“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 (2nd
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 (7th 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 (2nd ed.). Stamford, CT: Appleton & Lange
Roy, Sr. C.
(2009). The Roy adaptation model (3rd
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 (2nd ed.). Stamford, CT: Appleton & Lange
Roy, Sr. C.,
& Roberts, S. (1981). Theory
construction in nursing: An adaptation model. Englewood Cliffs, NJ:
Prentice-Hall.
