Sister Callista Roy’s

Adaptation Model

Presented By:
Mrs. Sandeep Kaur
Lecturer ,C.O.N
 INTRODUCTION

•Nursing is establishing itself as a scientific discipline.

•Its thrust toward scientifically sound social usefulness
including the development of conceptual models.
•The nursing models provide the basis for selecting
knowledge to be transmitted in nursing education.
 CONTD…

′
It is the framework for nursing
practice and the direction for
nursing research.
′
Sister callista Roy’s adaptation
theory (Roy and Obloy 1979,Roy
1980,1984,1989)
views the client as an adaptive
system.
BIOGRAPHICAL SKETCH OF
THE NURSE THEORIST

′
Sister callista Roy was born on oct,
14,1939.
′
She did her bachelors of arts in
nursing from mount st. Mary’s
college, losAngeles in 1963 and
masters of science in nursing
from ,University of
California,Los Angeles1966.
 CONTD….

′
She also received her masters of arts(M.A) in sociology
from the same university in 1975 and Ph.D in sociology .
′
Roy was an associate professor and chairperson of the
department of nursing at mount Saint Mary’s college
until 1982.
 CONTD….

′
From 1983 to 1985; she was Post Doctoral fellow at Robert
Wood Johnson at University of California, as a clinical
nurse scholar in neuroscience.

′
In 1988 Roy began the newly created position of
graduate faculty at, Boston school of nursing.
 CONTD….
′
According to Roy’s model, the goal of nursing is to help
the person’s adaptive system.
′
According to Roy’s model, the goal of nursing is to help
the person adapt to change in physiological needs,
self-concepts, role function and interdependent
relations during health and illness .
CONTD….
All individual must adapt
to the following demands:
1.Meeting basic physiological
needs.
2.Developing a positive self-
concept.
3. Performing social roles.
4. Achieving a balance between
dependence and
interdependence.
 CONTD….
It is role of nurse:
′
To find out demands which are
causing problems for a client.

′
To assess how well the client is
adapting to them. Nursing care
is then directed at helping the
client to adopt.
 ORIGIN OF THE MODEL:

′
While a student of M.sc. nursing, at the university of
California sister C. Roy was challenged in a
seminar by another nurse theorist Dorothy
E.JOHNSON to develop a theory of nursing ,
subsequently in 1970 the ‘ROY ADAPTATION
MODEL’ was born as a derivation of Bertalanfty (1968)
general system theory and Harry Helson’s Adaptation
level theory (1964).
ASSUMPTIONS
OF THE MODEL
 CONTD….
1. The person is a bio-
psycho-social being includes
and
biologic componentsand Physiology),
(Anatomy
psychological social
components.

2.The person is in constant interaction

with a changing environment
(interaction with physical, social &
psychological environment changes)
 CONTD…
3.To cope with a changing world, the
person uses both innate and acquired
mechanisms which are
biologic,psychological and social in
origin.
4.Health and illness are an
inevitable dimension of the
person’s life.
5.To respond positively to
environmental changes, the
person must adapt (changing
environment demands positive
response)
 CONTD….
6.The person’s adaptation is a
function of the stimulus, he is
exposed to and his adaptation level,
which is determined by the combined
effect of three classes of stimuli:

*focal stimuli
*contextual stimuli
*Residual stimuli
 CONTD….

*Focal stimuli or stimuli demanding prompt attention.

*Contextual stimuli or stimuli present in a
surrounding and situation.
*Residual stimuli such as belief, attitude and habits,
which have an indeterminate on the present situation.
 CONTD….

7. The person’s adaptation level is such that it comprises a

zone indicating the range of stimulation that will lead to a
positive response. (if the stimulus is within the zone the
person responds positively, however if the stimulus outside
the zone ,the person cannot make a positive response)
 CONTD….

8. The person is conceptualized

as having four modes of adaptation:
′ psychological needs
′
self-concept,
′
role function, and
′
interdependence relations.
Four philosophical assumptions based on
the humanist principles are as follows.
a.The individual shares in creative
power.
b.Behaves purposefully, not in
sequence of cause and effect.
c. Possesses intrinsic holism and
d.Strives to maintain integrity & to realize
the need for relationship.
 CONTD….
VERTIVITY

The term vertivity derived from

the Latin ‘veritas’ meaning the
trust, was coined by Roy. It’s a
principle of human nature

that affirms a “common

purposefulness of
existence”. human
 The four principles are
:
′ The individual is
viewed in the context of
the purposefulness of
human existence.
′
Unity of purpose of
human kind
′
Activity & creativity for the
common goods
′
Value of meaning of life.
5. CONCEPTS OF MODEL
′ Roy’s model is a system model that focuses on outcomes.
the major features of the system models are the:
-System and its environment
∙ A system is a set of parts connects to function as a whole
for some purposes and are interdependence of its parts.
 CONTD….

′
Keys elements in the Roy
adaptation model are-
1.The person who is recipient of
nursing care
2. The goal of nursing.
3. The concept of health
4.The direction of nursing
activities.
 CONTD…

′
Person: Roy uses person in her model as a concept to
identify the recipient of nursing care. critical to the model
is the description of recipient of nsg care as holistic
adaptive systems.

′
Persons as living systems are in constant interactions with
their environments between the system and the
environment occurs on exchange of information, matter
and energy.
Goal-the goal of nsg. as the
promotion of adaptive responses in
relation to the four adaptive modes
(physiological, self concept, role
function and interdependence)and
contribute to health.
′
Nsg activities-The nursing activities are
delineated by the model as those that promotes
adaptive responses in
situation of health and illness. The nsg
activities are identified as actions taken by
nurses to manipulate the focal, contextual
residual stimuli impringing on person.
 CONTD….
′
The nsg process acc. to Roy’s
model consists of six steps-
(1)Acceptance of behavior
(2)Acceptance of stimuli
(3)Nsg diagnosis
(4)Goal setting
(5)Intervention
(6)Evaluation
Health-health has been defined as a “state and process of
being and becoming an integrate and whole person’’
Health is a process where by individuals are striving to
achieve their maximum potentials.
Environment-stimuli from within the person and stimuli
from around the person represents the element of
environment acc. to Roy.
′
Environment is specifically defined by Roy as “all
conditions, circumstances influences surrounding and
affecting the development and behavior of persons and
groups.
6. THE PERSON AS AN
ADAPTIVE SYSTEM

In addition to the concept of person,goal of nsg,health

and environment and nsg activities in the model ,the
theory of person as an adaptive system employs
additional concepts.
The person as an adaptive system
 CONTD….
(1)Input-input coming from external
environment as well as internally from the
person as stimulus
stimuli(a a is a unit of
information,matter,or energy from the
environment or a person who elicits
response).The stimuli immediately confronting a
the person are focal stimuli greatest degree of
change impact on person.
 CONTD…

′
Contextual stimuli-observable, measureable and
reported by the person.

′
Residual stimuli-those make up characteristics of the
person that are present and relevant to situation.
CONTD…….

Example: Mr. smith experiencing the chest pain,

the stimulus immediately confronting Mr.
smith,the focal stimulus ,is the deficit of oxygen
supply to his heart muscles.The contextual stimuli
include the 90 degree of temperature ,the
sensation of pain ,Mr. smith’s age ,weight,blood
sugar level,and degree of coronary artery
patency.The residual stimuli include his history of
cigarette smoking and work relate stress.
 Adaptation level is a constantly changing point
that represents the person’s ability to cope with
the changing environment in a positive manner.
′
Adaptation level sets up a zone or a range within
which stimulation will lead to adaptive responses.
′
Stimuli falling outside their adaptive zone lead to
ineffective responses.
′
Suicide due to inability to cope up with the child is
an extreme example of an ineffective response.
Coping mechanisms
′
some coping mechanisms are
inherited or genetic such as
white blood defense system
against bacteria seeking to
invade the body.
′ some are learned as use of

antiseptics
CONTD….

�′ Mechanisms are of 2 types:

(1)Regulator is used primarily as a mechanism
to cope with physiological stimuli.
(2)Cognator used mainly as mechanism to cope
with psychological stimuli dealing primarily
in area of cognition, judgment and emotion.
� -Regulator and cognator mechanisms are
linked through the process of perception.
CONTD….
′
It is important to recognize that it is the manifestation of the
coping mechanism that can be observed and measured
within the adaptive modes. Thus adaptive modes are
often referred as effectors.
CONTD….
Effectors: Roy has identified four adaptive modes;
′
Physiological
′ self concept
′
role function
′
interdependence.
CONTD….
Adaptive responses output-
The behaviors that contribute to the general goals of the
person(i.e survival,growth,reproduction and mastery)are
considered adaptive response.
′
Behaviors not contributing to general goals are
considered ineffective responses.
′
Adaptive responses being about a state of
adaptation.
7. THEORY OF ADAPTIVE
MODES:

The theory of adaptive modes was developed in 1981,

consist of four parts:
′
physiological,
′
self concept,
′
role function &
′
interdependence.
 CONTD…

Each adaptive mode represents a grouping of behaviors

that promote the individuals movements towards the
general goals (survival, growth, reproduction, mastery).
 CONTD…..
(1)PHYSIOLOGICAL MODE
Physiological wholeness is achieved by
adapting to changes in physiological
needs.
′
The regulator coping mechanism is
primarily responsible for attaining and
maintaining this integrity.
′
other complex process that influences
regulator
activities are the senses, fluids and
electrolytes, neurological function &
endocrine function.
 Five primary needs have been identified as
necessary for physiological integrity:

′ oxygen,
′ nutrition,
′ activity rest,
′ protection,
′
elimination
CONTD…

(2)SELF CONCEPT MODE

Self concept is one of the 3 psychosocial modes, the basic

human need within modes in psychic integrity,which
means people need to know who they are so that can exist
with a sense of unity.
CONTD…..
′
Physical self: is an appraisal of one’s physical,
attributes, appearance, functioning,
sensation(feeling about self) sexually and
wellness illness status.

′
Personal self: is an appraisal of one’s own
characteristics, expectations, values & worth.
Personal self has been divided into the moral ethical
spiritual self ,self consistency & self ideal, self
expectancy e.g. I believe God will help me through
this surgery.
CONTD…..

(3)ROLE FUNCTION MODE:

The basic need in the role function adaptive model is for
social integrity. This means that people need to know
who they are in relation to others so that they can act. All
people have role in society. With each role there are
expected behavior .Role have been divided into primary,
secondary and tertiary.
CONTD….
(4)INTERDEPENDENCE MODE
Interdependence is a social adaptive mode,needs
affection adequacy or the feeling of security in
nurturing relationships.
′
Interdependence means the close relationship of
people that involves willingness & ability to love,
respect & value others and to accept & responds to
love, respect and value given by others.
′
Loneliness as a common adaptation problem
resulting from a disruption in the modes.
 Those currently identified
needs are listed below:

(a) Basic physiological needs-

′
Exercise and rest
′
Nutrition
′
Elimination
′
Fluid and electrolyte
′
Oxygen
′
Circulations
′
Regulations
 CONTD….
(b) self concepts:
′
Physical self
′
Personal self
′
Interpersonal self

(c) role mastery:

-Role failure
-Role conflict
CONTD….
(d)interdependence:-
Alteration,rejection,aggression,rivalry,
hostility,loneliness,dominance,exhibition.
-The aspects of care which are examined in view
of the model are:
′
The nature of the people receiving nursing care.
′
Cause of problems likely to require nsg
intervention.
′
Nature of assessment
 CONTD….

′
Nature of planning and goal setting process
′
The focus of nsg interventions during the
implementation of the nsg care plan
′
The nature of the process of evaluating the quality of effects
of the care given.
NURSING PROCESS ACCORDING TO
RAM

�A problem solving approach for gathering data, identifying the

capacities and needs of the human adaptive system, selecting and
implementing approaches for nursing care, and evaluation the
outcome of care provided.
o
�Assessment of Behavior: the first step of the nursing process which
involves gathering data about the behavior of the person as an
adaptive system in each of the adaptive modes.
 CONTD….

′
Assessment of Stimuli: the second step of the nursing
process which involves the identification of internal
and external stimuli that are influencing the person’s
adaptive behaviors.
Stimuli are classified as:
1)Focal- those most immediately confronting the person
2)Contextual-all other stimuli present that are affecting
the situation
3)Residual- those stimuli whose effect on the
situation are unclear.
′
Nursing Diagnosis: step three of the nursing process which
involves the formulation of statements that interpret data
about the adaptation status of the person, including the
behavior and most relevant stimuli
GOAL SETTING
′
the fourth step of the nursing process which involves the
establishment of clear statements of the behavioral
outcomes for nursing care.
′
Intervention: the fifth
step of the nursing
process which involves
the determination of
how best to assist the
person in attaining the
established goals
′
Evaluation: the sixth and
final step of the nursing
process which involves
judging the effectiveness
of the nursing
intervention in relation
to the behavior after the
nursing intervention in
comparison with the
goal established.
DEMOGRAPHIC DATA
′
Mr. NR
′ �Name Age
53years
�Sex
Male
�IP number Education ------
Occupation Marital status
Degree
Religion Informants
Bank clerk
�Date of admission
Married

Hindu

Patient and Wife

FIRST LEVEL ASSESSMENT
PHYSIOLOGIC-PHYSICAL MODE

Oxygenation:
′ Stable process of ventilation and stable process of gas exchange. RR=
18Bpm.
′ Chest normal in shape. Chest expansion normal on either side. Apex
′ beat felt on left 5th inter-costal space mid-clavicular line. Air entry
′ equal bilaterally. No ronchi or crepitus.
′ No abnormal heart sounds.
′ S1& S2 heard.
′ BP- Normotensive. .
 CONTD….
Nutrition
′
He is on diabetic diet (1500kcal). Non
vegetarian.
′
Recently his Weight reduced markedly (10
kg/ 6 month).
′
He has stable digestive process.
′
He has complaints of anorexia and not taking
adequate food.
′
No abdominal distension. No tenderness.

′
Bowel sounds heard.
′
Percussion revealed dullness over
CONTD….

Elimination:

′
No signs of infections, no pain
during micturation or
defecation.
′
Normal bladder pattern.
Using urinal for
micturation.
′
Stool is hard and he complaints
of constipation.
CONTD…
Activity and rest:
′
Taking adequate rest.
′
Sleep pattern disturbed at
night due unfamiliar
surrounding.
′
Not following any
peculiar relaxation
measure.
′
Like movies and
reading. No regular
pattern of exercise.
 CONTD….
o
Now, activity reduced due to
amputated wound. Mobility
impaired.
′ Walking with crutches.
′
Pain from joints present. No
paralysis.
′
ROM is limited in the left leg due to
wound.
′
No contractures present. No
swelling over the joints.
′
Patient need assistance for doing the
activities.
CONTD….

Protection:
′
Left lower fore foot is amputated.
′
Black discoloration present over the area.
′
No redness, discharge or other signs of infection.
′
Wound healing better now.
′
Pain form knee and hip joint present while walking.
′
Dorsalis pedis pulsation, not present over the left leg.
Right leg is normal in length and size.
′
All peripheral pulses are present with normal rate, rhythm and depth
over right leg.
CONTD….

Senses:
′
No pain sensation from the wound site.
Relatively, reduced touch and pain sensation in the
lower periphery; because of neuropathy.
Using spectacle for reading. Gustatory, olfaction, and
auditory senses are normal.
Fluids and electrolytes:
′
Drinks approximately 2000ml of water. Stable intake out
put ratio. Serum electrolyte values are with in normal
limit. No signs of acidosis or alkalosis. Blood glucose
elevated.
 CONTD….
Neurological function:
′
He is conscious and oriented.
′
He is anxious about the disease
conditon
′
Touch and pain sensation decreased
in lower extrimity.
Endocrine function
′
He is on insulin. No signs and
symptoms of endocrine disorders,
except elevated blood sugar value.
No enlarged glands.
CONTD….
Personal self:
′
Self esteem disturbed because of financial burden and
hospitalization. He believes in god and worshiping Hindu
culture.
ROLE PERFORMANCE MODE:
′
He was the earning member in the family. His role shift is
not compensated. His son doesn’t have any work. His
role clarity is not achieved.
INTERDEPENDENCE MODE:
′
He has good relationship with the neighbours. Good
interaction with the friends relatives.But he believes, no one
is capable of helping him at this moment. He says ”all are
under financial constrains”. He was moderately active in
local social activities
SECOND LEVEL ASSESSMENT
FOCAL STIMULUS:
′ Non-healing wound after amputation of great and
second toe of left leg- 4 week. A wound first found on
the junction between first and second toe-4 month
back. The wound was non-healing and gradually
increased in size with pus collected over the area.
′
He first showed in a local hospital,referred to medical
college; During hospital stay great and second toe
amputated. But surgical wound turned to non- healing
with pus and black colour. So the physician suggested
for below knee amputation.
That made them to come to ---Hospital, ---. He
underwent a plastic surgery 3 week before.
 CONTD….
CONTEXTUAL STIMULI:
′
Known case DM for past 10 years. Was on oral
hypoglycemic agent for initial 2 years, but switched to
insulin and using it for 8 years now. Not wearing foot
wear in house and premises.
RESIDUAL STIMULI:
′
He had TB attack 10 year back, and took complete
course of treatment. Previously, he admitted in
---Hospital for leg pain about 4 year back. . Mother’s
brother had DM. Mother had history of PTB. He is a
graduate in humanities, no special knowledge on
health matters.
CONCLUSION

′
Mr.NR who was suffering with diabetes mellitus
for past 10 years. Diabetic foot ulcer and
recent amputation made his life more stressful.
Nursing care of this patient based on Roy's
adaptation model provided had a dramatic
change in his condition. He studied how to use
crutches and mobilized at least twice in a day.
Patient’s anxiety reduced to a great extends by
proper explanation and reassurance. He gained
good knowledge on various aspect of diabetic
foot ulcer for the future self care activities.
 NURSING CARE PLAN
ASSESSMENT
ASSESS. OF NURSING GOAL INTERVEN EVALUA
OF
DIAGNOSIS TION TION
STIMULI
BEHAVIOUR

Ineffective Focal - Maintain Short term

1. Impaired Long-term the
wound area goal:
protection stimuli: skin objective:
clean as
and sense in Non- integrity 1. contamination Met: size of
physical- healing related to amputated affects the wound
physiologic wound after fragility of healing process.
decreased to
area will be
al mode (No amputation the skin - Follow less than 1x1
pain of great and secondary completely sterile technique cms.
sensation second toe to vascular healed by while providing WBC values
from the of left leg- 4 insufficie 20/5/08 cares to prevent became
infection and
wound site.) week ncy 2.Skin will normal on
remain delay in healing. 24/4/08

intact with - Perform

no ongoing wound dressing
with Betadine
ulcerations. which promote
healing and
growth of new
tissue.
ASSESS. OF ASSESSMENT NSG INTERVEN EVALUA
GOAL
DIAGNO TION TION
BEHAVIOUR OF
STIMULI SIS

Short-Term -Do not move Long term

Objective: the affected area goal:
i. Size of frequently as it Partially
wound affects the Met: skin
decreases to granulation partially
1x1 cm tissue formation. intact with
within -Monitor for no Continue
24/4/08. signs and ulcerations.
ii. No signs of symptoms of Plan,Reasse
infection infection or ss goal and
over the delay in intervention
wound healing.
within 1-wk -Administer the Unmet: not
iii.Normal antibiotics achieved
WBC values and vitamin C complete
within 1-wk supplementati healing of
iv. Presence on which will amputated
of healthy promote the area.
granular healing process. Continue
tissues in the plan
wound site Reassess
within 1-wk goal and
 ASSESS. OF ASSESSMENT
NURSING GOAL INTERVEN EVALUA
OF
DIAGNOSIS TION TION
BEHAVIOUR STIMULI

Focal stimuli: 2. Impaired Long term - Assess Short term

Impaired
the level of goal:
activity in During physical Objective:
restriction of Met: used
physical- hospital stay mobility Patient will
movement crutches
physiological great and related to attain correctly on
- Provide
mode second toe amputation of maximum active and passive 22/4/08.
amputated. the left forefoot possible exercises to all he is self
But surgical and presence of physical the extremities to motivated in
wound turned mobility with improve the doing minor
muscle tone and excesses
in 6 months.
to non- healing unhealed strength. Partially
with pus and wound Met: walking
- Make the
black colour. with
patient to
perform the minimum
ROM exercises support.
to lower
extremities
which will
strengthen the
muscle.
 ASSESSMENT
ASSESS. OF NURSING
OF GOAL INTERVEN EVALUA
DIAGNOSIS
STIMULI TION TION
BEHAVIOUR

Short term -Massage Long term

objective: upper and goal:
i.Correct lower Unmet: not
use of extremities attained
crutches which help maximum
with in to improve possible
22/4/08 circulation. physical
ii. walking - Provide mobility-
with articles near Continue
minimum to patient, plan
support- encourage Reassess
22/4/08 performing goal and
iii.He will activities interventio
be self within ns
motivated limits
in which
activities- promote a
20/4/08. feeling of
well being.
 CRITICISM

INTERNAL CRITISIMS

Adequacy
′ synthesis of concepts from multiple paradigms.
′
Conceptual models are grand theories.
′
Difficult to understand because of abstractness.
CONTD…
Clarity
′
Clarification of assumption needed , especially
philosophical assumptions.
′
Clarification of role , interdepence & self
concepts.
′
Ambiguity regarding concepts of cognator regulator
subsystems, effector mode/focal stimuli, adaptive
modes/ mechanism,env./internal stimuli.

′ Language is clear & easy to read &understand.

CONT…
′
Consistency & congruency
′
Physiologic mode not connected to other 3 modes.
′
Unclear boundaries , abstract , lack of
operational definition.
′
Systemic assessment potential limked to nursing process.
Level of theory development
′
Exemplary theory on development (melius,2007)
′
Grand theory used as conceptual framework for middle
range and micro theories.
′
Used as a framework for addressing adaptive needs
in individual , families & groups.
EXTERNAL CRITICISM
Complexity/ simplicity /discrimination
/pragmatism.
′
Simplicity is based on the language & terms.
′
Grand theories are inherently complex.
′
Complexity doesn’t bend into operationalizability for
research .
′
Studies based on the model moved from face
validity to construct validity studies and relational
research studies.
CONTD….
Reality convergence
′
Nutrsing interfaces between the individual & health
care system providing holistic care.
′
Nurses need to continue to learn and adapt to avoid
outsourcing.
′
Roy belives nurses can avoid extinction of the
profession by not allowing themselves to nurse
solely in the physiologi mode.
 CONTD….
Scope
′
Grand theory RAM
′
Middle range theory evolved RAM:-
♣ Caregivers’s effectiveness & well being.
∙ Coping with pain & chronicity.
∙ Coping with diabetes.
∙ Gentle touch in preterm infants.
 CONTD…

Significance
′
1987 – over 100,000 nurses have
graduated from program based on
RAM
′
Used by global scholars
′
Models used in research , curriculum
development, social issues , chronic
illness & development of research
instruments.
CONTD….
Utility
′
Research tool development
∙ Describes responses to health illness.
∙ Evaluates intervention
∙ Measures perception of adaptation levels.
∙ Measures perception of powerlessness & decision
making.
∙ Measures health care outcomes ofcancer patients.
∙ Regaining functional abilities after delivery.
′
Used to identify adaptive and maladaptive
behavior to stimuli.
∙ Lack of motivation to quit smoking.
∙ Assessing & planning care of surgical patients.
∙ Care of geriatric patients.
CONTD….
∙ Obstetrical, peadiatric and neonatal settings.
∙ Cardiac patients.
∙ Elder care
∙ Pshychiatric setting & organic brain syndrome.
9. APPLICATION OF R.A.M IN
NURSING

� (1) Nsg practice- R.A.M is a very useful method in nursing

practice specially in those setting where there are convert
psychological needs which are as essential as physical one.
Roy’s models are very effective in pediatrics as well as
community and rehabilatory nsg.
 CONTD….
( 2)Nursing Research-
R.A.M provide a conceptual model for
nursing process and this has been a
basis for number of research being
done.for e.g measuring functional
status after child birth,functional status
during pregnancy.

If research is to affect practitioners’

behavior, it must be directed at
testing and retesting conceptual
models for nursing practice. Roy has
stated that theory development and
the testing of developed theories are
nursing’s highest priorities. The
model must be able to regenerate
testable hypotheses for it to be
researchable.
 CONTD….
(3)Education-
RAM useful in educational setting. Roy states that the model defines for
students the distinct purpose of nursing which is to promote man’s adaptation in
each of the adaptive modes in situations of health and illness.