NBHS1104

FACULTY OF NURSING AND ALLIED HEALTH SCIENCES

MAY 2017

NBHS 1104

NURSING HEALTH ASSESMENT

MATRICULATION NO : 820415025642001
IDENTITY CARD NO. : 820415 - 02 - 5642
TELEPHONE NO. : 019-2176397 @ 0113-2175642
E-MAIL : umiaidilieya@oum.edu.my

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LEARNING CENTRE : PETALING JAYA CENTRE

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TABLE OF CONTENT

1.Introduction..................................................................................................................... 2

2.Understanding On The Identified Nursing Theory 3

2.1 Credentials And Background Of The Theorist . 3

2.2 Roy's Adaptation Model Practice..... 7

3. Emphasising On The Advantages Of The Identified Nursing Theory.. 5

In Enhancing Patient Outcome

4. Environment And Organization Background.. 9

5. Implementation of The Adaption Model In Diabetic Self Management Education. 9

6.Summary .......................................................................................................................... 13

7. Refference 14

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Introduction

The theory is defined as "a belief, policy, or procedure proposed or followed as the basis of
action". Nursing theory is "an organized framework of concepts and purposes designed to guide
the practice of nursing". The first nursing theories appeared in the late 1800s when a strong
emphasis was placed on nursing education. Nursing theories are developed to explain and
describe nursing care, guide nursing practice and provide a foundation for clinical decision
making.There are many different types of nursing theories. Nursing theories can be divided into
"grand theories" that are applicable on a broad scale, "middle-range theories" that apply to a
smaller subset of situations and "nursing practice theories" that guide nursing practice. Theories
can be further divided into categories including holistic, systems, adaptation and behavioral
orientations. Nursing theories are a relatively new component of the nursing profession. Despite
their recent appearance, nursing theories have a made a strong and lasting impact on the
education, training and development of professional nurses. They have also influenced patient
care and outcomes in everyday nursing practice.(Petiprin, 2016)

The majority of nursing theories are developed by nurses, but all the time professionals of
other healthcare professionals, such as physicians have given input into the development of
nursing theory. Nurses can develop their own theories or work with other nurses. Nurse theorists
often have the desire to explain, predict and describe the elements of nursing care and practice.
Nurse theorists often take their academic and clinical experience when formulating their theories.
Many clinical nursing theories have been developed by nurses who are active in nursing
practices and are most aware of the current conditions of the healthcare environment. At other
times, nurse theorists are inspired by the previous nurse theorists and incorporate some other
nursing theories into their own. (Petiprin, 2016)

Nursing theory affects daily practice of nursing. Most nurses use several theories in
practice rather than using one theory exclusively. Using a variety of nursing theories during a
given day, allow the nurse to choose the best theories to suit the situation. In an ideal setting,

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nursing theory serves to provide the basis for nursing care in every patient encounter. They have
also affected patient care and results in daily nursing practice. As the nursing profession
continues to grow and

defines itself, a new nursing theory is needed to guide nurses who practice in bed. They help
nurses use critical thinking skills, analytical skills and enhance understanding of concepts.
Nursing theory improves patient care, patient outcomes, and nurses-patient communication.
Through the use of nursing theory in practice, new knowledge and data are acquired that can
affect the future of nursing practice. (Petiprin, 2016)

One of the priorities that will be highlighted in nursing academic writing is about the mid
theory applied in the nursing process. Hence, the purpose of this writing is to illustrate the
development of intermediate theories, adapting to educating diabetic mellitus patients, through
theory and concept synthesis. Adaptation to the model of chronic illness proves the conceptual
relationship of Roy's Adaptation Model in a theory specific to chronic illness. Some concepts in
the process of diabetes, self-management, integration, and disease in diseases are synthesized
with theory through empirical evidence checks. This method of development of the theory
enhances the existing specificity of the theory and communicates the application to nursing
practice. Through this assignment, I will use RAM as the abbreviation for Roy's Adaptation Model.

2.Understanding On The Identified Nursing Theory

2.1 Credentials And Background Of The Theorist

Sister Callista Roy, a member of the Sisters of Saint Joseph of Carondelet, was born on
October 14, 1939, in Los Angeles, California. She received a bachelors degree in nursing in
1963 from Mount Saint Marys College in Los Angeles and a masters degree in nursing from the
University of California, Los Angeles, in 1966. While working toward her masters degree, Roy
was challenged in a seminar with Dorothy E. Johnson to develop a conceptual model for nursing.
While working as a pediatric staff nurse, Roy had noticed the great resiliency of children and their
ability to adapt in response to major physical and psychological changes. Roy was impressed by

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adaptation as an appropriate conceptual framework for nursing. Roy developed the basic
concepts of the model while she was a graduate student at the University of California, Los
Angeles, from 1964 to 1966. Roy began operationalizing her model in 1968 when Mount Saint
Marys College adopted the adaptation framework as the philosophical foundation of the nursing
curriculum. The Roy Adaptation Model was first presented in the literature in an article published
in Nursing Outlook in 1970 entitled Adaptation: A Conceptual Framework for Nursing (Harris,
2017)

The key concepts of Roy's Adaptation Model are made up of four components which are a
person,health,environment,andnursing.(Petiprin,2016)is defined by RAM as the process and
outcome in which thinking and feeling persons use conscious awareness to create integration
between human perception and their environment. Adaptation is manifested by four interrelated
modes of behavior including physiological, self-concept, role function and interdependence
modes . According to RAM, individual is described as an adaptive system that is able to respond
to different internal and external environmental stimuli whether positively or negatively.
Individuals' responses to any environmental change are subject to their coping processes. The
environmental stimuli are divided into focal, contextual and residual stimuli. The focal stimulus is
what immediately confronts the individual. Contextual stimuli are other factors that contribute to
the focal stimulus. Residual stimuli are the unknown environmental factors that can influence the
situation. RAM has classified coping processes into two subsystems, regulator and cognator. In
regulator subsystem, individuals respond automatically to the environmental stimuli through
innate, physiological adaptive processes. These processes include neural, chemical
and endocrine channels. The cognator subsystem processes changes in the environment
through cognitive and emotional channels involve personal perception and information
processing, learning, judgment and emotion.

The assessment of behaviors and stimuli that influence adaptation. Nursing judgment is
based on the assessment carried out before anticipating any intervention to manage the stimuli
systematically. Nurses are in a key place to ensure if the adaptive goals have been met. Nursing
goal promotes individuals and groups adaptation in each adaptive mode, consequently, it
contributes to improving health, quality of life and dying with dignity. The Adaptation Model states

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that health is an inevitable dimension of a person's life, and is represented by a health-illness

continuum. (Petiprin, 2016) Responses can be either adaptive or ineffective. Adaptive responses
promote integrity and help persons to achieve the adaptation goal. Ineffective responses do not
promote individuals' integrity and do not contribute to the adaptation goals. Finally, health was
defined by Roy as the process of achieving adaptation with the environmental stimuli, so, the
person is integrated and a whole. (Ghada Abu Shosha, 2012)

The factors that influenced the development of the model included family, education,
religious background, mentors, and clinical experience.In Roy's model, the questions that, is
who is the focus of nursing care? What is the target of nursing care? When is nursing care
indicated? Roys also explained that adaptation occurs when people respond positively to
environmental changes, and it is the process and outcome of individuals and groups who use
conscious awareness, self-reflection, and choice to create human and environmental integration.
(Petiprin, 2016)Thus, in order for the management of the care for the person with diabetes,
outpatient unit to have nursing care planned in accordance with the basic human needs, allowing
the achieving of positive results in the productive interactions between nurse and client, some
changes were proposed in the selected elements of the chronic care management. These
changes aimed to support the nursing process understood as a theoretical-methodological
instrument which guides the planning of the nursing (Luciana Gomes Furtado1, 2012)

2.2 Roy's Adaptation Model Practice

The Roy Adaptation Model is deeply rooted in nursing practice, and this, in part,
contributes to its continued success. It remains one of the most frequently used conceptual
frameworks to guide nursing practice, and it is used nationally and internationally. (Jacqueline
Fawcett, 2009) Roys model is useful for 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. Roys nursing process is well developed.
The two-level assessment assists in identification of nursing goals and diagnoses (Joyce J.
Fitzpatrick, 2014 )Early on, it was recognized as a valuable theory for nursing practice because of
the goal that specified its aim for activity and a prescription for activities to realize the goal.

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The goal of nursing and of the model is adaptation in four adaptive modes in a persons health
and illness. The prescriptive interventions are when the nurse manages stimuli by removing,
increasing, decreasing, or altering them.

When using Roys six-step nursing process, the nurse performs the following six
functions, firstly, assesses the behaviors manifested from the four adaptive modes, then
assesses the stimuli for those behaviors and categorizes them as focal, contextual, or residual
stimuli, third, makes a statement or nursing diagnosis of the persons adaptive state. Next step is
sets a goals to promote adaptation. Do implements interventions aimed at managing the stimuli
to promote adaptation for the fifth step and the last step is evaluates whether the adaptive goals
have been met. By manipulating the stimuli and not the patient, the nurse enhances the
interaction of the person with their environment, thereby promoting health The nursing process is
well suited for use in a practice setting. The two-level assessment is unique to this model and
leads to the identification of adaptation problems or nursing diagnoses (Martha Raile Alligood,
2013)

Intervention is based specifically on the model, but there is a need to develop an

organization of categories of nursing interventions Nurses provide interventions that alter,
increase, decrease, remove, or maintain stimuli The nursing judgment model outlined
by McDonald and Harms (1966) is recommended by Roy to guide selection of the best
intervention for modifying a particular stimulus. According to this model, a number of alternative
interventions are generated that may be appropriate for modifying the stimulus. Each possible
intervention is judged for the expected consequences of modifying a stimulus, the probability that
a consequence will occur (high, moderate, or low), and the value of the change (desirable or
undesirable).(Alligood, 2014)

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I have chosen the Model of Nursing Adaptation as a guide in implementing a task as a diabetes
educator because the concepts presented in this theory are relevant and appropriate for the
management of diabetics in performing nursing interventions. Diabetic education is unique
because most of the practitioners come from various health disciplines. Diabetes educator
remain individually accountable to the standards set by the discipline and by national,
state,local,and institutional regulations that define and guide professional practice.

3. Emphasising On The Advantages Of The Identified Nursing Theory In Enhancing Patient

Outcome

Diabetes educators have become a necessary cost-effective addition to the health care
team whose efforts are directed toward the improvement of the total care provided to the diabetic
patient. The role of the nurse educator in clinical practice and in hospital teams is a new
approach to improving the quality of patient education.(JD,1980) In Adaptation Model, nurses are
facilitators of adaptation. They assess the patients behaviors for adaptation, promote positive
adaptation by enhancing environment interactions and helping patients react positively to stimuli.
Nurses eliminate ineffective coping mechanisms and eventually lead to better outcomes. (Vera,
2014)The nurse educator has specific responsibilities in the evaluation of each diabetic patient.
An assessment of not only what that individual knows about his illness and where his educational
needs lie but also of each person's readiness to learn. Whereas the physician's contact time with
each diabetic patient is limited, the nurse educator has the time to spend with the patient and
family. One must listen to what each individual has to say about his diabetes and other problems
and to start the teaching-learning process care (Dudley, 1980)The nurse educator must be
skilled in this teaching-learning process and have a good background and understanding of
diabetes, including diabetes complications and problems.

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Roy developed the conceptual model known as the Adaptation Model of Nursing, which is a
problem solving approach utilized for collecting data, identifying the capacities and needs of
humans, and guiding the selection and implementation of nursing care very importantly, the
educator must have the capability and the responsibility to evaluate the effectiveness of the
teaching and learning that are done care (Dudley, 1980)

Diabetic Educator Nurse has been seen as leaders in chronic care, specifically in the
participation in the chronic care, which essentially presents productive interactions between the
team and the patient. Research has evidenced that when this professional takes on the central
role in her relationships with the diabetic patient, the latter's glycated hemoglobin levels reduce
significantly, he comes to need the hospital less, and the rate of mortality and incidence of
complication (myocardial infarction, angina, kidney disease) reduces, as a result of improving
healthy behaviors through planned nursing consultations. (Luciana Gomes Furtado1, 2012)It is
believed that these positive results are due to the fact of there being a much better
communication process between the nurse and the patient and to the nature of the former's
education and role, given that this professional uses strategies, such as the addressing of more
comprehensive issues, not being restricted only to treatment and diet, leadership of the client in
discussing behavioral change, and the integration of shared care for the management of the
diabetes and science to help people in fulfilling their basic needs and make them free of this help,
if possible, by teaching personal care. Also restoring, maintaining and promoting health in
collaboration with other professionals.

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4. Environment And Organization Background

The responsibilities of a nurse are becoming increasingly challenging if given the

opportunity to explore specific areas of expertise in providing quality services to clients. Currently,
Salak Health Clinic has 1510 active diabetic patients and is seeking treatment at this facility. The
Salak Health Clinic is located at the border of Negeri Sembilan and Federal Territory of Putrajaya.
This facility conceptualizes a full computing system to document client care plans. Applied
system is 'Teleprimary Care' which is only used by several clinics in Selangor and several clinics
in other countries as well. In addition, this facility also implements 'personalize care' for mother
and child health. In order to improve the quality of treatment and services, the Selangor State
Health Department and the Ministry of Health Malaysia have implemented the Family Doctor
Concept (FDC) discipline where clients and their families will be treated by the same doctor every
visit. The medical officer no longer only treats a single field of scope. 'Multitasking' practice has
been applied to this FDC discipline.

5. Implementation of The Adaption Model In Diabetic Self Management Education

The diabetes education teams integrated into primary care exhibited many of the
principles of person-centred care, as evidenced by the 2 overarching themes. The first is
personalized care, with the subthemes care environment, shared decision making, and patient
preference for one-on-one care. Participants described feeling included in partnerships with their
health care providers, as they collaborated with physicians and diabetes educators to develop
knowledge and set goals in the convenience and comfort of their usual primary care settings.
Many participants also expressed a preference for one-on-one sessions. The second theme is
patient-provider relationship, with the subthemes respect, supportive interaction, and facilitating
patient engagement. Supportive environments created by the educators built trusting
relationships, where patients expressed enhanced motivation to improve their self-care. Diabetes
educators integrated into primary care can serve to enrich the experience of patients, provide key
education to improve patient understanding, and support primary care physicians in providing
timely and comprehensive clinical care. Diabetes patients appear to benefit from convenient

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access to interprofessional teams of educators in primary care to support diabetes self-

management.

One approach to empower people with diabetes is by creating access, training and
support for diabetes self-management education (DSME). DSME is defined as collaborative
process through which people with or at risk for diabetes gain the knowledge and skills needed to
modify behaviour and successfully self-manage the disease and its related conditions" (Burke,
2014)DSME has been shown to be associated with improved diabetes outcomes, reduced
diabetes complications and decrease in healthcare costs.The American Association of Diabetes
Educators recommends that successful and effective diabetes management involves seven
specific self-care behaviours. (MDES Committee, 2016) They are Healthy Eating, Being Active,
Monitoring, Taking Medication, Reducing Risk, Problem Solving and Healthy (Austin, 2006)
Structured Diabetes self-management Education involves the 5-steps of educational process
namely assessment, goal setting, planning, implementation and evaluation. This should be
individualized and in collaboration with the person with diabetes (and caregivers). The
subsequent sections in this manual follow the 5-steps of DSME and the process is detailed in its
own section. (MDES Committee, 2016)

In the element 'Support for the person with diabetes for self-care', the basic human needs
which support the changes for the supporting of self-care for people with diabetes are to be
identified, through the use of the first three stages of the nursing process: the nursing history
(identification of the problems) nursing diagnoses (identification of the needs of the human
being); and the care plan (determination of the nursing care which the human being must receive
in the light of the nursing diagnosis established). The correlation of the theory with this element is
explained bearing in mind that nursing consists of the art and science of assisting the human
being in meeting his basic needs and in making him independent of this assistance, when
possible, by teaching self-care - as well as recovering, maintaining and promoting health in
collaboration with other professionals. (Luciana Gomes Furtado1, 2012)

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Also taken into consideration, in this correlation, was the context present in the above-
mentioned endocrinology sector, where the nursing consultation is not systematized, with the

health education being worked on in separate stages (medication, diet, physical exercise, care
for the feet), in sequential consultations (verbal information) without any basis in a model or
theory of nursing.This being the case, it is believed that by undertaking these changes, based on
the, it will be possible to raise the awareness of people with diabetes regarding their need to
make changes in their lifestyles, empowering them to problematize their condition, so as not to
accept their state, and making them believe that they can change their reality. These behaviors of
self-care are directed at physical activity, healthy eating, monitoring of glycemia, medication, the
resolution of problems, healthy coping, and the reduction of risks. (Roxas, 2013)

The second element refers to the Clinical information system regarding the person with
diabetes. In this aspect, it is fundamental that the information from the clinical records should be
organized and systematized, so as to make it possible to integrate it into the health information
systems, making it possible to document the nursing practice regarding the stages of the nursing
process. This documentation takes place in the nursing consultation, in the stages of the nursing
history, the nursing diagnosis, the care plan or nursing instructions (implementation of the care
plan) and the progression of the nursing (reporting of the successive changes which occur in the
patient being assisted). (Luciana Gomes Furtado1, 2012)

The third element refers to the 'Support for the clinical decision regarding the person with
diabetes', which should be directed by applying the nursing process, particularly when the nurse
develops clinical reasoning, to identify the nursing diagnoses, and therapeutic reasoning, when
she defines the planning and implements the nursing instructions. The objective is to promote
individualized and holistic care based on identifying the needs of the person with diabetes,
grounded in scientific knowledge. (Luciana Gomes Furtado1, 2012)

In this way, so as to ensure greater reliability and focusing in the nurse's decision-making
in the care for this specific clientele, it is hoped that terminological subset for people with diabetes
may be used in the specialized care, as a care benchmark. In this subset, the statements of the
diagnoses, outcomes and nursing interventions shall be based on RAM. Supporting the

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implementation of the nursing process in its various stages. It is reaffirmed that the subsets or
catalogs constitute a set of formulations of diagnoses, outcomes and nursing interventions for a
group of clients or selected health priority, which must be supported in their structuring in a
theoretical framework. (Luciana Gomes Furtado1, 2012)

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Summary

Diabetes Mellitus is a lifelong disease. Daily management is primarily self-directed as

people with diabetes spend less than 5% of their life with healthcare professionals who care for
them. It is essential that they are able to self-manage their condition to achieve optimal health,
good quality of life, minimize diabetes related complications and reduce the need for costly
healthcare. (MDES Committee, 2016) Roy's Adaptation Model (RAM) is one of the most common
frameworks used in different nursing aspects. The application of RAM is vary from design to
another based on the anticipated goals and the nature of adaptation level required for monitoring
Roy's Adaptation Model is one of the most useful conceptual frameworks that guides nursing
practice, directs research and influences education.It focuses on individuals' adaptation to
change able environment and guides the assessment of individuals' adaptation. RAM enhances
nurses' abilities to improve person interaction with the surrounded environment to provide an
effective adaptation.The RAM has a consistent nursing process that directs nursing practice
toward providing a holistic care for patients .

There are a lot of studies has been conducted using Roy's Adaptation Model. RAM has
shown a robust theoretical and conceptual framework especially in studies concern with the
consequences of some medical treatment. (Ghada Abu Shosha, 2012) Regardless of the setting,
communicating the information and supporting skills that are necessary to promote effective
coping and self-management required for day-to-day living with diabetes necessitate a
personalized and comprehensive approach. Effective delivery involves experts in educational,
clinical, psychosocial, and behavioral diabetes care.Clear communication and effective
collaboration among the health care team that includes a provider, an educator, and a person
with diabetes are critical to ensure that goals are clear, that progress toward goals is being
made, and that appropriate interventions (educational, psychosocial, medical, and/or
behavioral) are being used. A patient-centered approach to DSME/S at diagnosis provides the
foundation for current and future needs. Ongoing DSME/S can help the person to overcome

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barriers and to cope with the ongoing demands in order to facilitate changes during the course
of treatment and life transitions. (Powers, 2015 )

Refference

Alligood, M. R. (2014). Retrieved from Nursing Theorists and Their Work:

https://books.google.com/books?isbn=0323091946

Austin, M. M. (2006, January ). DIABETES EDUCATORS: PARTNERS IN DIABETES CARE

AND MANAGEMENT. Retrieved from http://journals.aace.com: https://doi.org/10.4158/EP.12.S1.138

Burke. (2014, FEB 12). Partnering with diabetes educators to improve patient outcomes.
Retrieved from ncbi.nlm.nih.gov:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926770/

Dudley, J. D. (1980). The Diabetes Educator's Role in Teaching the Diabetic Patient. Retrieved
from care.diabetesjournals.org/: https://doi.org/10.2337/diacare.3.1.127

Ghada Abu Shosha, M. A. (2012). Retrieved from academia.edu:

http://www.academia.edu/1775409/A_CRITICAL_ANALYSIS_OF_USING_ROY_S_ADAPTATION_M
ODEL_IN_NURSING_RESEARCH

Harris, K. D. (2017, Jan 8). 17. Adaptation model. Retrieved from nursekey.com:
https://nursekey.com/17-adaptation-model/#bib0310

Jacqueline Fawcett, J. G. (2009). Retrieved from F. A. Davis Company :

https://books.google.com/books?isbn=0803622287

JD, D. (1980). The diabetes educator's role in teaching the diabetic patient. Retrieved from
Diabetes Care: https://www.ncbi.nlm.nih.gov/pubmed/7408603

Joyce J. Fitzpatrick, . M.-2.-. (2014 ). Theories Guiding Nursing Research and Practice:
Making Nursing Knowledge . Retrieved from https://books.google.com/books?
id=isBnAwAAQBAJ&pg=PA169&lpg=PA169&dq=6%09(+Fawcett+J.
+Contemporary+Nursing+Knowledge:+Analysis+and+Evaluation+of+Nursing+Models+and+Theories.
+2+ed.+Philadelphia+(PA):+FA+Davis+Company;+2005.&source=bl&ots=wPfpx9tiiP&sig=5qe

Luciana Gomes Furtado1, M. M. (2012, August 20). Retrieved from

http://www.scielo.br/pdf/tce/v22n4/en_39.pdf:

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Martha Raile Alligood, A. M. (2013). Nursing Theorists and Their Work - E-Book, 7th Edition.
Retrieved from http://www.elsevierhealth.co.uk/nursing-theorists-and-their-work-e-book-
9780323266970.html?dmnum=12449.

MDES Committee. (2016). Retrieved from Malaysian Diabetes Educators Society:

https://mdes.org.my/mdes-publications/

Petiprin, A. (2016). Nursing-Theory.org. Retrieved from Nursing- Theory.org:

http://www.nursing-theory.org/

Powers, M. A. ( 2015 , Jul). Diabetes Self-management Education and Support in Type 2

Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of
Diabetes Educators, and the Academy of Nutrition and Dietetics. Retrieved from
http://care.diabetesjournals.org: https://doi.org/10.2337/dc15-0730

Roxas, R. D. (2013, September 21). Adherence to Self-Care Behavior in Patients Diagnosed

with Type 2 Diabetes Mellitus in the Outpatient Department of the Philippine General Hospital. Retrieved
from www.asean-endocrinejournal.org: www.asean-
endocrinejournal.org/index.php/JAFES/article/view/67/506

Vera, M. (2014, Aug 9). nurseslabs.com. Retrieved from Sister Callista Roys Adaptation
Model of Nursing: https://nurseslabs.com/sister-callista-roys-adaptation-model/

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