 Tracey
James
 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
Physiologic
 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.
362).
 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





Oxygenation
Nutrition
Elimination
Activity
Rest
Complex processes



Fluid balance
Electrolyte balance
Acid-base balance
Complex senses
 Neurologic function
 Endocrine function
 Groups





Operating resources
Participants
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:



Unity
Meaning
Purposefulness
 Need




is group integrity shared through:
Shared relations
Common goals
Common values
Co-responsiblity
 Implications



within the group, there must be:
Honesty
Soundness
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
involves:
Role development
Instrumental and expressive behaviors
Role taking process
 Need
is
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
facility
 Individual

Need is to achieve relational integrity using
process of affectional adequacy

Ex. The giving and receiving of



Love
Respect
Value
This is done through effective relations and
communication
 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
person
 Contextual

The contributing factors in the situation
 Residual
Other unknown factor that may influence the
situation
When the factors making up residual stimuli
become known, they are considered focal or
contextual

 Adaptation
is innate and/or acquired, in the
individual

Regulator subsystem receives input from the
external environment or the individual’s internal
state


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
experience)
 Ex. Laughter in response to stimuli
 Adaptation
responses within the group
require:

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:






1.
2.
3.
4.
5.
6.
Assessment of behavior
Assessment of stimuli
Nursing diagnosis
Goal setting
Intervention
Evaluation
*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:






Survival
Growth
Reproduction
Mastery
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
humans.
 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
compromised

Adaptation levels represent the condition of the
life processes, described on three different
levels

Integrated


Compensatory


Ex. Acid/Base balance is maintained by the entire body
Ex. When balance is disrupted, respiratory (lungs) and
metabolic (kidneys) compensatory mechanisms try to
compensate
Compromised

Ex. When the initial compensatory mechanism fails,
another tries to compensate, which eventually fails. The
system is now compromised by an acidosis or alkalosis
state.
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
nurse.
A patient exhibiting pain is amendable to the
nurse.
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
achievement.

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
process.
 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
 RAM
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
adaptation



Focal – The contributing factors most
immediately confronting the person
Contextual – The contributing factors in the
situation
Residual – Other factors that may influence the
situation.

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
adaptability
 RAM
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



Practice
Education
Research
 Model




considers
Goals
Values
The patient
Practitioner intervention
 The
model has been applied to the nursing
care of individual groups of people






Smokers
Caregivers of chronically ill family member
Cardiac care units
Chronic renal failure patients whom require
dialysis
Women in menopause
Adolescents with asthma
 This
model has been implemented to facility
units, including:







NICU
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
residual
Formulates a diagnosis of the person’s adaptive
state

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
met
The process can be repeated many times

 RAM
defines the distinct purpose of the
nursing students
 Distinguishes
nursing science from medical
practice
 Stresses
collaboration, but delineates
separate goals for nurses and physicians
 Nursing

goals
Help the patient put their energy into getting
well
 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
framework
 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
 RAM
continues to make a significant
contribution to the body of nursing
knowledge
 Needs to facilitate its use better in the
nursing practice


More thoroughly defined typology of nursing
diagnoses
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
education.
 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
research
-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



consuming
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
 RAM


has inspired the development of:
Middle range nursing theories
Adaptation instruments
 Persons
affect and are affected by the
environment
 Environment

is the source of stimuli
This stimuli can threaten or promote a person’s
existence
 RAM






includes concepts of
Nursing
Health-illness continuum
Environment
Adaptation
Nursing activities
Includes subconcepts




Regulator
Cognater
Stabilizer
Innovator
4




effector modes
Physiological-physical
Self-concept – group identity
Role function
interdependence
 RAM
continues to be one of the most
frequently used theories by the nursing
philosophy
 Basis for use has been identified at a national
and international level
 RAM provides the cornerstone of care plan
composition
 RAM
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