The “Callista Roy Adaptation Model” for Nursing started during the time Sr. Callista Roy started he masteral program in the pediatric nursing University of Los Angeles, California in 1964. On that time she was under the guidance of Dorothy E. Johnson who serve as her advisor and seminar faculty. Upon reading her teacher’s work on the need to define the goal of nursing as a way of focusing the development of knowledge practice, she was impressed. Even if she had just read a little about the concept of adaptation and was impressed with the resiliency of children she had cared for in pediatrics. Her advisor inspired her to develop on a concept of adaptation as a framework for nursing. One of the significant model used to developed this model by Roys’ was the concept 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. (Meyer, 2005)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. (Meyer, 2005)Approach to the Development of Nursing Knowledge.In the process of analysis of concepts, two main thoughts can be identified: the essentialist and the evolutionary. In the first, the purpose of analysis is to define the concept of interest in terms of its critical attributes or “essence”, whereas in the evolutionary thought, one considers concepts as being dynamic, “indistinct” rather than finite, absolute and “clear crystal”, dependent on the context, and having pragmatic usefulness or purpose.The concern for the development of concepts becomes even more important when we report to its use in nursing theories. In them, some concepts are considered central, such as person, environment, health and nursing. According to what has been previously exposed, these concepts suffer variations in their definitions according to the view of the theorist.Specifically with regards to the environment concept, Roy asserts that there are at least four different ways through which it is examined in nursing studies. In the first approach, the concept is called under specified meta-paradigm construct, which is compatible with the notion of environment as a mediating presence. The second view sees environment as the communicative context, that is, the phenomena under study exist in the social and historical position of the person. The third way to conceptualize the environment is to define it as social positions of an open field, where the nurse’s social position can be seen as positive when related to patients and negative for the profession’s institutional subordination to medicine. Lastly, the environment is still conceptualized as a survey list of extraneous variables, where effects that modify the variables of a hypothesis diminish the generalization of theoriesFour Essential Concepts of NursingThis model is comprised of the four domain concepts of person, health, environment, and nursing and involves a six step nursing process. Andrews & Roy (1991) state that the person can be a representation of an individual or a group of individuals. Roy’s models see the person as “a biopsychosocial being in constant interaction with a changing environment” (Rambo, 1984). The person is an open, adaptive system who uses coping skills to deal with stressors. Roy sees the environment as “all conditions, circumstances and influences that surround and affect the development and behavior of the person” (Andrews ; Roy, 1991). Roy describes stressors as stimuli and uses the term ‘residual stimuli’ his model is comprised of the four domain concepts of person, health, environment, and nursing and involves a six step nursing process. Andrews ; Roy (1991) state that the person can be a representation of an individual or a group of individuals. Roy’s models see the person as “a biopsychosocial being in constant interaction with a changing environment” (Rambo, 1984). The person is an open, adaptive system who uses coping skills to deal with stressors. Roy sees the environment as “all conditions, circumstances and influences that surround and affect the development and behavior of the person” (Andrews & Roy, 1991). Roy describes stressors as stimuli and uses the term ‘residual stimuli’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 interdependenceENVIRONMENT· 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 cultureHEALTH 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 compromisedNURSING· 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 interactionsNURSING 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 provided1. 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 modes2. Assessment of Stimuli: the second step of the nursing process, which involves the identification of internal and external stimuli that are influencing the person’s 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 stimuli4. 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 goals6. 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.Relationship among the Four Concepts gives an important aspect that human being needs such as biological, psychological and social need in order to adapt to its environment and attain great good health. The sources of this problem are the internal and external variables. The internal variables include the biological, psychological and cognitive. The biological source involves the genes of the human being, their sex and age, and its developmental level. The psychological problem involves mind and body interaction and self-concepts. The cognitive problem involves the lifestyle choice and spiritual religious beliefs. The sources of problems under the external variables are the environment. The climate, the surroundings and the geographic locations are some of the factors in the environment, which affects the adaptation of human being. The standard of living involves hygiene, food habit and propensity. Family and its cultural belief is also one of the external variables. The social support network involves the job satisfaction. These are the sources of problem that is beyond the control of human being. It is better to know this problem to avoid the illnesses that experience by human being.This theory of adaptive model is applicable to modern nursing. Roy’s work focuses on the increasing complexity of person and the environment self organization and on the relationship between the persons universe and what can be considered as Supreme Being or god. Since the focus of this model is the stability in health.The short fall of this concept model is that, Sister Callista Roy philosophical assumption “Person and earth are one and that they in god and of god” is not being defined or relate it clearly with the four concept of the adaptation model. It also lack of the three aspect of wellness like the occupational, spiritual and environmental.The internal structure of the conceptual model is logically consistent. With sights to improvement of this difficulty, we highlight the application importance of theoretical landmarks for a better knowledge construction in nursing, in intention of deepening the rendered assistance. The adaptation model utilization, presented validity and applicability in the study at issue, once it enabled the determination of important aspects for the nursing assistance the women with angina pectoris, considering them like a biopsychosocial, adaptive and holistic being. It contributed of significant form for the proposed goal, enabling a vision enlarged of the theory of Sister Callista Roy, elucidating her importance of the same for the nursing development, in the teaching, research and assistance scopes.The conceptual model is socially congruent. Because of the purpose of the theory is to promote adaptation in the environment based on the four modes. The person is affected by environmental stimuli. The focal stimulus is a change immediately confronting the person that requires adaptive response. Accompanying the focal stimulus are contextual and residual stimuli, which mediate and contribute to the effect of stimulus. It is socially significant, because it helps to develop the social interaction of the client to the family and to the other people or to the community, which is essential part of the society.The model leads to nursing actions that make the important differences in the client’s health status. The goal of nursing is “to promote adaptation by the use of nursing process, in each of the adaptive modes, thus contributing to the health, quality of life and dying with dignity. The criterion for judging when the goal has been reached in generally any positive response made by the recipient to the stimuli present that frees energy for responses to other stimuli.” The goal of adaptation is fostered through nursing assessment and intervention, with the client as an active participant.The over all contribution of these adaptation gives the nurse, student nurse and client in the community to realize the importance of being able to adapt the dynamically changing human nursing by providing the four modes or concept which is important in improving the client health status. The goal of Callista Roy model to enhance life processes through adaptation in four adaptive modes. References:Andrews, H., & Roy, C. (1991). The Adaptation Model. Norwalk: Appleton & Lange.Mckenna, Hugh (1997) Nursing Theories and Model. London: Routledge. 8:223-243Meyer, Kate (2005) The Roy’s Adaptation Model. Last Modified: December 5, 2005. Boston College. Available online : www2.bc.edu/~royca/htm/ram.htmRambo, B. (1984). Adaptive Nursing. Philadelphia: W.B. Saunders CompanyRoy C. (1995) Developing nursing knowledge: practice issues raised from four philosophical perspectives. Nurs Sci Q. * (5) 79-85.SciELO Brazil (2005) Historical evolution of the concept environment proposed in the Roy adaptation model. Last Modified: November 22, 2005. . Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo. Available online: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692006000200016&lng=es&nrm=&tlng=en
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