Read
over chapter 7-8 and select 2 grand theories or models. In your own words
summarize the main components of each of these models/ theories. Identify at
least 2 strengths and weakness of the models/theories in light of clarity and
practical value.
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 to 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
to coping with illness (Roy, et al., 2009). Sister Roy’s adaption model is
valuable theory used in nursing practice and research because, it assist the
nurse in identifying areas in a patients environment, soul and biological
functions that the nurse has control over to assist a patient towards health.
Roy model
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 in development because, it incorporates numerous other
theories, the theory is abstract in nature, and attempts to define global
aspects of the nurse’s role in overcoming obstacles a person may be challenged
with to achieve health (Tiedman, 2006). Roy’s model has many concepts, which
would benefit nursing practice and knowledge with future research and
development of the hypothesis presented within the model.
Sister Roy’s
model is set on the premise of patient centered care that focuses on the entire
person rather than a set of symptoms (Roy, et al., 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). The goal of every nurse is to assist a patient to navigate the situation
they are placed in when the patient becomes ill. Sister Roy’s model aids the
nurse in identifying environmental and internal factors that influence a person
behavior to aid the patient in coping with illness.
Roy believes
that the environmental surroundings and events of life affect the growth and
development of the person (Roy, et al., 2009). Roy defines three types of stress
the individual must overcome 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. Roy defines contextual
stimuli as outside changes that influence the situation. Roy defines residual
stimuli the norms, attitudes of the individual person that may affect the person’s
health (McEwen & Wills, 2011). Roy’s theory asserts that the nurse can help
the patient learn to effectively cope with stimuli faced in their environment
in order for the patient grows as an individual. With the nurse assistance the
patient in essence develops coping mechanisms’ that can be applied to all
aspects the patient life.
Roy defines two
internal coping processes in which a person has to use to cope with the
constant stresses in the environment. The first control process is the
cognitive subsystem; this is a person’s cognitive functions such as brain
processing, judgment, learning and emotion (McEwen & Wills, 2011). The
second process is regulator subsystem, this adaptive process is based 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 areas of physiological, self concept, role
function, interdependence (Tiedman, 2006). By identifying and naming abstract
concepts such as adaptive behaviors in patients it created knowledge about
patient care that was not readily available to apply to practice before the
creation of the model.
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’s 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
practical and useful. Roy’s model takes the abstract concept of coping
strategies, 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, et
al., 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). Roy’s model is also a mandated by the Joint commission
for planning the care of all patients in the hospital. Roy’s model is taught at
the fundamental levels of most nursing educational programs.
The adaption model
is the basis for care planning, which is used in the hospital, long-term care,
and community settings. The adaptation model allows the nurse to incorporate
spiritual beliefs into patient care without bringing the nurse’s own beliefs
into the plan of care (Roy, et al., 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, et
al., 2009). The adaptive model helps the nurse gain understanding of the entire
person.
A weakness
indentified about Roy’s theory is inconsistency in the concepts and terms
described in the model (Tiedman, 2006). Another weakness identified is the area
of time constrain because, it could take considerable amount of time for the nurse
to gain the experience and knowledge necessary to implement the model (Tiedman,
2006). With the recent push 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, et al., 2009). Further research on Roy’s model could
become invaluable to future nursing knowledge. Areas of nursing that are in
their infancy such as treating soldiers that have returned from combat and
adoptive children with childhood attachment disorders are areas that Roy’s
model could provide valuable information through research and application of
the model.
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. Examples of social systems include: government,
religion, education, and hospital environments (King, 2009). These social systems have multiple variables
that affect 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 healthcare
provider (King, 2009).
With the
increased advancement of technology, healthcare professional have control over
many aspects of life and death. Each person faces increased government
involvement in healthcare, which revolves around aspects of possibly rationing
health care (King, 2009). King asserts nurses have a greater ethical
responsibility than ever before in history to help patients navigate the
healthcare system (King, 2009). There has been 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 implemented to meet the needs of patients (King, 2009). Kings theory
gives the nurse a blue print in which to navigate a complex health care system.
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
patients bills of rights, code of ethics and standards of clinical practice,
and nurse care planning (King, 2009). The premise of King’s theory is that each
person is a unique whole individual that has the right to make informed
decisions about their health care (King, 2009). If a patient is an active participant
in their own health care plan, by setting personalized health care goals, there
is a greater chance goal attainment will be achieved (King, 2009). The nurse’s
role is to establish a therapeutic relationship with the patient sharing knowledge
allowing the patient to make informed health care decisions.
King’s theory is
based on the understanding the nurse patient relationship assist the patient to
grows and develops in order to reach a goal (King, 2009). The goal of the nurse
should always be the healthcare goal of the patient (King, 2009). The interaction that occurs between the nurse
and patient is the premise 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 affect 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.
King’s 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 to 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 et al., 2009). The second area King
defines is health. King defines health as the ability of a person to adjust to
continuous stressors in the environment (Clark et al., 2009). The third area addressed in King’s model is
the environment (Clark et al., 2009). King
believes that every person is subject to two environments, the external and
internal. The fourth concept of King’s theory is nursing (Clark et al., 2009). In King’s model when a therapeutic
relationship is established between the nurse and patient, the challenges to a
patient’s health can be overcome and health is achieved (Clark et al., 2009).
King’s 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 healthcare 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). King’s model has several strengths, it is logical, orderly, and the
terms are clearly defined and understandable (King, 2009). Also King’s theories are clearly defined and
testable in future research (King, 2009). King’s theory if beneficial in
conceptualizing an ideal nurse patient relationship, in which all nurses,
should strive to achieve. With the increase use of technology nursing scholars
need to continue to add to the knowledge of King’s theories to adapt to a new
healthcare environment.
References
( Clark, Kileen, Messmer, Sienloff, 2009).
