THE ROY'S ADAPTATION MODEL

Callista Roy
Introduction
O $7Callista Roy, a p7ominent nu7se theo7ist, w7ite7, lectu7e7, 7esea7che7 and
teache7
O !7oIesso7 and Nu7se Theo7ist at the Boston College oI Nu7sing in Chestnut
Hill
O Bo7n at Los Angeles on Octobe7 14, 1939 as the 2nd child oI M7 and M7s
Fabien Roy
O she ea7ned a Bachelo7 oI A7ts with a majo7 in nu7sing I7om Mount $t Ma7y's
College, Los Angeles in 1963
O a maste7's deg7ee p7og7am in pediat7ic nu7sing at the Unive7sity oI CaliIo7nia
,Los Angeles in 1966
O $he also ea7ned a maste7s and !hD in $ociology in 1973 and 1977
,7espectively
O $7 Callista had the signiIicant oppo7tunity oI wo7ing with Do7othy E
Johnson
O Johnson's wo7 with Iocusing nowledge Io7 the discipline oI nu7sing
convinced $7 Callista oI the impo7tance oI desc7ibing the natu7e oI nu7sing as
a se7vice to society and p7ompted he7 to begin developing he7 model with the
goal oI nu7sing being to p7omote adaptation
O $he joined the Iaculty oI Mount $t Ma7y's College in 1966, teaching both
pediat7ic and mate7nity nu7sing
O $he o7ganized cou7se content acco7ding to a view oI pe7son and Iamily as
adaptive systems
O $he int7oduced he7 ideas about Adaptation Nu7sing as the basis Io7 an
integ7ated nu7sing cu77iculum
O oal oI nu7sing to di7ect nu7sing education, p7actice and 7esea7ch
O Model as a basis oI cu77iculum impetus Io7 g7owth--Mount $t Ma7ys College
O 1970-The model was implemented in Mount $t Ma7ys school
O 1971- she was made chai7 oI the nu7sing depa7tment at the college

Influencing Factors
O Family
O Education
O Religious Bacg7ound
O Mento7s
O Clinical Expe7ience

THEORY DESCRIPTION
O The cent7al questions oI Roys theo7y a7e:
4 ho is the Iocus oI nu7sing ca7e?
4 hat is the ta7get oI nu7sing ca7e?
4 hen is nu7sing ca7e indicated?
O Roys Ii7st ideas appea7ed in a g7aduate pape7 w7itten at UCLA in 1964
O !ublished these ideas in "Nursing outlook" in 1970
O $ubsequently diIIe7ent components oI he7 I7amewo7 c7ystallized du7ing
1970s, 0s, and 90s
O Ove7 the yea7s she identiIied assumptions on which he7 theo7y is based

Explicit assumptions (Roy 1989; Roy and Andrews 1991)
O The pe7son is a bio-psycho-social being
O The pe7son is in constant inte7action with a changing envi7onment
O To cope with a changing wo7ld, pe7son uses both innate and acqui7ed
mechanisms which a7e biological, psychological and social in o7igin
O Health and illness a7e inevitable dimensions oI the pe7sons liIe
O To 7espond positively to envi7onmental changes, the pe7son must adapt
O The pe7sons adaptation is a Iunction oI the stimulus he is exposed to and his
adaptation level
O The pe7sons adaptation level is such that it comp7ises a zone indicating the
7ange oI stimulation that will lead to a positive 7esponse
O The pe7son has 4 modes oI adaptation: physiologic needs, selI- concept, 7ole
Iunction and inte7-dependence
O "Nu7sing accepts the humanistic app7oach oI valuing othe7 pe7sons opinions,
and view points" Inte7pe7sonal 7elations a7e an integ7al pa7t oI nu7sing
O The7e is a dynamic objective Io7 existence with ultimate goal oI achieving
dignity and integ7ity

Implicit assumptions
O A pe7son can be 7educed to pa7ts Io7 study and ca7e
O Nu7sing is based on causality
O !atients values and opinions a7e to be conside7ed and 7espected
O A state oI adaptation I7ees an individuals ene7gy to 7espond to othe7 stimuli

ROY ADAPTATION MODEL CONCEPTS: EARLY AND REVISED
O Adaptation -- goal oI nu7sing
O !e7son -- adaptive system
O Envi7onment -- stimuli
O Health -- outcome oI adaptation
O Nu7sing -- p7omoting adaptation and health

Concepts-Adaptation
O Responding positively to envi7onmental changes
O The p7ocess and outcome oI individuals and g7oups who use conscious
awa7eness, selI 7eIlection and choice to c7eate human and envi7onmental
integ7ation

Concepts-Person
O Bio-psycho-social being in constant inte7action with a changing envi7onment
O Uses innate and acqui7ed mechanisms to adapt
O An adaptive system desc7ibed as a whole comp7ised oI pa7ts
O Functions as a unity Io7 some pu7pose
O Includes people as individuals o7 in g7oups-Iamilies, o7ganizations,
communities, and society as a whole

Concepts-Environment
O Focal - inte7nal o7 exte7nal and immediately conI7onting the pe7son
O Contextual- all stimuli p7esent in the situation that cont7ibute to eIIect oI Iocal
stimulus
O Residual-a Iacto7 whose eIIects in the cu77ent situation a7e unclea7
O All conditions, ci7cumstances, and inIluences su77ounding and aIIecting the
development and behavio7 oI pe7sons and g7oups with pa7ticula7 conside7ation
oI mutuality oI pe7son and ea7th 7esou7ces, including Iocal, contextual and
7esidual stimuli

Concepts-Health
O Inevitable dimension oI pe7son's liIe
O Rep7esented by a health-illness continuum
O A state and a p7ocess oI being and becoming integ7ated and whole

Concepts-Nursing
O To p7omote adaptation in the Iou7 adaptive modes
O To p7omote adaptation Io7 individuals and g7oups in the Iou7 adaptive modes,
thus cont7ibuting to health, quality oI liIe, and dying with dignity by assessing
behavio7s and Iacto7s that inIluence adaptive abilities and by inte7vening to
enhance envi7onmental inte7actions

Concepts-Subsystems
O Cognato7 subsystem A majo7 coping p7ocess involving 4 cognitive-emotive
channels: pe7ceptual and inIo7mation p7ocessing, lea7ning, judgment and
emotion
O Regulato7 subsystem a basic type oI adaptive p7ocess that 7esponds
automatically th7ough neu7al, chemical, and endoc7ine coping channels

Relationships
O De7ived Fou7 Adaptive Modes
O 00 $amples oI !atient Behavio7
O hat was the patient doing?
O hat did the patient loo lie when needing nu7sing ca7e?

Four Adaptive Modes
O !hysiologic Needs
O $elI Concept
O Role Function
O Inte7dependence

Four Adaptive Mode Categories
O Tested in p7actice Io7 10 yea7s
O C7ite7ia oI signiIicance, useIulness, and completeness we7e met

Sample Proposition and Hypothesis for Practice
O $elI Concept Mode: Inc7eased quality oI social expe7ience leads to inc7eased
Ieelings oI adequacy
O !7oviding suppo7t Io7 new mothe7s can lead to positive pa7enting



THEORY DEVELOPMENT
Derived Theory
O 91 !7opositions
O Desc7ibed 7elationships between and among 7egulato7 and cognato7 and Iou7
adaptive modes
O 12 ene7ic p7opositions

Questions Raised by 21st Century Changes
O How can ethics and public policy eep pace with developments in science?
O How can nu7ses Iocus on human needs not machines?
O How can nu7ses cont7ibute to c7eating meaning and pu7pose in a global
society?

Scientific Assumptions for the 21st Century
O $ystems oI matte7 and ene7gy p7og7ess to highe7 levels oI complex selI
o7ganization
O Consciousness and meaning a7e constitutive oI pe7son and envi7onment
integ7ation
O Awa7eness oI selI and envi7onment is 7ooted in thining and Ieeling
O Human decisions a7e accountable Io7 the integ7ation oI c7eative p7ocesses
O Thining and Ieeling mediate human action
O $ystem 7elationships include acceptance, p7otection, and Ioste7ing oI
inte7dependence
O !e7sons and the ea7th have common patte7ns and integ7al 7elations
O !e7son and envi7onment t7ansIo7mations a7e c7eated in human consciousness
O Integ7ation oI human and envi7onment meanings 7esults in adaptation

Philosophical Assumptions
O !e7sons have mutual 7elationships with the wo7ld and od
O Human meaning is 7ooted in an omega point conve7gence oI the unive7se
O od is intimately 7evealed in the dive7sity oI c7eation and is the common
destiny oI c7eation
O !e7sons use human c7eative abilities oI awa7eness, enlightenment, and Iaith
O !e7sons a7e accountable Io7 the p7ocesses oI de7iving, sustaining, and
t7ansIo7ming the unive7se

Adaptation and Groups
O Includes 7elating pe7sons, pa7tne7s, Iamilies, o7ganizations, communities,
nations, and society as a whole

Adaptive Modes
A. Persons
O !hysiologic
O $elI Concept
O Role Function
O Inte7dependence
. Groups
O !hysical
O 7oup Identity
O Role Function
O Inte7dependence
Role Function Mode
O Unde7lying Need oI $ocial integ7ity
O The need to now who one is in 7elation to othe7s so that one can act
O The need Io7 7ole cla7ity oI all pa7ticipants in g7oup
Adaptation Level
O A zone within which stimulation will lead to a positive o7 adaptive 7esponse
O Adaptive mode p7ocesses desc7ibed on th7ee levels:
O Integ7ated
O Compensato7y
O Comp7omised
Integrated Life Processes
O Adaptation level whe7e the st7uctu7es and Iunctions oI the liIe p7ocesses wo7
to meet needs
O Examples oI Integ7ated Adaptation
O $table p7ocess oI b7eathing and ventilation
O EIIective p7ocesses Io7 mo7al-ethical-spi7itual g7owth
Compensatory Processes
O Adaptation level whe7e the cognato7 and 7egulato7 a7e activated by a challenge
to the liIe p7ocesses
O Compensato7y Adaptation Examples:
O 7ieving as a g7owth p7ocess, highe7 levels oI adaptation and t7anscendence
O Role t7ansition, g7owth in a new 7ole
Compromised Processes
O Adaptation level 7esulting I7om inadequate integ7ated and compensato7y liIe
p7ocesses
O Adaptation p7oblem
O Comp7omised Adaptation Examples
O Hypoxia
O Un7esolved Loss
O $tigma
O Abusive Relationships

THE NURSING PROCESS
O RAM oIIe7s guidelines to nu7se in developing the nu7sing p7ocess
O The elements :
O Fi7st level assessment
O $econd level assessment
O Diagnosis
O oal setting
O Inte7vention
O evaluation

Usefulness of Adaptation Model
O $cientiIic nowledge Io7 p7actice
O Clinical assessment and inte7vention
O Resea7ch va7iables
O To guide nu7sing p7actice
O To o7ganize nu7sing education
O Cu77icula7 I7ame wo7 Io7 va7ious nu7sing colleges

Characteristics of the theory
O Theo7ies can inte77elates concepts in such a way as to p7esent a new view oI
looing at a pa7ticula7 phenomenon
O Theo7ies must be logical in natu7e
O Theo7ies should be 7elatively simple yet gene7alizable
O Theo7ies can be the basis Io7 the hypotheses that can be tested
O Theo7ies cont7ibute to and assist in inc7easing the gene7al body oI nowledge
oI a discipline th7ough the 7esea7ch implemented to validate them
O Theo7ies can be utilized by the p7actitione7s to guide and imp7ove thei7
p7actice
O Theo7ies must be consistent with othe7 validated theo7ies, laws and p7inciples
but will leave open unanswe7ed questions that need to be investigated

Testability
O RAM is testable
O BBARN$ (1999) 7epo7ted that 163 studies have been conducted using this
model
O RAM is complete and comp7ehensive
O It explains the 7eality oI client, so nu7sing inte7ventions can be speciIically
ta7geted

Research studies using RAM
O Middle 7ange theo7ies have been de7ived I7om RAM
O 199-Ducha7me et al desc7ibed a longitudinal model oI psychosocial
dete7minants oI adaptation
O 199-Levesque et al p7esented a MRT oI psychological adaptation
O 1999-A MRNT , the u7ine cont7ol theo7y by Ji7ovec et al
O Dunn, HC and Dunn, D (1997) The Roy Adaptation Model and its
application to clinical nu7sing p7actice Jou7nal oI Ophthalmic Nu7sing and
Technology 6(2), 74-7
O $ama7el, N, Fawcett, J, K7ippendo7I, K, !iacentino, JC, EliasoI, B,
Hughes, !, Kowitsi, C, and Ziegle7, E (199) omen's pe7ception oI
g7oup suppo7t and adaptation to b7east cance7 Jou7nal oI Advanced Nu7sing
2(6), 129-126
O Chiou, C (2000) A meta-analysis oI the inte77elationships between the modes
in Roy's adaptation model Nu7sing $cience Qua7te7ly 13(3), 22-2
O eh, C H (2001) Adaptation in child7en with cance7: 7esea7ch with Roy's
model Nu7sing $cience Qua7te7ly 14, 141-14
O Zhan, L (2000) Cognitive adaptation and selI-consistency in hea7ing-
impai7ed olde7 pe7sons: testing Roy's adaptation model Nu7sing $cience
Qua7te7ly 13(2), 1-16

References
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!7actice , 37d ed No7wal, Appleton & Lange
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37d ed !hiladelphia, Lippincott
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!hiladelphia, Lippincott
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!7ocess & !7actice 37d ed London Mosby ea7 Boo
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