The following paper introduces the Roy Adaptation Model. The paper begins with describing the model and introduces Sister Callista Roy, the publisher. A background on the Roy nursing model is given in context to Sister Callista Roy’s education along with her credited influences that help to give rise to the model. The paper goes in detail to explain the components of the model including the four major concepts: humans as adaptive systems, environment, health, and the goal of nursing; two sub systems: the regulator and cognator subsystems; and four adaptive modes: physiological – physical, self-concept-group identity, role function, and interdependence.
Throughout the next section the strengths of the model are discussed which include aspects of the model’s ability to adapt and evolve to our changing times, the inclusion of the whole person or group; and limitations of the model that are discussed include the lack of consistent definitions for the concepts and terms within the Roy Adaptation Model, and time constraints encountered. The paper ends with the application of the Roy Adaptation Model to a clinical area of the nursing practice.
Sister Callista Roy’s Adaptation Model
The Nursing Model
In 1970, Sister Callista Roy proposed the Roy Adaptation Model. Callista Roy defined adaptation as “the process and outcome whereby thinking and feeling persons, as individuals or in groups, use conscious awareness and choice to create human and environmental integration” (Roy & Andrews, 1999, p. 30). Adaptation occurs as a result to a positive response a person has to changes in their surrounding environments.
This is also the process and outcome in which the use of self-reflection, conscious awareness, and choice creates human and environmental integration. A person’s background, religion, education, family, mentors, and clinical experience all influenced the Adaptation Model and helped to develop this model by asking the questions: Who is the focus of nursing care? When is nursing care indicated?
What is the target of nursing care (Lane, 2011)? The Roy Adaptation Model involves a series of six steps that throughout the nursing process, the nurse, along with other health care professionals, make necessary adjustments to the nursing care plan in response to how the patient is adapting and progressing. The six steps include: 1. The first level of assessment, which addresses the patient’s behavior 2. The second level of assessment, which addresses the patient’s stimuli 3. Diagnosis of the patient
4. Setting goals for the patient’s health
5. Intervention to take actions in order to meet those goals 6. Evaluation of the result to determine if goals were met (Lane, 2011). The Roy Adaptation Model helps nurses to organize and apply the knowledge of nursing science and related sciences to promote adaptation of individuals and groups. The model has broad implications for the nursing practice.
The Roy Adaptation Model has four major concepts that apply to individuals across their life span as well as families, groups, and other collective human adaptive systems. No age or situation is outside the scope of the model. Background on the Nursing Model Development
Sister Callista Roy began her work on the Roy Adaptation Model for nursing in 1964 when she was enrolled in the Master’s program in pediatric nursing at the University of California. Dorothy E. Johnson was her faculty advisor whom encouraged Roy to develop the model. Sister Callista Roy worked with faculty members from Mount St. Mary’s College in California for approximately seventeen years to develop the framework for a nursing based curriculum integrated in 1970. Mount St. Mary’s College was also involved in writing the first three textbooks on the adaptation model in 1976, 1984, and 1991.
“Through curriculum consultation throughout the USA and eventually worldwide, Dr. Roy received input on the use of the model in education and practice. By 1987 at least 100,000 nurses had been educated in programs using the Roy Adaptation Model” (Bradley, 2011). During the late 1990’s Callista Roy worked on redefining adaptation to better suit the changing times so her model too can adapt. She drew upon expanded insights in relating spirituality and science to present a new definition of adaptation and related scientific and philosophical assumptions.
Her philosophical stance articulates that nurses see persons as co-extensive with their physical and social environments. Dr. Roy remains committed to developing knowledge for nursing practice and continually updates the Roy Adaptation Model as a basis for this knowledge development (Bradley, 2010). Callista Roy credits the works of Helson’s view of the adaptation theory as forming the original basis of the scientific assumptions underlying the Roy model of 1964, von Bertalanffy’s general system theory of 1968, Davies’s discussion of self-organization of 1988, and Swimme and Berry’s 1992 concepts to accept, protect, and foster (George, 2011, p. 293, 317). Components of the Model
The Roy Adaptation Model is comprised of four major concepts: humans as adaptive systems, environment, health, and the goal of nursing; two sub systems: the regulator and cognator; and four adaptive modes: physiological-physical, self-concept-group identity, role function, and interdependence.
“The focus of nursing relationships and interactions can be at the level of the individual; groups, organizations, communities, and societies in which they are included” (Roy & Andrews, 1999, p. 35). Humans as adaptive systems are persons that have constant interactions with their environment both as individuals and in groups of families, communities, societies, and organizations.
As living systems, persons react to their environments that experience inputs, outputs, controls, and feedback that stimulates response for adaptation. The environment reacts with stimuli, internal and external, which include focal, contextual, and residual stimuli. Roy defines environment as “all conditions, circumstances, and influences that surround and affect the development and behavior of humans as adaptive systems, with particular consideration of person and earth resources” (Roy & Andrews, 1999, p. 52). Health is the outcome of adaptation and a state and a process of being and becoming integrated as a whole human being.
The ability of a person to meet the goals of growth, reproduction, survival, mastery, and person and environmental transformation expresses their integrity. Health in the Roy Adaptation Model is the process of integration of health which indicates successful adaptation and aims nursing practices to promote positive adaptive responses (George, 2011). The goal of nursing is to promote adaptation in response to the four adaptive modes for individuals and groups.
“Nurses contributing to health, quality of life, and dying with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental interactions. Nursing is the science and practice that expands adaptive abilities and enhances person and environment transformation.
This is done by assessing behavior and factors that influence adaptive abilities and by intervening to expand those abilities and to enhance environmental interactions” (Bradley, 2010). Roy has identified four adaptive modes as categories for assessment of behavior resulting from regulator-cognator coping mechanisms in persons or stabilizer-innovator coping processes in groups (George, 2011). The adaptive modes are physiological-physical, self-concept-group identity, role function, and interdependence.
The four modes are interrelated and a response in any one mode may have an effect on one or all of the other modes. Physiological-physical mode for the individual is concerned with basic needs requisite to maintaining the physical and physiologic integrity of the individual human system.
“It encompasses oxygenation, nutrition, elimination, activity and rest; protection; senses; fluid, electrolyte, and acid-base balance; neurologic function; and endocrine function. The basic underlying need is physiologic integrity” (Kearney-Nunnery, 2012, p. 50). The operating resources for the group include participants, physical facilities, capacities, and fiscal resources. The basic need is wholeness achieved by adapting to change in physical resource needs.
The self-concept-group identity mode for the individual addresses the beliefs and feelings that a person holds of himself or herself at a given time. The basic need is psychic and spiritual integrity, the need to know who one is so that can be or exist with a sense of unity, the physical self refers to the individual’s appraisal of his or her own physical being, including physical attributes, functioning, sexuality, health and illness states, and appearance. The group addresses shared relations, goals, and values that create a group self-image and involves interpersonal relationships (Kearney-Nunnery, 2012).
The role function mode focuses on the roles that a person occupies in a society and the roles they occupy within a group. The basic role function mode is social integrity and the need to know who one is in relation to others so that one will know how to act. For the group, the focus is on the group’s infrastructure that contributes to the accomplishments of the group.
The basic need is role clarity and the need to understand and commit so the group can achieve common goals (Kearney-Nunnery, 2012). Interdependence for the individual focuses on the need to achieve relational integrity from the security of a nurturing relationship such as the giving and receiving of love, respect, and value through affectional, resource, and developmental adequacy, and support systems (Kearney-Nunnery, 2012). For the group interdependence relates to social context, learning and maturing in relationships, achieving, and the feeling of security through independence with others. Strengths of the Model
The adaptation model provides several strengths that can be applied to all areas of nursing. First strength includes the ability of this model to adapt and evolve, itself, to the changing times rather than just being stationary. This model is logically organized and draws on the nurse’s observational and interviewing skills.
It is also evident from the amount of research using the Roy Adaptation Model reported in the literature and through the formation of the Roy Adaptation Association that research is supported (George, 2011). Another strength of this model includes the important fact that it will “focus on, and inclusion of, the whole person or group. The four modes provide an opportunity for consideration of multiple aspects of the human adaptive system and support; gaining an understanding of the whole system” (George, 2011, p. 323). Limitations of the Model
With population increases comes increases in hospital visits which means a constant decrease in the amount of time that nurses are able to be with their patients before moving on to the next one. Although this nursing model is very successful with adapting, one limitation it faces is time constraints. The amount of time required to fully implement the two areas of the Roy Adaptation Model assessment may be viewed as insurmountable.
This is particularly true as one begins to use the Roy Adaptation Model; a nurse more experienced in the use of the RAM may find the time constraints less compelling. One other limitation that can be addressed is the need for consistent definitions of the concepts and terms within the Roy Adaptation Model as well as for more research based on such consistent definitions (George, 2011, p. 323). Applying the Model to a Clinical Area of Nursing
The Roy Adaptation Model is a universal model that can be applied to many different clinical situations. An application of the model to a clinical area of nursing is recovery. When monitoring a patients progress immediately after a procedure up until time of departure, the patient needs will be changing. The patient will be adapting to inputs, outputs, controls, and feedback (Roy, 1997). Following steps will create a plan for the nurse and patient to follow for a full recovery. The first step is assessment of behavior followed by step two, assessment of stimuli; step three is nursing diagnosis, and step four sets goals both short term and long term.
Step five, intervention, is taken so that focal and contextual stimuli are altered and adaptation is promoted. Step six is where the evaluation of the short term and long term goal achievement is made, and further actions are taken if necessary (George, 2011, p. 316). The most important aspect of this model is “as priorities shift in a given situation, the model continues to give the practicing nurse direction and guidance” (George, 2011, p. 319) so the model itself is constantly adapting as well.