Journal of Applied Holistic Nursing Science, e-ISSN 3090-1316 Vol.
No.
February 2026 https://doi.
org/10.
70920/jahns.
Original Research Application of RoyAos Adaptation Model and SwansonAos Caring Theory in Nursing Care for PostAeHydatidiform Mole Patients: A Case-Based Study Atun Raudotul MaAorifah1.
Setyowati2.
Yati Afiyanti 3 Department of Nursing.
Faculty of Health Sciences.
Universitas Harapan Bangsa.
Indonesia.
Faculty of Nursing.
Universitas Indonesia.
Indonesia
ABSTRACT
Background: Nurses play a key role in improving womenAos reproductive health through theory-based care.
Gestational trophoblastic disease, including hydatidiform mole, is a highrisk condition with potential physical and psychological This study aimed to describe the application of RoyAos Adaptation Model and SwansonAos Caring Theory in nursing care for postAehydatidiform mole patients after curettage Methods: A descriptive case-based approach was conducted in a referral hospital.
Data were collected through comprehensive nursing assessments covering physiological, self-concept, role function, and interdependence domains, along with focal, contextual, and residual stimuli.
Nursing diagnoses, interventions, and evaluations were developed using RoyAos Adaptation Model and integrated with SwansonAos five caring processes.
Results: Theory-guided care improved bleeding and infection risk management, reduced anxiety, and enhanced patient understanding and adherence to follow-up care, including hCG monitoring.
Adaptive responses were particularly evident in psychological adjustment and coping.
ARTICLE HISTORY
Received : 28-1-2026
Published: 28-2-2026
KEYWORDS
Nursing care.
RoyAos Adaptation SwansonAos Caring Theory.
Hydatidiform mole.
Reproductive CONTACT Atun Raudotul Marifah Email of Corresponding Author atunraudotul@uhb.
Bachelor and Professional Nursing Program.
Faculty of Health.
Universitas Harapan Bangsa Purwokerto.
Indonesia Conclusion: The integration of RoyAos Adaptation Model and SwansonAos Caring Theory enhances adaptive capacity and supports recovery in postAehydatidiform mole patients, highlighting the importance of strengthening nursesAo theoretical competencies.
Cite this as: Atun Raudotul MaAorifah1.
Setyowati2.
Yati Afiyanti 3 .
Application of RoyAos Adaptation Model and SwansonAos Caring Theory in Nursing Care for PostAeHydatidiform Mole Patients: A Case-Based Study :
Original Research , 2.
https://doi.
org/10.
70920/jahns.
INTRODUCTION
Gestational trophoblastic disease (GTD) comprises a spectrum of pregnancy-related disorders arising from abnormal trophoblastic proliferation, with hydatidiform mole being the most common presentation (Joyce et al.
, 2022.
Bruce, 2.
Although advances in early diagnosis and clinical management have substantially reduced mortality, women diagnosed with hydatidiform mole remain at risk of significant physical complications, including excessive uterine bleeding and infection, as well as psychological distress related to uncertainty https://jurnal.
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February 2026 about malignancy risk and future fertility (Di Mattei et al.
, 2016.
Di Mattei et al.
, 2.
Following uterine evacuation, prolonged follow-up involving serial -human chorionic gonadotropin (-hCG) monitoring and contraceptive adherence is required, which may further challenge patientsAo emotional well-being and adaptive capacity during recovery (Ning et al.
In this context, nursing care plays a pivotal role in supporting both physical stabilization and psychosocial adaptation.
Recent literature has continued to emphasize biomedical aspects of GTD management, including diagnostic refinement, surveillance strategies, and oncological outcomes (Joyce et , 2022.
Bruce, 2.
Studies focusing on patient experiences consistently re port elevated anxiety, emotional distress, and reproductive concerns during the follow-up period after molar pregnancy (Di Mattei et al.
, 2016.
Di Mattei et al.
, 2.
Quantitative studies have shown that structured psychosocial support and educational interventions can significantly reduce anxiety levels and improve adherence to follow-up among women with GTD, highlighting the importance of non-pharmacological supportive care alongside medical management (Di Mattei et al.
, 2017.
Assis et al.
, 2.
However, nursing-specific research in this field remains limited and is often confined to general education or symptom-focused care, with little attention to explicitly theory-guided nursing interventions.
Nursing theories provide a strong conceptual foundation for holistic and systematic RoyAos Adaptation Model conceptualizes individuals as adaptive systems responding to focal, contextual, and residual stimuli through four adaptive modesAiphysiological, selfconcept, role function, and interdependenceAiallowing nurses to identify adaptive and maladaptive responses and plan targeted interventions (Roy, 2009.
Alligood, 2.
SwansonAos Caring Theory complements this framework by emphasizing relational and e thical dimensions of nursing through five caring processes: knowing, being with, doing for, enabling, and maintaining belief, which have been associated with improved emotional support and patient centered outcomes in maternal and reproductive health settings (Swanson, 1991.
Afiyanti & Milanti, 2.
Evidence from quantitative nursing studies in reproductive and maternal health contexts suggests that theory-based interventions can improve coping, psychological adjustment, and patient engagement in care (Wang et al.
, 2.
This study addresses the gap in the literature by describing the integrated application of RoyAos Adaptation Model and SwansonAos Caring Theory in nursing care for postAehydatidiform mole patients, offering a theory-guided approach that extends beyond biomedical management to support adaptive responses, emotional well-being, and continuity of reproductive health care following curettage.
MATERIALS AND METHOD
This study employed a descriptive case-based approach involving multiple clinical cases to document the application of theory-guided nursing care using RoyAos Adaptation Model and SwansonAos Caring Theory in postAehydatidiform mole patients following curettage.
A casebased descriptive design was selected to capture clinical complexity and contextualized nursing practice in real-world settings, particularly when the application of nursing theory is the primary focus (Yin, 2.
The study was conducted in the gynecology ward of a tertiary referral hospital in Bogor Regency.
Indonesia.
Five postAehydatidiform mole patients who had undergone uterine curettage and were receiving inpatient nursing care were included based on clinical relevance and availability during the study period, rather than statistical sampling, consistent with descriptive case-based nursing research (Polit & Beck, 2.
Data were collected through systematic nursing assessments guided by RoyAos Adaptation Model across four adaptive modesAiphysiological, self-concept, role function, and interdependenceAiand integrated with SwansonAos caring processes during routine nursing care https://jurnal.
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February 2026 (Roy, 2009.
Swanson, 1.
Each case was observed and documented at least twice during hospitalization to capture within-case changes and allow cross-case descriptive analysis.
Data analysis was conducted descriptively, with nursing assessment findings, diagnoses, interventions, and evaluation outcomes organized according to the theoretical frameworks, enabling systematic interpretation of adaptive responses (Alligood, 2.
Ethical approval was obtained from the institutional ethics committee, and written informed consent was secured from all participants prior to data collection RESULTS The characteristics and clinical conditions of postAehydatidiform mole patients are summarized in Table 1.
All five patients presented with vaginal bleeding and varying degrees of physiological compromise, including anemia and hemodynamic instability, and had undergone curettage prior to nursing care.
Nursing assessment findings and observed adaptive responses following theory-guided nursing care are presented in Table 2.
Dominant nursing problems were identified across physiological, self-concept, role function, and interdependence Following the implementation of theory-guided nursing care, observable improvements were noted in physical and psychological adaptation, coping behaviors, and understanding of follow-up care.
Table 1.
Characteristics and Clinical Conditions of PostAeHydatidiform Mole Patients Domain Description Age range 25Ae47 years Educational level Primary to secondary education Occupation Housewives Obstetric status G1AeG4 History of molar pregnancy Present in several patients Admission diagnosis Hydatidiform mole / suspected GTD Main clinical presentation Vaginal bleeding Hemodynamic condition Hypotension and tachycardia in some patients Hemoglobin level Reduced in most patients -hCG level Elevated, ranging from moderate to very high Post-curettage status First-time and recurrent curettage Table 2.
Nursing Assessment and Observed Outcomes Based on Theory-Guided Care
Domain
Key Findings Physiological mode
Bleeding risk, anemia, fatigue Self-concept mode
Anxiety, fear of disease progression and mortality Role function mode
Concerns regarding childcare and family roles Interdependence mode
Need for emotional and family support
Physical adaptation outcome Improved stability and symptom control
Psychological adaptation outcome Reduced anxiety and emotional distress
Coping strategies Improved acceptance and adaptive coping Better understanding of -hCG monitoring and Follow-up adherence care plan
DISCUSSION
This study demonstrates that the integration of RoyAos Adaptation Model and SwansonAos Caring Theory provides a coherent and clinically meaningful framework for nursing care in postAehydatidiform mole patients.
By synthesizing findings across cases, the findings are situated within contemporary theoretical and empirical literature.
Physiological problems such as vaginal bleeding, anemia, and post-procedural recovery needs were consistently identified in the nursing assessments.
These findings correspond with current evidence indicating that hemorrhage and anemia remain common complications following molar pregnancy and curettage, often leading to repeated hospitalization and prolonged recovery https://jurnal.
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February 2026 (Joyce et al.
, 2022.
Bruce, 2.
Within RoyAos Adaptation Model, these conditions function as focal stimuli that disrupt physiological adaptation.
The observed improvement in physical stability during the course of nursing care suggests that structured assessment and intervention based on adaptive modes may support physiological recovery in high-risk reproductive conditions, as also reported in recent nursing intervention studies (Wang et al.
, 2.
Beyond physical instability, psychological distress emerged as a prominent finding in this study.
Anxiety, fear of disease progression, concerns about mortality, and uncertainty regarding future fertility were commonly identified during nursing assessment.
Similar emotional responses have been widely documented among women with gestational trophoblastic disease, particularly during the prolonged period of -hCG surveillance (Di Mattei et al.
, 2021.
Braga et al.
, 2.
In this study, the reduction in anxiet y and improved coping observed after nursing care indicate that addressing psychological adaptation is an essential component of postAehydatidiform mole management.
Importantly, limited patient understanding of follow-up care, particularly regarding the importance of regular -hCG monitoring, emerged as a clinically significant issue in this study.
This finding is critical, as inadequate post-evacuation surveillance has been identified as a key factor contributing to delayed detection of malignant transformation, including gestational trophoblastic neoplasia (Joyce et al.
, 2022.
Bruce, 2.
Previous studies have emphasized that poor adherence to -hCG follow-up protocols remains a persistent challenge, especially when patient education and supportive communication are insufficient (Braga et al.
, 2.
From a nursing perspective, this finding underscores the central role of enabling and maintaining belief, as described in SwansonAos Caring Theory, in supporting patient understanding, adherence, and long-term safety.
The complementary use of RoyAos Adaptation Model and SwansonAos Caring Theory strengthens nursing practice by integrating systematic assessment with relational care.
RoyAos model facilitates the identification of maladaptive responses across physiological, se lf-concept, role function, and interdependence modes, while SwansonAos theory emphasizes the ethical and interpersonal dimensions of caring that are particularly relevant in emotionally complex Recent nursing literature supports the continued relevance of theory-based interventions in maternal and reproductive health, demonstrating their effectiveness in improving psychological adjustment, patient engagement, and adherence to care plans (Alligood, 2018.
Fawcett & DeSanto-Madeya, 2021.
Karimi et al.
, 2.
The improved coping strategies and follow-up understanding observed in this study are consistent with these reports.
From a theoretical standpoint, this study reinforces the applicability of nursing theories in contemporary clinical practice, showing that theoretical frameworks can be operationalized beyond educational settings.
From an implementation perspective, the fi ndings suggest that theory-guided nursing care is feasible within routine hospital environments and may enhance the quality and continuity of care for postAehydatidiform mole patients, particularly by addressing psychosocial needs that are often underemphasized in predominantly biomedical management approaches (Joyce et al.
, 2022.
Braga et al.
, 2.
Several limitations should be acknowledged.
The descriptive case-based design and small number of cases limit generalizability and do not allow causal inference.
In addition, outcomes were evaluated qualitatively through nursing observations rather than st andardized uantitative instruments.
Future studies are encouraged to involve larger samples, apply validated psychological measures, and employ longitudinal or comparative designs to further evaluate the effectiveness of theory-guided nursing interventions in patients with gestational trophoblastic disease.
Despite these limitations, the findings provide valuable insight into the role of nursing theories in supporting adaptive responses among postAehydatidiform mole patients.
This study contributes to the growing body of evidence advocating for theory-informed nursing practice https://jurnal.
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CONCLUSION
This study demonstrates that the application of RoyAos Adaptation Model integrated with SwansonAos Caring Theory can serve as a coherent framework to guide nursing care for postAe hydatidiform mole patients in addressing both physical and psychosocial needs.
Through a case-based synthesis, theory-guided nursing care was associated with physiological stabilization, reduced psychological distress, enhanced adaptive coping, and improved patient understanding of follow-up care, including -hCG monitoring.
These findings indicate that nursing theories can be operationalized meaningfully in clinical practice and contribute to holistic, patient-centered care in reproductive health settings.
SUGGESTION:
Future studies are recommended to involve larger samples and employ standardized quantitative instruments to further evaluate the effectiveness of theory -guided nursing interventions and strengthen evidence-based nursing practice for patients with gestational trophoblastic disease.
ACKNOWLEDGEMENT
The authors would like to express their sincere gratitude to the hospital management and nursing staff of the gynecology ward for their support and cooperation during data The authors also extend their appreciation to the patients who participated in this study and shared their experiences, making this work possible.
REFERENCES