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Roy's Adaptation Model: Effect of Care on Pediatric Patients

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Review Article
Roy’s Adaptation Model: Effect of Care on
Pediatric Patients
Neha Saini1, Veena Sharma2, Smriti Arora3, Fareha Khan4

Abstract
With focus on groups of children who have increased morbidity, Roy’s adaptation model (RAM) is
one of the most useful conceptual frameworks that guide nursing practice. It focuses on individual’s
adaptation to changeable environment and guides the assessment of individual’s adaptation. The
four modes of adaptation defined in RAM are physiologic, self-concept, role function and
interdependence modes. Nurses help to meet the needs of individuals in these modes of adaptation.

Keywords: Effectiveness, Care based on Roy’s Adaptation Model, Physiological dimensions

Introduction
Nursing of infants, children and adolescents is consistent with the definition of nursing as “the diagnosis and
treatment of human response to actual or potential health problems.” This definition incorporates the four essential
features of contemporary nursing practice: attention to the full range of the human experiences and responses to
health and illness without restriction to a problem focused orientation, integration of objective data with knowledge
gained from an understanding of the patient or group’s subjective experience, application of scientific knowledge to
the process of diagnosis and treatment and provision of a caring relationship.1

Recent concern has focused on groups of children who have increased morbidity, are children living in poverty, LBW
children, children with chronic illness and homeless children. Therefore, the art of pediatric nursing care should focus
on philosophy of care, family centered care, and traumatic care (prevent or minimize the child’s separation from the
family, promote a sense of control, and prevent or minimize bodily injury and pain) which can be guided and provided
by theory-based nursing practice.1

Nursing has made phenomenal achievement in the last century that has led to the recognition of nursing as an
academic discipline and a profession. A move towards theory-based practice has made contemporary nursing more
meaningful and significant by shifting nursing focus from vocation to an organized profession. The need of the
knowledge base to guide professional nursing practice has been realized and many theoretical frameworks have been
contributed by nurses.2

Within nursing, the development and utilization of nursing models is an area of constant growth. A conceptual model
deals with abstractions that are assembled because of their relevance to a common theme. It is supposed that the
utilization of nursing models in clinical practice gives design to the nursing process.
1
MSc. Nursing Student, Child Health Nursing Department, 2Associate Professor, 4Tutor, Rufaida College of Nursing, Jamia Hamdard.
3
Professor, Amity College of Nursing, Haryana, India.
Correspondence: Ms. Neha Saini, Rufaida College of Nursing, Jamia Hamdard, India.
E-mail Id: nehasaini_06@yahoo.in
Orcid Id: http://orcid.org/0000-0003-4235-2808
How to cite this article: Saini N, Sharma V, Arora S et al. Roy’s Adaptation Model: Effect of Care on Pediatric Patients. Int J Nurs
Midwif Res 2017; 4(1): 52-60.
Digital Object Identifier (DOI): https://doi.org/10.24321/2455.9318.201708
ISSN: 2455-9318

© ADR Journals 2017. All Rights Reserved.

Int. J. Nurs. Midwif. Res. 2017; 4(1)
It has also been proposed that nurses will become more
autonomous and subsequently more accountable in
what they do if they use the nursing model in practice.3
In order for the nursing model to be rendered useful
within a practice area, it must be examined and defined.
Roy’s adaptation model (RAM) is one of the most useful
conceptual frameworks that guide nursing practice. It
focuses on individual’s adaptation to changeable
environment and guides the assessment of individual’s
adaptation. RAM enhances a nurse’s ability to improve a
person’s interaction with the surrounding environment
to provide an effective adaptation. The RAM has a
consistent nursing process that directs nursing practice
towards providing a holistic care of patients. RAM
facilitates communication among nurses and fosters the
development of common goals of patients care.3
Sister Callista in 1976 built the framework for RAM,
where she viewed the client as an adaptive system.
According to RAM, the goal of nursing is to help the
person’s adaptive system to change in physiological
Figure 1.Roy’s Adaptation Model
Concept of Roy’s Adaptation Model
There are numerous challenges in terms of caring for
the pediatric patient. The first and most important
question that flashes in a nurse’s mind in a clinical
setting is how they can help their clients and give them
care. In this regard, scholars have suggested several
important models and strategies. One of the nursing
models that have vastly and deeply worked on
adaptation in psychobiological and social dimensions is
Roy’s adaptation model, which aims at administration of
nursing interventions for improvement of adaptive
53
Saini N et al.
needs, self-concept, role function, and interdependent
relationship during health and illness.
Roy’s Adaptation Model
Adaptation is the primary concept of interest in RAM. It
is defined as the process and outcome in which thinking
and feeling persons use conscious awareness to create
integration between human perception and their
environment. RAM depicts the individual as a bio-
psychosocial being who is able to identify internal and
external stimuli that are influencing the person’s
adaptive behaviors. An individual responds in two
processes called the regulator and cognator subsystems.
The regulator subsystem includes autonomic body
responses. Cognitive subsystem responds through four
cognitive emotional channels: perceptual and
information processing, learning, judgment, and
emotion. Adaptation occurs when both the subsystems
are stimulated resulting in behavioral change measured
in physiological, self-concept, role function, and
interdependence as shown in Fig. 1.3
responses in each dimension (physiological, self-
concept, interdependence, and role function).4
Based on RAM, the pediatric patient is precisely
detected and his/her adaptive behaviors are increased
through nursing intervention and manipulation of their
causes as their stimulants, and consequently, a better
physiological and psychological adaptation is obtained.4
Based on this model, detection of unknown behavioral
stimulants leads to precise exploration of the causes of
patients’ maladaptive behaviors and helps the nurses to
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Saini N et al.
design an accurate care plan to solve the pediatric
patients’ problems (through adaptive behaviors).
Therefore, it is predicted that adaptive behaviors
(healthy behaviors) are increased in pediatric patients
by application of interventions that are designed based
on this model, which results in a reduction in
complications.4
A study was conducted by Clarke et al.6 in which RAM
focuses on a patient as a human being, the environment
surrounding them, their present health, and nursing
application or nursing responsibilities for that patient.
Each aspect plays an important part in understanding
the model as a whole. “RAM is the theoretical
framework that makes the combination of science-
based activities a uniquely nursing activity, directing
nursing care in a holistic direction.”5,6
According to Roy’s and Andrews, adaptation is the
primary concept of interest in RAM. It is defined as the
process and outcome in which thinking and feeling
persons use conscious awareness to create integration
between human perception and their environment.
Roy’s depicts the individual as a bio-psychosocial being
who is able to adapt to environmental stimuli
categorized as focal or contextual. Individual responds
to the stimuli through two processes called the
regulator and the cognitive subsystems.
The regulator subsystem includes autonomic bodily
responses through neural, chemical and endocrine
responses. Cognitive subsystem responds through four
cognitive emotional channels: perceptual and
information processing, learning, judgment, and
emotions. Adaptation occurs when the cognator and
regulator subsystems are stimulated resulting in
behavioral changes measured in physiological, self-
concept, role function and interdependence.7
Though it is all mentioned in books to provide care on
the basis of nursing theories in order to follow principles
of nursing care, still when we work in the clinical setting
it is not followed. Through the evidence-based practice
and a nursing theory is focused to guide assessment,
interventions, evaluation, and implementation of
nursing care, in order to improve the maladaptive
behavior with the problems related to health, the RAM
can be used.
8
Modes of Roy’s Adaptation Model
The four modes of adaptation defined in RAM are
physiologic, self-concept, role function and
interdependence modes. Nurses help to meet the needs
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Int. J. Nurs. Midwif. Res. 2017; 4(1)
of individuals in these modes of adaptation. The
classification of the individual’s positive physiologic
mode adaptation indicators are as follows:
Physiologic mode
The physiological mode measures all bodily functions.
Oxygenation
• Balanced ventilation period
• Balanced gas exchange style
• Sufficient gas exchange
• Sufficient compensation period
Nutrition
• Balanced digestion period
• Sufficient nutrition style for body requirements
• Supplying metabolic and nutritional requirements
with altered nutrition style
Elimination
• Sufficient bowel evacuation period
• Balanced bowel evacuation style
• Sufficient urination period
• Balanced urinary elimination style
• Efficient coping methods in case of altered
evacuation style
Activity and Rest
• Sufficient activity period
• Sufficient empowerment of balancing movements
during immobility
• Sufficient activity and resting style
• Sufficient sleep period
• Environmental changes effecting sleep disturbances
Protection
• Intact skin
• Sufficient healing period
• Sufficient secondary protection against changes in
immune status and skin integrity
• Sufficient immune period
• Sufficient heat regulation
Senses
• Sufficient emotion period
• Efficient integration of emotional data input
• Balance of perceptive input and evaluation
• Efficient coping methods in case of altered sense
54
Int. J. Nurs. Midwif. Res. 2017; 4(1)
Fluid-electrolyte and acid-base balance
• Sufficient period in fluid balance
• Balanced electrolyte levels of body fluids
• Balanced acid-base status
• Efficient organization of chemical buffering
Neurologic Function
• Efficient response in sense, perception, coding,
concept formation, memory, language, planning
and motor response
• Integration of thought and sense processes
• Development of flexibility and functional
effectiveness during neurologic system aging and
alteration
Endocrine Function
• Efficient hormonal regulation during body and
metabolic processes
• Efficient hormonal regulation in reproductive
development
• Negative feedback closed-circuit balance in
hormonal regulation
• Balanced hormone cycle rhythm
• Efficient stress management methods
Self-Concept Mode
Focuses personal aspects of human system especially
psychic and spiritual integrity. It deals with the
perception of the physical self.
The classification of the individual’s positive self-concept
mode adaptation indicators are as follows:
• Positive body image
• Effective sexual function
• Spiritual integrity in physical growth
• Sufficient compensation for body changes
• Sufficient coping methods in loss
• Efficient period in end-of-life
• Sufficient integration of own ideas
• Balanced consistency
• Efficient period in moral-ethic and spiritual
development
• Functional self-respect
• Efficient coping methods in threat against oneself
Role Function Mode
It deals with the social integrity, focuses on performance
of activities associated with various life roles.
55
Saini N et al.
The classification of an individual’s positive role function
mode adaptation indicators are as follows:
• Identification of roles
• Efficient role changing period
• Combination of non-verbal and explanatory role
movements
• Combination of primary, secondary and tertiary
roles
• Efficient example in fulfilling roles
• Efficient coping methods in role changing
• Responsibility to fulfill roles
• Combining efficient roles
• Balanced role sufficiency
Interdependence Mode
It deals with social integrity and it focuses on affectional
relationships, provision and receipt of social support.
The classification of an individual’s positive
interdependence mode adaptation indicators are as
follows:
• Sufficient love
• Balanced love, respect, giving and taking value
• Efficient dependent and independent examples
• Efficient coping methods in case of loneliness and
separation
• Sufficient development for learning and maturation
in relationships
• Sufficient communication and relation
• Providing developmental talent in formation of
attention and care
• Trust in relationships
• Sufficiency of support systems and close individuals
in providing development
Application of Roy’s Adaptation Model in
Pediatric Care
Waweru et al.9 conducted a study to assess the
adaptation of children living with AIDS in the self-
concept mode. They considered coping with AIDS as
focal stimuli, the environment of care as the contextual
stimulus, while the developmental level of the school-
aged children was the residual stimulus. Waweru et al.
has completely supported the RAM in which various
stimuli are affecting the self-concept mode. Also this
study indicated that RAM could be used cross culturally.
Ramini et al.10 conducted a study to use the RAM to
examine adaptive strategies of adolescents with cancer.
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Saini N et al.
The questions have been used to reflect the
physiological mode in the study related to the most
distressing physical problems. The self-concept mode
includes questions associated with feelings about body
and self. The role function mode includes questions
about the activities done by the breast cancer support
group and the satisfaction level indicated these
activities. The questions reflected the interdependence
mode was related to the quality and quantity of support
received from the support group. Results showed that
adolescents and young adults reported evidences of
positive adaptation.
11
Linda conducted a study and the purpose of this study
was to link theory to practice by comparing the
effectiveness of a theory-based nursing intervention
with that of standard nursing practice. An intervention
to address loss, guided by RAM, was tested for its effect
on health outcomes among persons with chronic illness
and found that the adaptation was increased.
Afrasiabifar et al.12 conducted a study and the aim of the
present study was to examine the effect of RAM-based
patient education on adaptation of hemodialysis. The
results showed significant differences in the mean
scores of physiological and self-concept models
between the test and control groups (P=0.01 and P=0.03
respectively). Also a statistical difference (P=0.04) was
observed in the mean scores of the role function mode
of both groups. There was no significant difference in
the mean scores of interdependence modes between
the two groups.
Radhamaniamma4 conducted a study and described a
detailed case application of RAM in the nursing care of
patients with rheumatoid arthritis. The assessment and
intervention were guided by RAM. An assessment tool
for rheumatoid arthritis patient was prepared and
administered to patients and found significant
difference in the outcomes.
Implications of Roy’s Adaptation Model
Nursing Education
1. Encourage the students for effective utilization of
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Int. J. Nurs. Midwif. Res. 2017; 4(1)
evidence-based practice, caring for pediatric
patients.
2. Student nurses may be provided with learning
experience for use of theory-based care as an
intervention, caring for pediatric patients.
3. Student nurses and staff nurses can be educated for
the use of care based on RAM for early
identification and management of patients with a
disease condition caring for pediatric patients.
Nursing Practice
1. Nurses have a vital role in providing effective care
to treat disease conditions for pediatric patients.
This can be done by motivating nurses to
understand the importance of theory-based care in
the management of diseases.
2. Domains of the model are to be considered and
assessed before providing care to the pediatric
patient.
3. Based on RAM, the pediatric patient can be
precisely detected and patient’s adaptive behaviors
are increased through nursing intervention and
manipulation of their causes as their stimulant.
Nursing Administration
1. The finding of the study could serve as a basis for
administration to organize in-service education for
nursing personnel to emphasize the importance of
care based on RAM for pediatric patient.
2. The nurse administrators are in the pivotal position
to formulate policies and implementation of this
evidence-based practice at bed-side caring for
pediatric patients.
3. They can also encourage further researches as per
the recommendation.
Nursing Research
• Promote more researches on theory-based nursing
care in order to manage chronic as well as acute
diseases in pediatric patients which can improve the
base of professional knowledge in nursing.
• Promote effective utilization of research findings on
management of diseases caring for pediatric
patients.
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Int. J. Nurs. Midwif. Res. 2017; 4(1) Saini N et al.

Developing a Nursing Care Assessment Tool and Planning Nursing Care for a Pediatric Patient
Questionnaire Based on Roy’s Adaptation Model (Physiological Modes) for Children with URTI

Aspect of Physiological Modes to be Area to be Evaluated Before After Intervention

Measured Intervention
Problems associated with oxygenation 1. Respiratory rate(12-18/min)
Normal (2)
Abnormal (1)
2. Depth of respiratory
Deep (3)
Moderate (2)
Shallow (1)
3. Rhythm of respiration
Regular (2)
Irregular (1)
4. Chest retraction
No (2)
Yes (1)
5. Oxygen saturation of the child.
<80% (1)
81-90% (2 )
>90% (3)
6. Capillary refill time
<3 sec (2)
>3 sec (1)
7. Cough
Yes (1)
No (2)
8. Dyspnea
Yes (1)
No (2)
9. Nasal discharge
Yes (1)
No (2)
10. Nasal flaring
Yes (1)
No (2)
11. Grunting
Yes (1)
No (2)
Problems associated with nutrition 1. Weight of the child
Normal (2)
Abnormal (1)
2. Appetite
Good (2)
Poor (1)
3. Nausea and vomiting
Yes (1)
No (2)
Problems associated with activity and 1. Does the child have difficulty in getting up in the morning?
rest Yes (1)

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Saini N et al. Int. J. Nurs. Midwif. Res. 2017; 4(1)

No (2)
2. Duration of sleep
<4 hours (1)
4-6 hours (2)
6-8 hours (3)
>8 hours (4)
3. Activity intolerance?
Yes (1)
No (2)
Yes (1)
No (2)
5. General weakness
Yes (1)
No (2)
6. Irritability
Yes (1)
No (2)
7. Restlessness
Yes (1)
No (2)
8. Breathing worsens at night
Yes (1)
No (2)
Problems associated with protection 1. Is there any dryness and crackling of the skin due to various
procedures?
Yes (1)
No (2)
2. Is there any delayed wound healing process?
Yes (1)
No (2)
3. Temperature
Normal temperature (2)
Abnormal temperature (1)
4. WBC Count
Normal (2)
Abnormal (1)
Problems associated with fluid and 1. Is there any episode of vomiting during the course of illness?
electrolyte Yes (1)
No (2)
2. Is there any episode of loose motion during the course of illness?
Yes (1)
No (2)
3. Does the child have dry lips?
Yes (1)
No (2)
4. Does the child have poor skin turgor?
Yes (1)
No (2)
5. Serum Sodium
Normal (2)
Abnormal (1)
6. Serum Potassium

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Int. J. Nurs. Midwif. Res. 2017; 4(1)
Nursing Care on Questionnaire Based on Roy’s Adaptation Model to Assess Physiological Dimensions
Nursing Diagnosis
Ineffective airway clearance related to
increased mucous production as
evidenced by cough
Risk for imbalanced nutrition less than
body requirements related to loss of
appetite as evidenced by weight loss
Activity intolerance related to acute or
prolonged illness as evidenced by
reduced physical mobility, exertional
dyspnea, tachypnea
Ineffective thermoregulation related to
infection as evidenced by elevated body
temperature
59
Saini N et al.
Normal (2)
Abnormal (1)
7. Serum Chloride
Normal (2)
Abnormal (1)
Intervention
Assess patient’s condition
Establish rapport to patient and SpO2
Monitor and record vital sign
Assist patient to change position every 30 minutes
Elevate head of bed and align head in the middle, position the
patient in semi fowler’s position
Auscultate lung fields, noting areas of decreased/absent airflow and
adventitious breath sounds
Encourage steam inhalation
Encourage to increase fluid intake.
Administer meds as ordered
Suction nasal, tracheal or oral PRN
Review client’s chest X-ray for severity of acute/chronic
Provide health teachings regarding effective coughing and deep
breathing exercise.
Assess the child weight. Evaluate general nutritional state, obtain
baseline weight.
Provide small, frequent meals, including dry foods and/or foods that
are appealing to patient.
Consider limiting use of milk products
Elevate the patient’s head and neck, and check for tube’s position
during NG tube feedings.
Auscultate for bowel sounds. Observe for abdominal distension.
Multivitamins can be provided in order to replenish lost vitamins.
Teach the importance of feeding during illness.
Determine patient’s response to activity. Note reports of dyspnea,
increased weakness and fatigue, changes in vital signs during and
after activities.
Provide a quiet environment and limit visitors during acute phase as
indicated. Encourage use of stress management and diversional
activities as appropriate.
Assist patient to assume comfortable position for rest and sleep.
Assist with self-care activities as necessary.
Provide for progressive increase in activities during recovery phase
and demand.
Explain importance of rest in treatment plan and necessity for
balancing activities with rest.
Monitor vital signs 4 hourly.
Assess skin temperature.
Tapid sponge should be provided
Instruct SpO2 to provide with loose clothing.
Encourage fluid intake orally or intravenously as ordered.
Measure intake and output
Monitor WBC count.
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 Saini N et al. Int. J. Nurs. Midwif. Res. 2017; 4(1)

To administer antipyretics as prescribed by physician.

Imbalanced fluid and electrolyte related
to indigestion as evidenced by vomiting/
diarrhea
Check for the source of infection.
Assess the general condition of the patient to check the base line
data.
Assess for hypotension and tachycardia.
Assess skin turgor, moisture of mucous membranes.
Investigate reports of nausea and vomiting.
Monitor intake and output (I&O), noting color, character of urine.
Calculate fluid balance. Be aware of insensible losses. Weigh as
indicated.
Administer medications as indicated: antiemetic’s, antidiarrheal,
antibiotics as needed
Provide supplemental IV fluids as necessary

Conclusion 4. Radhamaniamma J. Nursing care of patients with

Recent concern has focused on groups of children who
have increased morbidity, are children living in poverty,
LBW children, children with chronic illness and homeless
children. Therefore, the art of pediatric nursing care
should focus on philosophy of care, family centered care
and atraumatic care, which can be guided and provided
by theory-based nursing practice. Within nursing, the
development and utilization of nursing models is an area
of constant growth. RAM is one of the most useful
conceptual frameworks that guide nursing practice. It
focuses on individual’s adaptation to changeable
environment and guides the assessment of individual’s
adaptation. RAM aims at administration of nursing
interventions for improvement of adaptive responses in
each dimension (physiological, self-concept,
interdependence, and role function.
Conflict of Interest: None
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Nursing Journal 2008; 34: 72-79.
rheumatoid arthritis: An application of Roy’s
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5. Kraszewski L. Sister Callista Roy and the Adaptation
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Date of Submission: 07th Apr. 2017
Date of Acceptance: 22nd May 2017

ISSN: 2455-9318 60

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