Biography and Career of Dr Patricia Benner

Dr. Benner earned her Bachelor of Arts degree in nursing from Pasadena College in 1964. She went
on to earn a Master of Science in Medical-Surgical Nursing from the University of California at San
Francisco in 1970, and a Ph.D. from the University of California at Berkeley in 1982
In the late 1960s, Benner worked in the nursing field. This included working as a Head Nurse of the
Coronary Care Unit at the Kansas City General Hospital and an Intensive Care Staff Nurse at the
Stanford University Hospital and Medical Center. From 1970 until 1975, she was a Research
Associate at the University of California at San Francisco School of Nursing.

Following that, she was a Research Assistant to Richard S. Lazarus at the University of California at
Berkeley. From 1979 until 1981, she was the Project Director at the San Francisco
Consortium/University of San Francisco for a project achieving methods of intra-professional
consensus, assessment, and evaluation. Since 1982, Dr Benner has been working in research and
teaching at the University of California at San Francisco School of Nursing.

Dr Benner has published nine books, including From Novice to Expert, Nursing Pathways for
Patient Safety, and The Primacy of Caring. She has also published many articles. In 1995, she was
awarded the 15th Helen Nahm Research Lecture Award from the University of California at San
Francisco School of Nursing.
She is currently a professor emerita in the Department of Physiological Nursing at the University of
California at San Francisco School of Nursing. Some of her works include:

 Educating Nurses: A Call for Radical Transformation (Jossey-Bass/Carnegie

Foundation for the Advancement of Teaching)
  From Novice to Expert: Excellence and Power in Clinical Nursing Practice,
Commemorative Edition
 Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics, Second
Edition
 Clinical Wisdom and Interventions in Acute and Critical Care: A Thinking-in-
Action Approach, Second Edition
 Interpretive Phenomenology: Embodiment, Caring, and Ethics in Health and Illness
(Nurse-patient relations)
 New Nurses Work Entry: A Trouble Sponsorship
 Stress and Satisfaction on the Job
Dr Patricia Benner's Contribution to Nursing Theory: From
Novice to Expert Concept
Patricia Benner developed a concept known as “From Novice to Expert.” This concept explains that
nurses develop skills and an understanding of patient care over time from a combination of a strong
educational foundation and personal experiences.

Dr Benner proposed that a nurse could gain knowledge and skills without actually learning a theory.
She describes this as a nurse “knowing how” without “knowing that.” She further explains that the
development of knowledge in fields such as nursing is made up of the extension of knowledge
through research and understanding through clinical experience.

The theory identifies five levels of nursing experience: novice, advanced beginner, competent,
proficient, and expert.

1. A novice is a beginner with no experience. They are taught general rules to help perform
tasks, and their rule-governed behavior is limited and inflexible. In other words, they are
told what to do and simply follow instruction.
2. The advanced beginner shows acceptable performance, and has gained prior experience
in actual nursing situations. This helps the nurse recognize recurring meaningful
components so that principles, based on those experiences, begin to formulate in order to
guide actions.
3. A competent nurse generally has two or three years’ experience on the job in the same
field. For example, two or three years in intensive care. The experience may also be
similar day-to-day situations. These nurses are more aware of long-term goals, and they
gain perspective from planning their own actions, which helps them achieve greater
efficiency and organization.
4. A proficient nurse perceives and understands situations as whole parts. He or she has a
more holistic understanding of nursing, which improves decision-making. These nurses
learn from experiences what to expect in certain situations, as well as how to modify plans
as needed.
5. Expert nurses no longer rely on principles, rules, or guidelines to connect situations and
determine actions. They have a deeper background of experience and an intuitive grasp of
clinical situations. Their performances are fluid, flexible, and highly-proficient. Benner’s
 writings explain that nursing skills through experience are a prerequisite for becoming an
expert nurse.
These different levels of skills show changes in the three aspects of skilled performance: movement
from relying on abstract principles to using past experiences to guide actions; change in the learner’s
perception of situations as whole parts rather than separate pieces; and passage from a detached
observer to an involved performer, engaged in the situation rather than simply outside of it.

The levels reflect movement from reliance on past principles to the use of past experience and
change in the perception of the situation as a complete whole with certain relevant parts. Each step
builds on the previous step as principles are refined and expanded by experience and clinical
expertise.

Benner’s theory of From Novice to Expert changed the understanding of what it means to be an
expert in the nursing field. This moves the label from a nurse with the highest pay or the most
prestigious title to the nurse who provided the best care to his or her patients.

Concept Analysis (Part One): Novice to Expert, Nursing Concept

Defined
Updated: May 22, 2020
In this three part series we will review the theory, identify how it can be used for the developing
nurse with particular focus on the role of the hospital educator (whether that be the educator
within the education department, the nurse manager, the charge nurse, or any other leader
supporting competency development), and review how the theory can be applied to the
development journey of the educator themselves.

Patricia Benner, a researcher, author, and nursing educator, created the Model of Novice to
Expert, which applies the idea of transition in practice from novice to expert nurse. Benner’s
model expresses that as nursing skills and knowledge build, the care delivered strengthens and
the nurse makes their way to the expert stage. This model is based on intuitive decision-making.
Benner’s model encompasses five progressive stages, with novice being stage one and expert
being stage five. This model is considered a middle range theory. The requirements for each
stage are clearly defined and measurable and it also integrates more specific concepts. As this
theory relates to a specific concept, the scope is finer. As the nurse meets the clearly delineated
requirements of one of the stages, it is a predictive model. The stages are met through application
of practical knowledge and clinical experience. Nurses often incorporate many of these thoughts
and share the philosophies found within this theory without definition.

The nursing metaparadigm includes person, health, nursing, and environment. The
metaparadigm emphasizes holistic care as it highlights humanistic aspects woven with scientific
knowledge. Knowing-how is primarily skill-based and developed through hands-on clinical
experiences and mentorships. As nurses develop deeper understanding of practice, knowing-that
guides their actions and reactions. This model is increasingly relevant to nursing practice, as
these connecting concepts align with the nursing field as a whole. Knowledge gained through
formal education and observation, along with that obtained through preceptorships and work
experience, encourage ongoing role development and strengthened ways of knowing.

The 4 Metaparadigms in Nursing as defined by Patricia Benner:

Nursing
Patricia Benner described nursing as an
“enabling condition of
connection and
concern”

(Marriner-Tomey, 1989, p192) which shows a high level of emotional

involvement in the nurse-client relationship. She viewed nursing practice as
the care and study of the lived experience of health, illness, and disease
and the relationships among these three elements.
Person
Benner stated that a
“self-interpreting being, that is, the person does not come into the
world predefined but gets defined in the course of living a life. A person also
has… an effortless and non-reflective understanding of the self in the world.
The person is viewed as a participant in common meanings.”

(Tomey,2002 p173) Benner believed that there are significant aspects that
make up a person. She had conceptualized the major aspects of
understanding that the person must deal as:1. The role of the situation
2. The role of the body. 3. The role of personal concerns.
4. The role of temporality.

Health
Patricia Benner focused
“on the lived experience of being healthy and ill.”
She defined health as what can be assessed, while well-being
is the human experience of health or wholeness.
Well-being and being ill are recognized as different ways of being in the
world. Health is described as not just the absence of disease and
illness. Also, a person may have a disease and not experience illness because
illness is the human experience of loss or dysfunction, whereas disease is what
can be assessed at the physical level.

Environment
Instead of using the term
“environment”
, Benner used the term
“situation”
, because it suggests a social environment with
social definition and meaning. She used the phenomenological terms of
Being situated and situated meaning, which are defined by the person’s
engaged interaction, interpretation an understanding of the situation.

Patricia Benner Nursing Theory: From Novice to Expert

LEVELS OF NURSING EXPERIENCE
She described 5 levels of nursing experience as;


Novice


Advanced beginner


Competent


Proficient


Expert

Stage 1: Novice
Beginners have had no experience of
the situations in which they are expected to perform. Novices are taught
rules to help them perform. The rules are context-free and independent of
specific case hence the rules tend to be applied universally. The rule-
governed behavior typical of the novice is extremely limited and inflexible.
As such, novice have no “life experience” in the application of rules.
“Just tell me what I need to do and I’ll do it”

Stage 2: Advanced Beginner

Advanced Beginner are those who can demonstrate marginally
acceptable performance, those who have coped with
enough real situations to note, or to have pointed out to them by a
mentor, the recurring meaningful situational components. These
components require prior experience in
actual situations for recognition. Principles to guide actions begin to be
formulated. The principles are based on experience.

Stage 3: Competent
Competence, typified by the nurse who has been on the job in the same
or similar situations two or three years, develops when the nurse begins
to see his or her actions in terms of long-range goals or plans of which he
or she is consciously aware. For the competent nurse, a plan establishes
a perspective, and the plan is based on considerable conscious,
abstract, analytic, contemplation of the problem, The Conscious,
deliberate planning that is characteristic of this skill levels help
achieve efficiency and organization. The competent nurse lacks the
speed and flexibility of the proficient nurse but does have a feeling of
mastery and the ability to cope with and manage the many contingencies of
clinical nursing. The competent person does not yet have enough
experience to recognize a situation in terms of an overall picture or in terms
of which aspects are most salient, most important.
Stage 4: Proficient
The proficient performer perceives situations as whole rather than in terms
of chopped up parts or aspects, and performance is guided by maxims.
Proficient nurses understand a situation as a whole because they perceive
its meaning in terms of long-term goals. The proficient nurse

Stage 5: The Expert

The expert performer no longer relies on an analytic principle (rule,
guideline, maxim) to connect her or his understanding of the situation
to an appropriate action. The expert nurse, with an enormous
background of experience, now has an intuitive grasp of each situation and
zeroes in the accurate region of the problem without wasteful consideration
of a large range of unfruitful, alternative diagnosis and solutions. The expert
operates from a deep understanding of the total situation.

Patricia Benner Nursing Theory: From Novice to Expert

Seven Domains of Nursing Practice


Helping role


Teaching or coaching function



Diagnostic client-monitoring function


 Effective management of rapidly changing situations


Administering and monitoring therapeutic interventions and regiments



Monitoring and ensuring quality of healthcare practices



Organizational and work-role competencies

Sister Callista Roy: Adaptation Model of Nursing

UPDATED ON JULY 2, 2023

BY ANGELO GONZALO, BSN, RN

Get to know Sister Callista Roy’s biography and Adaptation Model of Nursing in
this study guide for nursing theories.

Table of Contents
  Biography of Callista Roy
 Education and Career
 Adaptation Model of Nursing
 Works
 Published works
 Awards and Honors
 Callista Roy’s Adaptation Model of Nursing
 Assumptions
 Scientific Assumptions
 Philosophical Assumptions
 Major Concepts of the Adaptation Model
 Person
 Environment
 Health
 Nursing
 Adaptation
 Internal Processes
 Regulator
 Cognator
 Four Adaptive Modes
 Physiological-Physical Mode
 Self-Concept Group Identity Mode
 Role Function Mode
 Interdependence Mode
 Levels of Adaptation
 Integrated Process
 Compensatory Process
 Compromised Process
 Six-Step Nursing Process
 Analysis
 Strengths of the Roy’s Adaptation Model
 Weaknesses
 Recommended Resources
 See Also
 References
 External Links
Biography of Callista Roy
Sister Callista L. Roy (born October 14, 1939) is a nursing theorist, professor, and
author. She is known for her groundbreaking work in creating the Adaptation
Model of Nursing.

Education and Career

Callista Roy received her Bachelor of Arts Major in Nursing from Mount Saint
Mary’s College in Los Angeles in 1963 and her master’s degree in nursing from
the University of California in 1966.

After earning her nursing degrees, Roy began her sociology education, receiving
both a master’s degree in sociology in 1973 and a doctorate in sociology in 1977
from California.

During her time working toward her master’s degree, Roy was challenged in a
seminar with Dorothy E. Johnson to develop a conceptual model for nursing. Roy
worked as a pediatric nurse and noticed a great resiliency of children and their
ability to adapt to major physical and psychological changes. Impressed by this
adaptation, Roy worked towards an appropriate conceptual framework for
nursing.

She developed the model’s basic concepts while she was a graduate student at
the University of California from 1964 to 1966.

In 1968, she began operationalizing her model when Mount Saint Mary’s College
adopted the adaptation framework as the nursing curriculum’s philosophical
foundation.

Roy was an associate professor and chairperson of the Department of Nursing at

Mount Saint Mary’s College until 1982 and was promoted to the professor’s rank
in 1983 at both Mount Saint Mary’s College and the University of Portland. She
helped initiate and taught in a summer master’s program at the University of
Portland.
 Sr. Callista Roy. Photo: Boston College

She was a Robert Wood Johnson postdoctoral fellow at the University of

California, San Francisco, from 1983 to 1985 as a clinical nurse scholar in
neuroscience. During this time, she researched nursing interventions for cognitive
recovery in head injuries and the influence of nursing models on clinical decision
making.

From 1987 to the present, Roy began the newly created resident nurse theorist
position at Boston College School of Nursing, where she teaches doctoral,
master’s, and undergraduate students.

In 1991, she founded the Boston Based Adaptation Research in Nursing Society
(BBARNS), which would later be renamed the Roy Adaptation Association.

Roy’s other scholarly work includes conceptualizing and measuring coping and
developing the philosophical basis for the adaptation model and nursing’s
epistemology.

Roy belongs to the Sisters of St. Joseph of Carondelet.

Adaptation Model of Nursing

Sr. Callista Roy’s Adaptation Model of Nursing was developed by Sister Callista
Roy in 1976. The prominent nursing theory aims to explain or define the
provision of nursing. In her theory, Roy’s model sees the individual as a set of
interrelated systems that maintain a balance between these various stimuli. The
adaptation Model of Nursing is discussed further below.

Works

The Roy Adaptation Model (3rd Edition)

Sr. Callista Roy has numerous publications, including books and journal articles,
on nursing theory and other professional topics. Her works have been translated
into many languages all over the world.

Roy and her colleagues at Roy Adaptation Association have critiqued and
synthesized the first 350 research projects published in English based on her
adaptation model.

Her most famous work is on the Roy adaptation model of nursing.

Published works

1. Roy, S. C. (2014). Generating middle-range theory: From evidence to

practice. New York, NY: Springer.
2. Roy, S. C., & Harrington, A. (2013). Roy adaptation model-based
research: Global view. Generating Middle range theory: From
evidence to practice (pp. 355-365). New York, NY: Springer.
3. Roy, S. C. (2013). From US nurse theorist’s view of person and good
of society: Dr. Callista Roy (p. 3), in Cristina Monforte, RN, MSN, PhD
(Ed.), Catalunya: Universitat Internacional de Catalunya (UIC).
4. Roy, S. C., Barone, S. H. (2013). Pedagogic materials for generating
middle range theories: Evidence for practice. In S.C Roy (ed.).
Generating Middle Range Theory: From Evidence to Practice. New
York, NY: Springer.
5. Roy, S. C. (2011). Research-based on the Roy adaptation model: Last
25 years. Nursing Science Quarterly, 24(4), 312-320.
6. Roy, S. C. (2011). Extending the Roy Adaptation Model to Meet
Changing Global Needs. Nursing Science Quarterly, 24(4), 345-351.
7. Senesac, P. M., Roy, S. C. (2010). Sister Callista Roy’s Adaptation
Model, In M. Parker and M. Smith (Ed.), Nursing Theories and
Nursing Practice (ed., pp. 40 page manuscript). Philadelphia, PA: F.A.
Davis.
8. Jones, D. A., Roy, S. C., K. A. (2013). Marjory Gordon Living Legend.
NANDA- International Journal of Nursing Terminologies and
Classification, 21(2), 2.
9. McCurry, M.S., Hunter Revell, S., & Roy, C. (2010). Knowledge for the
good of the individual and society: Linking philosophy, disciplinary
goals, theory, and practice. Nursing Philosophy, 11(1), 42-52.
10.Roy, C. (2009). The Roy Adaptation Model, 3rd edition. Upper Saddle
River, NJ: Prentice-Hall Health.
11.Barone, S., Roy, C., & Frederickson, K. (2008). Instruments used in Roy
Adaptation Model-based research: Review, critique, and further
directions. Nursing Science Quarterly. 21(4), 353-362.
12.Roy, C. (2007). Update from the future: Thinking of Theorist Callista
Roy. Nursing Science Quarterly, 20(2), 113-116.
13.Roy, Sr. C. & Jones, D. (Editors). (2007). Nursing knowledge
development and clinical practice. New York, NY: Springer.
14.Jones, D.A., Roy, C.A., & Avant, K. (2010). Marjory Gordon, living
legend. NADA- International Journal of Nursing Terminologies and
Classifications, 21(2), 80-81.
15.Roy, C. (2010). Assessment and the Roy Adaptation Model. (M. Ito,
Trans.). Journal of Japan Society of Nursing Diagnosis, 15(1), 35-41.
16.Roy, S.C., & Dowlatshahi, M. (2010). Forward. In Nursing Concepts
and Nursing Theories Glossary (pp. 2-3). Tehran, Iran: Medical
Sciences Publishing Center.
17.Roy, S. C., Zhan, L. (2010). Sister Callista Roy’s Nursing Adaptation
Model and its Applications. In M. Parker & M. Smith (Eds.), Nursing
Theories and Nursing Practice, 3rd edition, (pp. 167-181).
Philadelphia, PA: F.A. Davis.
18.Roy, C. (2010). Nursing practice and research based on the Roy
Adaptation Model. Bulletin of St. Mary’s College, 5-13.
19.Roy, C. (2010). Thoughts from a theorist. Roy Adaptation Review,
13(1), 5.
20.Roy, C.(2009). Forward. In J. Cutliffe, K. Hyrkas, & H.P. Mckenna (Eds.),
Nursing Models: Application to Practice. London. UK: Quay Books.
21.Roy, C., & Solodiuk, J. (2009). Global nursing conference focused on
knowledge for good of persons and society with reflections from
Ph.D. students. International Network for Doctoral Education in
Nursing (INDEN) Newsletter, 8(1), 5-6.
22.Roy, C., Whetsell, M.V., & Frederickson, K. (2009). The Roy Adaptation
Model and research: Global perspective. Nursing Science Quarterly,
22(3), 209-211.
23.Roy, C. (2009). Thoughts from a theorist. Nursing Science Quarterly,
12(1), 4.
24.Roy, C. (2009). Assessment and the Roy Adaptation Model. The
Japanese Nursing Journal, 29(11), 5-7.
25.Roy, C. (2008). Adversity and theory: The broad picture. Nursing
Science Quarterly. 21(2), 138-139.
26.O’Connor, A. & Roy, C. (2008). Electric power plant emissions and
public health. American Journal of Nursing. 108(2), 62-70.
27.Magee, T. & Roy, C. (2008). Predicting school-age behavior problems:
The role of early childhood risk factors. Pediatric Nursing, 34(1), 37-
43.
28.Willis, D., Grace, P., & Roy, C. (2008). A central unifying focus for the
discipline: Facilitating humanization, meaning, choice, quality of life,
and dying. Advances in Nursing Science. (31)1. online only:
www.advancesinnursingscience.com
 29.Chayput, P. & Roy, C. (2007). Psychometric testing of the Thai version
of coping and adaption processing scale—short form (TCAPS-SF).
Thai Journal of Nursing Council, 22(3), 29-39.
30.Roy, C. (2007). Update from the future: Thinking of Theorist Callista
Roy. Nursing Science Quarterly, 20(2), 113-116.
31.Roy, C. (2007). The Roy Adaptation Model: Historical and Philosoph-
ical Foundations. In Maria Elisa Moreno, et al. (Eds.) Applicacion Del
Model Adaptacion en el Ciclo Vital Humano, 2nd Edition. Chia,
Columbia: Universidad de La Sabana.
32.Roy, C. (2007). Fundamental History and Philosophy of the Roy
Adaptation Model. In Guitierrez, M. dC (Ed.) Adaptacion y Cuidado
en el ser Humano: Una Vision de Enfermeria. Bogota: Editorial El
Manual Moderno, Universidad de la Sabana, 1-12.
33.Roy, C. & Lindendoll, N. (2006). Defining international consensus on
mentorship in doctoral education. Journal of Research in Nursing,
11(4), 345-353.
34.Morgillo-Freeman, S. & Roy, C. (2005). Cognitive behavior therapy
and the Roy Adaptation Model: A discussion of theoretical
integration. In S.M. Freeman & A. Freeman (Eds.), Cognitive Behavior
Therapy in Nursing Practice. New York: Springer Publishing
Company, 3-27.
35.Roy, C. & Gray, M. (2005). Role of the supervisor/mentor. In Ketefian,
S. & McKenna, H.P. (Eds.). Doctoral Education in Nursing International
Perspectives. New York: Routledge.
36.Roy, C. (2003). Reflections on Nursing Research and the Roy
Adaptation Model. Igaju-syoin Japanese Journal, 36(1), 7-11.
37.Whittemore, R. & Roy, C. (2002). Adapting to Diabetes Mellitus: A
Theory Synthesis. Nursing Science Quarterly, 15(4), 311-317.
Awards and Honors

Sr. Callista Roy has received numerous honors due to her work and contribution
to the nursing profession.

In 2007, Roy was named a Living Legend by the American Academy of Nursing
and the Massachusetts Registered Nurses Association.
Roy is also a Sigma Theta Tau member, and she received the National Founder’s
Award for Excellence in Fostering Professional Nursing Standards in 1981.

Among her achievements include an Honorary Doctorate of Humane Letters from

Alverno College in 1984, honorary doctorates from Eastern Michigan University
(1985), and St. Joseph’s College in main (1999).

She also received the American Journal of Nursing Book of the Year Award for the
Roy Adaptation Model Essentials.

Here are more of her awards & honors:

 2013 – Distinguished Graduate Award, Bishop Conaty/Our Lady of

Loretto High School
 2013 – Honorary Doctoral Degree, Holy Family University
 2013 – Alumni Award for Professional Achievement, UCLA
 2013 – Excellence in Nursing, The University of Antioquia, Medellin
Colombia
 2011 – Nursing Science Quarterly Special Issue Honoring the work of
Callista Roy, Vol. 24, Num. 4, Oct. 2011
 2011 – Faculty Senior Scientist Poster Exemplar Award, Yvonne L.
Munn Center for Nursing Research and the Nursing Research Expo
Committee, Massachusetts General Hospital
 2011 – The Sigma Mentor Award, Sigma Theta Tau International
Alpha Chi Chapter
 2010 – University of Southern Alabama Picture Gallery of Theorist,
University of Alabama
 2010 – Inducted to Nurse Researcher Hall of Fame, Inaugural Class,
Sigma Theta Tau International, Honor Society of Nursing
 2010 – “Sixty Who have Made a Difference,” UCLA School of Nursing,
6th Anniversary
 2010 – Inductee, Sigma Theta Tau International Nurse Researcher
Hall of Fame
 2007 – American Academy of Nursing Living Legend Award
Callista Roy’s Adaptation Model of Nursing
The Adaptation Model of Nursing is a prominent nursing theory aiming to
explain or define the provision of nursing science. In her theory, Sister Callista
Roy’s model sees the individual as a set of interrelated systems that maintain a
balance between various stimuli.

The Roy Adaptation Model was first presented in the literature in an article
published in Nursing Outlook in 1970 entitled “Adaptation: A Conceptual
Framework for Nursing.” In the same year, Roy’s Adaptation Model of Nursing
was adapted in Mount St. Mary’s School in Los Angeles, California.

Roy’s model was conceived when nursing theorist Dorothy Johnson challenged
her students to develop conceptual models of nursing during a
seminar. Johnson’s nursing model was the impetus for the development of Roy’s
Adaptation Model.

Roy’s model incorporated concepts from Adaptation-level Theory of Perception

from renowned American physiological psychologist Harry Helson, Ludwig von
Bertalanffy’s System Model, and Anatol Rapoport’s system definition.

First, consider the concept of a system as applied to an individual. Roy

conceptualizes the person in a holistic perspective. Individual aspects of parts act
together to form a unified being. Additionally, as living systems, persons are in
constant interaction with their environments. Between the system and the
environment occurs an exchange of information, matter, and energy.
Characteristics of a system include inputs, outputs, controls, and feedback.

Assumptions

Scientific Assumptions

 Systems of matter and energy progress to higher levels of complex

self-organization.
 Consciousness and meaning are constructive of person and
environment integration.
 Awareness of self and environment is rooted in thinking and feeling.
 Humans, by their decisions, are accountable for the integration of
creative processes.
  Thinking and feeling mediate human action.
 System relationships include acceptance, protection, and fostering of
interdependence.
 Persons and the earth have common patterns and integral
relationships.
 Persons and environment transformations are created in human
consciousness.
 Integration of human and environmental meanings results in
adaptation.
Philosophical Assumptions

 Persons have mutual relationships with the world and God.

 Human meaning is rooted in the 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.
Major Concepts of the Adaptation Model

The following are Callista Roy’s Adaptation Model’s major concepts, including the
definition of the nursing metaparadigm as defined by the theory.

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.”

Based on Roy, humans are holistic beings that are in constant interaction with
their environment. Humans use a system of adaptation, both innate and acquired,
to respond to the environmental stimuli they experience. Human systems can be
individuals or groups, such as families, organizations, and the whole global
community.
Environment

“The conditions, circumstances and influences surrounding and affecting the

development and behavior of persons or groups, with particular consideration of
the mutuality of person and health resources that includes focal, contextual and
residual stimuli.”

The environment is defined as conditions, circumstances, and influences that

affect humans’ development and behavior as an adaptive system. The
environment is a stimulus or input that requires a person to adapt. These stimuli
can be positive or negative.

Roy categorized these stimuli as focal, contextual, and residual. Focal stimuli are
that confront the human system and require the most attention. Contextual
stimuli are characterized as the rest of the stimuli present with the focal stimuli
and contribute to its effect. Residual stimuli are the additional environmental
factors present within the situation but whose effect is unclear. This can include
previous experience with certain stimuli.

Health

“Health is not freedom from the inevitability of death, disease, unhappiness, and
stress, but the ability to cope with them in a competent way.”

Health is defined as the state where humans can continually adapt to stimuli.
Because illness is a part of life, health results from a process where health and
illness can coexist. If a human can continue to adapt holistically, they will
maintain health to reach completeness and unity within themselves. If they
cannot adapt accordingly, the integrity of the person can be affected negatively.

Nursing

“[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.”

In Adaptation Model, nurses are facilitators of adaptation. They assess the

patient’s behaviors for adaptation, promote positive adaptation by enhancing
environment interactions and helping patients react positively to stimuli. Nurses
eliminate ineffective coping mechanisms and eventually lead to better outcomes.

Adaptation

Adaptation is 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.”

Internal Processes

Regulator

The regulator subsystem is a person’s physiological coping mechanism. The

body attempts to adapt via regulation of our bodily processes, including
neurochemical and endocrine systems.

Cognator

The cognator subsystem is a person’s mental coping mechanism. A person uses

his brain to cope via self-concept, interdependence, and role function adaptive
modes.
Four Adaptive Modes

Diagrammatic Representation of Roy’s Human Adaptive Systems. Click to enlarge.

The subsystem’s four adaptive modes are how the regulator and cognator
mechanisms are manifested; in other words, they are the external expressions of
the above and internal processes.
Physiological-Physical Mode

Physical and chemical processes are involved in the function and activities of
living organisms. These are the actual processes put in motion by the regulator
subsystem.

This mode’s basic need is composed of the needs associated with

oxygenation, nutrition, elimination, activity and rest, and protection. This model’s
complex processes are associated with the senses, fluid and electrolytes,
neurologic function, and endocrine function.

Self-Concept Group Identity Mode

In this mode, the goal of coping is to have a sense of unity, meaning the
purposefulness in the universe, and a sense of identity integrity. This
includes body image and self-ideals.

Role Function Mode

This mode focuses on the primary, secondary, and tertiary roles that a person
occupies in society and knowing where they stand as a member of society.

Interdependence Mode

This mode focuses on attaining relational integrity through the giving and
receiving of love, respect and value. This is achieved with effective
communication and relations.

Levels of Adaptation

Integrated Process

The various modes and subsystems meet the needs of the environment. These
are usually stable processes (e.g., breathing, spiritual realization, successful
relationship).
Compensatory Process

The cognator and regulator are challenged by the environment’s needs but are
working to meet the needs (e.g., grief, starting with a new job, compensatory
breathing).

Compromised Process

The modes and subsystems are not adequately meeting the environmental
challenge (e.g., hypoxia, unresolved loss, abusive relationships).

Six-Step Nursing Process

A nurse’s role in the Adaptation Model is to manipulate stimuli by removing,

decreasing, increasing, or altering stimuli so that the patient.

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

2. Assess the stimuli, categorize them as focal, contextual, or residual.
3. Make a statement or nursing diagnosis of the person’s adaptive
state.
4. Set a goal to promote adaptation.
5. Implement interventions aimed at managing the stimuli.
6. Evaluate whether the adaptive goal has been met.
Analysis

As one of the weaknesses of the theory that applying it is time-consuming,

applying the model to emergencies requiring quick action is difficult to complete,
the individual might have completed the whole adaptation process without the
benefit of having a complete assessment for thorough nursing interventions.

Adaptive responses may vary in every individual and may take a longer time
compared to others. Thus, the span of control of nurses may be impeded by the
time of the patient’s discharge.

Unlike Levine, although the latter tackled adaptation, Roy focused on the whole
adaptive system itself. Each concept was linked with the coping mechanisms of
every individual in the process of adapting.
When an individual presents an ineffective response during his or her adaptation
process, the nurses’ roles were not clearly discussed. The main point of the
concept was to promote adaptation, but none were stated on preventing and
resolving maladaptation.

Strengths of the Roy’s Adaptation Model

 The Adaptation Model of Callista Roy suggests the influence of

multiple causes in a situation, which is a strength when dealing with
multi-faceted human beings.
 The sequence of concepts in Roy’s model follows logically. In the
presentation of each of the key concepts, there is the recurring idea
of adaptation to maintain integrity. Every concept was operationally
defined.
 The concepts of Roy’s model are stated in relatively simple terms.
 A major strength of the model is that it guides nurses to use
observation and interviewing skills in doing an
individualized assessment of each person. The concepts of Roy’s
model are applicable within many practice settings of nursing.
Weaknesses

 Painstaking application of the model requires a significant input of

time and effort.
 Roy’s model has many elements, systems, structures, and multiple
concepts.
Recommended Resources
Recommended books and resources to learn more about nursing theory:

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information, check out our privacy policy.

 Nursing Theorists and Their Work (10th Edition) by Alligood

Nursing Theorists and Their Work, 10th Edition provides a clear, in-
depth look at nursing theories of historical and international
significance. Each chapter presents a key nursing theory or
 philosophy, showing how systematic theoretical evidence can
enhance decision making, professionalism, and quality of care.
 Knowledge Development in Nursing: Theory and Process (11th
Edition)
Use the five patterns of knowing to help you develop sound clinical
judgment. This edition reflects the latest thinking in nursing
knowledge development and adds emphasis to real-world
application. The content in this edition aligns with the new 2021
AACN Essentials for Nursing Education.
 Nursing Knowledge and Theory Innovation, Second Edition:
Advancing the Science of Practice (2nd Edition)
This text for graduate-level nursing students focuses on the science
and philosophy of nursing knowledge development. It is
distinguished by its focus on practical applications of theory for
scholarly, evidence-based approaches. The second edition features
important updates and a reorganization of information to better
highlight the roles of theory and major philosophical perspectives.
 Nursing Theories and Nursing Practice (5th Edition)
The only nursing research and theory book with primary works by
the original theorists. Explore the historical and contemporary
theories that are the foundation of nursing practice today. The 5th
Edition, continues to meet the needs of today’s students with an
expanded focus on the middle range theories and practice models.
 Strategies for Theory Construction in Nursing (6th Edition)
The clearest, most useful introduction to theory development
methods. Reflecting vast changes in nursing practice, it covers
advances both in theory development and in strategies for concept,
statement, and theory development. It also builds further
connections between nursing theory and evidence-based practice.
 Middle Range Theory for Nursing (4th Edition)
This nursing book’s ability to break down complex ideas is part of
what made this book a three-time recipient of the AJN Book of the
Year award. This edition includes five completely new chapters of
content essential for nursing books. New exemplars linking middle
range theory to advanced nursing practice make it even more useful
and expand the content to make it better.
  Nursing Research: Methods and Critical Appraisal for Evidence-
Based Practice
This book offers balanced coverage of both qualitative and
quantitative research methodologies. This edition features new
content on trending topics, including the Next-Generation NCLEX®
Exam (NGN).
 Nursing Research (11th Edition)
AJN award-winning authors Denise Polit and Cheryl Beck detail the
latest methodologic innovations in nursing, medicine, and the social
sciences. The updated 11th Edition adds two new chapters designed
to help students ensure the accuracy and effectiveness of research
methods. Extensively revised content throughout strengthens
students’ ability to locate and rank clinical evidence.
See Also
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 Nursing Theories and Theorists: The Definitive Guide for

Nurses MUST READ!
In this guide for nursing theories, we aim to help you understand
what comprises a nursing theory and its importance, purpose,
history, types or classifications, and give you an overview through
summaries of selected nursing theories.