adaptation model

Sister Callista Roy

ADAPTATION MODEL

•All about Sr. Callista Roy•Critical thinking in the Roy’s Adaptation Model

Sister Callista Roy

Sr. Callista Roy

(1979, 1984, 1989, 1991)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 persons life.

To respond positively to environmental changes, the person must adapt.

The person’s adaptation is a function of the stimulus he is exposed to and his adaptation level.

The person’s adaptation level is such that is comprises a zone indicating the range of stimulation that will lead to positive response.

The person has 4 modes of adaptation:Physiologic needsSelf conceptRole functionInterdependence

“Nursing accepts the humanistic approach of valuing other person’s opinions, and viewpoint”

interpersonal relations are an integral part of nursing.

There are dynamic objective for existence with ultimate goal of achieving dignity and integrity.

The central questions of Roy’s theory are:Who is the focus of nursing care?What is the target of nursing care?When is nursing care indicated?

HISTORY AND BACKGROUND

Sr. Callista Roy Prominent nurse theoristWriterLecturerResearcherteacher

Born: in Los AngelesOn October 14, 1939

2nd child and Daughter of Mr. and Mrs. Fabien RoyAchievements:

1963 Bachelor of Arts with Major in Nursing< Mount St. Mary’s College, los Angeles>1966 Master’s Degree in Pediatric Nursing< University of California, Los Angeles>1973 Master’s Degree in Sociology1977 PhD in Sociology

Also worked with Dorothy E. JohnsonNature of Nursing:

Service to society

Teachings:Professor and Nurse Theorist

<Boston College of Nursing, Chesnut Hill>1966 Faculty (Pediatric and Maternity Nursing)

<Mt. St. Mary’s College>Goal of Nursing:

Promote adaptationDirect nursing educationPracticeResearch

1970 the model was implemented in Mt. St. Mary’s College.

1971 was made chair of the Nursing Department at the College.

OVERVIEW OF ROY’S ADAPTATION MODEL (RAM)

The RAM provides a useful framework for providing nursing care for the persons in health and in acute, chronic, and terminal illness.


The RAM views the person as an adaptive system in constant interaction with an internal and external environment.


A system is a set of parts connected to function as a whole for some purpose.

The environment is the source of a variety of stimuli that either threaten or promote the person’s unique wholeness.


The person’s major task is to maintain integrity in face of these environmental stimuli.

Integrity is “ the degree of wholeness achieved by adapting to changes in needs” (Roy and Andrews, 1999, p. 102)


categories of Environment stimuli:

Focal stimulus, the internal or external stimulus most immediately challenging the person’s adaptation. The focal stimulus is the phenomenon that attracts the most one’s attention.



Contextual stimuli, are all other stimuli existing in a situation that strengthen the effect of the focal stimulus.



Residual Stimuli, are any other phenomena arising from person’s internal and external environment that may affect the focal stimulus but whose effects are unclear (Roy and Andrews, 1999)


These three types of stimuli act together and influence that adaptation level, which is a person’s “Ability to respond positively in a situation.”


A person does not respond passively to environmental stimuli; the adaptation level is modulated by a person’s coping mechanisms and control processes.


Roy categorizes the coping mechanisms into regulator or the cognator subsystems.

the coping mechanisms of the regulator subsystem occur through neural, chemical, and endocrine processes. These are automatic responses to stimuli.


Roy categorizes the coping mechanisms into regulator or the cognator subsystems.

The coping mechanisms of the cognator subsystem occur through cognitive-emotive processes – perceptual and information processing, learning, judgment, and emotion


The two control processes that coincide with the regulator and cognator subsystem when a person responds to a stimulus are the stabilizer subsystem and the innovator subsystem.


The stabilizer subsystem refers to “the established structures, values, and daily activities whereby participants accomplish the primary purpose of the group and contribute to common purpose of society. (Roy and Andrews, 1999, p.47)


The innovator subsystem refers to cognitive and emotional strategies that allow a person to change to higher levels of potential. (Roy an dAndrews, 1999)


Roy proposed that the behavioral responses of the regulator and cognator subsystems can be observed in any of the four adaptive modes:

PhysiologicalSelf-conceptRole functioninterdependence.


The self- concept adaptive mode refers to psychological and spiritual characteristics of the person.”(Andrews and Roy, 1991a p.15). A person’s self- concept consists of all beliefs and feelings that one has formed about one self.

The self- concept is formed both from internal perceptions and from the perceptions of others. The self- concept changes overtime and guides one’s actions.

The self-concept incorporates two components:

Physical selfPersonal self


The physical self incorporates :Body sensation Body image

The personal self incorporates :Self consistencySelf-idealMoral-ethical-spiritual self

Psychic integrity is the goal of the self concept mode.

Concepts- Adaptation

Responding positively to environmental changesThe process and outcome

of individuals and groups who use conscious awareness, self-reflection and choice to create human and environmental integration.

Health and Adaptation

Health:

A state and process of being and becoming integrated and whole that reflects person and environmental mutuality.


Adaptation:the process and

outcomes whereby thinking and feeling persons, as individuals and in groups, use conscious awareness and choice to create human and environment integration.


Adaptive Responses:Responses that

promote integrity in terms of the goals of the human systems, that is: survival, growth, reproduction, mastery and personal and environmental integration.


Ineffective Responses:responses that do

not contribute to integrity in terms of the goals of the human system.


Adaptation levels represent the condition of the life processes described on three different levels:

IntegratedCompensatoryCompromised

Assumptions of Roy’s Adaptation Model

Scientific:Systems of matter and

energy progress to higher level of complex self-organization.Thinking and feeling mediate

human reaction.Integration of human and

environment meanings result in adaptation

Assumptions of Roy’s Adaptation Model

Philosophical:Persons have mutual

relationships with the World and God.Persons use human creative

abilities of awareness, enlightenment, and faithPersons are accountable for

the processes of deriving, sustaining, and transforming the universe.

Critical Thinking in the Roy’s Adaptation Model (RAM)

RAM utilizes the nursing processes to promote critical thinking.Roy has conceptualized the nursing

process to comprise the following six simultaneous , ongoing, and dynamic steps

Assessment of behaviorAssessment of stimuliNursing diagnosisGoal settingInterventionevaluation


Assessment of behavior

Involves gathering data about the behavior of the person as an adaptive system in each adaptive mode.Behavior is an action or reaction to a

stimulus.A behavior may be observable or non-

observable.

Phases of Process

Physiological Adaptive

Mode

Interdependence Adaptive

Mode

Self- concept Adaptive

Mode

Role Function Adaptive

Mode

ASSESSMENT OF

BEHAVIOROxygenatio

nNutrition

EliminationActivity and

RestProtection

SensesFluids and electrolytes

Neurological function

Endocrine function

Significant other

•Giving•Receiving

Support system

•Giving•Receiving

Physical self•Body sensation•Body image

Personal self•self consistency•Self ideal•Moral- ethical- spiritual self

Instrumental•Primary•Secondary

Role•Tertiary role

Expressive•Primary•Secondary•tertiary

Critical Thinking in the Roy’s Adaptation Model (RAM)Assessment of stimuli

Assessment of stimuli involves the

identification of internal and external

stimuli that are influencing the person’s

adaptive behavior.

Stimuli that arises from the environment

are classified as:

Focal- those most immediately

confronting the person.


Contextual- all other stimuli present that

are affecting the situation.

Residual- those stimuli whose effect on

the situation are unclear.

During this level of assessment, the

nurse analyzes subjective and objective

behaviors and delves more deeply fro

possible causes of a particular set of

behaviors.

Phases of Process


Mode


Mode


Mode


Mode

ASSESSMENT OF STIMULI

Focal stimulus

Contextual stimuli

residual stimuli

• Focal stimulus

• Contextual stimuli

• residual stimuli

• Focal stimulus



• Focal stimulus




Nursing Diagnosis:

Involves the formulation of statements

that interpret data about the adaptation

status of the person, including the

behavior and most relevant stimuli.

The diagnostic statement indicates an

actual or a potential problem related to

adaptation.

Phases of Process


Mode


Mode


Mode


Mode

NURSING DIAGNOSIS Statement

of behaviors with most relevant stimuli

Statement of

behaviors with most relevant stimuli

Statement of


Statement of



Goal Setting:

Involves the establishment of clear

statements of the behavioral outcomes for

nursing care.

The process focuses on promoting

adaptive behaviors.

Should include the behavior to be

changed, the change expected,

timeframe.

Phases of Process


Mode


Mode


Mode


Mode

GOAL SETTING Behavior

change expected

Time frame

Behavior change

expected

Time frame

Behavior change

expected

Time frame

Behavior change

expected

Time frame


Intervention:

Involves the determination of how best to

assist the person in attaining established

goals.

Arise from a solid knowledge base and

are aimed at the focal stimulus whenever

possible.

Phases of Process


Mode

Interdependence Adaptive Mode

Self- concept Adaptive Mode

Role Function Adaptive Mode

INTERVENTION Management of stimuli

•Alter•Increase•Decrease•Remove•Maintain

Management of stimuli







Evaluation:

Involves judging the effectiveness of the

nursing intervention in relation to the

behavior after the nursing intervention in

comparison with the goal established.

“has the person moved toward

adaptation”

Phases of Process


Mode


Mode


Mode


Mode

EVALUATIONObservations of behaviors

after interventions

have been completed

to see if goals have

been obtained

Observations of behaviors

after interventions

have been completed


been obtained


after interventions

have been completed


been obtained


after interventions

have been completed


been obtained

CONCEPTS PersonBio-psycho-social being in constant interaction with a changing environment.

Uses innate and acquired mechanisms to adapt.

Functions as a unity of 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.

CONCEPTS

CONCEPTSHealthInevitable dimension of person’s life.

Represented by a health-illness continuum.

A state and a process of being and becoming integrated and whole.

CONCEPTSNursingTo promote adaptation in the four adaptive modes, thus contributing to health, quality of life and dying with dignity.

Thank you

adaptation model

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