Sunday, December 14, 2008

health and illness


Mind and body go together ,move together, get well together and got sick together.

Through out history, philosophers and scientists have debated the nature of the relationship between mind and body. There is now a renewed interest in holistic health practices ,based on idea that mental processes influence physical well being and vice versa. Research is identifying the links between thoughts feelings and body functioning. Many believe that all illness have psycho physiological component. Physical disorders have a psychological component and mental disorders a physical one.

Illness is never an isolated event. The client and family must deal with changes resulting from illness and treatment. Each client responds uniquely to illness and therefore nursing interventions must be individualized. The client and family commonly experiences psychological changes ,environment, personal behaviours and psychosocial factors play an interactive role of illness and health. Being hospitalised for any illness or injury can create emotional problems and unacceptable behaviour in patients who, under trying circumstances are mentally sound and emotionally mature.


“Health is a state of complete physical, mental and social wellbeing and not merely absence of disease or infirmity” ( W.H.O 1946)

“Health means being well and using powers to the fullest extent. Disease is reparative process nature institutes because of some want of attention”
( Florence Nightingale)
“Illness is a state in which a persons physical, social, developmental, or spiritual functioning is diminished or impaired compared with previous experience”
(Potter and Perry )
“Illness is the human experiences of disease”
( Kniesal and Ames -1986)

Illness is defined as an absence of health or deteriorated rhythm of life ,diminished coping, an unsuccessful adjustment to life and a loss of the sense of well being and vitality .Most people perceive illness as threatening. Illness may impose necessary changes on the individuals life style. The common psychological consequences of illness is:-
Ø Uncooperativeness
Ø Gets too personal self centeredness
Ø Illness with negative process
Ø Dependent
Ø Demanding
Ø Hostility
Ø Ambivalence
Ø Aggression
Ø Paranoid
Ø Sense of shame
Ø Guilt ,fear, anxiety, regression etc.

Individuals react to illness in many different ways. Some patients show reluctance and uncooperativeness towards health care. Co-operation is a subject of concern to most health professionals who work with ill patients. It means consciously carrying out duties ,taking medications as ordered and modifying life activities as adviced.Although uncooperativeness can result from lack of knowledge. ,simple forgetting may cause uncooperativeness on the part of someone with the best of knowledge and indecision. Sometimes exercise are omitted because as individual is busy or is unwilling to take time for them .Some times a person omits a prescribed care because of a wish ,feel normal and not different .Some therapies recommended are very expensive and the person may not have financial resources for them. Some times patients do not co-operate with the family members showing withdrawal and rejects and care and do the reverse of what is asked to do.
Research says that adopting appropriate health related behaviour is the result of three sets of beliefs, The first set comprises belief about the seventy of the diseases or its complicatory and effect on daily living. Secondly the set is composed of the persons beliefs about her own ability to perform the prescribed behaviour. Then thirdly beliefs related to their perception of the benefits that will occur from the prescribed health.
During the second stage of illness patients are concerned about their survival and the effect of the disease in their lives. As a result their lives. As a result their behaviours are very self cantered .These behaviours are considered as adaptive for this stage of illness and are characterised by
Patients become very subjective and judge everything in relation to him or her. If the nurse frowns or yarns while talking to the patient ,the patient thinks that the nurse doesn’t like him or her or knows some bad news about the patients condition. When people are talking in the hall ,the patient is sure that they are talking about him or her.
2) constriction of interest
This occurs because patients main concern is oneself and what is happening to ones body or going on in one’s room or in the immediate environment .At this time , one’s energies are diverted to trying to overcome the problems associated with the disease or medical condition and are not available for divers ional activities. some people may watch TV, read a paper or glance at a book but their span of attention is short. Their interest is minimal and the content is quickly forget.
3) Emotional dependency
The dependency creates feelings of ambiance in which one likes and appreciates the assistance that one is getting and at the same time resents the condition and need for the assistance.
4)Hypochondria sis
Means intense anxiety about the usual and normal functions of the body. When sick and anxious about recovering, the patient focuses attention on factors that he or she had previously noticed.

Every person responds to the threat of illness in a unique and special way. Illness may bring about the necessary changes in an individuals life style . Illness causes one to feel alone in facing ones problems.
Clients who have a progressive or terminal illness with little or no hope of recovery face continual change or loss. The client may be overwhelmed by illness related physical or neurological problems or by needs for care or limitations of self care ability. Roles and relationships may change and other people in the clients life may be uncomfortable or withdrawn from client.

Nursing care:-
Initial goal focus on ensuring that the client is safe and his or her physiological needs are met diminishing depressive or withdrawn behaviour.
1. Anticipatory grieving related to potential loss of health,abilities,or life.
Objective:- The client will demonstrate decreased suicidal ,withdrawn or depressive symptoms
- approach client and initiate interactions
- approach the client in a non-judgemental way
- as a client tolerates encourage discussion of the illness
- encourage the client to verbalize the feelings
2. Hopelessness related to depression
Objective;- The client demonstrates decreased suicidal , withdrawn or depressive symptoms
- assess the clients suicidal potentials
- encourage the client to express his feelings
- help the client to identify the resources
- encourage the client to be as independent as possible in self care activities.


The individual develops from a child into an adult he is learning to become progressively more independent ,with an innate tendency to strive towards greater independence. Dependence is seen in every aspect of nature. likewise every human being is dependent on someone for some reasons. No person ever becomes entirely independent .In illness also the client depends on healthcare professionals for the relief of symptoms. The client accepts sympathy ,care, and protection. The more ill the client the more they are excused from responsibilities. The client may require assistance from others to meet basic human needs of daily living and may need emotional support.
As the patient recovers from his illness he needs to regain his independence gradually. He requires encouragement from nursing staff. This behaviour becomes maladaptive when the client does not becomes independent even though his condition does not require total care. They show extreme dependence on other people particularly need to be taken care of. They are often pre occupied with a fear of being left to take care of themselves.
Nursing care:-
Nursing goals with dependent clients include fostering the development of basic skills and confidence in the clients own abilities .Using limit setting and communicating clear, consistent expectation of the client can be useful.
1. Ineffective individual coping related to inadequate skills for daily living or next changes crisis
Objective:-The client will demonstrates decreased ,manipulative, attention seeking behaviour
-Assess the clients immediate environment and hospital room for potentially dangerous objects.
- Teach the client needed social skills
- Encourage the client to take direct action to meet personal needs
2. Powerlessness related to dependence on others to meet needs
Objectives:- The client will identify present skills and level of functioning
- Encourage the client ventilate feelings
- Encourage the client to share feelings with other clients
- Begin with a interview and works towards the goal of the clients discharge and independence from the hospital
The term demanding client refers to the client who puts a very firm and forceful request for something or it is a desire of the consumers for a particular product or service.
a) Antisocial personality disorder
It is a pattern of socially irresponsible, exploitative and guiltless behaviour that reflects a disregard for the rights of others .These individuals exploit and manipulate others for personal gain.

b) Histrionic personality disorders
It is characterised by colourful, dramatic and extroverted behaviour is excitable ,emotional people. They have difficulty maintaining long lasting relationships, although they require constant affirmation of approval and acceptance from others.

c) Narcissistic personality disorders
Person with narcissistic personality disorder have an exaggerated sense of self worth. They lack empathy and are hypertensive to the evaluation of others. They believe that they have the inalienable right to receive special consideration and that desire is sufficient justification for possessing whatever they seek.


Hostility is a hostile behaviour is characterised by verbal abuse ,threatened aggressive or violent behaviour,un co-operativeness and the therapeutic milieu, behaviours that have been defined as undesirable, unacceptable or in violation of established limits.
Hostility is a multidimensional construct that is thought to have cognitive, affective, and behavioural components. The cognitive component is defined as negative beliefs about and attitudes towards others ,including cynicism and mistrust .The affective component typically labelled as anger refers ton an unpleasant emotion ranging from irritation to rage and can be assessed with regard to frequency ,intensity and target ,the behavioural component is thought to result from the attitudinal and affective component and is an action intending to harm others ,either verbally or physically.

Hostile transference:-
If a patient internalizes anger and hostility ,this resistance may be expressed as depression and discouragement. The patient may ask to terminate the relationship on the grounds that there is no chance of getting well. If the hostility externalized the patient become critical ,defiant, irritable and may express doubts ,about the nurse training ,experience or competence. The patient may attempt to complete with the nurse by reading books on psychology & debating intellectual issues rather than working on real life problems.
Nursing management:-
Goal:- Preventing harm to the client and others
Limiting or diminishing hostile or aggressive behaviour
To promote the clients ability to control his or her own behaviour
To help the client to develop skills


It refers to simultaneous existence of contradictory or opposing emotions. Attitudes ,ideas or desires for the same person, thing or situation.
Eg: - Mixed love ;Hate feelings or it refers to the experiences of having two opposite feelings at the same time
The feelings make the person want to do two opposite things at one, normally everyone experiences ambivalence at some point ,but for these people it is more pervasive and they may be unable to make decisions. It sometime appears that the client is completely committed to treatment. He or she may do whatever is asked but within a short time may demand to leave ,complaining of being held against his or her will. The urges to leave & stay are both equally strong, making the persons seem erratic when infarct it is ambivalence This may be a cause of mood affect incongruence.
The client also may lack the ability and label their emotions .When asked how they will feel about a situation ,they may respond by saying “I DON,T KNOW”. These may be based on an impaired capacity to recognize and name what they are experiencing rather than avoidance or resistance.

Suicidal ambivalence :-

There is often ambivalence that accompanies thought of suicide. Some people do not really wish to die , but instead want to communicate a dramatic message to others concerning their distress .their suicidal attempts involve no lethal methods such as minimal drug ingestion or minor wrist slalshing.this group is disproportionately female in the united states perhaps because women have been socialised to feel helpless & to fantasize being rescued.
There is another subject of people who are ambivalent about dying and to leave the question of death to fate. Although loss of a love relationship, financial problems, or feelings of meaninglessness may be present, a person in this group still entertains some hope of working things out.


Alexander states that aggression can arise from such feeling states as anger , anxiety, tension , guilt ,frustration and hostility.

Aggressive behaviour:-
Aggression is disagreeing by feeling unpleasant and cantankerous aggressive behaviour include blaming, shaming , refusing to take no for an answer ,making belittling remarks, humiliating or embarrassing another in the presence of another sampling feet, banging doors ,cursing , stammering the receiver down and crying.
All ill person may feel angry at the impairment of abilities, activities or sensations that the illness beings about sometimes this anger is expressed directly or indirectly
Toward significant others in the health care worker. Because anger is difficult emotion to accept ill people may attribute to others using the coping mechanism of projection.

Types of aggression;-

Aggressive behaviours can be classified as mild ( e.g.; sarcasm) , moderate ( e.g.; slamming doors) ,severe (e.g.; threat of physical violence against others) or extreme (e.g.;- physical acts of violence against others)
Alexander identifies aggression by the following definers characters
· Sarcasm
· Verbal or physical threat
· Changes in voice tone
· Degrading comments
· Pacing
· Throwing or striking objects or people
· Suspiciousness
· Suicidal ideation
· Self mutilation
· Invasion of personal space
· Increase in agitation or irritability
· Disturbed thought process and perception
· Misinterpretation of stimuli
· Anger disproportionate to an event
Etiology:- Aggressive behaviour may be related to feelings of anger or hostility, homicidal ideation, fears, delusion , hallucination, or other psychotic processes, to substance use to a personality disorders or to other factors .

Assessing risk factors;-
Prevention is the key issue in the management of aggressive or violent behaviour. the individual who becomes violent usually feels an underlying helpless . three factors that have been identified as important considerations in assessing for potential violence include.
1) Past history of violence
2) client diagnosis
3) current behaviour
Course of disorder :-
Aggressive behaviour may develop gradually or occur suddenly ,especially in a client who is psychotic or intoxicated .Some signs that a client might become aggressive include restlessness ,increasing tension or psychomotor agitation ,making threats, verbal abuse or increasing voice volume.

Nursing diagnosis:-
· Risk for other directed violence
· Ineffective coping
· Risk for injury
· Non compliance
· Impaired social interactions
· Chronic low self esteem
Paranoid behaviour is the presence of persistent delusion .the behaviour includes a tendency to expert exploitation by other ,doubling trust, worthiness of others , doubling trust, worthiness of others , bearing grudge and quick to anger .paranoid behaviour is the mechanism of projection. It is a common sociopathic
Personality ,the eccentric social isolate ,or the individual gone preoccupied with particular religious or political views. The person is called paranoid when he become suspicious of others ,complains that he is being watched ,followed and talked about ,paranoid behaviour can be understood as extreme form of defence mechanism of projection rather than face anxiety generated by recognition of his own hostility in to others ,namely it is they who are unjustly trying to harm him
For e.g.:-“ my family just want to put me out of the hospital and be done with me”

A brief in trust worthiness of others usually sets for the tones of positive interaction, doubt about trusting arise wrongly in individual circumstances ,such as promise gone unfulfilled . In such cases pronounced distortion can occur in our ability to trust others. The individual may loss self esteem, feel very insecure of him, because he is highly anxious and ultimately behave in a manner persecutory delusion or hallucination is predominant. Some describe it reasonable but suspiciousness can grow out of principal.So that the person becomes suspicious about anything.

When the dominating idea become fixed and unshakable ,is not open to reason and is followed by loss of insight, the idea is then clearly ,a delusion and a paranoid delusional state is said to be present .when it exists independently in an individual whose personality remains otherwise well preserved. It is called a paranoid psychosis ,which usually develops at the age of 30-40 and may remain for the rest of patient life.

Deafness blindness ,cultural and social isolation always enhance the possibility of a paranoid state developing . psychoanalytically paranoid ideas are thought to be the result unresolved homosexual conflict ,or once shows ideas perhaps precipitated by an assault on an individuals self esteem.

When the patient believes that his illness was punishment for sin or wrong doing they may react with feeling of shame and guilt. Also certain disease may make an individual feel disgraced or ashamed ,depending up on his family feel disgraced or ashamed. ,depending up on his family and cultural background . some people feel that they share their family by having certain unacceptable condition E.g.;- Mental disorders ,epilepsy, venereal disease& T.B .guilt related to illness damage self concept. In some conditions such as alcoholism, others may view the patient as weak ,or he may think of himself in those terms. Then it precipitates the feelings of being, rejected. Sexually unacceptable or socially threatening diseases cause a patient to be rejected and then he may experience a sense of shame.

It is a feeling of apprehension uneasiness ,agitation, uncertainty and fear occurring when a person anticipates threat. Anxiety is the most common emotional response to stress. Individuals feel anxious whenever they are threatened .whether the threat is perceived or actual. This worry can translate in to stress or the persons psychologic response to a stimulus such as rushing perspiring and becoming earless. It is a major component of mental health disturbances.

Level of anxiety:


Signs and symptoms


· increased degree of alertness
· increased vigilance
· increased motivation
· slight increase in vital sings


· subjective distress
· alert only to specific information
· possible headache, diarrhoea, nausea and vomiting


· feeling of impending danger
· selective attention
· feelings of fatigue


· major perceptual distortion
· immobilization ;inability to function
· feeling of terror

Guidelines for managing anxiety:-
· Listen actively and focus on having the patient discuss personal feelings
· Use positive remarks and focus on the positive aspects of life
· Explain all procedures ,policies, diagnostic studies, medication, treatments or protocols for care
· Explore coping strategies and work with the patient to practice and use them effectively.
· Use distraction as indicated to ….and prevent self from being overwhelmed.
Anger is a particularly complex emotion as it can have appositive or negative impact. Anger id is considered to be dysfunctional when the experience negative impact up on the person experiencing emotion.
The client or family may experience anger because of the illness. The anger of family members might be directed towards the client because the illness has disrupted their routine, their plans and , in some cases their ,economic and emotional support.
In some cases of illness people show anger in order to hide his feelings or emotions. He wanted to make other people think that illness didn’t affect him.
Ways to managing anger;-
· Positive self- talk .
· Change of environment
· Write about your feelings
· Listen to music
· Reading
· Being along
· Count to 50
· Deep breathing exercise

Denial of illness is an avoidance & self protecting mechanism , which permits the individual to either ,disregard or transform the implications of consequences of a thought or an act. Denial means fear& anxiety. In situation of permanent disability ,denial may be called hope. Denial is a defence mechanism characterised by avoidance of disagreeable realities & unconscious refusal to face intolerance thoughts, feelings or needs ,or desires.
Denial is a defence mechanism by which people void the implication of an illness. They may act as if the illness were not severe , as if it will shortly go away or as if it will have a few long term implications. In extreme cases , the patient may even deny that he or she has the illness, despite having been given clear information about the diagnosis.
Denial is the subconscious blocking out of the full realization of the reality implications of the disorder. It is a common reaction to chronic illness that has been observed among patients, with stroke, cardiac clients and cancer patients. denial of the implication of symptoms may act as a deterrent to seeking proper treatment.
Denial may be functional ,allowing time for emotional integration of overwhelming information or allowing a person to tolerate a chronic or progressive plight. During deterioration and decline , denial may be what helps the patient to face each day.
Denial may be adaptive , which helps individual get through a difficult traumatic experiences until they are better able to cope with reality.

A non instructive , questioning approaching should yield a change in the denial in a few days. If the patient or family is unable to respond and continuous to delay the illness beyond a few days or is unable to make important decisions about care. The denial is considered ineffective or maladaptive. During the rehabilitation phase of illness, denial may have adverse effects of client interference with the ability to take in necessary information that will be part of the patients treatment or self management programme.

According to Hans Selye (1974) ,stress is a non-specific response to any demand made on the body selye formed such demands stressors.
Any situations, event or agent that produces stress is considered a stressor. A stressor can be internal or external. E g;- a head ache is an internal stressor , where as difficult assignment is an external stressor.
Stress is a pattern of disruptive psychological and physiological functioning that occurs when an environmental events is appraised as a threat to important goals and ones ability to cope.
Indicate feelings of
Withdrawn behaviour is a withdrawal from contact with others. Extreme withdrawn behaviour reflects a need to feel safe secure and can indicate feelings of anxiety , fear or sometimes anger. Illness , particularly long term or severe illness may cause a client to withdraw. Regardless of weather the client is in a hospital or at home , she may avoid interaction ,remain in her room or resort to solitary activities such as continuously watching television. Withdrawn behaviour is characterised by silence, failure to make eye contact, recalling from touch. Superficial conversation without any self disclosure or sharing of feelings and denial of feelings. The patient may deny a reality such ,as his own illness and its effect on his life.


Ill clients may experience behavioural and emotional changes ,changes in self concept and body image , and life style changes, behavioural and emotional changes associated with short-term illness are generally mild and short lived. The individual ;for e.g.: may become irritable and lack the energy or desire to interact in the usual fashion with family members or friends. More acute responses are likely with severe ,life threatening ,chronic or disabling illness. Anxiety ,fear, anger, withdrawal, denial, a sense of hopelessness ,and feelings of powerlessness are all common responses to severe or disabling illness.
Certain illness can also change the clients body image or physical appearance. Especially if there is severe searing or loss of a limb or special sense organ. The clients self esteem and self concept may also be affected. Many factors can play a part in low self esteem, and a disturbance in self concept. Loss of body parts and function ,pain disfigurement ,dependence on others,unemployers financial problems, inability to participate in social functions, strained relationships with others and spiritual distress.
Ill individuals are also vulnerable to loss of autonomy, the state of well being independent and self directed without outside control. Family interactions may change so that the client may no longer be involved in making family decisions or even decisions about their own health care.

A persons illness affects not only the person who is ill but also the family or significant others. The kind of effect and its extend depend chiefly on three factors:
a) the member of the family who is ill.
b) the seriousness and length of the illness
c) the cultural and social customs the family follows.
The changes that can occur in the family include the following .
· Role changes
· Task reassignments and increased demands on time.
· Increased stress due to anxiety about the outcome of the illness for the client and conflict about unaccustomed responsibilities.
· Financial problems
· Loneliness as a result of separation and pending loss change in social customs.


Abnormal illness can be modified by psychological techniques. The use of cognitive therapies in the modification of illness behaviour is based on the rationale that fully or irrational pattern of thinking modulate maladaptive emotions and behaviours wooley,Blackwell and wriget (1978)reported a treatment programme that focus on enhancing the patients ability to take independent action in coping with his or her illness. Wooley et al targeted specific goals to alter a patients illness behaviour .these goals included.
1)Having the patient assume responsibility for his or her care .
2)Decreasing the care taking response by others, especially physicians and family members.
3)Altering the social contingencies that supported illness behaviour.
4)Decreasing the frequency of compliance throughout hospitalisation and illness behaviour. These goals included.
increasing achievement orientation, and finally
5)Collecting one year follow up data on the generalization of success from target to no target behaviour.
This heightened perceptual sensitivity to bodily sensations, and their subsequent misinterpretation by the patient may lead the patient to believe that he or she is the victim of some disease process. Such a conviction may often precede the development of illness behaviour. Rational emotional therapy ,their for would focus on the therapist first eliciting the precipitating external stimulus events, then determining the specific thought patterns ,that constitutes the internal response to these events that generate negative emotions ,and finally helping the patient modify these beliefs and thought patterns.
Lewinsohn et al (1982) have provided guidelines for implementing a treatment programme that attempts to assist the patient in
Ø Decreasing the frequency and the subjective aversive ness of unpleasant events in life.
Ø Increasing the frequency of pleasant events in his or her life.
The five steps suggested in accomplishing this goal include….
a) daily monitoring of pleasant and unpleasant events
b) relaxation training
c) managing aversive events
d) time management
e) increasing pleasant activities

Illness causes changes in clients life styles, patterns and their behaviour .patient may express anxiety about the consequence of illness, sometimes they show anger towards others, in order to hide their .but some people go in to a depressed state, which can lead to serious consequences. Being hospitalized for any illness may also cause emotions. So both the health team members and family have to give support to the patient.

CONCLUSION When persons become ill, they progress through stages of illness behaviour, which are influenced by psychosocial and cultural factors , the accessibility of health care system and the nature of the illness itself. They shows certain behaviours to adjust with the situation. It has a effect on the client and family, including behavioural and emotional changes in roles, body image, elf concept and family dynamics


Holistic health approach is an ancient health approach which considers the whole person and how he interacts with his or her environment. It emphasizes the connection of mind, body and spirit.
Ancient healing traditions, as far back as 5000 years ago in India and China, stressed living a healthy way of life in harmony with mature Socrates (4th century BC). Warned against treating only one part of the body “for the part can never be well unless the whole is well.” Although the term holism was introduced by Jan Christraian Smuts in 1926, it wasn’t until the 1970s that holistic become a common adjective in our modern vocabulary.
Holistic health is based on the law of nature that a whole is made up of inter dependent parts. The earth is made up of systems, such as air, land, water, plants and animals. If life is to be sustained, they cannot be separated for what is happening to one is also felt by all of the other systems. In the same way an individual is a whole made up of inter dependents parts, which are the Physical, mental, emotional and spiritual. When one part is not working at its best, it impacts all of the other part of that person. Holistic health supports searching higher level of wellness as well as preventing illness. People enjoy the vitality and well being that results from their positive life style changes and are motivated to continue this process throughout their lives.

Holism is a model in health, which involves identifying the interrelationships of the bio-psycho-social spiritual dimensions of the person, recognizing that the whole is greater than sum of its parts. (AHA).

Complementary and alternative modalities:
Complementary therapies are those therapies used in addition to conventional treatment recommended by the person’s health care provider. (AHA)

Holistic Nursing:
Holistic Nursing is defined as all nursing practice that has healing the whole person as its goal. (AHA)

Holistic Nursing:
Holistic nursing is defines as all nursing practice that has healing the hole person as its goal. (AHNA)
Holistic nursing is a specially practice that draws a nursing knowledge. Theories, expertise and intuition to guide nurses in becoming therapeutic partners with people in their case. This practice recognizes the totality of the human being the interconnectedness of body, mind, emotion, spirit, social/cultural, relationship, context and environment.
The holistic is an instrument of healing and a facilitator in the healing process. Holistic nurse’s honor each individual’s subjective experience about health belief and values.
Holistic nurses may integrate complementary/alternative modalities in to clinical practice to treat people physiological and spiritual needs. Doing so does not negate the validity of conventional medical therapies, but serves to complement broaden and enrich the scope of nursing practice and to help individuals access their greatest healing potential.
The practice of holistic nursing requires nurses to integrate self care, self responsibility, spirituality and reflection in their lives. This may lead the nurse to great awareness of the interconnectedness with self, others nature and spirit. This awareness may further enhance the nurses understanding of all individuals and their relationships to the human and global community and permits nurses to use this awareness to facilitate the healing process.
Holistic nursing is not necessity something that you do, it is an attitude a philosophy and a way of being.

AHNA Holistic Nursing Description:
American holistic nursing associates described five values based on which holistic nursing is practiced. And those core values are as follows; standards of Holistic Nursing Practice. American holistic Nurses Association has given five core values as standards of practice.

Core Values 1: Holistic Philosophy, Theories and Ethics:
Core value 1 presents the philosophies concepts that explore what access when the nurses honors knowledge and depends the understanding of inner knowledge and wisdom. It explores relationship centered care. It lays the foundation for transpersonal human easing, the art of holistic nursing and provides insight into how people create change and sustain these new health behaviour changes related to wellness, values classification and motivation theory. Holistic ethics is also addressed in both personal and professional.

Core Value 2: Holistic Education and Research:
A core value 2 addresses the psycho physiology of body mind healing spirituality and health. Energetic healing also is developed to expand further ones understanding and practice of holism. Guidelines for holistic research also are explored to provide a framework for establishing evidence based practice.

Core Value 3: Holistic Nurses Self Care:
Core value 3 develops and explores the concepts of therapeutic presence and the qualities and characteristics of becoming an instrument of healing. It also explores the importance of welfare.

Core Value 4: Holistic Communication, Environment:
Core value 4 explores therapeutic communication and the art and skills of helping. The necessary steps in creating an external as well as internal healing environment are expended to help nurses recognize that each person’s environment includes everything surrounding the individual both the external and internal. Concepts related to cultural diversity are presented so that nurse can recognize each person as a whole body mind spirit being such recognition facilities the development o a mutually concreted plan of care that addresses the cultural background, health beliefs, sexual orientation, values and preferences of each unique individual.

Core Value 5: Holistic Casing Process:
This expands the nursing process to the holistic casing process. The nursing process is a six point circular process assessment, patterns/challenges/needs, outcomes, therapeutic care plan, Implementation and evaluation.
Acupuncture literally means ‘needle piercing’ the practice of insisting very fine needles into the skin to stimulate specific automatic points in the body; called acceptant, for therapeutic purposes. Along with the usual method of puncturing the skin with the fine needles, the practioners of acupuncture also use heat, pressure, friction, suction or impulses of electromagnetic energy to stimulate the points. The acu points are stimulated to balance the movement of energy (qi) in the body to restore health.
In short acupuncture is the method to regulate and animation or corrects the flow of qi to restore health.

Philosophy of the Dao:
Dao is often described as the path o the way of life. The laws of the Dao advocate moderation, living in harmony with nature and striving for balance. They believe that moderation in all areas of life is essential to a long and fruitful life. We are fueled by these treasures. Qi or chi, shen and Jing. Chi is the energy or vital substance, shen is the spirit and Jing is our essence. Qi is both the life force and the orienting principle flowing through all things and establishing their inter connectedness. Chinese believe that every living thing has chi in the body. Shen is the treasure that gives brightness to life and is responsible for censcienseness and mental abilities. Sometimes it is compared o soul. Within the individual shen is manifested in personality thought, sensory pertplacen and the awareness of self. Jing is responsible for growth, development and reproduction. Jing represents a persons potential for development Chinese behaved that everyone is born with a firuite amount of Jing. As we go through life, we lose consume our Jing which is not replaceable. But acupuncture can reduce the loss of Jing.
Nutritional Therapy:
Nutritional therapy is a science based yet holistic, approach to illness and health. It promotes treatment of the whole person and focuses a causes and prevention of illness rather than merely suppression of symptoms. A major emphasis of the therapy is recognizing that each of us is bio chemically unique and that effective treatment needs to be custom tailored to each person’s individual needs.
The approach involves you and your practitioner working together to ascertain details of your health, both pat and present. Information will be gathered about your symptoms, family medical history, life style, diet and the environment in which you live and work. These have an important bearing on your well-being and will help yours practitioner to construct a comprehensive picture of your health and devise a programme of treatment for your needs.

It is a holistic treatment of caring for the body with pleasant smelling botanical oils such as rose, lemon, lavender and peppermint. The essential oils are added to the bath or massaged in to the skin inhaled directly or diffused to scent an entire roam. Aromatherapy is used for the relief of pain care of the skin, alleviate stress and fatigue and invigorate the entire body. Essential oils are believed to affect the mood alleviate fatigue, reduce anxiety and promote relaxation. When inhaled, they work on the brain and nervous system through stimulation of the olfactory nerves.
The essential oils are aromatic essence extracted from plants, flowers, trees, fruits, grasses and seeds with distinctive tie, psychological and physiological properties. There are about 150 essential oils. Most of these oils have antiseptic properties, anti-inflammatory, analgesic antidepressant and expectorant. Aromatherapy is one of the fastest growing fields in alternative medicine. It is widely used at home, clinics and hospitals for a variety of applications such as pain relief for women in labour pain reliving pain caused by side effects of chemotherapy and also or rehabilitation of cordial patients.
Aromatherapy is already slowly getting in to the mainstream. In Japan, engineers are incorporating aroma systems in to new buildings. In one such application, the scent of lavender and rose is pumped in to the customer area to calm the waiting customers, which the perfumes from lemon and eucalyptus are used in the bank teller counters to keep the staff alert.

In the early 1900, William Fitzgerald noted that application of pressure to certain points on the hands caused anesthesia in other parts of body. And this exploration led him to establish this technology.
Reflexology is based on the theory that ten equal longitudinal zones sum the length of the body from the top of the head to the tips of the toes. The purpose of this therapy is two fold, first, relaxation it self is an important goal. Reflexology is effective in helping the body mind restore and maintain its natural state of health because foot manipulation triggers deep relaxation.
The second goal of this therapy is to release congestion or tension along the longitudinal and lateral zones by pressure manipulation at the precise endpoints of the zones. This pressure stimulates the reflexes in the feet to cause a corresponding release.

Yoga is practiced as a way of life that includes ethical models for behaviour and mental and physical exercise aimed at producing spiritual enlightenment.
Yoga consists of various physical postures that are practiced to promote strength and flexibility, increase endurance, promote relaxation and reduce ones response to stress.

Nursing consideration:
Encourage patients to find a type of yoga that is compatible with their physical conditions and goals.

Naturopathic medicine is a way of life with emphasis an client responsibility, client education, health maintenance and disease prevention. Naturopaths believe in the vitalist doctrine which maintenance that the organism. Vitality and susceptibility are just as important as or more important than the causes of disease.

Chiropractic Therapy:
This is a manual healing art, developed in 1985 in lowa. Chiropractic science investigates the relationship between the structure (the spine) and function (mainly the nervous system) of the human body to restore and preserve health. The underlying principle is that the functions of the body are controlled by the system (nervous system) mainly 31 pairs of spinal nerves that fed all organs of the body, after branching off the spinal column. Since these nerves are surrounded by vertebrae and other musculoskeletal component any distortion of the structure of musculoskeletal system affects the nervous system. The central tenet of the chiropractic profession is intervertebral manipulation that is characterized by short-lever, specific, high-velocity controlled forceful thrusts deseeds at certain joints by the practiner using his hand or an instrument.

Mind – Body Modalities:
Most people acknowledge that there is a mind – body connection knowing how this communication occurs assists in the understanding of the mind – body modalities of relaxation, meditation and imagery.
Neuropeptides, the neuro chemicals, are behaved to be the messenger molecules that connect body and mind. Neuropeptides have properties that allow them to affect neurologic and physiologic tissue receptors.
Relaxation is the state of generalized decreased cognitive, physiological and/or behavior all arousal. The relaxation response is characterized by decreased heart and respiratory rates, BP, O2 consumption and increased alpha brain activity and peripheral skin comparatives. The long term goal of relaxation therapy is for the person to continually monitor himself or herself for indicatives of tension and to consciously let go and release the tension contained in various body parts.

Visualization technique is the conscious mind to create mental images to evoke physical changes in the body, improve perceived well – being, and or enhance self awareness. For eg, the client may be directed to begin slow, abdominal breathing while focusing in the rhythm of breathing the client them instructed to visualization occur waves coming to shoes with each inspiration, them seeding with each expiration. Next the client is instructed to take notice of the smells and sounds that he is experiencing. As the imagery session progresses, the client may be instructed to visualization warmth entering the body during inspiration and tension is leaving during expiration.

Meditation seeks to change one’s physiology to a more relaxed state and alter one’s prescription to an increased acceptance of reality.

Nursing Considerations:
Patients seeking inpatient case might have a meditation practice they want to continue. Nurses can provide the time necessary for this.
This is a group of therapeutic procedures that use electronic or electro mechanical instruments to measure, process, and provide information to person about their neuromuscular and automatic nervous system activity. The information or feedback is given in the form of analog or binary or auditory/visual feedback. And clients are taught how to read their bodies signals more accurately and are empowered to make therapeutic changes. Educating client how to react more healthfully to their own stress is the work of biofeedback.

Therapeutic touch:
A healing modality that involves touching with the conscious intent to help or heal. Therapeutic touch decreases anxiety, relives pain, and facilitates healing process. The process of Therapeutic touch has four phases.
1. Centering one self physically and psychologically;
2. Exercising the natural sensitivity of the hand to assess the energy field of the client for clue to differentiate the quality of energy flow.
3. Mobilizing areas in the client’s energy field that appear to be men flowing.
4. Directing one’s excess body energies to assist the client to repattern his own energies.

Music Therapy:
Music has demonstrated effectiveness in reducing pain, decreasing anxiety, promoting relaxation etc. music consists of sound waves that vibrate at particular frequencies. When these frequencies are harmonious with our bodies we experience the music as pleasant.

Humor therapy:
Humor cousins was a well know editor of Saturday Review when he retracted spondylitis in 1964. He wrote about using humor therapy to treat his acute and debilitating illness. More secret research (Behnett) found that improved immune response was corrected with experiences of mirthful laughter.

Nursing Role in Complementary And Alternative Therapies:
The majority of people using and seeking information about CAM are well educated and have a strong desire to actively participate in the decision making about them health case. The integrative medicine approach is consistant with the holistic approach nurses are taught to practice Nurses have the potential for becoming essential participant in this type of health case philosophy. Many nurses already practice forms of CAM by offering relaxation, imagery massage and therapeutic touch to their clients. Nurses should be knowledgeable of CAM therapies to make appropriate recommendations to allopathic primary case provides about which therapies may be useful for clints. It is also important for nurses keep abreast of the current research being done in this area to provide accurate information to every one.

The development of CAM continues to be a patient-driven phenomenon. Clients seem to be increasingly unsatisfied with allopathic treatments and are turning to CAM for relief of symptoms and heating. There is a great opportunity here for nurses to expand their practice to meet existing patient needs as well as to promote health. Holistic care for an identification of areas in which holistic nurses can improve patient care. As new modalities demonstrate their effectiveness, they can be added to the assessment. Nursing is expanding its knowledge base to include information that explains selected CAM. Higher education facilities are available in holistic nursing. It is expected that CAM will become a larger part of the practice of nurses.

1. PotterPatricia A, Perry Anne Griffin;
“Fundamentals of Nursing” ;( 2005); 6th edn; Missouri; Mosby Ine 968 – 987.
2. Carol Tayler, Carol Lillis Le Mone;
“Fundamentals of Nursing”; 2004; 5th edn; Philadelphia; Lippircott Williams and Wilkings ; P P 685 – 705.
3. Lowis White; “Basic Nursing”; 2002; A1bany; Delmas Ine; PP 345-369.
4. Lewith G, Kenyen J, Lewis P;
“Complementary Medicine an integrated approach”1998; Oxford University Press; PP 36-38.
5. Dossey Montgomery B, Keegem L, Gazette Cathic; “Holistic Nursing, A Hared book for Practice”; 2004;4th edn; Massachusetts; Janes and Basllett Publishers; PP 5-898.
6. Adles C, Adles S; “Biofeedback and psychosomatic Disorders”; 1989; 2nd edn; Baltimore; Lippincott Williams and Wilkins; PP 10-89.

1. Eisenberg D and others: Trends in alternative medicine use in the United States, 1990-1997, JAMA 280:1569, 1998.
2. Good M: Effects of relaxation and music or post operative pain a review, Journal of Advanced Nursing 24:905, 1996.
3. Krieger D: Searching for evidence of physiological change, American Journal of Nursing 75:784; 1999.
4. Heidt P: Effects of therapeutic touch on anxiety level of hospital lived patients, Nursing Research 30:32, 2002.
5. Folders S: The basic concepts of alternative medicine and their impact on our views of health, Journal of Alternate and complementary medicine 4:147, 2004.

Wed Sites:



Sister callista Roy, a member of the Sisters of Saint Joseph of Carondler, was born October 14th 1939,in los angels , California. She received a bachelor of arts in nursing in 1963 from mount saint Mary’s college in los angels and a master of science in nursing from the University of California at los angels in 1966. After earning her nursing degrees, Roy began her education in sociology, receiving both an M.A, in sociology in 1973 and a PhD in sociology in 1977 from the university of California.

The Roy Adaptation Model has evoked much interest and respect since its 1964 inception by Sister Roy as part of her graduate work under the guidance of Dorothy E Johnson at the University of California, los angels. In 1970, the faculty of mount saint Mary’s college in los angels adopted the Roy adaptation model as the conceptual framework of the undergraduate nursing curriculum. That same year Roy first published her ideas about adaptation.

Roy credits the works of von bertalanffy’s (1968) general system theory and Helson’s (1964) adaptation theory as forming the original basis of the scientific assumptions underlying the Roy model. Table 15-1 identifies the assumptions following from the initial philosophical and scientific perspectives. The philosophic assumptions flow, according to Roy, from humanism and veritivity. The term vertivity was coined by Roy to identify the common purposefulness of human existence.(roy,1988)
Table 15-1 Assumptions underlying the Roy adaptation model
System theory
Adaptation-level theory


Control processes

Information feedback

Complexity of living systems
Behaviour as adaptive

Adaptation as a function of stimuli
And adaptation level

Individual ,dynamic adaptation levels

Positive and active processes of responding.




Interpersonal process


Unity of purpose

Activity, Creativity

Value and meaning of life

In response to the 25th anniversary of the model’s publication, Roy restated the assumptions that form the basis of the model and redefined adaptation. Adaptation is defined as” the process and outcome whereby thinking and feeling persons, as individuals or in groups, use conscious awareness and choice to create human and environmental integration
Table 15- 2 vision basic to concepts for the 21st century
Scientific assumptions
Systems of matter and energy progress to higher levels of complex self organization

Consciousness and meaning are constitutive of person and environment integration

Awareness of self and environment is rooted in thinking and feeling

Humans by their decisions are accountable for the integration of creative processes

Thinking and feeling mediate human action

System relationships include acceptance, protection, and fostering of interdependence

Persons and the earth have common patterns and integral relationships

Persons and environment transformations are created in human

Integration of human and environment meanings results in adaptation

The four major concepts of the Roy Adaptation Model (RAM) are the following:
1. humans as adaptive systems as both individuals and groups
2. the environment
3. health
4. the goal of nursing
5. the direction of nursing activities

The first area of concern is the identity of the recipient of nursing care. it may be a person, family, a group, a community or a society. Each is considered by the nurse as a holistic system. The living systems are in constant interaction with the environment. There are both internal and external changes. Within this changing world persons must maintain their own integrity that is each person continuously adapts. Hence the person is viewed as a holistic adaptive system.

The person as an adaptive system
External Focal regular - adaptive modes adaptive
Coping - physiologic response
Or stimulus Contextual mechanism functions or
Cognator - self concept ineffective
-role functions response
Internal Residual -interdependence

The input
Roy identifies inputs as stimulus. Roy categorises these stimuli as focal, contextual or external stimulus most immediately challenging the person’s adaptation. It attracts ones attention contextual stimuli are all other stimuli existing in a situation that strengthen the effect of focal stimuli. Residual stimuli are any other phenomena arising from a person’s internal or external environment that may affect the local stimuli but the effects are unknown. These 3 stimuli act together and influence the adaptive level which is a person’s ability to respond positively in a situation.

The process
Roy has used the term coping mechanisms to describe the control process of the person as an adaptive system. Roy presents a unique nursing science concept of control mechanism. These mechanisms are called as regulator and cognator. The transmitters of the regulatory systems are chemical neural or endocrine in nature. The other control subsystem is the cognator subsystem. Cognator control processes are related to the bigger brain functions of perception, information processing, judgement and emotion. Maximum use of coping mechanism broadens the adaptation level of an individual and increases the range of stimuli to which a person can positively respond.

The effector
Roy postulates 4 adaptive modes refers to the way a person responds as a physical being to stimuli from the environment. These needs are oxygen, nutrition, elimination, activity, rest and protection. The self concept adaptive mode refers to physiologic and physical characteristics of the person. This includes self concept, beliefs and feelings that one has formed about one self. The interdependent adaptive mode refers to coping mechanisms that result in the giving and receiving of love, respect and value. The role function adaptation mode refers to primary, secondary, or tertiary roles the person the person prefers in the society, the role as a functioning unit of the society.

The output
Output of the person as a system is the behaviours of the person. It can be external or internal behaviour; hence it can be observed and measured or subjectively reported.

Goals of nursing
Roy defines the goal of nursing as the promotion of adaptive responses in relation to the adaptive modes. Adaptive responses are those that positively affect health humanistic values of the ray adaptation model are linked to its definition of the specific purpose or goal of nursing. Human existence is viewed as a goal setting. Goals are the end point behaviour that the person is to achieve. Long term goals would reflect resolution of adaptive problem and the availability of energy to meet other goals (survival, growth, reproduction and mastery). Short term goals identify expected client behaviour after manipulation of focal, contextual or residual stimuli, as well as state client behaviour that indicate cognator or regulator coping.

plans for implementation: nursing implementation are planned with the purpose of altering or manipulating the stimuli .implementation may also focus on broadening the persons coping ability or adaptation zone, so that the total stimuli fall with in that person ability to adapt.

Evaluation: the nursing process is completed by evaluation. Goal behaviour are compared to the persons output behaviours and movement toward or away from goal achievement is determined .readjustment to goals and interventions are made based on evaluation data.

Internal neural spinal cord→ effectors → autonomic
↑ Brainstem and reflex
Stimuli autonomic reflects response

intact intact → responsiveness hormonal responsiveness body
Circulation pathways of endocrine→ output →of target organs → response
To from glands organs or tissues

Stimuli ↓
Neural perception → short term→ psychomotor → effectors
Memory choice of

long term
(The regulator) TABLE 15-3


Intact pathways
And apparatus for → processes for
Perceptual processing selective attention, coding
And memory

Learning → imitation, reinforcement,
And insight → psycho → effects → response
Judgement → problem-solving and choice of
Decision making response

Emotion defences to seek relief
→ and affective appraisal
And attachment
External stimuli (The cognator) TABLE 15-4

The coping processes, cognator-regulator and stabilizer promote adaptation in human adaptive systems. However, the coping process is not directly observable. Only the responses of the person or group can be observed, measured, or subjectively reported. Roy has identified four adaptive modes as categories for assessment of behaviour resulting from regulator cognator coping mechanism in persons or stabilizer –innovator coping processes in groups. These adaptive modes the nurse can identify adaptive or ineffective responses in situations of health and illness.
a) physiological-physical model
The physiological mode represents the human system’s physical responses and interactions with the environment (Roy and Andrews,1999).for the individual ,the underlying need of this mode is physiologic integrity, which is composed of the basic needs associated with oxygenation, nutrition, elimination, activity and rest and protection. The complex processes of this mode are associated with oxygenation, nutrition, elimination, activity, and rest and protection. The complex processes of this mode are associated with the senses; fluid, electrolyte, and acid base balance, neurological function; and endocrine function. These needs are processes may be defined as follows:
The processes (ventilation, gas exchange, and transport of
gases) by which cellular oxygen supply is maintained by the body
The series of processes by which a person takes in nutrients,
then assimilates and uses then to maintain body tissue, promote growth, and provide energy
Expulsion from the body of undigested substances, fluid wastes and excess ions
Activity and rest
Body movements that serves various purposes and changes in such movement so energy requirements are minimal
Non-specific (surface membrane barriers and chemical and cellular defences) and specific (immune systems) defence processes to protect the body from foreign substance.
The processes by which energy(light, sound,heat,mechanical vibration, and pressure) changes to neural activity and becomes perception
Fluid, Electrolyte
And , acid-base balance
The complex process of maintaining a stable internal environment of the body
Neurological function
Key neural processes and the complex relationship of neural function to regulator and cognator coping mechanisms
Patterns of endocrine control and autonomic nervous systems to maintain control of all physiologic processes

The physical is the focus of assessment in the first adaptive mode for a family, group or collective human adaptive system. The need underlying this mode is resource adequacy or wholeness. For groups, the mode relates to basic operating resources such as participants, physical facilities, and fiscal resources.

b) Self concept-group identity mode:
For individuals, the self concept mode relates to the basic need for psychic and spiritual integrity or a need to know the self with a sense of unity. Self concept has the component of physical self and personal self. The physical self includes body sensation and body image is how the person views the physical self. Self consistency represents the person’s efforts to maintain self organization and avoid disequilibrium; self ideal represent the person’s belief system and self evaluator. The need underlying the group identity mode for a family, group, or a collective is identity integrity. In collectives “the mode consist of interpersonal relationships, group self image, social milieu, and culture.

c) Role function model:
Role function mode is category of behaviour for both individuals and groups. A role consist of a set of expectations how a person in a particular position will behave in relation to a person who holds another position. The need underlying this mode is social integrity. More specifically, Roy states the social integrity knows who one is in relation to a person who holds another position. The need underlying this mode is social integrity. More specifically, Roy states the social integrity knows who one is in relation to others so that one can act appropriately. For the individual this focuses on the roles of the individual in society, Role behaviour in group’s means through which the social system achieves goals and functions. The need underlying the role function mode in groups is termed role clarity. The mode includes functions of members of the administration and staff, information management, decision making systems, systems to maintain order, or the need for group members to understand and commit to fulfilling expected responsibilities.

d) Interdependence mode:
The interdependence mode applies to adaptive behaviour for both individuals and groups. Behaviour is assessed as it relates to interdependence relationships of individuals and groups. For individuals, the underlying need of this mode is relational integrity or security in nurturing relationships. The mode focuses on the giving and receiving love, respect, and value with significant others and support systems. Significant others are those persons who are of greatest importance to the person. Support systems are identified as those who help the person meet the needs for love, respect, and value. For groups, interdependence relates to social context, including both public and private contacts within and outside the group. The components are context, infrastructure, and resources.


Human being
Person is a bio psychosocial being in constant interaction with a changing environment and recipient of nursing care as living system.
Roy has broadly defined environment as “all conditioning circumstances and influences that surround and effect the development and behaviour of the persons or group.” Thus all stimuli, whether internal or external are part of the persons environment. Within her model, Roy specifically categorizes stimuli as focal, contextual, and residual. Changes in the environment act as catalysts, stimulating person to make adaptive responses. Thus stimuli from within the person represent the element of environment. To quote an example, elderly person admitted to hospital all the conditions of influence on him.
Health is been defined as “a state and process of being and becoming an integrated and whole person. “ Holism and integrated functioning are not only basic premises of system theory, but are also congruent with the philosophical assumptions of Roy’s Adaptation Model. The integrity of the person is expressed as the ability to meet the goals of survival, growth, reproduction and mastery. The aim of nurse practicing under the Roy model is to promote the health of the person by promoting adaptive responses.
Roy defines the goal of nursing “as the e promotion of adaptive responses in relation to the four adaptive modes. Adaptive responses are those that positively affect the health. Stimuli and persons adaptation level are inputs to the person as any adaptive system. The person’s adaptive level determines whether a positive response to internal or external stimuli will be elicited. Nursing seeks to reduce ineffective responses and promote adaptive responses as output behaviour of the person. The nurse therefore promotes health in all life process, including dying with dignity. A person’s ability to cope varies with the state of the person at different times.
Nursing activities or interventions are delineated by the model on those that promote adaptive responses in situations of health and illness. As a rule these approaches are identified as action taken by the nurse to manage the focal, contextual, or residual stimuli on the person. By making these adjustments, the total stimuli fall within the adaptive level of the person, whenever possible the focal stimulus- that which represents the greatest degree of changes in the focus of nursing activity. For a person with chest pain, the focal stimulus is the imbalance between the demand for oxygen by the body and the supply of oxygen that the heart can provide. To alter the focal stimuli, the nurse manages the stimuli of demand so that an adaptive response can be made. In turn, when focal stimuli can not be altered, the nurse promotes an adaptive response by altering contextual stimuli.
In addition, the nurse may anticipate that the person has a potential for in effective response secondary to stimuli, likely to be present in a particular situation. The nurse acts to prepare the person for anticipated changes through strengthening regulator and cognator coping mechanism. Plans that broaden the person’s adaptation levels correlate with the ideas of health promotion currently found in the literature. Finally nursing actions suggested by the model include approaches aimed at maintaining adaptive responses that support the person’s effort to creativity use his or her coping mechanisms.


The nursing process is a vehicle or decision making method compatible with the practice of nursing using the RAM. After making a behavioural assessment and a nursing judgement, nurses assess stimuli affecting responses, make a nursing diagnosis, set goals, and implement interventions to promote adaptation. Roy offers the following broad aims for nursing in response to the assumptions written for the 21st century: “nurses aim to enhance system relationships through acceptance, protection and fostering of interdependence and to promote personal and environmental transformations”.
The RAM offers guidelines to the nurse in application of the nursing process. The elements of the Roy nursing process include assessment of behaviour, assessment of stimuli, nursing diagnosis, goal setting, intervention, and evaluation
Assessment of behaviour
Assessment of behaviour is considered to be the gathering of responses or output behaviours of the human system as an adaptive system in relation to each of the four adaptive modes: physiological-physical, self –concept- group identity, role function, and interdependence. Roy defines behaviour as “actions or reactions under specified circumstances, it can be observable or non observable”. The nurse, through the process of observation, careful measurement, and skilled interview techniques, gathers the specific data. Assessment of the client in each of the four adaptive modes enhances a systematic and holistic approach.
Assessment of stimuli
After gathering behavioural assessment data, the nurse analyzes the emerging themes and patterns of client behaviour to identify responses or adaptive responses requiring nurse support with continual involvement of the human system receiving care. Behaviour that varies from expectation, norms, and guidelines frequently represents ineffective responses. Roy has identified frequently occurring signs of pronounced regulator activity and cognator ineffectiveness. The presence of these behaviours also suggests ineffective response. When ineffective behaviours or adaptive behaviours requiring nurse support with continual involvement of the human system receiving care. Behaviour that varies from expectations, norms, and guidelines frequently represents ineffective responses, Roy has identified frequently
occurring signs of pronounced regulator activity and cognator ineffectiveness, The presence of these behaviours also suggests ineffective responses. When ineffective behaviours or adaptive behaviours requiring support are present, the nurse assesses the internal and external stimuli that may be affecting behaviour. In this phase of assessment, the nurse collects data about the focal, contextual, and residual stimuli challenging the person’s coping. For groups, ineffective responses may be indicated by increased stabilizer activity associated with innovator effectiveness. For example, the death of the wage earner in a family could result in frenzied housecleaning by the rest of the family in preparation for the return of the member to the house (increased stabilizer activity) along with refusal to arrange the funeral (innovator effectiveness). Adaptive responses requiring nursing support include behaviours related to promoting, maintaining, or improving adaptive responses that will not continue to be effective with the occurrence of anticipated future changes. They may also include behaviours that are adaptive but that could be strengthened through education or anticipatory guidance.
The assessment of stimuli uses the same skills as assessment of behaviour and clarifies the nature of the focal stimulus, it should be remembered that behaviour in one mode can serve as a focal stimulus for another mode, and that a given focal stimulus may influence more that one mode. The first priority is given to behaviours that indicate a threat to the integrity of the system (ineffective response). The nurse identifies significant contextual and residual stimuli. Common influencing stimuli have been identified by Roy and her colleagues.
Signs of pronounce regulator activity:
1. Increase in heart rate or blood pressure
2. Tension
3. Excitement
4. Loss of appetite
5. Increase in serum cortisol
Signs of cognator ineffectiveness include:
1. Faculty perception and information processing
2. Ineffeective learning
3. Poor judgement
4. Inappropriate affect
Culture: Socioeconomic status, ethinicity, belief system
Family/ aggregate participants; structure and tasks
Developmental stage: age, sex, tasks, genetic factors, longevity of aggregate, vision.
Integrity of adaptive modes: physiologic (including disease pathology):- physical (including basic operating resources):-self concept group identity; role function; interdependence modes.
Cognator- innovator effectiveness: Perception, Knowledge, Skill.
Environmental considerations: Change in internal or external environment, medical management: use of drugs, alcohol, tobacco; political or economic stability
Nursing diagnosis
A nursing diagnosis is an interpretative statement that represents a judgement that the nurse makes in relation to the adaptation status of the human adaptive system (Roy and Andrews 1999) . The method suggested by Roy is stating the observed behaviour along with the most influential stimuli. Using this method, a diagnosis for Mr. Smith could be stated as: “chest pain caused by a deficit of oxygen to the heart muscle associated with an overexposure to hot weather.” A nursing diagnosis can also be a statement of adaptive responses that the nurse wishes to support. For e.g.: if Mr. Smith is keeping help through vocational counselling to adapt to his physical limitation, the nurse may diagnose a need to support this behaviour. In this case, an appropriate diagnosis would be: “adaptation to role failure by seeking an alternative career.” Roy and others also have developed a typology of indicators of positive adaptation.
Goal setting
The goal of nursing intervention is to maintain and enhance adaptation, and to change ineffective behaviour to adaptive behaviour. Goal setting involves making clear statements of the desired behavioural outcomes of nursing care. These outcomes will reflect adaptation. Roy suggests that goal statements be in terms of the desired behaviour of the desired behaviour of the human system. A complete statement is as one that includes the behaviour of the human system. A complete statement is described as one that includes the behaviour desired, the change expected, and a time frame. Goals may be long term or short term relative to the situation.
In the case of Mr. smith the short term goal would read: Mr. smith will proceed with daily activities( behaviour) with no chest pain (change) after 30 minutes of rest( time frame). The long term goal statement would read: Mr.Smith will be able to resume work (behaviour) in a new field (change) in six months (time frame).
Nursing interventions are planned with the purpose of altering stimuli or strengthening adaptive process. The nurse plans specific activities to alter the selected stimuli appropriately. Nursing activities manage stimuli by “altering, increasing, decreasing, removing or maintaining them” as most appropriate to the situation. By using these strategies, the nurse adjusts stimuli so that the total stimuli fall within that person’s ability to cope. The coping processes of the person are the usual means of adaptation for the human adaptive system. It is when the coping processes are unable to respond effectively that the integrity of the person is compromised.
Consider Mr. Smith, previously discussed, who has chest pain. The nurse might identify a need for information related to heart disease, a need for low fat diet information, a need for cooking classes as well as for programme of cardiac
rehabilitation exercise to increase cardiac strength and endurance. These plans of care alter the contextual stimuli and assist the patient in reaching the long term goal of resuming productive work.
Evaluation occurs to establish the effectiveness of the actions taken. The nurse and the involved individuals look collaboratively at the behaviours to see if the behavioural goals have been reached. Goal behaviours are compared to the client’s output responses and movement toward or away from goal achievement is determined. If the goals have not been achieved, the nursing process begins again with additional questions relating to the accuracy and completeness of the assessment data, the match between identified goals and the client systems wishes, and the ways in which interventions were carried out. Readjustments to goals and interventions are made on the basis of evaluation data.


Individual situation
In a recovery room, the RAM can be applied to nursing assessment and interventions in various clinical situations. In the following case study, the Roy model is applied to a person during the period of immediate recovery from surgery and anaesthesia.
Assessment of behaviour focuses on the physiologic mode responses during the first hour of recovery time after a person experiences surgery and general anaesthesia. By applying the RAM, significant behaviours can be conceptualised as regulator output responses. Increased sympathetic or parasympathetic system activity can signal regulator system activity. Regulator output responses that vary from baseline values determined for the person’s presurgery measures of heart rate, blood pressure, and respiratory rate. Immediately up on observation of changes from the baseline, assessment of stimuli is done. Goals are set with the basic survival of the person as a priority. Interventions are taken so that focal and contextual stimuli are altered and adaptation is promoted. The evaluation of goal achievement is made, and further actions are taken as necessary.
Mrs. Reed is received from surgery after a major abdominal operation. Before surgery, her baseline vital signs were; HR-80bts/mt, BP-120/80mm Hg, RR-16/mt. After 45 minutes in recovery, her vital signs are: HR-150bts/mt, BP-90/60 mmof Hg, RR-32/mt.Increased regulator output response is signalled by sympathetic nervous system stimulation of the heart in response to decreased blood pressure. The nurse decides that Mrs. Reed is showing an ineffective response. Therefore, assessment of stimuli is done. The focal stimulus is a decrease in arterial blood pressure secondary to an unknown underlying cause. The contextual stimuli are: age 45 yrs, cool extremities, poor nail blanching, no food or drink for 12 hrs, and intra venous infusion of dextrose 5% in water with lactated ringers solution at 100 cc /hr. also, contextual stimuli include 200 cc of IV fluids infused during surgery, 10 cc of urine excreted during the first 45 mts in recovery, 1.5 hrs of general anaesthesia, estimated blood loss of 500cc during surgery, no operative site bleeding, and level of consciousness slow to respond to tactile stimuli after 45 mts in recovery. The residual stimuli include history of renal infections.
The nursing diagnosis of a decreased arterial blood pressure secondary to fluid volume deficit is made. A fluid volume loss is suggested both by the contextual data and both by the changes in the baseline heart rate, blood pressure, and urine output. The nurse then intervenes by altering contextual stimuli so that an adaptive response is promoted. The goal of a circulatory volume adequate to maintain a blood pressure of +/- 20 mm hg of baseline levels within 15 minutes is set. The nurse plans and then takes the following interventions steps. The IV rate is increased to 300cc per hr. the foot of the bed is elevated to increase venous return. 40% oxygen is given by mask. Mrs. Reed is verbally and tactilely stimulated and told to take slow deep breaths. The nurse prepares vasopressor medications for immediate use and applies an external continues blood pressure cuff for constant blood pressure monitoring. The nurse also consults with other team members as to Mrs. Reed’s clinical presentation.
A constant evaluation of the effectiveness of the nursing actions is made. The nurse holds Mrs. Reed in recovery until the goal of adequate circulation volume is met. Evaluation criteria include urine output greater than 30cc per hour, mental alertness, rapid nail bed blanching, blood pressure plus or minus 20 beats per minutes of baseline, and respirations =/- 5 / mts of presurgery levels.
Group situation
A school nurse surveys the members of the tenth grade in her school about personal substance use and finds that 30% of the teens are smoking more than 2 cigarettes per day. The students states that the smoking is cool, gives them a buzz, is a way to ‘break away from control by parents’, and that the health risk is ‘almost none’. Stimuli are assessed as; lack of adaptive coping by students to control developmental anxieties, lack of involvement by parent’s teen communication, and lack of knowledge related to the health risk of self-worth and esteem, ineffective use of substance to developmental anxieties, ineffective use of substance in separation issues with the family, and inadequate knowledge of health risks of smoking. The nurse sets the following goals; within three months, the students will state the myths related to the image of smoking created by advertising. Within four months, the tenth grade students will state the health risk of cigarette smoking. Within six months, the rate of cigarette used by tenth graders will decrease by 50% . Within one year, students will identify positive coping strategies to deal with developmental anxieties, and parents will increase involvement in teen activities. The nurse will create a core group of concerned teens, parents and teachers to plan strategies. The team decides to alter stimuli related to lack of positive role modelling in advertising that presents smoking as cool. Plans include use of posters that show a different image of the smoker, and talks by non-smoking college nursing students about setting life goals and building self esteem without use of substance. The group members secure resources including funding, space, and scheduling assistance. The team that the nurse has assembled develops many other strategies. One year later, smoking has decreased to 17% of the teens.


The RAM offers a variety of strengths for all areas of nursing. First, is the focus on, the whole person or group? The four modes provide an opportunity for consideration of multiple aspects of the human adaptive system and support gaining an understanding of the whole system. The importance of the spiritual aspects of the human adaptive system, often omitted from nursing assessment, is included in a manner that allows for incorporation of spiritually without imposition of the nurses beliefs. It is evident from the amount of research using the RAM reported in the literature and through the formation of BBARNS, that research is supported. Due to this research connection, the RAM is evolving rather than static. It is logically organised and draws on the nurses observational and interviewing skills.
Weaknesses have been identified in related to research and to practice. One is the need for consistent definitions of the concepts and terms within the RAM, as well as for more research based on such consistent definitions. Also, in a practice area that is increasingly challenged with time constraints, the amount of time required to fully implement the two areas of RAM assessment may be viewed as insurmountable. This is particularly true/ as one begins to use the RAM; a nurse more experienced in the use of the RAM may find the time constraints less compelling.
The Roy adaptation model identifies the essential concepts relevant to nursing as the human adaptive system is viewed as constantly interacting with internal and external environmental stimuli. The human adaptive system is active and reactive to these stimuli. Stimuli are defined as focal, contextual and residual. The internal coping processes of regulator and cognator for the individual and stabilizer and innovation for collective human adaptive systems are phenomena of concern to nursing. Support of coping processes may be the focus of nursing intervention. The four adaptive modes may be the first aspect of the model that the student or nurse is able to assimilate.


Research is a scientific process. It is called as scientific because the research are variable. It is a systematic search for answers to questions about facts and relationship between facts. The systematic method has an order and follows an acceptable procedure for conducting research in every field and more so in the field of nursing is demand of the day.
Definition of Research
1. “The development of knowledge about health and the promotion of health over the full size span, care of persons with health problems and disabilities and nursing research enhance the ability of individuals to response effectively to actual or potential health problems.”
- American Nurses Association, 1982
2. “Nursing research is concerned with systematic study and assessment of NSG problems or phenomena finding ways to improve NSG practice and patient cares through creative studies, initiating and evaluating change and taking actions to make new knowledge useful in nursing.”
- Vreciand
3. “Scientific Process that validates and refers existing knowledge and generate new knowledge that directly and indirectly influence nursing practice.”
4. “Nursing research in a process in which the researcher scientifically collects data to be used in the clinical administrative or instructional area in order to find solution to nursing problems, evaluates nursing practices, procedures, policies or curriculum assess the needs of patients, students or staff.
- Polet, A. Hungler.
5. “A systematic study of problems in patient care”.
- Diers
6. “A systematic detailed attempt to dissolver or confirm touch facts that relate to a specific problem to improve the practice and profession of nursing.”
7. “A systematic search for knowledge about issues of importance to nursing.”
- Polit and Hungler.
8. “A study of the problem in practice relating to the effect of nursing.”
- - Henderson.
9. “Nursing Research in the terms used to describe the evidence used to support nursing practice.”
Characteristics of research.:
- Research is always directed towards the assignment of a problem.
- Research is always based on empirical and observational evidence.
- Research involves precise observation and accurate description.
- Research emphasize to the development of theories and principles and generalization.
- Research is characterized by systematic, objectives and logical procedure.
- Research it marked by patients, courage and unhurried activities.
- Research requires that the researcher has full experience of the problem being studied.
- Research is replicable
- Research uses systematic method of problem solving.
- In research the factors which are not under study are controlled.
- Research requires full skill of writing report
The purpose of nursing research.
Nursing research in the systematic inquiry in the phenomena of interest in nursing science, namely the adaptation of individuals and groups to actual or potential health problems, the environment that influence health in humans and the theoretic interventions that affect the consequents of illness and promote health.

1. Identification:
Qualitative research of ten conducts a study to examine phenomena about which little is known. In some cases so little is known that the phenomena has yet to be clearly identified or named or has been inadequately defined or conceptualized. The in depth probing nature or qualitative research is well shifted to the task of answering such questions as “what is this phenomena? And what is its name”.
In quantitative research by contrast the researcher begins with phenomenon that has been previously studied or defined sometimes in a qualitative study. Thus in quantitative research, identification typically precedes the inquiry.
2. Description: the main objective of many nursing research studies is the description and elucidation of phenomena relating to the nursing profession. The researcher who conducts a description investigation observes, counts, describe and classifies when Phenomena that nurse researchers have been interested in describing are varied they include topics such as stress and copping in patients, pain management adaptation processes, health beliefs, rehabilitations success and time patterns of temperature reading.
3. Exploration: Exploratory research begins with some phenomenon of interest; but rather than simply observing and describing the phenomenon, exploratory research is aimed at investigating the full nature of the phenomenon, the manner in which it is manifested and the other factors with which it is related. For e.g. a descriptive quantities study of patients preoperative stress might seek to document the degree of stress patients experience before surgery and the percentage of patients who actually experience it. An exploratory study might ask the following. what factors are related to a patients stress level? Is a patient’s stress related to behavior of the nursing staff? Does a patients behavior of change in relation to the level of stress experienced.
4. Explanation :
The goals of explanatory research are to understand the underpinnings of specific natural phenomena and to explain systematic relationship among phenomena. Explanatory research is often linked to theories which represent a method of deriving, organizing and integrating ideas about the manner in which phenomena are interrelated where as descriptive research provides new information and exploratory research promising in sign explanatory research attempts to offer understanding of the underlying causes or full nature of a phenomenon.
5. Prediction and Control:
Without current level of knowledge technology and theoretical progress there are numerous problem that defy absolute comprehension and explanation yet it is frequently possible to make predications and control phenomena’s based on finding from research user in the observe of complete understanding.
Through prediction one can estimate the probability of a specific outcome in a given situation, with predictive knowledge nurses could anticipate the effect that nursing interventions would have a patient and families.
If one can predict the out come of a situation the next step is to control or manipulate the situation to produce the described outcome.
Scope of research
- It promotes scientific and legal thinking
- Operational it is involved in solving operational problems e.g.
Industries, factor
- It is also used as an aim to economic policy and gained its importance in government and has gained its importance in government and business
- It facilitates the decision of policy making
- It studies the economic and social structure of nation and gives a detailed account of the change taking place in society
- It helps in predicting future development
- It studies the motivation underlying the consumer behavior
- It helps social scientists in studying social relationship and seeking answers for various social problems
- It helps in the attainment of high position in social structure
- It helps in development of new ideas and insight and for analysis, for generation of new advancement of a profession
- It is a measure or means of attaing live hood for professionals
Types of Research Studies:
1. Fundamental or Basic Research: Fundamental research here means research of a scientific nature which has practically no connection. It is absolutely remote in nature as for as social science research is concerned. Fundamental or basic research is primarily intended to find out certain basic principles viz; John Robinson’s imperfect competition theory in economics, Maslow’s, Hierarchy of needs theory in motivation.
2. Applied Research: Applied research already stated in the application of aavailable scientific methods in social science research which helps to contradict alter or modify any existing theory or theories and help to formulate policy, applied research, they more concerned with actual life. It also suggests remedial measure to alleviate social problem. E.g. of applied research may be
a) John Horseman’s Descriptions without punishment theory.
b) Clayton Alderfer’s: existence relatedness and growth theory which contraindicated Maslow’s hierarchy of needs theory.
3. Descriptive research: Descriptive research is usually a fact finding approach generalizing across – section study of the present situation for e.g. a study on problems of industrial relation in India with an inter – displinary approach it is classified under conclusive research.
4. Historical Research: Resistor is the research is the research on past social forces which have shaped the present for e.g. To study the present state of Indian labor we may research on the part historical forces.
5. Formulations or exploratory research: Formulation or exploratory research helps us investigate any problem with suitable hypothesis. This research on social science in particularly important for clarification of any concept and throwing new light for further research an principle of developing hypothesis and its testing with statistical tools.
6. Ex post facto Research: Ex post facto research is an empirical enquiry for situation that have already occurred for e.g., market failure for any company’s product if studied or researched later may be categorized as export facto research. Apart from this declaration or slow rate of growth in national income when studied to formulate the future polices on this account is classified an ex-port facto research
7. Experimental research; Although experimental research in primarily possible in areas of physical science with the help of hypothesis, may also be carried out in social science if such research enable us to quantity the findings to apply the statistical and mathematical tools and to measure the results thus qualified. It is also classified under conclusive research.
8. Case study approach: Study approach to social science research is particularly initiated at the micro level e.g. study of a particular industrial unit or units study some banking limits etc, may be categorized as a case – study. This type of study is intensive in nature and data complication requires exhaustive study of the units with at most sincerity.
Other Classification:
I. Type of Quantitative Research.
1. Descriptive Research
2. Correlation Research
3. Quasi – experiment Research.
4. Experimental Research.
II. Types of Qualitative Research
1. Phenomenological Research
2. Grounded Theory Research
3. Ethnographical Research
4. Historical Research.

III. Outcome Research:
Types of Quantities Research:
Descriptive Research

Descriptive Research is the exploration and description of Phenomena in real life situation it provides an accurate amount of characteristics of Particular individual’s situation or groups, through descriptive studies, researcher discover new meaning describe what exists, determines the frequency with which something occurs and categorize. The outcome of descriptive research includes the description of concepts, identification of relationships and development of hypothesis that provide a basis for future quantities research.
Correlation Research:
Correlation, research involves the systematic investigation of relationship between or among variables. To do this the researcher measures the selected variables. To do this, the researcher measures the selected variable in a sample and then use correlation statistics to determine the relationships among the variable using correlation analysis, the researcher is able to determine the degree or strength and type (positive or negative) of a relationship between two variables. The strength of a relationship varies ranging from – 1 (perfect -ve correlation) to +ve (perfect +ve correlation) with “O” indication no relationships.
Quasi – Experimental Research:
The purpose of quasi experimental research is to examine casual relationship or to determine the affect of one variable an another. It involves implementing a treatment and examining the effect of this treatment using selected methods of measure quasi experimental studies differ from experimental studies by the level of control achieved by researchers.
Experimental Research:
Experimental research is and objective systematic highly controlled investigation for the purpose of predicting and controlling phenomena in nursing practice. In an experimental study, causality between the independent and the dependent variables is examine under highly controlled conditions experimental research is considered the most powerful quantitative method because of the rigorous control of variables. The three main characteristics of experimental studies are
1. Controlled manipulation of at least one treatment variable (Independent variable).
2. Exposure of some of the subjects to the treatment (experimental group) and no exposure of the remaining subjects control group and
3. Random assignment of subjects to either the control or experimental group in an experimental studies in strengthened by random selection of subjects and the conduct of the study in a lab or research facility.
Qualitative Research:
1. Phenomenological Research:
Phenomenology is both a philosophy and a research method. The philosophical position taken by phenomenological researchers are very different from the positions that are common in nursing culture and research tradition.
2. Grounded theory Research:
Grounded theory research is an inductive technique that emerged from the discipline of sociology, the term grounded means that the theory that developed from the research has its soon in the data from which it was derived.
3) Ethnographic Research:
Ethnographic research was developed by anthropologist as a mechanism for studying culture. The world ethnography means “portrait of people” many nurses involved in this type of research obtained their doctoral preparation in anthropology and have used anthropological technique to examine cultural issues of interest in nursing.
4) Historical Research:
Historical research examines events of the part many histories believes that the greatest values of historical knowledge is increased self – understanding in addition historical acknowledge provides nurses with an increased understanding of their profession.
Research is a scientific process, it is systematic method has an order and follows an acceptable procedure for conducting research in every field and more so in the field of nursing is demand of the day.
Nursing Research is a systematic study of the problems of patient care.
The Research purpose in nursing can be further described in several ways in such as identification.
Description, exploration, explanation, prediction and control.
The main characteristics of Research is always directed towards the solution of a problem and based on empirical and observational evidence.

Introducing to Nursing Research is concerned with types with a systematic study of problems related problem. Research is always directed towards the observational evidence. In NSG Research it maintains identified and define the elements composing the problem and inters relationship among elements. Analysis and interpretation and Synthesis of the collected facts along with previously known fact and theories are judged to be relevant to the problems observation and evaluation of the out comes of action are followed as warranted by modification of course of action.


1. B.T., Basavantappa, Nursing Research – Jaypee Medical Publication, 1995 Page No. 4-24.
2. Nancy Burns, Understanding Nursing Research, Founders 2007 Page No. 18-20.
3. Dipak Kumar Bhattacharyya, Research Methodology, Excel Books 2nd Edt, 2006 page 27-30.
4. Kols L. Lokesh “Methodology of Educational Research” 3rd edn 1996, Vikas Publishing house Pvt. Ltd., Pg 08-101.
5. Benise, F. Plit, Charyl Tatano Beck “Nursing Research, Principles and methods, 7th edn. Tippinwts. Publisher Pg 8-20.
6. T.K, Indrane “Research Methodology for Nurses” 2005, Jaypee brother Publishers Page No. 1-4.
7. R.T. Bhaskara Rao “Research Methdology” 2nd edn. 2005 Parals Medical Publciation Pg NO. 8-6.

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