SISTER CALLISTA ROY

Introduction
Roy's Adaptation Model focuses on a person's coping
(adaptive) abilities in response to a constantly changing
environment (Lopes, Pagliuca, & Araujo, 2006).

Nursing can promote effective coping by asking, "How can

I modify this patient's environment to facilitate his
adaptation?" (Chitty & Black, 2011, p. 311).
 FIRST PUBLISHED
• 1970 published in “Nursing Outlook”
• 1999
 Development of the Model
• Roy believed that the environment and the individual are
sources of stimuli that require modification to promote
adaptation in the patient (Chitty & Black, 2011, p. 313).

• Health is defined as the process of achieving adaptation

with the environment stimuli so the person is integrated
and a whole (Shosha & Al kalaldeh, 2012).

• Adaptation is manifested by four interrelated modes of

behavior including physiological, self-concept, role function
and interdependence modes.
 ADAPTATION
• “A PROCESS OF RESPONDING
POSITIVELY TO ENVIRONMENTAL
CHANGES”
 ADAPTATION LEVELS
• Constantly changing stimuli
- Focal
- Contextual
- Residual
 COPING MECHANISMS
• INNATE (AUTOMATIC)
• ACQUIRED (LEARNED)
 Roy's values on nursing and
knowledge development
• Acoping
person’s behavioral responses are ineffective for
when the demands of the environment are too
high or the person’s adaptive resources are too low

•
(Chitty & Black, 2011, p. 313).
Nursing goals are to promote adaptation for
individuals contributing to health, quality of life, and

•
dying with dignity.
Nurses need to assess patient behavior and factors
that influence adaptive abilities. By doing this, nurses
can plan interventions to expand abilities to adapt and
enhance environmental interactions (Connell School
of Nursing, 2010).
METAPARADIGMS OF MODEL
• Person
• The person must learn to adapt by being
consciously aware and use choice in order
to integrate their condition with their
environment with the help of nursing.
- Individual nursing vs group nursing
- Coping mechanism
- Behaviors – adaptive modes
METAPARADIGMS OF MODEL
• Environment
- Three kinds of stimuli exist in the
environment including focal, contextual
and residual. All conditions, circumstances
and influences surrounding a person affect
their healing process and the development
and behavior of a person. According to
Roy, having a healthy environment for the
patient is key for healing.
METAPARADIGMS OF MODEL
• Health
– The health of a person relies heavily on the
state of their environment and their ability to
adapt to it. Roy defines health as “a state and
process of being and becoming integrated
and whole that reflects person and
environmental mutuality.”
METAPARADIGMS OF MODEL
• Nursing
-Nursing is a science which expands
adaptive abilities in patients and enhances
the transformation in person and
environment through assessment,
diagnosis, goal setting, intervention and
evaluation.
 CONCEPTS UNIQUE TO THE MODEL
• Holistic adaptive system
- 3 types of stimuli
- Adaptation levels
- Coping mechanisms
 THREE TYPES OF STIMULI

• Focal Stimuli- internal or external stimuli

that most immediately confront the human
system
• Contextual stimuli – all other stimuli that
contribute to the effect of the focal stimuli
• Residual stimuli – environmental stimuli
within or without the human system with
effects in the current situation that are
unclear
 ADAPTATION LEVEL
• Life processes – described in 3 levels
- integrated
- compensatory
- compromised
• Adaptation levels- “a constantly changing point,
made up of focal, contextual and residual stimuli,
which represent one’s own standard of the
range of stimuli to which one can respond with
ordinary adaptive responses”
 COPING MECHANISMS
• Innate coping mechanisms
• Acquired coping mechanisms
• Regulator subsystem
• Cognator subsystem
 ROLE FUNCTION MODE
3 ROLES
• Primary – determined by age, sex, and
developmental stage, determines majority
of behaviors
• secondary - normally achieved positions,
assumed to complete developmental tasks
• tertiary roles – role associated obligations,
freely chosen, temporary in nature
 COMPONENTS
• Each role has instrumental components –
going to work, doing housework, assisting
with child care
• and expressive components – sending a
gift, hugging children, complaining about
boss
 CLINICAL PRACTICE

- Utilization
- Nurses’ role
 SUBSYSTEMS
• Persons as a whole are made up of 6
subsystems which respond either through
innate (natural) or acquired (learned)
responses.
• 2 coping systems which are the cognator
and regulator, the cognator being the
psychological mechanism and the
regulator being the physiological
mechanism and the 4 adaptive modes
 CLINICAL PRACTICE
• Assess behaviors manifested from 4
adaptive modes
-physiological
-self-concept
-role function
-interdependence
 ROY’S DEFINITION OF
HEALTH
• “HEALTH IS THE PROCESS OF BEING
AND BECOMING AN INTEGRATED AND
WHOLE PERSON”
 STIMULI
• Focal – most immediate
• Contextual – not center of attention or
energy of patient, all other stimuli
• Residual – “environmental factors within or
without the human system with effects in
the current situation that are unclear”
 PATIENT ASSESSMENT
• Nursing diagnosis
• Goal setting
• Intervention
• Evaluation
• Detailed patient history
 NURSING PROCESS
FRAMEWORK FOR PATIENT
ASSESSMENT
• Assesses the behaviors manifested from
the four adaptive modes
• Assesses the stimuli for those behaviors
and categorizes them as focal, contextual,
or residual stimuli
• Make a statement or a nursing diagnosis
of the person’s adaptive state
 NURSING PROCESS
CONTINUED
• Sets goals to promote adaptation
• Implements interventions aimed at
managing the stimuli to promote
adaptation
• Evaluates whether the adaptive goals
have been met
 MODEL WITHIN CONTEXT OF
NURSING EDUCATION
* Teaches the
student to promote Physiological
(Physical responses)
Self concept
(Thoughts & beliefs)

adaptation of the
patient in each of
the 4 adaptive
modes.
Interdependence
Role function
Relations with people
(behavior in society)
(Love, respect, value)
 Nursing student focus
• To help patient
put energies
into getting well.
Theory development for students

I have a
Theory idea
Teaching Students
to Care for Patients
 Research of the Model
• Review of research is ongoing
• Practice
• Theory development
• Evaluation of research instruments to
measure key concepts.
 Example of Research Instrument
• STRESS
– Stress
– Touch interventions
– Reduction of pain
– Environmental considerations
– State
– Stability
 Development of Model r/t
spirituality and global consideration
 Development of middle range
theories
• Example
– Dunn (2004) Chronic
pain
• Findings were
manifestations of
adaptation to chronic
pain are its effects on
functional ability and
psychological and
spiritual well-being.
 STRENGTHS OF MODEL
•Arrangement of concepts
-Adaptation – goal of nursing

-Person – adaptive system

-Environment – stimuli

-Health – outcome of adaptation

-Nursing – promoting adaptation and health

 STRENGTHS
• Clearly defined nursing process
• Useful in guiding clinical practice
• Accommodates for physical as well as
psychosocial needs
• Encourages professionalism is nursing by
the use of complete nursing diagnosis
related care plan
 STRENGTHS
• Patient plays an active role – nurse is a
guide
• Persons values and opinions are
considered and respected
 STRENGTHS
• Easy to use in out patient settings
 Roy Model Applications
• Smoking cessation group
• Women with breast cancer
• Caregivers with chronically ill family
members
• Persons with chronic renal failure
• Community health nursing
 LIMITATIONS
• Assumptions – 4 adaptive modes
• Holistic view
• Condition-response based
• Person as an adaptive system
• No direction for priority setting
 LIMITATIONS
• Difficult to use where rapid change occurs
 CASE STUDY
Primary role 32 year old
young adult
male

husband teacher

father
Laundry
2x week colleague
Fix dinner Secondary roles
2x week student
Cub scout coach
leader
Tertiary roles
Roles in the Roy adaptation model
 NURSING ASSESSMENT
• Abdominal pain
• Angry outbursts
• Elevated liver enzymes
• Nausea and vomiting
• Low level of self esteem
• Inter-actional skills
 NURSING DIAGNOSIS
• Adaptive and ineffective behaviors
• Focal stimuli - alcohol
• Contextual stimuli - stress
• Residual - family history
 GOAL SETTING
• Behavior outcomes
- Attend AA meeting
- Counseling for anger management
- Medication regime
- No alcohol
- No angry outbursts
 INTERVENTION
• Taking prescribed meds to help with
anxiety and withdrawal symptoms
• Exercise regime
• Positive family interaction as evidenced by
increased family time – meals with family,
playing with children
• Assigning a sponsor for AA class
 EVALUATION
• Degree of change as evidenced by
change in behavior
- Has attended AA meetings for five weeks
- Participating with a counselor for anger
issues
- Taking family walks five nights per week
- Remains sober
- Taking meds as prescribed
 ANALYSIS
• Outcome theory based
 ANALYSIS
• Science and art of nursing
• Holistic needs
• Testing of hypothesis
• Most frequently used model to guide
nursing
• Model is taught as part of curriculum of
most baccalaureate, master, and doctoral
programs of nursing
• Inspires many middle range nursing
theories
 Case Study 2
A seventy-nine year old man, with a history of congestive heart failure (CHF), lost his wife last
year and now lives alone. His wife used to cook all of his meals and manage his medications
for him. He still remains social with his friends, meeting them for coffee and breakfast each
morning. He enjoys being outdoors and reading, though his eye sight has diminished lately,
and he is embarrassed to share this with his children. While he maintains his appointments
with his physician, the patient has had an increasing number of hospital admissions related to
CHF and often waits until his symptoms are severe before seeking medical attention. His lasix
are scheduled BID and he does not like taking his night time dose because he is up all night
urinating. Though he has children who are active in his care, they are busy taking care of their
own children. His daughter drops in to check on him a few times a week, bringing him dinners
that she has frozen for him to eat throughout the week. For lunch or sometimes dinner, the
patient will have a can of soup and enjoys drinking things such as gatorades and juices.

Using what you have learned from the presentation and your textbook, complete an
assessment on the patient’s environment. What conclusions can you reach as to why the
patient's condition is worsening? What type of interventions would you then complete?
 REFERENCES
• Roy, Sister Callista. (1984). Introduction to Nursing: An Adaptation
Model. Englewood Cliffs, NJ: Prentice-Hall, Inc.

• Andrews, Heather A., Roy, Sister Callista. (1986). Essentials of the

Roy Adaptation Model. Norwalk, CT: Appleton-Century-Crofts.

• Alligood, Martha Raile, Tomey, Ann Marriner. (1998). Nursing

Theorists and Their Work. St. Louis, MO: Mosby – Yearbook, Inc.

• The Roy’s adaptation Model. Current Nursing. Obtained on 12/1/08

from website
http://currentnursing.com/nursing_theory/Roy_adaptation.

• WEB SITE IMAGES obtained from following sites:

-bc.edu
-nursingtheories.blogspot.com
-barnesandnoble.com
-pearsonhighered.com
-sariprena.blogspot.com
-turbosquid.com