THEORETICAL FOUNDATIONS IN NURSING

Sister Callista Roy:

Adaptation Model of Nursing
(Week No. 9)

INTRODUCTION

The Adaptation Model states that health is an inevitable dimension of

a person’s life, and is represented by a health-illness continuum.
Health is also described as a state and process of being and becoming
integrated and whole.

The Adaptation Model states that health is an inevitable dimension of

a person’s life, and is represented by a health-illness continuum.
Health is also described as a state and process of being and becoming
integrated and whole.

The environment has three components: focal, which is internal or

external and immediately confronts the person; contextual, which is
all stimuli present in the situation that all contribute to the effect of
the focal stimulus; and residual, whose effects in the current situation
are unclear. All conditions, circumstances, and influences surrounding
and affecting the development and behavior of people and groups
with particular consideration of mutuality of person and earth
resources, including focal, contextual, and residual stimuli.

LEARNING OUTCOME

After finishing this module the student will be able to:

1. Demonstrate comprehensive understanding in sister Callista Roy
Adaptation model
2. Explain the Concept of Adaptation model
3. Define the metaparadigm of Roy Adaptation model

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OUTLINE

1. Credentials and Background of the Theorist

2. Definition of adaptation and adaptation model
3. Major concepts
4. Major Assumptions
5. Theoretical Assertions
a. Nursing
b. Health
c. Environment
d. Person
6. References

CONTENT

Credentials and Background of the Theorist

Sister Callista Roy is a highly respected nurse theorist, writer, lecturer,

researcher, teacher and member of a religious community. She currently
holds the position of professor and nurse theorist at Boston College Connell
School of Nursing. Her name is one of the most recognized in the field of
nursing today worldwide. She is considered among nursing’s great living
thinkers. Roy earned an undergraduate degree in nursing from Mount St.
Mary's College in 1963, followed by a master's degree in nursing from
University of California, Los Angeles (UCLA) in 1966. She then earned
master’s and doctoral degrees in sociology from UCLA. She served as a
postdoctoral fellow in neuroscience nursing at the University of California,
San Francisco. She has been awarded four honorary doctorates
Roy’s other scholarly work includes conceptualizing and measuring coping
and developing the philosophical basis for the adaptation model and for the
epistemology of nursing.

Nurses also promote adaptation for individuals and groups in the four
adaptive modes, thus contributing to health, quality of life, and dying with
dignity by assessing behaviors and factors that influence adaptive abilities
and by intervening to enhance environmental interactions. The Four
Adaptive Modes of Roy’s Adaptation Model are physiologic needs, self-
concept, role function, and interdependence.

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Definition of Adaptation
Adaptation is the “process and outcome whereby thinking and feeling
persons as individuals or in groups use conscious awareness and choice to
create human and environmental integration.”

Adaptation model
In this model, humans (as individuals or in groups) are holistic, adaptive
systems. The environment consists of internal and external stimuli that
surround an individual or group. Health is seen as a sound, unimpaired
condition leading to wholeness. Nursing's goal is to promote modes of
adaptation that support overall health.

Four modes of adaptation support integrity:

1. Physiologic-physical
2. Self-concept group identity
3. Role function
4. Interdependence.
Levels of Adaptation
1. Integrated Process

• The various modes and subsystems meet the needs of the

environment. These are usually stable processes (e.g., breathing,
spiritual realization, successful relationship).

2. Compensatory Process

• The cognator and regulator are challenged by the needs of the

environment, but are working to meet the needs (e.g., grief, starting
with a new job, compensatory breathing).

3. Compromised Process

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• The modes and subsystems are not adequately meeting the

environmental challenge (e.g., hypoxia, unresolved loss, abusive
relationships)

Six-Step Nursing Process

A nurse’s role in the Adaptation Model is to manipulate stimuli by removing,

decreasing, increasing or altering stimuli so that the patient

1. Assess the behaviors manifested from the four adaptive modes.

2. Assess the stimuli, categorize them as focal, contextual, or residual.
3. Make a statement or nursing diagnosis of the person’s adaptive
state.
4. Set a goal to promote adaptation.
5. Implement interventions aimed at managing the stimuli.
6. Evaluate whether the adaptive goal has been met.

MAJOR ASSUMPTIONS

Scientific assumptions

• Systems of matter and energy progress to higher levels of complex

self-organization.
• Consciousness and meaning are constructive of person and
environment integration.

• Awareness of self and environment is rooted in thinking and feeling.

• Humans by their decisions are accountable for the integration of

creative processes.
• Thinking and feeling mediate human action.

• System relationships include acceptance, protection, and fostering of

interdependence.
• Persons and the earth have common patterns and integral
relationships.

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• Persons and environment transformations are created in human

consciousness.

Philosophical Assumptions

• Persons have mutual relationships with the world and God.

• Human meaning is rooted in the omega point convergence of the

universe.

• God is intimately revealed in the diversity of creation and is the

common destiny of creation.
• Persons use human creative abilities of awareness, enlightenment,
and faith.

• Persons are accountable for the processes of deriving, sustaining,

and transforming the universe.

Theoretical Assertions

Person

“Human systems have thinking and feeling capacities, rooted in

consciousness and meaning, by which they adjust effectively to changes in
the environment and, in turn, affect the environment.”

Based on Roy, humans are holistic beings that are in constant interaction
with their environment. Humans use a system of adaptation, both innate
and acquired, to respond to the environmental stimuli they experience.
Human systems can be individuals or groups, such as families,
organizations, and the whole global community.

Environment

“The conditions, circumstances and influences surrounding and affecting the

development and behavior of persons or groups, with particular
consideration of the mutuality of person and health resources that includes
focal, contextual and residual stimuli.”

The environment is defined as conditions, circumstances, and influences that

affect the development and behavior of humans as an adaptive system. The

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environment is a stimulus or input that requires a person to adapt. These

stimuli can be positive or negative.

Roy categorized these stimuli as focal, contextual, and residual. Focal

stimuli are that which confronts the human system and requires the most
attention. Contextual stimuli are characterized as the rest of the stimuli
that present with the focal stimuli and contribute to its effect. Residual
stimuli are the additional environmental factors present within the situation,
but whose effect is unclear. This can include previous experience with certain
stimuli.

Health

“Health is not freedom from the inevitability of death, disease, unhappiness,

and stress, but the ability to cope with them in a competent way.”

Health is defined as the state where humans can continually adapt to

stimuli. Because illness is a part of life, health is the result of a process
where health and illness can coexist. If a human can continue to adapt
holistically, they will be able to maintain health to reach completeness and
unity within themselves. If they cannot adapt accordingly, the integrity of
the person can be affected negatively.

Nursing

“[The goal of nursing is] the promotion of adaptation for individuals and
groups in each of the four adaptive modes, thus contributing to health,
quality of life, and dying with dignity.”

In Adaptation Model, nurses are facilitators of adaptation. They assess the

patient’s behaviors for adaptation, promote positive adaptation by enhancing
environment interactions and helping patients react positively to stimuli.
Nurses eliminate ineffective coping mechanisms and eventually lead to
better outcomes.

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References
Roy, C. and McLeod, D. (1981) The theory of the person as an adaptive

system. In George, J. (Ed.). Nursing theories: the base for professional

nursing practice. Norwalk, Connecticut: Appleton & Lange.

Roy, C. and Adrews, H. A. (1999). The Roy adaptation model (2nd ed). In

McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA:

Lippincott Williams & Wilkins

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