When the senses are no longer nurses’ greatest allies in caregiving: the perspective of Callista Roy’s Adaptation Model in Covid-19

Contributor: Ana Rita Rodrigues (Portugal)

March 2020. In the middle of the 21st century, humanity is experiencing its greatest challenge: a pandemic! An invisible and easily spread virus has emerged and has created the greatest instability experienced in our era. Suddenly, we are being asked to forget interpersonal relationships, contact with others, social gatherings, hugs… we are being isolated at home to protect ourselves and others from this deadly virus.

In health care, the challenge was also imposed. Suddenly, patients with SARS-CoV 2 infection began to occupy the Intensive Care Unit (ICU) to the detriment of other patients to whom I provided care on a daily basis. The challenge was imposed on me and on Nursing. I had to learn how to care for these patients, hidden behind a waterproof plastic suit, surrounded by sweat and with my senses, so necessary for my activity, completely conditioned. Touch, sight, hearing, and smell were no longer my greatest allies, and I had to learn to take care of the person with my glasses fogged up, with two pairs of gloves, without being able to touch the person as I could before.

^{The COVID ICU has a red zone that’s sealed with negative pressure air to keep the airborne virus particles from leaving the room. Staff are required to wear full PPE, including N95 respirators and eye protection, for most of their 12-hour shifts.
Alan Hawes/Medical University of South Carolina (Source)}

It was a very difficult time! Fear and fatigue took over me. Fear of contracting the infection and of transmitting it to my family members, and the fatigue was much more accentuated by working under these conditions. In fact, Diogo et.al. (2021) identified anxiety and fear as some of the main feelings of frontline nurses fighting SARS-CoV 2 infection.

The patients found it difficult to see my face and hear my voice. I saw the fear on their faces: fear of the diagnosis, prognosis, and the unknown, fear of not seeing the faces of the health professionals caring for them, and fear of the isolation that prevented them from physical contact with their relatives. So what would Callista Roy do?

Callista Roy’s nursing theory, with her Adaptation Model, was the basis for my intervention. This model, published in 1970 and part of the Outcomes Nursing Thought (Kerouac et al., 1994) is the foundation for understanding the individual as a system capable of adapting to different stimulations. Roy et al (2009) described the person or group as an adaptive system with internal processes for dealing with change. Environment is defined as all the conditions, circumstances and influences that surround the person, affecting their development and behavior. Health is a state and process of becoming integrated and complete, which depends on one’s adaptation. Finally, nursing is defined as the science and practice that aims to promote adaptive responses in order to contribute to the transformation of the person and the environment, helping them to regain health and quality of life (Roy, 2001).

The person’s adaptation process was due to the contagion of a recent disease with an uncertain prognosis, the estrangement from the family, and the change in the healthcare environment.

Although Roy (2001) considers that the senses play an important role in the person’s adaptive process, I, as a health professional, had to adapt to caring for the person with my senses very altered by the presence of personal protective equipment, having to search for strategies to support and stimulate the person to create adaptive responses in this very difficult phase and to involve the family in the care process, although in a very different way than before.

Throughout this whole situation, I was left with one certainty: regardless of the situation experienced, nurses always find strategies to care for people as best they can. Even if our senses are impaired and even if we are afraid, we will always be there!

References

Diogo, P. M., Sousa, M. O., Rodrigues, J. R., Silva, T. A. & Santos, M. L. (2021). Emotional labor of nurses in the front line against the COVID-19 pandemic. Revista Brasileira de Enfermagem. 74 (suppl 1). https://doi.org/10.1590/0034-7167-2020-0660

Kérouac, S., Pepin, J.; Ducharme, F.; Duquette, A.; Major, F. (1994). El pensamiento enfermero. Barcelona: Masson,S. A..

Roy C. (2001). The Roy Adaptation Model. Lisbon: Instituto Piaget

Roy, C., Whetsell, M., Frederickson, K. (2009). The Roy Adaptation Model and Research – Global Perspective. Nursing Science Quarterly. Vol.22. Number 3. pp. 209-211

About Ana Rita Rodrigues

I am a nurse with 16 years of experience. Initially, I started working in the surgery field, but 9 years ago, I moved into the Intensive Care Unit (ICU). I love this area for the constant challenge it poses to me. I work in ICU of the Vila Franca de Xira’s Hospital.

I am also a student of the Master’s Degree in Nursing in the area of Medical-Surgical Nursing – the person in Critical Situation, at the Institute of Health Sciences of the Catholic University of Portugal, Lisbon. This post was carried out in the curricular unit of nursing theories, with the pedagogical supervision of Professor Zaida Charepe (PhD, Associate Professor).