Nursing Theorist: Sr. Roy Adaptation Model The Roy Adaptation model for Nursing had its beginning when Sister Callista Roy happened to get admitted in the Masters Program of pediatric nursing in the University of California, Los Angeles, in the year 1964. At that time, Sr. Callista was familiar with the idea of 'adaptation' in nursing, and it must be mentioned that Sr. Callista's adviser at that time was Dorothy E. Johnson, who believed firmly in the need to define nursing as a means of focusing the development of knowledge, for the practice of nursing. When Sr. Callista Roy started working with children in the pediatric ward of the hospital, she was quite impressed with the basic resiliency of the small children who had been admitted into the wards for treatment. This was why when the first seminar in pediatric nursing was called for; Sr. Callista Roy proposed that the basic goal of nursing must be to promote patient adaptation. (The Roy Adaptation Model, History)

This idea was accepted, and Dorothy E. Johnson, Sr. Callista Roy's mentor, encouraged her to develop on this theory of adaptation, and create a basic framework for nursing based on this very concept. The use of 'systems theory' as had been defined by Von Bertalanffy was an important early concept of the model, as was the work of Helson who had earlier defined adaptation as a process of responding in a positive manner to all types of changes in the environment, including three important types of stimuli, which were: focal, contextual, and residual. Sr. Callista Roy made appropriate adaptations of this theory and others and used them to describe the situations of sick and ill people, as well as for healthy people free of diseases. Dohrenwend, Lazarus, Mechanic, and Selye were a few others who influenced Sr. Callista Roy in her adaptation theory of nursing. Gradually, during the 1970's, this particular model started to become the primary operating model for a nursing based integrated curriculum in Mount St. Mary's College, in Los Angeles. By the year 1987, more than 100,000 nurses had been educated based on this system, and by this time, humanist values had also been included into the Roy Adaptation Model.

However, by the time it was the end of the 1990's, Sr. Callista Roy felt that she had to re define adaptation as such, and for this purpose, she drew upon other previously existing insights on relating the varied concepts of spirituality and science so that a new definition of adaptation could be created, which would be based on philosophical as well as scientific assumptions, and this is what was presented. When taken philosophically, it was Sister Roy's opinion that all nurses saw the patient as somebody who was actually co existing with the prevalent physical and social environment, and that nurse scholars generally adopted a value-based view that was in fact deeply rooted in the beliefs and the hopes of an average human being, and therefore developed a discipline that would primarily enhance the well being of the same people. In fact, Sister Callista Roy has at times, even used the term 'cosmic unity' to describe the manner in which human beings and the Earth have certain commonalities, like for example, some general common patterns, and also some mutuality of relations. What this actually meant was that all individuals who are able to think and feel for themselves, and whose basic ideas and concepts are firmly rooted in consciousness and in meaning, are responsible and accountable for deriving, and then for sustaining and also transforming the very universe. (The Roy Adaptation Model, History)

According to Polit and Henderson, Roy's Adaptation Theory is about human beings being basically 'biopsychosocial adaptive systems' who are fully capable at all times of coping with various environmental changes through a simple process of adaptation. (Models and Theories of Nursing, Callista Roy's Adaptation Model) It has often been stated that Sr. Callista Roy's Adaptation model has been extremely useful in nursing practice, in research and in evaluation, and in administration as well. The model consists basically of four domain concepts of person, health, environment, and nursing, and it consist of a six step nursing process for the patient. According to Andrew and Roy, 1991, the meaning of 'person' here can refer to one single individual, or to a group of individuals. The basic idea is that a person or an individual, is a biopsychosocial being who is always in constant touch with the environment...

Therefore, the person or the individual is in essence an open adaptive 'system' which uses the various coping skills available to him to adapt well and effectively to the changing environment, and also, to stressors of various different kinds. Sr. Callista Roy defined this environment as, according to Andrews and Roy, 1991, 'all conditions and circumstances and influences' within the environment, which surround and have an impact on the basic development of the person, and also on his behavioral patterns. (Callista Roy's Adaptation Model)
In fact, Sr. Callista Roy saw stressors as being stimuli for the person, and she used the term 'residual stimuli' to talk about those stressors which were having an impact on the person, but whose impact was in fact not very clear or obvious. The original Adaptation Theory of Sr. Callista Roy stated that health and illness and sickness are on a continuum with several different states and degrees of being, but later on, this theory was altered to state that health as such is nothing but a process of being, and the process of becoming an integrated and a whole individual. The usefulness of the theory lies in the fact that Roy desired that adaptation must be promoted and encouraged in each of the four modes of the person as described above, and that doing this effectively would mean that the person's health, his basic quality of life, and a dignity in death would all be easily achieved. In general, Sr. Callista Roy believe in utilizing a six step nursing process, starting with an assessment of the person's behavior, then moving on to an assessment of various stimuli around the person, and thereafter moving on to the nursing diagnosis, and setting a realistic goal for the person, and then starting the process of intervention, and finally, evaluation.

In the first step, the person's behavior is assessed and evaluated, according to the mode which he has been observed as being in. this observed behavior will then be compared to the existing norms and then it is decided whether the behavior is adaptive, or whether it is ineffective. The second step deals with the various factors that generally influence the behavior of the person, and the various different stimuli are classified, according to Rambo, 1984, either focal, or contextual, or residual. The nursing diagnosis that would follow this would make mention of the ineffective behaviors, along with the probable causes for such ineffective behaviors. This would bring the nurse to the next step, which is that of appraisal. At this point, goal setting must be the essential focal pint, and the goals that have been set must be realistic as well as attainable, and they must be set with the collaboration and assent of the person involved. Intervention would come in as a fifth step, and this is when the stimuli in the person's environment are manipulated. This stage is also euphemistically known as the 'doing phase'. After this is the final and evaluation step, which is when the degree of change that has taken place as a result of bringing in certain changes in the environment are evaluated, and the results of such changes are determined. If the change has been found to be ineffective in any particular case, then these behaviors are re- assessed, and the recommended interventions would be revised. (Callista Roy's Adaptation Model)

An example in the form of a case study would explain the usefulness of Sr. Callista Roy's Adaptation Model in nursing practice better. Janice, a 34-year-old married woman with two children, happened to shift from her home in the Interior, to the Lower Mainland, when her husband was transferred. Her opinion is that she was feeling reasonably well and healthy until the news that her husband had been transferred was given to her, and it was soon afterwards that she started to feel depressed and anxious. The reasons, she stated, were because she had many friends in her old hometown, whereas in the new place she had none, and her children too felt the same way. In addition, she had to take up a new job, which proved to be another stressor, because she was to take care of a child with Attention deficit Hyperactivity Disorder' and she felt that she could not agree with the present management style of the assigned teacher. (Case Study)

All this took their toll on Janice, and she started to experience acute anxiety attacks, as…