Sister Callista Roy’s Adaptation Theory

Abstract

This is a paper on Sister Callista Roy’s Adaptation Model (RAM). I will discuss the basis of the theory which is to view the person as an adaptive system. The ability of a person to adapt to internal and external stimuli and the effects of the following three classes of stimuli: focal, contextual and residual. This overview will discuss how the theory defines and describes a person, environment, health, nursing and the goal of nursing. A patient scenario will be provided and the model applied that shows the essence of Sister Callista Roy’s Adaptation Module.

Sister Callista Roy’s Adaptation Theory

Sister Callista Roy, a member of the Sisters of Saint Joseph of Carondelet, was born on October 13, 1939, in Los Angeles, California. She received a bachelor’s degree in nursing in 1963 from Mount Saint Mary’s College in Los Angeles and a master’s degree in nursing from the University of California, Los Angeles, in 1966. After earning her nursing degree, Roy began her education in sociology, receiving both a master’s degree in sociology in 1973 and a doctorate in sociology in 1977 from the University of California (Alligood, 2010). While working toward her master’s degree, Roy had noticed the great resiliency of children and their ability to adapt in response to major physical and psychological changes.

Roy was impressed by adaptation as an appropriate conceptual framework for nursing. Roy developed the basic concepts of the model while she was a graduate student at the University of California, Los Angeles, from 1964 to 1966. Roy began operationalizing her model in 1968 when Mount Saint Mary’s College adopted the adaptation framework as the philosophical foundation of the nursing curriculum.

The Roy Adaptation Model was first presented in the literature in an article published in Nursing Outlook in 1970 entitled “Adaptation: A Conceptual Framework for Nursing” (Alligood, 2010). Roy was an associate professor and chairperson of the Department of Nursing at Mount Saint Mary’s College until 1982. She was promoted to the rank of professor in 1983 at both Mount Saint Mary’s College and the University of Portland. She helped initiate and taught in a summer master’s program at the University of Portland.

From 1983 to 1985, she was a Robert Wood Johnson postdoctoral fellow at the University of California, San Francisco, as a clinical nurse scholar in neuroscience. During this time, she conducted research on nursing interventions for cognitive recovery in head injuries and on the influence of nursing models on clinical decision making. In 1987, Roy began the newly created position of nurse theorist at Boston College School of Nursing. Roy has published many books, chapters, and periodical articles and has presented numerous lectures and workshops focusing on her nursing adaptation theory (Alligood, 2010).

Overview of Adaptation Model

The Roy Adaptation Model applies the two concepts of systems and adaptation to nursing practice. In the context of Roy’s work, the term system refers to a grouping of units that are related and connected, thus forming a unified whole. (A system may be an individual, family, group, community, or society.) Adaptation refers to effective coping mechanisms that promote integrity for a person, or group of persons, in terms of survival, growth, reproduction and mastery. In general, Roy asserts that a person is a biophysical being (or system) in constant interaction with a changing environment and that a person has four different modes of adaptation.

A internal and external environmental changes occur, needs change that may result in the necessity for active copying to restore integrity. Each client system (either person or group) has a zone that surrounds a variable level of adaptation. Stimuli that fall within the zone of adaptation result in positive adaptations that support integrity. Stimuli that fall outside the zone will result in negative responses that do not support adaptation or integrity (Alligood, 2010) The four modes of adaptation that support integrity are as follows: Physiologic-physical adaptation for an individual occurs when the five needs of oxygen, nutrition, elimination, activity/rest, and protection are met, in addition to adequate neurologic and endocrine function and balanced fluids, electrolytes, and acid-base chemistry.

Adaptation for a group includes adequate number of participants to achieve goals, shared productive capacities, adequate physical facilities, and fiscal resources. (Sitzman, 2010). Self-Concept group identity adaptation for an individual occurs when psychic and spiritual integrity promotes a sense of purpose, unity, and meaning in the universe. Adaptation for a group includes group identity maintained through honestly shared relations, goals, and values, coupled with a shared sense of achievement (Sitzman, 2010). Role function adaptation for an individual includes knowing who one is in relation to others and involves the use of various adaptive modes suited to the unique multiple roles expected of each individual. (Sitzman, 2010).

Interdependence adaptation for an individual includes the giving and receiving of love, participating in satisfying relationships, and engaging in meaningful communication. Adaptation for a group includes involvement in continually maturing collective relationships and achieving adequate food, shelter, health, and security through interdependence with other group members (Sitzman, 2010). There are four major concepts that constitute the Roy Adaptation Model. Humans are wholistic, adaptive systems as both individuals and groups. “As living systems, persons are in constant interaction with their environments.

Between the system and the environment occurs an exchange of information, matter and energy. Characteristics of a system include inputs, outputs, controls, and feedback” (Sitzman, 2010). The environment is made up of internal and external stimuli from around the individual or group system. Environment includes “all conditions, circumstances, and influences that surround and affect the development and behavior of humans as adaptive systems, with particular consideration of person and earth resources” (Sitzman, 2010). Health is defined as “a state and process of being and becoming an integrated whole as a human being….[integrity is defined as] soundness or unimpaired condition leading to wholeness” (Sitzman, 2010).

The goal of nursing is the promotion of the four modes of adaptation, thereby supporting the overall integrity of the human adaptive system. Nurses also seek to reduce ineffective responses through anticipating and addressing potential concerns and also effectively attending to current concerns (Sitzman, 2010). The Adaptation Model contains a six step nursing process (Fawcett, 2005). The first step is to assess behaviors that may come from the four modes (Fawcett, 2005). The second step is to assess and categorize the stimuli of those behaviors (Fawcett, 2005). The third step is to make a nursing diagnosis based on the person’s adaptive state (Fawcett, 2005).

The fourth step is to set goals and promote adaptation (Fawcett, 2005). Step five is to implement the interventions that are aimed at managing stimuli and promote adaptation (Fawcett, 2005). The sixth step is to evaluate the obtainment of the goals (Fawcett, 2005). There are two subsystems within the Roy Adaptation Model (RAM), the regulator and the cognator, both of which require assessment in RAM. Cognator subsystem, a major coping process involving four cognitive-emotive channels: perceptual and information processing, learning, judgment and emotion.

The regulator subsystem is a basic type of adaptive process that responds automatically through neural, chemical and endocrine coping channels (Sitzman, 2010). Within RAM, a person is defined and described as human are holistic, adaptive systems. “As an adaptive system, the human system is described as a whole with parts that function as unity for some purpose. Human systems include people as individuals or in groups including families, organizations, communities, and society as a whole” (Roy, 1999).

Despite their great diversity, all persons are united in a common destiny (Roy, 1999). The environment is described and defined as “all the conditions, circumstances, and influences surrounding and affecting the development and behavior of persons or groups, with particular consideration of the mutuality of person and earth resources that includes focal, contextual, and residual stimuli” (Sitzman, 2010). “It is the changing environment [that] stimulates the person to make adaptive responses” (Sitzman, 2010). “Health is a state and a process of being and coming integrated and a whole person. It is a reflection of adaptation, that is, the interaction of the person and the environment” (Sitzman, 2010).

Roy derived this definition from the thought that adaptation is a process of promoting physiological, psychological, and social integrity and that integrity implies an unimpaired condition leading to completeness or unity. In her earlier work, Roy viewed health along a continuum flowing from death and extreme poor health to high-level and peak wellness. During the late 1990s, Roy’s writing focused more on health as a process in which health and illness can coexist. Drawing on the writings of Illich (1974, 1976), Roy wrote “health is not freedom from the inevitability of death, disease, unhappiness, and stress, but the ability to cope with them in a competent way” (Sitzman, 2010). Health, wellness and illness are differentiated, but are one inevitable, coexistent dimension of the person’s total life experience. Nursing is concerned with this dimension.

When mechanisms for coping are ineffective, illness results. Health ensues when humans continually adapt. As people adapt to stimuli, they are free to respond to other stimuli. The freeing of energy from ineffective coping attempts can promote healing and enhance health (Sitzman, 2010) Roy defines nursing broadly as a “health care profession that focuses on human life processes and patterns and emphasizes promotion of health for individuals, families, groups, and society as a whole” (Sitzman, 2010). Specifically, Roy defines nursing according to her model as the science and practice that expands adaptive abilities and enhances person and environmental transformation.

She identifies nursing activities as the assessment of behavior and the stimuli that influence adaptation. Nursing judgments’ are based on the assessment, and interventions are planned to manage the stimuli (Sitzman, 2010). Roy differentiates nursing as a science from nursing as a practice discipline. Nursing science is “a developing system of knowledge about persons that observes, classifies, and relates the processes by which persons positively affect their health status”. Nursing as a practice discipline is “nursing’s scientific body of knowledge used for the purpose of providing an essential service to people, that is, promoting ability to affect health positively”. “Nursing acts to enhance the interaction of the person with the environment – to promote adaptation” (Sitzman, 2010)

Roy’s goal of nursing is “the promotion of adaptation for individuals and groups in each of the four adaptive modes thus contributing to health, quality of life, and dying with dignity” Nursing fills a unique role as a facilitator of adaptation by assessing behavior in each of these four adaptive modes and factors influencing adaptation and by intervening to promote adaptive abilities and to enhance environment interactions. (Sitzman, 2010). The patient scenario I will use for the application of (RAM) will be a gentleman in his late 30s who was brought to the hospital by EMS after losing consciousness and wrecking his big rig. Upon assessment and clinical workup, the patient (Larry) was found to have diabetes.

The regulator subsystem was in effect when he was told of his diagnosis. He began to sweat, became short of breath and became very nervous and anxious. The cognator subsystem was the emotions he had about the situation. Larry became scared and teary eyed. Larry’s two subsystems were internally processing that he was a diabetic. Larry just bought a new cab and is an independent trucker.

He will lose his CDL license to operate his truck due to his diagnosis. The stimuli that affected his ability to cope were all three forms of environmental stimuli. The focal stimuli was his immediate need to continue driving his truck. The contextual stimuli was how others were trying to help him. The residual stimuli was the feelings he had about the whole situation. Larry was very anxious, depressed, and scared at the onset, but he eventually adopted and overcame those obstacles. Larry then began the psysiologic mode. His first concern was what kind of food is he going to have to eat, will he pass out again. Larry then adapted through the self-concept mode.

After seeing himself as useless and not able to feed his family, Larry was able to overcome these thoughts. Larry was able to adapt in the role function mode by realizing that he may not be able to drive a truck for a living, but he will be able to make a living in the transport industry in other ways. By learning to take care of himself and think outside the box, Larry adapted through the interdependence mode. I was using RAM and didn’t know it. I continued to provide support, education, and suggestions on how to possibly overcome his dilemma. Roy’s Adaptation Model is widely used in many nursing schools and by nurses because of the model views a person as holistic and contributes to the knowledge of nursing (Fawcett, 2005).

References

Alligood, M. &. (2010). Nursing theorists and their work (7th ed.). Maryland Heights, Missouri: Mosby Elseview. Fawcett, J. (2005). Roy’s adaptation model. In J. Fawcett, Analysis and evaluation of contemporary nursing knowledge: Nursing models and theories (2nd ed., pp. 364-437). Philadelphia, PA: F.A. Davis. Peterson, S. &. (2009). Middle range theories: Application to nursing research. Philadelphia, PA: Lippincott, Williams & Williams. Roy, C. &. (1999). The Roy adaptation model (2nd ed.). Upper Saddle River, NJ: Pearson Education. Sitzman, K. &. Eichelberger, L. (2010). Understanding the work of nurse theorists: A creative beginning. Sudbury, MA: Jones and Barlett.