Untitled Essay, Research Paper

Roy began work on her theory in the 1960s. She drew from existing work of

a physiological psychologist, and behavioral, systems and role theorists.

She was keenly interested in the psycho/social aspects of the person from

the start and concentrated her education on this aspect of Person. Thus,

the language/thinking of psychology and sociology became second nature to

her. The need for intense study of the language and ideas behind Roy’s Adaptation

Model is its biggest drawback in applying it to many clinical areas. The

confusion in the physiological mode’s categories could be explained by her

concentrating on the psych social during her education.

In 1980, Roy and Reihl advocated a single unified model

of nursing and suggested this would insure stability of the discipline of

nursing. They maintained concepts and propositions of other models could

be combined in summary statements related to person, goals of nursing and

the nursing process. According to Fawcett, this position is a simplistic

solution to a difficult problem. Nursing, with its limited experience with

metaparadigms and conceptual models, is not ready for restrictions on its

ways of thinking. It’s my belief that this act of advocating a single unified

model was an act of multi-oppressed thinking influenced by men, the Roman

Catholic Church and the medical world.

During a 1987 conference of nursing theorists, Sister

Roy made a number of deferring remarks to a speech made earlier by a male

Bishop.

Fawcett also says the Roy Adaptation Model has an extensive Page 2

vocabulary and that some familiar words (ie adaption) have been given new

meanings in Roy’s attempt to translate mechanistic ideas into organismic

ones.

Oppressed Group Behaviour:

-assimilating the values and characteristics of the Oppressors.

-Nursing leaders represent an elite group promoted because of their allegiance

to maintaining the status quo.

-leaders of Oppressed Groups are controlling, coercive and rigid.

Oppressors:

-education is important to maintaining the status quo.

-Roy’s Model follows the Medical Model and tends to be Totalitarian and therefore

is familiar to Medicine – they would want to encourage it.

-behaviour preferred by Oppressors is rewarded.

-token appeasement (approval) is given to halt change or revolt.

The contributions of this conceptual model are that it

will lead to more systematic assessments of clients and an increased quality

of nursing practice. It could foster nursing knowledge through organized

research and it could provide a more organized curriculum.Roy’s definition of person

Roy defines the person as an Adaptive Open System. The

Systems’ Input is: a) three classes of stimuli: focal, contextual and residual,

within and without the system and b) the systems’ adaptation level or range

of stimuli in which responses will be Page 3

adaptive. Inputs are mediated by the systems’ Regulator (psychological) and

Cognator (Psych/social aspects of person) subsystems. The system runs into

difficulty when coping activity is inadequate as a result of need deficits

or excesses. System effectors (body organs that become active with stimulation)

are the four modes (physiological, self concept, role function and

interdependence) that the Cognator and Regulator can demonstrate activity

through. Output of the person as system may be adaptive or ineffective. Adaptive

responses contribute to the goals of the system ie: survival, growth promotion,

reproduction and self mastery. Ineffective responses do not contribute to

the systems’ goals.

The person receives nursing care. Roy implies the client

has an active role in care and that he is a bio-psycho-social being who

constantly interacts with a changing environment.

The focus of nursing is the person. Roy in 1978, commented

that although the model may be applied to family, community in society it

was developed specifically for the person (medical model influence -

Totalitarianism)

Perception links the Cognator and Regulator. Inputs to

the Regulator are transformed into perception. Perception is a process of

the Cognator, responses following perception are feedback into both the Regulator

and Cognator.

Of the Cognator, there are three modes described by Roy.

Self concept is the need for psychic integrity and perception of worth.

Role function is the need for social integrity, and interaction Page 4

with others. Interdependence is the balance of dependence/ independence with

others.

I like the concept of person as open systems and the concept

of dividing ’stimuli’ into focal, contextual and residual categories. There

is definitely a need for more emphasis and understanding of the person’s:

cognitive coping mechanisms.

Again, Roy tends to imply that the person/adaptive system

is reacting to and trying to ‘fit’ into his surroundings – another manifestation

of the Roman Catholic fatalistic view of mankind.

Persons, family, communities are capable of affecting

their environment and letting it affect and expand their capabilities at

the same time. It does not have to be ‘God’s Will’. For example a person

does not have to accept that he and his will be struck down by bowel CA,

or heart disease. A change in diet, exercise, decreasing stress and not smoking

will allow them to alter their future. Because the medical model is so dependent

and fixated on treating pathologies, the public has gradually neglected or

given up their ability to protect themselves against disease.

Think of the health care system or the prevailing medical

model as the oppressor and the public as the oppressed. There is a clear

understanding that the content of education/information is just as crucial

to an oppressed group as access to it. Self esteem, or faith in their own

ability to care for themselves and make the right decisions; is low. The

doctor or nurse always knows or is right. For example, in the PACU, when

we question some patients about their past health and how they feel now,

it’s very common to Page 5

hear ‘I don’t know, you should ask my doctor.’ When they are reassured that

it is their opinion I want, they will answer. If I express surprise that

they have suffered so much, for so long, they often say something to the

effect of: “I figured if the doctor wanted me to have more treatment/painkiller,

he would have given it to me.”

To paraphrase H. Jack Geiger, a civil rights worker: “Of

all the injuries inflicted on the oppressed people, the most corrosive wound

within, the internalized oppression that leads some victims, at an unspeakable

cost to their own sense of self, to embrace the values of their

oppressors.”Roy – Health

Roy’s original model says that health is on a health-illness

continuum from wellness to death. The degree of health or illness that the

system experiences is an inevitable dimension of a person’s life. The Roman

Catholic Church, with it’s fatalistic view of Human Life may have influenced

Roy.

Currently, Roy defines Health as a process of becoming

an integrated and whole person and a process of being. Health is the goal

of the person’s behaviour and the person’s ability to be an adaptive

organism.

Adaptation is a process of responding positively to

environmental changes. The person encounters adaptation problems in a changing

environment especially in situations of health and illness. Adaptive responses

to pooled effects of focal, contextual Page 6

and residual stimuli are either positive ie: promote integrity of the system

re: goals of survival, growth, reproduction and self mastery, or ineffective

(do not contribute to goals). According to Chin and Kramer, theoretical

conceptualizations of health as a state of adaption implies conforming or

adjusting to environmental stimuli in order to “fit” within the environment.

This suggests that (fatalistic) events external to the person are primary

as a determinant of health and that person and environment are separate entities.

This follows the totality paradigm. Roy’s categorization of systems responses

to a changing environment as adaptive or ineffective indicates health is

seen as a dichotomy (a process of dividing into two mutually exclusive or

contradictory groups). Unhealthy or healthy as seen by the medical model

is another example of totality or mechanistic paradigms. Fawcett says that

no explicit definition of health or illness is given by Roy so it must be

inferred that adaptive responses signify wellness and that inadaptive responses

signify illness.

My view of health is not based as firmly on the medical

model or is as fatalistic as Roy’s. For example: Anesthesia prescribing Valium

pre-op for a normal response to impending surgery and the nurse administering

it because it is an accepted (and quick) way of dealing with pre-op

jitters.

In this case, the doctor and the nurse have decided on a course of action

for the patient in place of providing pre-op answers to questions, different

options and letting the patient expand his ability to manage his state of

health and himself.Roy – Environment/Society Page 7

Environment/Society constantly interacts with the individual

and determines, in part, adaptation level. Stimuli originate in the environment.

The environment: refers to all the internal/external conditions, circumstances

and influences affecting the person, and his development and behaviour.

The internal and external environment provide input (or

stimuli). The environment is always changing and interacting with the person.

The stimuli are divided into focal; contextual and residual categories.

Focal stimuli immediately confronts the adaptive system ie: an M.I., a death

in the family. Contextual stimuli or “background stimuli” is genetic makeup,

sex, maturity, drugs, alcohol, tobacco, self concept, role function,

interdependence, socialization, coping mechanisms (Cognator and Regulator),

physical and emotional stress, culture, religion, environment. Residual stimuli

are beliefs, attitudes, experiences, traits which may be relevant but effects

are indeterminate and therefore cannot be validated.

Roy’s general idea of the role Environment/Society play

in the effects on the person make it seem like the person is a fairly passive,

adaptive system – only reacting to stimuli from his environment, but not

affecting it. My own earlier comments on Environment/Society are basically

the same. I’s like to emphasize that I’ve become more aware of the fact that

Human beings/families/community can also affect or alter their inner and

outer environment. That they don’t have to accept the fatalistic view “that

it’s God’s Will.”, or that Doctors/Nurses know best. Page 8

The best example is the use of the PCA pumps for pain

control. When instructed properly the patient has control over the amount

of noxious, focal stimuli in his inner environment. He does not have the

stress of waiting to see if the health care worker (Dr, Nurse, etc) is willing

to alter his focal stimuli/environment for him. I have found it best in the

PACU to hand over the control of the PCA pump as soon as possible as this

ability to control this one aspect of their environment has it’s own positive

analgesic effect on patients.

During a 1987 lecture at a nursing theorist conference,

Roy made the comment that although it might be the will of the client or

the client’s family to turn off the ventilator, that “the affects on society

as a whole had to be considered, as the Bishop stated in his remarks this

morning.” To me, this appears to emphasize the idea in Roy’s work that the

person, as a adaptive system is only to be affected by external stimuli (in

society, environment, R.C. church) and is not affecting his environment/society

equally, that he should accept his fate.Roy – Nursing

According to Roy, the Nurse using the Nursing Process,

promotes adaptation responses during health and illness to free energy from

ineffective/inadequate responses to increase health and wellness. Goals,

mutually agreed on and prioritized, are proposed to meet the global goals

of: Survival/Growth Promotion/Reproduction of race/society/attaining full

potential or mastery of self. Page 9

The nurse uses activities to increase adaptive and decrease

ineffective responses during illness and health. These activities alter or

manipulate the client’s focal, contextual and residual stimuli and expand

his repertoire of effective coping mechanisms.

Nursing focuses on the person (adaptive system) as a biopsychosocial being

at some point along the health-illness continuum. In contrast, Medicine focuses

on biological systems and the patient’s disease. It’s goal is to move the

patient along the continuum from illness to health. Nursing’s goal is to

increase adaptation in four modes of physiological, self concept, role function

and inter-dependence. The nurse acts as an external regulatory force to modify

stimuli affecting adaptation of the system (person). For example; instead

of using the verbal analogue scale to assess whether I’ll continue with I.V.

morphine, I prefer to let the patient decide his care. Is a VAS of 4 O.K.

for him, is he comfortable enough to rest, breath, move and cough?

My views are fairly similar to Roy’s as far as the type

of information that needs to be gathered before setting goals. It’s a good

framework for improving assessments of each patient. The emphasis on the

Cognator (self concept, role function, inter-dependence) is assuming that

all nurses understand the subtle differences between these modes and have

the time to interview patients in depth. This concept of nursing could be

more easily applied to psychiatric nursing, community nursing, or long term

care facilities. Her grouping of needs in the physiological mode are also

a source of confusion and frustration at Mt. Sinai where Page 10

I work. For example: a state of hypervolemia or hypovolemia could be under

Oxygenation and/or Fluids and Electrolytes. The need to do neurovascular

checks could come under Oxygenation/Activity and Rest/or Senses and Neuro

functioning. Roy, herself, has said that in acute care areas, a need to

prioritize and focus on survival is necessary and that adhering to closely

to her model would be cumbersome in such settings.