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The behavioral system model for nursing. In: J. Roy Eds. New York: Appleton-Century-Crofts; ; In: M. Parker Ed. New York: National League for Nursing; ; King IM. Toward a theory for nursing: general concepts of human behavior. New York: Wiley; A theory for nursing. Systems, concepts, process. King's conceptual framework and theory of goal attainment. Levine ME. Introduction to clinical nursing. The conservation principles: a model for health. In: K. Pond Eds. Davis; ; Neuman B, Fawcett J. The Neuman systems model. Neuman B, Young RJ.

A model for teaching total person approach to patient problems. Nursing Research ; Orem DE. Nursing: concepts of practice. New York: McGraw-Hill; Louis: Mosby; Rogers ME. An introduction to the theoretical basis of nursing. Nursing: Science of unitary, irreducible, human beings: Update In: EAM. Barrett Ed. Roy C. Introduction to nursing: an adaptation model.

Roy C, Andrews HA. The Roy adaptation model, 2nd ed. Stamford, CT: Appleton and Lange; Leininger MM. The theory of culture care diversity and universality. Leininger Ed. Newman MA. Health as expanding consciousness. Parse RR. Man-living-health: a theory of nursing. The human becoming school of thought: a perspective for nurses and other health professionals. Thousand Oaks, CA: Sage; Schmidt, N.

Response to "The pediatric nurse-A societal need". Self-Care, Dependent-Care and Nursing ; 12 2 : Orlando IJ. The dynamic nurse-patient relationship. New York: G. Putnam's Sons; Peplau HE. Interpersonal relations in nursing. Interpersonal relations: A theoretical framework for application in nursing practice.

Nursing Science Quarterly ; 5: Watson J. Nursing: Human science and human care: a theory of nursing. Watson's theory of transpersonal caring. In: P. Neuman Eds. The relationship of theory and research. Middle range theories: application to nursing research. Philadelphia: Lippincott Williams and Wilkins; Middle range theory for nursing.

New York: Springer; Barnum BJS.


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Nursing theory: analysis, application, evaluation, 3rd ed. Borrowed theories, shared theories, and the advancement of nursing knowledge. Nursing Science Quarterly ; Popper KR. Normal science and its dangers. In: I. Musgrave Eds. London: Cambridge University Press; ; Conjectures and refutations: the growth of scientific knowledge. New York: Harper and Row; What's behind the research? Discovering hidden assumptions in the behavioral sciences.

Doornbos MM. Using King's systems framework to explore family health in the families of the young chronically mentally ill. Sieloff Eds. Thousand Oaks, CA: Sage. King's systems framework and family health: The derivation and testing of a theory. Journal of Theory Construction and Testing ; 4: Wicks MN. Family health as derived from King's framework. Thousand Oaks, CA: Sage; ; A test of the Wicks family health model in families coping with chronic obstructive pulmonary disease.

Journal of Family Nursing ; 3: Latham L.

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Letter to the Editor. Nursing: Seeking its source and survival. Adaptation: A conceptual framework for nursing. Nursing Outlook ; 18 3 : Roy C, Roberts SL. Theory construction in nursing. An adaptation model. Alligood MR.


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Philosophies, models, and theories: critical thinking structures. Marriner Tomey Eds. Altered cognition: an information processing approach.

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Mitchell, L. Hodges, M. Walleck Eds. Norwalk, CT: Appleton and Lange; a; Alterations in cognitive processing. In: C. Kunkel Eds. Philadelphia: Saunders; ; Implications of the 21st century developments of the Roy adaptation model. Kennebunkport, ME; ; May. Tsai P-F. Development of a middle-range theory of caregiver stress from the Roy adaptation model. Dissertation Abstracts International 60, B; A middle-range theory of caregiver stress. Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Kruszewski AZ. The spatial and temporal environments intervene in each of the concepts of ill person, nursing, and health in a complex person-environment interaction [ 58 ].

The circadian human being is subjugated to continuous adaptation through external time signals Zeitgebers , with light being the most powerful, followed by feeding time, daily activity and resting, social interaction, and exercising. All these factors allow the individual to keep adapted and guided to the temporal environment in his daily activities [ 59 - 61 ].

All of these factors generate desynchronization with the external time-givers [ 60 , 62 ]. This state is called chronodisruption that is defined as a significant disturbance of the temporal internal order of the physiological, biochemical and behavioral circadian rhythms. Chronodisruption is associated with a higher incidence of metabolic syndrome, cardiovascular diseases, cognitive and affective disorders, sleep disorders, some types of cancer, premature aging, and accidents [ 63 , 64 ].

Chronodisruption can be potentiated by the hospital as a new environment for the patient, a place where ambient clues appear different from clues generally found in daily activities: illumination, noise, infrastructure, temperature, workers, ventilation, security, visiting time, number of patients in each room, clinical assessment, invasive procedures, laboratory tests, and medications intake. All these elements together can alter the circadian synchroni-zation of a patient physiologically, psychologically, and socially.

The aim of hospital staff interventions is to allow hospitalized patients to conserve or restore in concordance with their internal clock and their environment. This can be accomplished using the following eight principles:. Constant exposure to bright light, both during day and night, has negative effects on circadian rhythms [ 65 ], creating an inadequate environment to sleep [ 66 ]. Parameters such as light intensity, frequency and duration of light exposure, and spatial distribution, are already established [ 67 ].

Noise is a major source of environmental pollution and has a harmful effect on health and wellbeing. Sound levels higher than decibels dB interfere with communication, disrupt sleep, and can lead to increased stress in patients. Recommended sound levels in hospital rooms are 35 dB. Although the circadian clock can be entrained by temperature cycles [ 74 ], its free-running period is relatively constant within a broad range of physiological parameters.

This phenomenon is called temperature compensation [ 75 ]. Extreme temperatures, however, have the potential to disrupt sleep continuity, and therefore may contribute to an adverse care environment. Thus, an adverse environment with extreme temperatures associated with changes in the level of light e. Suitable drug administration is important to align therapy to endogenous rhythms. The pharmacodynamics and pharmacokinetics of a drug can be altered according to the time of day that the medication is administered [ 78 ], thus controlling the efficacy and toxicity of the drug.

Chronotherapy can be delivered through a variety of strategies and may include both time and site-specific drug application regimens. Chronopharmacological techniques ensure that drug levels in the blood are within therapeutic ranges during periods of maximal disease. An example of this is seen in how evening doses of antihypertensive therapy can be used to prevent morning rises in blood pressure [ 79 ].

The evening dose of the drug may thus be well timed with diurnal changes in blood pressure, preventing diurnal worsening of hypertension. Another example is chemotherapy in which researchers have found that the toxic effects of more than 30 anticancer drugs vary by timing of administration [ 80 ]. Currently, however, a large number of drugs are administered without considering time of day or adjusting schedules to chronotherapeutic principles. This situation may lead to treatment failure or increased risk for drug toxicity.

Furthermore, alterations in the circadian rhythms of biochemical, physiological, and behavioral processes induced by the drug itself can alter homeostatic regulation and exacerbate the disease [ 81 - 86 ]. Therefore, nurses must consider chronopharmacology as a means of increasing the efficacy of drugs and improving drug tolerance, paying attention to potential side effects of circadian disruption. Clinical procedures and tests in hospitalized patients often require patient preparation food deprivation, fluid intake, laxatives, etc.

Also, several usual care practices such as taking vital signs or laboratory samples are performed unexpectedly, without preparing the patient. For example, vaginal delivery or caesarean sections are programmed in accordance to personnel convenience, thus altering the timing of the natural birth process. All these elements generate distress, anxiety, fear and further a patient's internal desynchronization. Additionally, it should be emphasized that several biochemical and physiological variables show a circadian variation [ 87 - 92 ].

There is an association between sleep duration and food intake [ 93 ]. The timing of food intake and behavior are controlled by the internal circadian clock, and the circadian control of food intake and digestion has important metabolic implications [ 93 , 94 ]. For example, chronic circadian misalignment has been proposed to be the underlying cause for the adverse metabolic and cardiovascular health effects of shiftwork [ 95 ].

Furthermore, it was recently reported that timing of food intake influences the success of a weight-loss diet [ 96 ], suggesting that novel therapeutic strategies should incorporate not only the classic caloric intake and macronutrient distribution but also the timing of food. A disruption in social rhythms may lead to instability in circadian rhythms [ , ]. The hospitalization process leads to a rupture of social ties, including separation from family, friends and daily activities [ ].

Therefore, it is important that hospital nurses encourage social habits and interactions by facilitating visiting hours, providing information about what is happening in their environment, and promoting leisure and recreation. Taken together, these factors allow patients a proper synchronizat-ion with the social environment, reduce stress levels, and transition back into the family setting after hospital discharge. Disturbed sleep quality is associated with deficits in psychologic, behavioral, and somatic functions and predicts the emergence of deficits in interpersonal and psychosocial functioning [ ].

These practices, commonly referred to as sleep hygiene, influence sleep quality. Nurses will understand that, in addition to controlled environmental factors, there are a number of individual and intrinsic factors that induce and maintain sleep through personal routines [ ]. In summary, there is clearly a need for incorporating these eight principles into bedside practice protocols as well as a need for further research to assess the positive outcomes of these efforts.

There is strong scientific evidence that demonstrates a reciprocal relationship between a robust endogenous circadian system and the presence of regularly programed Zeitgebers. During disease, the correct function of the circadian synchronization system can be more dependent on exposure to intentionally programmed stimuli. Light levels, physical activity, temperature, and feeding are key elements for the internal synchronization of the central circadian clock and peripheral circadian oscillators.

In such conditions, a regularly programed exposure to Zeitgebers, based on rational and scientific criteria, would be very important to recovery and well being [ ]. Avoiding desynchronization and promoting circadian homeostasis contributes to optimal physiological function, general good health, and reduced susceptibility to comorbidities in persons with an acute or chronic illness [ ].

For the health system, paying attention to circadian principles could reduce costs by preventive interventions that diminish patient complications and reduce hospital stay Fig. The circadian nursing care of the hospitalized patient and costs in health system. Chronobiology applied to patient care has broad implications for clinical practice, basic clinical research, and the training of new health care professionals. Knowledge of human circadian variations physiological, psychological, behavioral, and social , as well as knowledge of how a disease behaves during a hour period, considering its signs and symptoms, as well as the desired and undesired side effects of medications, will generate an appropriate care plan for the timing needs of the patient.

A care plan should includes ensuring a stable external environment for the individual, with suitable light-dark cycles, low noise, constant temperature, and proper drug and food administration. In addition minimizing isolation and encouraging social interaction should be introduced into the plan of care for any long-term patient. This holistic approach presents an integration of existing scientific knowledge on chronobiology and the art and skill of nursing practice.

The patient is in continuous interaction with the environment family, group, community, society, and hospital room and, accordingly, experiences particular life styles and responses to health and disease. The need to have an updated knowledge base on biological rhythms requires that the nurse interact with other disciplines, both basic biomedical sciences and clinicians.

Given that certain circadian traits are inherited, understanding the genetic architecture of molecular mechanisms of the circadian clock regulation can provide the necessary knowledge for individualizing patient care, and thus facilitating a rational therapeutic approach to their hospital care. Finally, the performance of nursing care based on current scientific knowledge of chronobiology can positively impact the costs of health systems to detect and prevent elements of the individual or the environment that may disrupt or interfere with the patient's recovery. This can help reduce hospitalization time, medical and surgical complications, and reduce morbidity and mortality.

However, more research is required in the area of circadian nursing care to determine the practical utility of this theory and to generate new knowledge that can strengthen the training of new professionals and the quality of current professional nursing practice. The middle-range theory development was supported by grants from Universidad de Ciencias Aplicadas y Ambientales U. The authors confirm that this article content has no conflict of interest. National Center for Biotechnology Information , U. Journal List Open Nurs J v. Open Nurs J. Published online Feb Author information Article notes Copyright and License information Disclaimer.

Abstract The circadian system controls the daily rhythms of a variety of physiological processes. Keywords: Biological rhythms, chronobiology, circadian rhythms, hospital, middle-range theory, nursing. Open in a separate window.

Sister Callista L. Roy - Biography and Works - Nurseslabs

Temporal Environment as a Synchronizer The spatial and temporal environments intervene in each of the concepts of ill person, nursing, and health in a complex person-environment interaction [ 58 ]. Noise Level Regulation Noise is a major source of environmental pollution and has a harmful effect on health and wellbeing.

Temperature Levels Regulation Although the circadian clock can be entrained by temperature cycles [ 74 ], its free-running period is relatively constant within a broad range of physiological parameters. Adequate Drug Administration Suitable drug administration is important to align therapy to endogenous rhythms. Chronopharmacological techniques ensure that drug levels in the blood are within therapeutic ranges during periods of maximal disease severity. Rationale for Management of Practices and Procedures Clinical procedures and tests in hospitalized patients often require patient preparation food deprivation, fluid intake, laxatives, etc.

Control of Feeding Schedules There is an association between sleep duration and food intake [ 93 ]. Encourage Social Interaction A disruption in social rhythms may lead to instability in circadian rhythms [ , ]. Promote Adequate Sleep Pattern Sleep Hygiene Disturbed sleep quality is associated with deficits in psychologic, behavioral, and somatic functions and predicts the emergence of deficits in interpersonal and psychosocial functioning [ ]. Aschoff J. Exogenous and endogenous components in circadian rhythms.

Buonomano DV. The biology of time across different scales. Nat Chem Biol. Feng D, Lazar MA. Clocks, metabolism, and the epigenome. Mol Cell. Remembering the father of chronobiology and chronomics Franz Halberg, MD 5 july , - 9 june ,. Clin Ter. Golombek DA. Sleep is rhythm and the rhythm, rhythm is. Schulz P, Steimer T. Neurobiology of circadian systems. CNS Drugs. Pharmacogn Rev. Bass J. Circadian topology of metabolism. Halmos T, Suba I. Physiological and pathophysiological role of the circadian clock system. Orv Hetil.

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Savvidis C, Koutsilieris M. Circadian rhythm disruption in cancer biology. Mol Med. The clock in the brain neurons, glia, and networks in daily rhythms. Handb Exp Pharmacol. The human circadian metabolome. Richards J, Gumz ML. Advances in understanding the peripheral circadian clocks. Tamosiunas G, Toledo M. Chronopharmacology a new variable that could account for the variability of the therapeutic response. Arch Med Int. Quality of sleep in patients hospitalized in an Intensive Care Unit. Enferm Intensiva. Sleep and sleep disorders in the hospital. Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying.

Nurs Sci Q. Davidson JE. Facilitated sensemaking a strategy and new middle-range theory to support families of intensive care unit patients. Crit Care Nurse. Using the Roy adaptation model to develop an antenatal assessment instrument. Roy C. Research based on the Roy adaptation model last 25 years. McEachron DL. The prominent nursing theory aims to explain or define the provision of nursing. Roy has numerous publications, including books and journal articles, on nursing theory and other professional topics. Her works have been translated into many language all over the world.

Roy and her colleagues at Roy Adaptation Association, has critiqued and synthesized the first research projects published in English based on her adaptation model. Roy has received numerous honors due to her work and contribution to the nursing profession. Save my name, email, and website in this browser for the next time I comment. Notify me of follow-up comments by email. Notify me of new posts by email. Since we started in , Nurseslabs has been visited over million times as of and has become one of the most trusted nursing websites helping thousands of aspiring nurses achieve their goals.