Roy Adaptation Theory: A Holistic Nursing Framework

Introduction

Not every idea is perfect, and neither is any person — so theoretical stances continually proliferate. In the field of nursing it makes sense that there would be theories designed to advance care, patient psychology, and medicine's effect on the body. Yet care, the very essence of nursing, seems the most crucial focus of all. Care theories have been advanced to provide guidance for every facet of the practice, and the Roy Adaptation Model is one of the most prominent among them. This essay examines the Roy Adaptation Theory from multiple angles in an attempt to recognize its place in nursing.

The Theorist: Callista Roy

"Sister Callista Roy was born in 1939 in Los Angeles, CA" (Masters, 2011). This is where most discussions of Roy begin, and that single sentence tells the researcher three crucial things about the subject. First, she is a nun — her title makes that clear. Second, by her birth date, she became a leader in nursing at a time when women were rarely leaders in any field except possibly nursing and teaching, and even then they did not commonly hold positions of authority. Third, she was born on the West Coast, which, even at that time, was a comparatively fertile environment for women's ideas to take root. That first sentence of most articles and book chapters on her life's work therefore offers a remarkable amount of context about the person herself.

Roy began her college career at Mount St. Mary's College. She earned 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 education enabled her to meet people who would influence her life's work, but none more so than Dorothy Johnson (Chesnay, 2007). Johnson held a seminar during which she challenged students to complete a "conceptual model for nursing" (Masters, 2011). Roy accepted 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 "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 maintains 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 individual and creating the wellness and balance that is desired (Roy & Andrews, 2008).

This theorist is compelling because her model embodies the belief that healing should not consist solely of modern symptom recognition and alleviation. Roy recognized that the whole person — body, mind, and spirit — are linked in the concept of wellness. The goal of a nurse is to promote wellness, and it seems counterproductive to engage one part of the human whole while neglecting the others. If a patient does not engage the mind in the healing process, there is a reasonable chance that the illness which attacked the body will return with greater force. To promote healing, therefore, is to promote the entire package of mind, body, and spirit.

Philosophic Basis and Worldview

A deeper understanding of the theory requires examining how it functions as a system. Two broad concepts exist in research for understanding systems, and they can also help clarify how a psychological or nursing theory operates. A mechanistic theory treats the individual as a single organism — it is simplistic and centralized. For example, every worker on an automobile assembly line has one specific task and is specialized to that function alone. The other type of system is organic (or organismic), which speaks to joint specialization and decentralization (Basavanthappa, 2007). Roy's theory is organic because she recognized that adaptation does not happen through any single bodily system or any one person in isolation. The model requires multiple elements beyond the purely physiological in order for healing to occur. Because this nursing theory is highly decentralized, it is definitively organic.

The concept of worldview also requires a discussion of the four metaparadigm concepts in nursing: person, health, environment, and nursing. Any nursing theory will contain some element of each, but one or more of these will typically sit at its core.

Regarding the person, Roy and Andrews (2008) state: "the human system is described as a whole with parts that function as a unity for some purpose. Human systems include people as individuals or in groups, including families, organizations, communities, and society as a whole." This conception of personhood is closely tied to Roy's sociological training. She viewed people as systems rather than solitary figures, which aligns well with the organic nature of the theory as a whole.

The person is also part of the environment and must make adaptive changes because of that environment (Roy & Andrews, 2008). People are able to survive within their environment because they understand and process the stimuli they receive (Peck, 2008). The goal of the model, however, is not simple survival but rather allowing the person to thrive within 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). A person cannot be truly healthy unless they first understand the relationship between their personhood and their environment. This is best illustrated with the example of an extreme stressor: the body responds to environmental threats with physiological activity that can be harmful if prolonged. A healthy person, however, is able to mitigate that response and regain the homeostasis of health.

Regarding nursing, Sister Roy holds that her patients need to understand how they function as an "integrated system" (Basavanthappa, 2007) before they can become whole and healthy. She stated that "nursing is to promote adaptation for individuals and groups in the four adaptive roles" (Masters, 2011). The nurse becomes key to the theory whenever he or she comes into contact with someone who is unwell. A patient in distress may not yet understand the need for adaptation, and a nurse helps encourage the roles of community, science, personhood, and spirituality — if requested — in the patient's life. The nurse can also play a critical role in helping the family with their own healing process.

Roy integrated all four metaparadigms so thoroughly that it is difficult to place her theory squarely within just one. If pressed, the person and the environment emerge as the most central concepts, with a slight edge toward the person. While the environment is not static, it is largely constant in its basic form. If a person learns to adapt to one type of change, that knowledge can be applied to similar environmental challenges in the future. The adaptation that the person accomplishes, therefore, is the central function of the theory.

References

Basavanthappa, B. T. (2007). Nursing theories. Japee Brothers Publishing.

Butts, J. B., & Rich, K. L. (2010). Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning.

Chesnay, M. D. (2007). Caring for the vulnerable: Perspectives in nursing theory, practice, and research. Jones & Bartlett Learning.

Current Nursing. (2010). Roy's adaptation model. Retrieved from http://currentnursing.com/nursing_theory/Roy_adaptation_model.html

Ivanov, L. L., & Blue, C. L. (2008). Public health nursing: Leadership, policy & practice. Cengage Learning.

Lampe, S. (2008). Minnesota state senator Kathy Sheran, BSN, RN, MS. Creative Nursing, 14(4), 189–198.

Masters, K. (2011). Nursing theories: A framework for professional practice. Jones & Bartlett Learning.

Meleis, A. I. (2007). Theoretical nursing: Development and progress. Lippincott, Williams & Wilkins.

Peck, S. (2008). Survivorship: A concept analysis. Nursing Forum, 43(2), 91–102.

Rogers, C., & Keller, C. (2009). Roy's adaptation model to promote physical activity among sedentary older adults. Geriatric Nursing, 30(2), 21–26.

Roy, C., & Andrews, H. A. (2008). The Roy Adaptation Model. Pearson Prentice Hall.

Shores, C. I. (2010). Spiritual perspectives of nursing students. Nursing Education Perspectives, 31(1), 8–18.

Sitzman, K., & Eichelberger, L. W. (2010). Understanding the work of nurse theorists: A creative beginning. Jones & Bartlett Learning.

Tagliareni, M. E. (2007). What binds us together: Bringing voice and value to the work we do each day. Nursing Education Perspectives, 28(6), 302–303.