THE ROY ADAPTATION MODEL

Background of Sister Callista Roy:

◦ born on October 14, 1939 in Los Angeles California

◦ She is a nurse theorist, writer, researcher and professor

◦ She is a fellow in the American Academy of Nursing, an honorary nursing society that elects nursing
leaders annually

◦ Has numerous publications, including books& journal articles on nursing theory & other professional
topics

◦ Roy’s Model was conceived in response to her Professor Dorothy Johnson challenge when she was
still a student during a seminar to develop conceptual models of nursing. Johnson’s nursing model
was the impetus for the development the Adaptation Model.

◦ Dr. Roy is best know for her work on the Roy Adaptation Model of Nursing (RAM). Her current clinical
research is an intervention study to engage families in cognitive revival of clients with mild head
injury. Her other scholarly work includes conceptualizing, measuring, and developing the
philosophical basis for the Adaptation Model and for the Epistemology of Nursing.

◦ Roy recognized the works of Von Bertalanffy’s (1968) General System Theory and Helson’s (1964)
Adaptation Theory as a basis os scientific assumptions for her Model

THE ROY ADAPTATION MODEL

◦ 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 who strives
to maintain a balance between various stimuli.

◦ Overview of RAM:

◦ •The RAM provides a useful framework for proving nursing care for persons in health and in acute,
chronic, and terminal illness.

◦ 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, & feedback

METAPARADIGM

Person

◦ Is the recipient of nursing care; main focus of nursing

◦ A biopsychosocial being in constant interaction with a changing environment.
◦ The person is an open adaptive system who uses coping skills to deal with stressors.
◦ It includes people as individuals or in groups (families, organizations, communities, nations & society
as a whole)
◦ An adaptive system has cognator and regulator subsystems to maintain the 4 adaptive modes
Health

◦ Was originally described by Roy as a health-illness continuum; health & illness were considered an
inevitable dimension of the person’s life.
◦ More recently, Health is the process of being and becoming an integrated and whole person (Roy &
Andrews, 1999)
◦ It is a reflection of adaptation that is the interaction of the person & the environment.
Adaptation is defined as the process and outcome whereby thinking and feeling, as individuals and groups,
use conscious awareness and choice to create human and environmental integration
Environment

◦ Conditions, circumstances and influences that surround and affect the development and behavior
of the person.

◦ Consists of internal & external environments, which provide input in the form of stimuli

◦ Stressors are stimuli that are significant in human adaptation: stages of development, family &
culture

Nursing

◦ Nursing is the science and practice that expands adaptive abilities and enhances person and
environment transformation.

◦ Roy’s goal of nursing is the promotion of adaptation in each of the 4 modes thus contributing to
health, quality of life and dying with dignity.

◦ Nursing is about the increase, enhancement, modification and alteration of the stimulus to achieve
adaptation

THE KEY CONCEPTS

◦ The person is adapting in a stable interaction with the environment, either internal or external.

◦ The environment serves as the source of a range of stimuli that will either threaten or promote the
person’s unique wholeness.

◦ The person’s major task is to maintain integrity in face of these stimuli.

INTEGRITY- the degree of wholeness achieved by adapting to changes in needs.

SYSTEM – is a set of parts connected to function as a whole for some purpose & that does so by virtue of the
interdependence of its parts.

• Roy considers the recipient of care to be an open adaptive system

• react & interact with other systems in the environment.

• have boundaries that are flexible & open to permit interaction with other systems.

• employ a feedback cycle of input, throughput & output.

◦ Input – defined as stimuli which can come from the environment or from within a person.

TYPES of ENVIRONMENTAL STIMULI (Helson, 1964)

▪ FOCAL - the internal or external stimulus most immediately confronting the person adaptation, it
attracts the most of one’s attention.

▪ Contextual - all other stimuli present in the situation that strengthens/contribute the effect of the
focal stimulus.

▪ Residual - those stimuli that can affect the focal stimulus.

◦ The three types of stimuli act together and influence the adaptation level which is defined as the
ability to respond positively in a situation. A person’s adaptation level may be described as
integrated, compensatory, or compromised (Roy & Andrews, 1999). VV

COPING MECHANISM

◦ are the processes that a person uses for self-control.

◦ are innate or acquired ways of interacting with the changing environment. innate coping
mechanisms are genetically determined or common to the species & are genetically viewed as
automatic process.

◦ acquired coping mechanisms are developed through strategies such as learning.

CATEGORIES OF COPING MECHANISM

◦ REGULATOR SUBSYSTEM

- major coping process involving the neural, chemical, and endocrine system

(e.g., increase in vital signs- sympathetic response to stress.)

◦ COGNATOR SUBSYSTEM

– is a major coping process involving four cognitive

- emotive channels: perceptual & information processing; learning; judgment & emotion

(e.g. effects of prolonged hospitalization for a 4year-old child)

Subsystem coinciding with the Control Processes

◦ Stabilizer subsystem – analogous to regulator: concerned with stability. It is associated with system
maintenance & involving established structures, values & daily activities whereby participants in a
group accomplish the purpose of the social system.

◦ Innovator subsystem – analogous to cognator: concerned with creativity, change& growth. It allows
the person to change higher levels of potential through cognitive & emotional strategies.

◦ Adaptation is done through two main coping subsystem, the regulator and the cognator. Roy did
not explain further the mechanism of these 2 because its mechanism cannot be directly observed &
unknown. However, its behaviors are manifested in the four adaptive modes.

4 Adaptive Modes

1. Physiological – the way a person responds as a physical being to a stimuli from the environment.

a. Goal: Physiological Integrity

Five Physiologic Need:

◦ oxygenation, nutrition, activity, rest, and protection.

Four Complex Processes:

◦ senses; fluids, electrolytes & acid-base balance; neurologic function; endocrine function

2. Self-Concept – Group Identity Mode

◦ focuses specifically on the psychological & spiritual aspects of the human system.

◦ Self- concept

◦ – defined as the composite of beliefs & feelings about oneself at a given time & is formed from
internal perceptions of other’s reaction.

◦ Two components:

◦ 1. physical self (body sensation, body image)

◦ 2. personal self (self-consistency, self-ideal, moral ethical spiritual self)

◦ Group Identity

◦ - reflects how people in groups perceive themselves based on environmental feedback.

◦ - comprised of interpersonal relationships, group self-image & culture.

◦ a. Goal: Psychological Integrity

3. ROLE FUNCTION MODE

◦ - a role is a set of expectations about how a person occupying one’s position behaves towards a
person occupying another position.
 ◦ a. Goal: Social Integrity

◦ - Roles are carried out with both instrumental behaviors (the actual physical performance of a
behavior) and expressive behaviors (are the feelings, attitudes, likes or dislikes that a person has
about a role or about the performance of a role).

◦ - Persons perform primary, secondary & tertiary roles

◦ O Primary – determines the majority of behavior engaged in by the person during a particular period
of life (age, sex, developmental stage).

◦ O Secondary – are those that a person assumes to complete the task associated with a
developmental stage & primary role (husband, wife).

◦ O Tertiary – related primarily to secondary roles & represent ways in which individuals meet their role
associated obligations.

◦ - temporary in nature, freely chosen by the individual.

4. INTERDEPENDENCE MODE

– focuses on close relationships which results to giving & receiving of love, respect, value, nurturing,
knowledge, skills, commitments, material possessions, time & talents

- Occurs between the person and the most significant other or between the person and the support system.

a. GOAL: Affectional Adequacy.

GOAL OF NURSING IN RAM

• PROMOTE ADAPTATION IN EACH OF THE FOUR ADAPTIVE MODES.

Adaptation Level

1. Integrated -Adaptation level at which the structures and functions of a life process are working as a
whole to meet human needs.

Example: Stable processes of ventilation, the complex process of breathing that exchanges air between
lungs and atmosphere.

2. Compensatory - Adaptation level at which the cognator and regulator have been activated by a
challenge to the integrated life processes.

Example: Grieving, role transition

3. Compromised – adaptation level resulting from inadequate integrated and compensatory life processes;
adaptation problem.

Examples: Hypoxia, Ventilatory Impairment, Unresolved loss, Abusive relationships.

EFFECTIVE & INEFFECTIVE ADAPTATION

Adaptive or ineffective responses result from these coping mechanisms. Adaptive response supports the
integrity of the person and the goals of adaptation. The major task of the person is to become accustomed
with environment stimuli in order to achieve survival, growth, development, and mastery. Ineffective
responses neither promote integrity nor contribute to the goals of adaptation. (Andrews & Roy, 1999)

NURSING PROCESS

◦ A problem-solving approach for gathering data, identifying the capacities and needs of the

◦ implementing approaches for nursing care, and evaluation of the outcome of care provided.

1. ASSESSMENT OF BEHAVIOR – Data gathering about the behavior of the person as an adaptive system in
each of the adaptive modes.

a. Observable behavior/objective cues: vital signs (blood pressure, respiratory rate, pulse rate,
temperature), gadgets attached/connected to patients.
b. non-observable behavior/subjective cues: feelings experienced by the person (anxiety) and reported to
the nurse.

2. ASSESSMENT OF STIMULI

a. A STIMULUS is defined as any change in the internal and external environment that induces a response in
the adaptive system. It is classified as focal, contextual or residual.

b. In this level of assessment, the nurse analyzes the subjective and objective behaviors and look more
deeply for possible causes of a particular set of behaviors.

3. NURSING DIAGNOSIS

a. Formulation of statements that interpret data about the adaptation on status of the person, including the
behavior and the most relevant stimuli.

b. Indicates an actual or potential problem related to adaptation.

4. GOAL SETTING

a. Establishment of clear statements of the behavioral outcomes for nursing care which is realistic and
attainable. This is done together with the client.

5. INTERVENTION

a. Determination of how best to assist the person in attaining the established goals

b. Any action taken by a professional nurse that will maintain if not to promote adaptive behavior of client.

6. EVALUATION

a. Judging the effectiveness of the nursing intervention in relation to the behavior after it was performed in
comparison with the goal established.