Roy Adaptation Model in Nursing Practice

The Roy Adaptation Model was proposed by Sister Callista Roy and first published in 1970. The model has greatly influenced the profession of nursing. It is one of the most frequently used models to guide nursing research. This paper discusses an overview of the model, the clarity of the model, five major key concepts in the model, simplicity and generalizability of the model, relationships within the model, and the impact of the model on nursing practice.

• An Overview Of the Roy Adaptation Model

The Roy Adaptation Model (RAM) was formally used in 1968 as the conceptual framework for the baccalaureate-nursing curriculum at Mount St. Mary’s College in Los Angeles, where Sister Callista Roy served as a chair of the Department of Nursing. The RAM was first published in 1970. Over the years, Roy has expanded the scientific assumptions and developed and refined philosophical assumptions of her model. Roy works exceptionally well with other nurses on a national and international basis, guiding them in the use of her model in education, service, practice, and research. Roy’s contributions to nursing science are substantial and laudable (McQuiston & Webb, 1995).

The adaptation concept was introduced to Dr. Roy in a psychology class. Roy had been impressed with the ability of children to recover from illness while working in pediatric nursing. The adaptation concept seemed to be a suitable concept upon which to base a conceptual model of nursing. Roy’s ultimate goal was to demonstrate that nursing practice, based on the science of nursing, makes a difference in the health status of the population (McQuiston & Webb, 1995).

• Clarity and Simplicity of the Roy Adaptation Model

According to Chinn and Kramer (2004), clarity refers to how well the theory can be understood and how consistently the ideas are conceptualized. Duldt and Giffin (1985) suggested that Roy’s arrangement of concepts in her model is plausible; however, the development of definitions in her model is insufficient compared to her original format. In addition, terms and concepts borrowed from other disciplines are not confined to nursing. Roy has recognized in her recent writing the holistic nature of persons who exist in a universe that is “progressing in structure, organization, and complexity. Rather than a system acting to maintain itself, the emphasis shifts to the purposefulness of human existence in a universe that is creative” (Roy & Andrews, 1999, p.35). Roy also believes that persons have mutual, integral, and simultaneous relationships with the universe and God. As humans, they “use their creative abilities of awareness, enlightenment, and faith in the process of deriving, sustaining, and transforming universe” (Roy & Andrews, 1999, p.35). The RAM model is not parsimonious because it has many major concepts, subconcepts, structures and other numerous relational statements. It is comprehensive, and it attempts to explain the reality of the clients so that nursing interventions can be specifically planned to meet the clients’ needs (McEwen & Wills, 2007).

• Key Concepts of the Roy Adaptation Model

According to Chinn and Kramer (2004), concepts can be defined in a list of definitions or narrative forms in the text but not labeled as definitions. They are not easy to find because they are not labeled and contain information that is not directly pertinent to the definition of the concept. The RAM contains a large number of defined concepts, including the metaparadigm concepts. The five major concepts of nursing explicates in the RAM are person, goal, health, environment, and nursing activities. By addressing all five concepts in this manner, health becomes an outcome of adaptive processes that reflects patterns of being and becoming whole and integrated with self and with the environment (Frederickson, 2000).

The first concept in the RAM model is persons. According to the Roy’s model, the persons recognize the unique role of the innate and acquire coping mechanisms to help them in adapting to their surroundings. Roy has discovered four main areas that address the activities of the coping mechanisms. She refers to these areas as adaptive modes. The four adaptive modes are physiological, self-concept, role function, and interdependence. These adaptive modes are often referred to as effectors (McQuiston & Webb, 1995).

Another concept described in the RAM is goal. The goal of nursing within this model is to promote adaptation in four adaptive modes, which will be discussed in detail later in this paper. Together the coping mechanisms and the modes reflect the integration of the individual (Roy, 1984, p.38). To help people in achieving their health maximum potential, nurses can initiate their actions with the assessment process. First, they make a judgment with regard to either the presence or absence of maladaptation. Then, they focus their assessment on the stimuli influencing the family’s maladaptive behaviors. They may also need to manipulate the environment, an element or elements of the client system, or both in order to promote health by promoting adaptation. It is the nurse’s role to promote adaptation in situations of health and illness in order to enhance the interaction of the persons with their environment (Roy & Andrews, 1999).

Roy (1976) describes health as being a state of successful positive adaptation to stimuli from the environment interfering with basic need satisfaction and threatening to disrupt the equilibrium. Health reflects the adaptation process and is demonstrated by adaptation in each of four integrated adaptive modes: physiologic, self-concept, role function, and interdependence (Roy, 1976). The integration of these four adaptive modes reflects wholeness. Health refers to a process that individuals are trying to achieve their maximum potential. This process is manifested in healthy people who exercise regularly, do not smoke, and pay special attention to the terminal stages of cancer in order to take control over symptoms, such as pain, and strive for integration within themselves and in relation to significant others (McQuiston & Webb, 1995).

Roy (1976) describes the environment as being both internal and external in relation to the person that act as stressors. Therefore, all stimuli, whether internal or external, are part of the person’s environment. The main goal of the interaction between the person and the environment is to maintain balance and growth. Within her model, Roy (1976) specifically categorizes stimuli as focal, contextual, and residual. Focal stimuli refer to the stimuli that are most immediately confronting a person. Contextual stimuli are all other stimuli that might have a positive or negative influence on the situation. Residual stimuli are internal and external factors that may be affecting the individual or group. When a residual stimulus is identified, it usually becomes a contextual stimulus but may turn out to be the focal stimulus (Roy, 1976). Changes in the environments can affect the development and behavior of the person and threaten his integrity (Roy & Andrews, 1999).

The last key concept in the Roy Adaptation Model is nursing activities, which also have been described as the nursing process. According to the RAM, there are six steps in the nursing process: assessment of behavior, assessment of stimuli, nursing diagnosis, goal setting, intervention, and evaluation. The nurse goes through the client system by utilizing the nursing process and managing incoming stimuli to promote adaptation. By assessing behaviors and the stimuli, the nurse can formulate nursing diagnoses for the client. Goals are established based on the nursing diagnoses, and interventions are developed to alter stimuli and to enhance the coping mechanism of the client (Roy & Andrews, 1999). In this context, nursing interventions become a powerful force for managing the focal or contextual stimuli to produce a source of stability and growth called adaptation level (Frederickson, 2000).

• Relationships in the Roy Adaptation Model

According to Chinn and Kramer (2004), relationships provide links among and between concepts. Furthermore, relationship statements that can be seen are usually peripheral to the core of the theory. The Roy Adaptation Model is comprised of four adaptive modes that make up the specific categories that serve as framework for assessment. The following information is directly quoted from McEwen & Wills (2007), as cited in Roy & Andrews (1999), that describes all four modes within the RAM:

Physiologic-physical mode: physical and chemical processes involved in the function and activities of living organisms; the underlying need is physiologic integrity as seen in the degree of wholeness achieved through adaptation to changes in needs. In groups, this is the manner in which human systems manifest adaptation relative to basic operating resources.

Self-concept-group identity mode: focuses on psychological and spiritual integrity and a sense of unity, meaning, and purposefulness in the universe.

Role function mode: refers to the roles that individuals occupy in society fulfilling the need for social integrity, it is knowing who one is, in relation to others.

Interdependence mode: the close relationships of people and their purpose, structure and development individually and in groups and the adaptation potential of these relationships.

• Generalizability and Accessibility of the Roy Adaptation Model

According to Chinn and Kramer (2004), the generality of a theory refers to its breadth of scope and purpose. Furthermore, a theory that contains extensive concepts will include more ideas with fewer words than the one that contains very narrow concepts. The RAM includes the concepts of nursing, person, health-illness, environment, adaptation, and nursing activities. It also includes two subconcepts (regulator and cognator) and four effectors: physiological, self-concepts, role function, and interdependence. The cognator manages processes that are related to brain functions such as perception, judgment, learning, and emotion. On the other hand, the regulator works primarily through the use of the autonomic nervous system in making physiologic adjustments (Roy, 1976). The regulator and cognator are coping subsystems that allow clients to adapt and make necessary changes when dealing with stress (Roy & Andrews, 1999). Roy (1984) defines her model as drawn from multiple middle range theories for use in nursing. The Roy Adaptation Model can be used for other theory building and testing in studying smaller ranges of phenomena because of its broad scope. Roy’s model is genralizable to use in a variety of clinical areas including both inpatient and outpatient settings, but this model is limited in scope because it mainly addresses the concept of person-environment adaptation and focuses primarily on the patient. (Marriner-Tomey & Alligood, 2006).

• The Impact of the Model on Nursing

The RAM has been used broadly to guide practice and to organize nursing education. A distinct advantage of the theories generated from Roy’s model is their extensive scope. These theories are applicable to all clinical settings in nursing practice. Several quantity and quality of literatures suggesting the Roy model are significant and helpful to those who want to discover more about the model and its relationship to the practice of nursing. Because of the model’s usefulness, the RAM was adopted as a component of nursing of the curricular framework of such widely diverse college and department of nursing as Mount Saint Mary’s College Department of Nursing, the University of Texas at Austin School of Nursing, Boston College School of Nursing, and the nurse practitioner program at the University of Miami in Florida (Phillips, 2002). The RAM has also been implemented around the globe to provide students and health care professionals alike the fundamental of nursing practice, help them to generate further knowledge and designate in which direction nursing should develop in the future.