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The Roy Adaptation Model for Nursing had it's beginning with Sister Callista Roy entered the masters program in pediatric nursing at the University of California in Los Angeles in 1964. Dorothy E. Johnson, Roy's advisor and seminar faculty, was speaking at the time on the need to define the goal of nursing as a way of focusing the development of knowledge for practice. During Roy's first seminar in pediatric nursing, she proposed that the goal of nursing was promoting patient adaptation. Johnson encouraged her to develop her concept of adaptation as a framework for nursing, throughout the course of her master's program. Von Vertalanffy's use of systems theory was a key component in the early concept of the model, as was the work of Helson.
Helson defined adaptation as the process of responding positively to environmental changes, and then went on to describe three types of stimuli, those being focal, contextual, and residual. Roy made derivations of these concepts for use in describing situations of people in both health and illness. Roy's view of the person as an adaptive system took shape from this early work, with the cognator and regulator being added as the major internal processes of the adapting person. After 17 years of work with the faculty at Mount St. Mary's college in Los Angeles, the model became the framework for a nursing-based integrated curriculum, in March 1970, the same month that the first article on the model was published in Nursing Outlook. The four adaptive models were added as the ways in which adaptation is manifested and thus as the basis for nursing assessment.
Through curriculum consultation and throughout the USA and eventually worldwide, Roy received input on the use of the model in education and practice. It is estimated that by 1987 at least 100, 000 nurses had been educated in programs built around the Roy Adaptation Model. As the discipline of nursing grew in articulating it's scientific and philosophical assumptions, Roy also articulated her assumptions. Roy's first descriptions included systems theory and adaptation-level theory, as well as humanist values. As time progressed, Roy developed the philosophical assumptions of veri tivity as a way of addressing the limitations she saw in the relativistic philosophical basis of other conceptual approaches to nursing and a limited view of secular humanism and published a major paper on her philosophical assumptions in 1988. It was during the late 90 's that Roy felt she should re-define adaptation for the 21 st century.
She related spirituality and science to present a new definition of adaptation and related scientific and philosophical assumptions. Roy's stance on the philosophy emphasizes that nurses see persons as co-extensive with their physical and social environments. Roy has used the term cosmic unity to describe that persons and the earth have common patterns and mutuality of relations and meaning and that persons through thinking and feeling capacities, rooted in consciousness and meaning, are accountable for deriving, sustaining, and transforming the universe. These ideas were explained in a 1997 publication and included in the 1999 revision of the theorist's textbook on the model. Other major developments of the model in the 1999 textbook include: expanding the adaptive modes to include relational persons as well as individual persons and describing adaptation on three levels of integrated life processes, compensatory processes, and compromised processes.
Roy has also outlined a structure for nursing knowledge development based on the Roy Adaptation Model and provided examples of research within this structure. Roy remains committed to developing knowledge for nursing practice and continually updating the Roy Model as a basis for this knowledge development. Person Roy defines the person as an adaptive open system. The systems' input is: A) Three classes of stimuli: focal, contextual, and residual, within and without the system and B) the systems' adaptation level or range of stimuli in which responses will be adaptive. Inputs are mediated by the systems' Regulator and Cognator subsystems. The system runs into difficulty when coping activity is inadequate as a result of need deficits or excesses.
System effectors are the four modes that the Cognator and Regulator can demonstrate activity through. Output of the person as the system may be adaptive or ineffective. Adaptive responses contribute to the goals of the system ie: survival, growth promotion, reproduction and self-mastery. Ineffective responses do not contribute to the systems' goals. Health Roy's original model says that health is on a health-illness continuum from wellness to death. The degree of health or illness that the system experiences is an inevitable dimension of a person's life.
Currently, Roy defines Health as a process of becoming an integrated and whole person and a process of being. Health is the goal of the person's behavior and the person's ability to be an adaptive organism. Adaptation is a process of responding positively to environmental changes. The person encounters adaptation problems in a changing environment especially in situations of health and illness. Adaptive responses to pooled effects of focal, contextual, and residual stimuli are either positive ie: promote integrity of the system, goals of survival, growth, reproduction and self mastery, or are ineffective. Environment The environment of a person constantly interacts with the individual and determines, in part, adaptation level.
Stimuli originate in the environment. The environment refers to all the internal / external conditions, circumstances and influences affecting the person, and his development and behavior. The internal and external environment provide input or stimuli. The environment is always changing and interacting with the person.
The stimuli are divided into focal; contextual, and residual categories. Focal stimuli immediately confronts the adaptive system. Contextual stimuli or "background stimuli" is genetic makeup, sex, maturity, drugs, alcohol, etc. Residual stimuli are beliefs, attitudes, experiences, traits which may be relevant but effects are indeterminate and therefore cannot be validated. Nursing According to Roy, the Nurse using the Nursing Process, promotes adaptation responses during health and illness to free energy from ineffective or inadequate responses to increase health and wellness.
Goals, mutually agreed on and prioritized, are proposed to meet the global goals of: survival / growth and promotion / reproduction of race / society /attaining full potential or mastery of self. The nurse uses activities to increase adaptive and decrease ineffective responses during illness and health. These activities alter or manipulate the client's focal, contextual and residual stimuli and expand his repertoire of effective coping mechanisms. Nursing focuses on the person as a bio psychosocial being at some point along the health-illness continuum. In contrast, medicine focuses on biological systems and the patient's disease. It's goal is to move the patient along the continuum from illness to health.
Nursing's goal is to increase adaptation in four modes of physiological, self concept, role function, and interdependence. The nurse acts as an external regulatory force to modify stimuli affecting adaptation of the system. My philosophy vs. Roy's philosophy While my own philosophy has not had near as much scrutiny as Roy's, I can find some generic similarities. My own personal nursing theory, having developed itself over the semester somewhat, revolves around the client's ability to respond to illness and health.
I focus on the person, not as an illness needing remedy, but as a complex grouping of physical and psychological emotions. To attain our highest goal for the patient, we must help them overcome their current trouble, and instead of leaving it at that, we must help them find ways to overcome the same difficulties in the future. They must not only regain their previous wellness, but must be stronger for having gone through the experience. It is this basic idea that I have established, where I can find myself associating the Roy's model of adaptation. And just as Roy is continually updating her model, we must continually update our own nursing philosophies, in order to maintain the maximum aid we can give the patient. It is in this that I believe all nurses agree with Roy: we must not remain static, but instead must continually learn and "adapt" to our own changing healthcare settings.
In applying Roy's model to a client with insomnia, the assessment begins with assessing behaviors in each of the four modes. Ineffective behaviors are noted. In this client's, the ineffective behaviors within the physiological mode include frequent night-time awakening and anxiety symptoms. Ineffective behavior within the self-concept mode includes their dependence on anxiolytics. Noted as ineffective behaviors in the role function mode would be their inability to carry out their roles, as an employee, family member, or other roles to their satisfaction. In the interdependence mode, ineffective behavior is identified as the client's belief that their marriage is good, perhaps being derived from a statement such as "my wife and I have a good relationship." Any feelings that this client has no one to talk to, would also be classified as ineffective behaviors.
The next step in Roy's model involves classification of stimuli. Focal stimuli, or that which the client expends their energy dealing with, are insomnia and a sense of a lack of control. Contextual stimuli, or all other stimuli present, includes current medications and their feelings about being on medication. Also included as contextual stimuli, is the client's predisposition to depression which they are currently experiencing, their lack of social supports, their expectations of their roles as a family member, sibling, and employee.
Residual stimuli, or that stimuli whose effect is not clear, would be the hunch that the client and their spouse likely have some marital difficulties. The next step is the nursing diagnosis, which is made once stimuli is confirmed with the client. The nursing diagnosis is a statement of the client's problems and includes the probable cause. The client's diagnosis could be stated as 'altered sleep pattern potentially related to taking Prozac at HS' and 'anxiety related to multiple stressors'. After the nursing diagnosis is made, goals are set. Goals for the client could include 'The client will have 6 hours of undisturbed sleep per night within 1 week of HS Prozac cessation'.
Another goal could be 'The client will report less anxiety within 2 weeks as evidenced by a reduction in her use of PRN Xanax'. Interventions would be carried out as applicable to the client and would be specific to the nursing goals. They are directed at promotion of adaptation. The final stage of the nursing process is evaluation. Evaluation includes the observation of change in the client's behavior. One would determine if her goals are met or not met.
One would ask the client about changes in her sleep pattern. One would evaluate any changes in behavior related to anxiety. If the behavior is not adaptive, then more assessment is needed and the interventions would be adjusted. In this manner, Roy's model would be applied to most any clinical situation. An understanding of Roy's Adaptation Model By References Roy, C. (1998) The Roy Adaptation Model 2 nd Edition. New York: Prentice Hall Andrews, Heather A. (1986) The essentials of the Roy Adaptation Model.
Connecticut: Appleton-Century-Croft. Roy, C. Akinsanya J. Crouch C. Fletcher L. Cox G.
Price B. (1982) The Roy Adaptation Model in Action (Nursing Models in Action S. ) New York: Palgrave Macmillan
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