CONCEPTUAL FRAME

WORK
Conceptual framework
The conceptual framework for this study is based on Sr. Callista Roy’s system adaptation
model developed in 1994.

Roy's model focuses on the concept of adaptation of the person. Her concept of nursing.
person, health and environment are all interrelated to the central concept. According to this
model, individual is considered as a holistic adaptive system consisting of input, control
process, output, which are in constant interaction with the internal and external environment.

According to Roy, environment is" all the conditions circumstances and influences
surrounding and affecting the development and behaviour of persons or group. It is changing
environment that stimulates the person to make adaptive responses" However any
environmental changes demands increasing energy to adapt to the situation. Factors in the
environment that affects the person are categorized as focal, contextual and residual stimuli.

A focal stimulus is the internal or external stimuli most immediately challenging the person's
adaptation to the human system. Contextual stimuli are all other stimuli present in the
situation that strengthen or contribute to the effect of focal stimulus but are not the center of
the person's attention. Residual stimuli are environmental factors inside or outside the human
system with effects in the current situation that are unclear.

The adaptation level is determined by the combined effect of the focal, contextual and
residual stimuli. Adaptation occurs when the person responds positively to environmental
changes. This adaptive response promotes the integrity of the person, which leads to health.

There are two interrelated subsystems in the Roy's model. The primary functional or control
processes subsystem consists of the regulator and the cognator. The secondary effector
subsystem consists of four adaptive modes These are physiological, self-concept, role
function and interdependence mode. The purpose of these modes is to achieve total
integration of the person.

Coping takes place in these two systems. A regulator is a subsystem coping mechanism,
which responds automatically through neural-chemical- endocrine processes. A cognator
coping subsystem, by way of self-concept, interdependence and role function adaptive mode
responds through four cognitive emotional channels: a complex process of perceptual
information processing, learning, judgement and emotion. Perception is a process of
cognator. The responses evoked by the cognator and regulator are manifested in the
subsystem of the person called the effectors or the adaptive mode: Physiological self-concept,
role function and interdependence mode. Physiological mode is associated with the physical
and chemical process involved in the function and activities of living organisms. Five needs
are identified this mode relative to the basic need of physiological integrity as oxygenation,
nutrition, elimination, activity and rest and protection. Role performance mode is one of two
modes and focuses on the roles the person occupies in the society. Self-concept mode
focuses specially on the psychological and spiritual aspects of human system. defined as the
composite of beliefs or feelings that an individual holds about herself at any given time. An
individual self-concept is compromised of the physical self (body sensation and body images)
and personal self (self-consistency, self-ideal, and moral- ethical - spiritual self).
Interdependence mode focuses on close relationship of people individually and collectively.
The most important components of the interdependence adaptive mode are person's
significant other (spouse, child, friend or god) and his or her social support system.

Specifically, Roy defines nursing according to her model as the science and practice that
expands adaptive abilities and enhances person and environmental transformation. Roy's goal
of nursing is the" promotion of adaptation for individuals and group in each of the four
modes that contribute to health quality of life and dying and dignity". Nursing fills a unique
role as a facilitator of adaptation by assessing behaviour in each of these four adaptive modes
and factors influencing adaptation and by intervening to promote adaptive abilities and to
enhance environmental interactions.

In this study, children with type 1 diabetes mellitus become the adaptive system. Diagnosis of
type 1 diabetes mellitus, need for regular follow up, need for regular insulin therapy and
physiological changes becomes the focal stimuli for children with type 1 diabetes mellitus.
The contextual stimuli incudes loss of school days. restriction from strenuous activities. The
residual stimuli include educational status of parents, lack of family support system, Religion
and beliefs, attitude, knowledge etc. In this study the behaviour responses of the children
with type 1 diabetes mellitus can be involved four adaptive and affecter modes. They exhibit
their adaptive responses by attaining therapeutic compliance thereby improvement in three
domains of life physical, psychological, social domain. The result may be adaptive or
maladaptive. The study aimed assess the therapeutic compliance through evaluating how
they diet, insulin therapy, exercise and follow up and ultimately the quality of life of children
with type 1 diabetes mellitus in the physical, psychological, social domain. Assessment
reveal the area where the children with type 1 diabetes mellitus need evaluation on so as to
maintain the integrity of the persons thereby improving the quality of e four domain of life
 Adaptive response good compliance,
improved QOL
Focal stimuli
Regulator
Diagnosis of type 1
diabetes mellitus
Need for regular check Physiological /physical mode
up QOL among children
with type diabetes
Need for regular insulin mellitus
therapy
Physical domain
Regular blood
investigation Children with Self concept Psychological domain
Role type 1 diabetes mode
Physical changes mellitus Academic domain
performanc
Contextual stimuli e mode Social domain
Loss of school days Inter dependence mode Therapeutic
compliance
Restriction of
strenuous activities Insulin therapy
Glucose monitoring
Diet and exercise
Residual stimuli
Follow up
Educational status of
parents
Religion Mal adaptive response
Cognator
Poor compliance , poor QOL
Figure 1:Conceptual frame work to assess the quality of life and therapeutic compliance of children with type 1 diabetes mellitus