NURS 8250 Week 10 Theory Application Paper Example

From Risk List to Adaptive Problem: Applying Roy's Adaptation Model to Adults Living With a Newly Implanted Cardioverter-Defibrillator

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College of Nursing, Walden University

NURS 8250: Advanced Theoretical and Scientific Perspectives in Nursing

Instructor Name

Month Day, Year

From Risk List to Adaptive Problem: Applying Roy's Adaptation Model to Adults Living With a Newly Implanted Cardioverter-Defibrillator

The Problem as a List

Before a framework is applied, a practice problem usually reads as a list. At a composite cardiac electrophysiology clinic, the problem of adults in the first six months after receiving an implantable cardioverter-defibrillator (ICD) has been written up that way: anxiety, depression, fear of shocks, driving restrictions, reduced activity, sexual concerns, family worry and unplanned calls to the clinic. Each item is real. Reviews of quality of life and psychological functioning in ICD patients describe anxiety and depressive symptoms as common concerns, especially after shocks (Sears & Conti, 2002), and some patients develop posttraumatic stress symptoms (Sears et al., 2011). But a list does not show how the items relate or where nursing should act. This paper applies Roy's adaptation model to the problem and rewrites it in the model's terms, then asks what that reveals.

The Model

Roy (2009) describes the person as an adaptive system. Stimuli from the internal and external environment come in three kinds: the focal stimulus, which most immediately confronts the person; contextual stimuli, other factors present in the situation that affect the response; and residual stimuli, factors whose effects are uncertain, such as beliefs and past experiences. The person responds through two coping processes: the regulator subsystem, largely physiological, and the cognator subsystem, involving perception, learning, judgment and emotion. Responses show up in four adaptive modes, which cover the body's functioning, the person's view of self, the roles the person fills and the person's close relationships with others. Responses that promote the person's integrity are adaptive; those that do not are ineffective. Nursing aims to promote adaptation, often by managing stimuli.

The Problem Rewritten in the Model's Terms

Table 1 places the items from the clinic's list into the model's structure.

Table 1

The ICD Problem in Roy's Terms

The same items from the clinic's list reappear, but now as stimuli, coping responses and effects in particular modes.

What the Rewriting Reveals

The problem has one focal stimulus. The list treated anxiety, avoidance and family worry as separate problems. In the model's terms, they are responses across several modes to one focal stimulus, the possibility of a shock. That suggests that interventions aimed at the meaning of that stimulus, such as clear information about what a shock is, what to do after one and how often they occur for patients like them, may reduce responses in several modes at once.

Some ineffective responses are cognator responses that can be changed. Avoiding exercise out of fear that exertion will trigger a shock is a judgment, not a physiological necessity. The model locates it in the cognator subsystem, where learning and perception can shift. That points nursing toward teaching and graded activity, which the list did not suggest.

Contextual stimuli can be managed. Driving restrictions, arm limits and discharge information are contextual stimuli the clinic partly controls. The timing and clarity of information about when driving can resume, for example, could reduce role function disruption without changing anything about the device.

Residual stimuli need to be asked about. A patient who once watched a relative collapse from heart disease brings a residual stimulus that no discharge checklist will find. The model makes asking about beliefs and past experiences part of assessment.

The interdependence mode puts the family in view. The list mentioned family worry as a single item. The model shows that overprotection by a partner can itself cause ineffective responses, such as reduced activity and loss of role. Interventions may need to include family members.

What the Model Does Not Reveal

The model has limits here. It does not distinguish ordinary adjustment from clinical anxiety, depression or posttraumatic stress, which require screening and possibly referral; the model's language of adaptive and ineffective responses is too broad for that judgment. It also offers no guidance on device programming, such as settings that reduce unnecessary shocks, which is medical work with major effects on the focal stimulus. And the model's categories can overlap, so that fear of shocks might be placed in self-concept or in the cognator subsystem; the choice matters less than recognizing the response. Finally, the model says little about the health system around the patient, such as how quickly the clinic answers a call after a shock, which may shape adaptation as much as anything the patient does.

Implications for a Clinic Project

Rewritten through Roy's model, the problem suggests a nurse-led program in the first six months after implantation with three parts: assessment across all four modes, including residual stimuli, at the first follow-up visit; teaching aimed at the meaning of the focal stimulus and at cognator responses such as activity avoidance, with a shock plan the patient and family practice; and management of contextual stimuli, such as clear written guidance on driving and activity timelines. Screening for depression and posttraumatic stress symptoms would sit alongside, drawing on clinical guidance rather than the model. The list of risk factors has become a structured problem with a place for nursing to act. The program's evaluation would follow the same structure, tracking activity levels, confidence in managing a shock, return to valued roles and family members' own worry, so that the measures match the modes in which the problem was found.

References

Roy, C. (2009). The Roy adaptation model (3rd ed.). Pearson.

Sears, S. F., & Conti, J. B. (2002). Quality of life and psychological functioning of ICD patients. Heart, 87(5), 488-493. https://doi.org/10.1136/heart.87.5.488

Sears, S. F., Hauf, J. D., Kirian, K., Hazelton, G., & Conti, J. B. (2011). Posttraumatic stress and the implantable cardioverter-defibrillator patient: What the electrophysiologist needs to know. Circulation: Arrhythmia and Electrophysiology, 4(2), 242-250. https://doi.org/10.1161/CIRCEP.110.957670