ADAPTATION MODEL

SISTER CALLISTA ROY

Born on October 14, 1939 in LA, California. Entered the Sisters of Saint Joseph of Carondelet after high school Received a Bachelors Degree in Nursing from Mount Saint Marys College in LA in 1963 1964-1966 Conceptualization of Model A MSN in Pediatric Nursing from UCLA in 1966 1966-1983 faculty and administrator in MSMC 1971-1974 chair, dept of nursing, MSMC Masters 1973 and Doctorate degree in Sociology in 1977 1978 Award, fellow of American Academy of Nursing

 1983-1985, Robert wood Johnson postdoctoral fellow at the University of California, San Francisco 1987 nurse theorist at Boston College school of Nursing Holds honorary doctorates from 4 other institutions 1991 Award, National League for Nursing Has published 3 books (1970, 1999, 2008) 1987 present Professor at William F. Connell school of nursing at Boston College, Massachusetts

PERSON

A biopsychosocial being/system in constant interaction with a changing environment. Holistic, adaptive system who uses coping skills to deal with stressors. A whole with the parts that function in unity for some purpose It includes people as individuals or in groups. An adaptive system which has cognator and regulator subsystems which act to maintain adaptation in the four adaptive modes: physiologiphysical,self-concept-group identity, role function, and interdependence

ADAPTATION
Process and outcome whereby thinking and feeling persons use conscious awareness and choice to create human environment integration. Every human life is purposeful in a universe that is creative and persons are inseparable from the environment. The Human adaptive system inputs of stimuli, outputs as behavioral responses that serve as feedback and control process known as coping mechanisms

REGULATOR SUBSYSTEM- automatic response to stimulus (neural, chemical and endocrine) COGNATOR SUBSYSTEM responds through four cognitive-emotive channels ( perceptual and information processing, learning, judgment and emotion) output responses of regulator subsystems can be feedback stimuli to the cognator subsystem.

Adaptive Responses promote the integrity of the human system Ineffective Responses neither promote nor contribute to the integrity of the human system Coping process innate or acquired ways of interacting with the changing environment. (regulator and cognator subsystems) 4 adaptation modes to assess behavior resulting from coping process.

1. Physiologic-Physical Mode Behavior pertaining to the physical aspect of the human system (physiologic integrity) Physical and chemical process Nurse must be knowledgeable about normal processes 5 needs ( oxygenation, nutrition, elimination, Activity and Rest, protection ) individual Basic operating resources (participants, physical facilities and fiscal resources)

2. Self-Concept-group Identity Mode The composite of beliefs and feelings held about oneself at a given time. Focus on the psychological and spiritual aspects of the human system. Need to know who one is, so that one can exist with a state of unity, meaning and purposefulness

2 modes (physical self and personal self) Physical self=body sensation & body image

Personal self=self-consistency, self-ideal and moral-ethical-spiritual self.

Self-consistency-efforts to maintain selforganization Self-ideal-what the person expects to be and do Moral-ethical-spiritual-persons belief system and self-evaluator

Body sensation-how person experiences physical self Body image-how person sees/views physical self

Group-Identity mode need for identity integrity consisting of interpersonal relationships, group self-image, social millieu and culture.

3. Role Function Mode Set of expectations about how a person occupying one position behaves toward a person occupying another position. Basic need- social integrity, the need to know who one is in relation to others so that one can act appropriately. Individual- role in society Group- role clarity (functions of members,decision-making systems, etc..)

4. Interdependence mode Behavior pertaining to interdependent relationships of individuals and groups Focus on the close relationships of people and their purpose Each relationship exist for some reason Involves the willingness and ability to give and accept from significant others (love, care, respect) Basic need-feeling security in relationships

ENVIRONMENT
All conditions, circumstances and influences surrounding and affecting the development and behaviors of the person. Stimuli may be focal, contextual and residual. Internal an External

Stimulus (inputs) something that provokes a response, point of interaction for the human system and the environment Focal stimuli internal or external stimulus most immediately affecting the system Contextual stimuli all other stimulus present in the situation Residual Stimuli internal or external factors whose effects are unclear.

HEALTH
A state and a process of being and becoming integrated as a whole person. Reflection of adaptation that is the interaction of the person and the environment The integrity of the person = ability to meet the goals of survival, growth, reproduction, mastery and person and environment transformation.

NURSING
Acts to enhance the interaction of the person with the environment to promote adaptation A science and practice that expands adaptive abilities and enhances person and environmental transformation.

1. Assesses behavior manifested from the four adaptive modes 2. Assess the stimuli and categorize them into type of stimuli & responses 3.Create a nursing diagnosis of the persons adaptive state 4. Set goals to improve adaptation (behavior to be observed, change,time frame) 5. Implement interventions to achieve goals (change stimulus) 6. Evaluate if goals have been met

E.g. A man in his 50s with history of diabetes had his leg amputated. Physiologic mode A: Focal stimulus: limitations for movement /ambulate Contextual stimulus: amputation of limb D: Impaired mobility r/t amputation of limb G: Patient should be able to verbalize understanding of situation and demonstrate rehabilitation measures

I: health teaching (safety measures, use of assistive devices) participation in self-care activities E: verbalization of understanding proper demonstration of rehab measures Interdependence Adaptive Mode A: patients significant other is his wife. Wife is emotionally distant. Focal Stimulus: emotionally distant wife Contextual Stimulus: ineffective communication skills and limited time together

D: Interrupted family process due to illness G: family members will verbalize feelings toward patients illness freely and appropriately I: Stress importance of communication encourage wife to assist in caring for husband (back rubs-pain) E: improved communication; wife performs caring behaviors; decision to spend more time together

Self-Concept Adaptive Mode A: patient was afraid of dying, believes that illness is a punishment from his past behaviors; relatives died of cancer. Focal stimuli: fear and anxiety of dying Contextual stimuli: disease complication; witnessing other family members death as a result of disease D: fear and anxiety of dying related to complications of diabetes and witnessing family members death G: Fear and anxiety will be decreased aeb relaxed mood, verbalization of new coping strategies

I: encourage ventilation of feelings; suggest new coping strategies; encouraged to attend meeting of support groups of diabetic amputees E: Role Function Adaptive Mode A: identify role of patient focal stimulus: fear of not being able to care for self and significant other in the future. Contextual stimulus: chronic illness, amputation of limb, increased dependency on others

D: Ineffective Role performance related to amputation of limb and increased dependency on others G: Effective Primary Role transition as manifested by willingness to allow others help him and a desire to resume self care activities as he becomes able I:encourage patient to rely on his support system for help when needed; positive reinforcement for accomplishment of self care activities; stress importance of maintaining independence with patient and family member. E: wife exhibits supportive behavior; patient can perform some self-care activities by himself.

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