Sister Callista Roy: Adaptation Model

Jill N Meyokovich, RN BSN

Sister Callista Roy

Born 1939-present y Member of the Sisters of Saint Joseph of Carondelet y BSN, MSN, Masters and Doctorate of Sociology y Professor, clinical nurse scholar, nurse theorist, author
y

Becoming of the Model

While working on masters, was mentored by Dorothy Johnson y Challenged to develop a conceptual model y Roy noticed the resiliency of children and change y Intrigued by adaptation becoming the eventual framework
y

Becoming of the Model cont

1968: Operationalization y 1970: Literature debut y 1977: Model presentation
y

Basis of Adaptation Model

Harry Helson y Rapoport definition Combination became definition of a person as an adaptive system y Dohrenwend, Lazarus, Mechanic, and Selye y Biological, and behavioral sciences y Underpinnings Johnsons behavioral model
y

Statement of theory
y

The goal of nursing is to promote adaptation for individuals and groups in each of the four adaptive modes, thus contributing to health quality of life, and dignity with dying (Roy 1999, p. 19)

Main premise of theory

y

When push comes to a shove, we will seldom disappoint ourselves. We all harbour greater stores of strength than we think. Adversity brings the opportunity to test our mettle and discover for ourselves the stuff of which we are made.Do not underestimate the power of a person to cope. He may be dependent now but deep within him lies the energy to adapt
http://nursingtheories.blogspot.com/2008/07/sister-callista-roy-adaptation-theory.html

My view of the RAM

y

I believe the adaptation model as a framework used to see a person who is constantly influenced by their environment; people have the chance to positively respond to their environment and adapt, or fail at adapting. It is the nurse who guides us in the succession of adaptation.

Metaparadigm
Person y Environment y Health y Nursing
y

Terms
Environment y Stimuli y Health y Adaptation y Ineffective responses y Adaptation level y Nursing
y

Key points
Key focus is adaptation y Person is an adaptive system affected by stimuli
y

Stimuli can be internal or external Positive outcome to stimuli allows adaptation Negative outcome/ineffective responses to stimuli alert the need for nursing intervention

Assumptions
y

Major assumptions
Scientific Philosophical Implicit

Humanism y Veritivity
y

Propositions
Nursing promotes adaptive responses y Nursing decreases ineffective responses y Nursing enhances interaction which promotes adaptation
y

Main concepts
y

Two internal mechanisms for adaptation

Regulator Cognator

Four adaptive modes

physiological-physical needs self concept group identity role function interdependence

4 modes
Physiological y Self-concept/group identity y Role function y Interdependence
y

Diagram RAM

Nursing Implications
Goal is directed to establishing adaptation y Contribute to health, quality of life and dying with dignity y Roy Adaptation Model Nursing Process
y
Assessment of behavior Assessment of stimuli Nursing diagnosis Goal setting Nursing intervention Evaluation

Internal criticism
Adequacy y Clarity y Consistency y Logical Development y Level of Theory Development
y

External Criticism
Complexity y Discrimination y Reality Convergence y Pragmatic y Scope y Significance y Utility
y

Tools/Instruments
y y y y y

Used to measure perceptions of powerlessness in decision making Health care outcomes for cancer patients Framework for adult survivors of multiple traumas Describe relationship between nursing intervention and interpretation of results Used as a basis for checklist for problematic behavior prediction

Application of theory to practice

y

Middle range theory areas

Caregiver well being Coping with pain Coping with chronicity

Practice reflection/problem
This is not the first situation that came to mind as I was reflecting this question, but this is the most appropriate situation, I believe for this exercise. There was a woman in her 40s who presented to the ED with a c/c of assault. She was pregnant, had been vomiting, and was assumed to have taken some type of psychoactive medication due to her erratic behavior. She was uncooperative with her nurse and was yelling, crying, refusing to take her medication, and refusing a urine specimen. After about one hour of trying to coerce compliance with the woman, my colleague desperately came to me and asked if I could try to talk some sense into this lady. Therapeutic communication is not my strong point Marian, you know that, was my response. However, we have a very tight nit bond of nurses in our department, and I felt my obligation to help. I proceeded into the room with a plan to place myself in an inferior position as to elicit a feeling of safety and comfort. I said nothing as I entered the room and immediately turned the lights taking a blanket from the shelf for her. I sat down in the chair next to her and said absolutely nothing for what felt like an eternity. Finally, I asked her how I could help her. She did not respond and I sat there for yet another eternity. When I stood up to walk out she told me to sit back down. Finally she began to talk, and might I add, for a VERY long time agreeing to comply with the treatment plan. I was thoroughly convinced that I was not going to be able to help this woman, but I was determined to try. I believe that all patients, even the most difficult ones, want help. Some people have great difficulty relinquishing control and giving trust to others. Therefore, I believe that by turning the lights off, I created a safety ground for her because she did not have to look at me. With the blanket, I showed compassion and offered her comfort. With my silence, I offered a willingness to help without saying so. By sitting in the chair, I made myself an equal instead of a superior. This was one of proud moments in my nursing career. I touched someone that was untouchable by others. And my fellow nurses were so shocked when I came back to the nursing station with a urine specimen they thought I voided in the cup myself! Although this was a difficult situation for the both the patient and I, I would have wanted the nurse to treat my mother or my sister just as I had treated her. I slept quite well that night.

Practice reflection/problem
y

Moreno, M., Duran, M., & Hernandez, A. (2009). Nursing care for adaptation. Nursing science quarterly. Jan, 67-73.

Research articles
y

Wright, P., Holcombe, J., Foote, A., & Piazza, D (1993). The Roy adaptation model used as a guide for the nursing care of an 8 year old child with leukemia. Journal of Pediatric Oncology 10(2), 68-74. Sercekus, P. & Mete, S. (2009). Effects of antenatal education on maternal prenatal and postpartum adaptation. Journal of Advanced Nursing Dec, 9991010.

Conclusion
RAM is a complex theory y RAM lends many applications to education and research y RAM theorizes that people are adaptive systems constantly influenced by stimuli y Nursing is used to increase adaptive behaviors y Nursing is used to decrease maladaptive behaviors
y

References
y y y y y y y y y

Alligood, M, & Tomey, A. (2010). Nursing theorists and their work: 7th ed. Maryland Heights MO: Mosby. Meleis, A. (2007). Theoretical nursing:4th ed.. Philadelphia: Lippincott William & Wilkins. Moreno, M, Duran, M, & Hernandez, A. (2009). Nursing care for adaptation. Nursing Science Quarterly, 22(1), 67-73. Peterson, S, & Bredow, T. (2009). Middle range theories application to nursing research: 2nd ed. Philadelphia: Lippincott William & Wilkins. Roy, C, & Andrews, H. (1999). Roy adaptation model. Stanford CT: Appleton & Lange. Roy, S.C. (1988). An Explication of the philosophical assumptions of the roy adaptation model. Nursing Science Quarterly, 1(26), 26-34. Sercekus, P, & Mete, S. (2009). Effects of antenatal education on maternal prenatal and postnatal adaptation. Journal of Advanced Nursing, Dec, 999-1010. Sister callista roy. (2008, July). Retrieved June 1, 2010 from http://nursingtheories.blogspot.com/2008/07/sister-callista-roy-adaptation-theory.html Wright, P, Holcombe, J, Foote, A, & Piazza, D. (1993). The Roy adaptation model used as a guide for the nursing care of an 8 year old child with leukemia. Journal of Pediatric Oncology Nursing, 10(2), 68-74.