Callista Roy is a renowned nurse, nursing theorist and nursing professor. Her six-step model theory of adaptation is a matrix of philosophical and scientific concepts, based on the concept of a patient as a complex adaptive system within other systems, rather than focusing on the illness or wound. The nurse determines the best course of treatment by assessing the patient and his environment, forming a diagnosis, establishing goals, determining the appropriate intervention to meet those goals and periodically evaluating whether the chosen course of action is working.
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Evaluate the patient. Aside from the obvious physical symptoms of pain, swelling and lack of mobility and vital statistics, the nurse should assess less apparent physical symptoms regarding sleep habits, elimination and nutrition. Roy's adaptation model also requires assessment of the patient's "self-concept mode," which involves questioning the patient on her level of anxiety, involvement in self-care, relationship with family and friends and general outlook.
Assess the stimuli affecting the patient's response to his environment. In Roy's theory, stimuli are divided into three levels: immediate, contextual and residual. Immediate stimuli means the wound or illness directly confronting the patient -- what brought him to the nurse or hospital to begin with. Contextual involves related health problems -- prior illnesses or accidents contributing to the present situation. Residual refers to stimuli whose effect on the current situation is yet unclear -- other, seemingly unrelated health problems, for example.
Diagnose. At this point, the nurse formulates a statement about the patient's present state, involving all relevant stimuli. An example: "Mr. X suffers from impaired mobility since having his foot amputated after a lawnmower accident. The patient feels frustration at his lack of activity and anxiety over his family's finances, but has not taken steps to attain the mobility that could be expected at this stage."
Set goals. A short-term goal for an elderly woman hospitalised after a fall might be to graduate from the hospital bed to a wheelchair. A long-term goal might be to return to her own home after a stay in an acute care facility.
Intervene. In the fifth stage, the nurse determines what steps the patient, his family and health care practitioners, and the larger society in which the patient functions must take to help the patient reach short- and long-term goals. At this stage, the nurse also should set a time for evaluation.
Evaluate. At a predetermined time, the nurse should meet with the patient, assess her progress, establish what goals have been met, and change the intervention steps, if necessary.
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