her advisor and seminar faculty was Dorothy E. Johnson who was writing and speaking on the need to define the goal of nursing as a way of focusing the development of knowledge for practice. Dr. Roy had read a little about the concept of adaptation and was impressed with the resiliency of children she had cared for in pediatrics. At the first seminar in pediatric nursing, she proposed that the goal of nursing was promoting patient adaptation. Throughout her course work in the master's program Dorothy Johnson encouraged her to develop her concept of adaptation as a framework for nursing. The use of systems theory as defined by von Bertalanffy was an important early concept of the model, as was the work of Helson. Helson defined adaptation as a process of responding positively to environmental changes and described three types of stimuli, focal, contextual and residual. Dr. Roy made appropriate derivations of these concepts for use in describing situations of people in health and illness. Other authors that influenced the early development of the central concepts of the model included Dohrenwend, Lazarus, Mechanic, and Selye. The view of the person as an adaptive system took shape from this early work with the cognator and regulator being added as the major internal processes of the adapting person.

The Roy Adaptation Model.

The second phase of the development of the model was the 17 years of work with faculty at Mount St. Mary's College in Los Angeles. The model became the framework for a nursing-based integrated curriculum in March 1970, the same month that the first article on the model was published in Nursing Outlook. The four adaptive modes were added as the ways in which adaptation is manifested and thus as the basis for nursing assessment. Specifically a content analysis was done on 500 samples of patient behavior from all clinical areas, collected by the nursing students and major categories named as physiologic, self concept, role function and interdependence. Contributors to the theoretical development of the adaptive modes included: Marie Driever for self concept; Brooke Randell for role function, and Joyce Van Landingham and Mary Tedrow for interdependence. Marsha Sato helped identify both common and primary stimuli affecting the adaptive modes and Joan Cho developed clinical tools for assessment. Many other faculty from Mount St. Mary's College were involved in writing the first three textbooks on the model in 1976, 1984 and 1991.

The Roy Adaptation Model.

Through curriculum consultation throughout the USA and eventually worldwide, Dr. Roy received input on the use of the model in education and practice. By 1987 at least 100,000 nurses had been educated in programs using the Roy Adaptation Model. As the discipline of nursing grew in articulating its scientific and philosophical assumptions, Dr. Roy also articulated her assumptions. Early descriptions included systems theory and adaptation-level theory, as well as humanist values. Later Dr. Roy developed the philosophical assumption of veritivity as a way of addressing the limitations she saw in the relativistic philosophical basis of other conceptual approaches to nursing and a limited view of secular humanism and published a major paper on her philosophical assumptions in 1988.

The Roy Adaptation Model.

By the late 1990s Dr. Roy felt on urgency to re-define adaptation for the 21st Century. She drew upon expanded insights in relating spirituality and science to present a new definition of adaptation and related scientific and philosophical assumptions. Her philosophical stance articulates that nurses see persons as coextensive with their physical and social environments. Further, nurse scholars take a value-based stance and rooted in beliefs and hopes about the human person, they develop a discipline that participates in enhancing the well-being of persons and of the earth. Dr. Roy has used the term cosmic unity to describe that persons and the earth have common patterns and mutuality of relations and meaning and that persons through thinking and feeling capacities, rooted in consciousness and meaning, are accountable for deriving, sustaining, and transforming the universe. These ideas were explained in a 1997 publication and included in the 1999 revision of the theorist's textbook on the model.

The Roy Adaptation Model. Other major developments of the model in the 1999 textbook, written with Dr. Heather Andrews, include: 1) expanding the adaptive modes to include relational persons as well as individual persons and 2) describing adaptation on three levels of integrated life processes, compensatory processes, and compromised processes. Dr. Roy has also outlined a structure for nursing knowledge development based on the Roy Adaptation Model and provided examples of research within this structure. Dr. Roy remains committed to developing knowledge for nursing practice and continually updating the Roy Model as a basis for this knowledge development.

Overview ASSUMPTIONS Scientific

ASSUMPTIONS Scientific Systems of matter and energy progress to higher levels of complex self-

organization Consciousness and meaning are constitutive of person and environment integration Awareness of self and environment is rooted in thinking and feeling Humans by their decisions are accountable for the integration of creative processes Thinking and feeling mediate human action System relationships include acceptance, protection, and fostering of interdependence Persons and the earth have common patterns and integral relationships Persons and environment transformations are crated in human consciousness Integration of human and environment meanings results in adaptation

ASSUMPTIONS
Philosophical
Persons have mutual relationships with the world and God. Human meaning is rooted in an omega point convergence of the universe. God is intimately revealed in the diversity of creation and is the common destiny of creation Persons use human creative abilities of awareness, enlightenment, and faith. Persons are accountable for the processes of deriving, sustaining, and transforming the universe

ASSUMPTIONS. PERSONS AND RELATING PERSONS

An adaptive

system with coping processes Described as a whole comprised of parts Functions as a unity for some purpose Includes people as individuals or in groups (families, organizations, communities, nations, and society as a whole) An adaptive system with cognator and regulator subsystems acting to maintain adaptation in the four adaptive modes: physiologic-physical, self-concept-group identity, role function, and interdependence.

ASSUMPTIONS
ENVIRONMENT

All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources

Three kinds of stimuli: focal, contextual, and residual .

Significant stimuli in all human adaptation include stage of development, family, and culture

ASSUMPTIONS
HEALTH AND ADAPTATION
Health:

A state and process of being and becoming integrated and whole that reflects person and environmental mutuality.
Adaptation:

The process and outcome whereby thinking and feeling persons, as individuals and in groups, use conscious awareness and choice to create human and environmental integration.
Adaptive

Responses:

Responses that promotes integrity in terms of the goals of the human system, that is, survival, growth, reproduction, mastery, and personal and environmental transformation
Ineffective

Responses: Responses that do not contribute to integrity in terms of the goals of the human system
Adaptation levels represent the condition of the life processes

described on three different levels:

Integrated, compensatory, and compromised

ASSUMPTIONS
NURSING
Nursing is the science and practice that expands adaptive abilities and enhances person and environment transformation. Nursing goals are to promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity . This is done by assessing behavior and factors that influence adaptive abilities and by intervening to expand those abilities and to enhance environmental interactions

ASSUMPTIONS
NURSING PROCESS
A problem solving approach for gathering data, identifying the capacities and needs of the human adaptive system, selecting and implementing approaches for nursing care, and evaluation the outcome of care provided. 1. Assessment of Behavior: The first step of the nursing process which involves gathering data about the behavior of the person as an adaptive system in each of the adaptive modes 2. Assessment of Stimuli: The second step of the nursing process which involves the identification of internal and external stimuli that are influencing the persons adaptive behaviors. Stimuli are classified as: 1) Focal- those most immediately confronting the person; 2) Contextual-all other stimuli present that are affecting the situation and 3) Residual- those stimuli whose effect on the situation are unclear. 3. Nursing Diagnosis: Step three of the nursing process which involves the formulation of statements that interpret data about the adaptation status of the person, including the behavior and most relevant stimuli 4. Goal Setting: The forth step of the nursing process which involves the establishment of clear statements of the behavioral outcomes for nursing care. 5. Intervention: The fifth step of the nursing process which involves the determination of how best to assist the person in attaining the established goals 6. Evaluation: The sixth and final step of the nursing process which involves judging the effectiveness of the nursing intervention in relation to the behavior after the nursing intervention in comparison with the goal established.

Using Roy's Adaptation Model When Caring for a Group of Young Women Contemplating Quitting Smoking Author: Villareal E.

Abstract: This article provides an overview of the use of Roy's adaptation model when caring for a group of young women who were in the precontemplation phase of smoking cessation. The model served as a guide to assess each member's level of adaptation in each of the four modes to identify actual or potential adaptation problems and then examining the stimuli that influence those problems. Nursing interventions focused on approaches to the management of stimuli to promote adaptation for the group by helping the members move to the phase of thinking of quitting smoking. Keywords: Roy adaptation model; nicotine dependence; precontemplation

Pre-amputation assessment using Roys Adaptation Model

Sarah Dawson British Journal of Nursing 7(9): 536 - 542 (14 May 1998)

This article describes the use of Roys Adaptation Model as a framework for the assessment of a 69-year-old man undergoing a right below-knee amputation. The model recognizes that individuals are subject to internal and external stressors which can lead to adaptive or ineffective responses. The practitioner can help the patient to make adaptive responses to these stimuli through nursing interventions. The components of the model are illustrated using the patient as a case study. A comprehensive assessment in the four adaptive modes (physiological, self-concept, role function and interdependence) is undertaken and nursing diagnoses are made.

Empowering adolescent with asthma to take control through adaptation

Abstract Clinical nurse specialists, family nurse practitioners, pediatric nurse practitioners, and pediatric nurses in schools, primary practice settings, and the emergency department are at the front line of caring for adolescents with asthma. By empowering adolescents, these health care professionals can reduce the cost of health care and morbidity for these patients. The purposes of this articles are (a) to discuss adolescence and powerlessness and (b) to identify nursing interventions that can empower adolescents to adapt behaviors that will enhance the prevention of acute attacks and encourage preventive management of the disease process. The article will also discuss current nursing strategies used with adolescents to promote feelings of power and control of medications and treatment based on current national guidelines and the Roy adaptation model.

ASSUMPTIONS
Adaptive Modes Individual Group Physiologic-physical Five needs-oxygenation, nutrition, elimination, activity and rest, protection Four complex processes-senses; fluid, electrolyte, and acid-base balance; neurologic function; endocrine function Operating resources: participants, capacities, physical facilities, and fiscal resources Self-concept-group identity Need is psychic and spiritual integrity so that one can be or exist with a sense of unity, meaning, and purposefulness in the universe Need is group identity integrity through shared relations, goals, values, and coresponsibility for goal achievement; implies honest, soundness, and completeness of identifications with the group Role function Need is social integrity; knowing who one is in relation to others so one can acct; role set is the complex of positions individual holds; involves role development, instrumental and expressive behaviors, and role taking process Need is role clarity, understanding and committing to fulfill expected tasks so group can achieve common goals; process of integrating roles in managing different roles and their expectations; complementary roles are regulated Interdependence Need is to achieve relational integrity using process of affectional adequacy, i.e., the giving and receiving of love, respect, and value through effective relations and communication Need is to achieve relational integrity using processes of developmental and resource adequacy, i.e., learning and maturing in relationships and achieving needs for food, shelter, health, and security through independence with others

Adaptive Modes

Individual

Group

Physiologicphysical

Five needsoxygenation, nutrition, elimination, activity and rest, protection Four complex processes-senses; fluid, electrolyte, and acid-base balance; neurologic function; endocrine function

Operating resources: participants, capacities, physical facilities, and fiscal resources

Self-conceptgroup identity

Need is psychic and spiritual integrity so that one can be or exist with a sense of unity, meaning, and purposefulness in the universe

Need is group identity integrity through shared relations, goals, values, and co responsibility for goal achievement; implies honest, soundness, and completeness of identifications with the group

Role function

Need is social integrity; knowing who one is in relation to others so one can acct; role set is the complex of positions individual holds; involves role development, instrumental and expressive behaviors, and role taking process

Need is role clarity, understanding and committing to fulfill expected tasks so group can achieve common goals; process of integrating roles in managing different roles and their expectations; complementary roles are regulated

Inter depende nce

Need is to achieve relational integrity using process of affectional adequacy, i.e., the giving and receiving of love, respect, and value through effective relations and communication

Need is to achieve relational integrity using processes of developmental and resource adequacy, i.e., learning and maturing in relationships and achieving needs for food, shelter, health, and security through independence with others

Conclusion
The theory or theories selected will need to be reexamined to determine which of its constructs ,or theoretical concepts ,are relevant and of interest to the research study. What behaviors best exemplify these concepts Which observations would best represent those behaviors Items from literature review are then used to substantiate aspects of the theoretical frame work ,and to relate the research question to the theory..