Application of Roy's

adaptation model
 Roy defines the goal of nursing as promotion
of adaptive responses in relation to adaptive
modes.
 Nursing activity support adaptive responses
and seek to reduce ineffective responses.
NURSING PRACTICE
NURSING PROCESS

 According to RAM nursing process is a

problem solving approach for gathering data,
identifying the capacities and needs of the
human adaptive system, selecting and
implementing approach for nursing care and
evaluate the outcome of provided care.
Elements of Roy’s nursing process

 Assessment of behavior
 Assessment of stimuli
 Nursing diagnosis
 Goal setting
 Intervention
 Evaluation
1. Assessment of behavior

The first step of nursing process which

involve gathering data about the behavior of
person as an adaptive system in each of
adaptive modes.
2. Assessment of stimuli:

the second step of nursing process which

involve the identification of internal and
external stimuli that are influencing the
person’s adaptive behavior.
Contd…

Classification of stimuli:
 Focal: Those most immediately confronting
the person.
 Contextual: All other stimuli present that
are affecting the situation.
 Residual: those stimuli effect on situation
are unclear.
3. NURSING DIAGNOSIS

 Third step of the nursing process which

involve the formulation of statements that
interpret data about the adaptation status of
the person including the behavior and most
relevant stimuli.
Contd…

 Roy indicate that NANDA diagnostic

categories may be related to adaptation
problem and refer to these categories as
clinical classifications.
4. Goal setting

 Forth step of the nursing process which

involves the establishment of clear
statements of the behavioral outcomes of
nursing care.
 A complete statement described as one that
includes behavior desired, change expected,
time frame.
 Goals may be short term or long term related
to situation.
5. Intervention

 The fifth step of nursing process which

involve the determination of how best to
assist the person in attaining the established
goals.
 Nursing activities manage stimuli by
managing, altering, increasing, decreasing
them so that total stimulus fall within person’s
ability to cope.
6. EVALUATION

 The sixth and final step of the nursing

process which involves judging the
effectiveness of the nursing intervention in
relation to the behavior after the nursing
intervention in comparison with the goal
establishment.
Nursing process application to
individual situation
EXAMPLE

Demographic data:
 Name-------------Mr. Ram

 Age sex-----------53yr.

 Education--------- graduate

 Occupation-------- bank clerk

 Marital status------Married

 Religion-------------Hindu

 Informant----------Patient and wife

FIRST LEVEL ASSESSMENT
PHYSIOLOGIC-PHYSICAL MODE

1. Oxygenation
• Stable processes of ventilation and gas exchange

• Chest normal in shape

• Air entry equal bilaterally

• No abnormal heart sounds

• Dorsalis pedis pulsation of affected limp is not

palpabable
• Apex beat felt on left 5th inter coastal space mid

clavicular line
Contd..

 S1 and s2 heard
 Peripheral pulses felt- normal rate and
rhythm
 No clubbing or cyanosis
2. Nutrition
 he is on diabetic diet. Non vegetarian

 Weight reduce markedly (10kg/6month)

 Stable digestive process

 Complaints of anorexia

 No abdominal distension

 Bowel sound heard

 No visible peristaltic movements

 Oral mucosa is normal

 Percussion revealed dullness over hepatic area

3. ELIMINATION
• No signs of infections.

• No pain during micturation

• Normal bladder pattern

• Using urinal for micturation

• Stool is hard

• He complaints of constipation
4. ACTIVITY AND REST
• Taking adequate rest

• Sleep pattern disturbed

• Like movies and reading

• Now activity reduced due to amputated

wound
Contd…

• Walking with crutches

• No paralysis
• ROM is limited in left leg due to wound
• Patient need assistance for activities
5. PROTECTION
• Left lower fore foot amputated

• Black discoloration over area

• No redness

• Using crutches
Contd…

• Wound healing better now

• Pain from knee and hip joint present while
walk
• Dorsalis pedis pulsation, not present over
left leg
• Several papules present over foot.
6. SENSES
• No pain sensation from the wound site.

Relatively, reduced touch and pain sensation

in lower periphery because of neuropathy
• Using spectacles for reading

• Gustatory, olfaction, auditory senses normal

7. FLUIDS AND ELECTROLYTES
• Drinks approximately 2000ml of water.

• Stable intake output ratio

• Serum electrolyte values within normal limit

• No signs of acidosis or alkalosis

• Blood glucose elevated

8. NEUROLOGICAL FUNCTION
• He is conscious and oriented

• Anxious about disease condition

• Stress

• Touch and pain sensation decreased in lower

extremity
• Thinking and memory intact
9. ENDOCRINE FUNCTION
• He is on insulin

• No sign and symptoms of endocrine disorder

• Except elevated blood sugar value

• No enlarged glands
SELF CONCEPT MODE

PHYSICAL SELF:
• He is anxious about changes in body image, but
accepting treatment and coping with the situation.
• He deprived of sexual activity after amputation
• Belongs to nuclear family, 5 members, stay along
with wife and three children
• Good relation with neighbors
• Good interaction with friends
PERSONAL SELF:
• Self esteem disturbed because of financial

burden and hospitalization

• He believes in god and worshiping hindu

culture
ROLE PERFORMANCE MODE

 He was earning member in the family. His

role shift is not compensated .
 His son doesn’t have any work
 His role clarity is not achieved
INTERDEPENDENCE MODE

 He has good relationship with the neighbors.

 Good interaction with friends relative
 But he believes no one is capable of helping
him at this moment
 All are under financial constraints
 He was moderately active in local social
activities.
FOCAL STIMULUS

 Non healing wound after amputation of great

and second toe of left leg 4 weeks. A wound
first found on junction between first and
second toe 4 month back. The wound was
non healing and gradually increased in size
with pus collected over area
 Hospitalization
CONTEXTUAL STIMULI

 Known case DM for past 10 years. Was on

oral hypoglycemic agent for initial 2 years,
but switched to insulin and using it for 8 years
now. Not wearing foot wear in house and
premises.
RESIDUAL STIMULI

 He had TB attack 10 years back and took

treatment.
 Previously he admitted in hospital for leg pain
4 yrs. Back
 Mother’s brother had DM and he is graduate
in humanities, no knowledge on health matter
 Mother had history of TB
NURSING DIAGNOSIS
  Impaired skin integrity related to fragility of the
skin secondary to vascular insufficiency
   Impaired physical mobility related to amputation
of the left forefoot and presence of unhealed
wound
 Anxiety related to hospital admission and unknown
Outcome of the disease and financial constrains.
  deficient knowledge regarding the foot care,
wound care, diabetic diet, and need of follow up
care.
GOALS

 Amputated area will be completely healed

 Skin will remain 
intact with no ongoing ulcerations
 Patient will attain maximum possible physical
mobility with in 6 months. 
 The client will remain free from anxiety
 Patient will acquire adequate knowledge
regarding the t foot care, wound care, diabetic
diet.
INTERVENTIONS

 Maintain the wound area clean as

contamination affects the healing process
  Perform wound dressing with Betadine 
  Monitor for signs and symptoms of infection
or delay in healing.
 Administer the antibiotics and vitamin C
supplementation 
 
Contd….

 Provide active and passive exercises

   Provide comfortable quiet environment for
the client and family
 Explain about the home care. Include the
points like care of wounds, nutrition, activity
etc.
CONCLUSION

 Mr. X who was suffering with DM for past 10

years. Diabetic foot and amputation made his
life more stressful.
 Nursing care of this patient based on Roy’s
adaptation model provided had a dramatic
change in his condition.
 Wound started healing and planned to
discharge
Contd…

 He studied how to use crutches and mobilize

twice in a day
 Patient anxiety reduced by proper
explanation and reassurance
 He gained good knowledge on various
aspect of diabetic foot ulcer for the future self
care activities.
ROYS NURSING PROCESS
APPLICATION TO GROUP
SITUATION
 A school nurse surveys the members of the
10th grade in school
 30 % of teens smoking 2 cigarettes a day
 Students states smoking as cool give them a
buzz
 Way to break away from control by parents
 Health risk almost none.
Contd..

 Stimuli are assessed as lack of positive role

modeling that present smoking as cool Lack
of adaptive coping by students to control
developmental anxieties
 Lack of involvement by parents in building
effective communication
 Lack of knowledge related to health risk of
smoking
Nursing diagnosis

 Ineffective use of substance to create sense

of self worth and self esteem
 Ineffective use of substances to control
developmental anxieties
 Ineffective use of substance in separation
issues with the family
 Inadequate knowledge of health risk of
smoking
Goals
 Within three months students will states the
myths related to image of smoking created by
media
 Within four months the 10th grade students
will state health risk of smoking
 Within six month rate of cigarette use by 10th
grader will decrease by 50%
 Within one year students will identify positive
coping strategies to deal with development
anxiety and increase parent involment
Interventions
 Nurse creates core group of concerned
teens, parents and teachers to plan
strategies.
 Team decide to alter stimuli related to lack of
positive role modeling in media
 Plan include use of poster that show different
images of smoker and talk by nonsmoking
college nursing students about setting life
goals
 Building self esteem without abuse
Evaluation

 One year later smoking has decreased to

17% of the teens.
THANK YOU