nes & Bartlett Learning, LLC
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onal Association of Long Term Care Administrator Boards
10
© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learnin
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ROY
ADAPTATION
National Association of Long Term Care Administrator Boards
MODEL:
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
NOT FOR Sister
SALE OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
Callista Roy
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nes & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
L e a r n i ng O b je c t i v e s NOT FOR SALE OR DISTRIBUTION
FOR SALE OR DISTRIBUTION
onal Association ofAfter
Long
Term this
Care
Administrator
Boards
completing
chapter
the student should
be able to
1. Describe the concepts of the Roy adaptation model as proposed by
©Roy
Jones & Bartlett Learning, LLC
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2. Explain the major concepts important to nursing as defined by Roy
© Jones & Bartlett Learnin
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National Association of Long Term Care Administrator Boards
3. Plan nursing care for a patient scenario utilizing the Roy adaptation model
© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learning, LLC
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K e y T e r mof
s Long Term Care Administrator Boards
National Association
Adaptation
nes & Bartlett Learning,
LLC
Adaptive
modes
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Cognator subsystem
© Jones
& Bartlett
Regulator
subsystem
Learning, LLC
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onal Association of Long Term Care Administrator Boards
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learnin
NOT FOR SALE OR DISTR
National Association of Long Term Care Administrator Boards
© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learning, LLC
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National Association of Long Term Care Administrator Boards
127
nes & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
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128
N ursing T heories : A F ramework for P rofessional P ractice
© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learnin
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S
ister C allista R oy was born in 1939 in
Los Angeles,
California.
She received aBoards
baccaNational Association of Long
Term Care
Administrator
laureate degree in nursing in 1963 from Mount
Saint Mary’s College. In addition to earning a mas© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
ter’s degree in nursing in 1966 from the University of
BACKGROUND
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OR DISTRIBUTION
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California–Los Angeles, Roy earned a master’s degree
sociology
in 1973, followed
by a doctorate in sociNational Association of Long TerminCare
Administrator
Boards
ology in 1977, both from the University of California
(Phillips, 2010, p. 335).
nes & Bartlett Learning, LLC
© Jones
& the
Bartlett
Learning,
LLC
Roy
developed
basic concepts
of her
model
FOR SALE OR DISTRIBUTION
NOT
FOR
SALE
OR
DISTRIBUTION
while she was a graduate student at the University of California–Los
Angeles
begin challenged
by Dorothy Johnson in a seminar to
onal Association of Long Term
Careafter
Administrator
Boards
develop a conceptual model for nursing. The Roy adaptation model was
first published in 1970. Since that time, Roy has published many books
© Jonesand
& articles,
Bartlett
LLC
& Bartlett Learnin
andLearning,
has presented
numerous lectures focusing©
onJones
the model
NOT
FOR
NOT FOR
SALE
OR
DISTRIBUTION
and its use in nursing practice. She has also continued to refine and rede-SALE OR DISTR
the model (Roy, 2009; Roy & Andrews, 1991, 1999) and has been
Nationalfine
Association
of Long Term Care Administrator Boards
awarded many honors for her contributions to nursing theory, practice,
research, and education (Phillips, 2010).
© Jones & Bartlett Learning,
LLC
Jones
& Bartlett
Learning,
LLC
Roy credits
Harry Helson’s adaptation©
theory
for playing
a key role
in
NOT FOR SALE OR DISTRIBUTION
NOT
OR
DISTRIBUTION
her early thinking and development of her
ownFOR
model.SALE
She also
credits
Rapoport’s definition of systems as well as concepts from Lazarus and
National Association of Long Term Care Administrator Boards
Selye (Roy & Roberts, 1981). In addition, Roy acknowledges the contributions made by other faculty and students to the development of the
model is
of the mostLLC
widely
nes & Bartlett Learning, LLCmodel. The Roy adaptation
© Jones
& currently
Bartlettone
Learning,
used frameworks in nursing
practice,
applied
hundreds of thouFOR SALE OR DISTRIBUTION
NOT
FOR being
SALE
OR by
DISTRIBUTION
sands of nurse in countries all over the world.
onal Association of Long Term Care Administrator Boards
T
he R oy adaptation model presents the
© Jones & Bartlett Learning,
LLC
© Jones & Bartlett Learnin
OVERVIEW
person as a holistic adaptive system in constant
NOT FOR SALE OR DISTR
NOT
FOR
SALE OR DISTRIBUTION
OF
THE
Roy
interaction with the internal and the external
National Associationenvironment.
of Long Term
Care
Boards
The main
taskAdministrator
of the human system
is to
ADAPTATION
maintain integrity in the face of environmental stimuli
MODEL
(Phillips, 2010). The goal of nursing is to foster suc-
© Jones & Bartlett Learning, LLC
cessful adaptation.
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© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
National Association of Long Term Care Administrator Boards
nes & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
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nes & Bartlett Learning, LLC
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onal Association of Long Term Care Administrator Boards
10 Roy Adaptation Model: Sister Callista Roy
© Jones & Bartlett Learning, LLC
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129
chapter
© Jones & Bartlett Learnin
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According to Roy and Andrews (1999), adaptation refers to “the proThe adaptation
cess and
outcome Association
whereby thinkingofand
feeling
persons
as individuals
National
Long
Term
Care
Administrator
Boards
level represents
or in groups, use conscious awareness and choice to create human and
the condition of
environmental integration” (p. 54). Adaptation leads to optimal health the life processes.
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
and well-being, to quality of life, and to death with dignity (Andrews & Three levels are
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SALE
OR
DISTRIBUTION
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Roy, 1991). The adaptation level represents the condition of the life pro- described by
Three levels
described
by Roy:
compensatory,
and Roy: integrated,
Nationalcesses.
Association
ofareLong
Term
Careintegrated,
Administrator
Boards
compromised life processes. An integrated life process may change to a compensatory, and
compromised life
compensatory process, which attempts to reestablish adaptation. If the
processes.
nes & Bartlett Learning,
LLC
Jones & Bartlett
LLC
compensatory
processes are not adequate,©compromised
processes Learning,
result
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FOR
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OR
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(Roy, 2009, p. 33).
in the Administrator
Roy adaptation model
include both innate coponal Association of Coping
Longprocesses
Term Care
Boards
ing mechanisms and acquired coping mechanisms. Innate coping processes
are genetically determined or common to the species; they are generally
& processes.
BartlettInLearning,
LLC coping processes are © Jones & Bartlett Learnin
viewed©asJones
automatic
contrast, acquired
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NOT
FOR
SALE
OR
DISTRIBUTION
learned or developed through customary responses (Roy, 2009, p. 41).
The processes for coping in the Roy adaptation model are further
National Association of Long Term Care Administrator Boards
categorized as “the regulator and cognator subsystems as they apply to
individuals, and the stabilizer and innovator subsystems as applied to
© Jonesgroups”
& Bartlett
Learning,
© Jones
& Bartlett Learning, LLC
(p. 33).
A basic typeLLC
of adaptive process, the regulator
subsysNOT FOR
OR
DISTRIBUTION
NOTchannels.
FOR SALE OR DISTRIBUTION
temSALE
responds
through
neural, chemical, and endocrine coping
Stimuli from the internal and external environment act as inputs through
National Association of Long Term Care Administrator Boards
the senses to the nervous system, thereby affecting the fluid, electrolyte,
and acid–base balance, as well as the endocrine system. This information
is all channeled
producing
an automatic,
nes & Bartlett Learning,
LLCautomatically, with the ©body
Jones
& Bartlett
Learning, LLC
unconscious
response
to
it
(p.
41).
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The second adaptive process, the cognator subsystem, responds
onal Associationthrough
of Long
Care Administrator
Boardsand information
fourTerm
cognitive–emotional
channels: perceptual
processing, learning, judgment, and emotion. Perceptual and information
processing
includes&activities
selective attention,
© Jones
BartlettofLearning,
LLC coding, and mem- © Jones & Bartlett Learnin
ory. Learning involves imitation, reinforcement, and insight. Judgment
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includes problem solving and decision making. Defenses are used to seek
National
Association
ofappraisal
Long Term
Care Administrator
Boards
relief from
anxiety and
make affective
and attachments
through
the emotions (p. 41).
The cognator–regulator and stabilizer–innovator subsystems func© Jones & Bartlett
Learning, LLC
© Jones & Bartlett Learning, LLC
tion to maintain integrated life processes. These life processes—whether
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nes & Bartlett Learning, LLC
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nes & Bartlett Learning, LLC
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onal Association of Long Term Care Administrator Boards
130
N ursing T heories : A F ramework for P rofessional P ractice
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learnin
NOT FOR SALE OR DISTR
integrated, compensatory, or compromised—are manifested in behaviors
the individual orof
group.
Behavior
viewedAdministrator
as an output of theBoards
human
NationalofAssociation
Long
Termis Care
system and takes the form of either adaptive responses or ineffective
responses. These responses serve as feedback to the system, with the
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
human system using this information to decide whether to increase or
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its efforts to cope with the stimuli (Roy, 2009, p. 34).
one can
identify
specific processes
inherent in the regulaNational Association ofAlthough
Long Term
Care
Administrator
Boards
tor–cognator subsystems, it is not possible to directly observe the functioning of these systems. The behaviors can be observed in four categories, or
nes & Bartlett Learning, LLCadaptive modes: physiologic–physical
© Jones & mode,
Bartlett
Learning, LLC
self-concept–group
identify
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mode, role function mode, and interdependence mode.
It is through these
fourCare
modesAdministrator
that responses to Boards
and interaction with the environment can
onal Association of Long Term
be carried out and adaptation can be observed (p. 43).
Behavior in the physiologic–physical mode is the manifestation of
© Jonesthe&physiologic
Bartlett activities
Learning,
© Jones
& Bartlett Learnin
of allLLC
cells, tissues, organs, and systems
making
NOT
FOR
NOT FOR
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OR
DISTRIBUTION
up the body. Five basic needs exist: oxygenation, nutrition, elimination,SALE OR DISTR
and rest, and protection. In addition, four processes are involved
Nationalactivity
Association
of Long Term Care Administrator Boards
in physiologic adaptation: the senses; fluid, electrolyte, and acid–base balance; neurologic function; and endocrine function. The underlying need
© Jones & Bartlett Learning,
LLC mode is physiologic integrity
© Jones
& Bartlett
Learning, LLC
for the physiologic
(p. 43).
When viewing
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FOR itSALE
OR DISTRIBUTION
the first mode in relationship to a group ofNOT
individuals,
is appropriate
to
use the terminology “physical mode” and to look at the group manifestaNational Association of Long Term Care Administrator Boards
tion of adaptation in terms of basic operating resources, because the basic
need associated with the physical mode for a group is resource adequacy
in physical
resource
needs
nes & Bartlett Learning, LLCor wholeness achieved by©adapting
Jonesto&changes
Bartlett
Learning,
LLC
(Roy, 2009, p. 43–44). NOT FOR SALE OR DISTRIBUTION
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The self-concept–group identity mode includes the components of the
onal Association of Long Term
Care
Administrator
Boardsand body image, and the personal
physical self,
including body sensation
self, including self-consistency, self-ideal, and moral–ethical–spiritual
basic need
underlying
the self-concept mode for the
individual
© Jonesself.
& The
Bartlett
Learning,
LLC
© Jones
& Bartlett Learnin
is psychic and spiritual integrity—that is, the need to know who one is
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NOT FOR SALE OR DISTRIBUTION
so that one can be or exist with a sense of unity (p. 44). “Group identity”
National
Long
Term
Care
Administrator
is Association
the term used toof
refer
to the
second
mode
with groups. ThisBoards
mode
comprises interpersonal relationships, group self-image, social milieu,
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
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National Association of Long Term Care Administrator Boards
nes & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
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10 Roy Adaptation Model: Sister Callista Roy
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131
chapter
© Jones & Bartlett Learnin
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culture, and shared responsibility of the group. Identity integrity is the
need underlying
group adaptiveof
mode
(p. 44).
Nationalthis
Association
Long
Term Care Administrator Boards
The role function mode focuses on the roles of the person in society
and the roles within a group. The basic need underlying the role function
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
mode is social integrity—that is, the need to know who one is in relation
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OR
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to others so that one will know how to act (p. 44).
Finally, the interdependence
modeCare
is a category
of behavior related
to
National Association
of Long Term
Administrator
Boards
interdependent relationships. This mode focuses on interactions related
to the giving and receiving of love, respect, and value. The basic need
nes & Bartlett Learning,
Jones
& Bartlett
Learning, LLC
of this modeLLC
is relational integrity, or the©
feeling
of security
in nurturing
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relationships. Thus it follows that two specific relationships are the focus
this mode
the individual:
significantBoards
others and support sysonal Associationwithin
of Long
TermforCare
Administrator
tems. For the group, the interdependence mode relates to the social context in which the group operates; important factors in this case include
© Jones
& Bartlett
Learning,
LLC
© Jones & Bartlett Learnin
infrastructure
and member
capability
(Roy, 2009,
p. 45).
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FOR
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OR
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In the Roy adaptation model, three classes of stimuli form the envi- NOT FOR SALE OR DISTR
ronment: the focal stimulus, contextual stimuli, and residual stimuli.
National Association of Long Term Care Administrator Boards
❖❖ “The focal stimulus is the internal or external stimulus most
immediately in the awareness of the individual or group— the
Bartlett
LLC in the consciousness” ©
object orLearning,
event most present
(p.Jones
35).
© Jones &
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& Bartlett Learning, LLC
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❖❖ “Contextual stimuli are all other stimuli present in the situation
National Association
of Long
Term
Care
Administrator
that contribute
to the effect
of the
focal
stimulus. That is, Boards
contextual stimuli are all the environmental factors that present to
the human adaptive system from within or outside but which are
nes & Bartlett Learning,
LLC
© Jones
Bartlett
Learning, LLC
not the
center of attention or energy”
(p. 35). &
Even
though the
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NOT
FOR SALE
OR DISTRIBUTION
contextual stimuli are not the center
of attention,
these factors
do
influence
how
people
deal
with
the
focal
stimulus.
onal Association of Long Term Care Administrator Boards
❖❖ Residual stimuli are environmental factors within or outside
human systems, the effects of which are unclear in the situation.
©
Jones & Bartlett Learning, LLC
© Jones & Bartlett Learnin
The effects of these stimuli may be unclear if there is no awareNOT FOR SALE OR DISTR
NOT
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ness on the part of the patient that a stimulus is an influence, or
it may not be
clear to the observer
that these
stimuli
areAdministrator
having
National
Association
of Long
Term
Care
Boards
an influence on the human system (p. 36).
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
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National Association of Long Term Care Administrator Boards
nes & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
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132
N ursing T heories : A F ramework for P rofessional P ractice
© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learnin
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I
n addition to the concepts already pre-
sented, Term
the fourCare
metaparadigm
concepts of
nursNational Association of Long
Administrator
Boards
MAJOR
ing are identified in the Roy adaptation model.
CONCEPTS
These concepts are summarized in Table 10-1.
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
OF NURSING
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OR DISTRIBUTION
NOT FOR SALE OR DISTRIBUTION
Person
ACCORDING TO
National Association of Long TermAccording
Care Administrator
Boards
to the Roy adaptation
model, humans are
Roy
holistic, adaptive systems. “The human system is
described
as a whole
with partsLearning,
that functionLLC
as unity
nes & Bartlett Learning, LLC
© Jones
& Bartlett
for some purpose. Human
systems
as individuals, or in
FOR SALE OR DISTRIBUTION
NOT
FORinclude
SALEpeople
OR DISTRIBUTION
groups, including families, organizations, communities, and society as a
onal Association of Long Term
Care
Administrator
Boards
whole”
(Roy
& Andrews, 1999, p.
31). The person is the main focus of nursing and is the recipient of nursing care. The person is specifically defined
adaptive Learning,
system with cognator
acting to
© Jonesas&“an
Bartlett
LLC and regulator subsystems
© Jones
& Bartlett Learnin
maintain
adaptation
in
the
four
adaptive
modes”
(Roy,
2009,
p.
12).
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NOT FOR SALE OR DISTRIBUTION
National Association of Long Term Care Administrator Boards
Environment
Environment is the second major concept of the model. It is understood
© Jones & Bartlett Learning,
© adaptive
Jones systems
& Bartlett
LLC
as the worldLLC
within and around humans as
(Roy, Learning,
2009,
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NOT
FOR
SALE
OR
DISTRIBUTION
p. 46). The environment refers to “all conditions, circumstances, and
National Association of Long Term Care Administrator Boards
ӗӗTABLE 10-1 Metaparadigm Concepts as Defined in the Roy Adaptation Model
nes & Bartlett Person
Learning, LLC“An adaptive system with cognator
© Jones
& Bartlett Learning, LLC
and regulator subsystems acting to
FOR SALE OR DISTRIBUTION
FOR modes”
SALE(Roy,
OR2009,
DISTRIBUTION
maintain adaptation in theNOT
four adaptive
p. 12)
onal Association
of Long Term
Care Administrator
Environment
“All conditions,
circumstances, andBoards
influences surrounding and affecting
the development and behavior of persons and groups, with particular
consideration of mutuality of person and earth resources” (Roy, 2009, p. 12)
Health
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learnin
“A
state
and
process
of
being
and
becoming
an
integrated
and
whole
that
NOT
FOR SALE OR DISTR
NOT FOR SALE OR DISTRIBUTION
reflects person and environment mutuality” (Roy, 2009, p. 12)
Care
Administrator
Nursing National
TheAssociation
goal of nursing is of
“to Long
promoteTerm
adaptation
for individuals
and groupsBoards
in
the four adaptive modes, thus contributing to health, quality of life, and dying
with dignity by
assessing behavior and factors©that
influence
abilities
Learning,
LLC
Jones
& adaptive
Bartlett
Learning,
and to enhance environmental factors” (Roy, 2009, p. 12)
© Jones & Bartlett
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LLC
NOT FOR SALE OR DISTRIBUTION
National Association of Long Term Care Administrator Boards
nes & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
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onal Association of Long Term Care Administrator Boards
10 Roy Adaptation Model: Sister Callista Roy
© Jones & Bartlett Learning, LLC
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133
chapter
© Jones & Bartlett Learnin
NOT FOR SALE OR DISTR
influences surrounding and affecting the development and behavior of persons and
groups, with
particular consideration
mutuality
of person
and
National
Association
of LongofTerm
Care
Administrator
Boards
earth resources” (p. 12). It is the changing environment that stimulates the
person to make adaptive responses (Andrews & Roy, 1991, p. 18). However,
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
any environmental change—even if positive—demands increasing energy to
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SALE
OR
DISTRIBUTION
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adapt to the situation. Factors in the environment that affect the person are
as focal,ofcontextual,
and residual
(Phillips, 2010,Boards
p. 343).
Nationalcategorized
Association
Long Term
Carestimuli
Administrator
Health LLC
nes & Bartlett Learning,
© Jones & Bartlett Learning, LLC
Health is “a state and process of being andNOT
becoming
integrated
FOR SALE OR DISTRIBUTION
FOR
SALEand
ORwhole
DISTRIBUTION
that reflects person and environment mutuality” (Roy, 2009, p. 12). In her
onal Associationearly
of Long
Term
Careabout
Administrator
Boards
writings,
Roy wrote
health as existing
along a continuum; she
now views this conceptualization of health as “simplistic and unrealistic
since it©does
not accommodate
the coexistence
of wellness and illness © Jones & Bartlett Learnin
Jones
& Bartlett Learning,
LLC
and excludes
individuals
with
chronic
disabilities
or
terminal illness who, NOT FOR SALE OR DISTR
NOT FOR SALE OR DISTRIBUTION
in spite of their condition, are dealing effectively with life’s challenges” The goal of
National
Longbegan
Term
CareonAdministrator
is
(p. 46–47).
During Association
the 1990s, Roy’s of
writings
to focus
health as nursingBoards
“to promote
a process in which health and illness can coexist (Roy & Andrews, 1999;
adaptation for
2010, p. 342). In either conceptualization, health is viewed as a
JonesPhillips,
& Bartlett
Learning, LLC
© Jones & Bartlett
Learning,
LLC
individuals
and
reflection of adaptation (Andrews & Roy, 1991, p. 21).
groups in the four
©
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adaptive modes,
thus contributing
to health, quality
Roy defines nursing as a “health care profession that focuses on human of life, and dying
with dignity
life processes
and patterns of people with a©commitment
promote health
nes & Bartlett Learning,
LLC
Jones & toBartlett
Learning,
LLC by
assessing behavior
and
full
life-potential
for
individuals,
families,
groups,
and
the
global
sociFOR SALE OR DISTRIBUTION
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and factors
ety” (Roy, 2009, p. 3). She defines nursing as the science and practice. The
that influence
onal Association of Long Term Care Administrator Boards
goal of nursing is “to promote adaptation for individuals and groups in
adaptive abilities
the four adaptive modes, thus contributing to health, quality of life, and and to enhance
dying with
dignity &
by Bartlett
assessing behavior
and factors
© Jones
Learning,
LLC that influence adap- environmental
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factors.”
tive abilities
and
to
enhance
environmental
factors”
(Roy,
2009,
p.
12).
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National Association of Long Term Care Administrator Boards
Nursing
National Association of Long Term Care Administrator Boards
Analysis of the Roy Adaptation Model
The analysis presented here consists of an examination of assumptions and
© Jonespropositions
& BartlettasLearning,
© Jones
& Bartlett Learning, LLC
well as a briefLLC
critique of the adaptation model
of nursing.
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nes & Bartlett Learning, LLC
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N ursing T heories : A F ramework for P rofessional P ractice
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Assumptions of the Roy Adaptation Model
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NationalAssumptions
Association
of Long
Administrator
Boards
included
in Roy’sTerm
model Care
are classified
into three categories:
philosophic assumptions, scientific assumptions, and cultural assumptions. Philosophic
include the
Learning,
LLC assumptions of the model
© Jones
& following:
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© Jones & Bartlett
LLC
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NOT
FOR
SALE
OR
DISTRIBUTION
❖❖ Persons have a mutual relationship with the world and a
God-figure.
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nes & Bartlett Learning, LLC
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❖❖ Human meaning is rooted in an omega point convergence of the
universe.
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❖❖ God is intimately revealed in the diversity of creation and is the
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common destiny of creation.
onal Association of Long Term Care
Administrator
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❖❖ Persons
use human creative
abilities of awareness, enlightenment, and faith.
❖ Persons are
accountable
for entering the process of deriving,
sus-& Bartlett Learnin
© Jones & ❖Bartlett
Learning,
LLC
© Jones
taining,
transforming the universe (Roy, 2009, p.NOT
31). FOR SALE OR DISTR
NOT FOR SALE
ORand
DISTRIBUTION
Scientific assumptions
of the
model
include
the following: Boards
National Association
of Long
Term
Care
Administrator
❖❖ Systems of matter and energy progress to higher levels of complex self-organization.
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
❖❖ Consciousness and meaning are constitutive
of person
enviNOT FOR SALE OR DISTRIBUTION
NOT FOR
SALEand
OR
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ronment integration.
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❖❖ Awareness of self and environment is rooted in thinking and
feeling.
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❖❖ Human decisions©
areJones
accountable
for integration
of creative
& Bartlett
Learning,
LLC
processes.
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❖❖ Thinking
and feeling mediate
human action.
onal Association of Long Term Care
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❖❖ System relationships include acceptance, protection, and fostering interdependence.
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© Jones & Bartlett Learnin
❖❖ Persons and earth have common patterns and integral relations.
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❖❖ Person and environment transformations are created in human
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consciousness.
❖❖ Integration of human environment meanings results in adaptation (Roy,
Learning,
LLC2009, p. 31).
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© Jones & Bartlett
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LLC
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nes & Bartlett Learning, LLC
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10 Roy Adaptation Model: Sister Callista Roy
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chapter
Cultural assumptions include the following:
© Jones & Bartlett Learnin
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Long
Care
❖❖National
ExperiencesAssociation
within a specificof
culture
willTerm
influence
howAdministrator
each element of the Roy adaptation model is expressed.
Boards
❖❖ Within aLearning,
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to the & Bartlett Learning, LLC
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culture
that will influence some or all of the elements
of the SALE OR DISTRIBUTION
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ORand
DISTRIBUTION
NOT FOR
Roy adaptation model to a greater or lesser extent.
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❖❖ Cultural expressions of the elements of the Roy adaptation model may
lead to changes in practice activities such as nursing assessment.
nes & Bartlett Learning,
LLC
Jones
& Bartlett
Learning, LLC
❖❖ As Roy
adaptation model elements©evolve
within
a cultural perFOR SALE OR DISTRIBUTION
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FOR
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OR
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spective, implications for education and research may differ from
the experience
in theAdministrator
original culture (Roy,
2009, p. 31).
onal Association of Long
Term Care
Boards
© Jonesof
& the
Bartlett
LLC
Propositions
Roy Learning,
Adaptation
Model
NOT FOR
ORpropositions
DISTRIBUTION
The following
are theSALE
relational
of the Roy adaptation model
(Fawcett,
2005, p. 382–383):
National
Association
© Jones & Bartlett Learnin
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of Long Term Care Administrator Boards
❖❖ Stimuli from the internal and external environments (through
the senses) serve as inputs to the nervous system and affect the
© Jones & Bartlett
Learning, LLC
© Jones & Bartlett Learning, LLC
fluid, electrolyte, and acid–base balance, as well as the endoNOT FOR SALE
OR
DISTRIBUTION
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crine system. This information is channeled automatically in the
appropriate of
manner,
an automatic,
unconscious response
is
National Association
Longand
Term
Care Administrator
Boards
produced (Roy & Andrews, 1999, p. 46).
❖❖ Internal and external stimuli, including psychological, social,
nes & Bartlett Learning,
LLC
© Jones & Bartlett Learning, LLC
physical, and physiological factors, serve as inputs to the cognaFOR SALE OR DISTRIBUTION
NOT
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tor subsystem (Roy & Andrews, 1999,
p. 47).
onal Association of ❖Long
Term
Care Administrator
Boards
❖ Stimuli
and adaptation
level serve as input
to human adaptive systems; processing of this input through control processes
results in behavioral responses (Roy & Andrews, 1999, p. 43).
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learnin
OR DISTR
❖❖NOT
HumanFOR
systems,
as individuals,
families, groups, organizations,
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OR DISTRIBUTION
or communities, must sense changes in the environment and
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Association
Term
Care Administrator
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make adaptations
in the way of
theyLong
function
to accommodate
new
environmental requirements (Roy & Andrews, 1999, p. 44).
❖❖ Adaptation
level affects
the human system’s ability©
to Jones
respond & Bartlett Learning, LLC
© Jones & Bartlett
Learning,
LLC
positively
in
a
situation
(Roy
&
Andrews,
1999,
p.
36).
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nes & Bartlett Learning, LLC
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N ursing T heories : A F ramework for P rofessional P ractice
© Jones & Bartlett Learning, LLC
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National
© Jones & Bartlett Learnin
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❖❖ The changing environment stimulates the person to make adaptive responses.
the environment
changes,
the person has
the
Association
of As
Long
Term Care
Administrator
Boards
opportunity to continue to grow, to develop, and to enhance the
meaning of life for everyone (Andrews & Roy, 1991, p. 18).
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
❖❖ The characteristics of the internal NOT
and external
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FOR stimuli
SALEinfluOR DISTRIBUTION
ence the adequacy of cognitive and emotional processes (Roy &
Andrews,
1999,
p. 547).
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Term
Care
Administrator Boards
nes & Bartlett Learning, LLC
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onal Association of
❖❖ The characteristics of the internal and external stimuli influence
(behavioral) responses
(Roy &&Andrews,
p. 547). LLC
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Bartlett1999,
Learning,
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❖❖ Human beings areNOT
described
adaptiveOR
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that are constantly growing and developing within changing environments.
Long Term Care
Administrator Boards
Health for human adaptive systems can be described as a reflection of this interaction or adaptation (Roy & Andrews, 1999, p.
53–54). Learning, LLC
© Jones & Bartlett
© Jones &
Bartlett Learnin
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FOR
SALE
OR DISTR
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OR
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❖❖ The goal of nursing is the promotion of adaptation in each of the
four adaptive modes, thereby contributing to health, quality of
National Association
of Long Term Care Administrator Boards
life, or dying with dignity (Roy & Andrews, 1999, p. 55).
❖❖ The general goal of nursing intervention is to maintain and
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LLC
Jones
& Bartlett
Learning,
LLC
enhance
adaptive behavior and to ©
change
ineffective
behavior
to
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adaptive (Roy & Andrews, 1999, p. 81).
National Association of❖Long
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Care
Administrator
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❖ It is the
nurse’s
role to
promote adaptation
in situations of
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health and illness and to enhance the interaction of human systems with the environment, thereby promoting health (Roy &
Jones & Bartlett Learning, LLC
Andrews, 1999, p.©55).
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onal Association of Long Term Care Administrator Boards
Brief Critique of the Roy Adaptation Model
The concepts of the Roy adaptation model are clearly and consistently
© Jonesdefined.
& Bartlett
Learning,
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& Bartlett Learnin
The model
is internally
consistent, even though it©
is Jones
a complex
NOT
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model
with OR
several
major concepts, subconcepts, and many
relational
statements. It has the level of complexity required to make it broad in
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scope and generalizable for both practice and research; however, once
learned, the model is logical and easy to understand (Phillips, 2010).
© Jones & Bartlett Learning, LLC
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nes & Bartlett Learning, LLC
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10 Roy Adaptation Model: Sister Callista Roy
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137
chapter
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T
he R oy adaptation model is commonly used
in nursing practice.
To use theof
model
in practice,
National
Association
Long
Term Care Administrator Boards
THE Roy
ADAPTATION
1. AssessLearning,
the behaviors
manifested from the
© Jones & Bartlett
LLC
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MODEL
ASOR
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fourOR
adaptive
modes (physiological–physical
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NOT FOR
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mode, self-concept–group identity mode, role
FRAMEWORK
National Association
of Long
Term Care Administrator
Boards
function mode,
and interdependence
mode).
FOR NURSING
2. Assess and categorize the stimuli for those
PRACTICE
nes & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
the nurse follows Roy’s six-step nursing process:
behaviors.
FOR SALE OR DISTRIBUTION
onal Association of
NOT FOR SALE OR DISTRIBUTION
3. Make a nursing diagnosis based on the perLong
Term
Care
Administrator Boards
son’s
adaptive
state.
4. Set goals to promote adaptation.
© Jones & Bartlett Learning, LLC
5.NOT
Implement
aimed at managing stimuli to promote
FOR interventions
SALE OR DISTRIBUTION
adaptation.
© Jones & Bartlett Learnin
NOT FOR SALE OR DISTR
National Association of Long Term Care Administrator Boards
6. Evaluate achievement of adaptive goals (Phillips, 2010).
Andrews and Roy (1986) pointed out that by manipulating the stimuli
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
rather than the patient, the nurse enhances “the interaction of the person
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NOT FOR SALE OR DISTRIBUTION
with their environment, thereby promoting health” (p. 51).
National Association of Long Term Care Administrator Boards
R
oy
specifically
addresses
incorpora -
nes & Bartlett Learning,
LLC
© within
Jonesthe& Bartlett Learning, LLC
tion
of a six-step nursing process
FOR SALE OR DISTRIBUTION
NOT
FOR SALE OR
DISTRIBUTION
context of her model, stressing that
although
THE
NURSING
onal
are discussed
for clarity, the process
is
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of Long
Termseparately
Care Administrator
Boards
ongoing and simultaneous (Roy, 2009, p. 57). Roy also
states in relationship to each of the steps of the nursing
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on highly
developedLLC
techniNOT FORand
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cal, interpersonal,
intuitive
as they assess
and initiate interventions involving approaches such as
National Association of Long Term Care
physical care, anticipatory guidance, health teaching,
and counseling (p. 59).
© Jones & Bartlett Learning, LLC
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PROCESS
AND THE Roy
© Jones & Bartlett Learnin
ADAPTATION
NOT FOR SALE OR DISTR
MODEL
Administrator Boards
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nes & Bartlett Learning, LLC
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N ursing T heories : A F ramework for P rofessional P ractice
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Assessment
© Jones & Bartlett Learnin
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NationalThe
Association
of process
Long Term
Care Administrator
Boards
first step of the
is the assessment
of behavior—after
all,
behavior is the indicator of how a human adaptive system manages to
cope with, orLLC
adapt to, changes in health status.
Behaviors
may be either
© Jones & Bartlett Learning,
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Learning, LLC
or non-observable (Roy, 2009, NOT
p. 58). FOR
In the nursing
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OR DISTRIBUTION
the primary concern is behavior that requires further adaptive responses
National Associationasof
Long
Care Administrator
Boards
a result
of Term
environmental
changes straining the
coping processes of the
adaptive system. The nurse must know how to assess for these behaviors,
their
contribution
to the
nes & Bartlett Learning, LLCcompare them to specific
© criteria
Jonesto&evaluate
Bartlett
Learning,
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maintenance
of
integrity,
and
identify
the
strengths
of
the
coping
proFOR SALE OR DISTRIBUTION
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cesses and the demands faced (p. 59).
onal Association of Long Term Care
Boards
DuringAdministrator
the assessment phase
of the nursing process, the nurse systematically considers behaviors manifested from the four adaptive modes
the stimuli for those behaviors, categorizing them as focal,
© Jonesand
& assesses
Bartlett
Learning, LLC
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contextual, or residual stimuli (Phillips, 2010, p. 435). The nurse uses
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observational skills, intuition, accurate measures (e.g., blood pressure
Nationalreading,
Association
Term
Care
eye chart, of
or Long
assessment
scale),
andAdministrator
interviewing skillsBoards
to systematically collect data related to behaviors (Roy, 2009, p. 59–60).
The nurse must then make a tentative judgment of the behavior. In
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
making this initial judgment as to whether a behavior is adaptive or inefNOT FOR SALE OR DISTRIBUTION
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fective, the nurse must continually involve the patient. Ultimately, the
perceptions
associated
with the effectiveness
of behaviors are
National Associationpatient’s
of Long
Term Care
Administrator
Boards
essential in determining if the behavior is adaptive or ineffective (p. 61).
In addition to the assessment of behaviors, the nurse must identify
nes & Bartlett Learning, LLCthe internal and external©
Jones
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stimuli
that &
areBartlett
influencing
behaviors. The
skills
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behaviors—namely,
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Administrator
measurement, and perceptive interview. To set priorities, the nurse, in
collaboration with the patient, identifies the focal, contextual, and resid© Jonesual&stimuli
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that Learning,
are influencing
behavior (p. 62). In addition,
“the nurse
FOR
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identifies
particular
stimulus of the adaptation level, NOT
that is,
inte- SALE OR DISTR
grated, compensatory, and compromised life processes that contribute to
National
Association of Long Term Care Administrator Boards
adaptive or ineffective behavior” (p. 62).
Analysis of the data results in a statement or nursing diagnosis reflective of the patient’s
a nursing
diagnosis within
© Jones & Bartlett Learning,
LLC adaptive state. In setting
© up
Jones
& Bartlett
Learning, LLC
the
framework
of
her
adaptation
model,
Roy
suggests
that
nurse
develop
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NOT FOR SALE OR DISTRIBUTION
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nes & Bartlett Learning, LLC
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10 Roy Adaptation Model: Sister Callista Roy
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139
chapter
© Jones & Bartlett Learnin
NOT FOR
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C R I T I C A L
statements that match behaviors and the most relevant stimuli. This type
of wording
of the diagnosis
facilitates
step of
goal setting
66–67).
National
Association
ofthe
Long
Term
Care(p.
Administrator
T H I N K I N G
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© Jones & Bartlett
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What do you
think about
During
the next
of the nursing process, the nurse and NOT
the patient
setSALE
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FOR
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the six-step
version of
will promote adaptation. “The goal statement should designate not only the nursing
process advocated
the behavior
to be observed but the way
behavior
will change
(as
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for use with the
observed, measured, or subjectively reported)
the time
fromOR
in which
FOR SALE OR DISTRIBUTION
NOTand
FOR
SALE
DISTRIBUTION
Roy adaptation
the goal is to be attained” (Roy, 2009, p. 77).
model? Do you
onal Association of Long Term Care Administrator Boards
believe that it
allows the nurse to
Implementation
meet
the standards
© Jones & Bartlett Learning, LLC
© Jones
& Bartlett Learnin
During the implementation phase of the process, the nurse determines
of
care practice
NOT
FOR
SALE OR DISTR
NOT
FOR
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how best to assist the patient in attaining his or her goals and chooses
requirements
interventions
to promote
the desired
through
either
changNational
Association
of adaptation
Long Term
Care
Administrator
Boards
for assessment,
ing stimuli or strengthening adaptive processes (Roy, 2009, p. 78). The
planning,
identification of possible approaches to nursing intervention includes the implementation,
© Jonesselection
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of which
stimuli to change.
nurse lists
and evaluation?
goals to promote adaptation. Goal setting within the framework of Roy’s
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involves theof
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consequences
of changing
the stimulus or affecting
a
Nationalprocesses.
Association
Long Term
Care Administrator
Boards
coping process are identified together with the probability (low, moderate,
or high) of their occurrence. In collaboration with the patient, the nurse
judges the outcome
desirable
or undesirable
nes & Bartlett Learning,
LLC of the consequence as©either
Jones
& Bartlett
Learning, LLC
(p.
79).
Once
the
appropriate
nursing
intervention
has
been
selected,
the
FOR SALE OR DISTRIBUTION
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nurse works with the patient to initiate steps that will alter the stimulus
onal Association of Long Term Care Administrator Boards
and enhance coping (p. 80).
© Jones & Bartlett Learning, LLC
Evaluation
© Jones & Bartlett Learnin
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NOT FOR SALE OR DISTRIBUTION
Evaluation focuses on judging the effectiveness of the nursing intervention in National
relation to the
behavior of theof
individual
or group.
To determine
if
Association
Long Term
Care
Administrator
Boards
the adaptive goals have been met, the nurse uses the same skills as were
employed in the assessment phase of the process—observation, intuition,
Jonesmeasurement,
& Bartlett and
Learning,
LLC
© Jones & Bartlett Learning,
interviewing
(Roy, 2009, p. 81).
©
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LLC
NOT FOR SALE OR DISTRIBUTION
National Association of Long Term Care Administrator Boards
nes & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
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N ursing T heories : A F ramework for P rofessional P ractice
© Jones & Bartlett Learning, LLC
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© Jones & Bartlett Learnin
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T
he following scenario illustrates nurs -
ing care
of the
patient
relative to one identified
National Association of Long
Term
Care
Administrator
Boards
SCENARIO
nursing problem framed by Roy’s adaptation
model. This scenario is not intended to cover all
ILLUSTRATING
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
aspects of care, but rather is intended to stimulate
CARE
NOT FOR NURSING
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NOT FOR SALE OR DISTRIBUTION
thinking about how specific care might be approached
FRAMED BY THE
thisAdministrator
theory as a framework
for practice.
National Association of Long Termusing
Care
Boards
Roy ADAPTATION
MODEL UTILIZING
nes & Bartlett Learning, LLC
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& Bartlett
Learning,
Mrs. M.
a 37-year-old
single mother
with twoLLC
schoolTHE NURSING
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FOR
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OR
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age children. Mrs. M. suffered multiple facial injuries
PROCESS
as a result of a motor vehicle accident several months
onal Association of Long Term Care Administrator Boards
ago. The injuries have healed without complication,
but she has moderate residual scarring.
© Jones & Assessment
Bartlett Learning,
LLC with the behaviors manifested
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of Mrs. M. begins
from
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FOR
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OR
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the four adaptive modes. The nurse uses observational skills, intuition,SALE OR DISTR
and interviewing skills to collect data. The nurse involves
Nationalmeasurements,
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of Long Term Care Administrator Boards
Mrs. M. in the assessment to verify the nurse’s own perceptions. The
nurse verifies that Mrs. M. has generally adapted well following the motor
© Jones & Bartlett Learning,
LLC The exception is the self-concept
© Jones mode:
& Bartlett
LLC
vehicle accident.
Some ofLearning,
her
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behaviors are ineffective in relation to adaptation,
as evidenced
by Mrs.
M.’s avoidance of social gatherings, wearing dark glasses and big hats,
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and wearing heavy makeup to cover her scars.
Next, the nurse and Mrs. M. set goals to promote adaptation. Goal setting
framework
statements
of measurable
nes & Bartlett Learning, LLC for Mrs. M. within the
© Jones
& involves
Bartlett
Learning,
LLC
behavioral
outcomes
of
nursing
care
that
will
promote
adaptation
related
to
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body image within the self-concept adaptive mode. The nurse, in collaboraonal Association of Long Term
Administrator
Boardsbased on current best practices to
tionCare
with Mrs.
M., chooses interventions
promote adaptation by either changing stimuli or strengthening Mrs. M.’s
processes.
EvaluationLLC
focuses on judging the effectiveness
of the
© Jonesadaptive
& Bartlett
Learning,
© Jones
& Bartlett Learnin
nursing interventions in relation to Mrs. M.’s behaviors. In addition, if any
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other nursing problems are uncovered during the assessment, the nurse
National
Association
of Long
Term Care
Boards
addresses
those problems
simultaneously
usingAdministrator
the process described
and
incorporating best practices to provide appropriate nursing care.
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© Jones & Bartlett Learning, LLC
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nes & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
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nes & Bartlett Learning, LLC
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onal Association of Long Term Care Administrator Boards
10 Roy Adaptation Model: Sister Callista Roy
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141
chapter
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C l as s r o o m A c t i v i t y 1 0 - 1
National Association of Long Term Care Administrator Boards
Form small groups. Each group should add to the plan of care for
Mrs. M. in the preceding scenario based on other potential or actual
© Jones &nursing
Bartlett
Learning,
© Jones
& Bartlett Learning, LLC
problems
typical LLC
for a patient with same medical
diagnosis
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OR
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FOR
or symptoms and demographics. Each group should develop a planSALE OR DISTRIBUTION
for one additional nursing problem using Roy’s theory as the basis for
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of Long Term Care Administrator Boards
practice, while considering at least one of the four adaptive modes.
Each group should then share its plan with the class.
nes & Bartlett Learning, LLC
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C l as s r o o m A c t i v i t y 1 0 - 2
onal Association ofForm
Long
Term Care Administrator Boards
small groups. Using a case study provided by
the instructor,
develop a plan of care using Roy’s nursing theory as the basis for
practice.
Each group
should then
share its plan
© Jones
& Bartlett
Learning,
LLCof care with the class.
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© Jones & Bartlett Learnin
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C l asNational
s r o o mAssociation
A c t i v i t yof1Long
0 - 3 Term Care Administrator Boards
Form small groups. Using a case study provided by the instructor,
a plan
of care using
one of the theories as the ©
basis
for prac© Jones &develop
Bartlett
Learning,
LLC
Jones
& Bartlett Learning, LLC
tice;
each
group
should
select
a
different
nursing
theory.
Each
groupSALE OR DISTRIBUTION
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should then share its plan of care with the class and discuss the simiNational Association
of Long
Term Care Administrator Boards
larities and differences
in care.
nes & Bartlett Learning, LLC
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onal Association of Long Term Care Administrator Boards
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National Association of Long Term Care Administrator Boards
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National Association of Long Term Care Administrator Boards
nes & Bartlett Learning, LLC
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142
N ursing T heories : A F ramework for P rofessional P ractice
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REFERENCES
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Andrews, H. A., & Roy, Sr. C. (1986). Essentials of the Roy adaptation
model. Norwalk, CT: Appleton-Century-Crofts.
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LLC
© Jones & Bartlett Learning, LLC
Andrews, H. A., & Roy, Sr. C. (1991). Essentials of the Roy adaptation
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model. In Sr. C. Roy & H. A. Andrews (Eds.), The Roy adaptation
definitive
(pp. 2–25).Boards
Norwalk, CT: Appleton
National Association ofmodel:
LongThe
Term
Carestatement
Administrator
& Lange.
Fawcett, J. (2005). Contemporary nursing knowledge development:
nes & Bartlett Learning, LLC
© Jones & Bartlett Learning, LLC
Analysis and evaluation of nursing models and theories (2nd ed.).
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Philadelphia: F. A. Davis.
Phillips,
D. (2010). Sister Callista
Roy: Adaptation model. In A. M.
onal Association of Long Term
CareK.Administrator
Boards
Tomey & M. R. Alligood (Eds.), Nursing theorists and their work (7th
ed., pp. 335–365). Maryland Heights, MO: Mosby.
© JonesRoy,
& Bartlett
Learning, LLC
© Jones & Bartlett Learnin
Sr. C. (1970). Adaptation: A conceptual framework for nursing.
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OR
DISTRIBUTION
Nursing Outlook, 18, 42–45.
Sr. C. (2009). of
TheLong
Roy adaptation
model
(3rd ed.). UpperBoards
Saddle
NationalRoy,
Association
Term Care
Administrator
River, NJ: Pearson.
Roy, Sr. C., & Andrews, H. A. (1991). The Roy adaptation model: The
© Jones & Bartlett Learning,
LLC
© Jones
& Bartlett Learning, LLC
definitive
statement. Norwalk, CT: Appleton
& Lange.
NOT FOR SALE OR DISTRIBUTION
NOT
FOR
ORed.).
DISTRIBUTION
Roy, Sr. C., & Andrews, H. A. (1999). The Roy adaptationSALE
model (2nd
CT: Appleton
& Lange.
National Association ofStamford,
Long Term
Care Administrator
Boards
Roy, Sr. C., & Roberts, S. (1981). Theory construction in nursing: An adaptation model. Englewood Cliffs, NJ: Prentice-Hall.
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