Presentor notes for Conceptual Nursing Models free essay sample

Slide 1 – This is Sister Calista Roy. Sister Roy’s Adaptation Model, referred to as RAM, was developed in 1960, but she continued to expand her conceptual model through the years. In the following slides, we will visit some of the main components of Sister Roy’s Adaptation Model of Nursing Concept. We have discussed the many different conceptual nursing models that affect the way we approach how we treat our patients. As a group, we selected Roy’s Adaptation Model (RAM) because it is the model we all most identify with. When assessing the various conceptual models, we found that RAM, when utilized used as an assessment tool, is an excellent concept in how to address or patients as whole individuals as opposed to just an illness or diagnosis. It helps nurses to consider all of the factors that may be affecting the patient, whether they are contributing to the loss of health or being capable in assisting to regain health. In the following slides, we will show how to utilize RAM in assessing the patient, identifying nursing diagnoses and factors affecting the patient’s health, and creating nursing care plans and appropriate goals based on this information. Ultimately, the goal is for us as nurses to identify what’s wrong and how we can effectively assist the patient in making changes to fix it. The RAM helps to encompass all of the factors affecting this process, not just the physical ones. Slide 2 The RAM conceptual model recognizes the individual as having bio-psychosocial components that affect their health. The nurse encourages and aides in assisting adaptation to these individual components by modifying external stimuli. The 4 ways a person adapts according to the RAM are: 1. Physiological – The basic physical needs required for survival. (E. g. food, water, oxygen, etc. ). 2. Self-Concept – This is how a person sees themselves or how they perceive themselves in the presence of other people in their environment. 3. Role Function – This refers to how a person socially interacts with other people and their need for social integrity. This can be seen in their roles and responsibilities in their life such as being a parent, a professional, or a friend. 4. Interdependence – This refers to how a person interacts with others to get help, affection and attention. Slide 3 These components help nurses to consider the different facets of each individual so that the patient may viewed as a multi-dimensional being, with all of the different perspectives of what affects each person taken into consideration as part of the nursing assessment. For example, first, what basic and immediate physical needs need to be tended to? Secondly, how does the patient’s self-concept affect their overall state? Thirdly, how do the patient’s roles in their life affect their ability for self-care? And finally, how does that patient go about getting what they need to be well? Are they able to ask for help? Are their methods for getting attention effective or self-destructive? These are examples of question nurses ask themselves as consideration for all of the factors affecting their patient’s total state of well-being. Slide 4 The RAM incorporates the four metaparadigm concepts of nursing, which are: person, health, environment, and nursing. The first metaparadigm of nursing addresses the person. The person is not just someone in the bed sick at the hospital. Nursing is concerned with them as a person in context to whatever environment they are in. The person can be sick or well. They may be considered as an individual or as part of a family or community. RAM relates because Roy considered that a person may have an individual self-concept, but they also perceive themselves in relation to others in their environment whether that be their family, employer, community, etc. The second metaparadigm, health is relative. A person may have terminal cancer, but they view their quality of life as good and feel healthy because their current treatments are relieving symptoms for now and their daily life remains relatively intact. Likewise, a person can be physically healthy but emotionally and psychologically unhealthy. RAM addresses health similarly. In RAM, a person is a bio-psychosocial being. The nurse is considering the whole person and their perception of themselves in their whole environment. Health in this area is also relative because the patient’s perception is taken into consideration. Slide 5 The third metaparadigm regarding environment, the nurse considers not just the immediate physical environment such as the hospital bed or clinic, but also whatever environment the patient is in. This could encompass both literal and figurative versions of their home life for example. All the internal and external influences that affect that person are considered as being a part of the environment in which they live. An example might be that while a person’s physical home is shabby, run down and without modern utilities and ample amounts of heat or food, their family is strong, supportive, loving and completely functional within their limitations. An alternate example would be a home that is affixed with all of the modern amenities, clean, warm and stocked with food, water and anything a child could ask for. However, if a child lives in this seemingly perfect home, but a loving, supportive and caring parent is either never present or if there is dysfunction in the family dynamics such as alcoholism or abuse, this impacts the environment as a whole. The RAM considers that the patient is affected by his or her environment and helps the nurse focus on how to assist them in adapting for a positive outcome. Finally, the fourth metaparadigm is that of nursing. Nurses care for individuals as well as communities, the sick and the healthy, by promoting overall health. Nurse may act as a care provider by tending to immediate physical needs of by taking the time to listen or advocate for the patient when they cannot for themselves. The nurse adapts according to what the patient needs to be well. RAM relates here as well because the role of the nurse changes according to what the person needs to adapt in order to achieve their health goals and an overall improved state of health. Slide 6 – There are 3 specific ways RAM can be used to improve nursing practice: formulate as assessment tool, use said tool to form nursing diagnoses, and to set goals. In slide #6, we discuss the assessment tool. To use RAM as the basis of an assessment tool, the nurse would use the four adaption modes of physiological, self-concept, role function and interdependence to gather pertinent data about the patient. For the physiological mode, the nurse would assess all that has to do with the physical body. Fundamental physical assessments such as vital signs, heart, lung and bowel sounds, skin condition such as turgor, color, tenting, neurovascular assessment including circulation, movement and sensation, intake and output patterns with nutrition and fluid status considerations are all examples of data obtained as part of the physiological mode of assessment. For the self-concept mode, the nurse would assess how a patient views themselves and in relation to others. An example of this would be a 60yr old female patient with colon cancer who might be feeling depressed and self-conscious about the colostomy she will need to save her life. For the role performance mode, the nurse would assess what effect the illness might have on the patient’s life in terms of their roles and responsibilities as they view them. For example, a father might be worried that he will not be able to provide for his family financially. Or, perhaps a woman who owns a family business may be concerned that the burden of operating the business while also caring for her children is resting solely on her spouse while she is ill and unable to assist with the daily duties. In the interdependence mode, the nurse would assess the patient’s support system. For example, an elderly woman who lives alone and has poor eyesight might be worried that her family will not have the time to assist her at home with her medications or be too proud to ask for help to the restroom when she needs assistance. Slide 7 – A secondary assessment is used to determine what stimuli are affecting the adaptive or lack of adaptive behavior. Stimuli affecting the patient’s response can be focal, contextual or residual. Here is a patient example where we can look and the different stimuli: A 50yr old man who presents with an exacerbation of COPD. Upon discussion and physical assessment, the nurse finds that the patient has a large amount of stress at home, mostly due to his chronic illness and continues to smoke despite his lung condition. He is only moderately compliant at best with his recommended medication regimen as prescribed by his doctor and admits he doesn’t know how to properly use his inhaler. A focused pulmonary assessment sounds reveal tight airways with moderate secretions and bilateral wheezing and lower lobe rhonchi. These finding are broken up into different types of stimuli as follows: Focal- Sputum and narrowed airways in a patient whose lung sounds reveal wheezing and rhonchi. Contextual- Patient history of COPD while having poor knowledge of how to self-manage the disease. Residual- The patient with COPD who continues to smoke to deal with stress in his/her family life. An effective assessment tool is needed to collect and document data on our patients so what we can identify abnormalities and monitor for changes. The assessment tool helps with the continuity of care so that the next nurse knows the patient’s baseline status as he or she performs their own assessment. Slide 8 – To use RAM as a tool to form a nursing diagnosis, the nurse collects data from all of the four modes and makes a statement (or nursing diagnosis) about the primary and secondary assessments as well as the stimuli thought to cause influence them. An example of appropriate nursing diagnosis based on the COPD patient’s assessment would be: Ineffective Airway Clearance due to excessive secretions. Being able to make a statement or nursing diagnosis about the data collected in the assessments performed as well as their possible contributing factors enables the nurse to identify areas that need attention in order to help the patient adapt in a more effective fashion. Slide 9 – By using the assessment data already collected, the nurse can easily set a nursing care plan and set appropriate patient goals based on the nursing diagnosis for areas that need improvement. For example, the gentleman with an exacerbation with COPD might have the following goals: Patient will maintain a patent airway and breath sounds clear, patient will demonstrate adequate airway clearance and will use effective methods of coughing, and patient will consider smoking cessation. Slides 10 11 – These are example of studies released or published that discuss that actual application of the RAM to the nursing process. In the study regarding menopausal women, the RAM was especially effective in that it addressed the psychological as well as the physical changes these women were experiencing. In the study in the International Journal of Nursing Education, Kaur, H. Mahal, R. (2012), they discussed the RAM as helping nurses to collect and organize information on their patient in a fashion that focuses on the meaningful data. This helps the nurse to identify those areas that need improvement and appropriately plan their care, goals and predictable outcomes around them. While some of the RAM concepts have seemed too abstract, as humans we are all aware of how some of these abstract concepts affect our daily lives, and are thus more than capable as empathetic beings, to adequately address these issues. Approaching patient care in a holistic fashion that addresses the whole patient allows for a more thorough assessment and meaningful approach to intervention and care.