SISTER CALLISTA ROY By Jammie Galeaz, Rebecca Joostens and Jeanette Dornak http://www.bc.edu/schools/son/faculty/featured/theorist.html SISTER CALLISTA ROY Why We Chose this Theory We chose this theory for a multitude of reasons: Familiarity with the theorist and use of her model in current nursing practice Sister Callista Roy is a Sister of Saint Joseph, one of us worked for a Catholic health system which was founded by eleven Sisters of Saint Joseph in 1889 The use of goal setting within the Roy Adaptation model because of it’s relevance in the field of nursing Introduction Callista L. Roy, RN, PhD, a well known Nurse Theorist, was born in the year 1939 in Los Angeles, California. Her education began at Mount Saint Mary’s College; however, her master’s degree and PhD in pediatric nursing and sociology are from the University of California There are four other institutions where she holds honorary doctorates Today Dr. Roy is a professor at William F. Connel School of Nursing at Boston College; she teaches at both undergraduate and graduate levels. Dr. Roy is known around the world for her Roy adaptation model for nursing Over the years she has traveled to over 30 countries to discus topics on this nursing theory Furthermore, Dr. Roy also has several publications in newspapers, books, and journal articles related to nursing theory or other professional subject matter (“Sr. Callista Roy,” 2007). Assumptions and Point of view Author’s motivation for the Model The idea of the Roy Adaptation Model (RAM) spawned from the resiliency of children Dr. Roy cared for in pediatrics Dr. Roy read books on the concept of adaptation and was impressed with what she saw in the children so much that she proposed the goal for nursing was to promote patient adaptation. Von Bertalanffy and Helson are the theorist that Dr. Roy used to create her early prototypes of the RAM. Helson’s definition of adaptation is for an individual to respond in a positive manor to environmental changes and portrays three kinds of stimuli: focal, contextual, and residual After 17 years of developing the RAM at Mount St. Mary’s College, the first article was published in Nursing Outlook. Not even a month later RAM became a framework for the nursingbased curriculum. (“Roy Adaptation Model,” 2007). Assumptions and Point of view Nursing Knowledge and Development By the year1987 over 100,000 nurses learned using RAM in their practice One of the changes to the model was the creation of four modes to which adaptation is manifested and provides a base for the assessment portion of the nursing process. physiologic self concept role function interdependence (“Roy Adaptation Model,” 2007). Assumptions and Point of view Philosophic values Dr. Roy is always re-examining her theory and tweaking it to fit the nursing needs of today. For example, early identifying factors of RAM include: systems theory, adaptation-level theory, and humanistic values; however, later she describes a philosophical assumption of veritivity being more effective than the philosophical relativistic approach in that it puts limitations on progress where veritivity does not. In the year 1988, Dr. Roy published a paper on these philosophical assumptions stressing the limited view of secular humanism in using certain conceptual approaches to nursing. (“Roy Adaptation Model,” 2007). Assumptions and Point of view In the 1990s, Dr. Roy decided to re-define adaptation and progress RAM into the twenty-first century. Dr. Roy expanded her insights to include a mixture of spirituality and science in this new improved definition of adaptation. Her philosophical position expresses that nurses view patients as coextensive with their surroundings, both physical and social environments. She encourages nurses to adopt a value-based stance which is founded in beliefs, and hopes about the individual, and that we accept a discipline that functions by promoting the well-being of patients and “of the earth.” Dr. Roy places emphasis on the idea of “cosmic unity” which is defined as “persons and the earth have common patterns and mutuality of relations and meaning and that persons through thinking and feeling capacities, rooted in consciousness and meaning, are accountable for deriving , sustaining, and transforming the universe” (“Roy Adaptation Model,” 2007). Today Dr. Roy has expanded the RAM even further with including rational persons and individual persons, depicting adaptation in three tiers of integrated life processes, compromised processes, and compensatory processes (“Roy Adaptation Model,” 2007). Information and Concepts Global Concepts: HUMAN BEING “As an adaptive system, the human system is described as a whole with parts that function as unity for some purpose. Human systems included people as individuals or in groups, including families, organizations, communities, and society as a whole.” (Roy & Andrews, 1999, p.31) People adapt to their environment and this change affects the environment. Information and Concepts Global Concept: ENVIRONMENT “All 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 earth resources that includes focal, contextual, and residual stimuli.” (Roy & Andrews, 1999, p. 18) Focal stimuli: “The internal or external stimulus most immediately confronting the human system.” (Roy & Andrews, 1999, p. 31) Contextual stimuli: “All other stimuli present in the situation that contribute to the effect of the focal stimulus.” (Roy & Andrews, 1999, p. 31) Residual stimuli: “Environmental factors within or without the human system with effects in the current situation that are unclear.” (Roy & Andrews, 1999, p. 32) Information and Concepts Global Concept: HEALTH “A state and process of being and becoming integrated as a whole person. It is a reflection of adaptation, that is, the interaction of the person and the environment.” Roy’s model indicates that health and illness can coexist. A person can be physically ill, but if they are adapting positively in another adaptation mode, they are also healthy. (Andrews & Roy, 1991, p/21) Information and Concepts Global Concept: HEALTH continued Two subsystems process environmental input, or stimuli, and function as primary coping mechanisms. Regulator coping mechanism “responds automatically through neural, chemical, and endocrine processes” (Andrews & Roy, 1991, p 14) Cognator coping mechanism “responds through four cognitive-emotive channels:” perceptual information processing Learning Judgement Emotion (Andrews & Roy, 1991, p. 14) These coping mechanisms respond based on an adaptive mode. The regulator coping subsystem responds through the physiological adaptation mode. The cognator coping subsystem responds through either the self-concept, interdependence, or role function adaptation modes. The following slides describe the adaptation modes. Information and Concepts Global Concept: HEALTH continued Physiological Adaptation Mode Meets basic need for physiological integrity Oxygenation Nutrition Elimination Activity and rest Protection Senses Fluid and electrolyte and acid-base balance Neurological function Endocrine function (Alligood & Tomey, 2010): Information and Concepts Global Concept: HEALTH continued Self-Concept Adaptation Mode Meets basic need for psychic and spiritual integrity Body sensation Body image Self-consistency Self-ideal or self-expectancy Moral-spiritual-ethical self (Alligood & Tomey, 2010): Information and Concepts Global Concept: HEALTH continued Interdependence Adaptation Mode Meets basic need for relational integrity or security in nurturing relationships Significant others in a person’s life Give and receive love, respect, and value (Alligood & Tomey, 2010): Information and Concepts Global Concept: HEALTH continued Role Function Adaptation Mode Meets basic need for social integrity Knowledge of society’s expectations are Appropriate action within society (Alligood & Tomey, 2010): Information and Concepts Global Concepts: NURSING Nursing is…“The science and practice that expands adaptive abilities and enhances person and environmental transformation.” (Alligood & Tomey, 2010) Nurses are to be aware of the adaptive behaviors of the person as well as the environmental stimuli that influence the behavior. Nurses plan interventions based on the stimuli and help the person positively adapt to the stimuli. Nurses use the following process (Alligood & Tomey, 2010): Assessment of behavior Assessment of stimuli Nursing diagnosis Goal setting Intervention Evaluation Interpretation & Inference and Implications & Consequences Assessment of the 4 Global Concepts Roy’s Model of nursing expands hugely on the 4 Global Concepts. Roy’s Model describes how each of the concepts are related to each other and how they effect/change each other Roy delves further into each concept, creating additional concepts within each umbrella term. For example, her concept of environment breaks the environment down into various types of stimuli. Interpretation & Inference and Implications & Consequences The following questions led Roy to her theory: Who is the focus of nursing care? What is the target of nursing care? When is nursing care indicated? Roy’s influences behind this theory include: family, her religious background, mentors, clinical experiences, and education (Current Nursing, 2010) Interpretation & Inference and Implications & Consequences This theory is unique to nursing in that it clarifies who and what is at the center of the nursing care. All concepts center around how everyone and every thing surrounding the patient effects the patient’s outcome. The patient is a being who is effected by our nursing care and the environment in which they receive that care. The Nurse guides the patient through their time of health and/or illness towards a positive outcome: adaptation. Interpretation & Inference and Implications & Consequences Evaluation of the nursing model: this model is allencompassing for all nurses and in all areas of nursing. The concepts are very broad and can therefore be used in multiple ways For example: Her concept of a person is that each individual is many pieces that work together to form the whole that works in unity. No matter what area of nursing or what your focus is, that area of the person/ body is being studied, this concept stands true Health and wellness are inevitable parts of everyone’s life; can refer to any type of un-wellness. Her definition of the concept of adaptation is a positive response to any stimuli- no matter the environment- therefore this could apply to any nursing environment. (Current Nursing, 2010) Interpretation & Inference and Implications & Consequences What practice situations can/has this model been used in? This model can be used in many different clinical settings. It is applicable to any situation. This model was used by Roy herself in both Maternity and Pediatric Nursing This model can be used from labor and delivery, newborn care and all the way through the end of life. Since Health and Illness are both described as part of everyone’s life, a co-existence of the two can be had and can lead to the patient being allowed to have a dignified passing just as much as a patient can experience a time a healing. Resources and Web-links Current Nursing. (2010, November 13). Roy's adaptation model. Retrieved from http://currentnursing.com/nursing_theory/Roy_adaptation_m odel.html Lewis, T. (1988). Leaping the chasm between nursing theory and practice. Journal of Advanced Nursing, 13(3), 345-351. Retrieved from EBSCOhost. Roy Adaptation Model. (2007). Boston College. Retrieved October 11, 2007, from http://www.bc.edu/~royca/htm/ram/htm Roy, C., & Andrews, H. (1991). The Roy adaptation model: The definitive statement. Norwalk, CT: Appleton & Lange. Roy, C., & Anderews, H. (1999). The Roy adaptation model (2nd ed.). Upper Saddle River, NJ: Pearson Education, Inc. Sr. Callista Roy, PhD, RN, FAAN. (2007). Boston College. Retrieved October 10, 2007, from http://www.bc.edu/schools/son/faculty/theorist.html Tomey, M.A. & Alligood, M.R (2005). Nursing Theorists and their Work (7th ed.). St. Louis: Elsevier.