Sister Callista L. Roy 1939-present

Adaptation Model

Sister Callista L. Roy 1939-present

Biography

 was born October 14, 1939, in

Los Angeles, California.

 In 1963, she earned a Bachelor of Arts Degree in

Nursing from Mount St. Mary's College in Los

Angeles.

 In 1966, she earned a Master's Degree in Pediatric

Nursing from the University of California-Los

Angeles.

 She also earned a Master's Degree in Sociology in

1973 and went on to complete a Doctorate degree in

Sociology in 1977.

 She is a sister of St. Joseph of Carondelet.

Relevance and Application of Nursing Theories

in Advancing Nursing Science through Research:

Our Millennial Direction

Nursing

“[The 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.”

 In Adaptation Model, nurses are facilitators of adaptation. They

assess the patient’s behaviors for adaptation, promote positive

adaptation by enhancing environment interactions and helping

patients react positively to stimuli. Nurses eliminate ineffective

coping mechanisms and eventually lead to better outcomes.

Person

“Human systems have thinking and feeling capacities, rooted in

consciousness and meaning, by which they adjust effectively to

changes in the environment and, in turn, affect the environment.”

 Based on Roy, humans are holistic beings that are in constant

interaction with their environment. Humans use a system of

adaptation, both innate and acquired, to respond to the

environmental stimuli they experience. Human systems can be

individuals or groups, such as families, organizations, and the

whole global community.

Health

“Health is not freedom from the inevitability of death, disease,

unhappiness, and stress, but the ability to cope with them in a

competent way.”

 Health is defined as the state where humans can continually adapt

to stimuli. Because illness is a part of life, health is the result of a

process where health and illness can coexist. If a human can

continue to adapt holistically, they will be able to maintain health to

reach completeness and unity within themselves. If they cannot

adapt accordingly, the integrity of the person can be affected

negatively.

Environment

 The environment is defined as conditions, circumstances,

and influences that affect the development and behavior of

humans as an adaptive system. The environment is a

stimulus or input that requires a person to adapt. These

stimuli can be positive or negative.

Adaptation Model of Nursing

 Developed in 1964.

 aims to explain or define the provision of

nursing science.

 The model sees the individual as a set of

interrelated systems who strives to maintain

a balance between various stimuli.

 The model provides a way of thinking about

people and their environment that is useful in

any setting. It helps one prioritize care and

challenges the nurse to move the patient

from survival to transformation.

Roy Adaptation Model (RAM)

 The person is adapting in a stable interaction with the

environment, either internal or external.

 The environment serves as the source of a range of stimuli

that will either threaten or promote the person’s unique

wholeness.

 The person’s major task is to maintain integrity in face of

these environmental stimuli.

Focal stimuli

are that which confronts the human system and requires the most attention.

Contextual stimuli

are characterized as the rest of the stimuli that present with the focal stimuli and contribute to its effect.

Residual stimuli

are the additional environmental factors present within the situation, but whose effect is unclear. This can include previous experience with certain stimuli.

Integrity

- the degree of wholeness achieved by adapting to changes in needs.

Adaptation Level

the ability to respond positively in a situation.

Adaptation occurs when the total stimuli fall within the

individual's/family's adaptive capacity, or zone of adaptation. The

inputs for a family include all of the stimuli that affect the family

as a group. The outputs of the family system are three basic

goals: survival = physiologic mode; growth = self-concept mode;

continuity = role function mode

Integrated Process

- The various modes and subsystems

meet the needs of the environment. These are usually stable

processes (e.g., breathing, spiritual realization, successful

relationship).

Compensatory Process

- The cognator and regulator are

challenged by the needs of the environment, but are working

to meet the needs (e.g., grief, starting with a new job,

compensatory breathing).

Compromised Process

- The modes and subsystems are not

adequately meeting the environmental challenge (e.g.,

hypoxia, unresolved loss, abusive relationships).

Regulator subsystem

is a person’s physiological coping

mechanism. It’s the body’s attempt to adapt via regulation of our

bodily processes, including neurochemical, and endocrine

systems. Example: increase in vital signs – sympathetic

response to stress.

Cognator subsystem

is a person’s mental coping mechanism.

A person uses his brain to cope via self-concept,

interdependence, and role function adaptive modes. For

instance, the effects of prolonged hospitalization for a four-year

old child.

Stabilizer subsystem

is associated with system

maintenance and involving established structures,

values and daily activities whereby participants in a

group accomplish the purpose of the social system.

innovator subsystem

allows the person to

change higher levels of potential through cognitive and

emotional strategies.

The Four Adaptive Modes

 physiologic needs

 self-concept

 role function

 interdependence.

Physiologic Mode

Adaptation involves the maintenance of physical integrity. Basic

human needs such as nutrition, oxygen, fluids, and temperature

regulation are identified with this mode.

In assessing a family, the nurse would ask how the family

provides for the physical and survival needs of the family

members.

Self-concept Mode

A function of the self-concept mode is the need

for maintenance of psychic integrity. Perceptions

of one's physical and personal self are included

in this mode.

Families also have concepts of themselves as a

family unit. Assessment of the family in this

mode would include the amount of

understanding provided to the family members,

the solidarity of the family, the values of the

family, the amount of companionship provided to

the members, and the orientation (present or

future) of the family.

Role Function Mode

This mode focuses on the primary, secondary and tertiary roles

that a person occupies in society and knowing where he or she

stands as a member of society.

The family's role can be assessed by observing the

communication patterns in the family. Assessment should

include how decisions are reached, the roles and

communication patterns of the members, how role changes are

tolerated, and the effectiveness of communication

Interdependence Mode

This mode focuses on attaining relational integrity through the giving and

receiving of love, respect and value. This is achieved with effective

communication and relations.

• involves maintaining a balance between independence

and dependence in one's relationships with others. Dependent behaviors

include affection seeking, help seeking, and attention seeking. Independent

behaviors include mastery of obstacles and initiative taking.

• When assessing this mode in families, the nurse tries to determine how

successfully the family lives within a given community. The nurse would

assess the interactions of the family with the neighbors and other

community groups, the support systems of the family, and the significant

others.

Assessment of Behavior

Data gathering about the

behavior of the person as an adaptive system in each of the

adaptive modes.

Assessment of stimuli

categorize them as focal,

contextual, or residual. In this level of assessment, the nurse

analyzes the subjective and objective behaviors and look more

deeply for possible causes of a particular set of behaviors.

Nursing Diagnosis

Formulation of statements that

interpret data about the adaptation status of the person,

including the behavior and most relevant stimuli.

Goal setting

Establishment of clear statements of the

behavioral outcomes for nursing care which is realistic and

attainable. This is done together with the client.

intervention

Determination of how best to assist the

person in attaining the established goals.

Evaluation

Judging the effectiveness of the nursing

intervention in relation to the behavior after it was performed in

comparison with the goal established.

Acceptance by the Nursing Community Practice

 Outlines the features of the discipline and provides direction

for practice, education and research.

 Includes a goal that is specified as the aim for activity and

prescription of activities to attain goal.

 The nursing process is well suited for use in a practice

setting. The two-level assessment is unique to this model

and leads to identification of adaptation problems or nursing

diagnosis.

Education

 Serve as basis for student nurses who render care for clients

to promote adaptation with regard to their adaptive modes.

 Delineates nursing science from medical science.

 The goal of the nurse is to help a patient put his energy to

achieve recovery.

 Through this model, clarification of objective, identification

technique and specification of patterns for teaching and

learning can be achieved.

Research

 Roy’s theory culminated a number of propositions in which in

return generated specific hypothesis that can be developed

and tested.

 Roy’s model was used extensively to guide knowledge

development through nursing research.

 Roy together with her colleagues outlined a typology of

adaptation problems or nursing diagnosis in which research

and testing is considered necessary.

Strengths

 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 significant input

of time and effort.

 Roy’s model has many

elements, systems, structures

and multiple concepts.