Sister Callista Roy and the Adaptation Model

“God is intimately revealed in the diversity of creation and is the common destiny of creation; persons use human creative abilities of awareness, enlightment, and faith’ and persons are accountable for the process of deriving, sustaining, and transforming the universe.”

-          Sister Callista Roy

   ABSTRACT

Sister Callista Roy’s Adaptation Model is one of the most influential models in nursing. Over the years, it has guided nursing education, research & practice.  This written project is to emphasize the importance of the theory in nursing research and practice. The model is broken down to describe its effects on the four global concepts: nursing, person, environment & health. It further discusses each concept in detail and how one affects the others. Application of the model in the nursing realm is also explore. Lastly, a critique of the model is formulated.

THE THEORIST

Sister Callista Roy was born on October 14, 1939 in Los Angeles, California. She earned her baccalaureate degree in Nursing from Mount Saint Mary’s College in 1963; she earned her M.S. in Nursing in 1966 from the University of California, Los Angeles (UCLA). After earning her nursing degrees, she ventured into sociology. She received her master’s degree in sociology in 1973 and her doctorate in sociology in 1977 from UCLA (Philips, 2010). Roy has published many books, chapters, and periodical articles on her adaptation theory including Introduction to Nursing: An Adaptation Model (Roy, 1976, 1986). To date, Roy has received countless awards and honorariums, one of which is being recognized as a Living Legend by the American Academy of Nursing in 2007.

CONCEPTION OF THE MODEL

It was during her time at the UCLA that Roy developed the basic concepts of the Adaptation Model when she was challenged in a seminar by Dorothy Johnson, a nurse theorist herself, to make a nursing model as an assignment. While working as a pediatric staff nurse, Roy had noticed the great resiliency of children and their ability to adapt in response to major physical and psychological changes. She was impressed by adaptation as an appropriate conceptual framework for nursing. At the time of inception, the idea of adaptation was unique in its implications to nursing, but not to other fields. Roy credits the work of von Bertalanffy’s (1968) general systems theory and Helson’s (1964) adaptation theory as forming the basis of scientific assumptions underlying the Roy model. She also credits Rapoport’s definition of systems as well as concepts from Lazarus and Selye (Roy & Roberts, 1981). It was acknowledged that 1500 students and faculty contributed to the theoretical development of the adaptation model. (Roy, 1971)

THE ROY ADAPTATION MODEL

Roy’s Adaptation Model focuses on the patient as a human being, the surrounding environment, the present health, and the nursing responsibilities for that patient. Each aspect provides an important part in understanding the model as a whole. It views the person as a holistic adaptive system in constant interaction with the internal and the external environment. The main task of the human system is to maintain integrity in the face of environmental stimuli (Phillips, 2010). The goal of nursing is to foster successful adaptation.

Scientific Assumptions

Ø  Systems of matter and energy progress to higher levels of complex self-organization.

Ø  Consciousness and meaning are constitutive of person and environment integration.

Ø  Awareness of self and environment is accountable for the integration of creative processes.

Ø  Thinking and feeling mediate human action.

Ø  Systems relationships include acceptance, protection, and fostering of interdependence.

Ø  Persons and the earth have common patterns and integral relationships.

Ø  Persons and environment transformations are created in human consciousness.

Ø  Integration of human and environment meanings results in adaptation.

Philosophical Assumptions

Ø  Persons have mutual relationships with the world and God.

Ø  Human meaning is rooted in an omega point and convergence of the universe.

Ø  God is ultimately revealed in the diversity of creation and is the common destiny of creation.

Ø  Persons use human creative abilities of awareness, enlightenment, and faith.

Ø  Persons are accountable for the processes of deriving, sustaining and transforming the universe.

  

Adaptation

“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)

The adaptation level represents the condition of the life processes. Three levels are described by Roy: integrated, compensatory, and compromised life processes. An integrated life process may change to a compensatory process, which attempts to re-establish adaptation. Of the compensator processes are not adequate, compromised processes result. (Roy, 2009)

Adaptation occurs when the person responds positively to environmental changes. This adaptive response promotes integrity of the person which leads to health. Ineffective responses to stimuli lead to the disruption of integrity of a person (Andrews & Roy, 1986)

Nursing

“A health care profession that focuses on human life processes and patterns and emphasizes promotion of health for individuals, families, groups, and society as a whole” (Roy & Andrews, 1999 p.4)

Roy differentiates nursing as a science from nursing as a practice discipline. Nursing science is “a developing system of knowledge about persons that observes, classifies, and relates the processes by which processes persons positively affect their health status ( Roy, 1984). On the other hand “Nursing acts to enhance the interaction of the person with the environment --- to promote adaptation” (Andrews & Roy, 1991).

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” (Roy & Andrews, 1999). Nursing fills a unique role as facilitator of adaptation by assessing behavior in each of adaptation and by intervening to promote adaptive abilities and to enhance environment interactions (Roy & Andrews, 1999).

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” ( Roy & Andrews, 1999)

The person is defined as the main focus of nursing, the recipient of nursing care, a living complex, adaptive system with internal processes (cognator & regulator) acting to maintain adaptation in the four adaptive modes.

Coping processes in the model include innate coping mechanisms and acquired mechanisms.

Ø  Innate coping mechanisms – genetically determined or common to the species; they are generally viewed as automatic to the species.

Ø  Acquired coping processes – learned/developed through customary responses.

The processes of coping in the Roy adaptation model are further categorized as the regulator and cognator subsystems.

Ø  Regulator subsystem – responds through neural, chemical, and endocrine coping channels. Stimuli from the internal and external environment act as inputs through the senses to the nervous system, thereby affecting the fluid, electrolyte, and acid-base balance, as well as the endocrine system. This information is all channelled automatically, with the body producing an automatic, unconscious response to it (Roy, 2009).

Ø  Cognator subsystem – responds through four cognitive-emotional subchannels: perceptual and information processing, learning, judgement, and emotion.

o   Perceptual and information processing - includes activities of selective attention, coding, and memory.

o   Learning - involves imitation, reinforcement and insight. Judgement includes problem solving and decision making.

o   Defenses - are used to seek relief from anxiety and make affective appraisal and attachments through emotions.

Although one can identify specific processes inherent in the regulator-cognator subsystems, it is not possible to directly observe the functioning of these systems. The behaviors can be observed in four categories, or adaptive modes.

Ø  Physiologic-physical mode – manifestation of the physiologic activities of all cells tissues, and organs making up the body.

o   Five basic needs exist:

§  Oxygenation

§  Nutrition

§  Elimination

§  Activity and rest

§  Protection

o   In addition, four processes are involved:

§  Senses

§  Fluid, Electrolyte and Acid-base balance

§  Neurologic function

§  Endocrine function.

Ø  Self-concept-group identity mode – includes components of the physical self, including body sensation and body image, and the personal self, including self-consistency, self-ideal and moral-ethical-spiritual self.

o   Self-concept - its basic need for the individual is psychic and spiritual integrity --- that is, the need to know who one is so that one can be or exist with a sense of unity.

o   Group identity – the term used to refer to the second mode with groups. This comprises interpersonal relationships, group-self-image, social milieu, culture, and shared responsibility of the group. Identity integrity is the need underlying this group adaptive mode.

Ø  Role function mode - focuses on the roles of the person in society and the roles within a group. The basic need underlying the role function mode is social integrity – that is, the need to know who one is in relation to others so that one will know how to act.

Ø  Interdependence mode – a category of behavior related to interdependent relationships. This mode focuses on interactions related to the giving and receiving of love, respect, and value. The basic need of this mode is relational integrity, or the feeling of security in nurturing relationships. For the individual, significant others and support systems; and for the group, infrastructure and member capability (Roy, 2009).

Health

“Health is a state and a process of being and becoming integrated and a whole person. It is a reflection of adaptation, that is, the interaction of the person and the environment.” (Roy & Andrews, 1991)

Health ensues when humans continually adapt. As people adapt to stimuli, they are free to respond to other stimuli. The freeing energy from ineffective coping attempts can promote healing and enhance health (Roy, 1984).

Environment

Environment is all the conditions, circumstances and influences surrounding and affecting the development and behaviours of persons and groups, with particular consideration of the mutuality of person and earth resources that includes the focal, contextual, and residual stimuli (Roy & Andrews, 1999).

                In the Roy Adaptation model, there are three classes of stimuli that form the environment:

Ø  Focal stimulus – the internal or external stimulus most immediately in the awareness of the individual or group – the object or event most present in the consciousness.

Ø  Contextual stimuli – are all other stimuli present to the situation that contribute to the effect of the focal stimulus.  Even though the contextual stimuli are not the center of attention, these factors do influence how people deal with the focal stimulus.

Ø  Residual stimuli – are environmental factors within or outside human systems, the effects of which are unclear in the situation. The effects of these stimuli may be unclear if there is no awareness on the part of the patient that a stimulus is an influence, or it may not be clear to the observer that these stimuli are having an influence on the human system.

THEORETICAL ASSERTIONS

Roy’s model focuses on the concept of adaptation of the person. Her concepts of nursing, person, health, and environment are all interrelated to this central concept (Phillips, 2010). The person continually experiences environmental stimuli. Ultimately, a response is made and adaptation occurs. That response may be either an adaptive or ineffective response. Adaptive responses promote integrity and help the person to achieve the goals of adaptation, that is, they achieve survival, growth, reproduction, mastery, and person and environmental transformations. Ineffective responses fail to achieve or threaten the goals of adaptation. Nursing has a unique goal to assist the person’s adaptation effort by managing the environment. The result is attainment of an optimal level of wellness by a person (Andrews & Roy. 1986).

                As an open living system, the person receives inputs or stimuli from both the environment and the self. The adaptation level is determined by the combined effect of the focal, contextual and residual stimuli. Perception is the interpretation of stimuli, and perception links the regulator with the cognator in that “input into the regulator is transformed into perceptions. Perception is a process of the cognator. The following responses are feedback into both the cognator and regulator. The four adaptive modes of the two subsystems in Roy’s model provide form or manifestations of the cognator and regulator activity. Responses to stimuli are carried out through the four adaptive modes (Phillips, 2010). Adaptation occurs when a person is able to responds positively to the stimulus. When it is unable to do so, disruption of the system occurs. The role of nurses is to enhance the adaptation capability of the human systems.

ACCEPTANCE OF THE NURSING COMMUNITY

In Practice

                The Roy Adaptation Model is universally used in nursing practice. To use the model in practice, the nurse follows Roy’s six-step nursing process:

1.       Assess the behaviors manifested from the four adaptive modes.

2.       Assess and categorize the stimuli for those behaviors

3.       Make a nursing diagnosis based on the person’s adaptive state

4.       Set goals to promote adaptation

5.       Implement interventions aimed at managing stimuli to promote adaptation.

6.       Evaluate achievement of adaptive goals

Andrews and Roy (1989) pointed out that by manipulating the stimuli, rather than the patient, the nurse enhances “the interaction of the person with their environment, thereby promoting health”.

Education & Research

                The adaptation model has been useful in the educational setting and has guided nursing education at Mount Saint Mary’s College – Department of Nursing, Los Angeles since 1970. As early as 1987, more than 100,000 student nurses had been educated in nursing programs based on the Roy Adaptation Model in the United States and abroad. Roy believes that curricula based on this model support understanding of theory development by students as they learn about testing theories and experience theoretical insights. It also provides educators a systemic way of teaching students to assess and care for their patients within the context of their lives, rather than plain victims of illness (Phillips, 2010).

                Roy’s model has generated a number of general propositions. From these general propositions, specific hypotheses can be developed and tested. Data to validate or support the model are created by the testing of such hypothesis; the model continues to generate more of this type of research. The Roy Adaptation Model has been the theoretical source of a number of middle range theories. The utility of those theories in practice sustains the life of the model (Fredrickson, 2010).

References:

Andrews, H.A., & Roy, Sr. C (1986). Essentials of the Roy adaptation model. Norwalk, CT: Appleton-Century-Crofts

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

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.

Roy, Sr. C. (1970) Adaptation: A conceptual framework for nursing. Nursing outlook, 18, 42-45

Roy, Sr. C. (1984) Introduction to nursing: An adaptation model (2^nd ed.). Stamford, CT: Appleton & Lange

Roy, Sr. C. (2009). The Roy adaptation model (3^rd ed.) Upper Saddle River, NJ: Pearson.

Roy, Sr. C., & Andrews, H. A. (1991). The Roy adaptation model: The definitive statement. Norwalk, CT: Appleton & Lange.

Roy, Sr. C., & Andrews, H.A. (1999) The Roy adaptation model (2^nd ed.). Stamford, CT: Appleton & Lange

Roy, Sr. C., & Roberts, S. (1981). Theory construction in nursing: An adaptation model. Englewood Cliffs, NJ: Prentice-Hall.