Not every idea is perfect and neither is any person, so the propagation of theoretical stances proliferate. In the field of nursing it makes sense that there would be theories which were designed to advance the fields of care, patient psychology and of medicine's effect on the body, but care, the essence of nursing seems the most crucial. Care theories have been advanced providing guidance for every facet of the practice, and the concept of the Roy adaptive model is just one of the many. This essay will examine the Roy adaptive theory from every angle in an attempt to recognize its place in nursing.
"Sister Callista Roy was born in 1939 in Los Angeles, CA" (Masters, 2011). This seems to be where all of the discussions of Ms. Roy begin, and it tells the researcher three crucial items about the subject. First, she is either a nun or her parents chose a very common term for her first name (she is a nun). By her birth date it can be said that she became a leader in the world of nursing at a time when women were not leaders in any field except possibly nursing and teaching. Even then they did not have the usual ability to lead in those fields. Finally, she was born on the west coast, which even at that time was a better place for ideas from women to take root. The first sentence of most articles and sections of books about her life's work then actually offer a lot of information about the person.
Roy began her college career at the Mount St. Mary's College. She achieved a "Bachelor of Arts with a major in nursing from Mount St. Mary's College in 1963; a Master's degree…in pediatric nursing in 1969; and, she also earned a Master's and a PhD in sociology in 1973 and 1977 respectively" (Current Nursing, 2010). Her degrees enabled her to meet people who were to influence her life's work, but none more so than Dorothy Johnson (Chesnay, 2007). Johnson held a seminar during which she challenged the students to complete a "conceptual model for nursing" (Masters, 2011). Roy took her up on that challenge and began developing her adaptation model.
In context, the theory is designed around a holistic approach to healing and wellness (Roy & Andrews, 2008). Roy believed that the "human beings and groups are…holistic, adaptive systems that constantly change and interact with their environment. Health is a process of being and becoming integrated and whole and reflects environment and person mutually" (Rogers & Keller, 2009). In other words, Roy believes that a person's goal is to "maintain integrity" (Masters, 2011). The whole person, mind and body is involved in the process of revitalizing the person and creating the wellness and balance that is desired (Roy & Andrews, 2008).
This theorist was chosen for this essay project because the theory embodies a personal belief that healing should not just include modern symptom recognition and alleviation methods. Roy realized that the whole person -- body, mind and spirit -- are linked in the idea of wellness. The goal of a nurse is to promote wellness, and it seems ridiculous to engage one part of the nascent whole while neglecting other parts. The blossoming health that should occur is cut off before it can truly begin. If the person does not engage the mind in the healing process there is a good chance that the ill which attacked the body will return in greater force. Therefore, to promote healing is to promote the entire package of mind, body and spirit with it.
The discussion to this point has been about the basic tenets that make up the Roy's theory. Further discussion requires a deeper understanding of the theory as Roy intended it. Two concepts exist in the research which were devised to understand systems which can also be used to understand how a psychological (or in this case nursing) theory works. A mechanistic theory is one that looks at the individual as a single organism. It is simplistic and centralized. For example, every person on an automobile assembly line has a specific task. The person is specialized to that task and they perform that specific function. The other type of system is one that is organic (or organismic). The organic system speaks of joint specialization and decentralization (Basavanthappa, 2007). The theory in question is organic because Roy realized that adaptation did not happen because of one bodily system or one person. The adaptation theory requires that there be other elements involved than just the physiological for the person to heal. Because this nursing theory is very decentralized it is definitely organic.
The idea of worldview also requires a discussion of what the theorist had in mind with regard to the different metaparadigm concepts of person, health, environment and nursing. Of course, any nursing theory is going to contain some piece of every element, but one or more of these is going to be at the core of the theory.
About the person, Roy and Andrews (2008) say "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." Her thought of personhood is very tied to her studies in sociology. She believed in the view that people are systems rather than solitary figures. This ties in very well to the organic nature of the theory as a whole.
The person is part of the environment, and must make adaptive changes because of that environment (Roy & Andrews, 2008). People are able to survive in their environment because they understand the stimuli as they receive them (Peck, 2008). Of course, the goal of the model is not simple survival, but allowing the person to thrive in the context of their environment.
Roy believed that "health is a state and process of being and becoming integrated and whole that reflects person and environment mutuality" (Masters, 2011). Basically a person cannot be healthy unless they first understand the relationship of their personhood to their environment. This is best understood by using the example of an extreme stressor. The body responds to the environment with certain activity that can be harmful if they are prolonged. However, the healthy person will be able to mitigate their response to the environment and regain the homeostasis of health.
First, and foremost, Sister Roy is a nurse who believes that her patients need to understand how they are an "integrated system" (Basavanthappa, 2008) before they can become whole and healthy. She said "nursing is to promote adaptation for individuals and groups in the four adaptive roles" (Masters, 2011). A nurse is key to the theory when he or she comes in contact with someone who is unhealthy. A patient is most likely in some degree of distress and they may not be in complete understanding of the need for adaptation. A nurse helps to encourage the roles of community, science, personhood and spirituality (if that is requested) into the life of the patient. The nurse can also be key in assisting the family with their own healing.
Roy integrated all of the metaparadigms to such an extent that it difficult to decide where she most accurately falls within the four concepts. However, it would have to be between person and environment, with a possible slight edge to the person. This theory makes it understood that the nurse is an integral piece of the healing environment, and that healing itself is an outcome of proper attention to the adaptation that can occur. The reason that it seems that the person is most important in this theory is that while the environment is not static, it is largely unchanging. If a person learns to adapt to a specific type of change then they can use that knowledge to adjust to a similar environmental challenge. Therefore, the adaptation that the person is able to accomplish is the central function of the theory.
Several definitions present themselves as important to the discussion of the theory. The first element that needs to be understood from a global perspective is adaptation itself. Roy and Andrews (2008) said "adaptation refers to the process and outcome whereby thinking and feeling persons as individuals or in groups, use conscious awareness and choice to create human and environmental regulation." This speaks to the holistic approach which the theory is based on. "thinking and feeling" are integral in regulation of the environment in which a person lives whether that be outside or inside the individual or group. Also, it is interesting to note that Roy's idea of healing has a very powerful group context. Not that healing occurs in a village atmosphere, but that concerned people, whether family or those otherwise affected, become important in the manifestation of the healing process.