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Roy’s Adaptation Model (RAM) is a nursing conceptual framework that guides in the assessment of a patient’s adaptation to changeable environment. In other words, the model serves as a guideline for enhancing the ability of nurses to improve a patient’s interaction with both the physical and non-physical environment for effective adaptation as a treatment option. As a result, the framework incorporates nursing processes that directs a nursing practitioner towards offering comprehensive care for patients with various medical conditions. RAM fosters the establishment of common goals and efforts towards attaining those goals.
Implementation of Roy’s Adaptation Model
As suggested by its name, the model’s primary concept is adaptation. Jayasree defines RAM as a process through which humans employ their cognitive and emotional capabilities to discern linkages between perception and the environment (487). In other words, the model suggests that an individual’s wellbeing is a result of bio-psychosocial factors as defined by three mediums referred to as the focal, contextual, and residual stimuli. Focal elements are those that confront a person directly, contextual factors are those that facilitate the focal elements, while residual stimuli are the stimuli that are unknown to an individual.
RAM also proposes that people respond to the above stimuli in two ways; cognator and regulator subsystems. Cognator response system involves the use of four cognitive emotional networks including emotion, judgement, learning, and processing of information. Regulator response system involves automatic body reactions including neural processes through endocrine and chemical adaptation systems (487). Thus, adaptation is achieved when the two response systems, regulator and cognator are activated leading to behaviour change that can be measured through physiological, role function, self-concept, and inter-dependence systems.
Physiological mode encompasses all bodily functions including nutrition, oxygenation, activity and rest, waste elimination, neurological function, electrolytes and fluid, and protection among others. Self-concept involves personal factors including psychological and spiritual. In other words, it entails the perception of the self. Role function incorporates social integrity (487). Lastly, interdependence also involves social integrity including interpersonal relationships. According to Roy, nursing should be aimed at promoting patient adaptation through converting the ineffectual responses and maintaining adaptive responses. Hence, the Roy model incorporates evaluation of stimuli, diagnosis, goals, assessment and intervention.
The table below illustrates the RAM based tool
Case Study Assessment
Sample and Procedures
Jayasree, a senior teacher at the Salalah Nursing Institute at Oman, provides a case study to illustrate the implementation of RAM to a patient with rheumatoid arthritis (486). In particular, he employs the model assessment tool on a patient with rheumatoid arthritis at the Sultan Qaboos Hospital, Oman. As shown in the figure above, the first step involved physiological assessment, which involved evaluation of the physiological body functions. The second step was the analysis of self-concept; the third step was the assessment of the role function, and lastly an evaluation of the interdependence mode.
The next step after gathering patient’s data was the preparation of the nursing care plan that consists of such factors as level one and two assessment, nursing diagnosis, establishment of the intervention goal, and specific interventions. A table was created comprising both the nursing care plan on the horizontal axis and the vertical axis comprised the adaptation-psychosocial mode. The nursing care plan included assessment of behaviour, assessment of stimuli, diagnosis, goal setting, and evaluation.
The results on physiological mode revealed the existence of chronic pain. Assessment on self-concept attested insecurities about body image and low self-esteem. On role function, the client mentioned fatigue, chronic pain, stiffness, unemployment due to her situation, and dependence on other people for all her needs. Lastly, assessment on interdependence also showed such aspects as decreased mobility due to physical deformity, and fatigue that leads to loneliness and social withdrawal. The findings on nursing care plan revealed such diagnosis as chronic pain for physical function, body image for self-concept, altered role performance for role function, and social withdrawal for interdependence. The goals included decrease of pain, boosting of self-esteem, helping the client in effective decision making, and maintaining the patient’s satisfactory social patterns. Interventions were also guided by the goals and they included reduction of the factors causing pain, encouraging the patient to discuss her feelings, and adherence to medication (490-491). The table below summarizes the findings;
Table 1: Findings
Discussion and Recommendation
It is evident that the model is comprehensive as it captures all aspects affecting a person. The in-depth nature of the model makes it in holistic patient care that is effective through identifying the root cause of a particular problem that may be overlooked by normal treatment that only involves the issuance of drugs. The only shortcoming of the model is that it requires skilled nursing personnel who understand the bio-psychosocial aspects that affect people. However, the existence of a simplified model makes its implementation more feasible.
Recommendations for future studies may involve the incorporation of technology in implementing the approach to reach more people given that the world is shifting towards a digital era. In particular, future research should narrow towards technological approaches that can make the model easily accessible to everyone to help in self-diagnosis and online access of psychosocial support. In this way, the application of the model will be more abridged and effective to a wide client base, and the nurses’ role will be more simplified.
Summary and Conclusion
RAM is a nursing model that provides an inclusive framework for problem diagnosis in nursing care. The tool is highly useful for both nursing professional and patients as it applies a bio-psychosocial approach in identifying an underlying problem and offers specific approaches towards solving the problem for better patient care. The framework facilitates better communication among nursing professionals and their patients, offers an inclusive nursing care plan. The current article provides a case study to demonstrate the implementation of the model on a patient with rheumatoid arthritis. The outcomes reveal that indeed the model is comprehensive and effective in problem diagnosis and intervention.
Jayasree, Radhamaniamma. “Nursing Care of Patients with Rheumatoid Arthritis:- An Application of Roy’s Adaptation Model.” Journal of Pharmaceutical and Biomedical Sciences. I27.27 (2013): p.486-492
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