FACULTY OF HEALTH

School of Nursing and Midwifery

Learning Disaili!y Nursing
Roys Adaptation Model of Nursing
"esource #ac$
Fiona "ich
Senior Lec!urer
"OY%S ADA#TAT&ON MODEL OF NU"S&N'
(ac$ground !o !he Theoris!
American
Paediatric Nursing background
Basic concepts of the Theory developed between 196 and 1966
Theory operationalised in 196!
"esearched cognitive recovery in head in#uries of children
&nfluences
1$ %&periences in Paediatric Nursing ' "oy noticed the childrens( resilience to adapt
in response to physical and psychological change
)$ *arry *elson(s Adaptation Theory which suggests that adaptive responses are a
function of incoming stimulus$ The ability of a person to adapt is determined by
the effects of + classes of stimuli,
i- .ocal /timuli which immediately confronts the individual
ii- 0onte&tual /timuli1 which is all other stimuli present
iii- "esidual /timuli1 which are relevant factors which may affect the
behaviour of the individual1 but whose effects are not validated
+$ "apoport(s systems Theory
$ *ans /elye(s work on stress and coping mechanisms
2$ Abraham 3aslow(s work on *umanism
&n!roduc!ion
"oy focuses on the concept of adaptation of man$ *er concepts of Nursing1 the
Person1 *ealth and the %nvironment are all interrelated to this central concept$
*elson(s view that adaptation is a process of responding positively to environmental
changes was used by "oy as the foundation for the model$ This view1 combined with
"apoport(s definition of a 4system4 lead to "oy(s theory of the person as an adaptive
system$ The model has been further refined using concepts from other theorists
including *ans /elye and Abraham 3aslow$
Ma)or Conce*!s and Defini!ions
Sys!e+ ' a system is a set of units1 so related or connected as to form a unity
or whole
Ada*!a!ion Le,el ' a person(s adaptation level is a constantly changing point
made up of focal1 conte&tual and residual stimuli$ The adaptation level
is the person(s ability to respond positively to that stimuli$
Ada*!a!ion #role+s ' adaptation problems occur as a result of inade5uate
responses to stimuli
"egula!or ' the automatic response of an individual which is regulated by
neural'chemical'endocrine control ' e$g$ fight-flight responses
Cogna!or ' the response of an individual which is made following processing
by the use of any of the following,
Perception
6nformation
7earning
8udgement
%motion
#hysiological Mode ' the body(s basic needs and ways of dealing with
adaptation in regard to, fluid and electrolytes9 e&ercise and rest9
elimination9 nutrition9 circulation and o&ygen9 and regulation :including
the senses1 temperature and endocrine regulation-
Self-conce*! Mode ' the beliefs and feelings that one holds about oneself at
a given time1 formed from perceptions of other(s reactions$ 6ncludes
the physical self :self image- and the personal self :self'ideal or
e&pectancy1 the moral and ethical self-
"ole #erfor+ance Mode ' "ole function is the performance of various duties
based on given positions in society ' e$g$ wife1 mother1 nurse1 student1
patient etc$
&n!erde*endence Mode ' a persons relations with significant others and
support systems
Ma)or Assu+*!ions
Assu+*!ions fro+ Sys!e+s Theory
1$ A system is a set of units1 so related or connected as to form a unity or
whole
)$ A system is a whole that functions as a whole by virtue of the
interdependence of its parts
Discussion
#oin!
In relation to application to learning disability nursing, do people who
have learning disabilities necessarily function as a whole?
+$ /ystems have inputs1 outputs and control and feedback processes
Discussion
#oin!
In relation to application to learning disability nursing, people who have
learning disabilities may also have communication problems. How
difficult would make input, output, control and feedback processes?
Assu+*!ions fro+ Helson%s Theory
1$ *uman behaviour represents adaptation to environmental and organismic
forces '
Discussion
#oin!
In relation to application to learning disability nursing, people who have
learning disabilities may not have the physical/sensory/intellectual ability
to adapt to environmental/organismic forces. How would you ensure
adaptation took place?
)$ Adaptive behaviour is a function of the stimulus and adaptation level ' ie
the effect of focal1 conte&tual and residual stimuli
Discussion
#oin!
In relation to application to learning disability nursing, adaptive behaviour
on the part of people who have learning disabilities may be seen as
"challenging". here may be a need to teach other means of adapting to
situations and a need to increase the repertoire of adaptive responses
+$ Adaptation is a process of responding positively to environmental changes
Discussion
#oin!
In relation to application to learning disability nursing, people who have
learning disabilities may not produce a positive response to
environmental changes, but may produce ineffective responses !such as
behaviour which has produced a desired effect in the past, but which is
challenging"
Assu+*!ions fro+ Hu+anis+
1$ Persons have their own creative power
Discussion
#oin!
In relation to application to learning disability nursing, do people who
have learning disabilities have creative power?
)$ A person(s behaviour is purposeful and not merely a chain of cause and
effect
Discussion
#oin!
In relation to application to learning disability nursing, is this true of
people who have learning disabilities?
+$ A person is holistic
$ A person(s opinions and viewpoints are of value
Discussion
#oin!
In relation to application to learning disability nursing, are people who
have learning disabilities valued by society?
2$ The interpersonal relationship is significant
#ara+e!ers of Nursing
The na!ure of Nursing
"oy(s goal of nursing is to help man adapt to changes in his physiological
need, self concept, role function and interdependent relations during health
and illness$
Discussion
#oin!
his goal relates well to learning disability nursing, as the self concept as
defined by #oy may be damaged due to institutionalisation and
devaluing of individuals by society$s attitude.
In respect of role function, are people who have learning disabilities
encouraged to develop positive positions and roles in society? his
%uestion of role function relates very well to the concept of &ocial #ole
'alorisation which emphasises the enhancement of the social role of
individuals or groups at risk of social devaluation !(olfensberger, )*+,".
Nursing1 according to "oy1 fulfils a uni5ue role as a facilitator of adaptation by
assessing behaviour in each of these four adaptive modes and intervening by
managing the influencing stimuli,
Physiological need ' in learning disability nursing, managing the
influencing stimuli for the physiological needs of people who
have learning disabilities may involve adapting the
environment to meet the needs of physical and/or sensory
disabilities
/elf'concept ' in learning disability nursing, managing the influencing
stimuli for the self-concept of people who have learning
disabilities may involve social role valorisation and de-
institutionalisation
"ole function ' in learning disability nursing, managing the influencing
stimuli for the role function of people who have learning
disabilities may involve facilitating valued social roles and
positive life e-periences of individuals
6nterdependent "elations ' in learning disability nursing, managing the
influencing stimuli for the interdependent relations of people
who have learning disabilities may involve assisting in the
maintenance of links with the family, encouraging relationships
and support of other members of society who may or may not
have a learning disability and supporting the individual as a
surrogate relation
The Na!ure of !he #erson
The person1 according to "oy is the recipient of Nursing 0are and is a living1
comple&1 adaptive system with internal processes :regulator and cognator
processes- which act to maintain adaptation in the four modes$
Discussion
#oin!
In learning disability nursing, the %uestion should be asked - can people
with learning disabilities maintain adaptation without support in all
cases? he aim of the learning disabilities nurse is to ma-imise the
potential of the individual, therefore should this read "... maintain
adaptation within limitations of potential" ... ?
The Na!ure of Heal!h
*ealth1 according to "oy1 is a state and a process of being and becoming an
integrated and whole person ' an integrated whole$ Adaptation is a process
of promoting physiological1 psychological and social integrity ' integrity implies
an unimpaired condition leading to completeness or unity$
;hen mechanisms for coping are ineffective1 illness results$ *ealth ensure
when man continually adapts to stimuli$ As people learn to adapt to one set
of stimuli1 e$g$ mastering self'feeding1 they can then concentrate on mastering
another set of stimuli$ 4.reeing of energy from ineffective coping attempts
can promote healing and enhance health4$
Discussion
#oin!
In relation to learning disability nursing, #oy$s definition of illness seems
to blend very well, as illness in learning disability nursing, would be
regarded as an inability to function independently as a whole, or an
inability to adapt to society because of impaired mental or physical
conditions. However, #oy$s definition of illness implies total dependence
which is not necessarily the case. here may be a need to indicate the
level of nursing intervention that is re%uired - ie full physical assistance,
partial physical assistance or educative assistance as in .rem$s model
of nursing.
The Na!ure of !he En,iron+en!
According to "oy1 the environment is all the conditions1 circumstances and
influences surrounding and affecting a person(s behaviour$ .actors in the
environment that affect the person are categorised as focal1 conte&tual and
residual stimuli$ In learning disability nursing, the environment can have an
immense effect on the behaviour of an individual, particularly if one considers
the effects of institutionalisation or the antecedents of behaviour which
challenges services.
Ac!i,i!y #ead the profile of /ndrew &mith over the page and e-amine the
assessment documentation and care plan on the following pages.
#rofile of Mr Andrew S+i!h
3r Andrew /mith is a ) year'old man with severe learning disabilities$ *e lives in
an eight'bedded unit in the grounds of an old institution which is currently being
developed as a housing estate$ The unit has a sister eight'bedded unit ne&t door $
These units are primarily for residential care1 but the unit that Andrew lives on also
has + short'stay beds within the units$
<enerally1 Andrew is a sociable person and en#oys the company of staff$ *e en#oys
making other people laugh by his comic facial e&pressions and revels in attention$
Andrew tends to be hostile towards the other service'users however1 e&pecially if
they appear to be receiving more attention than himself1 or if he feels they are
making fun of him $ *e can also become hostile towards service users who are
admitted for short term care$ This hostility is e&pressed through biting staff and=or
service'users1 pushing people over or punching others$ Andrew can also become
aggressive towards others if asked to do something that he does not want to do or if
he feels he is not able to do1 for e&ample if asked to put his coat on$
Andrew has lived in this home for the past > years$ Previously he lived at home with
his parents1 however1 his parents are elderly and his mother was not able to cope
with his aggressive outbursts$ 6f Andrew became aggressive towards his mother1 she
tended to pander to his re5uests$ As a result1 he came to e&pect more and more
from his mother and resorted to aggression if any re5uest was denied$
Andrew?s parents visit him every /aturday and always take him out to the local caf@
for coffee$ *e looks forward to this and en#oys dressing in his smart clothes for the
occasion$ *is parents do not take him far from the unit because they are concerned
about possible aggression towards them$
*e has little clear speech1 but manages to make his needs known by gestures and
grunts$ Andrew?s self'help skills are also limited$ Although he is mobile1 he has a
left'sided hemiplegia A he has some use of his left hand and tends to drag his left leg
when walking$ *e is capable of feeding himself1 but is not able to cut his food up$
*e is not able to take himself to the toilet and has no control over his bladder or
rectal sphincter and as a result is doubly incontinent$ *e is also prone to constipation
and despite a high fibre diet re5uires regular phosphate enemas to prevent him from
becoming impacted$
Andrew is not able to dress himself without assistance1 but will position himself in
such a way as to make dressing easier for the staff$ /taff feel that Andrew would be
capable of dressing himself despite his physical disabilities given the correct
incentive$
Andrew has no occupation outside of the unit1 but has the responsibility for taking the
rubbish bags to a collection point$ *e is fearfully possessive of this role and will
become aggressive towards other clients if they attempt to help him$ *e en#oys
social outings and shopping trips and looks forward to these immensely$
"OY%S MODEL OF NU"S&N'
Assess+en! Tool
ASSESSMENT OF &NFLUENC&N' ST&MUL&
Assess+en! of Focal S!i+uli
:indicate the changes facing the
individual which re5uire a change in
behaviour-
Frequent change of clients staying at the unit
Lack of attention
Assess+en! of Con!e.!ual S!i+uli
:indicate all other changes present
which would contribute to the
behaviour-
Lack of occupation
Lack of self help skills
Assess+en! of "esidual S!i+uli
:indicate historical factors which may
affect the behaviour-
Previously allowed to control his mother by becoming aggressive if he did not receive his
requests
ASSESSMENT OF SU( SYSTEMS
Assess+en! of *hysiological +ode
:6ndicate basic needs and ability to
adapt in regard to fluid B electrolytes9
e&ercise B rest1 elimination1 nutrition1
circulation B o&ygen1 senses and
regulation of body systems-
left-sided hemiplegia makes self-help skills difficult, but has adapted to this disability for
feeding and mobilising
Little clear speech, but has adapted to this through the use of grunts and gestures
Doubly incontinent
Prone to constipation
Assess+en! of self conce*! +ode
:indicate beliefs and feelings held
about physical self :self image- and
personal self :self ideal or
e&pectancy-
Has an awareness of his appearance and enoys wearing smart clothes
Does not like other clients to make fun of his appearance
!noys the company of others and appears to feel reected if not given the desired attention
"ives the impression that he feels superior to other clients
Assess+en! of role *erfor+ance
+ode
:indicate role function=performance of
various duties based on given
positions in society-
Has no occupation outside of the home
Has one particular duty inside of the home which makes him feel superior to other clients
Assess+en! of in!erde*endence
+ode
:identify a persons relations with
significant others and support
systems-
!noys company of staff, but not necessarily other clients
#ehaviour towards other clients is often negative - possibly due to his feeling of superiority
!noys the company of his parents, but still tries to control his mother through his aggression
"OY%S MODEL OF NU"S&N'
Nursing Care #lan
Need 'oal "egula!ors/Cogna!ors Nursing &n!er,en!ion
$ggression towards
clients who are
admitted for respite
care
%o eliminate
aggression towards
short-term care
clients
&egulators - possible automatic
response to strangers - ie
fight'flight response
(ognators - Past e)perience has
proven this strategy to be
successful - ie aggression
towards others usually means
that he will get his own way
*hort-%erm +ntervention,
!nsure that $ndrew has attention when short-
term care clients are present
&eward $ndrew for more appropriate behaviour
towards short-term care clients
Long-%erm +ntervention,
%o provide living accommodation which does not
have a rapid turn-over of clients -accommodation
should be in the community, close to parents.
home/
Ac!i,i!y .utline below a pen-picture of a person with learning disabilities with
whom you have worked then complete the nursing process
documentation for #oy0s 1odel of 2ursing on the following pages..
"OY%S MODEL OF NU"S&N'
Assess+en! Tool
ASSESSMENT OF &NFLUENC&N' ST&MUL&
Assess+en! of Focal S!i+uli
:indicate the changes facing the
individual which re5uire a change in
behaviour-
Assess+en! of Con!e.!ual S!i+uli
:indicate all other changes present
which would contribute to the
behaviour-
Assess+en! of "esidual S!i+uli
:indicate historical factors which may
affect the behaviour-
ASSESSMENT OF SU( SYSTEMS
Assess+en! of *hysiological +ode
:6ndicate basic needs and ability to
adapt in regard to fluid B electrolytes9
e&ercise B rest1 elimination1 nutrition1
circulation B o&ygen1 senses and
regulation of body systems-
Assess+en! of self conce*! +ode
:indicate beliefs and feelings held
about physical self :self image- and
personal self :self ideal or
e&pectancy-
Assess+en! of role *erfor+ance
+ode
:indicate role function=performance of
various duties based on given
positions in society-
Assess+en! of in!erde*endence
+ode
:identify a persons relations with
significant others and support
systems-
"OY%S MODEL OF NU"S&N'
Nursing Care #lan
Need 'oal "egula!ors/Cogna!ors Nursing &n!er,en!ion
Discussion
#oin!
*aving completed your assessment and care plan using "oy?s model1 how do you
feel the model caters for the following needs and rights of clientsC
Needs,
Psychological
/ocial
Physical
/piritual
"ights,
0hoice
Privacy
"espect
Dignity
/elf'e&pression
6ndividuality
Participation in Nursing 3ethods and 0onsultation
Ac!i,i!y &den!ify 0 *osi!i,e as*ec!s of !he +odel for *eo*le wi!h learning disaili!ies
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&den!ify 0 nega!i,e as*ec!s of !he +odel for *eo*le wi!h learning disaili!ies
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