 Tracey
 Jamie Tornga
 Tracie Peterson
 Pamela Eyer
 Sister
Roy worked with pediatrics and
noticed the resiliency of children to adapt
physically and mentally to their illness
In this work, Roy identified a goal of nursing
Promoting the patient’s ability of adaptation.
With the help of nursing student, over 500
responses from patients were collected from all
clinical areas.
The four modes of adaptation that were
analyzed from the samplings
 Self Concept
 Role Function
 Interdependence
Sister Callista Roy used this as the foundation of her
conceptual model.
 According
to Roy, humans are holistic,
adaptive systems.
 People are resilient and adaptable.
 Our reading states:
“As an adaptive system, the human system is
describe as a whole, with parts that function
as unity for some purpose” (Tomey, 2006, p.
 Adaptation occurs through innate or acquired
coping mechanisms used to respond to
challenging environmental stimuli.
 Physiological-physical
 Self-concept
– group identity
 Role Function
 Interdependence
 Individuals
have basic needs:
Five needs
Complex processes
Fluid balance
Electrolyte balance
Acid-base balance
Complex senses
 Neurologic function
 Endocrine function
 Groups
Operating resources
Capacities, or jobs
Physical facilities
Fiscal Resources
 Need
is psychic and spiritual integrity
So that one can be or exist within the universe,
with a sense of:
 Need
is group integrity shared through:
Shared relations
Common goals
Common values
 Implications
within the group, there must be:
Completeness of identifications
 The
Knowing who one is in relation to others so one
can act
 Role
set for the individual
Complex positions the individual holds
Ex. Mother, Nurse, Co-worker
 This
need is social integrity
Role development
Instrumental and expressive behaviors
Role taking process
 Need
Role clarity
 Understanding and committing to expected tasks
So the group can achieve common goals
 The
process of integrating roles in managing
different roles and their expectations
Ex. Nurse Manager
 Complementary
roles are regulated
Ex. Policy and procedures for nurses in the same
 Individual
Need is to achieve relational integrity using
process of affectional adequacy
Ex. The giving and receiving of
This is done through effective relations and
 The
need is to achieve relational integrity
using processes of developmental and
resource adequacy
Ex. Learning and maturing in relationship
Through interdependence with others
The needs for food, shelter, health, and security
are achieved.
 According
to Roy, environment is “all the
conditions, circumstances, and influences
surrounding and affecting the development
ad behavior of persons or groups, with
particular consideration of the mutuality of
persons and earth resources that includes
focal, contextual and residual stimuli”
(Tomey, 2006, p. 362).
 The
stimuli in which the person must adapt
to is in the environment.
 The
Internal sources
stimuli can be:
Ex. Interpersonal stress
External sources
Ex. A car coming directly at you
 Focal
The stimuli most immediately confronting the
 Contextual
The contributing factors in the situation
 Residual
Other unknown factor that may influence the
When the factors making up residual stimuli
become known, they are considered focal or
 Adaptation
is innate and/or acquired, in the
Regulator subsystem receives input from the
external environment or the individual’s internal
The adaptation occurs through physiologic responses
by the individual (neural-chemical-endocrine function
alters the response)
 Ex. Increase in heart rate, in response to stimuli
Cognator subsystem receives input from external
and internal stimuli
The adaptation occurs through psychological responses
by the individual (cognition, emotion, and past
 Ex. Laughter in response to stimuli
 Adaptation
responses within the group
Stabilizer subsystem control process involves the
established structures, values, and daily
activities used by the group to accomplish its
primary purpose and contribute to common
purposes of society
Ex. Homes and jobs
Innovator subsystem control process involves the
structures and processes necessary for change
and growth in human social systems
Ex. Businesses, schools, and education for members of
the group.
These components within the group
subsystems provide basis for a community to
remain stable in periods of stagnation.
These subsystems allow for sustainability of
the group during periods of minor or major
change, within the surrounding environment.
 Roy’s
theory can be applied in a 6-step
nursing process:
Assessment of behavior
Assessment of stimuli
Nursing diagnosis
Goal setting
*Doesn’t this sound familiar….
Dr. Roy believes in the link between humans,
earth and God. She believes that awareness
of self and environment is rooted in thinking
and feeling. She believes that humans, the
universe, and God have a common destiny.
 Health
can be defined as:
A state and process of being and becoming
integrated and whole that reflects person and
environmental mutuality
 Adaptation
can be defined as:
The process ad outcome whereby thinking and
feeling, persons, as individuals and in groups, use
conscious awareness and choice and human and
environmental integration
 Adaptive
resources can be defined as:
Responses that promote integrity, in terms of the
goals of the human system
Goals for the human system:
Personal transformation
Environmental transformation
 Ineffective
responses can be defined as:
Responses that do not contribute to integrity, in
terms of the human system
Ex. Smoking, Alcohol, and Illicit drugs
 Adaptation
is necessary to maintain health in
 Our bodies have the ability to adapt to stress
and illness.
 When our bodies are unable to adapt to the
stress of an illness:
The integrity of the system, as a whole, is
Adaptation levels represent the condition of the
life processes, described on three different
Ex. Acid/Base balance is maintained by the entire body
Ex. When balance is disrupted, respiratory (lungs) and
metabolic (kidneys) compensatory mechanisms try to
Ex. When the initial compensatory mechanism fails,
another tries to compensate, which eventually fails. The
system is now compromised by an acidosis or alkalosis
Roy defines nursing broadly as a “health care
profession that focuses on human life process
and patterns and emphasizes promotion of
health for individuals, families, groups, and
society as a whole” (Tomey, 2006, p. 361).
The nurse gathers data about the patient, as
an adaptive system and assesses how the
behavior is helping or hindering the adaptive
system, in the adaptive models.
The nurse must identify stimuli that he or she
can amend.
A medical diagnosis is not amendable to the
A patient exhibiting pain is amendable to the
Ex. Assessing for pain frequently and
intervening with pain medication and
therapy, in a timely manner.
The nurse must interpret the data about the
adaptation status of the patient, including
the behavior and most relevant stimuli.
The nursing diagnosis is a statement that
identifies the behaviors of interest together
with the most relevant influencing stimuli.
 Describes
the behavior by the patient and
the desired changes the nurse wishes to
make in those behaviors.
 Goals are described in a concise and clear
manner, with a measureable timeframe for
Ex. “Patient will verbalize 3 positive coping
mechanism for stress by discharge.
 Goals
may be stated for behaviors that need
to be changed, as well as for behaviors that
should be maintained.
 This
is the management of stimuli
 The nurse may alter, increase, decrease,
remove, or maintain stimuli
 The nurse implements approaches that have
the capability of changing the stimuli or
increasing the effectiveness of the adaptive
 The nurse can modify the interventions to
enhance the adaptive beings’ ability to adapt
to the stimuli.
This is when the nurse uses a systematic
approach to assess the effectiveness of the
interventions and goals. The nurse will
assess and reassess the behaviors of the
adaptive being and the patient’s behaviors.
 Two
levels of assessment are unique to this
model: Behavior and Stimuli
Leads to the identification of adaptation
problems or nursing diagnosis
Basic foundation for writing care plans
 Theory
implications within the individual
(patient) and the immediate persons (group)
within patient’s environment
considers the symbiotic relationship of
the individual and the group
The individual has impact upon the group
The group has impact upon the individual
RAM considers these impacts as components of
the “whole” patient, in question
 Classifies
environmental stimuli within
Focal – The contributing factors most
immediately confronting the person
Contextual – The contributing factors in the
Residual – Other factors that may influence the
When factors making up residual stimuli become
known, they are considered focal or contextual
 Provides
basis for framework for nursing
care, but defines some framework for
nursing education and policy
Considers the patient, as well as the nurse
 Explores
the patient’s environment further
than other theories
Ex. Considers aspects of a patient’s home, job,
and community to have impact on the his/her
is deeply rooted in nursing practice
 Most
frequently used conceptual framework
to guide nursing practice
 Used
nationally and internationally
 Useful
for nursing practice
Outlines features of the discipline
 Valuable
theory for nursing practice
Includes a goal that is specified, as the aim for
activity and prescription for activities to realize
the goal
 Useful
for guiding nursing practice in
institutional settings
 Provides direction for
 Model
The patient
Practitioner intervention
 The
model has been applied to the nursing
care of individual groups of people
Caregivers of chronically ill family member
Cardiac care units
Chronic renal failure patients whom require
Women in menopause
Adolescents with asthma
 This
model has been implemented to facility
units, including:
Acute Surgical units
Rehab units
Acute Medical units
Orthopedic units
Neurosurgical units
Many others
The nurse performs the following six functions
Assess the behaviors manifested from the
adaptive models
Assess the stimuli for those behaviors
Categorizing the stimuli as focal, contextual, or
Formulates a diagnosis of the person’s adaptive
Also known as “Nursing Diagnosis”
Sets goals to promote adaptation
Implements interventions aimed at managing the
stimuli to promote adaptation
Alter stimuli
Increase stimuli
Decrease stimuli
Remove stimuli
Maintain stimuli
Evaluate whether the adaptive goals have been
The process can be repeated many times
defines the distinct purpose of the
nursing students
 Distinguishes
nursing science from medical
 Stresses
collaboration, but delineates
separate goals for nurses and physicians
 Nursing
Help the patient put their energy into getting
 Provides
educators with a systematic way of
teaching student
The students are taught to assess and care for
patients within the context of their lives, rather
than just victims of illness
Taught as a part of curriculum in
BSN programs
MSN program
Doctoral programs in nursing
 Widely
used in research today
 Continues
to be the most commonly used
 Continually
being revised and redefined on
different occasions
 Further
research is needed
Design studies to test propositions related to
environment and nursing
Have interventions based on the concepts of
proposition that have been previously supported
continues to make a significant
contribution to the body of nursing
 Needs to facilitate its use better in the
nursing practice
More thoroughly defined typology of nursing
Organization of categories of interventions
Roy has currently redefined health, decreasing
the emphasis of the concept of health-illness
continuum and conceptualizing health as
integration and wholeness of the person
(Alligood, et al., 2010)
 When
one accomplishes adaptation in each
of the 4 responses, it will then contribute to
one’s health, quality of life, and being able
to die with dignity
 This model gives a more theoretical approach
to be able to answer some of the most
pressing questions on how we are to give
nursing care
 This model can be applied to nursing, the
patient, the family, and the community.
 The
Adaptation Model is simple to
understand and can be applied, not only
research, but to nursing practice and
 Gives nurse educators a conceptual
framework for their curriculums
 The RAM is continually evolving due to
research, rather than statistics.
 The
four modes offer an opportunity for the
consideration in the multiple aspects of the
human adaptive system and support, gaining
an understanding of the system, as a whole
 It
is the most widely used framework for the
guidance of nursing practice
Outlines the features of the discipline
Provides direction for practice, education and
-Alligood, et al, 2010
 According
to the model, you will develop
multiple interventions to be able to
accommodate for different stimuli
These interventions will allow you to judge the
consequences that could or could not happen and
adjust the stimuli accordingly
Adjustment allows you to see the value of the change,
whether the change is desirable or undesirable.
 The
model is unable to cope with or respond
to constantly changing stimuli
Most prevalent limitation
 Time
Requires 2 areas of assessment
More time consuming in the beginning
It can take years to for full implementation and
understanding of new theories
 Easily
generalized to all settings of nursing
practice, but is limited within the scope
Addresses the person-environment adaptation of
the patient
Information about the nurse is implied
- Alligood, et. 2010
 Finally,
one person’s behavior cannot be
conceptualized on a health-illness
continuum, because one adaptive mode is
affected by the other modes and it is
continually changing.
 Greatly
influenced the nursing profession
 Most frequently used model
Guides nursing research
Guides education
Guides practice
has inspired the development of:
Middle range nursing theories
Adaptation instruments
 Persons
affect and are affected by the
 Environment
is the source of stimuli
This stimuli can threaten or promote a person’s
includes concepts of
Health-illness continuum
Nursing activities
Includes subconcepts
effector modes
Self-concept – group identity
Role function
continues to be one of the most
frequently used theories by the nursing
 Basis for use has been identified at a national
and international level
 RAM provides the cornerstone of care plan
is an exciting and ever evolving model
that has helped to build a foundation for
conceptual nursing. Sister Roy's contribution
to the nursing profession is enormous and
continues to grow.
 In
what ways have you used RAM in your
nursing career?
 What pro and cons do you see in using RAM in
your institution/unit?
 What step in the RAM process can you most
relate to your everyday practice and how?
Please respond to these questions in the
discussions areas.
Also, if you have any additional questions, please
feel free to share these questions with the group

Callista Roy*s Adaptation Model