The Role of Roy’s Adaptation Model in Nursing Theory

Feeding intolerance has been identified as a significant problem for infants in the Neonatal Intensive Care Unit (NICU). Inquiry has revealed massage therapy as a possible nursing intervention for the problem (Shaeri et al., 2017). Additional knowledge is desired to determine if new research findings present clinically significant evidence for use of the intervention in the NICU patient population. Toward this end, a PICO question has been formulated: does massage application given to infants born at less than 37 weeks gestation reduce feeding intolerance?

Given the increased prominence of theory-based nursing, identifying an applicable nursing framework is important. One model that can be used in addressing the identified problem is Roy’s adaptation model (RAM). Indeed, RAM is one of the most common nursing models. Essentially, the model emphasises patient adaptation to the environment (Saini et al., 2017). As per the model, the nurse focuses on improving the patient’s ability to interact with the adjacent environment. Viewing the individual as an adaptive system, RAM asserts that the role of the nurse during the care process is to help the individual adapt to changes in four areas: physiological needs (e.g. oxygenation, nutrition, and neurologic function); self-concept (e.g. self-perception and spirituality); role function (e.g. social roles); and interdependent relationships (e.g. social support, social relationships, and communication). Adaptation in this case denotes the process in which an individual consciously integrates their human perception and their surrounding environment. Theoretically, an individual has the ability to identify internal and external stimuli and to respond to the stimuli through autonomic and cognitive mechanisms, ultimately leading to behavioural change.

RAM is applicable to the paediatric population and more specifically to the identified PICO problem. As per the model, the paediatric patient’s adaptive behaviour is enhanced by applying a nursing intervention that manipulates the underlying causes, thereby resulting in physiological and psychological adaptation (Saini et al., 2017). Feeding intolerance in preterm infants is mainly attributable to poor functioning of the infant’s digestive system, such as slow gastric emptying (Shaeri et al., 2017). In line with RAM, this is a physiologic need. As a result, the role of the NICU nurse is to help the infant adapt to extrauterine life during the neonatal period. The nurse can achieve this by enhancing the infant’s interaction with the surrounding environment. More specifically, the nurse increases the infant’s extrauterine adaptation by applying interventions that enhance the infant’s digestive function. Massage therapy is one of the interventions nurses can use to achieve this. The intervention stimulates parasympathetic activity and improves digestive functioning by increasing the speed of peristalsis, speeding up bowel transit time, slowing down abdominal expansion, accelerating defecation frequency, and decreasing vomiting frequency (Shaeri et al., 2017). Simply, massage therapy promotes physiological adaptation.



References
Saini, N., Sharma, V., Arora, S., & Khan, F. (2017). Roy’s adaptation model: effect of care on paediatric patients. International Journal of Nursing & Midwifery Research, 4(1), 52-60.
Shaeri, M., Ghadami, A., Valiani, M., Armanian, A., & Rarani, S. A. (2017, March). Effects of abdominal massage on feeding tolerance in preterm infants hospitalized in selected hospitals of Isfahan-Iran. International Journal of Pediatrics, 5, 4503-4510. http://dx.doi.org/10.22038/ijp.2017.21376.1795