calista roy

et al.
Journal of Psychiatric and Mental Health Nursing, 2004, 11, 221–228
An analysis of Roy’s Adaptation Model of Nursing as used within
acute psychiatric nursing
D. PATTON rpn rnt bns(hons) pgdiped msc
Lecturer, School of Nursing and Midwifery, University College Dublin, Ballsbridge Campus, Ballsbridge, Dublin, Ireland
Correspondence:
D. Patton
School of Nursing and Midwifery
University College Dublin
Ballsbridge Campus
Ballsbridge
Dublin
Ireland
E-mail: [email protected]
PATTON D. (2004) Journal of Psychiatric and Mental Health Nursing 11, 221–228
An analysis of Roy’s Adaptation Model of Nursing as used within acute psychiatric
nursing
This article examines the use of Roy’s Adaptation Model of Nursing within acute psychiatric nursing. The analytical framework used to analyse the model was that of McKenna’s
(1997) framework. The author believed this framework would allow for analysis of an
abstract nature to occur. After examining the model under different headings it was concluded that there exists a research gap in relation to the use of Roy’s model within acute psychiatric nursing. It is recognized that Roy’s model is well developed and therefore has the
potential to positively effect nurse practice and patient outcomes within acute psychiatric
nursing. However, it is also acknowledged that a greater level of research-based evidence is
required in order to fully justify the use of the model within acute psychiatric nursing.
Keywords: McKenna’s analytical framework, nursing models, Roy’s model
Accepted for publication: 10 September 2003
Introduction
Within nursing the development and utilization of nursing
models is an area of constant growth. Within psychiatric
nursing the development and use of nursing models is not
so evident (Barker 2001). The reason for this may lie in the
fact that psychiatric nursing can go without the use of nursing models, as such models do not address what nurses do
within clinical realities (Gournay 1995). It is supposed that
the utilization of nursing models in clinical practice gives
design to the nursing process; itself a systematic cycle
designed to give a semblance of structure to the deliverance
of nursing care (Walsh 1991). It has also been proposed
that nurses will become more autonomous and subsequently more accountable in what they do if they use a
nursing model in practice (Smith 1996). In order for a nursing model to be rendered useful within a practice area it
must first be examined and defined in such a way that
makes it clear that its use will benefit nursing practice and
patient outcomes.
© 2004 Blackwell Publishing Ltd
For the purpose of this article the author will analyse
Roy’s Adaptation Model/Theory of Nursing (Roy &
Andrews 1999), using McKenna’s (McKenna 1997) analytical framework as a conceptual guide. The author believes
that this particular analytical guide is somewhat more all
encompassing than other analytical theories, such as those
by Chinn & Kramer (1995), Fawcett (1995) and Metzger
McQuiston & Webb (1995). The author also believes that
McKenna’s guide allows analysis of an abstract kind to
occur. In analysing Roy’s model the author will pay attention to previous work Roy has completed on her model,
which was first published in 1970 (Roy 1997), but which
was further refined through the 1970s and 1980s (Roy
1997). The most recent expansion of the model occurred in
1999 (Roy & Andrews 1999). The main focus of this article
will be on analysing the use of Roy’s model within acute psychiatric nursing. In performing this, the author will use citations from relevant literature, make reference to his own
experiences of using the model within an acute psychiatric
environment and use the example of a short case study.
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D. Patton et al.
How Roy’s theory was developed
Whilst studying for her master’s degree at the University of
California (1964–66), Sr. Callista Roy was challenged in a
seminar by the nurse theorist Dorothy Johnson, to develop
a conceptual model of nursing. In her clinical practice as a
paediatric nurse Roy had become impressed by the ability
of children to adapt with illness. This impression gave Roy
the idea that adaptation may be a useful conceptual foundation upon which to build a nursing theory. Roy also
identified the positive role that nursing had to play in the
promotion and enhancement of adaptation. At a theoretical level, the work of Harry Helson, a non-nursing theorist,
influenced Roy greatly with regards to the merits of adaptation (Roy 1984). Helson had formulated a theory of
adaptation, which stated that people adapt positively or
negatively to incoming stimuli. Helson first identified the
focal, contextual and residual stimuli that must be
addressed in assessing a patient using Roy’s model. Roy’s
earlier work focused on the importance of nursing science
in promoting positive patient outcomes (Roy & Andrews
1991). However, her most recent definition of nursing has
moved slightly away from this notion of nursing science
being so integral to providing good nursing care (Roy &
Andrews 1999).
Two main types of theory development exist. These are
inductive and deductive theory development (Metzger
McQuiston & Webb 1995). It is apparent that Roy’s theory
was developed both inductively and deductively. From an
inductive perspective Roy’s personal clinical observations
influenced her beliefs on what should underpin a nursing
model. Student observations of 500 patients also helped
Roy to conclude that human behaviour falls within one or
more areas of human functioning (Roy 1980). Within her
theory these functional areas are called the four adaptive
modes. More specifically these modes are labelled the physiological, role function, interdependence and self-concept/
group identity modes. The physiological mode focuses on
the physical needs of the patient whilst the other three
modes focus on the psychosocial needs of the patient. The
goal of the nurse is to help the patient regain or maintain
adaptation within one or more of these modes. When
assessing a patient who is experiencing an acute form of a
mental illness, it may not always be possible to classify
behaviour into one of the four modes. Indeed, it may be
questioned if it is good practice to put areas of patient functioning into certain categories. This may reinforce the
scheme of patient labelling.
Roy’s initial observations were made mainly within paediatric nursing care environments. How children and those
adults with an acute mental health problem adapt or cope
with illness may differ significantly. Subsequent nursing
222
interventions may also differ. At quite a primitive level, the
above issues may lead to the usefulness of Roy’s model
within an acute psychiatric setting being called into question. However, the above point helps to illustrate how
adaptable the model is. Such adaptability may prove of
value in the provision of care to persons with an acute form
of a mental illness.
As already stated Roy deduced heavily from the workings of Harry Helson. Helson’s adaptation theory is very
much the parent theory to Roy’s nursing theory. A major
concern exists in relation to Helson’s theory on adaptation
in that it was limited to an investigation of the responses of
the retina of the eye to environmental stimuli (Helson, cited
by Fawcett 1987, p. 266). In response to this Roy states
that Helson’s theory is applied widely within health care
(Roy 1997). At a broader level the use of Helson’s theory
may be seen as another example of nursing theorists borrowing ideas from theorists outside the nursing profession.
Perhaps nursing should be attempting to formulate models,
which are developed solely within the realms of nursing.
The use of an approach such as reflective practice may help
nurses define what they do. Subsequently, development
of nursing theory, which is ‘nursing’ specific, may develop.
Reflective practice may be defined as that reflection which
may occur upon or during practice, which leads to the
development of intuitive or tacit knowledge. It has been
stated that this knowledge type may be more apt within the
world of professional (Schon 1983) or nursing (Benner
1984) practice. Because of the intangibility of psychiatric
nursing (Chapman 1999), knowledge and subsequent practice development may prove difficult. Allowing for the
development of tacit-based knowledge may therefore serve
the advancement of psychiatric nursing in a more meaningful way.
In conclusion Roy paints a philosophical picture of a
nurse assisting a patient to adapt to a current life difficulty
whilst maintaining adaptive health and living patterns. The
act of nursing is defined as practical and scientific in nature
(Roy & Andrews 1999). Therefore, nursing help should be
given in a way that incorporates good practice underpinned
by a sound scientific base.
How the theory is internally structured
Many concepts underpin Roy’s model. She outlines concepts relating to the general theory of the person as an integrated whole and to the four adaptive modes and their
subcomponents. Nine scientific and five philosophical
assumptions are contained within the model. The philosophical assumptions are stated in an abstract way. At a
practice level the model may appear quite complex. Initially the author found the model difficult to understand.
© 2004 Blackwell Publishing Ltd, Journal of Psychiatric and Mental Health Nursing 11, 221–228
Roy’s Adaptation Model of Nursing
Only after extensive reading upon the model did he come
to a greater understanding of its content and how it may be
applied to psychiatric nursing practice. Some nurses may be
resistive towards using the model if they perceive it as complex. Also, by not being knowledgeable about the model
nurses may become passive in its deliverance. Patients may
also find the model difficult to understand. This may inhibit
their willingness to partake within formulating their care
plan and subsequent nursing interventions. The patient’s
role within the nursing process may then be negatively
affected (Rodwell 1996, Cahill 1998). However, it could be
questioned if it is always prudent for nurses to try to orientate patients to the complexities of this model whilst they
are experiencing an acute form of mental illness. Doing so
may lead to a deterioration in the patient’s mental state. A
further issue is that of nurses maintaining control over
patients by using this model in a complex way. It has been
identified in a phenomenologically based study that
patients perceive nurses as having power through knowledge (Nordgren & Fridlund 2001). This may occur if
nurses do not engage with patients in informing them
about the model. Some psychiatric nurses may find it easier
to practise if they maintain some control over those for
whom they are caring. Nurses who do talk to patients
about the model may use diagrammatic representations to
help those patients understand how the model works. On
a more positive note, by being so well defined, the strict
application of the model to any practice area may lead to
the deliverance of a high standard of systematically constructed nursing care.
It could be argued that structured care could be provided without using Roy’s model, for example, by nurses
implementing the nursing process without guidance from
any nursing model. The medicalized nature of the nursing
process does not imply that nurses either involve patients in
their care or focus on adaptive health patterns. However,
Roy’s model makes it clear that patients are involved in the
assessment of their care needs and in the planning of appropriate nursing interventions. Roy’s model is also quite
unique in that it explicitly states that the nurse should focus
on positive patient health patterns as well as health patterns, which are maladaptive in nature. Within the Republic of Ireland (ROI), psychiatric patient care is structured
by multidisciplinary teams (MDT), which are teams made
up of various heath care professionals employed by individual service areas. Using a nursing model may lead to
fragmentation in patient care in that the model is nursing
specific. An assessment tool and problem intervention
strategy open to use by all within the MDT may lead to
more all encompassing patient care. In defence of Roy’s
model, the author is of the opinion that Roy’s model will
allows nurses to present patient progression in a structured
way to colleagues within the MDT. At a more ideal level,
using Roy’s model may allow nurses to talk about patients
in a more positive light with MDT colleagues.
A nursing model must address four key concepts, which,
combined, are known as the metaparadigm. As can be seen
in Appendix 1, these four concepts are those of health, the
person, the nurse and the environment (McKenna 1994).
All four concepts are addressed in Roy’s theory. Roy views
the person in a holistic way. A person’s functioning may be
enhanced or mitigated against by internal or environmental
stressors. These stressors when presenting may have three
types of stimuli. Focal stimuli represent an immediate and
apparent cause of the problem; contextual stimuli are
other causative factors whilst residual stimuli relate to the
patient’s past experiences with the illness and how these
experiences may impact upon the patient’s current plight.
Regulator and cognator activities are manifested through
a patient’s illness. Regulator activities are physiological in
nature whilst cognator activities may range from a physical
attribute to a psychological or social attribute. In relation
to the three stimuli, it may only be possible to identify the
focal stimulus in some cases (Roy 1984). This is applicable
to acute psychiatry for three reasons. First, within the acute
psychiatric environment it may not always be possible to
carry out an in-depth initial assessment with patients. For
example, a patient experiencing an episode of psychosis
may find it difficult to communicate what has caused their
current problem. Second, some patients’ stay within an
acute setting may be quite short. For example once an acute
episode has subsided, a patient may be transferred to a
step-down acute unit. Not being an inpatient within an
acute unit for a lengthy period of time may not afford a
nurse time to carry out a comprehensive assessment of a
patient. Third, some patients within acute settings may not
want to be in hospital, therefore, they may not take part in,
or sabotage any nursing assessment.
The goal of nursing within the model is to promote, and
if possible, maintain patient adaptation within a current
difficulty. This goal may be achieved by the nurse and
patient partaking in a six-stage nursing process. These six
stages are: the assessment of patient behaviour, assessment
of stimuli, nursing diagnosis, goal setting, intervening and
evaluating. Assessing a patient may prove time consuming,
time that may not always be available within an acute setting. However, using Roy’s assessment process will lead to
a detailed holistic overview of the patient’s current situation. However, nurses must be aware that acutely ill
patients may not always be able to partake within a thorough assessment immediately after their admission. In such
cases it is the role of the nurse to assess and plan interventions, which he/she thinks will best meet identified patient
needs. Such care planning may be called maintenance care
© 2004 Blackwell Publishing Ltd, Journal of Psychiatric and Mental Health Nursing 11, 221–228
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D. Patton et al.
planning. When the patient becomes more receptive to partaking in their care, they should be immediately involved in
their care. This type of care planning is called contractual
care planning.
As regards nursing interventions, Roy & Andrews
(1999) stipulate that stimuli may be manipulated so that
the patient will be able to adapt to their current difficulty.
This consideration could be called into question on ethical
grounds. The term ‘manipulation’ may lead some nurses
to believe that they ultimately decide what care a patient
should receive. This would be in keeping with former
paternalistic trends within psychiatric nursing. Perhaps
more appropriate terminology would be that of being a
companion to the patient during his/her illness.
With regards to the concept of health, a healthy person
is one who can adapt to current difficulties. In her earlier
model Roy does not give a definite definition of what health
entails (Fawcett 1987). This lack of a clear definition of
health may be viewed as a positive attribute of the model.
By no definition being given nurses may conclude with
patients what health means to them. Although not stated
explicitly, Roy may be implying the uniqueness of how people and their perceptions of health interact. In the most
recent edition of her model Roy states that illness and
health can co-exist (Roy & Andrews 1999). In practice this
recognition of how health and illness can co-exist occurs
when adaptive and maladaptive health patterns are identified at assessment. This has a positive implication for psychiatric nursing in that a proportion of people function in
life with an enduring mental health difficulty. For example,
those people living in sheltered community dwellings. In
relation to acute psychiatric care, Roy’s model will allow
nurses to engage with patients in a way that allows patients
to have optimum input into their care and that allows them
to define what ‘being healthy’ means to them. By engaging
with the patient within a health-oriented context as
opposed to an illness one, the nurse may improve the
chances of recovery for the patient. Roy’s model implies
that nurses engage in a nursing process that does not correlate closely with the medical approach to mental illness.
Such a non-medical, non-problem-based approach to
patient care may serve to improve patient outcomes. By
being ‘health’-oriented, Roy’s model may militate against
the development of ‘sick role’ behaviour patterns, and may
assist the wider community to recognize that those with
mental health problems can exist as functional persons.
In conclusion, Roy’s model possesses many underlying
concepts. This may portray the model as complex and
therefore difficult to use in practice. In defence of the
model, the concepts, which underpin the model, are well
defined, therefore increasing the validity of the model. This
enhanced level of validity makes Roy’s model ideal for use
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in practice. Instead of being critical of the model perhaps
nursing should be looking towards such well-defined theories such as Roy’s in guiding nurse practice.
How the theory is used
How the model is used and guides nursing practice, the
quality of care given and the nursing process will be
addressed in this section. Some general issues relating to the
model’s use within acute psychiatric care have been presented. These issues, along with some other practice issues,
will now be further demonstrated in a short case presentation. Goals and interventions negotiated will be outlined
with reference to concepts deemed important within Roy’s
model.
David Kelly was a 22 years old male admitted on an
involuntary basis with symptoms of depression. After
being assessed by the medical registrar David was
accompanied to the acute unit by his parents and the
author. Prior to fulfilling a nursing assessment using
Roy’s model the author read what the medical registrar
had written in David’s medical notes and recorded some
collateral information from David’s family. The author
completed this to give him a basis to work on whilst
assessing David. The Interdependence Mode of Roy’s
model identifies the importance of significant others and
support systems, recognizing the significant other may
be enacted through collecting collateral information
from them. The author initially assessed David for 1 h.
During this time David was more talkative than the
author had envisaged. An array of information relating
to the four modes was collected. Some of this information had not been collected as collateral information.
This point highlights the importance of the four modes
in allowing the nurse to perform a thorough initial
assessment. This array of information helped build a
holistic picture of David’s predicament, as opposed to a
purely medical picture. The fulfilment of a first and second level assessment and the formulation of interventions and goals occurred over the following 2 days.
Roy’s model gives scope to the initial patient assessment
to be carried out over an extended period of time. Using
Roy’s model allows for the nurse to spend time with the
patient in trying to seek solutions to the patients presenting life and health difficulties. Appendix 2 provides
a brief summary of some of the problems and interventions that the author and David concluded upon. The
author found that David related in an increasingly open
fashion, the longer the author spent in his company.
Much of this time was spent by the author helping
David to recognize his adaptive and maladaptive health
patterns and subsequent interventions. By being jointly
© 2004 Blackwell Publishing Ltd, Journal of Psychiatric and Mental Health Nursing 11, 221–228
Roy’s Adaptation Model of Nursing
formulated, the author found David to be more receptive to receiving help. Also, the identification of positive
health patterns helped David develop an overall more
positive schema, which the author believes helped him
in gaining strength to overcome the problems, which
had led to his depression. At times the author and David
did not agree with the evaluation of certain interventions. However, the fact that David could disagree with
the author within a mutual relationship must be appreciated. The author believes that using Roy’s model led
to this. On discharge, David responded positively to a
patient satisfaction questionnaire. The author believes
that using Roy’s model helped him provide care for
David in a way, which allowed David to feel satisfied
with the help he had received.
The only true way to measure the effectiveness of any
model is to perform a concurrent or retrospective audit
upon its usefulness. No research exists detailing how useful
Roy’s model is within acute psychiatric care, although it
has been evaluated within a forensic care setting (Miller
1991). The research gap that is evident in relation to the
model should be addressed both qualitatively and quantitatively in order for the more intangible aspects of using the
model to be explored effectively. Patients should also be
involved in evaluating the model, although this may prove
problematic within acute psychiatry, as some patients may
not want to be involved in an evaluation process. This may
result from the fact that they do not want to be in hospital
or result from the nature of their illness. In order to overcome this, patients should be asked to evaluate their care
on discharge.
The question of how generalizable the theory is may be
answered by an exploration of its possible use within nurse
practice, education and research. It is evident that Roy’s
model is used within psychiatric nurse practice, and more
specifically within acute psychiatric nursing practice. However, there is a severe shortage of research-based literature
into the use of the model within psychiatric nursing. The
theory has been studied within the context of general, paediatric and community nursing. Findings within these environments have been mixed. At a broader level, in order for
models to be researchable they must be able to generate
testable hypotheses. Roy’s model has the ability to do this
because of the well-defined theoretical structure of the
model.
Evidence-based practice is very much to the fore within
contemporary nursing (Cranston 2002). Employing evidence-based nursing interventions usually means the use of
research findings into what is best practice within a particular area (McClarey & Duff 1997). Such research findings
may come from quantitative or qualitative studies, both of
which aim to contribute to nursing knowledge (Begley
1996). As alluded to earlier Roy supports the development
of nursing science and the use of science in practice. However, in the more recent editions of her model, Roy has
placed a greater emphasis on the correlation between nursing science and nursing practice. Adopting the philosophy
that nursing science and practice are closely related may
help bridge the nursing theory–practice gap.
According to Roy (1979), her model defines for student
nurses the distinct purpose of nursing. She also states that
her model will allow students to develop new practicebased theories (Roy 1979). Because of the complexity of
the model this may not be possible for students in the earlier part of their training. The author would suggest the
teaching of the model in a spiralled way. This way, students
may be better able to correlate their practice experiences
with the theoretical content of the model and therefore help
them bridge the theory–practice gap.
It appears that the model has the potential to be generalized within the areas of nurse practice, education and
research. Roy’s adaptation theory in itself has generated a
general theory of the person as a holistic system and theories relating to the four adaptive modes. The model has the
potential to generate specific practice theories pertaining to
one or all of the four modes. These defined practice theories
may lead to the enhancement of psychiatric nursing care.
For example, more specific theories into how a high level of
psychosocial care may be delivered to patients. Such theories may have value for psychiatric care as virtually all psychiatric disorders have psychological and social elements.
This aspect of the model makes it somewhat implicit that
the theory has the potential to benefit psychiatric nursing.
Other ideas that underpin the model and which have relevance for psychiatric nursing are those of a person being a
holistic entity, possessing a unique adaptation zone and
that patients should be involved in the formulation of their
care plans.
When compared to other models
Within the context of acute psychiatric nursing in the ROI
the author is familiar with three other models/theories.
First, Orem’s Self-Care Deficit Theory focuses upon the
nurse helping the patient become more independent in
meeting their health needs (Orem 1995). Although not
made explicit in Roy’s model, it is implied that the nurse
strives to help the patient become more self-sufficient in
their care. Roper, Logan and Tierney developed their
model around how nurses assist patients achieve their
activities of daily living (Roper et al. 2000). In relation to
psychiatric nursing, the main criticism of this model is
that it is slightly more medical in nature than Roy’s
model. The final model is Barker’s Tidal Model (Barker
© 2004 Blackwell Publishing Ltd, Journal of Psychiatric and Mental Health Nursing 11, 221–228
225
D. Patton et al.
2001). This model developed from a series of studies
which examined the need for psychiatric nursing care and
how power exists in nurse–patient relationships (Barker
et al. 1999, Barker et al. 2000). The model supports the
idea that mental illness is caused by problems in living.
The Tidal Model emphasizes the importance of the nurse
interacting with the patient in trying to gain a lived understanding of what the patient is experiencing. By doing this
the nurse will come to understand the patient as something more than someone with a mental illness. The nurse
in using the Tidal Model will not attempt to dictate to a
patient how best to alter their life pattern. Rather, the
nurse uses interaction with the patient as a guide in directing how nursing help should progress. How the model
may be used in practice is demonstrated metaphorically.
However, it is clearly understandable and applicable to
acute psychiatric nursing. Why the model is presented
metaphorically could be questioned, on the grounds that it
lacks a definable structure and may therefore be difficult
to understand for both nurses and patients. Roy’s model,
although complex, is clearly definable. Unlike Roy’s
model, the Tidal Model was formulated with clear reference to psychiatric nursing and initially with particular
reference to acute psychiatric nursing. Available evaluations of the Tidal Model in practice would seem to indicate that its use is very much warranted within the wider
field of psychiatric nursing care (Fletcher & Stevenson
2001, Stevenson et al. 2002). Such evidence does not exist
to support the use of Roy’s model within psychiatric nursing. Where the Tidal Model and Roy’s Adaptation Model
compare is within their underlying philosophies. Both
models imply the importance of patient uniqueness and
how the nurse can help patients recover from their current
difficulty.
Conclusions
Roy’s model is underpinned by many theoretical concepts and assumptions. There is no doubt that the model
holds the potential to positively effect patient care and
nursing practice in acute psychiatric nursing. Some of the
positive attributes that the model possesses are those of
the patient being a holistic being and the importance of
the patient partaking with the nurse in formulating their
care. The model also identifies health promotion as
important within the caring relationship. On a slightly
more negative note, the model presents as complex and
may prove time consuming to use in practice. Finally,
there is also an urgent need for research into the effectiveness of Roy’s model within acute psychiatric nursing,
in terms of its ability to help patients acquire positive
health outcomes.
226
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Appendix 1
The metaparadigm
Nursing
Person
Holistic, adaptive systems
cognator internal processes
adaptation maintained by regular and
A health care profession
scientific and practical in nature
Emphasizes health promotion for persons and the wider community
Biological, psychological, social and spiritual in nature
Through
Focus of nursing
Health
Nursing process
A reflection of adaptation
a unique state to each person
assessment of patient behaviour
assessment of stimuli
nursing diagnosis
goal setting
intervening
evaluating
Within adaptation, health and ill-health can co-exist
Environment
Ill-health caused by
Focal stimuli
Contextual stimuli
Residual stimuli
Regulator and cognator symptoms
Conditions, circumstances and influences affecting person and group
development
manifested in 4 modes
Physiological Mode
Interdependence Mode
Self-Concept Mode
Role Function Mode
Person must adapt to these inputs
Appendix 2
Problems identified and interventions planned within the four adaptive modes
Self-Concept Mode
Problem: David had a negative perception of his existence and wanted to perceive himself more positively.
Intervention: It was agreed that I would spend dedicated daily time talking to David about how his day was progressing and how he felt about
himself. We agreed that the focus of our interaction during this dedicated time would be on David being positive about himself and his
existence.
Outcome: Over time David began to talk more positively about himself and the life he was living/going to live.
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Problem: David was finding it difficult to access spiritual guidance.
Intervention: I arranged for the hospital chaplain to come and visit David. As well as this I agreed to accompany David to the hospital oratory
when he wanted some ‘time out’ to think.
Outcome: The hospital chaplain visited David on a regular basis whilst he was in hospital. This seemed to have a positive effect on David. Visiting
the hospital oratory also seemed to affect David in a positive way.
Role Function Mode
Problem: David was worried that he may loose his job.
Intervention: I helped arrange getting a ‘sickness certificate’ which was then forwarded to his employer.
Outcome: David did not loose his job.
Problem: David was worried about how his family may perceive him whilst in his current state.
Intervention: I informed David’s family of the importance of providing positive reinforcement to David when they visited him. I also spent time
with David after family visits talking about what the visit represented for him.
Outcome: David’s family were very supportive of him whilst he was hospitalized. Just after his admission David did not talk at length with any
family member when they visited. This altered over time.
Interdependence Mode
Problem: David was concerned that he may be left alone whilst in hospital.
Intervention: I asked David’s family to ensure that one or more of them attended each evening at visiting time. I also asked them if it would be
possible for some of David’s friends to visit him.
Outcome: One or more of David’s family visited each evening. A number of David’s friends also visited regularly.
Physiological Mode
Problem: David had a poor appetite.
Intervention: I explained to David the importance of eating an adequate amount of solid food and of remaining hydrated. David choose what
food he wanted to eat and when. A record was kept of what David ate and drank.
Outcome: David’s appetite improved as his admission progressed. David did eat and drink adequately during the first couple of days of his
admission.
Problem: David thought he was going mad in the sense that something was wrong with his brain.
Intervention: I talked to David about his illness and assured him that his brain was not distorted.
Outcome: David’s thought processes in relation to how he perceived that anatomy of his brain altered as his admission progressed.
Problem: David was slightly constipated in the days immediately after his admission.
Intervention: I informed David of the importance of remaining hydrated. I also encouraged David to walk as much as he could around the unit
and within the enclosed garden.
Outcome: David’s slight constipation did not become anything more than a passing problem in the initial period after his admission.
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