INTRODUCtON

Sister Callista Roy was born October 14th, 1939 in Los Angeles, California. She received a
bacculaureate degree in nursing in 1963 from Mount Saint Mary’s College. In addition to
earning a mater’s degree in nursing in 1966 from the University ofCalifornia–Los Angeles, Roy
earned a master’s degree in sociology in 1973, followed by a doctorate in socology in 1977,
both from the University of California (Phillips, 2010, p. 335).Roy developed the basic concepts
of her model while she was a graduate student at the University of California–Los Angeles after
begin challenged by Dorothy Johnson in a seminar to develop a conceptual model for nursing.
The Roy adaptation model was first published in 1970. Since that time, Roy has published many
books and articles, and has presented numerous lectures focusing on the model and its use in
nursing practice. She has also continued to refine and redefine the model (Roy, 2009; Roy &
Andrews, 1991, 1999) and has been awarded many honors for her contributions to nursing
theory, practice, research, and education (Phillips, 2010)

The Roy adaptation model is currently one of the most widelyused frameworks in nursing
practice, being applied by hundreds of thousands of nurse in countries all over the world .

OVERVIEW OF ROY'S ADAPTATION MODEL

The Roy adaptation model presents the person as a holistic adaptive system in constant
interaction with the internal and the externalenvironment. The main task of the human system
is to maintain integrity in the face of environmental stimuli (Phillips, 2010). The goal of nursing
is to foster sucessful adaptation.

This model comprises the four domain concepts of person, health, environment, and nursing; it
also involves a six-step nursing process. Andrews & Roy (1991) state that the person can be a
representation of an individual or a group of individual.Roy's model sees the person as "a
biopsychosocial being in constant interaction with a changing environment"(Rambo I984).The
person is an open, adaptive system who uses coping skills to deal with stressors. Roy sees the
environment as "all conditions, circumstances and influences that surround and affect the
development and behaviour of the person"( Andrews and Roy 1991). Roy describes stressors as
stimuli and uses the term residual stimuli to describe those stressors whose influence on the
person is not clearly(Andrews and Roy 1991). Originally, Roy wrote that health and illness are
on a continuum with many different states or degrees possible(Rambo 1984).More recently,
she states that health is the process of being and becoming an integrated and whole person.
(Andrew and Roy 1991). Roy's goal for nursing is "the promotion of adaptation in each of the
four modes, thereby contributing to the person's health, quality of life and dying with
dignity"(Andrews and Roy 1991). These four modes are physiological, self-concept, role
function and interdependence.

Roy employs a six-step nursing process: assessment of behaviour; assessment of stimuli;

nursing diagnosis; goal setting; intervention and evaluation. In the first step, the person's
behaviour in each of the four modes is observed. This behaviour is compared with norms and is
deemed either adaptive or ineffective. The second step is concerned with factors that influence
behaviour. Stimuli are classified as focal, contextual or residual(Rambo 1984).The nursing
diagnosis is the statement of the ineffective behaviours along with the identification of the
probable cause. This is typically stated as the nursing problem related to the focal stimuli,
forming a direct relationship. In the fourth step, goal setting is the focus. Goals need to be
realistic and attainable and are set in collaboration with the person.(Rambo 1984). There are
usually both short term and long term goals that the nurse sets for the patient. Intervention
occurs as the fifth step, and this is when the stimuli are manipulated. It is also called the 'doing
phase' (Rambo 1984).] In the final stage, evaluation takes place. The degree of change as
evidenced by change in behaviour, is determined. Ineffective behaviours would be reassessed,
and the interventions would be revise.(Andrews and Roy 1991).

The model had its inception in 1964 when Roy was a graduate student. She was challenged by
nursing faculty member Dorothy E. Johnson to develop a conceptual model for nursing practice.
Roy's model drew heavily on the work of Harry Helson, a physiologic psychologist.(Roy
1980).The Roy adaptation model is generally considered a "systems" model; however, it also
includes elements of an "interactional" model. The model was developed specifically for the
individual client, but it can be adapted to families and to communities.

ASSUMPTIONS ON ROY'S ADAPTATION MODEL

Assumptions of the Roy Adaptation Model Assumptions included in Roy’s model are classified
into three categories: philosophic assumptions, scientific assumptions, and cultural assump-
tions. Philosophic assumptions of the model include the following:

❖ Persons have a mutual relationship with the world and a God-figure.

❖ Human meaning is rooted in an omega point convergence of the universe.

❖ God is intimately revealed in the diversity of creation and is the common destiny of creation.

❖ Persons use human creative abilities of awareness, enlightement, and faith.

❖ Persons are accountable for entering the process of deriving, sus-taining, and transforming
the universe (Roy, 2009, p. 31).

Scientific assumptions of the model include the following:

❖ Systems of matter and energy progress to higher levels of complex self-organization.

❖ Consciousness and meaning are constitutive of person and envronment integration.

❖ Awareness of self and environment is rooted in thinking and feeling.

❖ Human decisions are accountable for integration of creative processes.

❖ Thinking and feeling mediate human action.

❖ System relationships include acceptance, protection, and fosteing interdependence.

❖ Persons and earth have common patterns and integral relations.

❖ Person and environment transformations are created in human consciousness.

❖ Integration of human environment meanings results in adaptation (Roy, 2009, p. 31).

Cultural assumptions include the following:

❖ Experiences within a specific culture will influence how each element of the Roy adaptation
model is expressed.

❖ Within a culture, there may be a concept that is central to the culture and that will influence
some or all of the elements of the Roy adaptation model to a greater or lesser extent.

❖ Cultural expressions of the elements of the Roy adaptation model may lead to changes in
practice activities such as nursing assessment.

❖ As Roy adaptation model elements evolve within a cultural pespective, implications for
education and research may differ from the experience in the original culture (Roy, 2009, p. 31).

ROY'S VIEW ON THE METAPARADIGM

The metapradigm in nursing is comprised of four parts ; Person,HealthEnvironment and

Nursing.

PERSON
"Human systems have thinking and feeling capacities, rooted in consciousness and meaning, by
which they adjust effectively to changes in the environment and, in turn, affect the
environment." - Sister Callista Roy, 1999

Roy defines humans as holistic beings that are constantly interacting with their environment.
They use a system of adaptation, both innate and acquired, to respond to the environmental
stimuli they experience. Human systems can be individuals or groups, such as families,
organizations, and the whole global community. Roy believes that there is a common
purposefulness to human existence,which includes both unity and diversity.

HEALTH

"Health is not freedom from the inevitability of death, disease, unhappiness, and stress, but the
ability to cope with them in a competent way." - Sister Callista Roy, 1999

Roy defines health as the state where humans can continually adapt to stimuli. Because illness
is a part of life, health is the result of of a process where health and illness can coexist. If
humans can continue to adapt holistically- that is, physically, mentally, socially and spiritually-
they will be able maintain health to reach completeness and unity within themselves. If they
cannot adapt, or adapt with ineffective responses, the integrity of the person can be negatively
affected.

ENVIRONMENT

"the conditions, circumstances and influences surrounding and affecting the development and
behavior of persons or groups, with particular consideration of the mutuality of person and
health resources that includes focal, contextual and residual stimuli." - Sr. Callista Roy, 1999

Roy defines environment as the stimuli or input that requires a person to adapt. This stimuli can
be positive or negative, big or small. She categorized this stimuli as focal, contextual, and
residual. Focal stimulus is that which confronts the human system, and requires most of the
person's attention. Contextual stimuli are characterized as the rest of the stimuli that present
with the focal stimuli, and contribute to its effect. Residual stimuli are the additional
environmental factors present within the situation, but whose effects are unclear. This can
include previous experiences with certain stimuli.

Example: Smoking

Focal- nicotine addiction. Contextual- belief that smoking is enjoyable, relaxing, part of
routine.Residual- beliefs about body image, and weight gain with smoking cessation

NURSING

"[The goal of nursing is] the promotion of adaptation for individuals and groups in each of the
four adaptive modes, thus contributing to health, quality of life, and dying with dignity." - Sister
Callista,(Roy, 1999).

In the context of the Adaptation Model, nurses are facilitators of adaptation. They assess the
patient's behaviors for adaptation, promote positive adaptation by enhancing environment
interactions. By helping patients to react positively to stimuli, they are eliminating ineffective
coping mechanisms and eventually leading to better outcomes.

ADAPTIVE SYSTEM

The adaptive system has inputs of stimuli and adaptation level, outputs as behavioral responses that
serve as a feedback, and control process as known as coping mechanism.

The Input: which consists of stimuli and adaptation level.

STIMULI: are the internal and external environment. The main task of human system is to maintain
integrity in the face of environmental stimuli. There are three classes of stimuli form the environment.

1) The focal stimulus: the internal or external stimulus most immediately in the awareness of the
individual or group-the object or event most present in the consciousness.

2) Contextual stimuli: all other stimuli present in the situation that contribute to the effect of the focal
stimulus or all the environmental factors that present to human adaptive system from within or outside
but which are not the center of attention or energy, but these factors do influence how people deal with
the focal stimulus

. 3) Residual stimuli: environmental factors within or outside human systems, the effects of which are
unclear in the situation

. The effect of these stimuli may be unclear if there is no awareness on the part of the patient that a
stimulus is an influence, or it may not be clear to the observer that these stimuli are having an influence
on the human system

ADAPTATION LEVEL

According to Roy and Andrews (1999), adaptation refers to “the process and outcome whereby
thinking and feeling persons as individuals or in groups, use conscious awareness and choice to
create human and environmental integration”.

The adaptation level is a changing point influenced by the situation and the internal resources of the
person, family or group. It represents the condition of the life processes. Three level are described by
Roy:

1). Integrated life process: level at which the structures and functions of a life process are working as a
whole to meet human needs,

2). Compensatory process: level at which coping mechanism (cognator and regulator) have been
activated by a challenge to the person or group,

3). Compromised process: level resulting from inadequate integrated and compensatory life processes;
an adaptation problem.

THE PROCESS

in Roy adaptation model, coping processes include both innate coping mechanism and acquired coping
mechanism. Innate coping processes are genetically determined or common to the species; they are
generally viewed as automatic processes. In contrast, acquired coping process are learned or developed
through customary responses. The coping processes are categorized as “the regulator and cognator
subsystems. A basic type of adaptive process, the regulator subsystem responds through neural,
chemical, and endocrine coping channels. Stimuli from the internal and external environment act as
input through the senses to the nervous system, thereby affecting the fluid, electrolyte, and acid-base
balance, as well as the endocrine system. It is all channeled automatically, with the body producing an
automatic, unconscious response to it.
 The second adaptive process, the cognator subsystem, responds through four cognitive-emotional
channels: perceptual and information processing, learning, judgment, and emotion. The cognator–
regulator and stabilizer-innovator subsystem function to maintain integrated life processes. These life
processes-whether integrated, compensatory, or compromised- are manifested in behaviors of the
individual or group.

OUTPUT

Behaviour

Behavior is viewed as an output of the human system and takes the form of either adaptive responses
or ineffective responses serving as feedback to the system, with the human system using this
information to decide whether to increase or decrease its efforts to cope with the stimuli.

Although one can identify specific processes inherent in the regulator-cognator systems, it is Not
possible to directly observe the functioning of these system.

The behaviors can be observed in four categories, or adaptive modes:

FOUR ADAPTIVE MODES

1.Physiological-Physical Mode

Physical and chemical processes involved in the function and activities of living organisms.
These are the actual processes put in motion by the regulator subsystem.

The basic need of this mode is composed of the needs associated with oxygenation, nutrition,
elimination, activity and rest, and protection. The complex processes of this mode are
associated with the senses, fluid and electrolytes, neurologic function, and endocrine function.

2.Self-Concept Group Identity Mode

In this mode, the goal of coping is to have a sense of unity, meaning the purposefulness in the
universe, as well as a sense of identity integrity. This includes body image and self-ideals.
3.Role Function Mode

This mode focuses on the primary, secondary and tertiary roles that a person occupies in
society, and knowing where he or she stands as a member of society.

4.Interdependence Mode

This mode focuses on attaining relational integrity through the giving and receiving of love,
respect and value. This is achieved with effective communication and relations.

CRITICS OF ROY'S ADAPTATION THEORY

The critics of Roy adaptation theory is divided into internal and external .

Internal Criticism

ADEQUACY

Roy’s Adaptation Model has been refined over the years, but there are still some areas that
need to be developed. Researchers suggest that a more thoroughly defined typology of nursing
diagnoses and an organization of categories of interventions would facilitate the model’s use
over the nursing practice. It is also noted by scientists who do research from the perspective if
the model that there is notable overlapping between the psychosocial categories of self-
concept, role function, and interdependence. Fredrickson (2000) recommended the following
for future research: first, there is a need to design studies to test propositions related to
environment and nursing. Second, interventions based on the concepts and propositions that
have been supported previously should be tested.

A more thoroughly defined typology of nursing diagnoses and an organization of categories of

interventions would facilitate the use of the RAM in the nursing practice. The overlapping in the
psychosocial categories of self-concept, role function, and interdependence is continued to be
noted by scientists who do research from this particular perspective.

CLARITY
The five main concepts (adaptation, person, nursing, environment and health) are well defined.
There is also clear definition of the four adaptive modes (physiological, self-concept,
interdependence and role function). But here have been reported difficulties in classifying
behaviour exclusively in one adaptive mode. However, this observation only proves that
behaviour in one adaptive mode affects and is affected by the other modes.

CONSISTENCY

Roy has recently re-defined health, deemphasizing the concept of a health-illness continuum
and conceptualizing health as integration and wholeness of a person. Because health was not
conceptualized in this manner initially, this opens up an new area of research. Fredrickson
(2000) concluded that there is good empirical support for Roy`s conceptualization of person
and health. The recommendations are as follows: First, there is a need to design studies to test
propositions related to environment and nursing. Second, interventions based on concepts and
propositions should be tested..

LOGICAL DEVELOPMENT

Derivation of the Roy’s Model includes Harry Helson’s Adaptation Theory, which states
Individuals adapt to whatever their current situations are, so everyone tends to view his or her
current status quo as normal. Adaptive theories are ones that deal with the system’s ability to
adjust to stimulus itself based on a predetermined set of concepts. Roy’s theory fit well with
these theories.

Roy’s theory is also consistent with other holistic theories, such as psychoneuroimmunology
and psychoneuroendocrinology. For instance, psychoneuroimmunology proposes a
bidirectional relationship between the mind and the immune system. But in comparison, Roy’s
adaptation model is broader, and provides a theoretical foundation for research about, and
nursing care of, a person as a whole.

LEVEL OF THEORY DEVELOPMENT

The Roy’s Adaptation Model is a grand theory. Grand theories are at the higher level of Middle
Range Theories. These grand theories are frameworks consisting of concepts and relational
statements that explicate abstract phenomena. In fact, the Roy Adaptation Model is used to
guide the development of Middle Range Theories, which are more circumscribed, elaborating
more concrete concepts and relationships

External Criticism

COMPLEXITY

There are four main concepts of Roy’s adaptation model namely: person, nursing, environment
and health. It includes two subconcepts (regulator & cognator) and four modes (physiological,
self-concept, role function & interdependence). Though the main concepts are easily
understood, the great number of subconcepts make it somewhat difficult to grasp the whole
model at first.

DISCRIMINATION

Roy’s Adaptation Model is one of the most frequently used models to guide nursing research,
education, and practice. It’s influence is evidenced by the vast number of qualitative and
quantitative studies it has guided.

REALITY CONVERGENCE

Assumptions from systems theory and assumption from adaptation level theory have been
combined into a single set of scientific assumptions. Roy also combined the assumptions on
humanism and veritivity into a single set of philosophical assumptions. All scientific
assumptions ring true. Though, a problem with the philosophical assumptions would be that
not all people in the world recognize that there is a ‘supreme being’ or God. This had my
attention because recognition of a higher being is widely used in the assumptions

PRAGMATIC

The model has a clearly defined nursing process and can be useful in guiding clinical practice. It
gives us direction, as nurses, to provide holistic care directed to our patient. In fact by the year
1987, a mere 19 years after the initial operationalization of the model. It was estimated that
more than 100,000 nurses in the United States and Canada were prepared to practice using the
Roy Model. Senesac (2003) reviewed the literature for evidence that the Roy Adaptation Model
is being implemented in nursing practice. She reported that the RAM has been used to the
greatest extent by individual nurses to understand, plan, and direct nursing practice in the care
of individual practice.

SCOPE

Roy’s model covers quite a broad scope, but this is viewed as an advantage, simply because it
can be used for theory building; and for deriving middle range theories for testing in studies of
smaller ranges of phenomena.

SIGNIFICANCE

The Roy Adaptation Model remains to be one of the most frequently used conceptual
frameworks to guide nursing practice, and it is used nationally and internationally. The model is
useful particularly in nursing practice, because it outlines the features of the discipline and
provides direction for practice, education, and research. The model considers goals, values, the
patient, and practitioner interventions. The two level assessments assist in identification of
nursing goals and diagnoses.

UTILITY

From the beginning, the model has been supported through research in practice and education.
Roy herself stated that theory development and the testing of developed theories are the
highest priorities for nursing. The model continues to generate many testable hypotheses to be
researched. To date, it has been used in countless studies. Roy & a group of seven scholars
conducted a meta-analysis, critique, and synthesis of a 163 studies based on the Roy
Adaptation Model that had been published in 44 English journals on five continents and
dissertations and theses from the United States. Of the 163 studies, 116 met the criteria
established for testing the propositions from the model. Twelve generic propositions based on
Roy’s earlier work were derived. To synthesize the research, findings of each study were used
to state ancillary and practice propositions, and support for the propositions was examined. Of
the 265 propositions tested, 216 (82%) were supported.

APPLICATION OF ROY'S ADAPTATION MODEL TO NURSING PROCESS

Nursing goals are to promote adaptation for individuals and groups in the four adaptive modes, thus
contributing to health, quality of life, and dying with dignity

This is done by assessing behavior and factors that influence adaptive abilities and by intervening to
expand those abilities and to enhance environmental interactions.
Mr.NR who was suffering with diabetes mellitus for past 10 years. He developed a diabetic foot ulcer
and had to undergo amputation. He was admitted in Hospital. Mr. NR was selected for application of
RAM in providing nursing care.

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 approaches for nursing
care, and evaluation the outcome of care provided.

Assessment of Behavior

the first step of the nursing process which involves gathering data about the behavior of the person as
an adaptive system in each of the adaptive modes.

Assessment of Stimuli

the second step of the nursing process which involves the identification of internal and external stimuli
that are influencing the person’s adaptive behaviors.Stimuli are classified as:Focal- those most
immediately confronting the person,Contextual-all other stimuli present that are affecting the situation
andResidual- those stimuli whose effect on the situation are unclear.

Nursing Diagnosis

step three of the nursing process which involves the formulation of statements that interpret data about
the adaptation status of the person, including the behavior and most relevant stimuli

Goal Setting

the forth step of the nursing process which involves the establishment of clear statements of the
behavioral outcomes for nursing care.

Intervention
the fifth step of the nursing process which involves the determination of how best to assist the person in
attaining the established goals

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
established.

DEMOGRAPHIC DATA.

Name Mr. NR

Age 53 years

Sex Male

IP number -----

Education Degree

Occupation Bank clerk

Marital status Married

Religion Hindu

Informants Patient and Wife

Date of admission 21/01/08

FIRST LEVEL ASSESSMENT

#Physiologic -physical mode

1.OXYGENATION.

Stable process of ventilation and stable process of gas exchange. RR= 18Bpm.
Chest normal in shape. Chest expansion normal on either side.

Apex beat felt on left 5th inter-costal space mid-clavicular line.

Air entry equal bilaterally. No ronchi or crepitus. NVBS. S1& S2 heard.

No abnormal heart sounds.

Delayed capillary refill+. JVP0.

Apex beat felt- normal rhythm, depth and rate.

Dorsalis pedis pulsation of affected limp is not palpable.

All other pulsations are normal in rate, depth, tension with regular rhythm.

Cardiac dull ness heard over 3rd ICS near to sternum to left 5ht ICS mid clavicular line.

S1& S2 heard.

No abnormal heart sounds. BP- Normotensive. .

Peripheral pulses felt-Normal rate and rhythm, no clubbing or cyanosis1.Oxygenation

2.Nutrition
He is on diabetic diet (1500kcal). Non vegetarian.

Recently his Weight reduced markedly (10 kg/ 6 month).

He has stable digestive process.

He has complaints of anorexia and not taking adequate food.

No abdominal distension. Soft on palpation. No tenderness.

No visible peristaltic movements.

Bowel sounds heard.

Percussion revealed dullness over hepatic area.

Oral mucosa is normal. No difficulty to swallow food

3.Elimination

No signs of infections, no pain during micturation or defecation.

Normal bladder pattern. Using urinal for micturation.

Stool is hard and he complaints of constipation.

4.Activity and Rest

Taking adequate rest.

Sleep pattern disturbed at night due unfamiliar surrounding.

Not following any peculiar relaxation measure.

Like movies and reading. No regular pattern of exercise.

Walking from home to office during morning and evening.

Now, activity reduced due to amputated wound. Mobility impaired.

Walking with crutches.

Pain from joints present. No paralysis.

ROM is limited in the left leg due to wound.

No contractures present. No swelling over the joints.

Patient need assistance for doing the activities.

5.Protection

Left lower fore foot is amputated.

Black discoloration present over the area.

No redness, discharge or other signs of infection.

Nomothermic.

Wound healing better now.

Walking with the use of left leg is not possible.

Using crutches.

Pain from knee and hip joint present while walking.

Dorsalis pedis pulsation, not present over the left leg. Right leg is normal in length and size.

Several papules present over the foot.

All peripheral pulses are present with normal rate, rhythm and depth over right leg.

6.Senses
No pain sensation from the wound site. Relatively, reduced touch and pain sensation in the lower
periphery; because of neuropathy. Using spectacle for reading. Gustatory, olfaction, and auditory senses
are normal.

7. Neurological Function.

Drinks approximately 2000ml of water. Stable intake out put ratio. Serum electrolyte values are with in
normal limit. No signs of acidosis or alkalosis. Blood glucose elevated.

He is conscious and oriented.

He is anxious about the disease condition.

Like to go home as early as possible.

Showing signs of stress.

Touch and pain sensation decreased in lower extremity. Thinking and memory is intact.

8.Endocrine function

He is on insulin. No signs and symptoms of endocrine disorders, except elevated blood sugar value. No
enlarged glands

#Self concept mode

1.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 a Nuclear family. 5 members. Stays along with wife and three children. Good relationship
with the neighbours. Good interaction with the friends. Moderately active in local social activities

2.Personal self

Self esteem disturbed because of financial burden and hospitalization. He believes in god and
worshiping Hindu culture.

#Role performance Mode

He was the earning member in the family. His role shift is not compensated. His son doesn't’t have any
work. His role clarity is not achieved.

#Interdependence mode

He has good relationship with the neighbors. Good interaction with the friends relatives. But he
believes, no one is capable of helping him at this moment. He says ”all are under financial constrains”.
He was moderately active in local social activities.

SECOND LEVEL ASSESSMENT

1.Focal stimulus

Non-healing wound after amputation of great and second toe of left leg- 4 week. A wound first found
on the junction between first and second toe-4 month back. The wound was non-healing and gradually
increased in size with pus collected over the area.

He first consulted in a local (---) hospital. From there, they referred to ---- medical college; where he was
admitted for 1 month and 4 days. During hospital stay great and second toe amputated. But surgical
wound turned to non- healing with pus and black colour. So the physician suggested for below knee
amputation. That made them to come to ---Hospital, ---. He underwent a plastic surgery 3 week before.

2.Contextual stimulus

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.

3.Residual stimulus

He had TB attack 10 year back, and took complete course of treatment. Previously, he admitted in ---
Hospital for leg pain about 4 year back. . Mother’s brother had DM. Mother had history of PTB. He is a
graduate in humanities, no special knowledge on health matters.

NURSING CARE PLAN

ASSESS. OF ASSESSMENT NURSING GOAL INTERVENTIO

BEHAVIOUR OF STIMULI DIAGNOSIS N
EVALUATION
Ineffective Focal stimuli: 1. Impaired skin Long-term Maintain the Short term
protection integrity related objective: wound area goal:
and sense Non-healing to fragility of clean as
in physical- wound after the skin 1. amputated contamination Met: size of
physiologic amputation of secondary to area will be affects the wound
al mode great and second vascular completely healing decreased to
toe of left leg- 4 insufficiency healed by process. less than 1x1
week 20/5/08 cms.
- Follow
(No pain 2.Skin will sterile WBC values
sensation remain technique became
from the while providing normal on
wound intact with no 24/4/08
ongoing cares to
site.) prevent
ulcerations.
infection and
Short-Term delay in Long term
Objective: healing. goal:

i. Size of - Perform Partially Met:

wound wound skin partially
decreases to dressing with intact with no
1x1 cm within Betadine ulcerations.
24/4/08. which promote
Continue plan
healing and
ii. No signs Reassess goal
growth of new
of infection and
tissue.
over the interventions
wound within - Do not move
1-wk Unmet: not
the affected
achieved
area
iii. Normal complete
frequently as it
WBC values healing of
affects the
within 1-wk amputated
granulation
area. Continue
iv. Presence tissue
plan Reassess
of healthy formation.
goal and
granular interventions.
- Monitor for
tissues in the
signs and
wound site
symptoms of
within 1-wk
infection or
delay in
healing.

- Administer
Impaired Focal stimuli:
activity in
physical- During hospital - Assess the Short term
physiologic stay great and level of goal:
second toe 2. Impaired Long term restriction of
al mode physical Objective: Met: used
amputated. But movement
surgical wound mobility related crutches
turned to non- to amputation - Provide correctly on
healing with pus of the left Patient will active and 22/4/08.
and black colour. forefoot and attain passive
presence of exercises to all he is self
maximum motivated in
unhealed possible the extremities
wound to improve the doing minor
physical excesses
mobility with muscle tone
in 6 months. and strength. Partially Met:
- Make the walking with
Short term minimum
objective: patient to
perform the support.
ROM exercises
to lower
extremities Long term
i. Correct use which will goal:
of crutches strengthen the
Unmet: not
with in muscle.
attained
22/4/08 maximum
- Massage the
ii. walking upper and possible
with minimum lower physical
support- extremities mobility-
22/4/08 which help to Continue plan
improve the Reassess goal
circulation. and
intervention
iii. He will - Provide
be self articles near to
motivated in the patient and
activities- encourage
20/4/08 performing
activities
within limits
which promote
a feeling of
well being.
 3. Anxiety
related to
Alteration hospital Long term
in Physical admission and Objective:
self in Contextual - Allow and Short term
stimuli: unknown The client will encourage the goal:
Self- Outcome of the
concept remain free client and
Known case DM disease and from anxiety family to ask Met:
mode for past 10 years financial demonstrated
questions.
and on constrains Bring up appropriate
treatment with common range effective
(He is insulin for 8 Short term coping with
objective: concerns.
anxious years. treatment
about i. - Allow the
changes in client and He is able to
demonstrating rest quietly.
body Residual stimuli: appropriate family to
image) no special range effective verbalize
knowledge in coping in the anxiety.
health matter. treatment Long term
- Stress that goal:
Change in frequent
Role ii. Being able
to rest and assessment are Unmet: client
performan routine and do not completely
ce mode. iii. Asking not necessarily remained free
(He was fewer imply a from anxiety
the questions deteriorating due to
earning condition. financial
member in constrains-
the family. - Repeat Continue plan
His role information as Reassess goal
shift is not necessary and
compensat because of the interventions
e). reduced
attention span
of the client
and family

- Provide
comfortable
quiet
environment
for the client
 and family

Contextual 4. deficient - Explain the

stimuli: knowledge treatment
regarding the Long term measures to Short term
Known case DM foot care, Objective: the patient and goal:
for past 10 years wound care, their benefits
and on Patient will Met:
diabetic diet, acquire in a simple Verbalization
treatment with and need of understandabl
insulin for 8 adequate and
follow up care. knowledge e language. demonstration
years.
regarding the t - Explain of foot care.
foot care, about the
wound care, Strictly
Residual stimuli: home care. following
diabetic diet, Include the
no special and need of diabetic diet
knowledge in points like care plan
follow up care of wounds,
health matter and practice in nutrition,
their day to activity etc.
day life. Unmet:
Demonstration
Short term of wound care.
objective: Clear the
doubts of the
i. patient as the
Verbalization Long term
patient may
and goal:
present with
demonstration some matters Unmet: not
of foot care. of importance. completely
ii. Strictly acquired and
- Repeat the
following practiced the
information
diabetic diet required
whenever
plan knowledge.
necessary to
Continue plan
iii. reinforce
Reassess goal
Demonstration learning
and
of wound care. interventions.
SUMMARY/CONCLUSION

Roy's Adaptation model identifies essential concepts relevant to the nursing profession.The
human adaptive system is constantly interacting with the internal and external stimuli which
affects individual health.It is the responsibility of nurses to manipulate specific stimuli to as to
help patient achieve optimal health.

It is useful in analysing groups,individual and societies.It is the responsibility of nurses to

facilitate adaptation of group and persons so as to enhance their welfare and well being.

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