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Roy's Adaptation Model

Introduction

Sr.Callista Roy- nurse theorist, writer, lecturer,


researcher and teacher

Professor and Nurse Theorist at the Boston College


of Nursing in Chestnut Hill

Born at Los Angeles on October 14, 1939.

Bachelor of Arts with a major in nursing - Mount St.


Mary's College, Los Angeles in 1963.

Master's degree program in pediatric nursing University of California ,Los Angeles in 1966.

Masters and PhD in Sociology in 1973 and 1977.

Worked with Dorothy E. Johnson

Worked as f faculty of Mount St. Mary's College in


1966.

Organized course content according to a view of


person and family as adaptive systems.

RAM as a basis of curriculum i at Mount St. Marys


College

1970-The model was implemented in Mount St.


Marys school

1971- she was made chair of the nursing department


at the college.

Assumptions (Roy 1989; Roy and Andrews 1991)


Explicit assumptions

The person is a bio-psycho-social being.

The person is in constant interaction with a changing


environment.

To cope with a changing world, person uses both


innate and acquired mechanisms which are
biological, psychological and social in origin.

Health and illness are inevitable dimensions of the


persons life.

To respond positively to environmental changes, the


person must adapt.

The persons adaptation is a function of the stimulus


he is exposed to and his adaptation level

The persons adaptation level is such that it


comprises a zone indicating the range of stimulation
that will lead to a positive response.

The person has 4 modes of adaptation: physiologic


needs, self- concept, role function and interdependence.

"Nursing accepts the humanistic approach of valuing


other persons opinions, and view points"

Interpersonal relations are an integral part of nursing

There is a dynamic objective for existence with


ultimate goal of achieving dignity and integrity.

Implicit assumptions

A person can be reduced to parts for study and care.

Nursing is based on causality.

Patients values and opinions are to be considered


and respected.

A state of adaptation frees an individuals energy to


respond to other stimuli.

Major Concepts

Adaptation -- goal of nursing

Person -- adaptive system

Environment -- stimuli

Health -- outcome of adaptation

Nursing- promoting adaptation and health

Adaptation

Responding positively to environmental changes.

The process and outcome of individuals and groups


who use conscious awareness, self reflection and
choice to create human and environmental
integration

Person

Bio-psycho-social being in constant interaction with

a changing environment

Uses innate and acquired mechanisms to adapt

An adaptive system described as a whole comprised


of parts

Functions as a unity for some purpose

Includes people as individuals or in groups-families,


organizations, communities, and society as a whole.

Environment

Focal - internal or external and immediately


confronting the person

Contextual- all stimuli present in the situation that


contribute to effect of focal stimulus

Residual-a factor whose effects in the current


situation are unclear

All conditions, circumstances, and influences


surrounding and affecting the development and
behavior of persons and groups with particular
consideration of mutuality of person and earth
resources, including focal, contextual and residual
stimuli

Health

Inevitable dimension of person's life

Represented by a health-illness continuum

A state and a process of being and becoming


integrated and whole

Nursing

To promote adaptation in the four adaptive modes

To promote adaptation for individuals and groups in


the four adaptive modes, thus contributing to health,
quality of life, and dying with dignity by assessing
behaviors and factors that influence adaptive abilities
and by intervening to enhance environmental
interactions

Subsystems

Cognator subsystem A major coping process


involving 4 cognitive-emotive channels: perceptual
and information processing, learning, judgment and
emotion.

Regulator subsystem a basic type of adaptive


process that responds automatically through neural,
chemical, and endocrine coping channels

Relationships

Derived Four Adaptive Modes

500 Samples of Patient Behavior

What was the patient doing?

What did the patient look like when needing nursing


care?

Four Adaptive Modes

Physiologic Needs

Self Concept

Role Function

Interdependence

THEORY DEVELOPMENT
Philosophical Assumptions

Persons have mutual relationships with the world and


God

Human meaning is rooted in an omega point


convergence of the universe

God is intimately revealed in the diversity of creation


and is the common destiny of creation

Persons use human creative abilities of awareness,


enlightenment, and faith

Persons are accountable for the processes of deriving,


sustaining, and transforming the universe

Adaptation and Groups

Includes relating persons, partners, families,


organizations, communities, nations, and society as a
whole

Adaptive Modes
A. Persons

Physiologic

Self Concept

Role Function

Interdependence

B. Groups

Physical

Group Identity

Role Function

Interdependence

Role Function Mode

Underlying Need of Social integrity

The need to know who one is in relation to others so


that one can act

The need for role clarity of all participants in group

Adaptation Level

A zone within which stimulation will lead to a


positive or adaptive response

Adaptive mode processes described on three levels:

Integrated

Compensatory

Compromised

Integrated Life Processes

Adaptation level where the structures and functions


of the life processes work to meet needs

Examples of Integrated Adaptation

Stable process of breathing and ventilation

Effective processes for moral-ethical-spiritual growth

Compensatory Processes

Adaptation level where the cognator and regulator


are activated by a challenge to the life processes

Compensatory Adaptation Examples:

Grieving as a growth process, higher levels of


adaptation and transcendence

Role transition, growth in a new role

Compromised Processes

Adaptation level resulting from inadequate integrated


and compensatory life processes

Adaptation problem

Compromised Adaptation Examples

Hypoxia

Unresolved Loss

Stigma

Abusive Relationships

THE NURSING PROCESS

RAM offers guidelines to nurse in developing the


nursing process.

The elements :

First level assessment

Second level assessment

Diagnosis

Goal setting

Intervention

evaluation

Usefulness of Adaptation Model

Scientific knowledge for practice

Clinical assessment and intervention

Research variables

To guide nursing practice

To organize nursing education

Curricular frame work for various nursing colleges

Characteristics of the theory

interrelated

logical in nature

relatively simple yet generalizable

can be the basis for the hypotheses that can be tested

contribute to and assist in increasing the general body

of knowledge of a discipline

can be utilized by the practitioners to guide and


improve their practice

consistent with other validated theories, laws and


principles

Testable

Research studies using RAM

Middle range theories have been derived from RAM

1998-Ducharme et al described a longitudinal model


of psychosocial determinants of adaptation

1998-Levesque et al presented a MRT of


psychological adaptation

1999-A MRNT , the urine control theory by Jirovec


et al

Dunn, H.C. and Dunn, D. G. (1997). The Roy


Adaptation Model and its application to clinical
nursing practice. Journal of Ophthalmic Nursing and
Technology. 6(2), 74-78.

Samarel, N., Fawcett, J., Krippendorf, K., Piacentino,


J.C., Eliasof, B., Hughes, P., Kowitski, C., and
Ziegler, E. (1998). Women's perception of group
support and adaptation to breast cancer. Journal of
Advanced Nursing. 28(6), 1259-1268.

Chiou, C. (2000). A meta-analysis of the


interrelationships between the modes in Roy's
adaptation model. Nursing Science Quarterly. 13(3),
252-258

Yeh, C. H. (2001). Adaptation in children with


cancer: research with Roy's model. Nursing Science
Quarterly. 14, 141-148.

Zhan, L. (2000). Cognitive adaptation and selfconsistency in hearing-impaired older persons:


testing Roy's adaptation model. Nursing Science
Quarterly. 13(2), 158-165.

Summary

5 elements - person, goal of nursing, nursing


activities, health and environment

Persons are viewed as living adaptive systems whose


behaviours may be classified as adaptive responses
or ineffective responses.

These behaviors are derived from regulator and


cognator mechanisms.

These mechanisms work with in 4 adaptive modes.

The goal of nursing is to promote adaptive responses


in relation to 4 adaptive modes, using information
about persons adaptation level, and various stimuli.

Nursing activities involve manipulation of these


stimuli to promote adaptive responses.

Health is a process of becoming integrated and able


to meet goals of survival, growth, reproduction, and
mastery.

The environment consists of persons internal and


external stimuli.