Keville Frederickson

Niveles de bienestar espiritual y fortaleza relacionados con la salud en adultos mayores

This study investigated the relationship between the levels of Spiritual Well-being and the levels of Health Related Hardiness in Mexican population of abuts 65 years and older. The framework was based on the Roy adaptation model, Pollocks, Health Related Hardiness and Spiritual Well-being of Reed. The design was descriptive co relational, the sampling was probabilistic random. The sample (n=160) had a level of significance of 0.05 for a mean difference of medium 1.6, a size effect and a potency of 80. The instruments were the Health Related Hardiness Scale, with an Alpha of 0.801 and the Spiritual Well Being with an Alpha of 0.973. Multiple Linear Regression was used to investigate the effect of the demographic variables on the Spiritual Well-being. The mean age of the subjects was of 73.9 (DE=4.3) 62.5% were females. The Correlation Coefficient between Spiritual Well-being and Health Related Hardiness was r. 684 p

Instruments Used in Roy Adaptation Model-Based Research: Review, Critique, and Future Directions

The purpose of this secondary analysis is to identify and critique the instruments most frequently used to measure concepts of the Roy adaptation model. Of the 123 instruments used in 231 studies over 30 years, 20 instruments met the criteria for secondary analysis. Based on established criteria, 14 were judged to have high usefulness, three have moderate usefulness, one has limited usefulness, and two are not recommended for use with the model. Recommendations include locating and developing instruments in key content areas including adaptation in groups, and particularly developing measurement strategies consistent with the philosophical assumptions of the model and multiple ways of knowing.

Cross-Cultural Analysis for Conceptual Understanding: English and Spanish Perspectives:

Culture and primary language provides the context for understanding between the patient and the nurse and therefore is part of the foundation for nursing care. Knowledge development in nursing is predicated on mutual understanding and interpretation of language. Concept development has been identified as one of the approaches to the development of nursing knowledge. Since the process of concept analysis is based on understanding a phenomenon through language and experiences, this process is culture-bound and language-specific. The purpose of this column is to discuss the value of interviews with people from two different cultures resulting in an attempt to develop nursing knowledge with international relevance. An example of an analysis of a concept, worry, is provided, and the effects of culture and language on this nursing concept are discussed. The analysis was the result of collaboration among nurses from Mexico and the United States of America.

Living with Multiple Sclerosis: A Roy Adaptation Model-Based Study:

This Roy adaptation model-based study examined how people make sense of the experience of living with multiple sclerosis. Eighteen persons diagnosed with multiple sclerosis participated in three interviews over a period of 1 year. Content analysis of the interview transcripts and the researcher’s logs and analytic memos yielded five recurring themes that reflect the Roy model adaptive modes: we’re not completely the same (physiological mode), how I view my future (self-concept mode), let me tell you about my feelings (self-concept mode), how I see work (role function mode), and let me tell you about my life (interdependence mode).

The Roy Adaptation Model and Research Global Perspective

Roy (2009) highlighted that, as members of a profession, nurses use specialized knowledge to contribute to the needs of society for health and well-being. The Roy adaptation model provides one approach to specialized knowledge. During the 1980s Roy enhanced the philosophical and scientific understanding of the concept of person in her writings and added groups as totalities made of parts that behave purposefully. The definition of person according to the Roy adaptation model includes people as individuals or as groups such as families, organizations, communities, and society as a whole. Roy (2009) defined environment as all conditions, circumstances, and influences that surround and affect the development and behavior of people as adaptive systems with particular consideration of human and earth resources. This definition implies focal, contextual, and residual stimuli. Although the model originated in the United States, scholars who now use the Roy adaptation model come from the global community. Some areas of significant impact include Eastern countries and Latin America. The Roy Adaptation Association of Japan (RAA-J) became the first international chapter of the Roy Adaptation Association in June 2006. The following year, Columbia followed with the RAA-C beginning in June 2007. Mexico added an RAA-M chapter in 2009. These groups serve as focal points for on-going international research and innovative practice applications in these countries. The collaboration in Japan was established over 25 years ago through Roy’s association with St. Mary’s College in Fukuoka, Japan, with many exchange visits of faculty, administrators, and students. An early focus was on curriculum implementation, first undergraduate then graduate programs. In addition, attention was on the embodiment of the RAA philosophical and spiritual philosophy into this Catholic institution established and administered by several generations of the Ide family. With the founding of RAA-J in 2006 and the linking of Seibo, St. Mary’s, and Tenshi Colleges, research became a greater focus. The impetus for this chapter began when Sumiko Tsuhako, one of the founders of RAA-J, spent time as a senior Fulbright Scholar at Boston College. She continues her research on children coping with pain. At the RAA conference in Boston in 2008, Tsuhako and Megumi Toriya presented their research on the relationship between coping strategies and impaired ADL in elderly stroke patients as the first report of Roy’s (2007) Coping and Adaptation Processing Scale (CAPS) Japanese version. Members of the RAA-J have attended and presented at the last two RAA annual conferences. Other RAA Executive Board Members Keville Frederickson and Carolyn Padovano also have visited RAA-J to bring new developments in research and theory. Padovano served as a consultant to the project of Japanese scholars developing an electronic health record for patients who need dialysis, maternity care, psychiatric care, and rehabilitation care. Years of data collection using the Roy adaptation model provided the basis for collaborating with vendors to ensure accurate documentation of nursing diagnoses, appropriate patient adaptation goals with related behaviors, stimuli, and interventions (Hidaka, Miyabayashi, Tsuhako, Ide, & Kanayama, 2007). Roy will return to Japan in 2009 to continue research and theory development with members of RAA-J. The work of international scholars in Columbia is wide-ranging and has included on-going collaborative exchanges with the RAA in the United States. At the RAA meeting in Los Angeles in 2006, Maria Elisa Moreno Fergusson presented a scholarly review of published applications of the Roy adaptation model in Latin America from 1996 and 2006. Contributions were found in the following categories: instrument design and validation, The Roy Adaptation Model and Research

Nursing Knowledge Development through Research: Using the Roy Adaptation Model

Almost half of the ancillary propositions tested in the metaparadigm category were related to the concept of person, and 94% were supported. Theoretically and empirically, there is support for Roys conceptualization of the person as an adaptive system. Almost 25% of the ancillary propositions tested were related to the concept of health, of which the great majority were supported. Theoretically and empirically, there is support for Roys conceptualization of health as an outcome of adaptation. Approximately 75% of the ancillary propositions tested were related to the concept of person or health. Of these, only 5 out of 55 ancillary propositions were not supported, or less than 10%. Less than 13% of the ancillary propositions that were tested focused on the metaparadigm concepts of environment or nursing. Of these, 15% were not supported. These findings are not surprising, because conceptual clarity is the foundation of practice theory. The hierarchy of research, according to the classic work by Dickoff and James (1968), progresses from understanding and describing phenomena to situation-producing theory. Nursing models are relatively young. Research is required to validate the concepts within the models. Situation-producing theory, based on the concepts, guides nursing actions and is necessary for a practice discipline to maintain its status as a profession. Based on the findings of the integrative research review, adequate research has provided support for Roys conceptualization of the metaparadigm concepts of person and health. Future research needs to be directed toward testing propositions derived from the RAM concepts of environment and nursing. Intervention studies need to be designed based on concepts that have been supported. Knowledge development through research and testing of propositions based on the RAM continues to contribute to nursing science. Future directions for RAM research are clear.

Evaluation of Healthy Living Wellness Program With Minority Underserved Economically Disadvantaged Older Adults.

The purpose of this Roy adaptation model-guided study was to test the effectiveness of a student registered nurse intern-led nursing intervention entitled the Healthy Living Wellness Program. A one-group pretest/posttest preexperimental design was used. The intervention was imparted to minority, underserved, economically disadvantaged older adults (N = 30). Significant findings pre- and postintervention were reported for body mass index, waist circumference, self-reported blood glucose, and weight. The findings supported the effectiveness of the nursing intervention, the Healthy Living Wellness Program, guided by the Roy adaptation model.

The Glass Menagerie as Heuristic for Explicating Nursing Theory

Tennessee Williams’ play, The Glass Menagerie, is interpreted through the lens of two different nursing theories, the Roy adaptation model and the human becoming theory. In the Roy adaptation model interpretation, adaptive levels of reality testing and stimuli that instigate withdrawal are explored, while in the human becoming theory interpretation, the themes of meaning, rhythmicity, and contranscendence are explicated.

Callista Roy’s Adaptation Model

The work of Sr. Callista Roy covers over 40 years. From the early development of the model through the application of the model to nursing education, practice, and research, Roy and the adaptation model have touched the lives of many, personally, professionally, intellectually, and spiritually (Roy, 2009). As part of the Roy Adaptation Association core and one of the founding members, it is an honor to present the articles in this issue of Nursing Science Quarterly and 419215 NSQ24410.1177/0894318411419215Frederi ckson / Guest EditorialNursing Science Quarterly

Response to Fawcett's Critiquing Contemporary Nursing Knowledge: A Dialogue

In response to Fawcett’s invitation to dialogue, I would like to consider extensions of her thinking rather than differences in perspective. Having used Fawcett’s books to teach theory, research, and theory development as well as nursing conceptual models for many years, my views tend to be consistent with hers. Therefore, this response addresses her statement that “the extension of that schema may be the most important work in which we can engage.” Fawcett responded to my question regarding the relationship between Carper’s (1978) four ways of knowing (for the purpose of this discussion, I will use Carper’s original work that resulted in four ways of knowing: empirical, ethical, personal, and aesthetic) and nursing conceptual models as middle-range theories that can provide a range of outcomes needed for nursing practice. She also referred me to two writings about viewing ways of knowing as types of theories (Fawcett, Watson, Neuman, Hinton-Walker, & Fitzpatrick, 2001) and as a schema for the linkage of conceptual models of nursing and the ways of knowing (Fawcett, 2002). I agree with the idea put forth in these writings that the four ways of knowing need to be integrated into our thinking as an approach that ensures the provision of professional nursing practice that is scientific, holistic, and humanistic. It is this integration that can provide a framework that acknowledges the complexity of the people. Fawcett (2002) identifies the ways of knowing as theories. I agree that holistic and humanistic practice would be the result of integrating specific concepts from a conceptual model with the ways of knowing theories. However, I would propose that if we subscribe to this integration representing the wholeness of the person, then this integration would be the ontology for nursing. To suggest that specific nursing models may reflect a particular way of knowing diminishes the acknowledgment that people are holistic, which is, in part, the unique perspective of nursing. An integrated approach may have the potential for bringing together the totality and simultaneity paradigms. In a clinical nursing situation (wherever there are people), I have subscribed to the totality paradigm and the Roy adaptation model (RAM) (Roy 1997a, 1997b) as a way to attend to the full range of people’s needs. These needs often include a physical aspect. My contention has been, based on my experience, that the simultaneity paradigm does not provide me with the tools and perspective to address the physical aspects. On the other hand, the philosophical assumptions and perspective of holism that the simultaneity paradigm offers are invaluable for nursing practice. In working with the RAM for more than twenty-five years, there has been a shift in Roy’s (1997a, 1997b) thinking toward the simultaneity paradigm, reflected in her revision of the RAM philosophical assumptions. Both paradigms are important for nursing and the development of nursing knowledge. It is premature to suggest that nursing is ready for a single integrated paradigm. I leave that for our progeny. For now, I propose that propositions may be derived from each of the nursing conceptual models that represent each pattern of knowing. If we believe that a conceptual model provides a framework for nursing, it should be able to provide propositions and outcomes that reflect each of the patterns of knowing. For example, a proposition derived from the selfconcept mode of the RAM utilizing aesthetics might state: Artistic expressions through music or art are expressions of the person’s state and are related to levels of self-consistency. A proposition derived from the RAM role function mode related to personal knowing might be: Breadth and depth of role variety in reminiscence is related to role integration. The inclusion of patterns of knowing in conceptual models has the potential for extending our perspective of nursing and the provision of direct care. I am delighted to have been invited to participate in this dialogue. The primary caveat is that current nursing practice conditions are in a climate of severe nursing shortages and a financial health care crisis. We need to translate the ideas of integrating ways of knowing so that society recognizes the value of nursing in outcomes other than the awareness that as the numbers of nurses at the bedside decrease the chances of dying increase.