An Examination of Callista Roy's Adaptation Model of Nursing in the Field of Wound Care

There are a variety of nursing theories in place that are useful for a variety of applications. In general, there are four "levels" of nursing theory: meta-theory, grand-scale theory, middle-range theory, and, finally, practical nursing theories (Parker and Smith, 2010). Each of these theories deals in a particular level of abstraction, with meta-theories being the most abstract and least practical, and practical nursing theories, obviously, being the most practical and applicable to specific problems in nursing. This paper will focus on practical nursing theories, Callista Roy's Adaptation Model of Nursing, to be precise. This theory is important because it examines many underlying physical issues in patients and nursing as a whole, making it extremely effective for examining and analyzing many of the symptoms and afflictions within the field of wound care.

One of the most effective ways this is done by focusing Roy's Adaptation Model of Nursing largely on the individual (although this individual may also symbolize a group of people) and their internal struggles and issues, and how they themselves are struggling to maintain a state of homeostasis, or balance, within their lives (Roy, 1997). The Adaptation Model of Nursing also contains a number of more abstract ideas concerning both the diagnosis and treatment of problems in patients and tends to be a broad yet very practical nursing theory (Roy, 1997). The Adaptation Model of Nursing also sees adaptation as a constant, driving force for the survival of both the individual and the group, and that, in order to overcome illness, disease, injury, or other hardship, adapting and limiting the effect of these negative symptoms is of the utmost priority for both individuals and groups (Roy, 1997). Many of the solutions for these problems come in the form of "modes," each of which pertains to a particular state of being for a patient. These include the self-concept mode, role function mode, interdependence mode, and physiological mode, and are used primarily as a means to monitor and maintain homeostasis within patients, even if that homeostasis is abstract or psychological (Roy, 1997).

To properly utilize these four modes, the Adaptation Model of Nursing must use a six-step process in order to diagnose and treat any sort of problem within an individual or group. The first step is the assessment of behavior, where a person is exposed to each of the four different modes, and their reactions and behaviors to these modes observed and noted to determine if anything is out of the ordinary (Meleis, 2011). The second step is similar, assessment of stimuli, and focuses on understanding the stimuli at work within an individual while also classifying this stimulus as either contextual, residual, or focal (Meleis, 2011).

The third step is the nursing diagnosis, which is simply the statement about the cause of the grief or imbalance within an individual or group and what unnatural behaviors led to that conclusion (Meleis, 2011). The fourth step, goal setting, is the act of finding a realistic goal that the person can agree with and strive to achieve. If a goal is too lofty, the person likely cannot achieve it, but if the goal is not lofty enough, the person will not change enough to make a significant difference (Meleis, 2011). The fifth stage is where the action happens, and is referred to as the "doing phase," which is where the person or group actually begin manipulating the negative stimuli around them that are causing them grief in an attempt to better their situation (Meleis, 2011). Finally, the sixth step is the evaluation of the progress that had been made and how much change, if any, has been made throughout the numerous trials and studies, which helps to determine if further studies or measures are required, and what behaviors are more prominent after testing than before testing (Meleis, 2011). Using these six steps, it is possible to find an adaptive yet practical solution to many problems facing the world of nursing today.

The Adaptation Model of Nursing also has practical benefits when treating specific ailments. For example, wound care, a major branch of nursing and a subject about which many theories have emerged can be fleshed out much more by applying Roy's Adaptation Model of Nursing against it. For example, another of the core tenants of Roy's theories is the concept of examining an individual as a being in constant search for homeostasis (Roy, 1997). For example, a patient who suffers a mild wound, it might be discovered after applying Roy's Adaptation Model of Nursing, might not need any major treatment at all, since that individual's body is constantly seeking homeostasis, and the wound is causing an imbalance in that homeostatic, meaning the wound will, inevitably, sort itself out. This particular application of Roy's theory is useful for keeping solutions to some of the more common issues in nursing simple, without having to look to other theorists to explain another theory. This is extremely useful for situations where time is of the essence, as is frequently the case in the field of wound care, which oftentimes requires nurses to make quick-thinking, split-second decisions.

This brings up another useful application of Roy's Adaptation model in the field of wound care: an examination of the underlying causes of an affliction by utilizing simple concepts (Roy, 1997). Essentially, this means that the Adaptation Model of Nursing is capable of determining the less obvious causes to afflictions, such as those in wound care, by examining factors such as outside stimuli on the patient (such as family life) (Roy, 1997). An example of this type of application might be a housewife who arrives at a nursing unit with a number of bruises inflicted by her husband. Most nursing theories would focus on the most effective and efficient way to treat the injury at hand. However, Roy's theory would focus on not just alleviating the current issue (oftentimes by way of homeostasis, as explained above) but analyzing the underlying issue, which, in this case, was the woman's husband. This way, Roy's theory attacks the root of the problem, so to speak, rather than simply treating the obvious symptoms, which could possibly lead to the problem re-emerging somewhere down the line.

Another way to gauge the effectiveness of Roy's model is to examine its effects on the patients themselves. Roy's Adaptation Model of Nursing theory is renowned for its practical benefits, and nowhere is this more apparent than within the field of wound care, which is, in and of itself, a very practical subset of nursing. One key reason that Roy's model works so well with wounded patients is that, according to one study, the field of practical nursing theories is undergoing a state of rapid change, and has been for many years (Parker and Smith, 2010). This means that having a nursing theory that is firmly grounded in reality and practical application is crucial, as it will allow the field of physical therapy to progress and evolve smoothly, without having to have its own internal philosophies changed every time there is a major transition, technologically or otherwise. Furthermore, Roy's Adaptation Model of Nursing theory, in and of itself, focuses largely on the adaptation of the patient (Parker and Smith, 2010).

This focus on change, which is one of the few principles that can be relied upon consistently, helps to "future-proof" the field of wound care by focusing on adaptation itself, so that practitioners may focus more on results and other concrete benefits, rather than somewhat arbitrary concepts such as comfort. Another aspect of the treating of wounds is that it requires a great deal of problem-solving skills, and this is complimented perfectly by the Adaptation Model of Nursing theory (Parker and Smith, 2010). This emphasis on problem-solving skills is mirrored by Roy's persistence in diagnosing more difficult-to-find symptoms, such as the observation of numerous types of stimuli and their effects on the patient (Parker and Smith, 2010). The benefits of Roy's Adaptation Model of Nursing also extend to the families of the patients because Roy's model can be used to assess families via a multi-step process that is very similar to her process of diagnosing problems in individual patients (Roy, 1997). For example, Roy's model examines the numerous adaptation modes within a family, such as the Interdependence mode, which asks the extent upon which family members rely on one another, are allowed to be independent, and their openness to assistance from members outside of the family (Roy, 1997).

Finally, the field of wound care requires that nurses be extremely flexible in both their methods of treatment for the numerous wound types that may arise as well as their application of nursing theories to this particular field. This is another reason that Roy's Adaptation Model is so effective for wound care. Essentially, the Adaptation Model is flexible as a nursing theory because it encompasses so many other concepts within it, making it a sort of catch-all solution for practical nursing problems such as wound care. The Adaptation Model is also ideal for wound care because the Adaptation Model of Nursing allows for a great deal of freedom within the individual utilizing it, as it forces the user to ask a number of questions, then form their own opinions and ideas based on what they themselves think would be best for the group or individual.

All told, Roy's Adaptation Model of Nursing Theory is extremely effective in the field of wound care, or any other field, for that matter. In fact, some nursing theorist analysts believe that the Adaptation Model can be applied to fields outside of nursing itself. This is the sign of a truly universal nursing theory, and one whose universal appeal makes it a prime candidate for analyzing practical issues within nursing. Roy's theory also is useful on a more abstract level as well, as it asks important questions regarding and individual and his or her interaction with the environment (Roy, 1997). In a way, Roy's Adaptation model could be seen as a replacement for all other nursing theories, since it attempts to explain even the other branches of nursing in a practical way.

References

Meleis, A. I. (2011). Theoretical nursing: Development and progress. Lippincott Williams & Wilkins.

Parker, M. E., & Smith, M. C. (2010). Nursing Theories & Nursing Practice. FA Davis.

Roy, C. (1997). Future of the Roy model: Challenge to redefine adaptation. Nursing Science Quarterly, 10(1), 42-48.