Roy's Adaptation Model

Introduction

• Sr.Callista Roy, a prominent nurse theorist, writer, lecturer, researcher and teacher
• Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill
• Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien Roy
• she earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College, Los Angeles in 1963.
• a master's degree program in pediatric nursing at the University of California ,Los Angeles in 1966.
• She also earned a master’s and PhD in Sociology in 1973 and 1977 ,respectively.
• Sr. Callista had the significant opportunity of working with Dorothy E. Johnson
• Johnson's work with focusing knowledge for the discipline of nursing convinced Sr. Callista of the importance of describing the nature of nursing as a service to society and prompted her to begin developing her model with the goal of nursing being to promote adaptation.
• She joined the faculty of Mount St. Mary's College in 1966, teaching both pediatric and maternity nursing.
• She organized course content according to a view of person and family as adaptive systems.
• She introduced her ideas about ‘Adaptation Nursing’ as the basis for an integrated nursing curriculum.
• Goal of nursing to direct nursing education, practice and research
• Model as a basis of curriculum impetus for growth--Mount St. Mary’s College
• 1970-The model was implemented in Mount St. Mary’s school
• 1971- she was made chair of the nursing department at the college.

Influencing Factors

• Family
• Education
• Religious Background
• Mentors
• Clinical Experience

THEORY DESCRIPTION

• The central questions of Roy’s theory are:
• Who is the focus of nursing care?
• What is the target of nursing care?
• When is nursing care indicated?
• Roy’s first ideas appeared in a graduate paper written at UCLA in 1964.
• Published these ideas in "Nursing outlook" in 1970
• Subsequently different components of her framework crystallized during 1970s, ’80s, and ’90s
• Over the years she identified assumptions on which her theory is based.

Explicit assumptions (Roy 1989; Roy and Andrews 1991)

• The person is a bio-psycho-social being.
• The person is in constant interaction with a changing environment.
• To cope with a changing world, person uses both innate and acquired mechanisms which are biological, psychological and social in origin.
• Health and illness are inevitable dimensions of the person’s life.
• To respond positively to environmental changes, the person must adapt.
• The person’s adaptation is a function of the stimulus he is exposed to and his adaptation level
• The person’s adaptation level is such that it comprises a zone indicating the range of stimulation that will lead to a positive response.
• The person has 4 modes of adaptation: physiologic needs, self- concept, role function and inter-dependence.
• "Nursing accepts the humanistic approach of valuing other persons’ opinions, and view points" Interpersonal relations are an integral part of nursing
• There is a dynamic objective for existence with ultimate goal of achieving dignity and integrity.

Implicit assumptions

• A person can be reduced to parts for study and care.
• Nursing is based on causality.
• Patient’s values and opinions are to be considered and respected.
• A state of adaptation frees an individual’s energy to respond to other stimuli.

ROY ADAPTATION MODEL CONCEPTS: EARLY AND REVISED

• Adaptation -- goal of nursing
• Person -- adaptive system
• Environment -- stimuli
• Health -- outcome of adaptation
• Nursing -- promoting adaptation and health

Concepts-Adaptation

• Responding positively to environmental changes.
• The process and outcome of individuals and groups who use conscious awareness, self reflection and choice to create human and environmental integration

Concepts-Person

• Bio-psycho-social being in constant interaction with a changing environment
• Uses innate and acquired mechanisms to adapt
• An adaptive system described as a whole comprised of parts
• Functions as a unity for some purpose
• Includes people as individuals or in groups-families, organizations, communities, and society as a whole.

Concepts-Environment

• Focal - internal or external and immediately confronting the person
• Contextual- all stimuli present in the situation that contribute to effect of focal stimulus
• Residual-a factor whose effects in the current situation are unclear
• All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources, including focal, contextual and residual stimuli

Concepts-Health

• Inevitable dimension of person's life
• Represented by a health-illness continuum
• A state and a process of being and becoming integrated and whole

Concepts-Nursing

• To promote adaptation in the four adaptive modes
• To promote adaptation for individuals and groups in the four adaptive modes, thus 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

Concepts-Subsystems

• Cognator subsystem — A major coping process involving 4 cognitive-emotive channels: perceptual and information processing, learning, judgment and emotion.
• Regulator subsystem — a basic type of adaptive process that responds automatically through neural, chemical, and endocrine coping channels

Relationships

• Derived Four Adaptive Modes
• 500 Samples of Patient Behavior
• What was the patient doing?
• What did the patient look like when needing nursing care?

Four Adaptive Modes

• Physiologic Needs
• Self Concept
• Role Function
• Interdependence

Four Adaptive Mode Categories

• Tested in practice for 10 years
• Criteria of significance, usefulness, and completeness were met

Sample Proposition and Hypothesis for Practice

• Self Concept Mode: Increased quality of social experience leads to increased feelings of adequacy
• Providing support for new mothers can lead to positive parenting

THEORY DEVELOPMENT
Derived Theory

• 91 Propositions
• Described relationships between and among regulator and cognator and four adaptive modes
• 12 Generic propositions

Questions Raised by 21st Century Changes

• How can ethics and public policy keep pace with developments in science?
• How can nurses focus on human needs not machines?
• How can nurses contribute to creating meaning and purpose in a global society?

Scientific Assumptions for the 21st Century

• 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
• Human 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 relations
• Person 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 intimately 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

Adaptation and Groups

• Includes relating persons, partners, families, organizations, communities, nations, and society as a whole

Adaptive Modes

A. Persons

• Physiologic
• Self Concept
• Role Function
• Interdependence

B.  Groups

• Physical
• Group Identity
• Role Function
• Interdependence

Role Function Mode

• Underlying Need of Social integrity
• The need to know who one is in relation to others so that one can act
• The need for role clarity of all participants in group

Adaptation Level

• A zone within which stimulation will lead to a positive or adaptive response
• Adaptive mode processes described on three levels:
• Integrated
• Compensatory
• Compromised

Integrated Life Processes

• Adaptation level where the structures and functions of the life processes work to meet needs
• Examples of Integrated Adaptation
• Stable process of breathing and ventilation
• Effective processes for moral-ethical-spiritual growth

Compensatory Processes

• Adaptation level where the cognator and regulator are activated by a challenge to the life processes
• Compensatory Adaptation Examples:
• Grieving as a growth process, higher levels of adaptation and transcendence
• Role transition, growth in a new role

Compromised Processes

• Adaptation level resulting from inadequate integrated and compensatory life processes
• Adaptation problem
• Compromised Adaptation Examples
• Hypoxia
• Unresolved Loss
• Stigma
• Abusive Relationships

THE NURSING PROCESS

• RAM offers guidelines to nurse in developing the nursing process.
• The elements :
• First level assessment
• Second level assessment
• Diagnosis
• Goal setting
• Intervention
• evaluation

Usefulness of Adaptation Model

• Scientific knowledge for practice
• Clinical assessment and intervention
• Research variables
• To guide nursing practice
• To organize nursing education
• Curricular frame work for various nursing colleges

Characteristics of the theory

• Theories can interrelates concepts in such a way as to present a new view of looking at a particular phenomenon.
• Theories must be logical in nature
• Theories should be relatively simple yet generalizable
• Theories can be the basis for the hypotheses that can be tested
• Theories contribute to and assist in increasing the general body of knowledge of a discipline through the research implemented to validate them
• Theories can be utilized by the practitioners to guide and improve their practice
• Theories must be consistent with other validated theories, laws and principles but will leave open unanswered questions that need to be investigated

Testability

• RAM is testable
• BBARNS (1999) reported that 163 studies have been conducted using this model.
• RAM is complete and comprehensive
• It explains the reality of client, so nursing interventions can be specifically targeted.

Research studies using RAM

• Middle range theories have been derived from RAM
• 1998-Ducharme et al described a longitudinal model of psychosocial determinants of adaptation
• 1998-Levesque et al presented a MRT of psychological adaptation
• 1999-A MRNT , the urine control theory by Jirovec et al
• Dunn, H.C. and Dunn, D. G. (1997). The Roy Adaptation Model and its application to clinical nursing practice. Journal of Ophthalmic Nursing and Technology. 6(2), 74-78.
• Samarel, N., Fawcett, J., Krippendorf, K., Piacentino, J.C., Eliasof, B., Hughes, P., Kowitski, C., and Ziegler, E. (1998). Women's perception of group support and adaptation to breast cancer. Journal of Advanced Nursing. 28(6), 1259-1268.
• Chiou, C. (2000). A meta-analysis of the interrelationships between the modes in Roy's adaptation model. Nursing Science Quarterly. 13(3), 252-258
• Yeh, C. H. (2001). Adaptation in children with cancer: research with Roy's model. Nursing Science Quarterly. 14, 141-148.
• Zhan, L. (2000). Cognitive adaptation and self-consistency in hearing-impaired older persons: testing Roy's adaptation model. Nursing Science Quarterly. 13(2), 158-165.

Summary

• 5 elements -person, goal of nursing, nursing activities, health and environment
• Persons are viewed as living adaptive systems whose behaviours may be classified as adaptive responses or ineffective responses.
• These behaviors are derived from regulator and cognator mechanisms.
• These mechanisms work with in 4 adaptive modes.
• The goal of nursing is to promote adaptive responses in relation to 4 adaptive modes, using information about person’s adaptation level, and various stimuli.
• Nursing activities involve manipulation of these stimuli to promote adaptive responses.
• Health is a process of becoming integrated and able to meet goals of survival, growth, reproduction, and mastery.
• The environment consists of person’s internal and external stimuli.

References

• George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
• Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
• Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia,  Lippincott.
• Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed. Philadelphia,  Lippincott.
• Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book.
• Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
• Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225