The Roy Adaptation Model

Overview of Theory 

The Roy Adaptation Model presents a person as consisting of human systems that continuously interacts with both the environment which encompasses the focal, contextual and residual stimuli ( Shahed et al., 2016) . Focal environment pertains to the internal and external environment while contextual stimuli comprises of stimuli that contribute to the former together with those stimuli that affect the current situation ( Shahed et al., 2016) . Moreover, the residual stimuli delineates to the factors that contribute to the formulation of thought and attitudes of an individual, including beliefs, behaviors and personal experiences. 

The model asserts that there are four modes of adaptation that are recognized by Roy which include physiologic, self-concept, role function and interdependence modes ( Hatami & Hojjati, 2019) . The synergy between the four modes significantly contributes to an individual being holistic in their adaptation to their environment during the recovery process therefore contributing to their continued wellbeing ( Hatami & Hojjati, 2019) . The model therefore emphasizes on the ability of nursing to be able to facilitate better adaptation of individuals to these environmental stimuli. It is safe to conclude that Roy Adaptation Model is a grand theory given the fact that the model offers nursing with an overall framework for the application of theory to practice together with defining the role of nursing and interventions used. 

Selection of Theory 

The Roy Adaptation Model (RAM) significantly contributes to patient care being systematic, purposeful, controlled and effective at the same time focusing on how nurses can best perform their roles ( Mohammadpour et al., 2016) . According to the RAM, the role of nursing and patient care is to aid patients in adaptation with the view that the improved interaction between an individual and the environment is vital for improving health, quality of life and end of life care ( Saini et al., 2017) . To this extent, the theory is vital to nursing practice given the fact that it is patient centered together with being among the models that consider nursing to be a science therefore recommending application evidence-based practices to patient care. 

Seven-Step Sequence in Translating Theory into Practice 

The seven-step process is essential to the translation of theories into evidence-based practice in addition to other forms of intervention and practical actions that may be adopted in the research process. The first step entails the identification of a practice problem that required for evidence to be gathered. It encompasses awareness of an issue through online journals, seminars, amidst an array of other sources of information in addition to the ability of coming up with new assessment and intervention methods ( Davidson & Zisook, 2017) . The second step is the use of PICOT format to formulate an inquiry on the problem that can be used to form intervention measures. The third step of the translation process entails a review of literature to establish the theoretical component of the problem that has been established in addition to providing a map of evidence that is available on the issue ( Davidson & Zisook, 2017) . The fourth step entails the critical evaluation of literature with a realistic review of the literature which involves appraisal, integration and evaluation of literature on a specific subject. 

The fifth step pertains to the recommendation of intervention measures that can be applied to that particular problem as has been evaluated an interpreted from the literature review findings ( Davidson & Zisook, 2017) . The sixth step of translation is the evaluation of how effective the intervention measures are expected to be in addition to the analysis of the best evaluation measures to apply to the research process. The seventh step encompasses the medium and means that would be used to reveal the findings and conclusions that have been arrived at by the research process ( Davidson & Zisook, 2017) . Moreover, it involves the identification of the target audience together with the affected population. 

Step 1 – Problem 

Nursing professionals and medical practitioners alike have had a seemingly insurmountable challenge in the establishment of long lasting end of life care intervention measures for breast cancer patients that is holistic in its approach. Research reveals the fact that breast cancer in its advanced staged is bound to critically undermine the quality of life of the patient due to the physical manifestations that accompany the condition ( Ortiz, 2018) . Additionally, scholarly findings point to the fact that the diagnosis and treatment of breast cancer is often accompanied by a significant impact on the psychosocial wellbeing of individuals, pointing for the need for establishment of sensitive intervention measures ( Cherny et al., 2018) . Statistics from the CDC reveal the fact that institutions that personalize treatment through precision medicine and patient care result in high satisfaction and absence of disparities in 78% of the cases (Friese et al., 2018) Nursing intervention and patient care methods chosen have to integrate the decision making, opinions, and interests of the patient which additionally creates the need for attention to the holistic nature of the care that is provided to patients of breast cancer ( McEwen & Wills, 2017) . Moreover, research findings point to the effect of the condition on the commitment and performance of daily roles and routines by individuals which has an effect on the social wellbeing of the patients and their role in social integrity ( Jennings, 2017) . 

Step 2 – Research Question 

Among female breast cancer patients (P), the application of the four modes of Roy Adaptation Model in the formulation of treatment and care strategies (I) is likely to result in better quality of treatment and patient care (O) as compared to strategies established without adherence to the model (C). 

Step 3 – Application of Theory to Determine and Guide Variable Selection and Measurement 

The research process involved an online search and survey of literature that has expounded on the issue of breast cancer and the adverse effects it has on the wellbeing of the individual patients ( Cherny et al., 2018) . The review will majorly consider empirical literature that has delved into the statistics of the extent of the phenomena. For instance, the study will expound on empirical literature delving into the application of RAM in the care and treatment of various conditions and the role it plays in ensuring patients are provided with quality of the care ( Ursavaş et al., 2014) . Moreover, the study intends to review empirical literature expounding on studies which indicate the need to focus on the quality of care and the nature of care provided, with a focus on patient centered care methods such as nursing models like RAM ( Jennings, 2017) . The theoretical approach chosen for the study is socio-political given the fact that it encompasses various aspects of the social life of patients in addition to focusing on the structures and systems put in place to facilitate better care for breast cancer patients. 

Interpretation of Literature findings 

Literature findings indicate the fact that focusing on palliative care is part and parcel of patient centered care and the process of ensuring that patients and their families are offered with the best treatment and care intervention ( Jennings, 2017) . Part of the optimization of patient care is the integration of nursing models that improve the quality of life and wellbeing of patients. The models applied should be interdisciplinary and fully engage the aspects of life of the patients encompassing therapeutics and ensured continuity of care and treatment offered ( Cherny et al., 2018) . Additional findings indicate that application of the four modes of RAM is essential in ensuring that holistic care is offered to care ( Ursavaş et al., 2014) . Research indicates that the focus of the nursing model on factors such as the social support provided to patients together with the self-concept and esteem of patients is vital for quality care and recovery of patients. 

Step 5 – Recommendations to address problem 

It is vital for nursing professions to focus on the facilitation of positive attitudes among patients through encouragement of patients to establish goals together with promoting healthy practices among the patients ( Saini et al., 2017) . Moreover, the research findings recommended the regular assessment and assertion of the optimal functioning of bodily functions amidst ensuring that the physiological functions of individuals are as optimal as possible ( Jennings, 2017) . Additionally, it is vital for facilities and institutions to focus on the provision of social support to patients ensuring that the individuals are able to maintain friendships and relationships that are vital to them even during the course of treatment. 

Step 6 – Plan to evaluate the innovative actions outcomes 

Evaluation is critical for the assessment of the efficiency and applicability of intervention measures that are arrived at through the application of nursing models ( Cherny et al., 2018) . Evaluation of the efficacy of the intervention action majorly encompasses the analysis of the outcomes of the interventions that have been recommended and applied to the problem ( Saini et al., 2017). The outcomes of the intervention will be compared to that of patients who did not adhere to RAM in the treatment of their medical conditions. 

Step 7 – Plan to disseminate the outcomes of the innovation 

The results of the innovation shall be disseminated through integration into scholarly journals that expound upon the subject matter. Moreover, the results shall be disseminated through publishing on online periodicals and journals that can be accessed through the internet. The results and outcomes of the innovation process shall target practicing nurses together with patients of breast cancer and their families. 

Summary 

The RAM through the four modes is critical is the establishment of holistic approaches to the treatment and wellbeing of patients with an intricate focus put on the patient centered nature of the intervention methods ( McEwen & Wills, 2017) . The research findings were collected through the internet and the socio-political theoretical concept applied given the need for comprehensive treatment methods for patients of breast cancer. The PICOT question therefore focused on the effect of this treatment and care approach compared to its non-application in the research process. Through the intervention measures established, the patients are ensured of quality care. 

References

Cherny, N. I., Paluch-Shimon, S., & Berner-Wygoda, Y. (2018). Palliative care: needs of advanced breast cancer patients.  Breast cancer (Dove Medical Press) ,  10 , 231–243. doi:10.2147/BCTT.S160462 

Jennings K. M. (2017). The Roy Adaptation Model: A Theoretical Framework for Nurses Providing Care to Individuals With Anorexia Nervosa.  ANS. Advances in nursing science ,  40 (4), 370–383. doi:10.1097/ANS.0000000000000175 

Ursavaş, F. E., Karayurt, Ö., & İşeri, Ö. (2014). Nursing Approach Based on Roy Adaptation Model in a Patient Undergoing Breast Conserving Surgery for Breast Cancer.  The journal of breast health ,  10 (3), 134–140. doi:10.5152/tjbh.2014.1910 

Shahed, S., Vanaki, Z., & Tahmasebi, M. (2016). Effect of an Educational-Supportive Program Based on Roy Adaptation Model on Marital Satisfaction in Mastectomy Patients Receiving Chemotherapy.  Evidence Based Care ,  6 (1), 71-78. 

Hatami, F., & Hojjati, H. (2019). Effect of Roy’s Adaptation Model on the Care Burden of Mothers of Children Under Chemotherapy (A Quasi-Experimental Study).  Medical-Surgical Nursing Journal ,  8 (1). 

Saini, N., Sharma, V., Arora, S., & Khan, F. (2017). Roy’s Adaptation Model: Effect of care on pediatric patients.  Int J Nurs Midwifery Res ,  4 (1), 52-60. 

Mohammadpour, A., Najafi, S., Tavakkolizadeh, J., & Mohammadzadeh, F. (2016). The Effects of the Roy’s Adaptation Model on Primigravida Women’s Self-Concept: A Randomized Controlled Trial.  Asian Journal of Pharmaceutical Research and Health Care ,  8 (1), 17-23. 

Davidson, J. E., & Zisook, S. (2017). Implementing family-centered care through facilitated sensemaking.  AACN Adv Crit Care ,  28 (2), 200-9. 

Ortiz, M. R. (2018). Patient-Centered Care: Nursing Knowledge and Policy.  Nursing science quarterly ,  31 (3), 291-295. 

McEwen, M., & Wills, E. M. (2017).  Theoretical basis for nursing . Lippincott Williams & Wilkins.