Roy Adaptation Model Critique

Internal Criticism

ADEQUACY

Roy’s Adaptation Model has been refined over the years, but there are still some areas that need to be developed. Researchers suggest that a more thoroughly defined typology of nursing diagnoses and an organization of categories of interventions would facilitate the model’s use over the nursing practice. It is also noted by scientists who do research from the perspective if the model that there is notable overlapping between the psychosocial categories of self-concept, role function, and interdependence. Fredrickson (2000) recommended the following for future research: first, there is a need to design studies to test propositions related to environment and nursing. Second, interventions based on the concepts and propositions that have been supported previously should be tested.

A more thoroughly defined typology of nursing diagnoses and an organization of categories of interventions would facilitate the use of the RAM in the nursing practice. The overlapping in the psychosocial categories of self-concept, role function, and interdependence is continued to be noted by scientists who do research from this particular perspective.

CLARITY

The five main concepts (adaptation, person, nursing, environment and health) are well defined. There is also clear definition of the four adaptive modes (physiological, self-concept, interdependence and role function). But here have been reported difficulties in classifying behaviour exclusively in one adaptive mode. However, this observation only proves that behaviour in one adaptive mode affects and is affected by the other modes.

CONSISTENCY

Roy has recently re-defined health, deemphasizing the concept of a health-illness continuum and conceptualizing health as integration and wholeness of a person. Because health was not conceptualized in this manner initially, this opens up an new area of research. Fredrickson (2000) concluded that there is good empirical support for Roy`s conceptualization of person and health. The recommendations are as follows: First, there is a need to design studies to test propositions related to environment and nursing. Second, interventions based on concepts and propositions should be tested.

LOGICAL DEVELOPMENT

Derivation of the Roy’s Model includes Harry Helson’s Adaptation Theory, which states Individuals adapt to whatever their current situations are, so everyone tends to view his or her current status quo as normal. Adaptive theories are ones that deal with the system’s ability to adjust to stimulus itself based on a predetermined set of concepts. Roy’s theory fit well with these theories.

Roy’s theory is also consistent with other holistic theories, such as psychoneuroimmunology and psychoneuroendocrinology. For instance, psychoneuroimmunology proposes a bidirectional relationship between the mind and the immune system. But in comparison, Roy’s adaptation model is broader, and provides a theoretical foundation for research about, and nursing care of, a person as a whole.

LEVEL OF THEORY DEVELOPMENT

The Roy’s Adaptation Model is a grand theory. Grand theories are at the higher level of Middle Range Theories. These grand theories are frameworks consisting of concepts and relational statements that explicate abstract phenomena. In fact, the Roy Adaptation Model is used to guide the development of Middle Range Theories, which are more circumscribed, elaborating more concrete concepts and relationships.

External Criticism

COMPLEXITY

There are four main concepts of Roy’s adaptation model namely: person, nursing, environment and health. It includes two subconcepts (regulator & cognator) and four modes (physiological, self-concept, role function & interdependence). Though the main concepts are easily understood, the great number of subconcepts make it somewhat difficult to grasp the whole model at first.

DISCRIMINATION

Roy’s Adaptation Model is one of the most frequently used models to guide nursing research, education, and practice. It’s influence is evidenced by the vast number of qualitative and quantitative studies it has guided.

REALITY CONVERGENCE

Assumptions from systems theory and assumption from adaptation level theory have been combined into a single set of scientific assumptions. Roy also combined the assumptions on humanism and veritivity into a single set of philosophical assumptions. All scientific assumptions ring true. Though, a problem with the philosophical assumptions would be that not all people in the world recognize that there is a ‘supreme being’ or God. This had my attention because recognition of a higher being is widely used in the assumptions.

PRAGMATIC

The model has a clearly defined nursing process and can be useful in guiding clinical practice. It gives us direction, as nurses, to provide holistic care directed to our patient. In fact by the year 1987, a mere 19 years after the initial operationalization of the model. It was estimated that more than 100,000 nurses in the United States and Canada were prepared to practice using the Roy Model. Senesac (2003) reviewed the literature for evidence that the Roy Adaptation Model is being implemented in nursing practice. She reported that the RAM has been used to the greatest extent by individual nurses to understand, plan, and direct nursing practice in the care of individual practice.

SCOPE

Roy’s model covers quite a broad scope, but this is viewed as an advantage, simply because it can be used for theory building; and for deriving middle range theories for testing in studies of smaller ranges of phenomena.

SIGNIFICANCE

The Roy Adaptation Model remains to be one of the most frequently used conceptual frameworks to guide nursing practice, and it is used nationally and internationally. The model is useful particularly in nursing practice, because it outlines the features of the discipline and provides direction for practice, education, and research. The model considers goals, values, the patient, and practitioner interventions. The two level assessments assist in identification of nursing goals and diagnoses.

UTILITY

From the beginning, the model has been supported through research in practice and education.  Roy herself stated that theory development and the testing of developed theories are the highest priorities for nursing. The model continues to generate many testable hypotheses to be researched. To date, it has been used in countless studies. Roy & a group of seven scholars conducted a meta-analysis, critique, and synthesis of a 163 studies based on the Roy Adaptation Model that had been published in 44 English journals on five continents and dissertations and theses from the United States. Of the 163 studies, 116 met the criteria established for testing the propositions from the model. Twelve generic propositions based on Roy’s earlier work were derived. To synthesize the research, findings of each study were used to state ancillary and practice propositions, and support for the propositions was examined. Of the 265 propositions tested, 216 (82%) were supported.

References:

Phillips, K.D. (2010). Sister Callista Roy: Adaptation model. In A. M. Tomey & M.R. Alligood (Eds.) Nursing theorists and their work (7^th ed., pp.335-365). Maryland Heights, MO: Mosby.

Peterson, Sarah J. Middle Range Theories. Wolters Kluwer Health p. 29

Smith, Mary Jane, PhD, RN & Liehr, Patricia R. PhD, RN. (2008) Middle Range Theories for Nursing Springer Publishing Company, New York. Second Edition.

Fawcett, J. (2005). Contemporary nursing knowledge development: Analysis and evaluation of nursing models and theories (2^nd ed.). Philadelphia: F.A. Davis

Fredrickson, K. (2000). Nursing knowledge development through research: Using the Roy Adaptation Model. Nursing Science Quarterly, 13, 12-16