While studying
for her master’s degree under Professor Dorothy Johnson, Sister Roy was
challenged to develop a working module of nursing (McEwen & Wills, 2011). Roy believed that nurses had expert knowledge
that would contribute the overall health of society (Roy, Whetsell,
Frederickson, 2009). Sister Roy met this challenge of creating a working
nursing model by identifying theoretical beliefs thought to be true about
nursing, and identifying conditions, objects, and entities within the profession
of nursing that had a relationship (Roy, etal, 2009).
Roy theory
incorporated concepts from other theories to include: Helson’s adaptation
theory, Von Bertalanffy’s system model, Rapport’s system definition, Dohrenrend
and Selye stress and adaptation model and Lazarus coping model (McEwen &
Wills, 2011). Roy placed these concepts in a model that could be applied,
studied, and researched. This module would be known as the Roy adaption model.
Roy’s model is an example of a grand theory because, it incorporates numerous
other theories, abstract in nature and attempts to define global aspects of the
nurses role in overcoming obstacles a
person may be challenged with to achieve health ( Tiedman, 2006).
Sister Roy’s
model is set on the premises of patient centered care that focuses on the
entire person rather than a set of symptoms (Roy, etal, 2009). Roy defines
health as becoming a complete whole person with the ability to adapt to stimuli
in the environment (McEwen & Wills, 2011). All people are in a constant
environment of change and each person has a unique way of adapting and
interacting continuously to the environment of fluctuation (McEwen & Wills,
2011).
Roy believes
that the environmental surroundings and events of life effect the growth and
development of the person. Roy defines three types of stress the individual
must adapt to become whole person, focal stimuli, contextual stimuli, and residual
stimuli (McEwen & Wills, 2011). Roy defines focal stimuli as any stress
that needs urgent attention, contextual stimuli as outside changes that
influence the situation, and residual stimuli the norms, attitudes of the
individual person that may affect the person’s health (McEwen & Wills,
2011).
Roy defines two
internal processes in which a person has to cope with the constant stresses an
individual is assaulted within the environment. The first control process is
the cognator subsystem, this is a persons congative functions such as brain
processing, judgment, learning and emotion (McEwen & Wills, 2011). The
second process is regulator subsystem; this adaptive process is biased on the
chemical processes of a person on a biological level (McEwen & Wills,
2011). Roy believes that these two internal processes result in four adaptive
behaviors by the individual in the area of physiological, self concept, role
function, interdependence (Tiedman, 2006).
Roy asserts the nurse can identify areas that
the patient needs assistance in coping and intercede on the patient’s behalf
through the use of the nursing process to promote a person health and wellbeing
(Tiedman, 2006). Roy defines a six step process for a nurse to identify and
relieve noxious stimuli from a patient environment in order to promote health. The six step process includes: assessment of
behavior and influences on behavior, formulating a nursing diagnosis, goal
setting with realistic attainable goals, interventions to meet those goals,
evaluation of the entire process and revision of goals not obtained (Tiedman,
2006).
Roy’s model is
very practical and useful. Roy’s model takes a very abstract concept coping and
defines it in such a manner that it can be identified, observed, evaluated and
studied (Tiedman, 2006). The adaptation model is effectively used with
individuals, groups, families and communities (Roy, etal, 2009). Roy’s model
has been successfully used by different cultures. Examples include the use in
Japan for the creation of an electronic medical record and in Mexico for nurse
scholars to gain insight into gang violence and Aids (Tiedman, 2006).
The adaption model
is the basis for care planning which, is used in the hospital, long-term care,
and community settings. The adaptation model has many strengths it allows the
nurse to incorporate spiritual beliefs into a patient care without bringing the
nurses own beliefs into the plan of care (Roy, etal, 2009). Roy’s model is
widely used, written about and researched and is continually evolving (McEwen
& Wills, 2011). Roy’s model is one of the first models nursing students
learn and implement (Roy, etal, 2009). The adaptive model helps the nurse gain
understanding of the entire person.
Some weakness
indentified about Roy’s theory is that there is not consistency in the concepts
and terms in the model (Tiedman, 2006). Another weakness identified is the area of
time constrain, because it could take considerable amount of time to implement
the model until the nurse is seasoned in it use (Tiedman, 2006). With the recent pushed towards electronic
medical records many hurdles have been overcome to make Roy’s model easier and
more time efficient, even for the novice nurse (Roy, etal, 2009).
The second model
being evaluated is King’s conceptual system theory of goal attainment and
transactional process. King looked to other disciplines to understand phenomenon
unique to nursing practice. King viewed each individual as a holistic being
that interacts with social systems, example include, government, religion, education
and hospital environments (King, 2009). That these social systems have multiple
variables that effect the decision making process and need to be studied in a
manner that conceptualizes them as a whole (King, 2009). Kings conceptual
theory of goal attainment is a way for the nurse to help the patient navigate
complex healthcare systems and obtain an outcome the patient desires from their
health care received (King, 2009).
With the
increased advancement of technology, health care professional having control
over many aspects of life and death. Each person faces increased government
involvement in health care, which revolves around aspects of possibly rationing
health care (King, 2009). King asserts
nurses have a greater ethical responsibility then ever before in history to
help patients navigate the health care system (King, 2009). There has a no greater time in history when an
individual patient should participate and take responsibility for their
personal health (King, 2009). King’s theory is a conceptual abstract model that
has been demonstrated to meet this increased needs (King, 2009).
King developed
her goal attainment theory by doing a systematic review of literature (King,
2009). King was successful in creating new nursing knowledge (King, 2009). King’s
theoretical knowledge stands out in practice today, some examples are: the
patient bills of rights, code of ethics and standards of clinical practice and
nurse care planning (King, 2009). The premise of Kings Theory is that each
person is a unique whole individual that has the right to make informed
decisions about their health care. If a patient is an active participant in
their own care, by setting personalized health care goals, there is a greater
chance goal attainment will be achieved. The nurse’s role is to establish a
therapeutic relationship with the patient sharing knowledge allowing the
patient to make informed health care decisions.
Kings theory is
biased on the understanding the nurse patient relationship is an interpersonal
relationship in which a person grows and develops in order to reach a goal (King,
2009). The goal of the nurse should always be the health care goal of the
patient (King, 2009). The interaction
that occurs between the nurse and patient is the premises for the nursing
process (King, 2009). For goal attainment to be achieved it requires
superior communication between the nurse and client (McEwen & Wills, 2011).When
the goal is obtained by a patient who is an active participate; the patient has
a greater satisfaction in the health care received and effective nursing care
has occurred (McEwen & Wills, 2011).
King states that
for a nurse patient relationship to be therapeutic the nurse and patient
perceptions, judgments and actions must be aligned with each other (King,
2009). Factors the nurse has to be aware
of that effect achieving symbiosis between the nurse and patient include:
beliefs about roles, stress, and perceptions about space and time (King,
2009). The way the nurse overcomes
incongruent perceptions and miscommunication is by being present with the patient
(King, 2009). The more time the nurse spends with the patient the less likely
communication breakdown will occur.
Kings goal attainment theory was a shift in thinking from many
nursing theories of the time (Clark, Kileen, Messmer, Sienloff, 2009). The first
area King attempted define in her model was the rights of a patient simply by
being human. She defined the human
component of her model as follows: that
every human is able to set goals and achieve them, all patients have the right
to informative health care, that all patients have the right to curative or
preventive health care, all patients have
the right to dignified death ( Clark
etal,2009). The second area King defines is health. King defines health as the
ability for a person to adjust to continuous stressors in the environment (Clark
etal, 2009). The third area addressed in
Kings Model is the environment (Clark etal, 2009). King believes that every
person is subject to two environments the external and internal. The fourth
concept of Kings Theory is nursing (Clark etal, 2009). In Kings Model when a
therapeutic relationship is established between the nurse and patient the other
three areas of her model that may challenge a patient’s health, can be overcome
and health is achieved (Clark etal, 2009).
Kings theory has several weaknesses it is very complex requiring
the reader to shift through large amounts of broad ideas, theories, and
repeated definitions to find and understand basic concepts (McEwen & Wills,
2011). King states that nurses should be concerned about health care and
education of groups but, her model concentrates on a single relationship
between the nurse and patient (King, 2009). King admitted that she wished she
would have included in her theory the spiritual aspect of the individual (King,
2009). Kings model has several strengths
it is logical, orderly and the terms are clearly defined and understandable
(King, 2009). Also Kings Theories are
clearly defined and testable in future research (King, 2009).
References
( Clark, Kileen, Messmer, Sienloff, 2009).
