Roys Adaptation Model

Introduction

Sr.Callista Roy- 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.
Bachelor of Arts with a major in nursing – Mount St. Mary’s College, Los Angeles in 1963.
Master’s degree program in pediatric nursing – University of California ,Los Angeles in 1966.
Master’s and PhD in Sociology in 1973 and 1977.
Worked with Dorothy E. Johnson
Worked as f faculty of Mount St. Mary’s College in 1966.
Organized course content according to a view of person and family as adaptive systems.
RAM as a basis of curriculum i at 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.

Assumptions (Roy 1989; Roy and Andrews 1991)

Explicit assumptions

The person is a bio-psycho-social being.
The person is in constant interaction with a changing environment.
To cope with a changing world, person uses both innate and acquired mechanisms which are biological, psychological and social in origin.
Health and illness are inevitable dimensions of the person’s life.
To respond positively to environmental changes, the person must adapt.
The person’s adaptation is a function of the stimulus he is exposed to and his adaptation level
The person’s adaptation level is such that it comprises a zone indicating the range of stimulation that will lead to a positive response.
The person has 4 modes of adaptation: physiologic needs, self- concept, role function and inter-dependence.
“Nursing accepts the humanistic approach of valuing other persons’ opinions, and view points” Interpersonal relations are an integral part of nursing
There is a dynamic objective for existence with ultimate goal of achieving dignity and integrity.

Implicit assumptions

A person can be reduced to parts for study and care.
Nursing is based on causality.
Patient’s values and opinions are to be considered and respected.
A state of adaptation frees an individual’s energy to respond to other stimuli.

Major Concepts

Adaptation — goal of nursing
Person — adaptive system
Environment — stimuli
Health — outcome of adaptation
Nursing- promoting adaptation and health

Adaptation

Responding positively to environmental changes.
The process and outcome of individuals and groups who use conscious awareness, self reflection and choice to create human and environmental integration

Person

Bio-psycho-social being in constant interaction with a changing environment
Uses innate and acquired mechanisms to adapt
An adaptive system described as a whole comprised of parts
Functions as a unity for some purpose
Includes people as individuals or in groups-families, organizations, communities, and society as a whole.

Environment

Focal – internal or external and immediately confronting the person
Contextual- all stimuli present in the situation that contribute to effect of focal stimulus
Residual-a factor whose effects in the current situation are unclear
All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources, including focal, contextual and residual stimuli

Health

Inevitable dimension of person’s life
Represented by a health-illness continuum
A state and a process of being and becoming integrated and whole

Nursing

To promote adaptation in the four adaptive modes
To promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental interactions

Subsystems

Cognator subsystem — A major coping process involving 4 cognitive-emotive channels: perceptual and information processing, learning, judgment and emotion.
Regulator subsystem — a basic type of adaptive process that responds automatically through neural, chemical, and endocrine coping channels

Relationships

Derived Four Adaptive Modes
500 Samples of Patient Behavior
What was the patient doing?
What did the patient look like when needing nursing care?

Four Adaptive Modes

Physiologic Needs
Self Concept
Role Function
Interdependence

THEORY DEVELOPMENT

Philosophical Assumptions

Persons have mutual relationships with the world and God
Human meaning is rooted in an omega point convergence of the universe
God is intimately revealed in the diversity of creation and is the common destiny of creation
Persons use human creative abilities of awareness, enlightenment, and faith
Persons are accountable for the processes of deriving, sustaining, and transforming the universe

Adaptation and Groups

Includes relating persons, partners, families, organizations, communities, nations, and society as a whole

Adaptive Modes

A. Persons

Physiologic
Self Concept
Role Function
Interdependence

B. Groups

Physical
Group Identity
Role Function
Interdependence

Role Function Mode

Underlying Need of Social integrity
The need to know who one is in relation to others so that one can act
The need for role clarity of all participants in group

Adaptation Level

A zone within which stimulation will lead to a positive or adaptive response
Adaptive mode processes described on three levels:
Integrated
Compensatory
Compromised

Integrated Life Processes

Adaptation level where the structures and functions of the life processes work to meet needs
Examples of Integrated Adaptation
Stable process of breathing and ventilation
Effective processes for moral-ethical-spiritual growth

Compensatory Processes

Adaptation level where the cognator and regulator are activated by a challenge to the life processes
Compensatory Adaptation Examples:
Grieving as a growth process, higher levels of adaptation and transcendence
Role transition, growth in a new role

Compromised Processes

Adaptation level resulting from inadequate integrated and compensatory life processes
Adaptation problem
Compromised Adaptation Examples
Hypoxia
Unresolved Loss
Stigma
Abusive Relationships

THE NURSING PROCESS

RAM offers guidelines to nurse in developing the nursing process.
The elements :
First level assessment
Second level assessment
Diagnosis
Goal setting
Intervention
evaluation

Usefulness of Adaptation Model

Scientific knowledge for practice
Clinical assessment and intervention
Research variables
To guide nursing practice
To organize nursing education
Curricular frame work for various nursing colleges

Characteristics of the theory

interrelated
logical in nature
relatively simple yet generalizable
can be the basis for the hypotheses that can be tested
contribute to and assist in increasing the general body of knowledge of a discipline
can be utilized by the practitioners to guide and improve their practice
consistent with other validated theories, laws and principles
Testable

Research studies using RAM

Middle range theories have been derived from RAM
1998-Ducharme et al described a longitudinal model of psychosocial determinants of adaptation
1998-Levesque et al presented a MRT of psychological adaptation
1999-A MRNT , the urine control theory by Jirovec et al
Dunn, H.C. and Dunn, D. G. (1997). The Roy Adaptation Model and its application to clinical nursing practice. Journal of Ophthalmic Nursing and Technology. 6(2), 74-78.
Samarel, N., Fawcett, J., Krippendorf, K., Piacentino, J.C., Eliasof, B., Hughes, P., Kowitski, C., and Ziegler, E. (1998). Women’s perception of group support and adaptation to breast cancer. Journal of Advanced Nursing. 28(6), 1259-1268.
Chiou, C. (2000). A meta-analysis of the interrelationships between the modes in Roy’s adaptation model. Nursing Science Quarterly. 13(3), 252-258
Yeh, C. H. (2001). Adaptation in children with cancer: research with Roy’s model. Nursing Science Quarterly. 14, 141-148.
Zhan, L. (2000). Cognitive adaptation and self-consistency in hearing-impaired older persons: testing Roy’s adaptation model. Nursing Science Quarterly. 13(2), 158-165.

Summary

5 elements – person, goal of nursing, nursing activities, health and environment
Persons are viewed as living adaptive systems whose behaviours may be classified as adaptive responses or ineffective responses.
These behaviors are derived from regulator and cognator mechanisms.
These mechanisms work with in 4 adaptive modes.
The goal of nursing is to promote adaptive responses in relation to 4 adaptive modes, using information about person’s adaptation level, and various stimuli.
Nursing activities involve manipulation of these stimuli to promote adaptive responses.
Health is a process of becoming integrated and able to meet goals of survival, growth, reproduction, and mastery.
The environment consists of person’s internal and external stimuli.

References

George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott.
Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott.
Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book.
Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225

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