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.
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.
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.
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.
This is the sixth and the final stage in this respect of nursing process and it involves the passing the judgment on the success or failure of the intervention. This is done by considering the behavior of the patient before and after the intervention using the Roy's approach and this is done against some specific goals that were established.
The major concepts in this theory are:
Environment-these are conditions or circumstances and influences that are bound to affect the behavior as well as the development of human for instance the adaptive system.
Health- is referred to as the state or the process of being of a person and becoming integrated and whole.
Person- is referred to as the human adaptive system and that which acts as a whole or part of a whole for a given purpose. The human system includes people or groups, communities, organizations, and societies acting as a unit or as one whole.
Here, adaptation is seen to help the person live with dignity and even if they have to die, then they die with dignity. Roy further indicates then that the levels of adaptation represented the prevailing conditions of life. She therefore gives four major of adaptation levels through which human interacts and respond to as well as adapt to the environment as:
Integrated- this is where the structure and the general function of the life process are geared towards meeting needs that the person may be having for instance stabilized breathing process or on the social level, the process of moral-ethical-growth within the individual. This can be said to the physical and chemical process that goes on within the person to be able to do the things that a living organism can do. This leads to wholeness at the end of it and the wholeness is achieved through adapting to changes in needs for instance the needs of a child keep changing vastly as they grow up.
Compensatory- this is a more complex adaptation level and involves the person adjusting and the person initiating the adaptation are both inspired by change in the life process. A good example here is the change in the role in life that one plays as they grow, or even the act of grieving as a growth process and transcendence.
Compromised life - this is yet another level of adaptation that comes as a result of inadequate integrated as well as compensatory life process. It is triggered by adaptation problem and some common examples are hypoxia, unresolved loss, stigma as well as abusive relationships.
Interdependence mode- this looks into the relationship of people and their purpose, structure as well as development. This can be as an individual or in a group and looks at the adaptation potential of these groups. This focuses on the concept of giving and receiving or expecting to receive love, value as well as respect. It emphasizes on relational integrity. The basis here is investing in relationship and feeling secure within the maturing relationship. This is an important aspect in the relation between the patient and the nurses.
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
This theory gives room for the possibility of a situation being influenced by…