Nursing Science

Research Issues Quarterly, 13:1, January 2000

Research Issues Violet M. Malinski, Contributing Editor

Research-Based Evaluation of
Conceptual Models of Nursing
Violet M. Malinski, RN; PhD
Associate Professor, Hunter-Bellevue School of Nursing, Hunter College, City University of New York

Ischolars
n this and subsequent issues, nurse ber of the Boston-Based Adaptation in
with expertise in particular Nursing Research Society (BBARNS),
nursing models will summarize and presents a summary of what has been
evaluate knowledge generated through learned from Roy adaptation model–
research in those models. In this col- based research over the past 25 years.
umn, Dr. Keville Frederickson, a mem-

Violet M. Malinski
Contributing Editor

Nursing Knowledge Development Through Research:

Using the Roy Adaptation Model
Keville Frederickson, RN; EdD; FAAN
Professor and Director, Graduate Programs, Lehman College,
Department of Nursing, City University of New York, Bronx

P rior to Parse’s (1987) identification of the prevailing nurs-
ing paradigm of totality and the identification of an emerging
paradigm of simultaneity, there were attempts to test all nurs-
ing models using a quantitative methodology. Parse believes
Editor’s Note: Send manuscripts concerning research using nursing
theories and models, new research methods, or research issues perti-
nent to nursing’s epistemology to Violet M. Malinski, RN, PhD, As-
sociate Professor, Hunter-Bellevue School of Nursing, Hunter Col-
lege, City University of New York, 425 E. 25th Street, Box 945, New
York, NY 10010-2590; work phone: (212) 481-5102; fax: (212)
481-4427; home phone: (914) 793-4145; e-mail: ViMM@aol.com.
Author’s Note: The author acknowledges the BBARNS group.
Nursing Science Quarterly, Vol. 13 No. 1, January 2000, 12-17
© 2000 Sage Publications, Inc.
that the philosophical basis of a model directs the research
methodology. Thus, the more Cartesian models, or those in
the totality paradigm, are appropriately tested using quantita-
tive methods, whereas the more existential phenomenologi-
cal frameworks need to be examined using qualitative re-
search methods.
One example of the adequacy of this belief is through ex-
amination of Fawcett’s (1989) research. Her earlier work
based on Rogers’ science of unitary human beings used a
quantitative design and consistently resulted in nonsupport of
hypotheses. Fawcett’s approach remained true to her beliefs,
which state that if hypotheses that are structured from the
Keywords: knowledge development, nursing research,
Roy adaptation model

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model cannot be supported, the logic of the model must be
called into question. Fawcett then used the Roy adaptation
model (RAM), finding support for her hypotheses through a
program of research that has focused on adaptation to un-
planned cesarean sections, multiple sclerosis, and cancer
(Fawcett & Tulman, 1990). One could argue that Fawcett’s
work supports the belief that quantitative methods are not ap-
propriate for testing models in the simultaneity paradigm.
However, the solution to the match between methodology and
paradigm is not this simplistic. A dilemma remains when
adopting Fawcett’s views about theory building—theoretical
support can be provided only for models that can be tested by
deriving and researching hypotheses and propositions. Ac-
cordingly, it seems that only models within the totality para-
digm can be validated, a highly debatable idea.
This column is not meant to be an arena for working out the
differences in nursing’s thinking about theory and theory de-
velopment. It is meant to show the evolution and current state
of research using the RAM, a nursing model within the total-
ity paradigm that has been tested in more than 200 quantita-
tive research studies. Although there are a few qualitative
studies, the vast majority of the studies used a quantitative de-
sign. This is fortunate for the model. Current thinking in nurs-
ing theory views the RAM within the totality paradigm, in
which quantitative methods are viewed as appropriate.
The Roy Adaptation Model
The RAM was proposed by Sr. Callista Roy and first pub-
lished in 1970. The original model was scientifically based on
Helson’s (1964) work on physical adaptation and on general
system theory (von Bertalanffy, 1968).
The model was developed by Roy with components expli-
cated from both the literature and clinical practice. The modes
or outcomes of adaptation were named by the classification of
incidents of patient behaviors as submitted by practicing
nurses. Over the years, Roy has expanded the scientific as-
sumptions and developed and refined the philosophical as-
sumptions. She has redefined adaptation to include nine sci-
entific assumptions that include (but are not limited to) the
concepts from Helson (1964) and system theory (Roy & An-
drews, 1999).
Roy’s original philosophical assumptions for the model
were first published in 1988 and most recently refined to fo-
cus on humanism and veritivity (Roy & Andrews, 1999).
Veritivity focuses on the common good, the roots of human
meaning, and the value and meaning of life.
As Roy’s thinking evolves, questions are emerging regard-
ing the model’s consistency with the totality paradigm. As the
definition of adaptation is expanded and the concept of veri-
tivity is refined, similarities with the simultaneity paradigm
have appeared. Does this mean that there is a lack of internal
consistency within the model? It can be argued that model
modifications are consistent with changes in social thinking
and nursing, the growth of the theorist, and research findings.
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Research Issues 13
There is an evolution in nursing science toward caring and an
emphasis on human science. Views about nursing theory need
to interact with and be open to ideological changes in nursing.
The primary concept in nursing’s metaparadigm is the per-
son. As society’s views about people change, it is quite likely
that another nursing paradigm will emerge, reflecting these
views.
The development of nursing knowledge through the RAM
has been extensive. Using Fawcett’s (1995) model for knowl-
edge development, there is a hierarchy for developing theory
from nursing models. One way of viewing nursing science is
through the published writings of nurse theorists. These
global perceptions are described as a conceptual model.
Theories are derived from the model and represent a system-
atic way of viewing the world. By deriving propositions from
the model, researchable hypotheses can be tested.
Subsequent research seeks to validate these views about
the individual, environment, health, and nursing. Proposi-
tions are statements that explain the relationship between the
concepts integral to the model. Research that explicates the
nature of the model as well as theories that confirm or support
the structure of the model add to the knowledge base of the
model as well as to nursing science (Frederickson, Jackson,
Strauman, & Strauman, 1991). Conversely, lack of support
for the propositions would be an appropriate conclusion when
the empirical data do not confirm the hypothesized expecta-
tions. The examination and synthesis of findings from a large
body of RAM research provides insights into the support of
propositions and the conceptualization of the RAM.
Knowledge Synthesis: Formation of the Boston-Based
Adaptation in Nursing Research Society (BBARNS)
In 1991, the BBARNS, a small group of researchers using
the RAM, began meeting with Roy. The first efforts of this
group resulted in the publication of a paper analyzing the
combined implications of five studies based on the RAM
(Pollock, Frederickson, Carson, Massey, & Roy, 1994). The
results served as an impetus to embark on a large-scale proj-
ect. An integrative research review was conducted on all
RAM research over the 25 years of the model. The group
added three more members whose research was also based on
the RAM.
Over the next 4 years (1994-1998) the group met, devel-
oped, and implemented the methodology for conducting the
integrative research review, which was then published. The
details of the methodology for the review and the full report of
the findings may be found in the monograph by Roy et al.
(1999). For the purpose of this column, the focus is on theory
building and support of the model through testing RAM
propositions specific to nursing’s metaparadigm concepts
and is derived from the monograph.
Theory building was based on propositions that were
tested by each of the studies. Of the 163 studies that met the
criteria for relatedness to the model and scientific soundness,
14 Nursing Science Quarterly, 13:1, January 2000
116 were identified as demonstrating adequate linkages to the
model. Therefore, only these 116 studies were used for
proposition testing and knowledge synthesis.
The BBARNS group selected 12 generic propositions pri-
marily from the work of Roy and Roberts (1981) for relevance
to the 116 studies and for the focus on the holistic view of the
person. The 12 propositions were categorized as pertaining to
one of three areas: the metaparadigm concepts, adaptation
processes of the person, and stimuli. The propositions are as
follows:
1. At the individual level, regulator and cognator processes af-
fect innate and acquired ways of adapting.
2. At the group level, stabilizer and innovator processes affect
adaptation.
3. The characteristics of the internal and external stimuli influ-
ence adaptive responses.
4. The characteristics of the internal and external stimuli influ-
ence the adequacy of cognitive and emotional processes.
5. The adequacy of cognator and regulator processes will af-
fect adaptive responses.
6. Adaptation in one mode is affected by adaptation in other
modes through cognator and regulator.
7. The pooled effect of focal, contextual, and residual stimuli
determines the adaptation level.
8. Adaptation is influenced by the integration of the person
with the environment.
9. The variable of time influences the process of adaptation.
10. The variable of perception influences the process of
adaptation.
11. Perception influences adaptation through linking the regu-
lator and cognator subsystems.
12. Nursing assessment and interventions relate to identifying
and managing input to adaptive systems. (Roy & Andrews,
1999, p. 547)
In addition to the generic propositions, ancillary proposi-
tions were derived from the studies. An ancillary proposition
is a more concrete statement within a generic proposition, of-
ten in the form of a middle-range theory.
Metaparadigm Concepts and the Propositions
The metaparadigm concepts (Fawcett, 1995) recognize
the person or group as an integrated whole that has innate and
acquired ways of adapting. Four of the generic propositions
specifically address the metaparadigm concepts: person, en-
vironment, health, or nursing. By addressing the concepts in
this manner, health becomes an outcome of adaptive pro-
cesses that reflects patterns of being and becoming whole and
integrated with self and with the environment. The following
propositions address the metaparadigm concepts.
The first proposition focuses on the concept of person. The
fifth proposition is specific to the concept of health. Proposi-
tion 8 focuses on the environment. Proposition 12 is specific
to the concept of nursing.
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Concept of Person
The first proposition focuses on the metaparadigm con-
cept of person as viewed by the RAM. According to the
RAM, the theory of the adapting person recognizes the
unique role of the innate and acquired coping mechanisms
(the regulator and cognator) in adaptation. Adaptation
through the regulator or cognator are processes that can affect
the person negatively or positively and produce a challenge to
the adaptive system in maintaining and enhancing the well-
being of the self. Adaptation is the core of the RAM theory.
The cognator and regulator are the active forces in the process
of adaptation for the person.
Derived from the first proposition, 35 ancillary proposi-
tional statements were tested. Of these, 33 supported the
proposition and 2 did not. The number of propositional state-
ments implies that the proposition is clear enough for use in a
substantial number of studies. As a proposition derived from
the concept of person within the metaparadigm, support of the
theoretical underpinnings of the relationships of these con-
cepts was validated.
As an example, five studies supported the ancillary propo-
sition “Cognitive processing affects self concept, and self-
concept may affect cognitive processing.” On the other hand,
a study by Roy (1977) did not support this ancillary proposi-
tion. The failure of Roy’s work to support the proposition may
be indicative of the early stages of measurement of the model
concepts.
Concept of Health
The fifth proposition states that the adequacy of cognator
and regulator processes will affect adaptive responses. De-
rived from the metaparadigm, this concept implies the con-
cept of health. The cognator and regulator operate to process
stimuli with the goal of adaptation, which in turn promotes
health. When the cognator and regulator processes are able to
contribute to the goals of adaptation, the overall results lead to
effective responses. On the other hand, when the cognator and
regulator processes do not contribute to the goals of adapta-
tion, ineffective responses result. The adequacy of the cogna-
tor or regulator has the greatest impact on the adaptation pro-
cess.
Most studies supported the fifth generic proposition,
which is specific to the concept of health. Of the ancillary
statements, 20 were derived and tested from this generic
proposition. Of these, 17 supported the ancillary propositions
and 3 did not. The ancillary proposition “Adaptive processes
relate to health” was tested by six studies. Three supported
this ancillary proposition and three did not. Frederickson
et al. (1991) found that perceived physical and psychosocial
well-being among cancer patients was related to longevity.
However, Phillips and Brown (1992) found no relationship
between adaptation to mill workers’ shift work and injuries.

Further testing should focus on health, namely, adaptation
among specific populations.
Concept of Environment
The eighth proposition identifies the influence of the inte-
gration of person with environment on adaptation. The mu-
tual interaction of persons and their environment is inherent
in the metaparadigm concept of environment. Conceptually,
the relationship is based on the processes of synthesizing the
individual’s internal and external environments. The goal of
the interaction is to maintain balance and growth for both the
self and the environment. It is the quality of the integration
that determines the adaptation level.
Eight ancillary propositions were derived from this ge-
neric proposition and tested, and all were supported. Four of
these propositions focused on stimuli, a primary concept in
Roy’s definition of environment. Armer (1989) found that re-
location adaptation among the elderly moving to congregate
living is influenced by a sense of prediction and control. Re-
sponses to environmental stimuli such as relocation, eye sur-
gery, or the use of a birth chair indicate that adaptation is fa-
cilitated by the individual’s integrating new stimuli as part of
the self and one’s environment. Future studies need to address
the integration of environment as promoting adaptation.
Concept of Nursing
Proposition 12 states that the goal of nursing interventions
is to enhance adaptation by managing input to adaptive sys-
tems. Derived from the metaparadigm concept of nursing,
model-based nursing assessments and interventions focus on
managing the focal and/or contextual stimuli. Nurses enter
the client system by using the nursing process and managing
incoming stimuli to promote adaptation. Nursing, therefore,
recognizes the role of identification and management of stim-
uli and developing theories of interventions and their effects
on patient outcomes. In this context, nursing interventions be-
come a powerful force for managing the focal or contextual
stimuli to produce a source of stability and growth called ad-
aptation level.
In the research reported on proposition 12, there were 11
ancillary propositions derived; 8 supported the propositions
and 3 did not. Of 5 ancillary propositions that tested nursing
interventions, 3 were supported and 2 were not. Guzetta
(1979), Meek (1993), and Parlin (1990) supported the ancil-
lary proposition that the goal of nursing interventions is to en-
hance adaptation and manage input to adaptive systems.
Meek (1993), Parlin (1990), and Prelewicz (1993) studied the
effects on the elderly of noninvasive interventions such as
massage and pets. Prelewicz (1993) found that animal-
assisted therapy did not significantly decrease loneliness
among the elderly in a nursing home. Although there was not
statistical significance in all studies related to the effects of
pets, there was clinical significance. The studies viewed pets
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Research Issues 15
as positive therapeutic aids for the elderly. In this instance, the
findings were in a positive direction and the intervention
posed few risks. Further testing needs to be done. Nursing in-
terventions that enhance adaptation are important both theo-
retically and clinically.
Summary
Almost half of the ancillary propositions tested in the
metaparadigm category were related to the concept of person,
and 94% were supported. Theoretically and empirically, there
is support for Roy’s conceptualization of the person as an
adaptive system. Almost 25% of the ancillary propositions
tested were related to the concept of health, of which the great
majority were supported. Theoretically and empirically, there
is support for Roy’s conceptualization of health as an out-
come of adaptation. Approximately 75% of the ancillary
propositions tested were related to the concept of person or
health. Of these, only 5 out of 55 ancillary propositions were
not supported, or less than 10%.
Less than 13% of the ancillary propositions that were
tested focused on the metaparadigm concepts of environment
or nursing. Of these, 15% were not supported. These findings
are not surprising, because conceptual clarity is the founda-
tion of practice theory. The hierarchy of research, according
to the classic work by Dickoff and James (1968), progresses
from understanding and describing phenomena to situation-
producing theory. Nursing models are relatively young. Re-
search is required to validate the concepts within the models.
Situation-producing theory, based on the concepts, guides
nursing actions and is necessary for a practice discipline to
maintain its status as a profession.
Based on the findings of the integrative research review,
adequate research has provided support for Roy’s conceptu-
alization of the metaparadigm concepts of person and health.
Future research needs to be directed toward testing proposi-
tions derived from the RAM concepts of environment and
nursing. Intervention studies need to be designed based on
concepts that have been supported. Knowledge development
through research and testing of propositions based on the
RAM continues to contribute to nursing science. Future di-
rections for RAM research are clear.
References
Armer, J. M. (1989). Factors influencing relocation adjustment
among community-based rural elderly (Doctoral dissertation,
University of Rochester, 1988). Dissertation Abstracts Interna-
tional, 50, 1321-B.
Dickoff, J., & James, P. (1968). A theory of theories: A position pa-
per. Nursing Research, 17, 197-203.
Fawcett, J. (1989). Spouses’ experiences during pregnancy and the
postpartum: A program of research and theory development. Im-
age: Journal of Nursing Scholarship, 21, 149-152.
Fawcett, J. (1995). Analysis and evaluation of conceptual models of
nursing (3rd ed.). Philadelphia: Davis.
16 Nursing Science Quarterly, 13:1, January 2000
Fawcett, J., & Tulman, L. (1990). Building a programme of research
from the Roy adaptation model of nursing. Journal of Advanced
Nursing, 15, 720-725.
Frederickson, K., Jackson, B., Strauman, T., & Strauman, J. (1991).
Testing hypotheses derived from the Roy adaptation model.
Nursing Science Quarterly, 4, 168-174.
Guzetta, C. E. (1979). Relationship between stress and learning. Ad-
vances in Nursing Science, 1(4), 35-39.
Helson, H. (1964). Adaptation level theory. New York: Harper &
Row.
Meek, Sr. S. (1993). Effects of slow stroke back massage on relaxa-
tion in hospice clients. Image: Journal of Nursing Scholarship,
25, 17-21.
Parlin, C. A. (1990). Physiological manifestations of human/animal
interaction in adult population over fifty-five (Master’s thesis,
University of Nevada, Reno, 1988). Masters Abstracts Interna-
tional, 28, 113.
Parse, R. (1987). Nursing science: Major paradigms, theories, and
critiques. Philadelphia: Saunders.
Phillips, J. A., & Brown, K. C. (1992). Industrial workers on rotating
shift pattern: Adaptation and injury status. AAOHN Journal, 40,
468-476.
Pollock, S., Frederickson, K., Carson, M., Massey, V., & Roy, C.
(1994). Contributions to nursing science: Synthesis of findings
Commentary
Violet M. Malinski
IAdaptation
t is clear from Frederickson’s column that the Boston-Based
in Nursing Research Society undertook a chal-
lenging task that demanded much energy, time, and commit-
ment. In the space provided here, she could provide only an
overall sketch of the work performed by a small group of indi-
viduals committed to the Roy adaptation model. The identifi-
cation of the 12 generic propositions will serve as a useful
guide for those using the model in practice, education, and ad-
ministration as well as in future research endeavors.
Frederickson identifies a number of interesting points.
One is the common allocation of quantitative methods to the
totality models/theories, and qualitative methods to the si-
multaneity models/theories. As Frederickson points out, the
reality is more complex. Parse’s simultaneity theory and Wat-
son’s totality theory both call forth qualitative designs.
Rogers, whose work ushered in the simultaneity perspective
in nursing, maintained that both were useful for Rogerian sci-
ence–based research, with choice of method determined by
the nature of the question and phenomena under study
(Rogers, 1994). Roy also sees both as potentially useful, call-
ing for multiple methods of study (Roy & Andrews, 1999).
However, she does discuss qualitative methods as founda-
tional to later quantitative work, one way of looking at the two
research approaches.
Conceptual fit is equally important. If, for example, the
phenomenon under study is reflective of person-environment
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from adaptation model research. Scholarly Inquiry for Nursing
Practice, 8, 361-372.
Prelewicz, T. N. (1993). The effects of animal-assisted therapy on
loneliness in elderly residents of a long-term care facility utiliz-
ing Roy’s adaptation model (Master’s thesis, D’Youville Col-
lege, 1993). Masters Abstracts International, 31, 1749.
Roy, Sr. C. (1970). Adaptation: A conceptual framework for nursing.
Nursing Outlook, 18(3), 43-45.
Roy, Sr. C. (1977). Decision-making by the physically ill and adap-
tation during illness (Doctoral dissertation, University of Cali-
fornia, Los Angeles, 1977). Dissertation Abstracts International,
38, 5060-A.
Roy, C., & Roberts, S. (1981). Theory construction in nursing: An
adaptation model. Englewood Cliffs, NJ: Prentice Hall.
Roy, Sr. C., & Andrews, H. (1999). The Roy adaptation model (2nd
ed.). Stamford, CT: Appleton & Lange.
Roy, Sr. C., Pollock, S., Massey, V., Lauchner, K., Velasco-Whetsell,
M., Frederickson, K., Barone, S., & Carson, M. (1999). The Roy
adaptation model-based research: Twenty-five years of contribu-
tions to nursing science. Indianapolis, IN: Sigma Theta Tau.
von Bertalanffy, L. (1968). General system theory. New York:
Braziller.
interaction and adaptation rather than integrality and mutual
process, a corresponding theoretical shift (such as Frederick-
son cites for Fawcett) is probably more reason for success
than the type of research per se.
Like Rogers, Roy identifies nursing as both science and
art. Roy further differentiates basic, clinical, and practical
knowledge. The science involves knowledge about people
adapting within a variety of life situations, “the how’s and
why’s of people functioning as adaptive systems” involving
cognator and regulator coping strategies and the four modes
(Roy & Andrews, 1999, p. 537). The clinical art and science
of nursing uses this basic knowledge “to understand people in
situations of health and illness,” and this understanding is
then translated into practical clinical knowledge about how to
enhance adaptation (p. 538). Given the latter focus, it is un-
derstandable that most of the research to date is quantitative,
as pointed out by Frederickson.
The metaparadigm provides a better fit for totality than for
simultaneity models/theories. Therefore, the four metapara-
digm concepts provide a useful organizing structure to exam-
ine the generic propositions and the contributions of the stud-
ies evaluated. Using this classification, Frederickson and her
colleagues have identified gaps in the current research that
can be addressed in future studies. Roy clearly articulates the
centrality of person and environment as two distinct concepts
in her model and therefore in Roy-based research. Frederick-