Roy's Adaptation Model

“When push comes to a shove, we will seldom disappoint ourselves. We all harbor greater stores of

strength than we think. Adversity brings the opportunity to test our mettle and discover for ourselves the stuff of which

we are made.”

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.

The Roy adaptation model has been in use for 30 years in nursing, education &research.

ADAPTATION

The process & outcome whereby thinking & feeling persons, as individuals or in groups, use conscious awareness & choice to create human & environmental integration.

ROY'S THEORY DEFINES

“Adaptation as the process by which an individual or group makes conscious choices to cope with his or her situation.” Adaptive responses increase people's ability to cope, and to achieve goals including survival, growth, mastery of their lives and "personal and environmental transformation." Successful adaptation integrates a bad situation into an individual's life, or at least helps compensate for the problem.

Sr.Callista Roy developed the Adaptation Model of Nursing in 1976.

THIS MODEL COMPRISES THE FOUR DOMAIN CONCEPTS

Human as adaptive system Health

Environment

Nursing & six step nursing process

1. Human as adaptive system

Roy conceptualizes the human system in a holistic perspective, as holism stems from the underlying philosophic assumption of the model.

H.L.Dunn, a system theorist, calls our attention to the smallest unit of our life, the cell. The cell is a living open system. The cell has its inner & outer worlds. From its outer world, it must draw forth the substances it needs to survive. System openness therefore implies the constant exchange of information, matter & energy between the system & environment.

[Diagrammatic representation of a simple system]

Adaptation level stimuli

FEEDBACK

INPUT

CONTROL

OUTPUT

Coping Mechanis

m

FEEDBACK

[The person as a system]

Diagram is used by Roy to represent humans as adaptive systems. The human adaptive system has inputs of stimuli & adaptation level, outputs as behavioral responses that serve as feedback, & control process known as coping mechanisms.

Holism is the aspect of unified meaningfulness of human behavior in which the human system is greater than the sum of individual parts.

Roy identifies input as stimuli & adaptation level.

TYPES OF STIMULI

Three types of stimuli influence an individual’s ability to cope with the environment. These include

Focal stimuli Contextual stimuli Residual stimuli.

Focal stimuli are those that immediately confront the individual in a particular situation. Focal stimuli for a family include individual needs; the level of family adaptation; and changes within the family members, among the members and in the family environment (Roy, 1983).

Contextual stimuli are those other stimuli that influence the situation.

Residual stimuli include the individual’s beliefs or attitudes that may influence the situation. Contextual and residual stimuli for a family system include nurturance, socialization, and support (Roy, 1983). 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

Responses

stimuli that affect the family as a group. The outputs of the family system are three basic goals: survival, continuity, and growth (Roy, 1983). Roy states (Clements and Roberts, 1983)

Since adaptation level results from the pooled effect of all other relevant stimuli, the nurse examines the contextual and residual stimuli associated with the focal stimulus to ascertain the zone within which positive family coping can take place and to predict when the given stimulus is outside that zone and will require nursing intervention.

Adaptation level is the combining of stimuli that represents the condition of life processes for the human adaptive system.

– Integrated– Compensatory

– Compromised

Integrated processes are present when the adaptation level working as a whole to meet the needs of the human system.

Compensatory process occur when the humans response system have been activated.

Compromised processes occur when the compensatory & integrated processes are not providing for adaptation.

CONTROL AS COPING MECHANISM

Roy has used the term coping mechanism to describe the control process of the human as an adaptive system

Roy presents a unique nursing science of control mechanisms:

– Regulator– Cognator

Roy’s model considers the regulator & cognator coping mechanisms to be subsystems of the person as an adaptive system.

The regulator mechanism works primarily through the autonomic nervous system and includes endocrine, neural, and perception pathways.

This mechanism prepares the individual for coping with environmental stimuli.

The cognator mechanism includes emotions, perceptual/information processing, learning, and judgment. The process of perception bridges the two mechanisms.

OUTPUT

Outputs of the human adaptive system are behavioral responses. Output responses become feedback to the system & to the environment.

Roy categorizes outputs of the system as either adaptive responses or ineffective responses. Adaptive responses are those that promote the integrity of the human system. The system’s integrity, or wholeness, is behaviorally demonstrated when the system is able to meet the goals in terms of survival, growth, reproduction, mastery & transformations of the system & the environment. Ineffective responses on the other hand do not support the goals of humans as adaptive systems. Ineffective responses can immediately or gradually threaten the system’s survival, growth, reproduction, mastery or transformations.

ADAPTIVE MODES

The Physiological-physical Mode: The physiological mode represents the human system’s physical responses & interactions with the environment.

The underlying need of this mode is physiologic integrity, which is composed of the basic needs associated with oxygenation, nutrition, elimination, activity & rest & protection.

The complex processes of this mode are associated with the senses; fluid, electrolyte, & acid base balance, neurological function & endocrine function.

Self-concept- Group Identity Mode: group identity mode, which refers to an individual's beliefs and feelings about him or herself.

For individuals, the self concept mode relates to the basic need for psychic & spiritual integrity or a need to know the self with a sense of unity.

Self concept is central to the person’s behavior because it consists of a person’s beliefs or feelings about himself or herself at any given time.

Self concept has the components of physical self & personal self. The physical self includes body sensation & body image, Body sensation is how the person experiences the physical self, & body image is how the person views the physical self.

The personal self includes self consistency, self ideal & moral ethical- spiritual self. Self consistency represents the person’s effort to maintain self organization & avoid disequilibrium, self ideal represents what the person expects to be &do, the moral-ethical-spiritual self represents the person’s belief system & self evaluator.

Role function Mode: which involves the perception of where the individual fits in the social network, how he or she relates to other people and should behave toward them.

A role consists of a set of expectations of how a person in a particular position will behave in relation to a person who holds another position.

The need underlying this mode is social integrity.

Interdependence Mode: which refers to the personal relationships he or she has with friends, family and life partners.

The underlying need of this mode is relational integrity or security in nurturing relationships.

The mode focuses on the giving & receiving of love, respect & value with significant others & support system.

2. Environment

According to Roy, stimuli from within the human adaptive system & stimuli from around the system represent the element of internal & external environment. Roy specifically defines environment as “all conditions, circumstances & influences that surround & affect the development & behavior of humans as adaptive systems, with particular consideration of person & earth resources”.

3. Health

Roy defines health as “a state & a process of being & becoming an integrated & whole human being”. The integrity of the person is expressed as the ability to meet the goals of survival, growth, reproduction, mastery & person & environment transformation.

Roy states that the term integrity is used to mean “soundness or an unimpaired condition leading to wholeness”.

ROY EMPLOYS A SIX-STEP NURSING PROCESS WHICH INCLUDES:

Assessment of behavior Assessment of stimuli

Nursing diagnosis

Goal setting

Intervention

Evaluation.

1. In the first step, the person's behavior in each of the four modes is observed. This behavior is then compared with norms and is deemed either adaptive or ineffective.

2. The second step is concerned with factors that influence behavior. Stimuli are classified as focal, contextual or residual (Rambo, 1984).

3. The nursing diagnosis is the statement of the ineffective behaviors along with the identification of the probable cause.

4. In the fourth step, goal setting is the focus. Goals need to be realistic and attainable and are set in collaboration with the person (Andrews & Roy, 1991).

5. Intervention occurs as the fifth step, and this is when the stimuli are manipulated. It is also called the 'doing phase' (Rambo).

6. In the final stage, evaluation takes place. The degree of change as evidenced by change in behavior is determined. Ineffective behaviors would be reassessed, and the interventions would be revised (Andrews & Roy).

ROY’S THEORY AS APPLIED TO:

1. NURSING PRACTICE

Using Roy’s six –step nursing process, the nurses assesses first the behaviors and second the stimuli affecting those behaviors. In a third step the nurse makes a statement or nursing diagnosis of the person’s adaptive state and fourth, sets goals to promote adaptation. Fifth, nursing interventions are aimed at managing the stimuli to promote adaptation. The last step in the nursing process is evaluation. By manipulating the stimuli and not the patient, the nurse enhances the interaction of the person with their environment, thereby promoting health.

2. EDUCATION

The adaptation model is also useful in educational setting. Roy states that the model defines for students the distinct purpose of nursing which is to promote man’s adaptation in each of the adaptive modes in situations of health and illness.

In the early 1980’s the School of Nursing at the University of Ottawa experienced a major curriculum change. This change included incorporating a nursing model by which to base their new curriculum. The change included incorporating a nursing model by which to base their new curriculum. The Roy adaptation model was one of the models to be included in the first year of the baccalaureate program. The professors had to meet four challenges during this change:

1. Adapting the course to be congruent with the Roy model,

2. Developing teaching tools suitable for student learning.

3. Sequencing of content for student learning

4. Obtaining competent role models.

3. RESEARCH

If research is to affect practitioners’ behavior, it must be directed at testing and retesting conceptual models for nursing practice. Roy has stated that theory development and the testing of developed theories are nursing’s highest priorities. The model must be able to regenerate testable hypotheses for it to be researchable.

STRENGTHS

RAM offers a variety of strength for all areas of nursing.

Focus on, & inclusion of the whole person or group.

The 4 modes provide an opportunity for consideration of multiple aspects of the human adaptive system & support gaining an understanding of whole system.

WEAKNESS

Weakness has been identified in relation to research &practice. One is the need for consistent definition of the concepts & terms within the RAM as well as for more research based on such consistent definitions.

SUB: ADVANCE NURSING PRACTICE

TOPIC: ROY’S ADAPTATION MODEL

SUBMITTED TO:

GOVT. COLLEGE OF NURSING

AHMEDABAD.

SUBMITTED BY:

SHAH KINJAL

GOVT. CON

AHMEDABAD.

BIBLIOGRAPHY

Roy, C.E., Nursing: Concepts of practice, 4th ed;1991, St. Louis, MO: Mosby-Year Book Inc. p.p-110-125 Tomey, A. & Alligood, M., Significance of theory for nursing as a discipline and profession. Nursing Theorists and their work., 4th ed;2001,Mosby, St. Louis, Missouri, United States of America. P.p.-25,45,68,220

George B. Julia, Nursing Theories- The base for professional Nursing Practice, 3rd ed;2000, Norwalk, Appleton & Lange.p.p-126-130

Wills M.Evelyn, McEwen Melanie, Theoretical Basis for Nursing, 5th ed; 2001,Philadelphia. Lippincott Williams& Wilkins. P.p-231-241

Meleis Ibrahim Afaf, Theoretical Nursing: Development & Progress,3rd

ed;1997,Philadelphia,  Lippincott. P.p-330-335

Taylor Carol,Lillis Carol,The Art & Science  Of Nursing Care ,4th ed; 2001,Philadelphia,  Lippincott. P.p-11,22,40,51,63

Potter A Patricia, Perry G Anne , Fundamentals Of Nursing –Concepts Process & Practice, 3rd ed;1992, London Mosby Year Book. P.p-16,19,21,31

WEBSITES

http://www.nursingtheory.net/models_adaptationframework.html http://upoun207tfn.blogspot.com/2010/07/application-of-roysadaptationdeficit.html http://currentnursing.com/nursing_theory/roys adaptationtheory.html