Contributor: Ana Luísa Quaresma Amaral

As expected in the 21st century, we encounter numerous changes in all areas, considering the astronomical technological development and constant changes in society. All these transformations and evolution characterize this century, leading to the emergence of new global challenges where Nursing is no exception.

We, nurses, frequently face various challenges during care delivery that require constant adaptability and flexibility. Significant population changes, like the increased life expectancy and advancements in health (technological or knowledge-based), are some factors that bring new challenges to the profession. These factors are also responsible for the growing need for continuous evolution in nursing care and our perspective on it.

These changes and their effects challenge us to reflect on the essence of nursing as a profession and discipline, and how much it requires constant adaptation from its professionals. This reflection leads me to increasingly realize that nurses use not only our practical skills and intrinsic tools, which we develop and perfect throughout our lives, but also the resources (theories, models, etc.) that have been developed throughout the history of nursing by various authors/theorists and transmitted to us during our academic training, to enable us to respond to the various situations we encounter during our professional practice.

With this perspective deeply rooted, when I think of us nurses and our ability to adapt to the person we care for and the environment in which they are situated, I can only compare us to a chameleon1. This is because, like a chameleon, we nurses develop our adaptability so that our care responds as individually as possible to people’s needs.

But how can a nurse be like a chameleon?

The chameleon has a unique ability to move each of its eyes independently, allowing a 360º panoramic view. This characteristic enables them to be constantly aware of their environment, perceiving any danger or change around them. Similarly, nurses also develop this vision in our care delivery, but in a metaphorical sense. That is, we use a holistic approach to treat each person, considering not only their physical element but also their emotional, social, environmental, and psychological aspects. Thus, just as a chameleon uses its wide vision to adapt and survive in its environment, we rely on holistic vision during health care delivery to ensure that it is of high quality and focused on the person.

Like chameleons, we demonstrate remarkable adaptability during health care delivery. Thus, just as the chameleon changes colour to adjust to its environment, nurses adapt their approaches and techniques to meet the specific needs of each patient. This may mean adjusting the use of various tools we acquire throughout our training and professional life. This ability to “change colour” is reflected in our multiparadigmatic approach, that is, we use different nursing theories and methods to offer personalized and effective care, ensuring that each person receives the care they deserve.

What is a multiparadigmatic approach? And why use it?

Throughout the history of nursing, various authors have contributed to the practice of nursing. These contributions have aided the development of the scientific and professional practice of nursing, and today they remain relevant and valid in the contexts in which we operate, making their use essential.

Nursing paradigms are one of the fundamental bases of nursing knowledge, establishing a set of beliefs that define how we see the world and provide guidance for our actions (Schwandt, 1994). They influence how we look at problems, how we solve them, and how knowledge about them is acquired and validated. Paradigms have also shaped the evolution of theoretical frameworks, which we continue to use nowadays (Kérouac et al., 1994).

We use nursing paradigms, often even unconsciously, and they are like the colours of a chameleon because it is through them and their use that we adapt our approach to the person we care for and the environment that surrounds them.
Given this need for adaptation and all the previously mentioned challenges, it is difficult not to realize that using only one paradigm is not enough to meet the person’s needs. This “monoparadigmatic” approach becomes limiting for nursing as it has not proven sufficient to address the necessary nursing care today.

Therefore, it is essential to change the thinking in nursing and stop looking at care through only one paradigm but rather use them all harmoniously and adapted to our care object, since no single approach can explain all health experiences and situations.

All these adaptive issues, essential in nursing, were addressed by Callista Roy, a theorist who focuses her approach on valuing individual adaptation capacity and a constantly changing environment (Adaptation Model).

What does Callista Roy’s Adaptation Model tell us?

Callista Roy developed the Adaptation Theory, also known as the Adaptation Model, which focuses on the person’s ability to adapt to changes in their environment and health status. Roy stated that the person is a living adaptive system, constantly seeking stimuli that lead to adaptation to a particular situation, where their behaviours can be classified as adaptive or ineffective responses (Galbreath, 2000).

The primary goal of the Adaptation Model is to achieve well-being through a positive adaptive response to physical, psychosocial, and environmental changes, promoting integrity and, consequently, the maintenance and promotion of health. This is why this theory is frequently used in nursing care today, as it helps us, nurses, provide more holistic and person centric care. This model simplifies our data collection, the formulation of nursing objectives and diagnoses, the selection of nursing interventions, and the evaluation of the nursing process (Sensac & Roy, 2015).

Callista Roy’s model also highlights that nurses need to undergo constant adaptation processes to new situations and challenges we encounter in our clinical practice, as we perform our duties in an ever-changing environment, with new technologies, practices, and knowledge continuously emerging. The ability to adapt is essential for us to provide quality care and stay updated on the best practices of the profession.

All characteristics of this model are essential to consolidate my perspective that we nurses are true chameleons of health care, as it validates our need for constant adaptation in the exercise of our profession.

What can I conclude from this?

The multiparadigmatic vision involves integrating different theoretical and methodological approaches to provide a better understanding and response to the multiple needs of the person. This includes combining empirical, interpretative, critical, and postmodern approaches, allowing for a more holistic and person focused nursing practice, which gives us, nurses, this chameleon-like stance.

By integrating the tools from Callista Roy’s Adaptation Theory into our clinical practice and combining this with a multiparadigmatic approach, we become more capable of providing the person with a comprehensive and flexible care approach. The integration of this theory with the multiparadigmatic vision allows us to practice in a more enriched and personalized manner, considering the complexity of the needs of the person we care for and ourselves (nurses). This promotes more effective, person focused care that is adaptable to the constant changes in the health environment.
Thus, our ability to adapt, like a chameleon, through the combination of the multiparadigmatic approach and Callista Roy’s Theory, is essential for delivering high-quality, person focused health care. By integrating these different tools, we nurses can understand and provide nursing care in a more complete and holistic manner, developing an inclusive, effective, and truly person-focused practice.

References

Apóstolo, J. & Gameiro, M.. (2005). Referências Onto-epistemológicas e Metodológicas da investigação em Enfermagem: uma análise crítica. Revista Referência, 11(1), 29- 38. https://rr.esenfc.pt/rr/index.php?module=rr&target=publicationDetails&pesquisa=&id_artigo=59&id_revista=4&id_edicao=12

Galbreath, J. G.. (2000). Calista Roy. In George, J. B. & Colaboradores (Eds.), Teorias de Enfermagem: Os Fundamentos à Prática Profissional (pp. 203-224). Artmed Editora.

Kérouac, M., Pepin, J., Ducharme, F., Duquette, J., & Major, P. (1994). Conceptions et stratégies. La pensée infirmière, ISBN: 2-7607-0584-6

Neves, M.. (2012). O papel dos enfermeiros na equipa multidisciplinar em Cuidados de Saúde Primários – Revisão sistemática da literatura. Revista de Enfermagem Referência, III(8), 125-134. Doi: 10.12707/RIII11124

Ribeiro, O., Martins, M., Tronchin, D. & Forte, E.. (2018). O olhar dos enfermeiros portugueses sobre os conceitos metaparadigmáticos de enfermagem. Texto Contexto Enfermagem, 27(2), http://dx.doi.org/10.1590/0104-070720180003970016

Schwandt, T.. (1994). Constructivist, Interpretivist Approaches to Human Inquiry. Handbook of Qualitative Research Thousand Oaks, California: Sage. https://www.researchgate.net/publication/232477264_Constructivist_Interpretivist_Approaches_to_Human_Inquiry

Sensac, P. & Roy, C..(2015). Sister Callista Roy’s Adaptation Model In, M. C. & Parker, E.P.. (Eds.) Nursing Theories and Nursing Practice. (153 – 164). ISBN 978-0-8036-3312-4

About Ana Luísa Quaresma Amaral

My name is Ana, and I have been a nurse since 2019, working in the Intensive Care context for the past two years. I am currently pursuing a Master’s in Medical-Surgical Nursing, focusing on Critical Care, at the School of Nursing at the Catholic University of Portugal in Lisbon. This post was prepared as part of the Nursing Theories course, under the guidance of Professor Zaida Charepe (PhD., Associate Professor).Chameleons of Care: Nurses and the Adaptation Theory of Callista Roy.