ADAPTATION MODEL

SR. CALLISTA ROY

CALLISTA ROY

Born on October 14, 1939 in Los Angeles

California

BSN in 1963 Mount St. Mary College, Los

Angeles

MA in Pediatric Nursing 1966/Doctorate in

Sociology in 1977 University of California,

L.A.

With honorary doctorate from 4 other

institutions

She is a nurse theorist and a professor

She is a fellow in the American Academy of

Nursing, an honorary nursing society that

elects nursing leaders annually

Has numerous publications, including books

& journal articles on nursing theory & other

professional topics

CALLISTA ROY

Her publications:

Introduction to Nursing: An Adaptation Model

Essentials of the Roy Adaptation Model

Theory Construction in Nursing: An Adaptation

Model

Essentials of the Roy Adaptation Model

Roy Adaptation Model: The Definitive

Statement

Her works has been interpreted in several

languages worldwide

METAPARADIGM

PERSON

Is the recipient of nursing care; main focus of nursing

A biopsychosocial being in constant interaction with a

changing environment.

The person is an open adaptive system who uses coping

skills to deal with stressors.

It includes people as individuals or in groups (families,

organizations, communities, nations & society as a whole)

An adaptive system has cognator and regulator subsystems

to maintain the 4 adaptive modes- physiologic-physical,

self-concept-group identity,role function,and

interdependence.

METAPARADIGM

ENVIRONMENT

Conditions, circumstances and influences that

surround and affect the development and

behavior of the person.

Consists of internal & external environments,

which provide input in the form of stimuli

Stressors are stimuli that are significant in

human adaptation: stages of development,

family & culture

METAPARADIGM

HEALTH

Was originally described by Roy as a health-illness continuum;

health & illness were considered an inevitable dimension of the

person’s life

More recently, Health is the process of being and becoming an

integrated and whole person.

Is it a reflection of adaptation that is the interaction of the person

& the environment

Adaptation is defined as the process and outcome whereby

thinking and feeling, as individuals and groups, use conscious

awareness and choice to create human and environmental

integration.

METAPARADIGM

NURSING

Nursing is the science and practice that expands

adaptive abilities and enhances person and

environment transformation.

Roy’s goal of nursing is the promotion of adaptation

in each of the 4 modes thus contributing to health,

quality of life and dying with dignity

Nursing is about the increase, enhancement,

modification and alteration of the stimulus to achieve

adaptation.

The Roy Adaptation Model (RAM)

THE KEY CONCEPTS:

The person is adapting in a stable interaction with the environment, either internal or external.

The environment serves as the source of a range of stimuli that will either threaten or promote the person’s unique wholeness.

The person’s major task is to maintain integrity in face of these stimuli.

INTEGRITY- the degree of wholeness achieved by adapting to changes in needs.

SYSTEM – is a set of parts connected to function as a whole for

some purpose & that does so by virtue of the interdependence

of its parts

- Roy considers the recipient of care to be an open adaptive

system

- react & interact with other systems in the environment

- have boundaries that are flexible & open to permit

interaction with other systems

- employ a feedback cycle of input, throughput & output

Input – defined as stimuli which can come from the

environment or from within a person

Throughput – makes use of a person’s processes &

effectors

Processes refer to the control mechanisms that a

person uses as an adaptive system

Effectors refer to the physiologic function, self-

concept & role function involves in adaptation

Output – is the outcome of the system, when the

system is a person, the output refers to the person’s

behaviors

Categories of Output:

Adaptive responses – those that promote integrity in

terms of the goals of the human system

Ineffective responses – those that do not contribute to

integrity in terms of the goals of the human system

TYPES OF STIMULI (Helson, 1964)

FOCAL – the internal or external stimulus most

immediately confronting the person, it attracts

the most attention.

CONTEXTUAL – all other stimuli present in the

situation that strengthens/contribute the effect of

the focal stimulus.

RESIDUAL - those stimuli that can affect the

focal stimulus but the effects are unclear.

The three types of stimuli act together and

influence the adaptation level which is

defined as the ability to respond positively in

a situation.

COPING MECHANISM

AND CONTROL PROCESSESS

COPING MECHANISM – are the processes that a

person uses for self-control

- are innate or acquired ways of interacting with

the changing environment

- innate coping mechanisms are genetically

determined or common to the species & are

genetically viewed as automatic process

- acquired coping mechanisms are developed

through strategies such as learning

CATEGORIES OF COPING MECHANISM

REGULATOR SUBSYSTEM - major coping process

involving the neural, chemical, and endocrine system

e.g. increase in vital signs- sympathetic response to

stress.

COGNATOR SUBSYSTEM – is a major coping process

involving four cognitive-emotive channels: perceptual

& information processing; learning; judgment &

emotion

e.g. effects of prolonged hospitalization for a 4year-

old child

CATEGORIES OF COPING

MECHANISM

CONTROL PROCESSES – stabilizer subsystem &

innovator subsystem

Stabilizer subsystem – analogous to regulator :

concerned with stability

Innovator subsystem – analogous to cognator::

concerned with creativity, change & growth

ADAPTATION LEVEL

1.Integrated - Adaptation level at which the

structures and functions of a life process

are working as a whole to meet human

needs.

Example:

Stable processes of ventilation, the

complex process of breathing that

exchanges air between lungs and

atmosphere.

ADAPTATION LEVEL

2. Compensatory - Adaptation level at

which the cognator and regulator have

been activated by a challenge to the

integrated life processes

EXAMPLE:

GRIEVING, ROLE TRANSITION,

ADAPTATION LEVEL

3. Compromised- Adaptation level

resulting from inadequate integrated

and compensatory life processes;

adaptation problem.

EXAMPLES:

• Hypoxia

• Ventilatory Impairment

• Unresolved loss

• Abusive Relationships

ADAPTIVE MODES – are categories of behavior to

adapt to stimuli

- can be used to determine a person’s adaptation

level

- can be used to identify adaptive or ineffective

responses by observing a person’s behavior in

relation to the adaptive modes

4 ADAPTIVE MODES

1. PHYSIOLOGICAL – the way a person responds as

a physical being to a stimuli from the environment.

GOAL: Physiological Integrity

Five Physiologic Needs: oxygenation, nutrition, activity

& rest , elimination & protection

Four Complex Processes: senses; fluids, electrolytes &

acid-base balance; neurologic function; endocrine

function

2. SELF-CONCEPT – GROUP IDENTITY MODE - focuses

specifically on the psychological & spiritual aspects of the

human system

Self- concept – defined as the composite of beliefs & feelings

about oneself at a given time & is formed from internal

perceptions of other’s reaction

Two components: 1. physical self (body sensation and body

image) 2. personal self (self consistency, self ideal, and

moral ethical spiritual self)

Group Identity – reflects how people in groups

perceive themselves based on environmental

feedback

- comprised of interpersonal relationships, group

self-image & culture

GOAL: Psychological Integrity

3. ROLE FUNCTION MODE – a role is a set of

expectations about how a person occupying one’s

position behaves towards a person occupying another

position.

GOAL: Social Integrity

- Roles are carried out with both instrumental behaviors

(the actual physical performance of a behavior) and

expressive behaviors ( are the feelings, attitudes, likes

or dislikes that a person has about a role or about the

performance of a role)

Persons perform primary, secondary & tertiary roles

Primary – determines the majority of behavior engaged in by

the person during a particular period of life ( age, sec,

developmental stage)

Secondary – are those that a person assumes to complete the

task associated with a developmental stage & primary role

(husband, wife)

Tertiary – related primarily to secondary roles & represent

ways in which individuals meet their role associated obligations

- temporary in nature, freely chosen by the individual

4. INTERDEPENDENCE MODE– focuses on close

relationships which results to giving & receiving of

love, respect, value, nurturing, knowledge, skills,

commitments, material possessions, time & talents

- Occurs between the person and the most

significant other or between the person and the

support system.

GOAL: Affectional Adequacy.

GOAL OF NURSING IN RAM

PROMOTE ADAPTATION IN

EACH OF THE FOUR ADAPTIVE

MODES

POINTS TO REMEMBER

Adaptive or ineffective responses result from the 4

modes of coping mechanisms.

Adaptive responses support the integrity of the

person and the goals of adaptation.

Ineffective responses neither promote integrity nor

contribute to the goals of adaptation.

NURSING PROCESS

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 of the

outcome of care provided.

6 STEPS in the NURSING PROCESS

1. ASSESSMENT OF BEHAVIOR

Data gathering about the behavior of the person

as an adaptive system in each of the adaptive

modes.

Observable behavior: vital signs

Non-observable behavior: feelings experienced by

the person (anxiety)

6 STEPS in the NURSING PROCESS

2. ASSESSMENT OF STIMULI

A STIMULUS is defined as any change in the

internal and external environment that induces a

response in the adaptive system. It is classified as

focal, contextual or residual.

In this level of assessment, the nurse analyzes the

subjective and objective behaviors and look more

deeply for possible causes of a particular set of

behaviors.

6 STEPS in the NURSING PROCESS

3. NURSING DIAGNOSIS

Formulation of statements that interpret data about

the adaptation on status of the person, including the

behavior and the most relevant stimuli.

4. GOAL SETTING

Establishment of clear statements of the behavioral

outcomes for nursing care which is realistic and

attainable. This is done together with the client.

6 STEPS in the NURSING PROCESS

5. INTERVENTION

Determination of how best to assist the person in

attaining the established goals.

6. EVALUATION

Judging the effectiveness of the nursing intervention

in relation to the behavior after it was performed in

comparison with the goal established.

Not all beautiful is always good,

But all good is always beautiful.

There is always a room for improvement,

And that is the biggest room in the house.