Your views and letters


In response to: Serçekuş P. & Mete S. (2010) Effects of antenatal education on maternal prenatal and postpartum adaptation. Journal of Advanced Nursing66(5), 999–1010.

The article by Sercekus and Mete (2010) provides yet another example of using the Roy Adaptation Model (RAM) to guide nursing interventions. Based on the premise that nursing involves helping individuals adapt to illness, the RAM provides a solid and tested base from which to conceptualize, build and implement interventions to promote adaptation in various patient populations.

Recent articles published in the Journal of Advanced Nursing have used the RAM as a theoretical context for social isolation in older adults (Nicholson 2009), and as a framework to guide nursing interventions which promote adaptation in patients with heart failure (Bakan & Akyol 2008). Sercekus and Mete (2010) conclude that the RAM provided guidance for antenatal education which had a positive effect on prenatal adaptation.

These findings as well as those of previous researchers support using the RAM to guide nursing interventions for other groups whose illnesses require adaptation. One such group is the growing population of cancer survivors, currently some 12 million in the United States of America (USA), and with the numbers growing worldwide. Most cancer patients make the transition from active treatment to survivorship with little preparation for living with the medical, functional, and psychosocial consequences of cancer and its treatment (Rancour 2008). In addition, recent research indicates that cancer survivors in midlife (ages 40–64) experience significantly greater needs than other age groups in all aspects of quality of life (Schlairet et al. 2010). In the USA, The Institute of Medicine (2005) has called for research to improve the quality of life of cancer survivors. The RAM provides a framework into which quality of life is a natural fit. Understanding the transition from cancer patient to cancer survivor in midlife using the RAM is therefore appropriate and timely.

Cancer disrupts many aspects of a person’s life, including distressing clusters of physical symptoms, an altered sense of time, and psychosocial sequelae that frequently accompany diagnosis and treatment. The RAM can assist the nurse to understand how a person during the midlife developmental stage adapts as a survivor of cancer. In particular, the scientific assumptions underpinning the RAM help to explain how a person adapts to life as a cancer survivor.

The following scientific assumptions (italicized) of the RAM (Roy 2009) can be applied to the midlife cancer survivor in the following ways.

  • • Systems of matter and energy progress to higher levels of complex self organization. The person in midlife is challenged to mature from an early adult focus on ego development to the midlife focus on integration of the developed ego into a more complex whole. Integration of the cancer experience into life as a survivor takes place as part of this midlife maturation process.
  • • Consciousness and meaning are constitutive of person and environment integration. As consciousness expands to include a broader understanding of the meaning of life’s achievements and disappointments, the midlife cancer survivor integrates the experience of illness into a life of greater wholeness during survivorship.
  • • Awareness of self and environment is rooted in thinking and feeling. The survivor integrates into the maturing personality the underdeveloped thinking function with the more developed feeling function, or vice versa. This higher level of self awareness promotes a deeper understanding of the cancer experience as it unfolded and continues to unfold in the social context.
  • • Person and environment transformations are created in human consciousness. From the standpoint of an expanded awareness of the self and one’s life experiences, the midlife cancer survivor can transform the experience of illness into one of holistic wellness.
  • • Integration of human and environment meanings results in adaptation. When the meaning of the cancer experience emerges as beneficial to the self and others, the midlife cancer survivor adapts to survivorship.

As an adaptive system, the midlife person uses conscious awareness and choice to integrate the experience of the cancer diagnosis and treatment into life as a cancer survivor. This means that nursing interventions need to provide midlife survivors with information which will allow the individual to expand awareness of options and choose the best way to create human and environment integration for successful adaptation during cancer survivorship.

Nursing interventions to support our many patient populations require our urgent attention. As Sercekus and Mete (2010) indicate, the RAM ‘can be used as a guide in the development of antenatal [and other] programmes’ (p. 1008).