Question

The patient is a 58-year woman diagnosed with Stage IIIB breast cancer which required a mastectomy, chemotherapy and radiation treatments. She has a variety of chronic illnesses, including hypertension, diabetes and asthma. She is knowledgeable her health and sees the doctor regularly to stay healthy.

She is very devout and grew up in a strongly devout family. Her church family is very important to her. Her mother and siblings live out of state. All of her family prays regularly for her along with their church and friends.

The patient was very sick as a child requiring frequent hospitalizations. Although her parents were repeatedly told that the patient would soon die from pneumonia, she always pulled through. This caused her family to note her strong-willed nature as a child. Her family nick name was the happy child because she was known for her cheerful, optimistic nature despite her frequent illnesses.

She has been married for 36 years. Her husband is very supportive. She has 2 grown sons who live about 4 hours away. Neither son is married. Her best friend is a local nursing instructor. The friend has taken her back and forth for most of her treatments because her husband cannot get time off. Her co-workers are very supportive and assisted with money and food during chemotherapy. She has been a teacher in the community for 20 years. Her former students created a face book page to keep up with her progress and regularly send her encouragement.

4. What is APAM in MRM theory?

1. What does it mean?
2. Describe her adaptation potential.
3. What was the stressor?
4. What was the arousal response?
5. What happened with the arousal?

Answer 1

The "adaptive potential assessment model (APAM)" is a model for identifying an individual's potential for mobilizing resources. The states of equilibrium, arousal and impoverishment describe the individual's resource mobilization and coping potential in the APAM.

OVERVIEW

MODELING AND ROLE‑MODELING THEORY (MRM; ERICKSON, TOMLIN & SWAIN, 1983) PROVIDES A PARADIGM AND THEORY FOR NURSING. MRM IS BEST DEPICTED AS A GRAND THEORY ENCOMPASSING NUMEROUS MID-RANGE THEORIES. MRM HAS BEEN APPLIED IN A VARIETY OF CLINICAL PRACTICE SETTINGS, EDUCATIONAL PROGRAMS, AND RESEARCH.

THEORY AND PARADIGM

The theory is based on philosophical beliefs and assumptions about people, environments, health and nursing. MRM was both inductively and deductively derived from practice experiences, empirical studies, and several foundational theories. Foundational theories upon which MRM is based include those of Maslow, Erikson, Piaget, Bowlby, Winnicott, Engel, Lindemann, Seyle, Lazarus, and Seligman. The difference between those basic theories and the derived theory (MRM) is the synthesis of the foundational theories in MRM.

In MRM, "Modeling" is to gain an understanding of the client's world from the client's perspective. That is to build a "model" of the client's world view. "Role‑Modeling" is based on the assumption that all humans want to interact with others, they want to carry out selected roles in society. Role-Modeling is using the client's model of the world to plan interventions that meet his or her perceived needs, grow, develop and heal. Role-Modeling requires that we aim to build trust, promote a positive orientation and a sense of control, affirm strengths and set specific mutual goals. Our nursing goal is to help people achieve quality, holistic health.

Major concepts in MRM are related to the underlying assumptions and philosophical beliefs regarding how people are alike, how they differ from each other, and what nurses do. Concepts related to how people are alike include holism, mind-body connections, basic needs including the need for affiliated-individuation, and needs for lifelong growth and development. Concepts that reflect how people are different from each other include genetic endowment, the unique model of the world, adaptation, and self-care. Concepts related to the nurse and nursing role are facilitation, nurturance and unconditional acceptance.

Several of the above concepts are original or uniquely defined in MRM theory. For example, the need for "affiliated-individuation" is original to MRM. "Self-care" is viewed as a tripartite concept consisting of self-care knowledge, self-care resources, and self-care actions. "Adaptation" is an ongoing, interactive process of coping that involves stressors, stress and the ability to mobilize resources. The "adaptive potential assessment model (APAM)" is a model for identifying an individual's potential for mobilizing resources. The states of equilibrium, arousal and impoverishment describe the individual's resource mobilization and coping potential in the APAM.

Breast cancer is a disease that not only has a high prevalence
and mortality but also profound psychological and psychosocial
ramifications. Women with breast cancer fear death and face complicated
medical decisions and concerns about their body image, sexuality,
and relationships.1

Thus, it is important to monitor patients' emotional adaptation
throughout the course of their disease, to support adaptive coping,
and to recognize psychological symptoms that are beyond the range
of "normal" adjustment and require psychiatric intervention.

Stressor:

A stressor is a chemical or biological agent, environmental condition, external stimulus or an event that causes stress to an organism. Psychologically speaking, a stressor can be events or environments that an individual would consider demanding, challenging, and or threaten the individual's safety.

Arousal response:

Physiological responses to fight or flight: When the body is initially challenged by a stressor it responds with physiological activation (also known as arousal) of a defense system to deal with the immediate stressor.

Another arousal system, the dopaminergic system, releases dopamine produced by the substantia nigra. ... This system projects to the limbic system and the prefrontal cortex. Stimulation of these axons and release of serotonin causes cortical arousal and impacts locomotion and mood.