¶ … Roy Model The patient history for Tory is the following: She is a 28-year-old professional in the HR division at a managing firm, who suffers from debilitating obsessive-compulsive disorder, which for the past few months has intruded into every sector of her personal and public life, even causing her to miss work. She is also now having suicidal thoughts, which are reoccurring for the past two weeks. She has considered jumping from the window of her apartment, even though she says she would not do it -- she simply imagines herself doing this and therefore fears that she might actually leap if she does not get control of herself. For years her work has been the only comfort in her life and now even that is in danger of being lost. Her background is that she is an only child of parents who divorced when she was 7. Her father moved to a different city and Tory was raised by her stern Methodist mother, who required that Tory devote herself to her studies and excel in her education. Tory preferred her father, who was more relaxed about life, but the tension between her parents caused it so that she rarely got to spend much time with her dad. Her mother was very emphatic about always being clean and instilled an obsession with cleanliness in Tory at an early age.

As Tory matured, she began to have strong sexual feelings that she did not know how to interpret, given her Methodist upbringing, and she was confused by them and did not dare talk to her mother about them. In college she began to see a boy who wanted to engage in sexual intercourse with her. She resisted for as long as she could but finally she gave in, and she then became pregnant. Her mother required that she have an abortion, then she and her mother went to Europe for a year. When they returned the boy had moved on to someone else, which is what her mother had hoped. Tory sank herself into her work but over the next few years her condition worsened. She had to engage in a dressing and undressing routine every day in which every article of clothing was put on or taken off in a specific order. This routine had intensified recently and Tory was doing it sometimes for half the day, unable to stop even though she realized how ridiculous it was. Because of this condition she was now missing work, unable to leave the house, obsessing over cleanliness in her appearance and unable to function on any professional or social level.

Her disease is a psycho-social disease that is rooted in her history with her mother and has a behavioral trigger that seems to have intensified with the abortion of her child when she was 21. Her physical health is good; she has no presenting illnesses other than her OCD -- but her suicidal thoughts suggest that she may be in a state of despair about her condition. Her environment is lonely: she lives alone in the city in a rented apartment, has no friends and her only social contact is at work, though she is very often simply so focused on her job that she does not even really socialize there. She does not communicate with her mother except when her mother calls, which is rare -- only a few times every few months. She does not communicate with her father either. She has presented herself for treatment because she fears she may be "losing her mind," as she put it.

Nursing care in the case of Tory would focus on the self-concept-group identity mode and would incorporate family therapy, involving both of Tory's parents to help with Tory's OCD, depression and suicidal thoughts. The aim would be to alter stimuli that are evident in Tory's life and strengthen adaptive processes so that adaptive behaviors can be triggered and Tory proceed out of her OCD and suicidal thoughts towards a more stable state. The stimuli that should be effected are more contact with her family and support group, which needs to be developed as there is virtually no existing support group for Tory at present....

As Roy (1980) notes, the Adaptive model takes a humanistic approach to valuing the person's life, and in Tory's case value has to not only be identified in her life but also added in terms of bringing friendship and familial support into her environment, which would then act as a stimuli for her to generate more positive behaviors and attitudes and to combat her depression, suicidal thoughts and her obsessive-compulsive disorder.
The questions that would need to be asked would include how Tory's family identifies itself and what its goal for itself as a group as well as for its members as individuals is. This will be difficult to assess given the nature/dynamic of the family, but with some work and understanding the family members may be able to work together to solve the problems facing this family dynamic. The values of the family, however, or complicated because clearly the mother values a strict stance on social mores whereas the father is more relaxed. Tory does not know what to value. She is submissive to her mother but prefers her father because he is so relaxed and happy.

Physiological mode would focus on the extent to which the family is able to help Tory to meet her basic needs. Can she shop for herself, provide food for herself? Are Tory's parents able to provide for themselves? From the assessment it appears that they are and that they could help Tory with her needs. Because persons are co-extensive with their surroundings, it is imperative to engage Tory's surroundings and those around her, to possibly identify friends at work who may be willing to help, to come to Tory's aid -- untapped potential that is waiting to be manifested, for instance (Roy, 1997). This would be helpful in eliminating Tory's seclusion, as she has effectively sealed herself off from her surroundings and, even though she knows what she is doing is wrong, she cannot help it and cannot stop. She admits to only presenting herself on a whim, as though something outside herself has made her do it, because she did not even think of it or deliberate on it -- she simply took herself to the hospital and confessed everything calmly, wondering if there is any hope for her or if she has already lost her mind and will never get it back for trying. She wonders too if this same sort of whim could cause her to jump out her apartment window to her death and that makes her all the more afraid to be alone now. This is a sign that Tory is ready to develop an interdependence mode of engagement that can provide the right set of positive stimuli for her to begin to improve (Roy, 1997).

As for function mode, the roles assumed by the parents would need so addressing: the father would need to take a more active role in Tory's life as he is a positive influence, while the mother would need to adopt a softer relationship so as not to push Tory further into herself. The mother is supportive in terms of providing a strong pillar of determination for Tory that was helpful in pushing her to achieve success at school and work, but internally Tory is suffering from a lack of confidence which she desperately needs and is not getting from anyone. Her father is not around to help so his role is limited but he could perhaps offer to be closer to Tory to help her in this trying situation. Family decisions are currently reached in a forced manner: the separation was not amicable and the parents do not communicate. Better communication needs to transpire for Tory's sake (Rambo, 2004; Roy, Florczak, 2011).

Interdependence mode would show that although Tory is independent from both parents, she is physically and psychologically handcuffed by her OCD, which she has inherited to some extent from her domineering mother. Moreover, her suicidal thoughts are expressive of a complete collapse of Tory's fundamental support system: she feels overwhelmed and undervalued and thus she imagines herself leaping to her death. This feeling has to be replaced by more positive feelings that can be generated through interconnectivity with friends and loved ones (Roy, 1980). The family is in need of a stronger support system and Tory is in need of this especially as she is isolated and has no confidants. The interaction of Tory in the community is nil. Her mother is more interactive at church. Her father is very interactive at both his work and in his community where he lives.

Tory's health is dependent upon her receiving some fresh stimuli that can serve as regulators of her psychology. Her self-concept has been severely damaged by her abortion of her child by the urging of her mother. She has literally closed up…