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classification of stimuli. Focal stimuli, or that which Janice expends her energy dealing with, are insomnia and a sense of a lack of control. Contextual stimuli, or all other stimuli present, includes current medications and her feelings about being on medication. Also included as contextual stimuli, is Janice's predisposition to depression which she is currently experiencing, her lack of social supports, her recent move, her expectations of her roles as a mother, wife and teacher's aide, and her guilty feelings regarding her childrens' loss of friendships. Residual stimuli, or that stimuli whose effect is not clear, would be the hunch that Janice and her husband likely have some marital difficulties. Also, one would suspect that her husband may be working excessively, repeating his father's pattern but replacing infidelity with work. Janice's father is an alcoholic and she describes her mother as 'anxious';the hunch is that Janice has some unresolved childhood issues.
The next step is the nursing diagnosis, which is made once stimuli is confirmed with Janice. The nursing diagnosis is a statement of Janice's problems and includes the probable cause. Janice's diagnosis could be stated as 'altered sleep pattern potientially related to taking Prozac at HS' and 'anxiety related to multiple stressors'. After the nursing diagnosis is made, goals are set. Goals for Janice could include 'Janice will have 6 hours of undisturbed sleep per night within 1 week of HS Prozac cessation'. Another goal could be 'Janice will report less anxiety within 2 weeks as evidenced by a reduction in her use of PRN Xanax'. Interventions would be carried out as applicable to Janice and would be specific to the nursing goals. They are directed at promotion of adaptation. The final stage of the nursing process is evaluation. Evaluation includes the observation of change in Janice's behaviour. One would determine if her goals are met or not met. One would ask Janice about changes in her sleep pattern. One would evaluate any changes in behaviour related to anxiety. If the behaviour is not adaptive, then more assessment is needed and the interventions would be adjusted. -Harjit, April 2002 |
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In applying Roy's Adaptation model to Janice's situation, the assessment begins with assessing behaviours in each of the four modes. Ineffective behaviours are noted. In Janice's situation, the ineffective behaviours within the physiological mode include frequent night-time awakening and anxiety symptoms. Ineffective behaviour within the self-concept mode includes her dependence on anxiolytics. Noted as ineffective behaviours in the role function mode are her inability to carry out her roles, as mother and teacher's aide, to her satisfaction. Ineffective behaviour is also noted in the role fuction mode manifested by Janice's emotional distance from her parents and her loss of friends related to the move. In the interdependence mode, ineffective behaviour is identified as her belief that her marriage is good because her husband 'doesn't run around'. Her feeling that she has no one to talk to is also manifested in the interdependence mode.
The next step in Roy's model involves |
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