Sister Callista Roy's adaptation model and nursing process framework

Sister Callista Roy Theory

At the age of 14 years old, Callista Roy had already started working in large general hospital where she moved from being a pantry, to maid to the nurse's maid. After considerations, Callista decided to join the Sisters of Saint Joseph Carondelet where she became a member for more that 40 years of her entire life. She joined college and pursued liberal arts program where she successfully completed a program in Bachelor of Arts majoring in nursing at Mount St. Mary's College in Los Angeles (The Trustees of Boston College, 2013).

She further pursed successfully her masters in Sociology and a doctorate in sociology as well both at University of California (Jones & Barlett, 2013). It was at this point that Roy wanted to fuse both sociological approach and nursing approach to the nursing care of the patients. She is accredited for coming up with and always updating the famous Roy Adaptation Model (RAM) which forms the framework for theory, practice as well as in-depth research. This is a model that has come to be used and loved by many across the globe in the nursing fraternity and medical field as a whole.

The RAM present an individual or the patient as a holistic adaptive system that constantly interact with the surrounding environment as well as the internal environment, with the major task of the human being seen as maintaining and upholding integrity in the face of these stimuli that influence him from the environment. According to Roy, adaptation simply means a process and outcome where feeling and thinking individuals, either in isolation or as a group in conscious decision and awareness as well as on independent choice strives to create human and environmental integration.

Nursing process according to RAM theory

According to the RAM approach to nursing, the process of nursing is actually a systematic problem solving approach that involves data collection, identification of the patient adaptive system needs, selection and implementation of the nursing care approaches and finally the evaluation of the outcomes from the care provided. There are therefore the following steps that are followed in the nursing care according to this Roy's model (Current Nursing, 2012):

Assessment of Behavior

This is the first step and involves data collection on the patient's behavior as an adaptive system using each of the adaptive modes above.

Assessment of stimuli

This involves the accurate identification of the external stimuli as well as the internal stimuli which influence the patients' adaptive behavior. In the Roy's model, the stimuli that are identified are often categorized as Focal stimuli which refer to those that are confronting the person immediately, the Contextual stimuli which are the other available stimuli that have a bearing or effect to the circumstances and lastly the Residual stimuli which here is used to refer to those whose contribution or effect to the circumstance under observation are unclear.

Nursing diagnosis

This is the third step and needs the nurse to formulate statements that help in the data interpretation on the adaptation and the status of the person in line with the progress with adaptation and also the most relevant stimuli observed and the behavioral pattern and changes.

Goal Setting

This involves formulation of clear statements of the behavioral results for the implementation at the nursing care. This gives the entire nursing process a definite and solid direction.

Intervention

This is the fifth stage in this nursing process under the Roy's method and here the nurse will determine which way is the best to help the patient to achieve the established goals at the beginning of the nursing process.

Assumptions

There are some fundamental assumptions that were proposed or highlighted by Roy in the RAM as to guide the application of the theory and the definition and understanding of the theory.

The scientific assumptions include;

That all systems of matter as well as energy progress to a higher status or form or levels within the complex self-organization hence the possibility of the application of the RAM.

The second assumption is that consciousness and meaning lead to construction of environment integration and person as well. In this regard, the integration cannot be achieved without the consciousness and the people involved in the process.

The awareness of self and awareness of the environment within which one is in is based on the thinking and feeling of the person. Thus nurses should be trained to tune their thinking in line with the environment like that of patients in need of their empathy.

The integration of creative process is purely a prerogative of human beings hence they are accountable for these.

Feeling and thinking mediate human action. Hence the nurses should help in the mentoring the patients to ensure they feel and think in a positive manner through the period that they are sick.

System of relationship basically cover the protection, acceptance and strengthening of interdependence.

The other assumption is that the earth and person have common patterns and integral relationships.

It is within the human consciousness that create transformations of the environment and persons.

The integration of the environment and human beings leads to adaptation.

There were also a number of philosophical assumptions that were propagated by this theory as follows:

That people have a mutual relationship with God as well as with the world.

The second is that the meaning of human is rooted in the omega point convergence of the universe.

Roy also insinuated that the diversity of creation reveals God intimately and He is the common destiny of all creation.

Persons (like nurses) use the human creative abilities of enlightenment, awareness and faith. This may be used by the nurses to help the patient recover psychologically.

People are responsible for the process of sustaining, deriving as well as transforming the universe (Gonzalo, 2011).

Strengths and weaknesses of the RAM theory

Strengths

This theory gives room for the possibility of a situation being influenced by multiple causes. This is advantageous for the nurses when dealing with people who are likely to be multi-faceted as most patients are.

The concepts that are presented above in Roy's model have a logical sequence with the idea of adaptation to maintain integrity being the central theme here.

It is also noteworthy that the concepts of Roy's Model are stated in simple terms that are easy to understand by any nurse.

The fact that this model encourages and guides the nurses to use more of the observational skills and interviewing skills while conducting personalized assessment of each patient.

The other strength is that the Roy's model has proven to be applicable in many incidences of the nursing practice and has proven to be helpful especially for the patients.

Weaknesses

The process of application of the model is tedious and time consuming since it involves creating rapport with the client and understanding the client which is a thing that requires time, effort and skill.

The model has several elements as seen above, several systems, structures and multiple assumptions and concepts as indicated above.

Analysis

Bearing the tedious and time consuming nature of the model, there is little possibility that it can be applied in an emergency situation in the nursing profession since emergencies need quick decisions and fast actions. There is then the possibility of a nurse successfully completing the adaptation process without necessarily having the benefit of carrying out a complete assessment for proper nursing intervention.

There is a possibility of the adaptive response to vary in each individual or patients hence there can be considerable difference in the application in different patients and even with different nurses. This means that the control span of the nurse may be cut short or stopped by the time the patient is discharged. This raises a further question of the role of the nurse when an individual or a patient displays ineffective response in the course of the adaptation procedure. The method is silent on such situations and yet, albeit they can be few, they are possibilities. The RAM concentrates on the adaptation and does not show how the nurse can prevent or even deal with maladaptation.

Application of Roy's Adaptation Method

There are various applications of this particular method within the nursing fraternity right from the daily nursing care to the education process in nursing studies and research that are in line with nursing. This approach has been proven essential and instrumental as portrayed below.

Application in nursing practice

The method that Roy suggested enables the nurses to systematically deal with patients by first assessing the behaviors of these patients and then after that looking at the stimuli that affect the behaviors observed in the patient. The third step as seen above is the nursing diagnosis then after that step he sets the goals that are meant to promote adaptation. The fifth step is aimed at managing the stimuli to promote adaptation and final step being evaluation. This then shows that by manipulating the stimuli and not the individual, there is an increased interaction between the patient and their respective environments, a fact that is promoted in the course of nursing practice. The model can therefore be said to aid in the studying the patient behaviors in totality hence providing a clearer picture of the patient. There is then the emphasis on the positive behavior of the patient which will in turn speed up the recovery process of the patient.

Application in education

The RAM is also very instrumental in the educational sectors since it sets straight the purpose of nursing which apparently to ensure the individual can adapt as fast a possible using the adaptive modes states hitherto in circumstances where the person may be sick. This model has been included in many university curriculums within the U.S. And has been studied among other major models like Roy model in nursing schools and colleges.

Application in research

It was the wish of Roy to have theory development and the testing of these theories to be thorough and a priority. The models that are admitted into the academic use and daily application must be able to generate testable hypothesis in order for them to be researchable. This was a contribution that the Roy model made in the research sector and continues to contribute to the nursing research as more people strive to find further ways of application of this model and means of improving it for better and more use within the nursing fraternity.