need help with a care plan

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My instructor assigned me a specific care plan. She said my nursing diagnosis is going to be "affectional adequacy." It's an interdependence care plan from the Roy model. This dx is not in my NANDA book so I'm struggling with it. I've never tried to create a care plan without my NANDA book. I have another book: "The Roy Adaptation Model" 3rd ed. but i don't find it very helpful, probably because i've never tried to create a care plan with it... all i got from it was a definition of affectional adequacy. can anyone here offer some guidance, tips, resources to help me create this care plan? i don't even know where to start. My pt information is as follows:

2 year old male admitted for a fever. hx of surgeries & hospitalizations due to congenital defect

Behaviors include:

mom and dad stayed with child during entire hospitalization (O, A)

mom sat on bed with child, played with toy trucks together (O, A)

during ultrasound, dad states, "it's be okay. it'll be over soon. I'm right here, buddy" (O,A)

during ultrasound, mom held child's hand (O, A)

after educating parents about offering more fluids to child, mom asked, "could you please bring us some milk cartons?" (O,A)

aunt and brothers visited (O, A)

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Your instructor is mistaken about this being a nursing diagnoses, is the charitable characterization, or perhaps you misunderstood her intent. It isn't. If you're bold, or perhaps can be convincingly disingenuous, show her the NANDA-I and ask her to show you where her diagnosis is an approved nursing diagnosis because you're having a hard time identifying it in there.

It may be that she wants you to describe what you learned about affectional adequacy and how to assess for it, which is a fine goal in itself. In that case, look in NANDA-I for actual nursing diagnoses that would relate to whether or not there were evidence of good parenting, role function, coping, attachment, etc., and take it from there.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

This is where the schools really MAKE ME ANGRY.....they might have a masters degree however...that does not necessarily qualify them to teach.....Grrrrrrrrrrr

All I can think of is....

NANDA-IDefinition: A pattern of expectations and desires for mobilizing energy on one’s own behalf that is sufficient for well-being and can be strengthened

Defining Characteristics

Expresses desire to enhance ability to set achievable goals; expresses desire to enhance belief in possibilities; expresses desire to enhance congruency of expectations with desires; expresses desire to enhance hope; expresses desire to enhance interconnectedness with others; expresses desire to enhance problem solving to meet goals; expresses desire to enhance sense of meaning to life; expresses desire to enhance spirituality

readiness for advanced hope related to affectional adequacy aeb....what behaviors?

or something like that....GrnTea any ideas????

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I was thinking along the lines of risk for impaired attachment, dysfunctional family processes, interrupted family processes, caregiver role strain, risk for impaired parenting, that sort of thing to look out for. However, the OPs process recording doesn't give me any clues that these are occurring, so I'm thinking maybe explain what affectional adequacy is, say that I would assess for the defining characteristics of these approved nursing diagnoses, and then say that I didn't find any.

Oh, wait, you're not supposed to learn anything about real nursing diagnosis here.

Lessee now. Hmm. That's gonna be hard to disguise if you actually, like LEARN something. So maybe, say you'll assess for (look up the defining characteristics and paraphrase a few of them so you can pretend you didn't really learn anything from an actual authoritative resource) and take it from there.

Gawd, I hate instructors like that. Carry on and keep calm, OP, it won't always be like this.

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thank you two very much for your input

I wasted a lot of time trying to figure this out. after paging through textbooks, searching the internet, searching allnurses, and posting here, i finally contacted my instructor, and she agreed to let me change my care plan. i should have asked earlier, but i wanted to make sure i exhausted all options before asking to do something different, to avoid sounding dumb...

i dont understand the point of "Roy nursing dx" if they cannot be used :mad:

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What did she say? How did she explain this thing? Enquiring minds wanna know. Me, my curiosity is really piqued by this.

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she didn't realize that the dx wasn't in NANDA, which is why she let me change my care plan idea. the list we picked the dx from was provided by my school and contains both "NANDA and Roy approved nursing diagnoses" except that Roy nursing diagnoses aren't in NANDA, which is why i said i dont get the point of them then... except to confuse us little students further...

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So...the next one she gives you isn't in NANDA-I either, and you ask her about that ... Sounds like somebody in the faculty has to get a better grip on nursing diagnosis, because the students, as you noticed, have a hard enough time getting it right without making up their own.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
she didn't realize that the dx wasn't in NANDA, which is why she let me change my care plan idea. the list we picked the dx from was provided by my school and contains both "NANDA and Roy approved nursing diagnoses" except that Roy nursing diagnoses aren't in NANDA, which is why i said i dont get the point of them then... except to confuse us little students further...
Wow....an instructor that doesn't know what is a NANDA diagnosis......or has a resource to look them up.....crazy.....:facepalm:

Strangely enough...I found this....How Do I Start A Nursing Diagnosis Using The Roy Adaptation Model........This page has free videos, resources, manuals and more dedicated to Assumption College for Sisters and How Do I Start A Nursing Diagnosis Using The Roy Adaptation Model!

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That link gets to a page on How to START a Nursing Diagnosis, but doesn't give nursing diagnoses themselves. I think this might be a useful checklist for a new student to get started on assessment, but the assessment data collected then get used in determining what determining factors for currently-approved nursing diagnoses, i.e., the ones in NANDA-I 2012-2014, are present.

I agree with my friend Esme that your faculty person has a lot to learn. In charity, let us hope that your experience with this will teach her how to do it better next semester :) Teachers learn too.

Posted on May 22, 2013

off.jpg listen.jpg M/F By Merle Huerta

The Roy Adaptation Model is a problem-solving approach that was developed by Sister Callista Roy. It is partly based on Abraham Maslow's "Hierarchy of Needs" and "Need Satisfaction Models" and Dorothy Johnson's "Behavior System Model." Roy's model focuses on how a patient uses adaptive coping methods to protect his or her physiological, psychic and social integrity to restore "need satisfaction." In nursing, data is gathered on a patient's ability to cope and adapt. A nursing care approach is implemented and outcomes of care are evaluated. Before developing a diagnosis, nursing professionals first must assess a patient's behavior.

off.jpg listen.jpg M/F Assess physiological behavior. Based on Maslow's "Hierarchy of Needs," learn whether the patient is satisfying basic needs such as oxygenation, nutrition, elimination, activity and rest. Evaluate more complex processes such as electrolytic balance, fluid intake and neurological and endocrine functions. Investigate how the patient functions. Is he or she able to function independently? Can he or she bath alone? Does he or she shop and cook for themselves? Does he or she maintain a clean and safe living environment?

off.jpg listen.jpg M/F Assess the patient's spiritual or psychological state. Ask how he or she sees himself or herself in terms of the universe, family, community and spiritual connection. Sense if he or she feels needed and whether he or she thinks life is meaningful and with purpose. According to Roy, feeling needed is part of the "group identity integrity," when one feels a sense of ownership with others.

off.jpg listen.jpg M/F Need is "social integrity," knowing who one is in relation to others. Knowing oneself is connected to knowing where one fits in a social hierarchy, family and community. Assess how much responsibility the patient holds, how he or she balances interactions, and whether he or she shies away or embraces interaction. Note how he or she approaches goals, how he or she satisfies them, whether he or she completes them and how he or she feels if goals aren't met.

off.jpg listen.jpg M/F How interdependent is the patient on others for love, affection and value. According to Roy, there is an inherent need to achieve "relational integrity" using a process of "affectional" adequacy. A patient should demonstrate some degree of relational integrity using developmental and resource adequacy. This means that he or she learned how to obtain food, shelter, health and security through interdependence with others.

off.jpg listen.jpg M/F After assessing behavior, the nursing professional should assess stimuli that might affect behavior. This is when a tentative nursing diagnosis can be formulated.

http://assumptioncollegeforsisters.collegefinancialaidoffice.com/how-do-i-start-a-nursing-diagnosis-using-the-roy-adaptation-model/

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
That link gets to a page on How to START a Nursing Diagnosis, but doesn't give nursing diagnoses themselves. I think this might be a useful checklist for a new student to get started on assessment, but the assessment data collected then get used in determining what determining factors for currently-approved nursing diagnoses, i.e., the ones in NANDA-I 2012-2014, are present.

I agree with my friend Esme that your faculty person has a lot to learn. In charity, let us hope that your experience with this will teach her how to do it better next semester :) Teachers learn too.

Posted on May 22, 2013

off.jpg listen.jpg M/F By Merle Huerta

The Roy Adaptation Model is a problem-solving approach that was developed by Sister Callista Roy. It is partly based on Abraham Maslow's "Hierarchy of Needs" and "Need Satisfaction Models" and Dorothy Johnson's "Behavior System Model." Roy's model focuses on how a patient uses adaptive coping methods to protect his or her physiological, psychic and social integrity to restore "need satisfaction." In nursing, data is gathered on a patient's ability to cope and adapt. A nursing care approach is implemented and outcomes of care are evaluated. Before developing a diagnosis, nursing professionals first must assess a patient's behavior.

the link given leads to this page.....
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So, OP, how did this all work out?

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