The Roy Adaptation Model
Theoretical Research Analysis
According to the National Cancer Institute (2015) an estimated 231,840 people will be diagnosed with breast cancer this year. Breast cancer is the most common type of cancer in females (National Cancer Institute, 2015). For most women a diagnosis of breast cancer is a life changing event. As women deal with the diagnosis they experience a gamut of emotions and physiological changes. According to Spiegel, Bloom, Kraemer, and Gottheil (1989) patients who are faced with life-changing diagnosis benefit from coming together to openly discuss challenges and emotions associated with their illness. Support groups providing opportunities for peer support and education are the suggested intervention in the literature …show more content…
and in the practice environment to help women adapt and cope with their diagnosis. Samarel, Fawcett and Tulman (1997) used the Roy Adaptation Model to design a study on cancer support groups that utilized significant other coaching in women with breast cancer.
Middle Range Theory
Roy’s Adaptation theory is made up of four domains: person, health, environment, and nursing. The model defines people as biopsychosocial beings that are constantly interacting with their environment (Butts & Rich, 2015). The environment consist of different types of stimuli. Focal stimuli are issues or immediate challenges facing an individual. Contextual stimuli are elements that contribute to the situation. Residual stimuli make up unknown factors that once identified become either focal or contextual stimuli. In order to respond positively to the environment individuals must adapt through four response modes: physiological, self-concept, role function, and interdependence (Butts & Rich, 2015). Through a six-step nursing process we can assess if the patient is adapting or ineffectively adapting to stimuli. Interventions can influence adaptation by addressing, increasing knowledge, or coping with stimuli. The six-step process is composed of assessment of behavior, assessment of stimuli, nursing diagnosis, goal setting, intervention, and evaluation (Butts & Rich, 2015). Mechanisms for adaptation in the model include regulator, which reflects physical well-being or status and cognator, which reflects education, knowledge, power, openness, ability to process, and decision making (Butts & Rich, 2015).
Empirical Research Methods
Research Design and Sample
An experimental randomized pretest-posttest control group study by Samarel, Fawcett and Tulman (1997) was conducted with a sample size of 181 women with newly diagnosed stage I or stage II breast cancer who had surgery within four months of enrollment in the study. The study explored the relationship between cancer support groups and adaptation to breast cancer. The women were randomized into one of three groups. A cancer support group that had significant other coaching serving as the experimental treatment group. A cancer support group without coaching serving as the control treatment group. Or a group that had no cancer support group serving as the no treatment control. The two groups that participated in the breast cancer support group attended two hour sessions once a week for eight weeks with the same content presented. A manual was provided to participants in the cancer support groups at the beginning of each session that covered the educational topics for that session.
Instruments
Adaptation was measured through the four response modes. The physiological mode was assessed by using the Symptom Distress Scale (SDS). The scale is valid with a Cronbach’s alpha coefficient of .82 at baseline for this study (Samarel, Fawcett & Tulman, 1997). The self-concept mode was gauged through emotional distress utilizing the Profile of Mood States-Linear Analog Self-Assessment. The scale is valid with a Cronbach’s alpha coefficient of .77 at baseline for this study (Samarel, Fawcett & Tulman, 1997). Functional status was assessed by utilizing the Inventory of Functional Status-Cancer to assess the role function mode. The scale is valid, however since all questions were not answered Fisher’s z transformation was utilized with a range of .64 to .74 at baseline (Samarel, Fawcett & Tulman, 1997). The interdependence mode was assessed using the Relationship Change Scale to measure the quality of relationship with the participant’s significant other. The scale is valid with a Cronbach’s alpha coefficient of .95 at baseline for this study (Samarel, Fawcett & Tulman, 1997).
Data Collection and Protection of Human Subjects
Adaptation was assessed pre, post, and eight weeks after intervention. For the two treatment groups data was collected at the first session, upon completion of the last session and eight weeks later. For the control group data was collected at the entry of the study, at eight weeks, and at 16 weeks via mail. An explanation of the study was given to all potential subjects prior to informed consent being obtained. There was minimal risk to participants in this study. At the end of the data collection period, the no treatment control group members were offered the opportunity to join a cancer support group with coaching.
Data Analysis Descriptive statistics were utilized to analyze the demographic data of the sample in this study. Inferential statistics were used to analyze data from the scales and tools utilized and the relationship with the intervention. Multivariate analysis of variance (MANOVA) was utilized to analyze symptom distress, emotional distress, and functional status. Analysis of variance (ANOVA) was used to analyze the quality of relationship changes.
Evaluation of Specification Adequacy
The Roy Adaptation Model is identified by the researchers in the study as the foundation for the intervention design and outcomes measures.
A clear description of the model, its concepts, and the relationship with the breast cancer population is explained in the article. Specification adequacy is described sufficiently in the article.
Evaluation of Linkage Adequacy
In this study, the physiological mode was identified as symptom management and measured using the Symptom Distress Scale (SDS). Emotional distress represented the self-concept mode which is measured through the Profile of Mood States-Linear Analog Self-Assessment. Inventory of Functional Status-Cancer measures functional status representing the role function mode. The interdependence mode is the quality of relationships with the significant other measured by the Relationship Change Scale. Linkage adequacy is appropriately described. Using the conceptual model usage rating scale this article rates a 4 = adequate …show more content…
use.
Significance of Middle-Range Theory Social significance is included in the introduction of the article by providing the estimated number of women who will be diagnosed with breast cancer that year from a reliable source. What was known at the time of the study from previous research is discussed. Information from a pilot study and how the research can add to the nursing body of knowledge on this subject is described. The study was conducted to determine if a relationship with cancer support groups that had significant other coaching would increase adaptation with illness. Samarel, Fawcett & Tulman (1997) concluded that more research is needed to examine the timing and length of support groups as well as other responses women have to breast cancer. The descriptions provided theoretical significance. Therefore, significance of the middle-range theory is established.
Internal Consistency
Concepts of the Roy Adaptation Model are defined in the explanation of the model and the linkage to the research. Terms and definitions are used consistently throughout the article providing sematic consistency. Inductive and deductive reasoning are used to form the hypothesis. Prior research is applied that postulates application to women with breast cancer therefore providing internal consistency.
Parsimony of the Middle-Range Theory
The theory and explanations of the concepts are presented clearly and concisely. Connections to the concepts and the breast cancer population are made. Higher quality relationships with significant other in the group with intervention of cancer support groups with coaching was found at completion but were not sustained eight weeks after. No difference was found between the experimental intervention, intervention control, and the control group related to symptom distress, emotional distress, and functional status. Therefore the theory is more parsimonious after testing (Fawcett & Garity, 2009).
Testability of the Middle-Range Theory
Operational definitions for the concepts and measurement are included in the article. Each concept has an identified research tool or scale that was implemented in the study to collect data on that concept. MANOVA, ANOVA statistical procedures were utilized to analyze the data. Therefore, testability was met.
Operational Adequacy
The research design, procedure for data collection including instruments used, and the protection of human subjects are discussed appropriately. The sample inclusion criteria reflected women recently diagnosed with stage I or stage II breast cancer who had surgery within four months of study start (Samarel, Fawcett & Tulman, 1997). Symptom distress, emotional distress, and functional status were the concepts used with the appropriate tool or scale to measure adaptation. In the discussion section the researchers concluded that most of the women at baseline had returned close to normal functional status and symptom distress had subsided by the start of the study. Not having known this at the time of the study, the information found adds to the body of knowledge allowing for more specific research based on this study’s findings. Data analysis methods discussed are appropriate, therefore this study meets operational adequacy.
Empirical Adequacy
The findings from this study are explained; however, do not support the hypothesis or align with the middle-range theory of Roy Adaptation Model. Researchers speculate the credibility of the Roy Adaptation Model (Samarel, Fawcett & Tulman, 1997). They also noted that the research design may have impacted the outcomes as the identified sample had for the most part returned to pre-diagnosis functional status. Also questioned was the timing of the interventions and length. The population studied also may have been too specific. Therefore, the study theory and interventions are not empirically adequate.
CTE
Pragmatic Adequacy
This research study did not support its own hypothesis; therefore, the intervention did not produce its desired outcomes.
The cancer support groups that had significant other coaching did have an outcome of improved relationship with significant other at the end of the intervention. However, the improvement was not sustained at eight weeks post intervention. Therefore, clinical significance was not found. For compatibility, researchers designed the intervention of coaching after the model used in pregnant patients and their significant others who attended classes in preparation for labor and delivery. One of the limitations in developing the sample noted by the researchers was subject and significant other availability to participate in weekly support group sessions. Today it may be hard for patients to make the time commitment to attend support groups. Willingness to use resources and implement new tools in this case I think would be accepted. Nurses and other healthcare providers in this field are dedicated to helping their patients adapt with their illness. The intervention in this study is consistent with what the public would expect. In this study, the intervention relied on cancer support groups that involved education, interpersonal relationship building, and in the experiment group significant other’s attendance to serve as the coach. The cancer support groups were led by trained professionals. The intervention did not cross over into another disciplines
practice; therefore, no legal control issues stand out. Further research is needed based on the findings of this study. Timing of the intervention, length, and increasing the sample population to include patients newly diagnosed with different stages of breast cancer who are in earlier stages of treatment were noted by the researchers as needing further investigation.
Legitimacy of the Conceptual Model
The Roy Adaptation Model served as guide in developing this study. However, when testing the theory, the empirical research methods utilized did not produce the hypothesized outcomes. Since the outcomes of this study did not reflect the hypothesis, researchers did question the credibility of the theory related to the intervention and population.
Conclusion
This study serves a good example of theory guided research. Empirical methods used or legitimacy of the model in this population are noted as limitations. Further research is needed on patients with breast cancer to identify interventions that help with adaptation to illness.
According to the National Cancer Institute (2015) an estimated 231,840 people will be diagnosed with breast cancer this year. Breast cancer is the most common type of cancer in females (National Cancer Institute, 2015). For most women a diagnosis of breast cancer is a life changing event. As women deal with the diagnosis they experience a gamut of emotions and physiological changes. According to Spiegel, Bloom, Kraemer, and Gottheil (1989) patients who are faced with life-changing diagnosis benefit from coming together to openly discuss challenges and emotions associated with their illness. Support groups providing opportunities for peer support and education are the suggested intervention in the literature …show more content…
and in the practice environment to help women adapt and cope with their diagnosis. Samarel, Fawcett and Tulman (1997) used the Roy Adaptation Model to design a study on cancer support groups that utilized significant other coaching in women with breast cancer.
Middle Range Theory
Roy’s Adaptation theory is made up of four domains: person, health, environment, and nursing. The model defines people as biopsychosocial beings that are constantly interacting with their environment (Butts & Rich, 2015). The environment consist of different types of stimuli. Focal stimuli are issues or immediate challenges facing an individual. Contextual stimuli are elements that contribute to the situation. Residual stimuli make up unknown factors that once identified become either focal or contextual stimuli. In order to respond positively to the environment individuals must adapt through four response modes: physiological, self-concept, role function, and interdependence (Butts & Rich, 2015). Through a six-step nursing process we can assess if the patient is adapting or ineffectively adapting to stimuli. Interventions can influence adaptation by addressing, increasing knowledge, or coping with stimuli. The six-step process is composed of assessment of behavior, assessment of stimuli, nursing diagnosis, goal setting, intervention, and evaluation (Butts & Rich, 2015). Mechanisms for adaptation in the model include regulator, which reflects physical well-being or status and cognator, which reflects education, knowledge, power, openness, ability to process, and decision making (Butts & Rich, 2015).
Empirical Research Methods
Research Design and Sample
An experimental randomized pretest-posttest control group study by Samarel, Fawcett and Tulman (1997) was conducted with a sample size of 181 women with newly diagnosed stage I or stage II breast cancer who had surgery within four months of enrollment in the study. The study explored the relationship between cancer support groups and adaptation to breast cancer. The women were randomized into one of three groups. A cancer support group that had significant other coaching serving as the experimental treatment group. A cancer support group without coaching serving as the control treatment group. Or a group that had no cancer support group serving as the no treatment control. The two groups that participated in the breast cancer support group attended two hour sessions once a week for eight weeks with the same content presented. A manual was provided to participants in the cancer support groups at the beginning of each session that covered the educational topics for that session.
Instruments
Adaptation was measured through the four response modes. The physiological mode was assessed by using the Symptom Distress Scale (SDS). The scale is valid with a Cronbach’s alpha coefficient of .82 at baseline for this study (Samarel, Fawcett & Tulman, 1997). The self-concept mode was gauged through emotional distress utilizing the Profile of Mood States-Linear Analog Self-Assessment. The scale is valid with a Cronbach’s alpha coefficient of .77 at baseline for this study (Samarel, Fawcett & Tulman, 1997). Functional status was assessed by utilizing the Inventory of Functional Status-Cancer to assess the role function mode. The scale is valid, however since all questions were not answered Fisher’s z transformation was utilized with a range of .64 to .74 at baseline (Samarel, Fawcett & Tulman, 1997). The interdependence mode was assessed using the Relationship Change Scale to measure the quality of relationship with the participant’s significant other. The scale is valid with a Cronbach’s alpha coefficient of .95 at baseline for this study (Samarel, Fawcett & Tulman, 1997).
Data Collection and Protection of Human Subjects
Adaptation was assessed pre, post, and eight weeks after intervention. For the two treatment groups data was collected at the first session, upon completion of the last session and eight weeks later. For the control group data was collected at the entry of the study, at eight weeks, and at 16 weeks via mail. An explanation of the study was given to all potential subjects prior to informed consent being obtained. There was minimal risk to participants in this study. At the end of the data collection period, the no treatment control group members were offered the opportunity to join a cancer support group with coaching.
Data Analysis Descriptive statistics were utilized to analyze the demographic data of the sample in this study. Inferential statistics were used to analyze data from the scales and tools utilized and the relationship with the intervention. Multivariate analysis of variance (MANOVA) was utilized to analyze symptom distress, emotional distress, and functional status. Analysis of variance (ANOVA) was used to analyze the quality of relationship changes.
Evaluation of Specification Adequacy
The Roy Adaptation Model is identified by the researchers in the study as the foundation for the intervention design and outcomes measures.
A clear description of the model, its concepts, and the relationship with the breast cancer population is explained in the article. Specification adequacy is described sufficiently in the article.
Evaluation of Linkage Adequacy
In this study, the physiological mode was identified as symptom management and measured using the Symptom Distress Scale (SDS). Emotional distress represented the self-concept mode which is measured through the Profile of Mood States-Linear Analog Self-Assessment. Inventory of Functional Status-Cancer measures functional status representing the role function mode. The interdependence mode is the quality of relationships with the significant other measured by the Relationship Change Scale. Linkage adequacy is appropriately described. Using the conceptual model usage rating scale this article rates a 4 = adequate …show more content…
use.
Significance of Middle-Range Theory Social significance is included in the introduction of the article by providing the estimated number of women who will be diagnosed with breast cancer that year from a reliable source. What was known at the time of the study from previous research is discussed. Information from a pilot study and how the research can add to the nursing body of knowledge on this subject is described. The study was conducted to determine if a relationship with cancer support groups that had significant other coaching would increase adaptation with illness. Samarel, Fawcett & Tulman (1997) concluded that more research is needed to examine the timing and length of support groups as well as other responses women have to breast cancer. The descriptions provided theoretical significance. Therefore, significance of the middle-range theory is established.
Internal Consistency
Concepts of the Roy Adaptation Model are defined in the explanation of the model and the linkage to the research. Terms and definitions are used consistently throughout the article providing sematic consistency. Inductive and deductive reasoning are used to form the hypothesis. Prior research is applied that postulates application to women with breast cancer therefore providing internal consistency.
Parsimony of the Middle-Range Theory
The theory and explanations of the concepts are presented clearly and concisely. Connections to the concepts and the breast cancer population are made. Higher quality relationships with significant other in the group with intervention of cancer support groups with coaching was found at completion but were not sustained eight weeks after. No difference was found between the experimental intervention, intervention control, and the control group related to symptom distress, emotional distress, and functional status. Therefore the theory is more parsimonious after testing (Fawcett & Garity, 2009).
Testability of the Middle-Range Theory
Operational definitions for the concepts and measurement are included in the article. Each concept has an identified research tool or scale that was implemented in the study to collect data on that concept. MANOVA, ANOVA statistical procedures were utilized to analyze the data. Therefore, testability was met.
Operational Adequacy
The research design, procedure for data collection including instruments used, and the protection of human subjects are discussed appropriately. The sample inclusion criteria reflected women recently diagnosed with stage I or stage II breast cancer who had surgery within four months of study start (Samarel, Fawcett & Tulman, 1997). Symptom distress, emotional distress, and functional status were the concepts used with the appropriate tool or scale to measure adaptation. In the discussion section the researchers concluded that most of the women at baseline had returned close to normal functional status and symptom distress had subsided by the start of the study. Not having known this at the time of the study, the information found adds to the body of knowledge allowing for more specific research based on this study’s findings. Data analysis methods discussed are appropriate, therefore this study meets operational adequacy.
Empirical Adequacy
The findings from this study are explained; however, do not support the hypothesis or align with the middle-range theory of Roy Adaptation Model. Researchers speculate the credibility of the Roy Adaptation Model (Samarel, Fawcett & Tulman, 1997). They also noted that the research design may have impacted the outcomes as the identified sample had for the most part returned to pre-diagnosis functional status. Also questioned was the timing of the interventions and length. The population studied also may have been too specific. Therefore, the study theory and interventions are not empirically adequate.
CTE
Pragmatic Adequacy
This research study did not support its own hypothesis; therefore, the intervention did not produce its desired outcomes.
The cancer support groups that had significant other coaching did have an outcome of improved relationship with significant other at the end of the intervention. However, the improvement was not sustained at eight weeks post intervention. Therefore, clinical significance was not found. For compatibility, researchers designed the intervention of coaching after the model used in pregnant patients and their significant others who attended classes in preparation for labor and delivery. One of the limitations in developing the sample noted by the researchers was subject and significant other availability to participate in weekly support group sessions. Today it may be hard for patients to make the time commitment to attend support groups. Willingness to use resources and implement new tools in this case I think would be accepted. Nurses and other healthcare providers in this field are dedicated to helping their patients adapt with their illness. The intervention in this study is consistent with what the public would expect. In this study, the intervention relied on cancer support groups that involved education, interpersonal relationship building, and in the experiment group significant other’s attendance to serve as the coach. The cancer support groups were led by trained professionals. The intervention did not cross over into another disciplines
practice; therefore, no legal control issues stand out. Further research is needed based on the findings of this study. Timing of the intervention, length, and increasing the sample population to include patients newly diagnosed with different stages of breast cancer who are in earlier stages of treatment were noted by the researchers as needing further investigation.
Legitimacy of the Conceptual Model
The Roy Adaptation Model served as guide in developing this study. However, when testing the theory, the empirical research methods utilized did not produce the hypothesized outcomes. Since the outcomes of this study did not reflect the hypothesis, researchers did question the credibility of the theory related to the intervention and population.
Conclusion
This study serves a good example of theory guided research. Empirical methods used or legitimacy of the model in this population are noted as limitations. Further research is needed on patients with breast cancer to identify interventions that help with adaptation to illness.