Sister Callista Roy’s Adaptation Model of Nursing

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The Adaptation Model of Nursing is a prominent nursing theory aiming to explain or define the provision of nursing science. In her theory, Sister Callista Roy’s model sees the individual as a set of interrelated systems who strives to maintain a balance between various stimuli.

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.” In the same year, Roy’s Adaptation Model of Nursing was adapted in Mount St. Mary’s School in Los Angeles, California.

Roy’s model was conceived when nursing theorist Dorothy Johnson challenged her students during a seminar to develop conceptual models of nursing. Johnson’s nursing model was the impetus for the development of Roy’s Adaptation Model.

Roy’s model incorporated concepts from Adaptation-level Theory of Perception from renown American physiological psychologist Harry Helson, Ludwig von Bertalanffy’s System Model, and Anatol Rapoport’s system definition.

First, consider the concept of a system as applied to an individual. Roy conceptualizes the person in a holistic perspective. Individual aspects of parts act together to form a unified being. Additionally, 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.

Major Concepts

Person

“Human systems have thinking and feeling capacities, rooted in consciousness and meaning, by which they adjust effectively to changes in the environment and, in turn, affect the environment.”

Based on Roy, humans are holistic beings that are in constant interaction with their environment. Humans use a system of adaptation, both innate and acquired, to respond to the environmental stimuli they experience. Human systems can be individuals or groups, such as families, organizations, and the whole global community.

Environment

“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 health resources that includes focal, contextual and residual stimuli.”

The environment is defined as conditions, circumstances, and influences that affect the development and behavior of humans as an adaptive system. The environment is a stimulus or input that requires a person to adapt. These stimuli can be positive or negative.

Roy categorized these stimuli as focal, contextual, and residual. Focal stimuli are that which confronts the human system and requires the most attention. Contextual stimuli are characterized as the rest of the stimuli that present with the focal stimuli and contribute to its effect. Residual stimuli are the additional environmental factors present within the situation, but whose effect is unclear. This can include previous experience with certain stimuli.

Health

“Health is not freedom from the inevitability of death, disease, unhappiness, and stress, but the ability to cope with them in a competent way.”

Health is defined as the state where humans can continually adapt to stimuli. Because illness is a part of life, health is the result of a process where health and illness can coexist. If a human can continue to adapt holistically, they will be able to maintain health to reach completeness and unity within themselves. If they cannot adapt accordingly, the integrity of the person can be affected negatively.

Nursing

“[The 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.”

In Adaptation Model, nurses are facilitators of adaptation. They assess the patient’s behaviors for adaptation, promote positive adaptation by enhancing environment interactions and helping patients react positively to stimuli. Nurses eliminate ineffective coping mechanisms and eventually lead to better outcomes.

Adaptation

Adaptation is the “process and outcome whereby thinking and feeling persons as individuals or in groups use conscious awareness and choice to create human and environmental integration.”

Internal Processes

Regulator

The regulator subsystem is a person’s physiological coping mechanism. It’s the body’s attempt to adapt via regulation of our bodily processes, including neurochemical, and endocrine systems.

Cognator

The cognator subsystem is a person’s mental coping mechanism. A person uses his brain to cope via self-concept, interdependence, and role function adaptive modes.

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Four Adaptive Modes

Diagrammatic Representation of Roy's Human Adaptive Systems.
Diagrammatic Representation of Roy’s Human Adaptive Systems. Click to enlarge.

The four adaptive modes of the subsystem are how the regulator and cognator mechanisms are manifested; in other words, they are the external expressions of the above and internal processes.

Physiological-Physical Mode

Physical and chemical processes involved in the function and activities of living organisms. These are the actual processes put in motion by the regulator subsystem.

The basic need of this mode is composed of the needs associated with oxygenation, nutrition, elimination, activity and rest, and protection. The complex processes of this mode are associated with the senses, fluid and electrolytes, neurologic function, and endocrine function.

Self-Concept Group Identity Mode

In this mode, the goal of coping is to have a sense of unity, meaning the purposefulness in the universe, as well as a sense of identity integrity. This includes body image and self-ideals.

Role Function Mode

This mode focuses on the primary, secondary and tertiary roles that a person occupies in society, and knowing where he or she stands as a member of society.

Interdependence Mode

This mode focuses on attaining relational integrity through the giving and receiving of love, respect and value. This is achieved with effective communication and relations.

Levels of Adaptation

Integrated Process

The various modes and subsystems meet the needs of the environment. These are usually stable processes (e.g., breathing, spiritual realization, successful relationship).

Compensatory Process

The cognator and regulator are challenged by the needs of the environment, but are working to meet the needs (e.g., grief, starting with a new job, compensatory breathing).

Compromised Process

The modes and subsystems are not adequately meeting the environmental challenge (e.g., hypoxia, unresolved loss, abusive relationships).

Six-Step Nursing Process

A nurse’s role in the Adaptation Model is to manipulate stimuli by removing, decreasing, increasing or altering stimuli so that the patient

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  1. Assess the behaviors manifested from the four adaptive modes.
  2. Assess the stimuli, categorize them as focal, contextual, or residual.
  3. Make a statement or nursing diagnosis of the person’s adaptive state.
  4. Set a goal to promote adaptation.
  5. Implement interventions aimed at managing the stimuli.
  6. Evaluate whether the adaptive goal has been met.

Analysis

As one of the weaknesses of the theory that application of it is time-consuming, application of the model to emergency situations requiring quick action is difficult to complete. The individual might have completed the whole adaptation process without the benefit of having a complete assessment for thorough nursing interventions.

Adaptive responses may vary in every individual and may take a longer time compared to others. Thus, the span of control of nurses may be impeded by the time of the discharge of the patient.

Unlike Levine, although the latter tackled on adaptation, Roy gave much focus on the whole adaptive system itself. Each concept was linked with the coping mechanisms of every individual in the process of adapting.

The nurses’ roles when an individual presents an ineffective response during his or her adaptation process were not clearly discussed. The main point of the concept was to promote adaptation but none were stated on how to prevent and resolve maladaptation.

Strengths

  • The Adaptation Model of Callista Roy suggests the influence of multiple causes in a situation, which is a strength when dealing with multi-faceted human beings.
  • The sequence of concepts in Roy’s model follows logically. In the presentation of each of the key concepts, there is the recurring idea of adaptation to maintain integrity. Every concept was operationally defined.
  • The concepts of Roy’s model are stated in relatively simple terms.
  • A major strength of the model is that it guides nurses to use observation and interviewing skills in doing an individualized assessment of each person.The concepts of Roy’s model are applicable within many practice settings of nursing.

Weaknesses

  • Painstaking application of the model requires significant input of time and effort.
  • Roy’s model has many elements, systems, structures and multiple concepts.

Assumptions

Scientific Assumptions

  • Systems of matter and energy progress to higher levels of complex self-organization.
  • Consciousness and meaning are constructive of person and environment integration.
  • Awareness of self and environment is rooted in thinking and feeling.
  • Humans by their decisions are accountable for the integration of creative processes.
  • Thinking and feeling mediate human action.
  • System relationships include acceptance, protection, and fostering of interdependence.
  • Persons and the earth have common patterns and integral relationships.
  • Persons and environment transformations are created in human consciousness.
  • Integration of human and environment meanings results in adaptation.

Philosophical Assumptions

  • Persons have mutual relationships with the world and God.
  • Human meaning is rooted in the 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.

See Also

References

  1. Wills M. Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing. Philadelphia. Lippincott Williams & Wilkins.
  2. Andrew, H.A. and Roy, C. (1991). Overview of the physiologic mode. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
  3. Roy, C. and McLeod, D. (1981) The theory of the person as an adaptive system. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
  4. Roy, C. and Adrews, H. A. (1999). The Roy adaptation model (2nd ed). In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.

External Links

With contributions by Wayne, G., Ramirez, Q., Vera, M. 

Last updated on
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Angelo Gonzalo, BSN, RN
Angelo Gonzalo earned his Nursing degree in the year 2010 and continued his studies at St. Paul University Manila taking up Masters of Arts in Nursing Major in Clinical Management. He worked as an intensive care nurse for more than six years. He advocates for proper training and development of new nurses, quality assurance and compassionate care. He has also been involved in community development for 10 years steering programs on good governance, health, sports, and education. Angelo aims to build a good foundation for aspiring nurses. He would like to impart the importance of understanding nursing theories that he hopes to be translated successfully to practice.

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