Roy’s Adaptation Model and Concepts

Nurses constantly seek to achieve excellence in practice. However, unplanned situations can occur and have the potential to result in loss of life or physical or psychological injury. There are other events that do not culminate to harm, but have the possibility to do so. Nonetheless, a sentinel event or near miss in nursing should not be an occurrence to come by. In clinical practice, application of nursing theories can aid in preventing unforeseen circumstances. For this reason, two nursing theories and the primary concept of each theory will be identified.

Furthermore, the summary of a near miss phenomenon and its importance with identifying unexpected incidents in developing critical thinking and decision making in patient-centered practice will be explored.

To begin with, Sister Callista Roy’s Adaptation Model (RAM), “views the person as an adaptive system in constant interaction with an internal and external environment” (Alligood, 2014, p. 264). According to Kaur and Mahal (2013), “the environmental stimuli include Focal, Contextual and Residual Stimuli. The Focal stimuli are the internal and external factors that immediately confront the individual. The Contextual stimuli are defined as internal and external factors that act on person’s perception of focal stimulus, the contextual stimuli are all other stimuli that contributes directly to the individual or a group’s responses. Residual stimuli are unknown factors that may be affecting the individual or group” (p. 60).

In patient-centered care, adaptation exists when individuals respond positively to environmental alterations. Although, when a “person does not respond passively to environmental stimuli; the adaptation level is modulated by a person’s coping mechanisms and control processes” (Alligood, 2014, p. 264). Roy’s Adaptation Model has grouped two coping process called regulator and cognator mechanism (Kaur & Mahal, 2013, p. 60). The regulator subsystem involves “basic neural, chemical and endocrine channels that process stimuli in an automatic unconscious manner” (Kaur & Mahal, 2013, p. 61).

The cognator subsystem incorporate “four cognitive- emotic channels for stimulus: perceptual/information processing, learning, judgment and emotion” (Kaur & Mahal, 2013, p. 61). Essentially, the “behavioral responses of these two subsystems can be observed in any of the four adaptive modes: physiological, self-concept, role function, and interdependence adaptive modes” (Alligood, 2014, p. 265). Nurses encourage individuals to reach optimum health through adaptation to environmental stimuli, which “enables the person to find meaning and purpose in life and to become an integrated whole” (Alligood, 2014, p. 266).

Newman’s Theory of Health as Expanding Consciousness

Margaret Newman’s Theory of Health as Expanding Consciousness “views health broadly as ‘encompassing disease’ and ‘unfolding as expanding consciousness’” (Zahourek, 2006, p. 86). An individuals’ health and illness is one entity and cannot be separated into parts. According to Weingourt (1998), “Newman’s concept of caring permits the caregiver to take time to understand the client’s unfolding pattern by entering into the disorder or disconnection with the client. Nursing actions are part of the process of being with the client, and are not oriented toward a pre-established goal determined by the nurse” (p. 30).

Therefore, the nurse-patient relationship becomes transformative and “a new level of consciousness develops which unites the mind and heart to form a new self-definition” (Wade, 1998, p. 716). As stated by Alligood (2014), “disruptions in patterns of human beings, such as disease or catastrophic life events, often become catalysts that potentiate unfolding of life processes that individuals naturally seek, thereby facilitating movement from one pattern of consciousness to another and transformation into order at a higher level—or expanded consciousness” (p. 396). The psyche is a powerful tool and transformation is to be embraced for an “individual becomes acutely aware that old ways of thinking and acting no longer work” (Wade, 1998, p. 716).

Near Miss Event

The knowledge gained from nursing theories can be applied in clinical practice. In the acute care facility, change of shift can be a chaotic and challenging moment. The continuous sound of telephones ringing and patient call lights loudly interrupting nurse-to-nurse handoff occurs on a daily basis. Near miss events may not be planned, but occur quite often in nursing practice. Medication errors are circumstances “defined as any preventable event occurred at any stage of drug therapy being related to professional practice, healthcare products, procedures and systems, which may or may not cause any harm to the patient” (Bereta Vilela & de Carvalho Jerico, 2016, p. 120).

The night shift was coming to an end and nurses were busily giving report. The night nurse reported that patient A’s intravenous fluids were running low and input an electronic request to pharmacy for the next dose. The request was fulfilled and the liter bag was placed in its designated locked area. Two hours later, patient A communicates that the intravenous fluid bag required an exchange. Upon arriving to the locked medication room to retrieve the dose, it was discovered that the bag of fluid vanished. Later that day, a nurse disclosed that another night nurse infused patient A’s intravenous fluid to a different patient. In a moment of shock, the shift supervisor was informed and an incident report noted.

It is imperative to utilize therapeutic communication and be truthful to the patient. With Newman’s theory, “the responsibility of the professional nurse is to establish a primary relationship with the client for the purpose of identifying meaningful patterns and facilitating the client’s action potential and decision-making ability” (Alligood, 2014, p. 399). Allow sufficient time for the patient to process the information and cope with the progression of events. The immediate response to this particular situation may not be a positive one, thus, coping by process of cognator mechanism with the use of Roy’s Adaptation Model. To prevent a near miss from occurring again it is important to adhere to state regulations, facility protocols and procedures, and assess the patient’s mental capacity with regards to adaptability and consciousness.

Conclusion

The health care system has gradually developed over the years, therefore, identifying sentinel events and near misses can bring forth positive changes. Rather than dwell on what has already come to past, use the situation as a learning opportunity. Do not make room for human error, but do not completely rely on the advancement of technology either. A near miss should be taken as seriously as a sentinel event. Patients look to nurses for health protection and guidance. The application of nursing theory in clinical practice is not an option, but becomes a requirement when finding resolutions in an unplanned event.

References

1. Alligood, M. R. (2014). Nursing theory: Utilization and application (5th ed.). Louis, MO: Elsevier.
2. Bereta Vilela, R. P., & de Carvalho Jerico, M. (2016). Medication errors: Management of the medication error indicator toward a more safety nursing practice. Journal of Nursing UFPE/Revista de Enfermagem UFPE, 10(1), 119-127.
3. Kaur, H., & Mahal, R. (2013). Development of nursing assessment tool: An application of Roy’s adaptation theory. International Journal of Nursing Education, 5(1), 60-64.
4. Wade, G. (1998). A concept analysis of personal transformation. Journal of Advanced Nursing, 28(4), 713-719.
5. Weingourt, R. (1998). Using Margaret A. Newman’s theory of health with elderly nursing home residents. Perspectives in Psychiatric Care, 34(3), 25-30.
6. Zahourek, R. P. (2006). Giving voice to what we know: Margaret Newman’s theory of health as expanding consciousness in nursing practice, research, and education. Western Journal of Nursing Research, 28(1), 85-88.

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