DNP 601 Module 6 Nursing Models and Theories Written Assignment Example

A Wide Model and a Close Theory: Roy and Mishel Compared for Adults Living With Defibrillators

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

DNP 601: Theoretical Foundations for Advanced Practice Nursing

Instructor Name

Month Day, Year

A Wide Model and a Close Theory: Roy and Mishel Compared for Adults Living With Defibrillators

Introduction

Nursing models and theories differ in scope. Conceptual models offer broad perspectives on person, environment, health and nursing, while middle-range theories focus on specific phenomena. This paper compares one of each, Roy's adaptation model and the uncertainty in illness theory from Mishel, as guides for caring for adults with implantable cardioverter defibrillators (ICDs), and evaluates their contributions using established evaluation criteria (Fawcett, 2005).

The Roy Adaptation Model

In the Roy Adaptation Model, a person is an adaptive system continually responding to environmental stimuli. Focal stimuli confront the person directly, contextual stimuli contribute to the situation, and residual stimuli have uncertain effects. Coping processes, the regulator and cognator subsystems, produce responses that show up in four adaptive modes, namely physiological, self-concept, role function and interdependence. Nursing aims to promote adaptation by assessing behaviors and stimuli and managing stimuli.

Applied to an ICD recipient, the focal stimulus is the device and the possibility of shock. Contextual stimuli include heart failure symptoms, job demands and family worries. Responses appear in each mode: physiological, such as poor sleep; self-concept, such as seeing oneself as fragile; role function, such as stopping driving or work; and interdependence, such as increased reliance on a spouse.

Mishel's Uncertainty in Illness Theory

Mishel (1988) described uncertainty as a cognitive state in which illness events cannot be given clear meaning. Antecedents include the stimuli frame and structure providers, uncertainty gets appraised either as a danger or as an opportunity, and coping then leads toward adaptation. The reconceptualized theory describes how people with chronic conditions may develop a new, probabilistic view of life over time (Mishel, 1990).

Applied to an ICD recipient, uncertainty arises from unpredictable shocks and unclear meaning of symptoms. Structure providers, such as clear education and credible clinicians, can reduce uncertainty. Higher uncertainty has been linked with weaker adjustment and greater distress in the first two months at home after implant (Mauro, 2008).

Evaluation Using Fawcett's Criteria

A Case Through Both Lenses

Take, for example, a composite 44-year-old electrician who received an ICD after surviving cardiac arrest. Six weeks later he has not returned to work, sleeps poorly and avoids lifting his toddler. Through Roy's model, the focal stimulus is the device and the memory of arrest; contextual stimuli include his job's physical demands and his family's fear; and ineffective responses appear in the physiological, role function and interdependence modes. Through Mishel's theory, his uncertainty centers on whether exertion will trigger a shock and whether the device will work if needed, and he appraises that uncertainty as danger. Roy's model shows how widely the problem reaches; Mishel's theory shows where to intervene first, by providing structure about activity and shocks.

Contributions to Nursing Science

The Roy model contributes a comprehensive, nursing-specific view of adaptation that keeps assessment holistic. Its breadth makes it hard to test directly, but it has generated middle-range theories and research programs. Mishel's theory contributes a precise, testable explanation of a common experience in illness, and its reconceptualization shows how theory develops through research.

Informing Evidence-Based Practice, Research, Leadership, Decision-Making and Patient Care

Evidence-based practice: Mishel's theory points to interventions that strengthen structure providers, such as standard shock plans, and to a validated measure to evaluate them. Roy's model ensures that evaluation looks beyond uncertainty to role and interdependence outcomes.

Research: A study could test whether a structure-provider intervention reduces uncertainty and improves adaptation in all four Roy modes, combining the strengths of both.

Leadership: A clinic leader could use Roy's model to design a comprehensive intake assessment and Mishel's theory to justify an education program.

Clinical decision-making: When a patient asks "When will it fire?", Roy's model prompts the clinician to assess self-concept and role function, while Mishel's theory suggests providing structure and assessing appraisal.

Patient care: Combining both allows care that is holistic and focused, attending to the whole person while targeting the experience that most limits adaptation.

Conclusion

Used together, Roy's model and Mishel's theory are stronger than either alone. The model provides a wide frame for assessment, and the theory provides a close focus for intervention and measurement. For ICD care, this pairing helps advanced practice nurses see the whole person and act on the uncertainty that shapes their adaptation.

References

Fawcett, J. (2005). Criteria for evaluation of theory. Nursing Science Quarterly, 18(2), 131-135. https://doi.org/10.1177/0894318405274823

Mauro, A. M. P. (2008). Uncertainty as a predictor of adjustment to an implantable cardioverter defibrillator. Progress in Cardiovascular Nursing, 23(4), 151-159. https://doi.org/10.1111/j.1751-7117.2008.00008.x

Mishel, M. H. (1988). Uncertainty in illness. Image: The Journal of Nursing Scholarship, 20(4), 225-232. https://doi.org/10.1111/j.1547-5069.1988.tb00082.x

Mishel, M. H. (1990). Reconceptualization of the uncertainty in illness theory. Image: The Journal of Nursing Scholarship, 22(4), 256-262. https://doi.org/10.1111/j.1547-5069.1990.tb00225.x