The Roy adaptation model was first propounded by Sr. Callista Roy of the Sisters of St.Joseph. It is a deductive theory like most of the other theories of nursing. The focus is on the inter-relatedness of four adaptive systems: physiological and psychosocial adaptations are possible. (McEwen and Wills, 2007) Johnson’s nursing theory was the trigger for the evolution of Roy’s adaptation theory. Some aspects of “Helson’s adaptation theory, von Bertalanffy’s system, Rapport’s system definition, the stress and adaptation theories of Dohrenrend and Selye, and the coping model of Lazarus” are incorporated (McEwen and Wills, 2007).
Nursing education, practice, and interventions all use this adaptation model frequently. The main purpose of nursing is to promote the adaptation of people to various situations of health and illness (Marriner-Tomey and Alligood, 2006) Nursing science is also differentiated from medical science and Sr Callista Roy stresses that separate goals must be defined for nursing and medical professionals. She believes that the curriculum for nursing students should be developed differently.
The objectives of the nurse are to help the patient use his energy to get well. There is a suggestion also from her that this model helps objectives to be clearly stated, apt content to be identified, and patterns for teaching modulated. (Marriner-Tomey and Alligood, 2006). This paper will be highlighting the Roy adaptation model of nursing, its significance to nursing, the researches which have used the model, and the procedure that I would follow for doing my research using the model.
The profession of nursing has much to thank the Roy adaptation model for. The graduate programs, the masters, and the doctoral programs have this model as part of their curriculum. (Marriner-Tomey and Alligood, 2006). Several quantitative and qualitative studies have used the Roy adaptation model. Middle-range nursing theories have been developed from this. Adaptation tools have been developed from the model. Roy believes that the focus of nursing is the individual who happens to be a holistic adaptive system. Regular and frequent interaction with the environment causes it to influence the human adaptive system which affects the development and behavior of the individual. (Marriner-Tomey and Alligood, 2006).
Environment affects and is affected by an individual. The many numbers of stimuli present in the atmosphere influence the individual in that his existence is either threatened or promoted. The adaptive system makes it a point to respond positively to the stimuli. Effective or ineffective responses can occur. If the person adapts to environmental stimuli, he survives, grows, reproduces, becomes efficient, and changes positively and his response has been effective. Roy’s definition of health is that it is a transition into an “integrated and whole human being”.
The Roy adaptation model is an outcome theory. The psychosocial aspects show overlap in the self-concept, role function, and interdependence. Recent changes that occurred are “Roy’s redefinition of health and de-emphasizing the concept of a health-illness continuum” (Marriner-Tomey and Alligood, 2006). Health is now believed to be an “integration and wholeness of a person”. Roy’s explicit assumptions consider the human being as a biopsychosocial being who is constantly interacting with his environment which is changing. He utilizes the mechanisms which are inborn and from experience to cope with the changes.
Health and illness are regarded as the inevitable dimensions of his life. Adaptation is the mechanism that the human being uses as a positive response; the stimulus that he meets with and his adaptation status decide his function. Modes of adaptation fall into four groups: physiological needs, self-concept, role function, and interdependence. The implicit assumptions claim that a person can be reduced to parts so that study and care are facilitated. Causality influences nursing. Each patient’s opinions and basic values are to be respected. The adaptation allows a person to freely respond to stimuli.
Roy’s concept of the model believes that the goal of nursing is adaptation and the adaptive system is the person himself. The environment would produce the stimuli and health would be the outcome after adaptation. The nurse promotes adaptation and health. The adaptation involves the person conscientiously through self-reflection and choice striving to create an integration of self and environment.
The concept of the person could be an individual or group as in families, organizations, communities, and society. The environment includes the conditions, circumstances, and influences which could affect the development and behavior of a person or groups which are dependent on the stimuli immediately close to the person or in a contextual manner or as residual. The role of the nurse is to promote adaptation in any of the four modes, contribute to health, quality of life, and dignified dying taking into consideration the factors that influence the adaptive abilities and planning interventions to increase environmental influences.
The scientific assumptions say that matter and energy lead to self-organization. The awareness of the environment is innate in human beings. Creative processes are dependent on the decisions by humans (McEwen and Wills, 2007). Human actions are mediated by thoughts and feelings. Interdependence, acceptance by close fellow beings, and protection make system relationships between human beings and the earth and this is adaptation. The philosophical assumptions understand that relationships exist between the world and God. God is revealed in the concept of Creator with a diversity of creation. Transformation of the universe occurs because of humans (McEwen and Wills, 2007). The following definitions have been selected from the “Nursing Theorists and their work” by Marriner-Tomey and Alligood (2006).
Roy defines nursing as “ a healthcare profession that focuses on human life processes and patterns and emphasizes the promotion of health for individuals, families, groups, and society as a whole” (Roy and Andrews, 1999 cited in Marriner-Tomey and Alligood, 2006).
A system is “a set of parts connected to function as a whole for some purpose and that does so by the interdependence of its parts” (Roy and Andrews, 1999 cited in Marriner-Tomey and Alligood, 2006). Systems also have inputs, outputs, and control and feedback processes (Andrews and Roy, 1991 cited in Marriner-Tomey and Alligood, 2006).
Adaptation level represents the condition of the life processes described on three levels as integrated, compensatory and compromised” (Roy and Andrews, 1999 cited in Marriner-Tomey and Alligood, 2006). It is a “constantly changing point made up of focal, contextual and residual stimuli, which represent the person’s standard of the range of stimuli to which one can respond with ordinary adaptive responses (Roy, 1984 cited in Marriner-Tomey and Alligood, 2006).
The focal stimulus is ‘the internal or external stimulus most immediately confronting the human system. (Roy and Andrews, 1999 cited in Marriner-Tomey and Alligood, 2006)
Contextual stimuli “are all other stimuli present in the situation that contribute to the effect of the focal stimulus. (Roy and Andrews, 1999 cited in Marriner-Tomey and Alligood, 2006)
Residual stimuli “are environmental factors within or without the human system with effects in the current situation that are unclear” (Roy and Andrews, 1999 cited in Marriner-Tomey and Alligood, 2006)
Innate coping mechanisms are “genetically determined or common to the species and are generally viewed as automatic processes; humans do not have to think about them” (Roy and Andrews, 1999 cited in Marriner-Tomey and Alligood, 2006).
Acquired coping mechanisms “are developed through strategies such as learning. The experiences encountered through life contribute to customary responses to particular stimuli” (Roy, 1984 cited in Marriner-Tomey and Alligood, 2006).
Nursing care systems have both visible and invisible “issues, trends, and visions. (Callista, 2000). Roy tells how the Nursing Administration Quarterly was instituted 25 years ago as a response to the necessity to identify the changing trends in nursing practice. Her article examines the visible and invisible forces which determine the future of nursing.
The Roy adaptation model was used by Villareal (2003 cited in Marriner-Tomey, 2006) in the care of a few young women who intended to stop smoking. The researcher applied the six-step nursing process to the research whereby the nursing care for the young women of mid-twenties ages of a support group. A two-level assessment had been done. The stimuli for all 4 adaptive models were the first step.
In the second step, a decision was made about all the kinds of stimuli: the focal stimulus which was the nicotine addiction; the contextual stimulus which was the belief about the enjoyment of smoking, the good feeling that it provides, the relaxation they get, the comfort that they enjoy in their leisure hours as a routine and the residual stimulus which was the beliefs and attitudes about their body image and that they developed a gain in weight when smoking was ceased. The diagnosis that was made by the researcher was that the women were not motivated enough to cease smoking.
They decided on short-term goals instead of the long-term goal of cessation. The interventions incorporated the discussion on the effects of smoking and its cessation. The reasons and beliefs on smoking were shared with the women. They were also educated on stress management, nutrition, physical activity, and self-esteem. The researcher’s efforts moved the women from pre-contemplation to a stage of contemplation which was the short-term goal achieved.
Women with early-stage breast cancer received social support in two ways (the phone and group social support) along with education on adaptation to their new illness. (Samare, Tulman, and Fawcett, 2002 cited in Marriner-Tomey and Alligood, 2006). The women in the experimental group received all three interventions. The first control group received telephone support and education. The second control group received only education. The emotional disturbances of mood and loneliness were found much reduced in the experimental group and first control group. The groups showed no differences where cancer-related distress or well-being was concerned. All parts of the research were guided by the adaptation model: the conceptualization, literature review, theory and hypotheses, and development of the interventions.
These researchers had earlier designed a resource kit for women. The Resource Manual for Women with Breast Cancer had eight chapters theoretically developed based on the four adaptive modes. Reinforcing of the information was also enabled. pamphlets, audiotapes, and videotapes supplemented the manual.
Dobratz (2003) studied the outcomes of learning in a nursing research course using this model of adaptation. Seven statements were selected for the evaluation tool. The students were to disagree or agree or strongly agree with them. Four open-ended questions were also asked. A Likert-type scale was used for the evaluation.
Araich (2001) used the adaptation model in a cardiac care unit. He conducted a two-level assessment to find out the possible interventions which promoted adaptation in the unit. Other studies which used the model include Keen’s study for the care of persons with chronic renal failure (1998 cited in Marriner-Tomey and Alligood, 2006). Women in menopause were studied by Cunningham (2002). Hennessy –Harstad (1999) studied adolescents with asthma.
The continued success of the nursing practice is contributed by the Roy adaptation model.
It happens to be the best and commonly used conceptual framework globally in nursing practice.
The features of the discipline are well defined. Practice, education, and research use the model with success (Marriner-Tomey and Alligood, 2006). The nursing process is well developed with specific goals, the assessment of values, assessment of the patient, and decides the appropriate interventions. The two-level assessment helps to identify the nursing goals and diagnosis (Brown and Baker, 1976 cited in Marriner-Tomey and Alligood, 2006).
In the research which I intend to do, I would be following the steps indicated in the theory of Roy’s adaptation model which has been followed by earlier researchers and proved successful. A person’s adaptation in four modes of situational health and illness will be investigated. The interventions would be the removal or enhancing or reducing or changing the stimuli. Practice-related hypotheses will be fairly easier to delineate with this model. A two-level assessment of the patient and the environmental stimuli will be first done. Six steps are involved in the process. The behaviors gathered from the four adaptive modes are assessed first.
Then the stimuli for those behaviors are assessed. They are classified into focal, contextual, and residual. A statement or a diagnosis is then made as to the patient’s situational health or illness. Then the adaptation process is attended to and goals are set for this. Interventions aimed at managing the stimuli are implemented to promote adaptation. The last step is evaluative and decides whether the goals have been met.
This easy process speaks for the frequency with which this model has been selected by nursing researchers for their work. Since health and illness are being worked with, the necessity for change is evident in nursing research. The struggle for change is by working with the stimuli and not the patient. The health of the patient is promoted by facilitating the interaction of the patient with his environment (Andrews and Roy, 1986 cited in Marriner-Tomey and Alligood, 2006).
The model is suitable for the nurses’ practice. The two-level assessment is particularly useful for the identification of the adaptation problems before making a diagnosis. The nursing interventions need categorization as a variety of them is being used for the change. Some patients need the removal of stimuli or some stimuli need to be removed. Other stimuli may have to be enhanced for the achievement of goals. Selection of the best intervention for the modification of a particular stimulus may be a difficult proposition. However, guidance is possible through the nursing judgment model of McDonald and Harms (1966 cited in Marriner-Tomey and Alligood, 2006).
Roy, herself has given this advice. The judgment model provides a variety of interventions that could be appropriate for the practice. The intervention may be selected according to the consequences it produces and also whether this change is desired. Guiding nursing practice in educational settings is another of the major functions of the Roy adaptation model. The hospital is an apt environment to use this model: the neonatal intensive care unit, rehabilitation unit, medical wards, an orthopedic hospital, or a neurosurgical unit could utilize the adaptation model with sure success (Roy and Andrews, 1999 cited in Marriner-Tomey and Alligood, 2006). Even expert nurse practitioners could use the model to help in their leadership roles.
Conclusion. The Roy adaptive model of nursing is a very practical concept to be followed in nursing education, practice, and research. The main essence of the model is that a patient is assisted to adapt to his environment by the nurse. She studies the environmental stimuli which have led to his situational health or illness. These are then adjusted or adapted by a change of increasing or decreasing or removing them altogether. The advantages of this model are an asset to nursing as a whole.
Araich, M. (2001). Roy’s adaptation model: Demonstration of Theory Integration into the process of care in coronary care. ICU Nurse Web Journal.
Marriner-Tomey, A. & Alligood, M.R. (2006). Nursing Theorists and their work. Elesevier Health Sciences.
McEwen, M. &Wills, E.M. (2007). The theoretical basis for Nursing, 2nd Edition, Lippincott, Williams, and Wilkins.
Roy, C. (2000). The visible and invisible fields that shape the future of the nursing care system Nursing Administration Quarterly, Fall, Vol. 25, No.1, p. 119-131.