Legacy, what is Legacy? As a nurse there is history and meaning behind everything that we do and stand for, this is based on our nursing legacy. Merriam-Webster dictionary defines legacy as: “something transmitted by or received from an ancestor or predecessor or from the past” (Merriam-Webster, 2015). The theoretical basis for our nursing interventions and knowledge is wrapped up in the legacy of our predecessors. Nursing Theory is defined by “a belief, policy, or procedure proposed or followed as the basis of action”. Nursing theory is “an organized framework of concepts and purposes designed to guide the practice of nursing” (http://www.nursing-theory.org, 2015).
This paper is based on this writers feelings on which nursing theory is the most complete and utilized nursing theory in the year 2015: Callista Roy’s adaptation model. This paper will reflect on the importance of nursing theory, it will summarize and explain the views of Callista Roy’s adaptation model. This paper will show the conclusion of ideas and understandings identified with the evaluation of Callista Roy’s adaptation model. Section One
The primary purpose of studying nursing theories is to study and test propositions and hypothesis in research to develop scientific knowledge in the field of nursing (Sieloff & Frey, 2007). It is important to understand how nursing knowledge and patient care is affected by the nursing theory that we choose to practice under. In the 2008 Willis et.al. Study and dialog on nursing basis argued that, nursing’s survival as a healing practice may depend on all nursing being able to clearly articulate a central unifying focus. Despite the nursing theory that one might choose to practice under, the unspoken law of do no harm and focus on caring for the patient as a whole continues to be the main focus of all nursing theories. Nursing theories help to guide our decisions as a nurse many using evidenced based research to develop their concepts. Section Two
Callista Roy’s nursing theory of adaptation model acknowledges three types of stimuli (conditions, circumstances, and influences) that affect a patient’s four modes of functioning. These modes of adaptation functioning are identified in 2012, by Callista Roy as physiologic needs, self-concept, role function and inter-dependence. The major concepts of the nursing metaparadigm identified by Roy are; person, environment, health and nursing (Roy, 2009). The argument by Callista Roy is that the relationship between the concepts identified must be blended by the patient in order to adapt to a given situation or illness.
The nurses’ goal should be to promote adaptation in all of the four adaptive modes of the Roy adaptation model (McEwn et al., 2011). This writer chose this theory based on this writers belief of interconnection between all of Roy’s concepts in development of a patients response to a situation, circumstance, or illness. As documented by Chitty & Black (2011), when the demands of an environmental stimuli are too great or a person’s adaptive mechanisms are too low; the person’s behavioral responses are ineffective for coping. Section Three
Callista Roy argues in the 2008 Willis et.al. Study and dialog, that nursing practice (action), and nursing knowledge are interrelated. Furthermore future nursing knowledge and development are reliant on nursing leadership and research. Nursing informatics plays a huge role in the research area of development. This writer feels that without the nursing data collection and quality improvement nursing theories cannot continue to grow. Nursing interventions and practice are key in developing nursing knowledge and the advancement of nursing interventions and care plans. The use of Roy’s Adaptation Theory relates to the patients connections with their external environment and how their environment affects their ability to change (Roy’s adaptation model, 2011).
In reflection of this writers nursing career this writer can recall many patient interactions that illustrate Roy’s adaptation model. First this writer will discuss a case-study that demonstrates the application of Roy’s Adaptation Theory, Mr. M, 89 male. Mr. M was seen in the emergency department for a chief complaint of left lower quadrant abdominal pain and diarrhea. Based on the patients elevated WBC of 16.5 and a positive CT abd/Pelvis identifying Diverticulitis, this patient was admitted to the hospital for antibiotic treatment, hydration and pain control.
During initial assessment of Mr. M. the nurse evaluates Mr. M’s coping methods based on Roy’s four main adaptation concepts. In the concept of physiological needs, Mr. M has been weakened not only by his age, but as well as the physiological aspects of diarrhea and infection/inflammatory state. In the self-concept group we can conclude that Mr. M is making proper health choices by seeking medical care in the emergency department. In the area of identifying role function, Mr. M has a strong relationship with his daughter. Mr. M is a widower, as his wife of 54 years has passed. Finally considering Mr. M’s conceptual interdependence mode, we note that Mr. M was living as an independent person, ambulated without a cane or walker, living approximately five minutes from his daughter.
The next duty of the nurse caring for Mr. M was to identify Mr. M’s response and ability to adapt to external factors described by Roy’s adaptation model. These concepts look at the connections between the person and their environment and how the environment affects the ability of the patient to adapt or function in their everyday world (Roy’s adaptation model, 2011). By blending information gathered through the use of Roy’s adaptation model the nurse was able to identify Mr. M’s ability to change and adapt to a new low residue diet. Through using this model of nursing care the nurse was able to identify barriers to learning and change in Mr. M. Not only by teaching Mr. M about diverticulosis and diet modification, but including his daughter in assisting with accountability, ensuring that his daughter would assist with meal preparation. Mr. M was able to demonstrate his ability to learn by identifying on a list of foods, which were low residue. Mr. M’s overall outcome was a short forty-eight hour hospital stay and no relapses for two years.
The second case-study that will be evaluated by this writer is the study of Mrs. C, 43 female. Mrs. C was seen in the emergency department for pelvic pain, and vaginal discharge. During the nurses initial assessment Mrs. C confided in this writer that she is currently homeless and preforming sexual favors for money to feed her addiction to methamphetamines. Based on the patient’s vaginal swabs it was identified in the emergency department that the patient had bacterial vaginitis. It was undetermined at the time of discharge whether the patient had a sexually transmitted disease. In the concept of physiological needs, Mrs. C. was high risk for continued exposure to sexually transmitted diseases secondary to her addiction and inability to obtain drugs without carrying out sexual favors for cash.
In the self-concept group we can conclude that Mrs. C was attempting to make proper health choices by seeking medical care in the emergency department. In the area of identifying role function, Mrs. C was at risk for continued high risk behaviors as she was homeless without family, financial support, or stability. Finally considering Mrs. C’s conceptual interdependence mode, we note that Mrs. C was an independent person, however was homeless and without shelter most of the week. Mrs. C stayed at a woman’s shelter once a week for a shower and a change of clothes.
The next duty of the nurse caring for Mrs. C was to identify her response and ability to adapt to external factors described by Roy’s adaptation model. These concepts look at the connections between the person and their environment and how the environment affects the ability of the patient to adapt or function in their everyday world (Roy’s adaptation model, 2011). By joining information gathered through the use of Roy’s adaptation model the nurse was able to identify Mrs. C’s ability to change and assist her in modifying her behavior, as well as give her resources to control her addiction. Through using this model of nursing care the nurse was able to identify barriers to learning and change in Mrs. C. Not only by teaching Mrs. C about safe sex as well as treatment clinics for her drug addiction. Mrs. C was ultimately discharged from the emergency department. This nurse was unable to reach Mrs. C at her listed contact number to inform of positive Herpes, and Gonorrhea and Chlamydia swabs. As the patient was homeless there was not an address listed to forward results. Mrs. C was
never seen again in the emergency department where this writer works. The case was turned over to the department of health services for further investigation, which is the law in Arizona. Section Four
In this nurses current role as a bedside nurse in the Emergency department it is crucial that we use all of our skills to develop a plan of care in a short period of time. This means that the nurse has to go through all steps of nursing-patient relationship quickly including the ability to gain information as well as a trusting relationship with the patient. Callista Roy’s adaptation model has been developed to identify a patient’s ability to function and cope in the world that they live in. Roy’s Adaptation Theory assists the nurse in identifying the needs of a patient. This model blends the concepts of nursing and the concepts of real life. Nurses must be able to identify a patient’s ability to change and modify behaviors and or life situations. Roy’s broad model provides a framework for the masters-prepared nurse to reach beyond the basic black and white care of a patient. It provides the ability for the nurse practitioner to address the patient as a whole. Taking into account family, friends and support systems in order to develop a plan of care that will allow the patient to be successful.
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