ROY’S ADAPTATION MODEL

 BRIEF BIBLIOGRAPHY
 Sister Callista L. Roy
 A highly respected nurse theorist, writer, lecturer, researcher, teacher and member of
the religious community.

 Born October 14th, 1939 in Los Angeles, California

 She is a member of the Sisters of St. Joseph of Carondelet
 Received her BSN from Mount Saint Mary's College in Los Angeles in 1963
 Worked as a pediatric staff nurse, where she noticed the amazing resiliency of the
children she cared for, and their ability to adapt to the major physical and psychological
changes they were experiencing.
 Professor and nurse Theorist at the Boston College of Nursing in Chesnut Hill
 Received her MSN from University of California, Los Angeles in 1966
 Master’s and PhD in Sociology in 1973 and 1977.
 In 1968, her alma mater Mount Saint Mary's adopted her model as the philosophical
foundation for their nursing curriculum.
 Worked as a professor and chairperson at Mount Saint Mary's, as well as professor at
University of Portland until 1983.
 From 1983-1985, she was a clinical nurse scholar in neuroscience during her Robert
Wood Johnson.
 Postdoctoral fellowship at University of California, San Francisco.
 In 1991, she founded the Boston Based Adaptation Research in Nursing Society
(BBARNS), which would later be renamed the Roy Adaptation Association.
 o Awards and Honors
 Sr. Callista Roy has received numerous honors due to her work and contribution to
the nursing profession.
 She received the American Journal of Nursing Book of the Year Award for the Roy
Adaptation Model Essentials.
 2007 – she was named “a Living Legend” by the American Academy of Nursing and the
Massachusetts Registered Nurses Association.
 1981 - she received the National Founder’s Award for Excellence in Fostering
Professional Nursing Standards.
 1984 – she received an Honorary Doctorate of Humane Letters from Alverno College.
 1985 – she received an Honorary Doctorates from Eastern Michigan University.
 1999 - she received an Honorary Doctorates from St. Joseph’s College.
 2007 – American Academy of Nursing Living Legend Award
 2011 – Nursing Science Quarterly Special Issue Honoring the work of Callista Roy, Vol.
24, Num. 4, Oct. 2011
 2013 – Excellence in Nursing, The University of Antioquia, Medellin Colombia

 Roy Adaptation Model Assumptions

Assumptions from systems theory and assumptions from adaptation level theory have been
combined into a single set of scientific assumptions. From systems theory, human adaptive
systems are viewed as interactive parts that act in unity for some purpose. Roy combined the
assumptions of humanism and veritivity into a single set of philosophical assumptions.
Humanism asserts that the person and human experiences are essential to knowing and valuing,
and that they share in creative power. Veritivity affirms the belief in the purpose, value, and
meaning of all human life. These scientific and philosophical assumptions have been refined for
use of the model in the twenty-first century.
 SCIENTIFIC ASSUMPTIONS

• Systems of matter and energy progress to higher levels of complex self-organization.

• Consciousness and meaning are constitutive of person and environment integration.
• Awareness of self and environment is rooted in thinking and feeling.
• Humans, by their decisions, are accountable for the integration of creative processes.
• Thinking and feeling mediate human action.
• System relationships include acceptance, protection, and fostering of interdependence.
• Persons and the earth have common patterns and integral relationships.
• Persons and environment transformations are created in human consciousness.
• Integration of human and environment meanings results in adaptation.
  PHILOSOPHICAL ASSUMPTIONS

• Persons have mutual relationships with the world and God.

• Human meaning is rooted in an omega point convergence of the universe.
• God is ultimately revealed in the diversity of creation and is the common destiny of creation.
• Persons use human creative abilities of awareness, enlightenment, and faith.
• Persons are accountable for the processes of deriving, sustaining, and transforming the
universe.
 There are also four implicit assumptions which state:
1. A person can be reduced to parts for study and care.
2. Nursing is based on causality.
3. A patient’s values and opinions should be considered and respected.
4. A state of adaptation frees a person’s energy to respond to other stimuli.

 MAJOR METAPARADIGM CONCEPTS

The metaparadigm concepts embedded within the RAM include person, environment, nursing
and health. There is a constant interaction on many levels allowing individuals and groups
(including families, communities, etc.) mutability and transformation. Utilizing the nursing
process, nurses can assess for “maladaptive behaviors” and develop care plans with interventions
that augment adaptation positively for improved outcomes (Kenney, 2013, p.368).
 Person – holistic beings that are in constant interaction with their environment.
 This applies to the individual (a bio-psycho-social being), to people within
groups and/or society in general. Coping mechanisms employed may either be
innate or acquired based on previous experiences.
 Environment – the conditions, circumstances and influences surrounding and affecting
the development and behavior of persons or groups, with particular consideration of the
mutuality of person and health resources that includes focal, contextual and residual
stimuli.
 Focal stimuli - confront the human system and require the most attention.
 Contextual stimuli - characterized as the rest of the stimuli present with the focal
stimuli and contribute to its effect.
 Residual stimuli - additional environmental factors present within the situation
but whose effect is unclear.
  Nursing – the promotion of adaptation for individuals and groups in each of the four
adaptive modes, thus contributing to health, quality of life, and dying with dignity.
 This applies to the nursing process and nurses’ ability to influence positive
adaptive responses to contribute to health
 Health – defined as the state where humans can continually adapt to stimuli
 Health is not freedom from the inevitability of death, disease, unhappiness, and
stress, but the ability to cope with them in a competent way.

 THEORY

Major Concepts
 Adaptation - goal of nursing
 Person - adaptive system
 Environment - stimuli
 Health - outcome of adaptation
 Nursing- promoting adaptation and health
Internal Processes
 Regulator/Regulator subsystem - a person’s physiological coping mechanism.
 Cognator/ cognator subsystem - a person’s mental coping mechanism.
Roy Model and the Nursing Process utilizes a bi-level assessment
 Assessment of behaviors:
- Behavior is an action or reaction under specified circumstances; behavior may be
observable, or not.
- Normally, a person adapts to stimuli positively, maintaining a “steady state” but in times
of stress when coping mechanisms are overwhelmed (i.e., illness), the person’s ability to
adapt to a new situation is impaired.
- The nurse observes behaviors (signs/symptoms) or responses of the patient and makes a
judgment as to whether the behavior is adaptive or ineffective.
 Assessment of stimuli:
- Stimuli are the underlying causes or factors contributing to the behaviors observed in first
level assessment; those things which provoke a response.
- Nurse identifies stimuli in all 4 adaptive modes; stimuli are manipulated via interventions
to achieve patient goals

Four Adaptive Modes Physiological, Self-Concept, Role Function,

Interdependence
 Physiological-Physical Mode - Physical and chemical processes are involved in
the function and activities of living organisms. These are the actual processes put
in motion by the regulator subsystem.
- Basic underlying need: promote physiological integrity
 Self-Concept Mode- deals with the person’s beliefs & feelings about
himself/herself.
- Basic underlying need:
a. psychic integrity - physical perceptions, ideals, goals,
moral/ethical beliefs
b. Physical self - how one sees his own physical being
c. body sensation: ability to express sensations/feel symptoms
d. body image: how one sees himself as a physical being
 Role Function Mode - involves the position one occupies in society; behaviors
associated with one’s position (role) in society.
a. Primary role: role based on age, sex, developmental state
b. Secondary role: role(s) a person assumes to complete tasks associated
with a primary role or developmental stage
c. Tertiary role: a role freely chosen; temporary; associated with
accomplishments of tasks or goals
  Interdependence Mode - deals with the person’s beliefs & feelings about
himself/herself.
- Basic underlying need: nurturance and affection
a. Significant others: intimate relationships (spouse, parent, God)
b. Support systems: fewer intimate relationships (coworkers,
friends)
c. Giving behaviors: giving love, nurturance, affection
d. Receiving behaviors: receiving/taking in love, nurturance,
affection

Levels of Adaptation
 Integrated Process - various modes and subsystems meet the needs of the
environment (e.g., breathing, spiritual realization, successful relationship)
 Compensatory Process - cognator and regulator are challenged by the
environment’s needs but are working to meet the needs (e.g., grief, starting with a
new job, compensatory breathing).
 Compromised Process - modes and subsystems are not adequately meeting the
environmental challenge (e.g., hypoxia, unresolved loss, abusive relationships).

Six-Step Nursing Process

A nurse’s role in the Adaptation Model is to manipulate stimuli by removing, decreasing,
increasing, or altering stimuli so that the patient.

1. Assess the behaviors manifested from the four adaptive modes.

2. Assess the stimuli, categorize them as focal, contextual, or residual.
3. Make a statement or nursing diagnosis of the person’s adaptive state.
4. Set a goal to promote adaptation.
5. Implement interventions aimed at managing the stimuli.
6. Evaluate whether the adaptive goal has been met.
  ANALYSIS
As one of the weaknesses of the theory that applying it is time-consuming, applying the model to
emergencies requiring quick action is difficult to complete, the individual might have completed
the whole adaptation process without the benefit of having a complete assessment for thorough
nursing interventions.
Adaptive responses may vary in every individual and may take a longer time compared to others.
Thus, the span of control of nurses may be impeded by the time of the patient’s discharge.
Roy focused on the whole adaptive system itself. Each concept was linked with the coping
mechanisms of every individual in the process of adapting.
When an individual presents an ineffective response during his or her adaptation process, the
nurses’ roles were not clearly discussed. The main point of the concept was to promote
adaptation, but none were stated on preventing and resolving maladaptation.

Strengths of the Roy’s Adaptation Model

 The Adaptation Model of Callista Roy suggests the influence of multiple causes in a
situation, which is a strength when dealing with multi-faceted human beings.
 The sequence of concepts in Roy’s model follows logically. In the presentation of each of
the key concepts, there is the recurring idea of adaptation to maintain integrity. Every
concept was operationally defined.
 The concepts of Roy’s model are stated in relatively simple terms.
 A major strength of the model is that it guides nurses to use observation and interviewing
skills in doing an individualized assessment of each person. The concepts of Roy’s model
are applicable within many practice settings of nursing.

Weaknesses
 Painstaking application of the model requires a significant input of time and
effort.
 Roy’s model has many elements, systems, structures, and multiple concepts
  CONCLUSION
The use of Roy Adaptation of Nursing enhances nursing care on a patient. Implementing this
model in practice is perceived and having a positive impact on personal sense of nurses as well as
on the image of nursing profession as a whole. The model is found effective in providing
direction towards achieving patient outcomes. According to the writer, the introduction of the
model the patient a positive difference in quality of patient care, primary due to comprehensive
approach to assessment and planning. In the clinical care setting, the model concepts were more
easily incorporated to practice than the actual language of model. A several stimuli which are
affecting the person from the internal and external environment in four different modes of
adaptation is being manage by nursing interventions. The stimuli are shown as aiming to affect
persons equilibrium, but with appropriate nursing interventions, they are diverted away from the
patient and effective adaptation is achieved. Overall, this model provides a structure for focusing,
organizing and directing thoughts and actions related to patient care and achieving, desired
patient outcomes efficiently and effectively.