• Users Online: 58
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 2  |  Page : 86-91

The effects of a care plan based on the roy adaptation model on depression among nursing home residents

Date of Submission01-Jul-2019
Date of Decision28-Oct-2019
Date of Acceptance01-Nov-2020
Date of Web Publication19-Apr-2021

Correspondence Address:
Esmaiel Maghsoodi
Department of Nursing, Maragheh University of Medical Sciences, Basij Square, Hashtrood Road, Maragheh
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nms.nms_51_19

Rights and Permissions
  Abstract 

Background: Depression is one of the most common mental disorders among nursing home residents. Nursing models are among the therapies with potential effects on depression. Objectives: This study aimed to determine the effects of a care plan based on the Roy's Adaptation Model (RAM) on depression among nursing home residents. Methods: This quasi-experimental study was conducted on sixty older adults selected from four nursing homes in Urmia, Iran. Participants were randomly allocated to a control and an intervention group. A care plan based on the RAM was designed and implemented for participants in the intervention group. The plan included individualized and group educations based on participants' maladaptive behaviors in the four modes of the RAM. During the intervention, participants' maladaptive behaviors and their stimuli were determined and measures were taken for their management. The intervention lasted for 1.5 months, followed by a 1-month supervision. Before and after the intervention, depression was assessed using the Geriatric Depression Scale. Data were analyzed through the independent- and the paired-sample t and the Chi-square tests. Results: The pretest and the posttest mean scores of depression were 5.78 ± 3.51 and 6.11 ± 3.64 in the control group and 6.81 ± 3.64 and 2.86 ± 2.50 in the intervention group. The between-group difference respecting the pretest mean scores of depression was not statistically significant (P = 0.21), whereas the posttest mean score of depression in the intervention group was significantly less than the control group (P < 0.001). Although the mean score of depression in the control group did not significantly change (P = 0.32), it significantly decreased in the intervention group (P < 0.001). Conclusion: The care plan developed in this study based on the RAM is effective in significantly reducing depression among nursing home residents. Therefore, it can be used for depression management in nursing homes.

Keywords: Care plan, Depression, Elderly, Nursing home, Roy Adaptation Model


How to cite this article:
Alidoost N, Naseri O, Jahanban A, Maslakpak MH, Maghsoudi B, Maghsoodi E. The effects of a care plan based on the roy adaptation model on depression among nursing home residents. Nurs Midwifery Stud 2021;10:86-91

How to cite this URL:
Alidoost N, Naseri O, Jahanban A, Maslakpak MH, Maghsoudi B, Maghsoodi E. The effects of a care plan based on the roy adaptation model on depression among nursing home residents. Nurs Midwifery Stud [serial online] 2021 [cited 2021 Jun 14];10:86-91. Available from: https://www.nmsjournal.com/text.asp?2021/10/2/86/314158




  Introduction Top


The global population is rapidly aging. Currently, older adults constitute 10% of the global population.[1] The global population growth rate is 1.7% per year, whereas the older adults' population growth rate is 2.5%. Estimates show that the population of older adults will doubles from 12% in 2015 to 22% in 2050,[2] which will increase residence in nursing homes.[3],[4]

Mental disorders, especially depression and anxiety, are among serious problems associated with aging.[5] Age-related physical and mental problems,[6] impaired self-esteem, reduced mobility, loss of friends and relatives, weakness, reduced physical and financial autonomy,[7] and age-related cognitive impairment are among the risk factors of depression among older adults.[8] Some studies reported that the prevalence of mental disorders, especially depression, among nursing home residents is as high as 80%.[7],[9] People with depression may experience problems such as low levels of energy, lack of concentration, changes in appetite and weight, suicidal attempts, feeling of regret, and self-destructive thoughts.[10]

Age-related physical and mental health problems result in the ineffective adaptation as manifested by unhealthy and maladaptive behaviors.[6] Maladaptive behaviors can, in turn, increase the risk of physical and mental health problems among older adults. Therefore, adaptation-promoting strategies may help prevent and manage health-related problems among these individuals.[11] The Roy's Adaptation Model (RAM) is one of these strategies. This model focuses on adaptation promotion and thereby, has positive effects on mental health[12] and depression among older adults.[13],[14] In this model, maladaptive behaviors are identified through careful examination,[15] and then, care measures are taken to promote physiological and psychological adaptation[16],[17] and manage maladaptive behaviors.[15] RAM is considered as a safe and low-cost noninvasive method for the promotion of physical and psychological adaptation.[18] A number of earlier studies have investigated the effect of implementing RAM-based care plans on adaptation among patients with heart failure[19] and quality of life of patients with cervical cancer,[20] chronic liver disease,[21] and nursing home residents.[6] However, no study is available on the effect of this model on depression among nursing home residents.

Objectives

This study aimed to determine the effects of a care plan based on RAM on depression among nursing home residents. It is hypothesized that there is a significant difference between nursing home residents who receive routine care and their counterparts who receive RAM-based care respecting their depression mean scores.


  Methods Top


Design and participants

This quasi-experimental study was conducted from December 2018 to June 2019 using a pretest–posttest parallel design. Participants were sixty older adults who were selected from four nursing homes in Urmia, Iran, namely Al-Zahra, Khanaeye Sabz, Ara, and Ferdows. Inclusion criteria were agreement for participation, age over 60, no known hearing or speech problems, orientation to time, place, object, and person, no history of hospitalization in psychiatric hospitals, no history of receiving psychological therapies or suffering any loss during the last 6 months before the study, and no history of known mental, memory, or thinking problems. Exclusion criteria were two or more absences from the intervention sessions and reluctance to stay in the study. Using a random allocation software, participants were randomly assigned to an intervention (n = 30) and a control (n = 30) group [Figure 1]. Due to the nature of the study the participants were not blind to the intervention.
Figure 1: The flow diagram of the study

Click here to view


The sample size was estimated based on the results of a former study.[22] Then, with a type I error of 0.01, a type II error of 0.1, a S1 of 3.14, a S2 of 1.84, a µ1 of 4.17, and a µ2 of 1.38, the number of participants in each group was estimated at 26. However, considering a possible dropout of 15%, we recruited 30 participants in each group.

Data collection instruments

A demographic questionnaire and the Geriatric Depression Scale were used for data collection through interviewing participants. The Geriatric Depression Scale includes 15 yes/no questions scored 0 or 1. The total score of this scale is 0–15 and is interpreted as follows: scores 0–3: no depression; scores 3.01–10: moderate depression; and scores 10.01–15: severe depression. A study in Iran confirmed the validity and reliability of this scale and reported a Cronbach's alpha of 0.9.[23] The reliability of the scale in the present study was assessed through internal consistency assessment which resulted in a Cronbach's alpha of 0.92. As all participants were aged, we collected all the data trough structured individual interviews. All interviews were conducted by the last researcher and each lasted for about 30 min. The researcher asked the questions and recorded the participants' answers in the questionnaire.

Intervention

To design the study intervention, we initially used RAM-based assessment forms and determined participants' maladaptive behaviors in the physiological, self-concept, role function, and interdependence modes and their focal, contextual, and residual stimuli. The forms were completed through a face-to-face interview with each participant. Then, an individualized four-session care plan was designed and implemented for each participant based on his/her maladaptive behaviors and their focal, contextual, and residual stimuli. In these individual weekly sessions, we attempted to correct each participant's maladaptive behaviors in the physiological, self-concept, role function, and interdependence modes through manipulating their focal, contextual, and residual stimuli. For instance, a participant with muscular weakness (a physiological problem) caused by limited mobility (the focal stimulus) was encouraged to do physical exercise such as walking. Moreover, a participant with constipation (a physiological problem) caused by limited intake of fluids and high-fiber foods (the focal stimulus) and decreased physical activity (the contextual stimulus) was provided with a high-fiber diet (consisted of fruits and vegetables) and adequate fluids and was asked to perform physical activity. Participants with maladaptive behaviors in the role function and interdependence modes were also provided with counseling services by a psychologist [Table 1].
Table 1: Examples of the components of the study intervention

Click here to view


Besides these individualized four sessions, two educational group sessions were held (at the start of the study) for all participants to address their common maladaptive behaviors. For instance, educations about maladaptive physiological behaviors were about proper nutrition, adequate and balanced physical activity, quality sleep, etc., Regarding maladaptive behaviors in the self-concept mode, educations aimed to make positive changes in participants' self-image and ideal image. In the interdependence mode, educations were mainly about peer relations, group discussions, and religious rituals. Educations in the role function mode were related to assuming some responsibilities in nursing homes, attending birthday or wedding parties, and organizing or joining sports teams.

During the first month after the intervention, we referred to the study setting to supervise participants' engagement in behavior modification activities. Before and after the study intervention, the Geriatric Depression Scale was completed for all participants. To prevent information leakage from participants in the intervention group to their counterparts in the control group, we asked the authorities of the study setting to settle participants in these groups in separate rooms.

Ethical considerations

This study was approved by the Institutional Review Board and the Ethics Committee of Urmia University of Medical Sciences, Urmia, Iran (codes: 92011331273 and IR.UMSU.REC1393.32, respectively). Informed consent was obtained from all participants, and they were assured about the confidentiality of their personal information. At the end of the study, the study intervention was taught to the staff of the study setting to use it for all older adults in the study setting.

Data analysis

Data were analyzed using the SPSS software v. 16.0 (SPSSInc, Chicago, IL, USA). At first, the Kolmogorov–Smirnov test was used for normality testing. Then, the independent-samples t- and the Chi-square tests were used to compare the groups respecting participants' demographic characteristics. Moreover, the independent- and the paired-sample t-tests were used, respectively, for between- and within-group comparisons in terms of the mean scores of depression. The level of significance was set at <0.05 in all testes.


  Results Top


One participant from the intervention group died during the study and the number of participants in this group reduced to 29 [Figure 2].

Most participants in the control (93%) and the intervention (96%) groups were female. Age mean in these groups was 70.10 ± 4.59 and 69.58 ± 7.03 years, respectively. No statistically significant differences were found between the groups respecting participants' age, gender, education level, marital status, income level, insurance, length of stay in nursing home, and number of children [Table 2].
Table 2: Between-group comparisons respecting participants’ personal characteristics

Click here to view


The results of the independent-samples t-test showed no statistically significant between-group difference respecting the pretest mean score of depression (P = 0.21). However, the posttest mean score of depression in the intervention group was significantly less than the control group [P < 0.001; [Table 3].
Table 3: Within- and between-group comparisons respecting participants’ mean score of depression

Click here to view


The mean score of depression in the control group changed from 5.78 ± 3.51 at pretest to 6.11 ± 3.64 at posttest. The paired-sample t-test showed that this change was not statistically significant (P = 0.32). However, the mean score of depression in the intervention group significantly decreased from 6.81 ± 3.64 at pretest to 2.86 ± 2.50 at posttest [P < 0.001; [Table 3].


  Discussion Top


Before the intervention, there was no statistically significant between-group difference respecting the mean score of depression. Therefore, the significant difference between the groups respecting the posttest mean score of depression is attributable to the effects of the study intervention. In agreement with our findings, previous studies reported the positive effects of RAM-based care plans on adaptation among patients with heart failure[19] and quality of life among patients with cervical cancer,[20] chronic liver disease,[21] and nursing home residents.[6] Similarly, a study found the positive effects of RAM on the control, energy and mobility, and social support aspects of quality of life among patients with type II diabetes mellitus.[24] Another study found the effectiveness of a RAM-based educational program in significantly increasing the number of psychological adaptive behaviors among patients with heart failure.[17] A study showed that nurses can play a significant role in improving psychological adaptation and promoting adaptive behaviors through employing RAM-based educational programs.[25] Mental health components, such as depression, are closely related to the quality of life.[1] Older people living in nursing homes are prone to depression due to staying away from family, physical, and psychological problems.[26] The results of the study showed that the use of the RAM, by manipulating the stimuli of maladaptive behaviors in physiological and psychological modes, can improve self-esteem, self-concept, communication with others, and delegation of roles, and with the improvement of psychological maladaptive behaviors, the rate of depression has also decreased. Examples of adaptive behaviors after manipulating the stimuli of maladaptive behaviors include physical activity such as exercising, participating in peer groups such as reminiscing, arranging more visits with family members, delegating responsibilities such as shopping or cleaning centers to the participants, and holding ceremonies and celebrations.

RAM considers humans as biopsychosocial beings with four adaptive modes, namely physiological, self-concept, role function, and interdependence. In the present study, we identified maladaptive behaviors and their focal, contextual, and residual stimuli in each mode and then, attempted to manipulate modifiable stimuli in order to promote adaptation and correct maladaptive behaviors. Psychological counseling by a psychologist was also employed in order to correct psychological maladaptive behaviors. Maladaptive behaviors, negative thoughts, and depression negatively affect self-concept and self-esteem. Poor self-concept and self-esteem can, in turn, aggravate maladaptive behaviors and negative thoughts and result in depression, anxiety, and stress. The most important stimuli for psychological maladaptive behaviors among older adults are poor self-esteem, poor spiritual well-being, isolation, role conflict, and negative thoughts. These stimuli can be managed through psychological counseling and education in areas such as spiritual growth, communication with God, love for one's own and others, participation in peer groups, and assuming responsibilities in nursing home. Previous studies reported the positive effects of education on depression, self-efficacy, and mental aspect of quality of life.[27],[28]

Contrary to our findings, a study showed that RAM had no significant effects on the mental aspect of quality of life among patients with type II diabetes mellitus.[24] This contradiction may be due to the differences between the studies in terms of intervention duration and participants' characteristics such as their desire to express their concerns.

The limitations of the study were its small sample size, short duration of its intervention, and participants' problems in answering the study questionnaires due to their sociocultural and age-related health conditions. Future studies are recommended to design RAM-based care plans with more educational and counseling sessions and longer follow-up assessment and evaluate their effects on the different aspects of mental health among older adults. Evaluating and comparing the effects of different nursing care models on different aspects of mental health are other areas for further investigation.


  Conclusion Top


This study concludes that as a simple and noninvasive nonpharmacological intervention, the RAM-based care plan developed in the present study is effective in significantly reducing depression and managing physical and mental health problems among nursing home residents. The findings of the present study can be used to develop RAM-based interventions for improving health-related outcomes among older adults, particularly nursing home residents.

Acknowledgment

The Vice Chancellor for Research and Technology of Urmia University of Medical Sciences is thanked for the financial support of this study. We would like to thank all older adults who participated in the study and the authorities of the study setting who collaborated with us during the study too.

Financial support and sponsorship

This study was funded by Urmia University of Medical Sciences with an approved code 96011331273.

Conflicts of interest

There is no conflicts of interest.

 
  References Top

1.
Manav Aİ, Yeşilot SB, Demirci PY, Öztunç G. An evaluation of cognitive function, depression, and quality of life of elderly people living in a nursing home. J Psychiat Nurs 2018;9:153-60.  Back to cited text no. 1
    
2.
World Health Organization. Ageing and Health: World Health Organization; 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. [Last updated on 2018 Feb 05].  Back to cited text no. 2
    
3.
Manzouri L, Babak A, Merasi M. The depression status of the elderly and it's related factors in Isfahan in 2007. Iran J Ageing 2010;4:27-33.  Back to cited text no. 3
    
4.
Adib-Hajbaghery M. Evaluation of old-age disability and related factors among an Iranian elderly population. East Mediterr Health J 2011;17:671-8.  Back to cited text no. 4
    
5.
Cong L, Dou P, Chen D, Cai L. Depression and associated factors in the elderly cadres in Fuzhou, China: A community-based study. Int J Gerontol 2015;9:29-33.  Back to cited text no. 5
    
6.
Hemmati Maslakpak M, Maghsoodi E, Sheikhi S. The effects of a care program based on the roy adaptation model on nursing home residents' quality of life. Mod Care J 2015;12:E8671.  Back to cited text no. 6
    
7.
Moghaddasifar I, Fereidooni-Moghadam M, Fakharzadeh L, Haghighi-Zadeh MH. Investigating the effect of multisensory stimulation on depression and anxiety of the elderly nursing home residents: A randomized controlled trial. Perspect Psychiatr Care 2019;55:42-7.  Back to cited text no. 7
    
8.
Pellegrino LD, Peters ME, Lyketsos CG, Marano CM. Depression in cognitive impairment. Curr Psychiatry Rep 2013;15:384.  Back to cited text no. 8
    
9.
Aly HY, Hamed AF, Mohammed NA. Depression among the elderly population in Sohag governorate. Saudi Med J 2018;39:185-90.  Back to cited text no. 9
    
10.
Cordova TJ. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). 5th ed. Washington DC: American Psychiatric Publishing; 2013.  Back to cited text no. 10
    
11.
Maghsoodi E, Naseri O, Hemmati Maslak Pak M. The effect of care plan application based on Roy's Adaptation Model on the spiritual well-being of elderly people in Urmia nursing homes. Int J Med Res Health Sci 2016;5:408-14.  Back to cited text no. 11
    
12.
Alligood MR. Nursing theorists and their work. 8th ed. California: Elsevier Health Sciences; 2013.  Back to cited text no. 12
    
13.
Russo S, Baumann SL, Velasco-Whetsell M, Roy C. A comparison of two case studies using the Roy adaptation model: Parents of opioid-dependent adults and bariatric surgery. Nurs Sci Q 2019;32:61-7.  Back to cited text no. 13
    
14.
Tsai PF. Predictors of distress and depression in elders with arthritic pain. J Adv Nurs 2005;51:158-65.  Back to cited text no. 14
    
15.
Roy C, Andrews HA. The Roy Adaptation Model. 3thed. University of Alberta Hospital, Canada: Pearson; 2008.  Back to cited text no. 15
    
16.
Alimohammadi N, Maleki B, Shahriari M, Chitsaz A. Effect of a care plan based on Roy Adaptation Model biological dimension on stroke patients' physiologic adaptation level. Iran J Nurs Midwifery Res 2015;20:275-81.  Back to cited text no. 16
    
17.
Naiem HS, Tabiee S, Saadatjoo S, Kazemi T. The effect of an educational program based on Roy adaptation model on the psychological adaptation of patients with heart failure. Mod Care J 2013;10:231-40.  Back to cited text no. 17
    
18.
Hay CG. Predictors of quality of life of elderly end-stage renal disease patients: An application of Roy's model. Atlanta: Georgia; 2005.  Back to cited text no. 18
    
19.
Bakan G, Akyol AD. Theory-guided interventions for adaptation to heart failure. J Adv Nurs 2008;61:596-608.  Back to cited text no. 19
    
20.
Mathew R, Seeta D. Improve quality of life of patients with cervical cancer: An application of Roy'sadaptation model. Int J Recent Sci Res 2016;7:11265-70.  Back to cited text no. 20
    
21.
Sharif F, Mohebbi S, Tabatabaee HR, Saberi-Firoozi M, Gholamzadeh S. Effects of psycho-educational intervention on health-related quality of life (QOL) of patients with chronic liver disease referring to Shiraz University of Medical Sciences. Health Qual Life Outcomes 2005;3:81.  Back to cited text no. 21
    
22.
Chan MF, Wong ZY, Onishi H, Thayala NV. Effects of music on depression in older people: A randomised controlled trial. J Clin Nurs 2012;21:776-83.  Back to cited text no. 22
    
23.
Malakouti K, Fathollahi P, Mirabzadeh A, Salavati M, Kahani S. Validation of geriatric depression scale (GDS-15) in Iran. Pejouhesh 2006;30:361-9.  Back to cited text no. 23
    
24.
Borzou SR, Mohammadi SK, Falahinia GH, Mousavi S, Khalili Z. Effects of roy's adaptation model in nursing practice on the quality of life in patients with type II diabetes. J Nurs Midwifery Sci 2015;2:1-7.  Back to cited text no. 24
  [Full text]  
25.
Mansouri A, Baraz S, Elahi N, Malehi AS, Saberipour B. The effect of an educational program based on Roy's adaptation model on the quality of life of patients suffering from heart failure: A clinical trial study. Jpn J Nurs Sci 2019;16:459-67.  Back to cited text no. 25
    
26.
Kwok JY, Choi KC, Chan HY. Effects of mind-body exercises on the physiological and psychosocial well-being of individuals with Parkinson's disease: A systematic review and meta-analysis. Compl Ther Med 2016;29:121-31.  Back to cited text no. 26
    
27.
Khoshab H, Bagheryan B, Abbaszadeh A, Mohammadi E, Kohan S. The effect of partnership care model on depression and anxiety in the patients with heart failure. Evi Based Care 2012;2:37-46.  Back to cited text no. 27
    
28.
Maghsoudi E, Hemmati MaslakPak M, Zareei F, PourRashid S, Sofiyani A, Shahidi L. The effect of care plan application based on Roy adaptation model on the self-efficacy in elderly people in urmia nursing homes. Res J Pharm Biol Chem Sci 2015;6:793-9.  Back to cited text no. 28
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Methods
Results
Discussion
Conclusion
Introduction
Methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed581    
    Printed16    
    Emailed0    
    PDF Downloaded75    
    Comments [Add]    

Recommend this journal