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318 UNIT III Nursing Conceptual Models

empowerment; empowerment with one’s feelings, caregiving and for the Roy Adaptation Model
teachers, family, and classmates; and how to learn to (Ducharme, Ricard, Duquette, et al., 1998; Levesque,
relax. Children in the control group received no inter- Ricard, Ducharme, et al., 1998).
vention. Using analysis of covariance, children in the Tsai, Tak, Moore, and Palencia (2003) derived a
treatment group reported significantly higher per- middle-range theory of pain from the Roy Adaptation
ceived social acceptance, perceived athletic compe- Model. In the theory of chronic pain, chronic pain is
tence, perceived physical appearance, and perceived the focal stimulus, disability and social support are
global self-worth. contextual stimuli, and age and gender are residual
Jirovec, Jenkins, Isenberg, and Baiardi (1999) have stimuli. Perceived daily stress is a coping process.
proposed a middle-range urine control theory Depression is an outcome variable manifested in
derived from the Roy Adaptation Model, intended all four adaptive modes. Path analysis provided par-
to explicate the phenomenon of urine control and tial support for the theory of chronic pain. Greater
to decrease urinary incontinence. According to the chronic pain and disability were associated with more
theory of urine control, the focal stimulus for urine daily stress, and greater social support was associated
control is bladder distention. Contextual stimuli with less daily stress. These three variables accounted
include accessible facilities and mobility skills. A re- for 35% of the variance in daily stress. Greater daily
sidual stimulus is the intense socialization about blad- stress explained 35% of the variance in depression.
der and sanitary habits that begin in childhood. This Other middle-range theories derived from the Roy
theory takes into account physiological coping mech- Adaptation Model have been proposed, but research
anisms, regulator (spinal reflex mediated by S2 to reports testing these theories were not found at the
S4, and coordinated detrusor muscle contraction time of this literature review. Tsai (2003) has pro-
and sphincter relaxation) and cognator (perception, posed a middle-range theory of caregiver stress.
learning judgment, and awareness of urgency or drib- Whittemore and Roy (2002) developed a middle-
bling). Adaptive responses to prevent urinary incon- range theory of adapting to diabetes mellitus using
tinence are described for the four adaptive modes. theory synthesis. Based on an analysis of Pollock’s
Effective adaptation is defined as continence, and (1993) middle-range theory of chronic illness and a
ineffective adaptation is defined as incontinence. The thorough review of the literature, reconceptualization
authors provide limited support for the theory of of the chronic illness model and the addition of con-
urine control through case studies. The theory of cepts such as self-management, integration, and
urine control illuminates the complexity, multidi- health-within-illness more specifically extend the Roy
mensionality, and holistic nature of adaptation. Adaptation Model to adapting to diabetes mellitus.
Researchers at the University of Montreal have Pollock’s (1993) research on adaptation to chronic ill-
proposed a middle-range theory of adaptation to ness theory included patients with insulin-dependent
caregiving that is based on the Roy Adaptation Model. diabetes, multiple sclerosis, hypertension, and rheu-
This middle-range theory has been tested in a num- matoid arthritis.
ber of published studies of informal caregivers of
demented relatives at home, informal caregivers of
psychiatrically ill relatives at home, professional care- Further Development
givers of elderly institutionalized patients, and aged The Roy Adaptation Model is an approach to nursing
spouses in the community. Perceived stress is concep- that has made and continues to make a significant
tualized as the focal stimulus. Contextual stimuli contribution to the body of nursing knowledge; how-
include gender, conflicts, and social support. Coping ever, areas remain for future development as health
mechanisms include active, passive, and avoidant care progresses. A thoroughly defined typology of
coping strategies. In this middle-range theory, the nursing diagnoses and an organization of categories
adaptive (nonadaptive) response (psychological dis- of interventions would facilitate its use in nursing
tress) is manifested in the self-concept mode. LISREL practice. Scientists who do research from the perspec-
analyses have provided support for many of the prop- tive of the Roy Adaptation Model continue to note
ositions of this middle-range theory of adaptation to overlap in the psychosocial categories of self-concept,