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316 UNIT III Nursing Conceptual Models

Self-Consistency Scale (Zhan & Shen, 1994), Zhan negative relationships were found between self-esteem
found that cognitive adaptation plays an important and depression, state anger, trait anger, anger-in, anger-
role in helping older adults maintain self-consistency out, anger control, and anger expression. In the second
in the face of hearing loss. Self-consistency was higher study, adolescents were sampled from participants of
for hearing-impaired men than for hearing-impaired regularly scheduled group sessions as part of an outpa-
women, but it did not vary for age, educational level, tient psychiatric treatment program. Self-esteem sig-
race, marital status, or income. nificantly differed by age group, with older adolescents
Nuamah, Cooley, Fawcett, and McCorkle (1999) scoring lowest on self-esteem. Self-esteem did not dif-
studied quality of life in 515 patients with cancer. fer by gender or whether or not they smoked tobacco.
These researchers clearly established theoretical link- A significant negative relationship was observed
ages among the concepts of the Roy Adaptation between self-esteem and depression. Unlike their study
Model, middle-range theory concepts, and empirical in well adolescents, no statistically significant relation-
indicators. Focal and contextual stimuli were identi- ship was found between self-esteem and the dimen-
fied. Variables in each of the adaptive modes were sions of anger. Self-esteem was not significantly related
operationalized. Using structural equation modeling, to parental alcohol use in either group.
the researchers found that two of the environmental Modrcin-Talbott, Harrison, Groer, and Younger
stimuli (adjuvant cancer treatment and severity of the (2003) tested the effects of gentle human touch on the
disease) explained 59% of the variance in biopsycho- biobehavioral adaptation of preterm infants based on
social indicators of the latent variable health-related the Roy Adaptation Model. According to Roy, infants
quality of life. Their findings supported the proposi- are born with two adaptive modes: the physiological
tion of the Roy Adaptation Model that environmental and interdependence modes. Premature infants often
stimuli influence biopsychosocial responses. are deprived of human touch, and an environment
Samarel and colleagues (1998, 1999) used the Roy filled with machines, noxious stimuli, and invasive
Adaptation Model to study women’s perceptions of procedures surrounds them. These researchers found
adaptation to breast cancer in a sample of 70 women that gentle human touch (focal stimulus) promotes
who were participating in an experimental support physiological adaptation for premature infants. Heart
and education group. The experimental group re- rate, oxygen saturation stability, increased quiet sleep,
ceived coaching; the control group received no coach- less active sleep and drowsiness, decreased motor
ing. Using quantitative content analysis of structured activity, increased time not moving, and decreased
telephone interviews, the researchers found that 51 behavioral distress cues were identified as effective
of 70 women (72.9%) experienced a positive change responses in the physiological adaptive mode. This
toward their breast cancer over the study period, study supports Roy’s conceptualization of adaptation
which was indicative of adaptation to the breast can- in infants.
cer. The researchers report qualitative indicators of Weiss, Fawcett, and Aber (2009) used the Roy
adaptation for each of Roy’s four adaptive modes. Adaptation Model to study adaptation in postpartum
Modrcin-Talbott and colleagues studied self-esteem women following caesarean delivery. Findings showed
from the perspective of the Roy Adaptation Model fewer adaptive responses in women with unplanned
in 140 well adolescents (Modrcin-Talbott, Pullen, caesarean delivery. Cultural differences in adaptive
Ehrenberger, et al., 1998) and 77 adolescents in an responses were found among African-American and
outpatient mental health setting (Modrcin-Talbott, Hispanic women compared to Caucasian women.
Pullen, Zandstra, et al., 1998). Well adolescents were Implications for nursing practice include early assess-
grouped in terms of early (12 to 14 years), middle (15 ment of adaptive responses and learning needs for
to 16 years), or late adolescence (17 to 19 years). Well patients who have had caesarean delivery to develop
adolescents were recruited conveniently from a large, a discharge teaching plan to facilitate adaptive
southeastern church. Self-esteem in well adolescents responses postdischarge.
did not differ by age group, gender, or whether or not The University of Montreal Research Team in
they smoked tobacco. Well adolescents who exercised Nursing Science (Ducharme, Ricard, Duquette, et al.,
regularly did score higher on self-esteem. Significant 1998; Levesque, Ricard, Ducharme, et al., 1998) is