Roy's Nursing Model as a Tool for Addressing Nurse Burnout
Abstract

This paper examines the adaptation model of Sister Callista Roy by describing the theory at the heart of the model, explaining its purpose, and analyzing its strengths and weaknesses. It provides an overview of the major assumptions underlying the model, as well as evidence of congruence with current nursing standards. Finally, it provides insight on the model’s contribution to the nursing discipline, its transcultural relevance, and its utility in the field.

Introduction

Sister Callista Roy’s adaptation model first appeared in 1970 as a conceptual framework for nursing. Roy developed the framework in response to theorist Dorothy Johnson who asked nurses to come up with new ways of looking at or understanding nursing. Roy built on the theories of Rapoport (systems theory) and Helson (adaptation-level theory of perception) to explain how individual health can best be understood as a process of adaptation that one must go through as one’s environment changes. This paper will describe Roy’s model and its purpose. It will analyze its assumptions, describe its concepts, and evaluate its validity. It will also discuss its contributions to nursing, its transcultural relevance, and its utility.

Description of Theory

Roy’s adaptation model posits that a person can be viewed in terms of a system. The various parts of the person work together to make up the whole person. Because life is not static, people’s parts are constantly adapting to the changing reality of one’s environment. Energy, information, and physical interaction are part of the exchange between the person and the environment, and this exchange consists of inputs, outputs, controls and feedback, as in any system. For a nurse to provide quality care to a patient, there should be focus on the individual’s parts and the degree to which the individual is adapting to his or her environment. Every person will have a physical regulator, which is what enables the body to regulate its own systems; and every person will have a cognator subsystem, which allows the person to cognitively cope by forming a self-concept and developing a sense of one’s role function (Alligood, 2017).

Purpose of the Theory

The purpose of the adaptation model is to enable the nurse and patient to maintain compliance and to increase life expectancy (Ursava?, Karayurt & ??eri, 2014). By assessing the patient in from a physiological, self-concept, role function and interdependence perspective, the nurse can be better positioned to provide holistic care. According to the model, there are six steps a nurse takes in providing care. First, the nurse assesses the patient and the patient’s behavior. Second, the nurse assesses the stimuli to which the patient is responding, i.e., the things in the patient’s environment that affect him. Third, the nurse provides a diagnosis. Fourth, the nurse assists the patient in setting goals for the patient’s health care plan. Fifth, the nurse proposes interventions to assist in meeting those health goals. Sixth, the nurse evaluates the intervention to see whether goals were met.

Level of Theory

Roy’s adaptation model has been used to develop middle-range theories with respect to psycho-social health and treatment of various issues (Shariatpanahi, Farahani, Rafii, Rassouli & Kavousi, 2019).

Analysis of Model

The strength of the model is that it provides a middle-range approach to nursing that blends psycho-therapeutic concepts with holistic nursing care. The outcome is that the whole person tends to be treated. Thus, its strength is that it provides the nurse with a sense of how to observe the multiple facets of the patient’s health. The weakness of the model is that it is rather complex and time-consuming to implement. It has extremely limited application in emergency nursing situations, and even though the adaptation process can be assessed, it is not necessarily the case that an effective nursing intervention will be implemented. Roy’s model focuses more on how the adaptive system works rather than on how the nurse can effectively use this understanding to provide fast, reliable, holistic, quality care to patients. It is thus better situated as a framework for nursing in the sense of offering up guiding principles that can shape the nurse’s perspective and orientation. The model does not provide a nurse with a sense of how to approach a patient who is unresponsive, for example, which restricts its practical utility.

Current Schematic Model

The model’s current schematic is that stimuli arrive in the person as an input and jumpstart the adaptation process. Control processes follow, with coping mechanisms (cognitive and physical) being used to facilitate how the mind and body respond to the stimuli. Effectors are then put to work, and these include the physiological function, the self-concept, the role function and interdependence. Output is discerned in both adaptive and ineffective responses, which serve as feedback for the individual and thus contribute to the person’ input (Alligood, 2017).

Major Assumptions

The major assumptions of Roy’s adaptation model are that 1) every individual has bio-psycho-social components and is always interacting with an environment in flux; 2) it is necessary that the person be able to adapt to environment alterations; 3) that adaptation is made possible by positive stimulus; 4) the modes of adaptation are based upon one’s unique physiological needs, role function, self-concept, and inter-dependence; 5) life is dynamic and the goal of life is to achieve dignity and integrity; 6) it is possible for the purposes of care and study to reduce an individual to parts, as the art of nursing is based on identifying causes, which means examining the various parts of the whole; 7) the values and beliefs of a patient are important and should always be respected; 8) by enabling oneself to adapt one is use energy in a dynamic way, i.e., respond to alternative stimuli in a positive manner (Alligood, 2013).

The philosophical assumptions of the model are that everyone has some kind of relationship with God and with the world, even if the relationship might appear to be non-existent. It can be understood in negative terms (Roy, 2018). However, the basis of this model is that there is an omega point in the universe at which all things converge. This idea is based on the writings of Teilhard de Chardin, who saw God as the omega point (Grumett, 2007). Thus, in Roy’s model, union with God is the ultimate destiny of mankind. God’s existence can be discerned through the world’s diversity...…more daunting than was first supposed. Just as a patient can experience mental breakdown, so too can the nurse, which is why it is important that the nurse have a sense of how person-centered care applies to nurses as well as to patients.

Roy’s adaptation model can help nurses to address their own issues in nursing; it is not just for treating patients. To prevent nurse burnout, the model can allow nurses to be more conscious of the inputs that are entering into their own system and how these inputs impact the control processes. If negative inputs are arriving, the cognator and regulator coping processes will cause one to alter or adapt one’s self-concept, physiology, role function and interdependence. It can explain why many nurses who arrive in the field with enthusiasm leave in dejection. They do not anticipate the need for their own adaptation in the field and thus simply seek to change their environment altogether instead of adapting their own coping processes.

Future Usefulness of the Model

The future usefulness of the model is evident in the attention given it by Alkrisat and Dee (2014) and others, such as DeSanto-Madeya and Fawcett (2016). Russo et al. (2019) also show that the model has utility and is likely to be of use in the future of nursing. The reason for its future usefulness is that nurses are being educated to have a more holistic approach to the process of providing care. To this end, they need to be able to engage in preventive health and increase the health literacy of patients by exploring with them their own environments, their own life dynamic, and helping the patient to see what feedback is arriving as inputs that can be addressed better through a more positive adaptive process on the part of the patient. The model can, in other words, help nurses to show where incongruence is found between the person and his or her environment. As the world is radically changing even now, as a result of COVID and a rise in unemployment, new technology, and alterations to how people live in society, nurses are going to need to be able to respond in a positive way to patients’ holistic needs. The Roy adaptation model can provide that assistance for the foreseeable future.

Conclusion

The Roy adaptation model provides nurses with a guide for assessing the individual parts of the patient and developing a sense of the patient’s adaptive needs. It enables the nurse to understand the patient’s environment, inputs, beliefs, expectations, and how that patient is adapting to health issues. By providing the nurse with this health care framework, it opens up the possibility for focused development on cultural competence and person-centered care. It works best as a framework and has less utility in terms of fast, emergency nursing situations. However, it does have validity, and it also can be used among nurses themselves as they seek to address the practice issue of how to deal with nurse burnout. Nurses can apply the Roy model to their own lives and careers and thus help to prevent their own degradation while working in the field providing care for patients.