CALLISTA ROYADAPTATION MODEL

SISTER CALLISTA ROY◦ Born on October 14, 1939 in LA, California.◦ Entered the Sisters of Saint Joseph of Carondelet after

high school◦ Received a Bachelor’s Degree in Nursing from Mount

Saint Mary’s College in LA in 1963◦ 1964-1966 Conceptualization of Model◦ A MSN in Pediatric Nursing from UCLA in 1966◦ 1966-1983 faculty and administrator in MSMC◦ 1971-1974 chair, dept of nursing, MSMC◦ Masters 1973 and Doctorate degree in Sociology in

1977◦ 1978 Award, fellow of American Academy of Nursing

◦ 1983-1985, Robert wood Johnson postdoctoral fellow at the University of California, San Francisco

◦ 1987 nurse theorist at Boston College school of Nursing

◦ Holds honorary doctorates from 4 other institutions

◦ 1991 Award, National League for Nursing◦ Has published 3 books (1970, 1999, 2008)◦ 1987 – present Professor at William F. Connell

school of nursing at Boston College, Massachusetts

PERSON ◦ A biopsychosocial being/system in constant

interaction with a changing environment. ◦ Holistic, adaptive system who uses coping skills to

deal with stressors.◦ A whole with the parts that function in unity for some

purpose◦ It includes people as individuals or in groups.◦ An adaptive system which has cognator and regulator

subsystems which act to maintain adaptation in the four adaptive modes: physiologi-physical,self-concept-group identity, role function, and interdependence

Metaparadigm

ADAPTATION◦ Process and outcome whereby thinking and

feeling persons use conscious awareness and choice to create human environment integration.

◦ Every human life is purposeful in a universe that is creative and persons are inseparable from the environment.

◦ The Human adaptive system – inputs of stimuli, outputs as behavioral responses that serve as feedback and control process known as coping mechanisms

REGULATOR SUBSYSTEM- automatic response to stimulus (neural, chemical and endocrine)

COGNATOR SUBSYSTEM – responds through four cognitive-emotive channels ( perceptual and information processing, learning, judgment and emotion) output responses of regulator subsystems can be feedback stimuli to the cognator subsystem.

Adaptive Responses – promote the integrity of the human system

Ineffective Responses – neither promote nor contribute to the integrity of the human system

Coping process – innate or acquired ways of interacting with the changing environment. (regulator and cognator subsystems)

4 adaptation modes to assess behavior resulting from coping process.

1. Physiologic-Physical Mode Behavior pertaining to the physical aspect

of the human system (physiologic integrity) Physical and chemical process Nurse must be knowledgeable about normal

processes 5 needs ( oxygenation, nutrition,

elimination, Activity and Rest, protection ) –individual

Basic operating resources (participants, physical facilities and fiscal resources)

4 Modes of Adaptation

2. Self-Concept-group Identity Mode The composite of beliefs and feelings held

about oneself at a given time. Focus on the psychological and spiritual

aspects of the human system. Need to know who one is, so that one can

exist with a state of unity, meaning and purposefulness

2 modes (physical self and personal self) Physical self=body sensation & body image

◦ Body sensation-how person experiences physical self

◦ Body image-how person sees/views physical self Personal self=self-consistency, self-ideal and

moral-ethical-spiritual self.◦ Self-consistency-efforts to maintain self-organization◦ Self-ideal-what the person expects to be and do◦ Moral-ethical-spiritual-person’s belief system and

self-evaluator

Group-Identity mode – need for identity integrity consisting of interpersonal relationships, group self-image, social millieu and culture.

3. Role Function Mode Set of expectations about how a person

occupying one position behaves toward a person occupying another position.

Basic need- social integrity, the need to know who one is in relation to others so that one can act appropriately.

Individual- role in society Group- role clarity (functions of

members,decision-making systems, etc..)

4. Interdependence mode Behavior pertaining to interdependent

relationships of individuals and groups Focus on the close relationships of people

and their purpose Each relationship exist for some reason Involves the willingness and ability to give

and accept from significant others (love, care, respect)

Basic need-feeling security in relationships

ENVIRONMENT◦ All conditions, circumstances and influences

surrounding and affecting the development and behaviors of the person.

◦ Stimuli may be focal, contextual and residual.◦ Internal an External

Stimulus – (inputs) something that provokes a response, point of interaction for the human system and the environment

Focal stimuli – internal or external stimulus most immediately affecting the system

Contextual stimuli – all other stimulus present in the situation

Residual Stimuli – internal or external factors whose effects are unclear.

HEALTH◦ A state and a process of being and becoming

integrated as a whole person.◦ Reflection of adaptation that is the interaction of

the person and the environment◦ The integrity of the person = ability to meet the

goals of survival, growth, reproduction, mastery and person and environment transformation.

NURSING◦ Acts to enhance the interaction of the person with

the environment to promote adaptation◦ A science and practice that expands adaptive

abilities and enhances person and environmental transformation.

1. Assesses behavior manifested from the four adaptive modes

2. Assess the stimuli and categorize them into type of stimuli & responses

3.Create a nursing diagnosis of the person’s adaptive state

4. Set goals to improve adaptation (behavior to be observed, change,time frame)

5. Implement interventions to achieve goals (change stimulus)

6. Evaluate if goals have been met

6 Step Nursing Process

E.g. A man in his 50’s with history of diabetes had his leg amputated.

Physiologic mode A: Focal stimulus: limitations for movement

/ambulate Contextual stimulus: amputation of limb D: Impaired mobility r/t amputation of limb G: Patient should be able to verbalize

understanding of situation and demonstrate rehabilitation measures

I: health teaching (safety measures, use of assistive devices)

participation in self-care activities E: verbalization of understanding proper demonstration of rehab measures Interdependence Adaptive Mode A: patient’s significant other is his wife. Wife is

emotionally distant. Focal Stimulus: emotionally distant wife Contextual Stimulus: ineffective communication

skills and limited time together

D: Interrupted family process due to illness G: family members will verbalize feelings

toward patient’s illness freely and appropriately

I: Stress importance of communication encourage wife to assist in caring for

husband (back rubs-pain) E: improved communication; wife performs

caring behaviors; decision to spend more time together

Self-Concept Adaptive Mode A: patient was afraid of dying, believes that illness is

a punishment from his past behaviors; relatives died of cancer.

Focal stimuli: fear and anxiety of dying Contextual stimuli: disease complication; witnessing

other family members’ death as a result of disease D: fear and anxiety of dying related to complications

of diabetes and witnessing family members’ death G: Fear and anxiety will be decreased aeb relaxed

mood, verbalization of new coping strategies

I: encourage ventilation of feelings; suggest new coping strategies; encouraged to attend meeting of support groups of diabetic amputees

E: Role Function Adaptive Mode A: identify role of patient focal stimulus: fear of not being able to care for

self and significant other in the future. Contextual stimulus: chronic illness, amputation

of limb, increased dependency on others

D: Ineffective Role performance related to amputation of limb and increased dependency on others

G: Effective Primary Role transition as manifested by willingness to allow others help him and a desire to resume self care activities as he becomes able

I:encourage patient to rely on his support system for help when needed; positive reinforcement for accomplishment of self care activities; stress importance of maintaining independence with patient and family member.

E: wife exhibits supportive behavior; patient can perform some self-care activities by himself.

Say the color

R-c;L-w