Nurse Theorist the Roy Adaption Model

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 in which he lives, and therefore, he can adapt easily to all the change that are taking place within 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 well as insomnia and other associated disorders. She therefore took some time off from work, and when she came back, she was put on medication to cope better with her depression and anxiety. It is Janice's opinion that she is dong better today, and this happened to her because of the fact that her father was an alcoholic, and her mother was a very anxious person, as a result, and she being an only child, was quite lonely most of the time. When Janice was put into group therapy to learn to recognize her own problems so that's he could deal with them better, she benefited tremendously. She can today manage her anxiety without any medication, and she can also recognize signs of depression and learn to minimize it before it becomes acute. It can be said that Sr. Callista Roy's Adaptation Model has definitely helped Janice to learn to recognize her own anxiety and to deal with it in an appropriate manner. (Case Study)

In a similar manner, Sr. Callista Roy's Adaptation Model has been found to be extremely useful in the promotion and in the maintenance of health and well being of a lot of individuals, and this study conducted to study the model for empirical evidence is ample proof of the fact. Four different groups of subjects were taken for the study: one group comprised of informal caregivers of demented relatives at home, another consisted of a group of informal caregivers of psychiatrically ill relatives at home, yet another was made up of a group of professional caregivers of elderly institutionalized patients, and finally, a group of aged spouses in the community. It was noted that at least in three studies, a number of theoretical propositions that had been derived from Sr. Callista Roy's Adaptation Model were being supported through this study, and this meant that the model was being given added credence and credibility. Certain areas of focus must be mentioned in particular, one of them being that of 'perceived stress', which was positively linked, either directly, or indirectly, to psychological distress, which in itself was an indicator of adaptation, when taken through the self-concept mode. The study also revealed that in the case of a contextual stimulus of conflicts, in the exchange of social support for the problem, and in the passive and avoidance coping strategies, Sr. Roy's model was proving to be very practical and useful indeed. (Levesque; Ricard; Ducharme; Duquette; Bonin, 1998)

In the case study of Janice, as mentioned earlier, Roy's model was applied, with commendable results, in the promotion of and in the restoration of the health of the patient, and later on, in the maintenance of this health in the patient. Therefore, to begin with, an assessment, which is the first step in Callista Roy's Adaptation model, was applied to Janice's behavior, in each of the four modes explained above. Ineffective behaviors were thereafter noted down, and in Janice's case, these were frequent night time awakening, and several types of anxiety symptoms. Ineffective behavior within the self-concept mode was Janice's dependence on medication, in this case, on axiolytics. In the role function mode, her ineffective behaviors were Janice's basic inability to carry out her various roles in life effectively and efficiently, and to her own complete satisfaction, and these roles were a mother, and a teacher's aide. (Roy's Model Applied)

In the same way, Janice had always maintained an emotional distance in her role as a daughter to her parents, and this gave rise to her ineffective behavior as a daughter in her role function mode, and also as a friend when she had to move form her old home to a new one. In the inter-dependence mode, it was found that Janice assumed that she was in a good marriage, just because of the fact that her husband 'did not run around'. This behavior was termed as ineffective, as was her feeling that she had no one to talk to or to communicate her feelings to. According to Roy's model, the next step would be to classify the stimuli. Focal stimuli, or the stimuli on which Janice was expending a large amount of her energy on, was found to be insomnia, and a basic sense that she lacked control in her life.

Contextual stimuli, according to Roy's model, in Janice's case were the current medications that she was taking, and also her feelings that she was on medication, and Janice's feelings of depression and anxiety, and her sense that she did in fact lack social support of any kind. In addition, her move from her old home, and her own expectations of her role as a good mother, and also as a teacher's aide in her new job, coupled with all her guilty feelings about the fact that her children were being forced to move, and thereby lose all the friendships that they had been enjoying in their old home: all these were the factors that added up in the contextual stimuli that Janice was facing. The residual stimuli, or the stimuli which were unclear, were in Janice's case, the vague feeling or hunch that Janice and her husband were in fact facing some sort of marital difficulties despite Janice stating that he was a good husband. In addition, certain childhood anxieties that Janice would have faced when she was a child, and which had been left unresolved, were also a part of the residual stimuli. The next step in the Roy Adaptation Model is that of the nursing diagnosis. This was undertaken when the stimuli were confirmed with Janice, and this included the statement of her problems, and their probable cause. After this goals were set, and one goal was that Janice would have six hours of sleep per night. After this step was the final step, that of evaluation, which is a determination of whether or not the goals have been met. (Roy's Model Applied)

When the Roy Adaptation Model was used for people with arthritis, it was found that the patients were able to report a significantly higher self-efficacy for pain management, and this is one of the greatest advantages of the model. (Recent Dissertations, theses, projects) Pluralism on the other hand, which means the questioning about one's own identity, is a part of self-identity, and the Roy Model includes pluralism as well in its adaptation mode. (Pluralism and Unity) The concepts in the Roy Adaptation has concepts that are all inter-related to one another, and since the systems that are dealt with are biological, psychological, and social, all patients would find it a great advantage to apply the model to themselves. (Roy's Model of Nursing) When a series of Nursing Conferences were held in the Northeastern area of the United States of America during the 1980's and 1990's, nurses form all over the country attended them, and this was indicative of the emergence of new trends in nursing and the fact that nurses were willing to learn them.