Sister Callista Roy is a nurse theorist and professor at the School of Nursing at Boston College, MA, where she teaches

doctoral, master’s, and undergraduate classes. Sr. Roy has contributed greatly to the nursing field through numerous publications, lectures, and workshops throughout the U.S. and abroad. As result of her invaluable contributions, she has been named a Living Legend by the American Academy of Nursing and the Massachusetts Registered Nurses Association (“Boston College William F. Connell School of Nursing,” n.d.). Roy developed the conceptual model known as the Adaptation Model of Nursing, which is a problem solving approach utilized for collecting data, identifying the capacities and needs of humans, and guiding the selection and implementation of nursing care (Nursing Theory: A companion to nursing theories and models, 2011). Roy’s model involves a six-step nursing process comprising: 1) assessment of behavior, 2) assessment of stimuli, 3) nursing diagnosis, 4) goal setting, 5) intervention, and 6) evaluation. For each one of these steps the person is analyzed in four adaptive modes - psychological, self-concept, role function, and interdependence modes - for his/her ability to adapt to stressors (Nursing Theory: A companion to nursing theories and models, 2011). The adaptation model is also effective in the evaluation of nursing interventions and it has been adapted to more specific topics such as chronic diseases by other investigators. In addition to the development of this influential conceptual model, Roy has developed mid-range theories to address practical issues since nursing theories are often too broad and complex to be readily applicable to daily nursing practice. In an article published in the Nursing Quarterly Journal, Whittemore and Roy (2002) explain a middle range theory of adaptation to Diabetes Mellitus (DM), which is based on Roy’s Adaptation Model and Pollock’s theory of adaptation to chro nic illness model (Pollock, 1993). I was intrigued by this article as diabetes - and chronic diseases in general - was one of the main reasons I became interested in the nursing field. In 2007 I began working on a large exercise trial for patients diagnosed with type 2 DM. My educational background was in exercise physiology and I had had several classes related to chronic diseases prior to beginning that position However, I was unaware of the pronounced lifestyle disruption diabetes can produce in patient s’ daily life. Thankfully, one of the members of our intervention team was a diabetes educator, which afforded me the opportunity to learn about the day-to-day challenges diabetic patients face, the various types of diabetes medications, their interaction with foods consumed, their effect on the ability to exercise, and possible hypoglycemic symptoms. I began to understand the intricacies of this health condition and the complexity of its management, which in turn changed my perception of patients’ challenges and the dramatic lifestyle adjustments it necessitates. Based on this experience, I decided I wanted to work with individuals diagnosed with DM or provide primary prevention to persons at high risk for developing this condition. Considering my background in exercise and nutrition, I realized having the nursing foundation was the missing piece of the puzzle. As I researched into the nursing career, I learned about other areas of nursing that appeal to me; however, diabetes education is still my number one interest. For this reason, I was excited to learn about the existence of this theoretical framework to guide holistic, patient-centered approach to nursing care of individuals diagnosed with DM. Prior to Whittemore and Roy’s development of the adaptation to DM theory, Pollock (1993) investigated the application of the adaptation model to chronic illness. She recognized the importance of psychological factors, while considering a key goal of living with a chronic disease is to identify the limitations resulting from the condition. She also acknowledged the importance of the patient reorganizing his/her environment as well as personal ideas as a means to successfully cope with chronic diseases. Interestingly, in many of the studies developed to test Pollock ’s theoretical framework, there was no association between psychosocial and physiological adaptation. The exceptions were the studies

The adapting to DM theory provides guidance in assisting these patients reach the lifestyle changes that are required for adequate control of their condition.. These processes are stabilization (physiologic adaptive responses to illness). 887-898. The adapting to DM theory begins at diagnosis and consists of three processes that are separate but interconnected. creates a comprehensive framework for nurses caring for individuals diagnosed with DM. Chase. This positive relationship between psychosocial and physiological adaptation was attributed to the fact that individuals diagnosed with DM are more likely to experience daily selfmanagement challenges as a result of their illness. Mandle. thus influencing behavior and adaptation. January 6). L. which filters the incoming stimuli. integration (psychosocial adaptive responses to illness). (1993). 311-317. and Efficacy of a Nurse Coaching Intervention in Type 2 Diabetes. In summary. Adapting to diabetes mellitus: A theory synthesis.html Pollock. Rosenstock and Kegels working in the U. . The Content. Integrity. & Roy. 86–92. References Boston College William F. S. Whittemore. Whittemore and Roy include health promotion behaviors as part of this model. Retrieved from: http://www. C.. this middle range theory.Diabetes Educator. 27. (2001). 2012 IntroductSeptember 9. Nursing Science Quarterly. C. 15. This peculiarity of DM prompted Whittmore and Roy (2002) to further investigate how the adaptation model could be applied to the specifics of this psychologically and behaviorally demanding chronic disease. Nursing Science Quarterly. which is essential considering the demanding nature of DM. Whittemore. Connell School of Nursing.. Another important construct of this theory is the patient’s perception. Application of Roy’s adaptation model in nursing practice. R. Moreover. C. 6. S. S. which is based on Roy’s adaptation theory and Pollock’s adaptation to chronic illness theory.  HBM was first developed by social psychologists Hochbaum. Adaptation to chronic illness: A program of research for testing nursing theory. numerous health-promoting behaviors are required for successful self-management and adaptation to life with DM. Retrieved from:http://currentnursing. (2002). and health-within-illness (union of stabilization and integration resulting in optimization of health potential). R. S. For this reason.observing patients with DM.S. Public Health Services inspired by a study of why people sought X-ray examinations for tuberculosis.bc. E. It emphasizes the in dividual’s perception and well as health promotion Nursing Theory: A companion to nursing theories and models (2011. \ Application of Health Belief Model This page was last updated on January's_adaptation_model. & Roy. 2013cal model that attempts to explain and predict health behaviors.

diabetic foot ulcer-rt : Farmer for 15 years. peripheral nerves and large arteries. No. Hosp. No. SM : 60 years : Male : Married : ------: -------: -------: ------: ----------------: Diabetes mellitus type II. The model was developed in response to the failure of a free tuberculosis (TB) health screening program. Retired from military service. Date of admission Ward/Unit Diagnosis Occupation : Mr.D i a b e t e s m e l l i t u s  Diabetes mellitus is a disease characterized by a chronically elevated blood glucose concentration. married. often accompanied by other clinical and biochemical abnormalities. involving many organs. The hyperglycaemia of diabetes results from an inadequate action of insulin. the kidney. The classification is important because of the different genetic backgrounds. male patient educated up to PDC suffering from diabetes for the last 10 years and frequent leg ulcers for the last one year. caused by low or absent insulin secretion. Hindu. metabolic effects. Diabetes may also be secondary to other disorders 1.  The study of social sciences helps to improve the care of the patient by increasing the nurse’s understanding of human behaviour and to stimulate intellectual and emotional growth and self knowledge. worked in ---Culture Religion : Hindu . treatment and consequences of the two types. including the eye. clinical presentations.  Mr. the presence of antagonists to the peripheral action of insulin or a combination of these factors. General information Name Age Gender Marital status Place IP. Primary diabetes mellitus is traditionally divided into either insulin dependent (IDDM or Type 1) or noninsulin dependent (NIDDM or Type 2).SM for my clinical assignment is a 60 year old.  The effects of the disease may be acute or chronic.

. “I have developed this ulcer a few weeks back. Patient’s Knowledge of Present illness  Patient explains his illness: “I have diabetes for the last 10 years”.” Now ulcer has developed in the right leg.” “It was not getting healed from the local hospital. 6. took medicine for 6 months Patient had a gun shot injury about 20 years back on the left forearm He is diabetic for the last 10 years. why I’m getting ulcers frequently” “I want to get discharged soon. will I be discharged next week?” (Patient had a foot ulcer in another leg 6 months back and was treated in ----.Caste : Thiyya 2. played for military for 6 years. I have come here” 5. Scholastic History  He had normal schooling till PDC 3. Developmental history        Normal birth at home No birth related or neonatal complications Norma childhood Started schooling at the age of 5 years Immunized for major infectious diseases He was a football player till the age of 32 He was recruited to military in Southern Command as a football player. left military and joined in ----as a staff. Diabetes is incurable” But. What the patient wants to know about the illness?  “I know. so. Socioeconomic Status  He has 7-8 acres of farm land 4. What has been his past experience with illness?Past Illness History  History of Koch’s disease 10 years back.

he does not know whether they had any major illness. Patient’s beliefs about the illness  Patient is a firm believer of god. but does not believe in individuals as god. He used to take 6 eggs per day till the age of 40 and reduced to 1 egg per day. 7. Does the patient have social support network? . He does not have any wrong belief that his illness is due any black magic or some possession. but his food habits points to the life style has contributed to the illness significantly. 8. Whether patient has accepted his illness?     “I’m not the person to develop this kind of an illness” “My food habits and exercise should have kept me free of this illness” “I used to take one or two pegs of brandy per day and some times more than that” “I have got it from my family” Inference: Patient has accepted the illness as a suffering which he has developed due to inheritance. He used to get double food in military because he was a football player in the MRC.Family History    History of diabetes mellitus in brothers and sisters No major illness in his knowledge Father and mother died 30 years ago.

He was advised a below knee amputation. He watches TV and reads newspaper. Which cultural differences can interfere with the patient’s treatment?  Patient is from ---district of ----. As he has adequate servants at home. He expects details of his blood sugar level regularly. and future state He is worried about the foot ulcer which is not heaing.   Patient has a good circle of friends and family His bystander in the hospital is a friend He believes in politics and is a party member 9. How the patient has adapted to illness?  He is well adapted to the illness. . So he could save his leg. His blood sugar fluctuates between normal and high value. recovery. he is worried whether the ulcer will get healed. but the nursing staff was not giving attention to his concerns. 12. Anxiety related to effects of illness. 14. He says he can bear the expense of treatment here. cost of treatment. but he decided to get discharged from there and came to -----. Does he express concern about his present condition? Yes. that he has 7-8 acres of agriculture land. which gives his some diversion from the problems. 10. he has not much trouble in carrying out his role. When he developed ulcer in his left leg 6 months back. 11. 13. his two toes were amputated in a local hospital. He looks after his property well. Has the patient’s accepted his present condition?  Patient has accepted his present condition. He plans to follow all the instructions well that ulcer will not develop in future. How does he cope with problems? As explained by patient?  He accepts his condition as a diabetic patient and understands the need for adherence to medication and life style modification. That is enough to look after his expense for treatment.

Pender. Milbank Memorial Fund Quarterly 44 (3): 94–12 Marriner TA. and in England 1. and the financial implications are significant: 5% of the total NHS budget and 10% of acute-sector resources are spent on diabetes. Local Learning Manager for First Contact Care in London. Raile AM. 2.REFERENCES 1.have the condition (DH. RGN. London These costs increase more than fivefold for treating disease-related complications (DH. NHSU. Sakraida T. BA. income and life expectancy. 2005 How a health promotion model reduces disabling complications of diabetes 1 October. 2001a). 2001a). BSc.3 million people . 2004 The incidence of diabetes is increasing worldwide. as well as lifestyle. "Why people use health services". St Louis: Mosby. Diabetes affects physical and psychological wellbeing.2 to 3% .Nola J. 5th ed. including:   Ischaemic heart disease Peripheral vascular and neuropathic disease . Nursing theorists and their work. The Health Promotion Model. relationships. Gloria Daly. Rosenstock IM (1966).

encouraging walking and ensuring that the needs of people from ethnic groups are taken into account when developing policies. Diabetes UK (2000) lists three key risk factors that can be tackled through effective health promotion: smoking. 1998a) can be delivered in a local setting. Acheson (DH. The St Vincent Joint Task Force Report (DH. These fall into two broad types that can be simply defined as: . 1995) challenged health-care professionals to develop models of care to reduce long-term complications. Many of Acheson’s recommendations (DH. 2001b) are to support patients with diabetes in managing their own lifestyles through structured support and education. improving access to services. Health promotion activities should be co-ordinated through effective partnerships across disciplines. Broadening the base for health interventions means addressing socioeconomic and environmental issues. But complications are not inevitable and much can be done to prevent or greatly reduce them (Stratton. 1997) identified five strategies for successful health promotion:      Build a healthy public policy Create a supportive environment Strengthen community action Develop personal skills Reorientate health services. Professionals across all agencies have a role in delivering effective local interventions to reduce inequalities at the same time as addressing health promotion and prevention initiatives to reduce diabetes complications.   Cerebrovascular disease Diabetic eye disease Diabetic renal disease. ethnicity. Tackling health inequalities Tackling health inequalities must be considered as part of developing an action plan or intervention. and delivered in a culturally sensitive way. The Jakarta Declaration (WHO. 1998). obesity and lack of physical activity. developing health promotion in schools. Partnership working Partnership working has a major role in delivering the aims of the Jakarta Declaration (WHO. The underlying principles of documents such as The NHS Plan (DH. Frameworks Several models exist to support health promotion. gender and status barriers. such as increasing the uptake of benefits within eligible groups. 1998a) highlighted 11 areas of inequality (Box 1). 2000) and The Expert Patient (DH. 1997). reducing inequalities and targeting education at all groups. professions and agencies. transcending age. The article on page 37 highlights the work of the Desmond project in this area.

1993).’ A strategy’s action plan should recognise the need for organic practice and realise that local actions are a combination of what is intended and what emerges along the way (Bryson. 2000). and its large and complex objectives should be factored into local action plans (Hrebiniak and Joyce. determined by their beliefs about consequences The expectations of others The individual’s perceived control and belief in their ability to change. strategic approach. so they can manage their individual and community programmes. These contribute to achieving a whole picture when developing local action plans for partnership working. Beattie. 1973. It lists three steps:    The individual’s attitude. Hancock. Achieving the plan depends on proactive communication and consultation skills. Any model for health promotion activity needs underpinning by the patient’s intention to change behaviour. Within these models practitioners have a role as either leaders (authority figures) or facilitators (negotiators) (Naidoo and Wills. Action plan The action plan in Table 1 is a guide to implementing a health promotion strategy to reduce complications of diabetes. The objectives are to build a healthy lifestyle support programme for people with diabetes. The theory of planned behaviour (Ajzen. 1985. 1984). based on a multiprofessional. Any strategy must consider ‘how?’ as well as ‘why?’. 1991) is one of many models of behaviour change cited in the Health Development Agency’s website resource (HDA. Beattie (1991) identifies four paradigms:     Health persuasion Personal counselling Community development Legislative action. Evaluation . procedures and tools designed to help leaders. Raeburn and Rootman. Each partner or agency involved is encouraged to use the same models to support their own initiatives while creating a multi-partnership. Bryson (1995) states: ‘Strategic planning is simply a set of concepts. multi-agency approach. Beattie’s health promotion model We have successfully used Beattie’s health promotion model in practice (Figure 1). 1986. managers and planners think and act. supported by an action plan (Table 1). 2001). 1991) Models that examine health determinants and recommend responsive serivces (Laframboise. 1989. The underlying principle is founded on partnership working with communities and users.  Models that define health promotion as a range of interventions (Tannahill. French and Adams. 1995).

Traditional health promotion evaluation assesses activities in terms of their impact on goals. 2001a) sets out 12 standards aimed at prevention. But this technique tends to be rigid. prevention.not just those with a health promotion remit. But it has been developed with a wider remit to sustain health promotion activities through community involvement and participation. 2000). impact and outcome . To be effective. using a biomedical model. The long-term view Health promotion activities must include socially empowering and enabling activities (Tones. in today’s climate of government targets. Judd et al (2001) advocate a three-step process. and ensure the eradication of inequality of health care for people with diabetes within ethnic-minority groups. helping people with diabetes manage their condition and preventing complications. health promotion must create healthy public policy and supportive environments. Downie et al (1996) identify two main types of evaluation:   Measuring what has been achieved Measuring how the objective has been achieved. The strategy used as an example here is based on the The National Service Framework for Diabetes (DH. improving services. measuring the changes taking place as well as targets achieved.that is. education. Author’s contact details . it is necessary to report milestone achievements to contribute to future decision-making and programme setting. and Tones (2000) argues against using biomedical indicators to evaluate health-promotion activities. Combining both methods enables health-care practitioners to monitor the process of change and to ensure that health promotion activity is relevant to the individual. There is a need to balance evaluation to accommodate community realities and professionals’ need for evidence of health improvement. 1986). Latest Policy Improving diabetes services and promoting lifestyle changes    The National Service Framework for Diabetes (DH. strengthen community action and reorientate health services (WHO. Standards 3 and 4 target lifestyle changes that reduce complications Standard 3: People with diabetes are empowered to enhance their personal control over the day-to-day management of their diabetes in a way that enables them to experience the best possible quality of life Standard 4: To maximise the quality of life of all people with diabetes and to reduce their risk of developing long-term complications. and protection are the responsibility of all . 2001a). foster individual or group skills and capacities. However. and ensuring that public health promotion. and the standards aimed at reducing complications of diabetes through promotion of healthy lifestyles. integrating evaluation of process. The Beattie strategy shown here recognises the need to move the emphasis in health promotion from ‘doing’ to building relationships for the longer term.

Department of Health. Riverside.Gloria Daly. (1998a)Independent Inquiry into Ine . I. In: Gabe. London: DH. Organizational Behaviour and Human Decision Processes 50: 179-211. M. Calnan.. Email:gloria. Department of Health and British Diabetic Ajzen.daly@nhsu. J. NJ: Simon and Schuster. London EC2V 7RS. Bryson. (eds) The Sociology of the Health Service. The Report. (1991)Knowledge and control in health promotion: a test case for social policy and theory. First Contact Care in London. Beattie. Local Learning Manager. M. 88 Wood Street. (1991)The theory of planned behaviour. London: Routledge/ Taylor and Francis. NSHU. Bury. (1995)A Guide to Strengthening and Sustaining Organisational Achievement. J. (1995)St Vincent Joint Task Force of Diabetes.