Sister Callista Roy

Roy Adaptation Model (RAM)

Roy Adaptation Model (RAM)

has evoked much interest and respect since its inception in 1964 by Roy as part of her graduate work at the University of California, Los Angeles, under the guidance of Dorothy Johnson.

Johnson's nursing model

➢ was the impetus for the development of the RAM.

von Bertalanffy's general system theory and Helson's adaptation theory.

➢ Roy credits the works of _______ as forming the basis of the scientific assumptions underlying the Roy model.

Roy also incorporated

➢ Rapoport's system definition, the stress and adaptation theories of Dohrenrend and Selye, and the coping model of Lazarus.

FOUR ESSENTIAL ELEMENTS OF THE RAM:

1. PERSON - recipient of nursing care

2. The concept of environment

3. The concept of health

4. Nursing

VERITIVITY

• affirms the belief in the purpose, values, and meaning of all human life.

HUMANISM

• asserts that the person and human experiences are essential to knowing and valuing and that they share in creative power.

NURSING

➢ Roy defines nursing as a health care profession that focuses on human life processes and patterns and emphasizes the promotion of health for individuals, families, groups, and society as a whole. ➢ 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.

PERSON

➢ According to Roy, humans are holistic, adaptive systems. ➢ As an adaptive system, the human system is described as a whole with parts that function as unity for some purpose. ➢ Human systems include people as individuals or in groups including families, communities, organizations, and society as a whole.

HEALTH

➢ Is a state and a process of being and becoming integrated and a whole person. ➢ It is a reflection of adaptation, that is, the interaction of the person and environment. ➢ Roy viewed health along a continuum flowing from death and extreme poor health to high level and peak wellness. ➢ Roy also 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."

ENVIRONMENT

➢ According to Roy, environment is all the conditions, circumstances, and influences surrounding and affecting the development and behavior of persons or groups, with particular considerations of the mutuality of person and earth resources that include focal, contextual, and residual stimuli.

INPUTS

as stimuli and adaptation level.

COPING MECHANISMS.

control processes known as

OUTPUT

as behavioral responses that serve as feedback

RESIDUAL STIMULI

3. RESIDUAL STIMULI - are those internal and external factors whose current effects are unclear.

FOCAL STIMULI

• stimulus most immediately confronting the person.

CONTEXTUAL STIMULI

are all other stimuli present in the situation that contribute to the effect of the focal stimulus. Contextual stimulus are all environmental factors that present to the person from within or without but which are not the center of the person's attention and/or energy.

INEFFECTIVE RESPONSES

• are those that do not contribute to integrity in terms of the goals of the human system.

ADAPTIVE RESPONSES

• are those that promote the integrity of the person. The person's integrity or wholeness, is behaviorally demonstrated when the person is able to meet the goals in terms of survival, growth, reproduction, and mastery.

COPING MECHANISMS

• describes the control processes of the person as an adaptive system.

INNATE COPING MECHANISMS

• are genetically determined or common to the species and are generally viewed as automatic processes

ACQUIRED COPING MECHANISMS

• are developed through strategies such as learning.

REGULATOR SUBSYSTEM

• a major coping process involving neural, chemical, and endocrine systems.

COGNATOR SUBSYSTEM

• a major coping process involving higher brain functions of perception or information processing, judgment, and emotion.

• Perception or information processing is related to the internal processes of selective attention, coding, and memory.

• Learning is correlated to the processes of imitation, reinforcement, and insight.

• Problem-solving and decision-making are the internal processes of defense to seek relief, affective appraisal, and attachment.

4 ADAPTIVE MODELS

1. PHYSIOLOGICAL MODE

2. SELF-CONCEPT MODE

3. ROLE FUNCTION MODE

4. INTERDEPENDENCE MODE

PHYSIOLOGICAL-PHYSICAL MODE

➢ Is associated with the physical and chemical processes involved in the function and activities of living organisms. ➢ Five needs are identified in the physiologicalphysical mode relative to the basic need of physiological integrity as flows: (1) OXYGENATION (2) NUTRITION (3) ELIMINATION (4) ACTIVITY & REST (5) PROTECTION.

PHYSICAL MODE

➢ - is the manner in which the collective human adaptive system manifests adaptation relative to basic operating resources, participants, physical facilities, and fiscal resources.

OPERATING INTEGRITY

➢ - is the basic need of the physical mode.

SELF-CONCEPT-GROUP IDENTITY MODE

➢ Is one of the three psychosocial modes. ➢ It focuses specifically on the psychological and spiritual aspects of the human system. ➢ The basic need underlying the individual selfconcept mode has been identified as PSYCHIC and SPIRITUAL INTEGRITY, or the need to know who one is so that one can be or exists with a sense of unity, meaning, and purposefulness in the universe.

SELF-CONCEPT

➢ is defined as the composite of beliefs and feelings about oneself at a given time and is formed from internal perceptions and perceptions of others' reactions.

Personal self

• made up of self consistency, self-ideal or expectancy, and the moral-ethical-spiritual self.

PHYSICAL SELF

involves sensation and body image.

IDENTITY INTEGRITY

➢ the basic need of the group identity mode.

GROUP IDENTITY MODE

➢ is composed of interpersonal relationships, group self-image, social milieu, and culture.

ROLE FUNCTION MODE

➢ Is one of two social modes and focuses on the roles the person occupies in society.

INSTRUMENTAL BEHAVIOR

➢ is the actual physical performance of a behavior.

EXPRESSIVE BEHAVIORS

➢ are the feelings, attitudes, likes or dislikes that a person has about a role or about the performance of a role.

PRIMARY ROLE

➢ determines the majority of behavior engaged in by the person during a particular period of life. It is determined by age, sex, and developmental stage.

SECONDARY ROLE

➢ are those that a person assumes to complete the task associated with a developmental stage and primary role.

Tertiary Role

➢ are related primarily to secondary roles and represent ways in which individuals meet their role associated obligations. Tertiary roles are normally temporary in nature, freely choses by the individual, and may include activities such as clubs or hobbies.

ROLE

➢ as the functioning unit of society, is defined as a set of expectations about how a person occupying one position behaves toward a person occupying another position.

SOCIAL INTEGRITY

➢ SOCIAL INTEGRITY - the basic need underlying the role function mode and is defined as the need to know who one is in relation to others so that one can act.

INTERDEPENDENCE MODE

➢ Focuses on close relationships of people and their purpose, structure, and development.

INTERDEPENDENT RELATIONSHIPS

➢ INTERDEPENDENT RELATIONSHIPS - involve the willingness and ability to give to others and accept from them aspects of all that one has to offer such as love, respect, values, nurturing, knowledge, skills, commitments, material possessions, time, talents.

RELATIONAL INTEGRITY

➢ the basic need of interdependence mode.

Interdependence mode focuses on two specific relationships:

➢ (1) SIGNIFICANT OTHERS - (2) SUPPORT SYSTEMS -

SIGNIFICANT OTHERS

persons who are the most important to the individual.

SUPPORT SYSTEMS

other people contributing to meeting interdependence needs.