ROY ADAPTATION THEORY

P R E S E N T E D B Y:
RITTIKA DAS NEOGI
1STYEAR M.SC NURSING
‘ADAPTATION IS VIEWED AS 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.’

SISTER CALISTA ROY.

 About the Theorist

 Sister Callista Roy is a nursing theorist, professor and author.

 She was born on October 14, 1939 at Los Angeles, California.
 She majored in nursing in 1963 from Mount Saint Mary's
College, Los Angeles. 
 She received Master's Science in Pediatric Nursing from
University of California.
 She was a postdoctoral scholar in Neuroscience Nursing at
University of California.
 About the Theorist

 Worked as a Pediatric Nurse, Nursing Instructor and in many different capacities.

 She was Professor and Nurse Theorist at the Boston College of Nursing.
 Dorothy E. Johnson mentored her to develop this adaptation model while pursuing
her Master's Degree. 
 Roy's Adaptation Model was implemented in Mount Saint Mary's School in 1970.
 The Roy Adaptation Model was first published in Nursing Outlook in 1970 entitled
“Adaptation : A Conceptual Framework for Nursing”.
 About the Theorist

 At present, she is a Professor at School of Nursing

at Boston.
 She has many Honorary Doctorate Degrees and
awards in excellence in fostering professional nursing
standards.
 Sister Callista Roy has also been recognized as a living
legend in 2007 by American Academy of Nursing.
 Theoretical Sources

 Roy credits Harry Helson’s Adaptation Theory (1947) for playing

a key role in her early thinking and development of the model.

 She credits Rapoport’s Definition of systems as well as concepts

regarding Theory of stress from Lazarus and Selye (1984).

 Roy acknowledges the contribution made by other faculty and

students to the development of the model.
 SCIENTIFIC
 
Consciousness is constructed of individual and environment integration.
 
Awareness of self and environment is rooted in thinking and feeling. 
 
Thinking and feeling mediate through human actions.
 
Relationships include acceptance, protection, and fostering
of interdependence.
   
Integration of human being and environment results in Adaptation.
 
 PHILOSOPHICAL

 
Individual has mutual relationships with the world and God. 
  
God is revealed in the diversity of creation

Individual use human creative abilities of awareness,

enlightenment, and faith.  

Individual are accountable for the processes of deriving,

sustaining, and transforming the universe.
 CULTURAL
 
Experience within a specific culture will influence how each element of
the Model is expressed.

Within a culture, central culture will influence the elements of the Roy
Adaptation.
 
Cultural expressions of the elements of Model may lead to changes in
practice activities like nursing assessment.

Due to multi-cultural perspective, implication and research may differ

from the experience in the original culture
Statement of the Theory

“The goal of nursing is to promote

adaptation for individuals and groups in
each of the four adaptive modes; i.e.
physiological needs, self-concepts, role
function and interdependent relations, thus,
contributing to health quality of life and
dying with dignity.”
 PERSON

Human beings are in constant interaction with

their environment which brings both internal and external
changes.
They respond to the environmental stimuli they experience.
The characteristic of openness in human allows a person to
adapt in constantly changing environment.

Human is as an adaptive system.

 ENVIRONMENT

 According to Roy, environment means "The conditions, &

circumstances affecting the development and behavior of
persons”.
 A person exists in an open relationship with the environment.
The internal and external stimuli affect the
person.
 NURSING
 The goal of nursing is the promotion of adaptation for human
beings by four adaptive modes leading to health, quality of life
and dying with dignity. 
 Nurses assess the client's behaviors, promote positive
adaptation by enhancing environment interactions and helps
clients react positively to stimuli.
 Nurses eliminate ineffective coping mechanisms.

Leads to better outcomes for the clients.

 HEALTH
Roy defines health as, “A state or process of being or becoming an
integrated and whole person.”
Health is not freedom from the inevitability of death, disease,
unhappiness, and stress, but the ability to cope with them.
If human being can adapt holistically, they will be able to maintain
health to reach completeness. If persons cannot adapt, the integrity of the
person is affected negatively. 

Health is the state where human can adapt to stimuli.

 Major Concepts of Roy's Adaptation Model


System: Parts which are interconnected and interdependent to form a unity. The system is
characterized by inputs, outputs, control and feedback processes.


Adaptation: Adaptation is the process and outcome where by thinking and feeling
individuals or groups use conscious awareness and choice to create human - environmental
integration.


Adaptation problems: Adaptation problem means the occurrence of a state due to
inadequate responses to meet deficit.
 Major Concepts of Roy's Adaptation Model

 Stimuli: A person’s adaptation is influenced by stimuli from the environment.

Categories
-Focal stimuli: The internal or external stimuli which immediately confront
the individual’s awareness and consciousness.
 
-Contextual stimuli: Contextual stimuli are all other stimuli that contribute to the effect of
the focal stimuli. Stimuli influence how people deal with the focal stimuli.
 
-Residual stimuli: Residual stimuli are environmental factors within or outside the human
system. These factors though effect on behavior.
 Major Concepts of Roy's Adaptation Model

Coping Processes: It includes both innate and acquired coping mechanism.

Innate mechanisms are inborn, genetically determined, common to the species
and are automatic process. Acquired coping are learned or developed responses.
 
The process of coping is further categorized by Roy as “The Regulator &
Cognator Subsystems are applied to individuals; whereas Stabilizer and
Innovator Subsystems are applied to groups”.
 Major Concepts of Roy's Adaptation Model

Levels of Adaptation: Adaptation level of an individual represents the condition of life process.
-Integrated process: The modes and subsystems meet the needs of the environment forming a
stable process (e.g. spiritual realization, breathing, successful relationship).

-Compensatory process: The cognator and regulator are challenged by the needs of the
environment, but trying to meet the needs (e.g. starting with a new job, grief, compensatory
breathing).
 
-Compromised process: The various modes and subsystems are not sufficiently meeting the
environmental challenge (e.g. unresolved loss, hypoxia, abusive relationships).
 Major Concepts of Roy's Adaptation Model

Levels of Adaptation
Integrated to Compensatory

An integrated life process may change to compensatory process where
attempt is made to re-establish adaptation.
Compensatory to Compromised

If the compensatory process are not adequate then result is compromised.
 Major Concepts of Roy's Adaptation Model

Internal processes or Subsystem

 
oRegulator: It is Physiological Coping Mechanism of an individual through which

the body attempts to cope through Neural, Chemical and Endocrine coping channels.
oStimuli from environment act as inputs through the senses to the nervous system.
oIt affects the fluid, electrolyte, acid-base balance and endocrine system.
oThis information is all channeled automatically.
oThe body produces an Automatic – Unconscious Response to it.
 Major Concepts of Roy's Adaptation Model

Internal processes or Subsystem

 
oCognator: Major coping process for individuals.
oIt involves 4 Cognitive-Emotive Channels:
a) Perceptual & Information processing: It includes activities of
selective attention, coding and memory.
b) Learning: It includes imitation, reinforcement and insight.
c) Judgement: It includes problem solving and decision making.
d) Emotion: It includes effective appraisal and attachment.
 Major Concepts of Roy's Adaptation Model

Adaptive Modes: Through the adaptive modes the responses to & interaction
with the environment can be carried out and adaptation can be observed. There are 4
adaptive modes:
a) Physiologic – Physical Mode
b) Self-concept – Group-identity Mode
c) The Role Function Mode
d) The Interdependence Mode
 Physiologic Physical Mode
 

It is the Manifestation of Physiologic Activities of all cells, tissues, organs and


systems that make up the body. It includes 5 basic needs of:
Oxygenation: Patterns of oxygen use related to respiratory and cardiovascular physiology and
pathophysiology. 
Nutrition: Patterns of nutrient used to maintain effective human functioning and how the nutrient
help for growth and repairing injured tissue.
Elimination: Patterns of elimination of waste products. 
Activity & Rest: How the pattern of activity and rest takes place in an individual.
Protection: Skin integrity and immunity.
 Physiologic Physical Mode
 

In addition, four processes are involved in Physiologic Adaptation:

a) Senses: Sensory-perceptual information

b) Fluid, Electrolyte, Acid-Base Balance: How the fluid and electrolyte balance maintained in the
body. 
c) Neurologic Functions: Relationship of neural function to regulator and cognator coping
mechanism
d) Endocrine Functions: How the endocrine system act in conjunction with nervous system to
maintain control of the body process. 
 Self-concept - Group-identity mode
The basic need underlying the self-concept mode is psychic and spiritual
integrity that is the need to know who one is so that one can exhibit a
sense of unity.

This mode includes :

a)Physical self (body sensation & body image)
b)Personal Self (self-consistency, self- ideal & the moral ethical- spiritual self)
 Self-concept - Group-identity mode


Body Sensation: How the individual experiences the physical self.
 

Body image: How the individual views the physical self.
 

Self-consistency: Individual’s efforts to maintain self-organization.


Self-ideal or expectancy: Represents what the individual expects to be and to do.
 

Moral-ethical-spiritual self: Represents individual’s belief system and self-
evaluation.
 Role Function Mode
 

It focuses on the role of the person in the society and group within.


The basic underlying need is Social Integrity. It includes:
 
a)
Primary role: It determines the majority of individual's behaviors and is defined by the individual's
sex, age, and developmental stages.

b)Secondary role: It includes to carry out the tasks required by the stages of development and primary
role. 
 
c)Tertiary role: These roles are temporary, feely chosen, and may include activities related to hobbies. 
 Interdependence Mode

It includes behaviour towards interdependent relationships like giving and receiving of
love, respect and value.
The basic underlying need is relational integrity and feeling of security in the
interdependent relationship.
It includes 2 specific relationships:
a) Relationship with significant others
b) Relationship with support systems
 Propositions of Roy Adaptation Model

 Stimuli from internal and external environment serves as inputs to the nervous
system which produces automatic unconscious response.
Stimuli and adaptation level serve as input to human adaptive systems.
 One must make adaptations to accommodate new environmental requirements.
 The internal and external stimuli influence behavioural responses.

Human beings are described as adaptive systems that are constantly

growing and developing within changing environments.
 Propositions of Roy Adaptation Model

 Health for human adaptive systems are reflections of adaptation.

 The Goal of Nursing is the promotion of adaptation there by contributing to
health, quality of life, dying with dignity.
 Nursing intervention is to maintain the adaptive behaviour and to change
ineffective behaviour to adaptive.
Nurse’s role is to promote adaptation in health and illness by
enhancing the interaction of human systems with the environment.
 Application of the Theory

Nursing Practice
The Roy adaptation model is one of most frequently used conceptual frameworks
used to guide nursing practice.
Senesce (2003): This model can be used by individual nurse to understand, plan
and direct nursing practice in the care of individual patients.
Villarreal (2003): applied this model in caring of young women who were
contemplating smoking cessation. 
Newman (1997): used the model to caregivers of chronically ill family
members. 
 Application of the Theory

Nursing Education
 Roy suggests this model helps to clarify objectives, identifies content
and specifies patterns for teaching and learning. 
 This model provides nursing educators a systemic way of teaching students to
assess and care for patients within the context of their lives rather than just as
victims of illness. 
 In the early 1980's the School of Nursing at the University of
Ottawa experienced a major curriculum change by incorporating this model as
base to their new curriculum.
 Application of the Theory

Nursing Research
This model is used in knowledge development.
Young-McCaughan (2003) by using Roy's Adaptation Model studied the effect of
a structured aerobic exercise tolerance, sleep patterns and quality of life in
patients with cancer.
Bournaki (1997) by using Roy's adaptation model studied Pain related
responses to venipuncture in school-age children. 
 Nursing Process and the Roy Adaptation Model

Roy specifically stresses that the nursing process is ongoing and continuous.
Roy states regarding nursing process that ‘Nurses rely on intuitive skills to assess and
initiate interventions.”

A nurse's role in the Adaptation Model is to manipulate stimuli by

removing decreasing, increasing or altering stimuli so that the patient can
adapt effectively. 
 
 Assessment
 Assessment of behaviour
 Nurse must identify the behaviours hinder adaptive process.
 In the First Level Assessment, the nurse assesses the behaviors manifested from the
four adaptive modes.
 The nurse uses observational skills, intuition, accurate measures and interviewing
skills to systematically gather data.
 In the Second Level Assessment, the nurse assesses the stimuli; categorize them as
focal, contextual, or residual leading to identification of internal and external stimuli
which influences individual's adaptive behaviors.
 Nursing Diagnosis

Analysis of data of both levels of assessment results in formulation of a nursing

diagnosis that reflects the patient’s adaptive state.

Goal Setting
 It involves clear statement of the behavioural outcomes of nursing care.
 The goal is to promote client's adaptation process through nursing care.
 Roy also suggests to provide time frame in which the goal is to be attained.
 Implementation

 The nurse chooses interventions to promote the desired adaptation through

either changing stimuli or strengthening adaptive process.
 The nurse and patient in collaboration identifies the desirable or undesirable
consequences.
 Once the appropriate nursing intervention has been selected, the nurse initiate
steps that will enhance coping.
 
 Evaluation

 
 Evaluation focuses on judging the effectiveness of the nursing intervention in
relation to the behaviour of the individual.
 To determine if the adaptive goals have been met, the nurse uses the same skills
as were employed in the assessment phase of the process – observation,
intuition, measurement and interviewing. 
 Clinical Application of the Theory

 Mr. Kumar, a 58 years old patient has been admitted to the

hospital with complaints of non-healing wound in his right leg
since 6 weeks. He is a known case of Diabetes Mellitus since
last 12 years and has been on insulin regimen. He was
admitted after various ineffective treatment for the non-
healing wound. He works in bank and is the sole earning
member of the family of 6. On admission he has been planned
for amputation of toes of right leg and a long hospital stay.
 Clinical Application of the Theory

Demographic Date of the Client 

 Name : Mr. Kumar
 Age : 58 years
 Sex : Male
 IP number : M2863
 Education : Post graduate
 Occupation : Bank officer
 Marital status : Married
 Religion : Hindu
 Informants : Client and Wife
 Date of admission : 04/04/2015
 Diagnosis : Diabetes mellitus
 First Level Assessment

 Physiologic-Physical Mode
Oxygenation 
- His capillary refill time delayed and Dorsalis pedis pulsation of affected limp is not
palpable. 
Nutrition:
-On diabetic diet, complaints of anorexia since admission.
 Elimination:
- He complaints of constipation since 3 days.
 Activity:
- Activity reduced now due to wound in right leg, walking with the help of crutches,
complaints of pain, needs assistance in activities. 
 
 First Level Assessment

 Physiologic-Physical Mode
Senses:
-Because of neuropathy, he has reduced touch and pain sensation in the lower periphery.
Fluids and Electrolytes: 
-Serum electrolyte values are within normal limit, RBS is 300 mg/dl.
 Neurological Function:
-He is very anxious about the disease condition and his family’s future.
Endocrine function:
-Due to DM he is on insulin since 9 years. 
 First Level Assessment

Self- Concept Mode

Physical Self 
-He is very anxious about body image changes, but he is accepting treatment and
trying to cope with the situation. 
Personal Self:
-Because of financial burden and hospitalization, self-esteem disturbed. 
Role Performance Mode 
-He was the only earning member in his family. His role shift is not compensated.
Interdependence Mode 
-Maintains good relationship with the family, neighbors, friends and relatives. 
 Second Level Assessment

 Focal Stimulus
- Non-healing wound leading to amputation, which is the cause of
hospitalization.
- Repeated hospital stay.
- Suffering from non-healing wound since considerable period.
- Ineffective treatment regimen.
 
 Second Level Assessment

 Contextual Stimuli
He is a known case diabetes mellitus for past 12 years.
He is not in habit of wearing footwear in house and premises.
 Residual Stimuli 
- He suffered from Tuberculosis 5 years back. His mother was diabetic. He is a
graduate in economies, so no special knowledge regarding health matters. 
 
 Nursing Process

ASSESSMENT NURSING GOAL PLANNED EVALUATION

DIAGNOSIS INTERVENTION
Focal Stimuli: Anxiety related to To reduce - Allow and encourage Coping through Cognator
Alteration in Physical change in body anxiety. him to ask questions. Subsystem
self of self control mode image, hospital - Allow him and to
due to change in body admission, Goal Met:
image. unknown outcome verbalize their anxiety.
-Able to take rest, uninterrupted
Contextual Stimuli: of the disease and - Provide comfortable
sleep for considerable time.
He is a known case of financial constraints and quiet environment
DM. He is aware of the as evidenced by for the patient. -Asking less question. Looking
planned reconstructive complaints of - Possible increased less stressed.
surgery. insomnia, interaction with family. Unmet:
Residual Stimuli: vocalization and
- Identify his -He is not totally free from
As a student of facial expressions
economics, he possesses of the patient. stressbuster and allow anxiety due to financial
limited health related such activity. constraints.
knowledge. - Music Therapy. -Continue plan, re-evaluate
goal and interventions.
 Critique of the Theory

Clarity: The concept is logical, but the development of definitions are inadequate. 

Simplicity: It is complex due to several major concepts, sub concepts.

Generality: It is generalizable to all settings in nursing practice. It addresses the concept

of person-environment adaptation and focuses primarily on the client.  

Empirical precision: Testable hypothesis. 

Derivable consequences: It has a clearly defined nursing process which is useful in

clinical practice. It generates new information through hypothesis testing. 

 Limitation

Theory is very conceptual.

 It is difficult to understand.

Four adaptive modes have unclear boundaries. 

Assignment