The Roy Adaptation Model (RAM) was created by Sister Callista Roy in 1964. Its development has been dynamic since then to become one of the most instrumental nursing models in the twenty first century.Many nurses worldwide practice nursing from the perspective of RAM.In this Paper, I'm going to take an overview of the Roy Adaptation Method and do an evaluation by taking a case study of an 82-year old patient (Mr. T.J) who has been suffering from chronic obstructive pulmonary disease (COPD), which is a progressive and irreversible condition characterized by diminished inspiratory and expiratory capacity of the lungs. The condition is aggravated by cigarette smoking and air pollution. The condition is usually caused by smoking and includes a few lung diseases, the most common being chronic bronchitis and emphysema.COPD is characterized by feeling short of breath, wheezing, frequent, long-lasting lung infections (the flue, pneumonia, etc) and feeling tired (fatigue).
According to Roy Adaptation Model, nursing
involves enhancing the interaction between the person and the environment to promote adaptation.RAM provides an effective way for providing nursing care to individuals in bad health and in acute, chronic and terminal illness. The Roy Adaptation Model views a person as an adaptive system in constant interaction with an internal and external environment, the environment being the source of stimuli that threaten or promote the wholeness of the individual. The person's main duty is to maintain integrity in the face of these environmental stimuli. Adaptation is the degree of wholeness achieved by adapting to changes as the need arises (Roy and Andrews, 1999, p.102). In RAM, these stimuli are categorized as focal, contextual or residual.
In RAM, this is defined as the internal or external stimulus that most immediately challenges the adaptation of the individual and is the one that attracts most of one's attention while contextual stimuli are all other stimuli existing in a situation that strengthen the effect of focal stimulus. Residual stimuli are any other phenomena arising from a person's internal or external environment that may affect the focal stimuli but whose effects are unclear (Roy and Andrews, 1999). According to Roy, an individual's adaptation occurs in four different modes:
The RAM is based on the essence of the following assumptions:Physiological Adaptive ModeIn the RAM, this refers to the way a person responds to a stimulus from the environment and the physiological needs of this mode are: oxygenation, nutrition, elimination, activity and rest and protection.Self-Concept Adaptive ModeThis refers to the physiological and spiritual characteristics of the person (Andrews 1991b; Andrews and Roy 1991a; Andrews and Roy 1999). A person's self-concept consists of all the beliefs and feelings one has formed about oneself and is formed from internal perceptions or from the perceptions of others. This changes over time and dictates one's actions.The Role Function Adaptive ModeThis refers to the roles the person performs in the society including primary, secondary and tertiary roles. A role is then defined as a set of expectations about how a person in one position treats another person in another position I society. Adaptive or ineffective responses result from these two coping mechanisms.Interdependence ModeThis refers to the coping mechanisms that arise from situations involving giving and receiving of love, respect and value (Andrews and Roy 1991a p. 17). This happens between a person and the person's support system- the other most important person to the individual.The main purpose of nursing is to help adaptation thereby promoting health. According to RAM, being healthy is the process of being integrated as a whole where integrity here refers to the soundness or unimpaired state which leads to the completeness of the individual.Adaptation NursingIn RAM, nursing is the science of promoting adaptation to environment for individuals and groups in situations involving health and illness.The central theme in the science of nursing based on RAM is enhancing patient adaptation.In Callista Roy's Role Function Adaptive Model, nursing process "relates directly to the view of the person as an adaptive system" and the following six simultaneous ongoing dynamic steps have been conventionalized:1) Assessment of behavior2) Assessment of stimuli3) Nursing diagnosis4) Goal setting5) Intervention6) EvaluationIn my COPD case study, after administration of medication, I taught the patient Pursed lip breathing, viz: 1)Breathe in through the nose for 1 count 2) Purse lips as if going to whistle and breathe out gently through pursed lips for 2 counts 3) Keep doing pursed lip breathing.
The top two priorities for the patient are: 1) Resting/activity balance and 2) Oxygenation.