Introduction
This paper focuses on Roy Adaptation Model (RAM). Callista Roy is the founder of this nursing theory. She came up with this model in 1964 in the course of her graduate studies at the University of California. Sister Callista Roy studied together with Professor Johnson who was the founder of seminars in advanced pediatric nursing. In these seminars, Professor Johnson used to assert the need for nurses to come up with a concise definition of nursing. In the course of these seminars, sister Callista demonstrated her integrity by declaring that she could offer a concise definition of nursing from her previous study on adaptation. Sister Callista’s definition of nursing revolved around adaptation as an aspect of nursing. The professor was keen on this definition and sought to find out more regarding this definition. Since that time, sister Callista dedicated most of her time in efforts to give further meaning to her definition.
Hence, Professor Johnson’s assertion on the need to provide nursing goals influenced Callista’s efforts in developing a model that could describe the goals of nursing. The model by Callista Roy uses adaptation methods to demonstrate the relationship between nursing and service to society. Nursing based on the RAM model aims at fostering system relationships through protection, acceptance and enhancing interdependence as well as supporting environmental and individual transformations (Roy, 2011a).
How we can utilize this Model
The RAM model by Callista Roy is relevant in the nursing practice from different perspectives. Broadly, we can use RAM in collecting data from patients, identifying physical, psychological, physiological and social needs of the patients, choosing the best method of practice in providing care for the patients, as well as assessing the ultimate results of the entire nursing process (Frederickson, 2011). Collecting data entails obtaining data regarding an individual’s action in relation to the adaptive forms. This forms the first step in every nursing process, and it creates a platform from which stimuli can be assessed. That is to say, we can employ the RAM model to identify both the external and internal stimuli, which are opting to be controlling adaptive actions of an individual. Also, another related use of the RAM model is in nursing diagnosis. Nursing diagnosis entails the examination of physical, psychological and mental actions. We can use the RAM model in creating statements that deduce information from the adaptation of an individual such as the most significant stimuli and conduct. We can utilize the RAM model in goal setting. That is to say, we can be able to establish apparent statements that demonstrate the behavioral consequence of care related to nursing. Further, we can be able to structure the best ways to assist an individual in realizing certain ends using the RAM model. Lastly, RAM creates an avenue in which we can evaluate the success of the nursing intervention and behavior that follows the intervention against expected goals.
Why we chose this Model
We chose the RAM model because its broad nature allows it to be applicable in many nursing situations. RAM is valuable in many nursing cases especially when it comes to the adaptation of patients in their diverse surroundings (Roy, 2011b). Besides, the model has several key concepts and relational aspects, which boosts the empirical accuracy of the model. This model also presents ideas in a logical way although some concepts and phrases do not adequately mirror the nursing practice. Also, the broad nature of RAM makes the model to be valuable in assessing and developing other theories of nursing.
Other Authorities who have used this Theory in their Work
There are several other scholars who have employed RAM as a guide in their work. Henderson, Fogel & Edwards (2003), used the concept of the environmental stimuli identified by RAM as a guide. This study aimed at evaluating tactics that black, American women who suffer from breast cancer employ in order to cope with the condition. This study also sought to establish a correlation between tactics of coping and social demographic aspects (Henderson et al., 2003). Henderson et al. (2003) employed RAM as a conceptual structure by employing the environmental stimuli described by RAM as a guide in his work. First, demographic data including income level, education, age and marital status as well as the duration of stay from the instance of diagnosis acted as the contextual stimuli, in the study. Second, breast cancer diagnosis acted as the focal stimulus and third, the unidentified aspects that could have an impact on patients coping strategies acted as the residual stimuli. While RAM does not recognize any correlation between adaptive response and contextual stimuli the study by Henderson et al. (2003) refuted this point.
The study by Henderson et al. (2003) recognizes search for social support and positive reappraisal as the most prevalent strategies of coping that black, American women who suffered from breast cancer utilized. Eventually, Henderson et al. (2003) pointed out that there was the need to carry out additional research in order to identify contextual variables that could be used to foretell strategies employed by black, American women who suffered from breast cancer. Conversely, some researchers formulated questionnaires out of the four adaptive models of RAM, which would direct the surveys process. First, the work of Zeigler, Smith & Fawcett (2004) gave an account regarding the results of an assessment of a project that sought to establish the experiences of both managers and members of a breast cancer support group that was community-based. Equally, Ramini, Brown & Buckner (2008) conducted a study that sought to establish the nature of adaptive strategies that teenagers suffering from cancer used. Most questions that Zeiglar et al. (2004) employed in order to demonstrate the physiological mode ad some connection with the most agonizing physical difficulties.
Queries involving the actions performed by the support group dealing with breast cancer, as well as levels of satisfaction constituted the role function mode. Similarly, queries to do with emotions and perceptions regarding the body and the individual represented the self-concept mode. Both queries demonstrated that the interdependence mode had some relationship with the quantity and quality that the support group provides to members. In the work of Ramini et al. (2008) queries that mirrored the physiologic mode involved description of experiences by teenagers in the course of treatment during regular days, physical health and the most undesirable effects that occurred to the teenagers upon receiving cancer treatment. Queries related to the function of the campaign, assisting cancer patients, as well as, attitude transformation of the public constituted the role function mode. Equally queries regarding emotions as well as the process of adapting changes that had a relationship with cancer and its treatment formed the cell concept mode. Lastly, the interdependence mode contained questions that had a relationship with the impact of cancer on personal associations.
These two studies by Ramini et al. (2008) and Zeiglar et al. (2004) concur with the model of RAM regarding adaptation. These scholars demonstrate that adaptation occurs in relationship with four interconnected behavior modes which include self-concept, physiologic, interdependence and role function. The most efficient actions that the support group of the breast cancer presented included social support, sharing experience and information, as well as emotional support. Also, Ramini et al. (2008) concurred with the model of RAM by demonstrating that adaptive behavior is a costly reaction to every change. Young adults, together with adolescents, gave accounts of valuable adaptation through their actions of having positive attitudes and managing body changes, which could be connected to cancer and its cure.
Overall Significance of the Theory
RAM model obtains preference of use among many scholars due to its capacity to combine different aspects of adaptations among people, that is to say, RAM can offer a valuable structure to evaluate the adaptation of persons despite their demographic and geographic differences. This model also provides a framework in which different forms of stimuli that have the capacity to influence the adaptation of an individual can be discovered. Since RAM is a broad model, many scholars use it as a conceptual framework to investigate different aspects of nursing in their work. Besides, other scholars use RAM as an outline to direct the interviews in their work.
Nursing Situation
Mohammed got involved in an accident, two months ago, which left his leg amputated. Mohammed works as an electrical engineer and his insurance cover, of 5 years, expired last year. The firstborn in Mohammed’s family is Osman, who is 13 years old and expecting to join high school next year. The second born is Abdul, who is five years old. Mohammed’s wife, called Nasra, is expectant, and she is a housewife. Amina, who is Mohammed’s mother, has an acute exacerbation of the chronic obstructive pulmonary disease. Mohammed’s father died two years ago after he got involved in a similar accident. The entire family has a strong commitment to the Islamic religion.
Such a nursing situation requires integration of many aspects of nursing, and thus, the application of RAM is most appropriate in establishing the best method of practice in providing care for this patient. In this case, we will use RAM in assessing the physical, psychological, interdependent and social behavior of the patient as well as choosing the best method of providing care to this patient.
Psychological State of the Patient
From the information above, it is clear that Mohammed is undergoing lots of psychological issues. First, Mohammed is a devout Muslim, and he is wondering why Allah did not save him from the accident. He feels disconnected from the entire Muslim community as he cannot participate in most religious events, due to his condition. Second, Mohammed fears that his condition may worsen due to a lack of hospital care, as his insurance cover expired. Third, Mohammed fears that his children will stop schooling due to school fees and that his mother’s condition may deteriorate due to inadequate care. Fourth, his father died from a similar accident, and thus he also fears that his condition will exacerbate, leading to his death. Thus, Mohammed feels unwanted in the universe as he cannot participate in most community events. Besides, he holds little meaning to life because he knows that he will eventually die, just like his father dies.
Physiological Behavior of the Patient
The patient does not have any problems with breathing, feeding or resting. However, the patient cannot engage in activities that require movement due to the amputation of his leg. In other words, some neurological functions of the patient are disabled. As a result, the patient cannot perform some basic skills such as shopping and cleaning the environment as he is in a wheelchair. Besides, the patient cannot wash his clothes, although, he can bathe alone.
Interdependence of the Patient
The patient depends on his family and friends in the Muslim community for love and value. The patient works as, an electric engineer, and this is how he has been able to provide for his family. The Company where the patient works encourage workers to ensure their lives and the patient had insurance that expired last year.
Social Integrity
The patient knows that he is the head and breadwinner in his family. The patient takes care of his sickly mother and pays school fees for his two children. The patient embraces interaction, particularly with his Muslim brothers.
The Best Method of Providing Care to this Patient
First, we recognize that Mohammed needs to adapt physically so that he can fit well in the environment. Hence, we will refer him to a physician who will offer him crutches and instruct him on how to use crutches effectively. This will enable Mohammed to move around and participate in religious activities that involve few movements. Besides, he will be able to perform the most basic activities.
Second, we recognize that Mohammed has some psychological fears. We will offer him and his family counseling, with the aim of ensuring that his mind is at rest. Besides, we will assure him that he will get better and eliminate any fears and thoughts of death, by providing many examples of persons who have experienced similar conditions and survived. Besides, we will persuade Mohammed’s family at home to share their worries with us, and we will try to find viable solutions to their problems.
Third, we will ensure that Mohammed’s surroundings are clean and calm, in order to help him alleviate anxiety. We will also pay regular visits to Mohammed’s site of amputation for assessment purposes.
Following the accomplishment of these procedures, we will evaluate the success of the nursing intervention and behavior that follows the intervention against expected goals.
Strengths and Weaknesses of RAM Theory
A key strength of RAM theory is its ability to offer patients with holistic care. The model can help Mohammed, and his family to adapt to situations that are psychological and physiological in nature, besides physical situations. Besides, the model creates room for evaluation of expected goals following the intervention.
Conversely, this model is unable to establish viable solutions to all situations. For instance, we are unable to assist Mohammed and his family to solve their financial concerns. Besides, this method does not emphasize the need to collect historical data about the patient. For instance, we do not realize whether Mohammed is under any medication or not.
References
Frederickson, K. (2011). Callista Roy’s adaptation model. Nursing Science Quarterly, 24(4) 301-303.
Henderson, P., Fogel, J. & Edwards, Q. (2003). Coping strategies among African-American women with breast cancer. Southern Online Journal of Nursing Research, 3, 1-20.
Ramini, S., Brown, R., & Buckner, E. (2008). Embracing changes: Adaptation by adolescents with cancer. Pediatric Nursing, 34, 72-79.
Roy, C. (2011a). Extending the Roy adaptation model to meet changing global needs. Nursing Science Quarterly, 24(4) 345–351.
Roy, C. (2011b). Research based on the Roy adaptation model: Last 25 years. Nursing Science Quarterly, 24(4) 312– 320.
Zeigler, L., Smith, A.P. & Fawcett, J. (2004). Breast cancer: evaluation of the common journey breast cancer support group. Journal of Clinical Nursing, 13, 467–478.