It is important to apply the concepts of nursing theory to real-world scenarios. There are a number of viable reasons for this, but perhaps the most prevalent of these is simply that it allows these real-world problems to be approached in a new way, while also testing the practicality of specific nursing theories in a real-life scenario. Another reason applying nursing theories to real-life scenarios is beneficial is because nursing theories are extremely versatile. That is to say, a real-world scenario could viably be approached using any nursing theory and solutions would be varied each time, depending on the specific nursing theory that is applied to the real-world problem. For this specific paper, the nursing theory that will be examined is Callista Roy's adaptation model of nursing, which Roy herself actually invented and discussed at length, although her nursing theory is rather old, hence the outdated date of the article (Roy 1997). This nursing theory will be used to form a unique perspective of a theoretical problem facing a fictional college, although the example itself occurs within the academic world with regularity.
The problem is as follows: A nurse educator has been hired to oversee a large group of students, but the private college that hired the educator is on probation with the Florida Board of Nursing for poor passing scores from students from the college. This is where the educator comes in, as she has been tasked with rectifying this problem. The students themselves are also well aware of the situation at hand, as well as the stakes for the new educator. This makes the situation stressful for all parties involved since the students have already paid their tuition to the college and would not be refunded if it were shut down due to its poor performance on the National Council Licensure Examination (NCLEX). In order to solve this problem, the fledgling educator plans to apply the nursing theory that she read about, known as the adaptation model of nursing theory, in order to maximize her chances of success with the students.
The adaptation model of nursing, which was invented by Callista Roy, focuses 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 diagnosis and treatment of problems in patients and tends to be a broad yet very practical nursing theory. 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 (Meleis 2011). Furthermore, the adaptive model of nursing theory utilizes four modes to achieve this homeostasis: the self-concept mode, role function mode, interdependence mode, and physiological mode (Meleis 2011). 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 these stimuli 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 the problem facing the new teacher at the nursing college.
The first step that should be taken by the new professor, in alignment with the adaptive model of nursing, is to assess the situation and behaviors of those around her. In this case, her wisest course of action is to interview students about their feelings of worthlessness and helplessness in regard to their low test scores. Another helpful idea is to talk to the professors and determine what measures they have taken to ensure that the students pass the NCLEX test adequately in order to see if there are any glaring omissions by these teachers. These interviews should then be compared to the results and norms of other colleges to determine what exactly the college is doing differently and how it may improve. Next, the teacher should apply the second step, the diagnosis, and examine the numerous stimuli around the college that may be influencing the students and causing low test scores. The first item to be addressed is the overall atmosphere of the college. If, for example, the college is regarded as a "party school," it is likely that this external stimuli is negatively contributing to these students' scores, and is an example of what is known as "contextual stimuli" (Roy 1997). Another factor that should be addressed is the teacher-to-student ratio. A low teacher-to-student ratio would mean less personal attention for students, more easily distracted students, and generally lower test scores overall because of it, which is a prime example of focal stimuli (Roy 1997). In order to apply the third step of the adaptive nursing theory, the new teacher must diagnose the exact factors leading to these lower test scores. Considering the research the teacher has likely undergone during the first two steps, it seems likely that she would, at this point, have a fairly solid idea of the numerous problems plaguing the college, and should be able to form a diagnosis of the probable causes of the students' low test scores. For example, the teacher might make the diagnosis that a combination of general rambunctiousness within the student population, coupled with a low teacher-student ratio to keep them in check, is leading to a general lack of focus and clarity throughout the college and adversely affecting their test scores.
Once the teacher has formed a solid diagnosis, backed up by evidence, along with her own personal feelings and notes, she must move on to step four: goal setting. Here, the teacher must utilize the diagnoses she formed in step three to create a goal for the students to work toward that would solve the problem of low test scores, but also be something the students can grasp and work towards. For example, simply making the goal "achieve higher test scores" would not work because this concept seems abstract and out of their league, and would potentially discourage the students. One goal that should be presented by the teacher is simply "perform better in the classroom." From here, the teacher can create goals in an increasingly difficult fashion, working her way up to "achieve higher test scores" in the process. This way, the students have the opportunity to work up to these lofty goals without feeling overwhelmed by them. With this achieved, it is time to move on to step five: intervention, also known as the "doing phase." Here, the teacher will oversee the implementation of the goals and ideas she mentioned in the previous steps. For example, the rearranging of classrooms to house fewer students at a time would thereby increase the teacher-student ratio to a factor that is easier for students and teachers alike to manage. Another measure that could be implemented is the use of some sort of curfew or mandatory study hall. While these two measures might seem positively Orwellian to students in most other colleges, implemented here, with the students fully aware of the stakes, it would make a powerful motivator, and likely lead to a greater sense of just how much is at stake for the students. Finally, the teacher should include the sixth step, in which they must evaluate the performance of the students by issuing a mock-test. This will allow her to gauge the students' performance and allow the teacher to understand what areas need improvement along with, generally, how well her plan has worked. This strategy would allow the teacher to slowly but surely increase the performance of the students using proven effective methods, with the proof of their effectiveness coming straight from the students themselves, as opposed to studies or things of that nature, which are not always specific enough, especially within a volatile college environment. Evidence from one article suggests that using hard, numerical data when evaluating students and their performance as crucial as it allows for pure, objective decision-making, and goes as far as to state that "We need to know how to judge whether a mark is high or low and how to compare marks between one test and another" (Cohen and Morrison 2011). Thusly, using objective means, such as test scores and the effective teacher-student ratio, to judge success is sound in this case.
One aspect of this plan is the ethical implications of the plan since many would consider stifling the "college atmosphere" a cruel means of ensuring test score success. However, this is simply not the case for a number of reasons. The largest ethical criticism of this plan is likely to come from the concept that these college students will be ill-prepared nurses since the methods that are being employed are rather unconventional in a standard college setting and that these college students will learn immoral and unethical practices from the college. One study indicates that, on the contrary, that professional nursing education does not significantly influence the development of nursing students' moral judgment, meaning that, from an influential standpoint, this measure to improve test scores can be implemented with relatively few negative lasting consequences for the students (Lee 2013). As for the expected outcome itself, if these plans are implemented properly, and with the correct application of Roy's adaptive model of nursing, the students should pass the test, thus ensuring the survival of the college itself, and establishing an effective method for ensuring test-score success, thus bolstering both the reputation and income-earning potential of the college.
This process of applying specific nursing theory to a real-life scenario helped to clarify just how these nursing theories actually function in practice. This also shows that nursing theories can be applied to much more than purely nursing-related subjects and fields. Roy's adaptation model of nursing is perfect for application to non-nursing problems because it is so focused on the impacts of those affected, rather than being sidetracked by philosophical or ethical questions. Furthermore, the adaptation model of nursing follows a very strict guideline and allows for a great deal of intervention by the person overseeing the particular study (the teacher, in this case) so that the situation is never out of the overseer's control. The adaptive model of nursing also categorizes many things that would be considered subjective or abstract by many, such as the numerous types of stimuli, or the usage of four different modes, which measure, among other things, quality of life. Finally, the adaptive 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. In doing this, the practitioner is able to secure a quality that would be difficult or impossible to achieve otherwise, which helps to make both the patient and the practitioner herself more informed and able to conquer their hardships as a result.
Cohen, L., Manion, L., & Morrison, K. (2011). Research methods in education. Routledge. 669- 671
Lee, M. I. (2013). Changes in nursing students' moral judgment and ways to evaluate the effect of ethics education. Journal of Korean Academy of Nursing Administration, 19(3), 351-360.
Meleis, A. I. (2011). Theoretical nursing: development and progress. Lippincott Williams & Wilkins.
Roy, C. (1997). Future of the Roy model: Challenge to redefine adaptation. Nursing Science Quarterly, 10(1), 42-48.