CHAPTER 1: OUTLINE OF THE STUDY
3.4 ELEMENTS OF ROY'S ADAPTATION MODEL
3.4.1 The person 50
Roy maintains that the recipient of nursing care may be the individual, the family, a group, a community or society. The recipient is considered an adaptive system (Fawcett, 1989:311). Figure 3; 1 presents the person as an adaptive system.
Figure3.1 The person as an adaptive system
Input ControlProcesses Effectors Output
Stimuli I Coping mechanisms -> Physiological Adaptive
-> Regulator Functions and
Adaptation level]
Cognator ->
Role Function ->
Ineffective Self-concept responses Interdependence
t
Feedback(Adapted from Fawcett, 1989:316)
t
In the context of this study the person is viewed as an individual professional nurse or group of professional nurses in the organisation. Organised groups of personnel such as professional nurses are viewed as the adaptive system in constant interaction with a changing environment (Henry, Arndt, Di Vincenti and Marriner- Tomey, 1989:90).
3.4.1.1 Adaptation
Adaptation refers to the person's response to the environment. It is aimed at maintaining and promoting achievement of goals. It is a dynamic rather than a static state of equilibrium. The dynamism occurs because stimuli in the
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environment are continually changing and acting as mediating forces to determine the person's adaptive level.
Adaptive behaviour is possible when the person can:
- keep securing adequate information about the environment,
- maintain satisfactory internal conditions for action and for processing information,
- maintain his autonomy or freedom of movement.
(Kunene, 1995:48)
The nurse managers can adopt the following strategies to accomplish adaptive behaviour among the professional nurses:
- Create an enviromnent in which the professional nurses feel at ease so that they can talk freely about the transformation of the health care system and how it affects them, challenge one another so as to come up with healthy adaptive responses and also explore issues related to the transformation and their changing role.
- Share information with professional nurses about the changing health care system that is the external and internal enviromnent of the organization, so that they are aware of the challenges facing them (Booyens, 1998: 149).
Adaptative responses reflect the person's ability to cope with stressors in the internal and external environment. There are many variables that contribute to stress in nursing, such as -
- stress resulting from the organisational environment
- stress developing from such conditions as task assignments for which the nurse feels herself inadequately prepared
- when the institution is undergoing a major reorganisation like the transformation of the health care system to a primary health care oriented approach (Booyens,
1998:146).
Kenton (1994: 12-19) suggests that it is not the external effects of stressors but the way one responds to them which is important. Some people handle stress better than others.
The nurse manager can lessen the stress levels of the professional nurses by providing them with sufficient up-to-date information about the developments in the health care services. They should also be given information about their changing roles in the changing health care system. The professional nurses should also be given the necessary support to handle their stress so that the adaptive response to the transformation is positive.
3.4.1.2 Coping
The concept of coping is significant in Roy's Adaptation Model. Murphy (1962), cited by Roy and Roberts (1981:56), defines coping as "any attempt to master a new situation that can be potentially threatening, frustrating, challenging .or gratifying". This definition has relevance to the study as we all are aware that professional nurses are committed to rendering quality patient care but feel threatened by transformation, especially when they feel that they are not adequately prepared for that change. This stressful situation then leads to frustration which the nurses have to handle so as to adapt effectively. Professional nurses are quite aware of the fact that nursing is not static and they have to continually adapt to changing situations.
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The nurse managers are challenged to devise coping mechanisms that will enable professional nurses to adapt and master the transformation of the health care system. Reorientation of professional nurses to primary health care can enable them to cope with the transformation.
Fawcett (1989:312) cites Roy (1984) who states that the adaptive system has two major internal control processes called the regulator and the cognator subsystems.
These subsystems are viewed as innate or acquired coping mechanisms used by the adaptive system to respond to changing internal and external environmental stimuli.
The regulator subsystem receives input from the external environment and from changes in the person's internal state. The changes are processed through neural- chemical endocrine channels to produce responses. The cognator subsystem also receives input from external and internal stimuli that involve psychological, social, physical and physiological factors including regulator subsystem outputs. These stimuli are then processed through cognitive / emotive pathways.
The internal and external stimuli trigger perceptual/information processing, learning, judgement and emotion. Regulator and cognator activity is manifested through coping behaviour in four adaptive (effector) modes. The four adaptive modes of the Roy's Adaptation Model are:
- the physiological mode - the self-concept mode - the role function mode - the interdependence mode.
•
The four adaptive modes are predicated on the person's need for physiological integrity, psychic integrity and social integrity, as illustrated on Table 3.I.
Table 3.1: Adaptive modes and needs
Adaptive Mode l. Physiological mode 2. Self-concept mode 3. Role function mode 4. Interdependence mode
Need
- >
Physiological integrity- >
Psychic integrity- >
Social integrity- >
Social integrityThe professional nurses' response to the transformation of the health care system was also channelled through the adaptive modes depending on the needs of the individual.