Conceptual Framework in Nursing Roles

The use of models allows nurses to focus on the role of nursing is applications, rather than medical practice. Using models makes causes patient care to be systematic, have purpose, be controlled and be effective. According to Roy, the ultimate goal of nursing is to increase compliance by the patients, thus leading to increased life expectancy. Although patient care is centered around the human response to illness, it is the patient that shoulders the burden of the suffering. The advanced practice nurse caring for the patient has to enter that suffering in order to promote healing and restore hope (Weiland, 2010).

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The central concepts of the discipline of nursing are person, environment, health and nursing. These four concepts are explained as: the person receiving the nursing, the environment within which the person exits, the health-illness continuum within which the person falls at the time of the interaction with the nurse. and the nursing actions themselves. (Masters, 2015). Closely related to nursing’s central concepts, the major metaparadigms identified by Roy are adaptation, person, environment, health and goal of nursing. Adaptation is defined as 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 (Schultz & Hand, 2015). The Adaptation Model presents the person as an adaptive system in constant interaction with the internal and external environments. The main task of the human system is to maintain integrity in the fact of environmental stimuli and the goal of nursing is to foster successful adaptation. Adaptation leads to optimal health and well-being, to a better quality of life, and to being able to die with dignity (Masters,2015).

Roy asserts that all people are in constant interaction with their environments and there is an exchange of information between the two (Schultz & Hand, 2015). According to Roy, there are three classes of stimuli in the environment: focal, contextual, and residual. Focal stimuli involves internal or external stimuli. This is the stimuli that a person is most immediately aware of. Contextual stimuli is all other stimuli present in the situation that contributes to the effect of the focal stimuli. Lastly, residual stimuli involves environmental factors within or outside human systems. Roy’s model defines health as a state and process of being and becoming an integrated and whole that reflects person and environment mutuality. Roy feels that by manipulating the stimuli rather than the patient, the nurse enhances the interaction of the person with their environment, thereby promoting health (Masters, 2015).

Roy’s believes that nursing actions promote a person’s adaptive responses. Nursing actions enhance a person’s interactions with the environment, and enhanced interactions of persons with the environment leads to adaptation. Nurses are able to do this by assessing the behaviors manifested in the four adaptive roles: assessing and categorizing the stimuli of those behaviors, making a nursing diagnosis based on the person’s adaptive state, setting goals to promote adaptation, implementing interventions to manage stimuli to promote adaptation, and evaluating achievement of adaptive goals (Masters, 2015).

 Using nursing theory in practice supports the advanced practice nurse role in patient care because it focuses on the human experience and their response to illness, theory guides APRN practice to meet human needs, and advances autonomous nursing practice by holding nurses accountable and encouraging them to incorporate more diverse ways of knowing. The Roy Adaptation model is perfect for marrying nursing theory and the concept of humanism. Focusing on the whole person directs decisions of care that ultimately result in healing. The advanced practice nurse paradigm of care encompasses not only a caring and therapeutic approach, but a curative one as well. It allows the advanced practice nurse to set goals that facilitate a humanistic approach while responding to patient needs, basically proving a congruence between the advanced practice nurse paradigm of care and Roy’s adaptation model (Weiland, 2010).

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 In conclusion, problems arise when the adaptive systems of a person are unable to respond to stimuli from internal or external environments (Butts & Rich, 2018). Nurses who conduct their practice from nursing theory base, while assisting individuals and families to meet their health needs, are more likely to provide comprehensive individualized care that exemplifies best practice (Kaur & Mahal, 2013). Philosophically, nursing is a holistic profession with a moral obligation to understand the human condition, and respect individual beliefs and values (Weiland, 2010).

References

• Butts, J.B. and Rich, K.L. (2018). Philosophies and Theories for Advanced Nursing Practice (3^rded.). Burlington, MA: Jones & Bartlett Learning.
• Kaur, H. and Mahal, J. (2013). “Development of Nursing Assessment Tool: An Application of Roy’s Adaptation Theory.” International Journal of Nursing Education, 5(1), pp. 60-64.
• Lozano, M.G., Marles, L.P.A., Giraldo, B.P., and Herrera, B.S. (2019). “Commitment and Human Tone: the Difference between Traditional Service and Nursing Care.” Nursing and Research Education, 37(1) e05. doi:10.7533/udeaiee.v37n1e05.
• Masters, K. (2015). Theories: A Framework for Professional Practice (2nd ed.). Burlington, MA: Jones and Bartlett Learning.
• Schultz, S. and Hand, M.W. (2015). “Usability: A Concept Analysis.” The Journal of Theory Construction and Testing, 19(2), pp 65-70.
• Weiland, S.A. (2010). “Integrating Spirituality Into Critical Care: An APN Perspective Using Roy’s Adaptation Model.” Critical Care Nursing Quarterly, 33(3), pp.282-291.