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Critical Assessment of a Nursing Conceptual Model

Ihssan Tahir
Department of Nursing, Jacksonville State University
NU 504: Nursing Theories
Dr. Richey & Dr. Djonret-Hall
October 2nd, 2020
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Sister Callista Roy began developing the Roy Adaptation Model (RAM) of Nursing while

obtaining her Master’s degree at University of California Los Angeles in 1966. During a course

with Dorothy E. Johnson, who created the Behavioral System Model, Roy was given the task of

creating a conceptual model for nursing.

As a pediatric nurse Roy witnessed a great amount of resilience and adaptiveness in ill

children and decided to curate a conceptual framework for nursing based on these experiences.

The basic tenants of the model were developed from 1964 to 1966 while Roy was completing her

graduate studies and teaching at St. Mary’s School (Gonzalo, 2019). It was estimated that Roy

used nearly 1,500 students, faculty members and patients in the development of this model

(Alligood, 2011). It would prove worthwhile because it is one of the foundations of nursing

models today.

During the development of RAM there was an emphasis on family, education,

religious background, mentors and clinical experience. The model was based upon the idea that

people are responsible for the process of establishing, sustaining, and evolving the world around

them. Some of the scientific assumptions include that awareness of self and environment is

rooted in thinking and feeling and a cultural assumption that should be noted is that experiences

with a specific culture will dictate how RAM is expressed. (Nursing Theories, 2012).

Roy explained that adaptation happens when people respond positively to environmental

disruptions and it is the process and outcome of individuals and groups who use “conscious

awareness, self-reflection, and choice to create human and environmental integration” (Nursing

Theory, 2019). The prime components of the model include person, health, environment and

nursing. Within the theory Roy also emphasized the regulator (physiological coping mechanism)
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and cognator (mental coping mechanism). Roy also detailed the contextual stimuli (affecting

current situation), focal stimuli and residual (beliefs and behaviors) stimuli which is identified by

the nurse.

While developing this theory Roy strongly believed that nursing was a scientific and

compassionate profession and emphasized the importance of specialized knowledge in

contributing health needs and well-being of the community (Ursavas, Karayurt, Iseri, 2014).

Through the Roy Adaptation Model there is a focus on providing holistic care to an

individual. The idea lies in the concept that the patient is connected to many external and internal

factors that dictate their quality of life. Adaptation to these factors have the likelihood of

increasing life expectancy, which is the ultimate goal of RAM. Assisting the patient in learning

these tools involves health promotion, compassion and ensuring the patient has autonomy

throughout the process. Humanism is another nursing value used throughout RAM. Humanism is

the understanding that individuals have purpose and highlight the importance of self-

determination and integrity (Berrerril, 2016).

Ursavas (2014) stated, “According to Roy adaptation model, the aim of nursing is to

increase compliance and life expectancy. Roy Adaptation Model evaluates the patient in

physiologic mode, self-concept mode, role function mode and interdependence mode aiming to

provide holistic care.”

According to Roy’s model, a person is a bio-psycho-social being in constant interaction

with a changing environment. He or she uses natural and learned mechanisms to adapt. Roy’s

goal of nursing is “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” (Alligood,

2011).
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There were several researchers that influenced Roy. The most notable influencer was

Harry Helson. Helson’s research, particularly his work in psychophysics, aided Roy in the

development of her model (Alligood, 2011). Other prominent scholars included Ludwig von

Bertalanffy’s System Model, and Anatol Rapoport’s system definition.

The metaparadigm concepts of RAM are person, environment, health and nursing are all

clearly described and relate directly to the mode and link them appropriately. The person is in

constant exchanges with an evolving environment. According to Alligood (2011) any

environmental change demands increasing effort to adapt to the given circumstance. Factors in

the environment that affect the person are categorized as focal, contextual, and residual stimuli.

A focal stimulus is the confrontation with one’s internal and external environment (Ursavas,

Karayurt, Iseri, 2014).

Roy defined health as the process of being and becoming an integrated and complete

person. Roy (1991) wrote, “Health is not freedom from the inevitability of death, disease,

unhappiness, and stress, but the ability to cope with them in a competent way”. According to

Alligood (2011), Roy identified nursing activities as the assessment of behavior and the stimuli

that influence adaptation. The nursing process that Roy identified was:

1. Assesses the behaviors manifested from the four adaptive modes

2. Assesses the stimuli for those behaviors and categorizes

them as focal, contextual, or residual stimuli

3. Makes a statement or nursing diagnosis of the person’s adaptive state

4. Sets goals to promote adaptation

5. Implements interventions aimed at managing the stimuli to promote adaptation

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6. Evaluates whether the adaptive goals have been met

(Alligood, 2011)

Roy’s Adaptive Model has more than one worldview which lies directly in its

philosophy. Within this model patients’ values and core beliefs are respected and should be

considered. A person is in charge of their outcome, autonomy is upheld. There has been much

development of RAM throughout the last several decades which has allowed it to be a model that

can be applied to diverse patient groups (Alligood, 2011).

The Roy Adaptation Model is credible because it has a clear and distinct nursing process

to gather information from a patient. Proper nursing assessments involves collecting pertinent

information from a patient. Stress and coping mechanisms employed by a patient are one of the

questions I inquire about during triage intakes as an emergency room nurse. RAM has tangible

results that can be measured when utilizing the process. This model is extensively used in

oncology and palliative care units to aid patients in holistic healing and recovery.

The Roy Adaptation Model is one of the most widely used nursing models both nationally and

internationally. Roy has been the recipient of many awards throughout the last several decades.

These recognitions and awards include honorary doctorates from Alverno College, Eastern

Michigan University and St. Josephs College in Maine (Fawcett, 2018). The Roy Academia

Nursology Research Center has been established at St. Mary’s University of Kurume, Japan in

recognition of Roy’s work.

RAM is taught in most nursing programs throughout the country and both institutional

and noninstitutional settings have used the model in their care of patients. This model has

influenced the development of many middle-range theories and has been employed in distinct

research studies. According to Alligood (2011) RAM continues to populate many testable
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hypotheses to be researched. Weiss, Fawcett and Aber (2009) used the RAM to describe

“women’s physical, emotional, functional and social adaptation; postpartum concerns; and

learning needs during the first two weeks following caesarean birth and identify relevant nursing

interventions.” The results of the study indicated that there were fewer adaptive outcomes in

women with unplanned caesarean delivery.

Other examples of this model being used in research include the study entitled “Breast

cancer: evaluation of the Common Journey Breast Cancer Support Group” (Zeigler, Smith,

Fawcett, 2004). This qualitative study used the RAM to evaluate both facilitators and

participants.

Dunn (2004) used RAM as a foundation to establish a middle-range theory of adaptation

for chronic pain. According to Alligood (2001),” In Dunn’s model of adaptation to chronic pain,

pain intensity is specified as the focal stimulus.”

In another example, researchers at the University of Montreal have used a middle-range

theory of adaptation to caregiving that is rooted in the RAM. According to Alligood (2011),

“This middle-range theory has been tested in a number of published studies of informal

caregivers of demented relatives at home, informal caregivers of psychiatrically ill relatives at

home, professional caregivers of elderly institutionalized patients, and aged spouses in the

community.”

Additional theories based on RAM include:

- Flood, M. (2005). A mid-range nursing theory of successful aging. Journal of Theory

Construction and Testing, 9, 35-39.

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- Hamilton, R.J., & Bowers, B.J. (2007). The theory of genetic vulnerability: A Roy model

exemplar. Nursing Science Quarterly, 20, 254-264.

- Tsai, P., Tak, S., Moore, C., & Palencia, I. (2003). Testing a theory of chronic pain.

Journal of Advanced Nursing, 43, 158-169.

In summary, Roy’s Adaptive Model is a respected and widely utilized model for many

nurses, researchers and theorists. It has been utilized in an innumerable amount of studies and

clinical/non-clinical settings. RAM has assisted in generating theories for a wide variety of

patient populations which range from those suffering from post-traumatic stress disorder to

menopausal women.
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References

Alligood, M. R. (2018). Nursing Theorists and Their Work (9th ed.). St. Louis, MO: Elsevier. 

Dunn, K. (2004). Toward a Middle-Range Theory of Adaptation to Chronic Pain - Karen S.

Dunn, 2004. Retrieved September 25, 2020, from
https://journals.sagepub.com/doi/10.1177/0894318403260474

Gonzalo, A. (2019, September 10). Sister Callista Roy: Adaptation Model of Nursing. Retrieved
October 02, 2020, from https://nurseslabs.com/sister-callista-roys-adaptation-model/

Roy's Adaptation Model of Nursing. (2020, July 21). Retrieved October 02, 2020, from
https://nursing-theory.org/theories-and-models/roy-adaptation-model.php

Roy's Adaptation Model. (2020, July 12). Retrieved September 29, 2020, from
https://nursology.net/nurse-theorists-and-their-work/roys-adaptation-model/

Ursavaş, F., Karayurt, Ö, & İşeri, Ö. (2014, July 1). Nursing Approach Based on Roy Adaptation

Model in a Patient Undergoing Breast Conserving Surgery for Breast Cancer. Retrieved

September 26, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351537/

Weiss, M., Fawcett, J., & Aber, C. (2009). Adaptation, postpartum concerns, and learning needs
in the first two weeks after caesarean birth. Retrieved September 25, 2020, from
https://pubmed.ncbi.nlm.nih.gov/19821872/

Zeigler, L., Fawcett, J., & Smith, P. (2004). Breast cancer: Evaluation of the Common Journey
Breast Cancer Support Group. Retrieved September 29, 2020, from
https://pubmed.ncbi.nlm.nih.gov/15086633/