[An exercise in mutual complementation between nurses and educators].
This article describes the strategy adopted by the Philippe Pinel Institute of Montreal in implementing the Callista Roy conceptual model. The institute, which specializes in forensic psychiatry, has some 300 patients. It is interesting to note that there are approximately twice as many therapists as nurses at the institute. This seemed at the outset to be a major stumbling block. The authors give an overview of the institute's mission, which is fourfold: health care, teaching, research and guardianship of the patients. The reasons for adopting the Roy model and the process followed are described. The primary challenge was to change the organization's corporate culture and health care philosophy. This was enormously time-consuming and required a great deal of mental energy and conscious effort on the part of the staff. To ensure successful implementation, the institute addressed not only the philosophical and policy dimensions of the model (the why), its technical aspect (the how), but also its logical and systematic dimension (the what). The article describes the elements of the model and its assumptions, with an emphasis on the various modes of adaptation to stimuli. It also looks at the training approach that was taken, the methods used to overcome resistance to change and the problems encountered. The clinical example will help readers better understand the implementation process. The subject is a 27-year-old woman, mother of a 10-year-old son and a four-month-old baby girl. She was confined to the institute by a court order after having drowned the infant while giving her a bath. The assessment process consisted of: data collection, analysis and determination of relevant stimuli, for example, the stimuli that could be manipulated, either to promote more adaptive behavior patterns, or to diminish negative responses. Normal daily and weekly activities are the means through which behavioral change can be achieved. The nursing care plan describes this in detail.