Presented by:Sandra Elwood, RN, BSNStacy Christensen, RN, BSNKaren Gozel, RN, BSNVicky Grove, RN, BSNMinnesota State University MoorheadNURS 600

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*Introduction*

Sister Callista RoyBorn October 14, 1969

Bachelors Degree in Nursing 1963

Masters Degree in Nursing 1966

Masters Degree in Sociology 1973

Doctorate in Sociology 1977

htnursingtheoriestp://.blogspot.com/2008/07/sister-callista-roy-adaptation-theory.html

*Dr. Sister Callista Roy was born October 14, 1939. She is a member of the Sisters of St. Joseph of Carondelet. She has had a long history in the profession of nursing. She started working at the age of 14 in a large hospital and has not quit helping people since then (Nurses.info 2010). She got her bachelors degree in the science of nursing at Mt. St. Marys College in Los Angeles in 1963 (Alligood and Tomey 2010). Roy received her masters degree in nursing from the University of California, Los Angeles in 1966. She also received a masters degree in sociology in 1973 and a doctorate in sociology in 1977 from the University of California. Roy was encouraged to develop a conceptual model for nursing by Dorothy E. Johnson while pursuing her masters degree. Her adaptation model was developed while working in a hospital as a pediatric nurse. It was then that she observed the abilities of the children to adapt to the physical and psychological changes (Alligood and Tomey 2010). Mt. St. Marys College adopted her Adaptation model in 1968. This theory is the foundation for their nursing program. Her model was also published in Nursing Outlook in 1970 (Alligood and Tomey 2010). Roy has been an associate professor and chairperson in the department of nursing at Mt. St. Marys. She has also been a professor at both Mt. St. Marys and the University of Portland. She has been a clinical nurse scholar and conducted research by implementing nursing interventions in the neuro science setting. She became a nursing theorist at Boston College in 1987. Roy has had many books and articles published. 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 (Alligood and Tomey 2010).*

Origin of Roys Adaptation ModelRoy adapted some of her theory development from Harry Helsons Adaptation Theory (Wikipedia 2011).

Roy incorporated Helsons theory with Rapoport's definition of system (Alligood and Tomey 2010).

1500 scholars and students contributed

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*Dr. Roys Adaptation Model was developed while she was in graduate school at the University of California, Los Angeles. Its origins are that Roy adapted some of her theory development from Harry Helsons Adaptation Theory (Wikipedia 2011). This portion of Helson's model defined the different types of stimuli; focal, contextual and residual, and how the individual responds to each of them. Roy incorporated Helsons theory with Rapoport's definition of system to view the person as an adaptive system (Alligood and Tomey 2010). She also used other broad principles from Dohrenwend, Lazarus, Mechanic, and Selye. Roy gave special credit to Driever, Martinez, and Sato for their contributions. There were greater than 1500 scholars and students who contributed to this model. In 1977 Roy presented her model as a curriculum framework and by 1987 it was estimated that more than 100,000 nurses had been prepared to practice Roys model (Alligood and Tomey 2010). *

Purpose of Roys Adaptation Model

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Evolution of Roys Adaptation Model

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Theoretical ConceptsBasic Concepts

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Theoretical Concepts (cont.)Coping Mechanisms

RegulatorCognator*

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Four Adaptive ModesPhysiologicalSelf-ConceptRole FunctionInterdependence

StimuliFocalContextualResidual

http://www.infahealth.com/basic-nursing-science/callista-roy-adaptation-model-of-nursing/Theoretical Concepts (cont.)

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*There are two levels of assessments that need to be done on a client. The first is assessing the behaviors of the client within the four adaptive modes. The second is to assess the stimuli that persuade these behaviors (Villareal, 2003). The diagram above represents the human adaptive system. I will next go into more detail of the of the adaptive modes and types of stimuli.

Theoretical Concepts (cont.)Four Adaptive Modes (cont.)

Physiological-Physical ModeOxygenationNutritionEliminationActivity and RestProtection*

Within a persons environment, behaviors and responses to interactions can be observed through four adaptive modes. The physiological-physical adaptive mode deals with a persons basic needs and pertains to an individuals physical and chemical processes to function. Behaviors observed in this mode reflect an individuals efforts for oxygenation, nutrition, elimination, activity and rest, and protection (Villareal, 2003). The behavior goal in this mode is physiologic integrity and for the individual to be able to adapt to changes in needs (McEwen & Wills, 2011). *

Theoretical Concepts (cont.)Four Adaptive Modes (cont.)Self-Concept Mode

* Physical Self* Personal SelfBody sensation Self-consistencyBody image Self-ideal Moral-Ethical-Spiritual*

The self-concept adaptive mode pertains to the psychological and spiritual dimensions of behavior. Roy describes it as the composite of beliefs or feelings that an individual holds about him- or herself at any given time (as cited in Alligood & Tomey, 2010, pg. 344). Physical and personal self are two components of the mode. Body sensation and body image make up the physical self, and personal self is comprised of self-consistency, self-ideal, and moral-ethical-spiritual self (Alligood & Tomey, 2010). The goal of behavior in this mode is psychological and spiritual integrity and for one to have a sense of purpose, meaning, and unity in the world (McEwen & Wills, 2011). *

Theoretical Concepts (cont.)Four Adaptive Modes (cont.)Role Function

(McEwen & Wills, 2011, pg. 172)*

The role-function adaptive mode pertains to an individuals role or roles in society. Roy and Andrews describe it as the set of expectations about how a person occupying one position behaves toward a person occupying another position (as cited in Villareal, 2003, pg. 378). The way in which an individual carries out or fulfills his or her social role is suggestive of his or her level of social integrity, which is the goal of behavior in this mode (McEwen & Wills, 2011). *

Theoretical Concepts (cont.)Four Adaptive Modes (cont.)Interdependence ~ RELATIONSHIPS ~

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The interdependence adaptive mode relates to relationships and interactions of people. The giving and receiving of love, respect, and value are the main focus of this mode. The behavior goal of this mode is relational integrity. The two relationships that are specific to this mode are significant others and support systems. Significant others are people that one has close relationships with that include family members, spouses, a boyfriend, God, and friends. The social support system includes those who help meet ones interdependence needs (Alligood & Tomey, 2010). *

Theoretical Concepts (cont.)Types of Stimuli

FocalContextualResidual*Contextualstimuli FocalstimuliContextual stimuliResidualStimuliResidual StimuliResidualStimuli

*A nurse must then assess the stimuli that is affecting a person. An individual can have problems with adaptation when they are unable to cope with or properly respond to constantly changing stimuli from their internal and external environments. Roy categorizes three classes of stimuli as being focal, contextual, and residual (Alligood & Tomey, 2010). Focal stimuli is described by Roy and Andrews (1999) as "the internal or external stimulus most immediately confronting the human system" (as cited in Alligood & Tomey, 2010, pg. 338). Contextual stimuli is "all other stimuli present that contribute to the effects of the focal stimuli" (Alligood & Tomey, 2010, pg. 336). Residual stimuli is any other stimuli that cannot be validated or the effects are unclear (Alligood & Tomey, 2010).Roy and Andrews (1991) list several frequent or common stimuli as being a person's age, gender, socioeconomic status, culture, belief system, family dynamics, knowledge of stressors, use of drugs, medications, alcohol, and tobacco, and political and economic stability (as cited in Nayback, 2009).The nurse needs to find ways to manipulate the stimuli to promote adaptation in an individual. *

http://1010report.com/?p=27Application to Health a state and a process of being and becoming integrated and a whole person. It is a reflection of adaptation, that is, the interaction of the person and the environment (as cited in Alligood & Tomey, 2010, pg. 342)*

*Roy defines health as being "a state and a process of being and becoming integrated and a whole person. It is a reflection of adaptation, that is, the interaction of the person and the environment" (as cited in Alligood & Tomey, 2010, pg. 342). Roy conceptualizes health as a process, and that one must meet goals of survival, growth, reproduction, and mastery ("Roy's", 2011). Illness occurs when one cannot cope. Responses that do not add to the goals to meet integrity are called ineffective. An individual needs to regularly adapt to maintain health. When an individual does adapt to stressors, health can occur as they are free to focus on other environmental stimuli (Alligood & Tomey, 2010).

Application to Nursing

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Application to Environment

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Application to Person

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Application to Nursing Practice

Nursing ProcessAssess BehaviorAssess StimuliNursing DiagnosisGoal SettingInterventionsEvaluation*http://www.glogster.com/glog.php?glog_id=1420666&scale=54&isprofile=truehttp://www.ageia.net/p/home_health_care/home_Care_resources/bend-or-97702/at-home-care-group-2737http://www.tobacco-facts.net

*Roy's well developed model is frequently used worldwide as it provides direction for practice, education, and research (Alligood & Tomey, 2010). Roy uses a six-step nursing process when assessing individuals. In the first step, the nurse gathers data about the behavior from the four adaptive modes. In the second step, the nurse evaluates the stimuli that is causing the behaviors and classifies them as focal, contextual, or residual stimuli. In the third step, the nurse uses the process of judgment to make a statement or nursing diagnosis. Setting goals is the fourth step. Goals ought to be declared for ineffective behaviors that are to be changed to adaptive behaviors. In the fifth step, the nurse implements nursing interventions that will manage stimuli and strengthen the adaptive system. Lastly, in the sixth step, the nurse evaluates and judges the effectiveness of the goals (Alligood & Tomey, 2010).

An example of the use of Roy's model was used in a group of young women contemplating quitting smoking. The women's thoughts and feelings were explored as well as their perceptions of stimuli that made them want to smoke. Nursing interventions were focused on the women gaining an understanding of smoking addiction and recognizing behaviors and stresses that triggered them to smoke. In conclusion, with the help of Roy's model, the women were able to move from a precontemplation stage to contemplating quitting smoking (Villareal, 2003).*

Application to Education

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Application to Research

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http://staciecampanelli.com/2011/04/peace-of-mind-is-born-of-clarity/Critique of Theory Clarity

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Critique of TheorySimplicity

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Critique of Theory Generality

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Critique of TheoryEmpirical Precision TestableResearch

Qualitative studiesQuantitative studiesEducationPracticeTheory development

*http://money.cnn.com/magazines/moneymag/bestjobs/2010/snapshots/76.htmlhttp://www.bon.texas.gov/practice/

*The RAM is testable and empirically precise as it has been used in 163 studies since 1970 (McEwen & Wills, 2011). Many qualitative and quantitative studies have observed and tested the concepts and relationships of the RAM. Several nursing programs have adopted this model in their curriculum that include Mount Saint Marys College, the University of Texas, the nurse practitioner program at the University of Florida, Boston College School of Nursing, and in several nursing schools in Japan and France as well (McEwen & Wills, 2011). Roy's model has also stimulated the development of numerous middle range theories and adaptation instruments. Some theories include the theory of psychological adaptation, the Urine Control Theory, and the model of psychosocial determinants of adaptation (McEwen & Wills, 2011). Not only is the RAM used extensively in practice in the United States, but aboard as well (Alligood & Tomey, 2010).

Critique of TheoryDerivable Consequences

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Analysis and Evaluation

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http://nirajbhartiblog.wordpress.com/2011/02/18/how-to-get-the-ideas-to-write-a-blog-post/Discussion

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Alligood, M. R. & Tomey, A. M. (2010). Nursing theorists and their works. (7th ed.). Maryland Heights, MO: Mosby Elsevier. McEwen, M. & Wills, E. M. (2011). Theoretical basis for nursing. (3rd ed.). Philadelphia, PA: Wolters Kluwer health/Lippincott Williams, and Wilkins.Nayback, A. M. (2009). PTSD in the combat veteran: Using Roys Adaptation Model to examine the combat veteran as a human adaptive system. Issues in Mental Health Nursing, 30(5), 304-310.doi: 10.1080/01612840902754404 Roys Adaptation Model. (2011). Retrieved from http://currentnursing.com/nursing_theory/Roy_adaptation_model.htmlVillareal, E. (2003). Using Roys Adaptation Model when caring for a group of young women contemplating quitting smoking. Public Health Nursing, 20(5), 377-384. doi: 10.1046/j.1525-1446.2003.20506.x

*References

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*Introduction**Dr. Sister Callista Roy was born October 14, 1939. She is a member of the Sisters of St. Joseph of Carondelet. She has had a long history in the profession of nursing. She started working at the age of 14 in a large hospital and has not quit helping people since then (Nurses.info 2010). She got her bachelors degree in the science of nursing at Mt. St. Marys College in Los Angeles in 1963 (Alligood and Tomey 2010). Roy received her masters degree in nursing from the University of California, Los Angeles in 1966. She also received a masters degree in sociology in 1973 and a doctorate in sociology in 1977 from the University of California. Roy was encouraged to develop a conceptual model for nursing by Dorothy E. Johnson while pursuing her masters degree. Her adaptation model was developed while working in a hospital as a pediatric nurse. It was then that she observed the abilities of the children to adapt to the physical and psychological changes (Alligood and Tomey 2010). Mt. St. Marys College adopted her Adaptation model in 1968. This theory is the foundation for their nursing program. Her model was also published in Nursing Outlook in 1970 (Alligood and Tomey 2010). Roy has been an associate professor and chairperson in the department of nursing at Mt. St. Marys. She has also been a professor at both Mt. St. Marys and the University of Portland. She has been a clinical nurse scholar and conducted research by implementing nursing interventions in the neuro science setting. She became a nursing theorist at Boston College in 1987. Roy has had many books and articles published. 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 (Alligood and Tomey 2010).**Dr. Roys Adaptation Model was developed while she was in graduate school at the University of California, Los Angeles. Its origins are that Roy adapted some of her theory development from Harry Helsons Adaptation Theory (Wikipedia 2011). This portion of Helson's model defined the different types of stimuli; focal, contextual and residual, and how the individual responds to each of them. Roy incorporated Helsons theory with Rapoport's definition of system to view the person as an adaptive system (Alligood and Tomey 2010). She also used other broad principles from Dohrenwend, Lazarus, Mechanic, and Selye. Roy gave special credit to Driever, Martinez, and Sato for their contributions. There were greater than 1500 scholars and students who contributed to this model. In 1977 Roy presented her model as a curriculum framework and by 1987 it was estimated that more than 100,000 nurses had been prepared to practice Roys model (Alligood and Tomey 2010). **

**

**

**

*There are two levels of assessments that need to be done on a client. The first is assessing the behaviors of the client within the four adaptive modes. The second is to assess the stimuli that persuade these behaviors (Villareal, 2003). The diagram above represents the human adaptive system. I will next go into more detail of the of the adaptive modes and types of stimuli. Within a persons environment, behaviors and responses to interactions can be observed through four adaptive modes. The physiological-physical adaptive mode deals with a persons basic needs and pertains to an individuals physical and chemical processes to function. Behaviors observed in this mode reflect an individuals efforts for oxygenation, nutrition, elimination, activity and rest, and protection (Villareal, 2003). The behavior goal in this mode is physiologic integrity and for the individual to be able to adapt to changes in needs (McEwen & Wills, 2011). *The self-concept adaptive mode pertains to the psychological and spiritual dimensions of behavior. Roy describes it as the composite of beliefs or feelings that an individual holds about him- or herself at any given time (as cited in Alligood & Tomey, 2010, pg. 344). Physical and personal self are two components of the mode. Body sensation and body image make up the physical self, and personal self is comprised of self-consistency, self-ideal, and moral-ethical-spiritual self (Alligood & Tomey, 2010). The goal of behavior in this mode is psychological and spiritual integrity and for one to have a sense of purpose, meaning, and unity in the world (McEwen & Wills, 2011). *The role-function adaptive mode pertains to an individuals role or roles in society. Roy and Andrews describe it as the set of expectations about how a person occupying one position behaves toward a person occupying another position (as cited in Villareal, 2003, pg. 378). The way in which an individual carries out or fulfills his or her social role is suggestive of his or her level of social integrity, which is the goal of behavior in this mode (McEwen & Wills, 2011). *The interdependence adaptive mode relates to relationships and interactions of people. The giving and receiving of love, respect, and value are the main focus of this mode. The behavior goal of this mode is relational integrity. The two relationships that are specific to this mode are significant others and support systems. Significant others are people that one has close relationships with that include family members, spouses, a boyfriend, God, and friends. The social support system includes those who help meet ones interdependence needs (Alligood & Tomey, 2010). **A nurse must then assess the stimuli that is affecting a person. An individual can have problems with adaptation when they are unable to cope with or properly respond to constantly changing stimuli from their internal and external environments. Roy categorizes three classes of stimuli as being focal, contextual, and residual (Alligood & Tomey, 2010). Focal stimuli is described by Roy and Andrews (1999) as "the internal or external stimulus most immediately confronting the human system" (as cited in Alligood & Tomey, 2010, pg. 338). Contextual stimuli is "all other stimuli present that contribute to the effects of the focal stimuli" (Alligood & Tomey, 2010, pg. 336). Residual stimuli is any other stimuli that cannot be validated or the effects are unclear (Alligood & Tomey, 2010).Roy and Andrews (1991) list several frequent or common stimuli as being a person's age, gender, socioeconomic status, culture, belief system, family dynamics, knowledge of stressors, use of drugs, medications, alcohol, and tobacco, and political and economic stability (as cited in Nayback, 2009).The nurse needs to find ways to manipulate the stimuli to promote adaptation in an individual. **Roy defines health as being "a state and a process of being and becoming integrated and a whole person. It is a reflection of adaptation, that is, the interaction of the person and the environment" (as cited in Alligood & Tomey, 2010, pg. 342). Roy conceptualizes health as a process, and that one must meet goals of survival, growth, reproduction, and mastery ("Roy's", 2011). Illness occurs when one cannot cope. Responses that do not add to the goals to meet integrity are called ineffective. An individual needs to regularly adapt to maintain health. When an individual does adapt to stressors, health can occur as they are free to focus on other environmental stimuli (Alligood & Tomey, 2010).

*

*

*

*Roy's well developed model is frequently used worldwide as it provides direction for practice, education, and research (Alligood & Tomey, 2010). Roy uses a six-step nursing process when assessing individuals. In the first step, the nurse gathers data about the behavior from the four adaptive modes. In the second step, the nurse evaluates the stimuli that is causing the behaviors and classifies them as focal, contextual, or residual stimuli. In the third step, the nurse uses the process of judgment to make a statement or nursing diagnosis. Setting goals is the fourth step. Goals ought to be declared for ineffective behaviors that are to be changed to adaptive behaviors. In the fifth step, the nurse implements nursing interventions that will manage stimuli and strengthen the adaptive system. Lastly, in the sixth step, the nurse evaluates and judges the effectiveness of the goals (Alligood & Tomey, 2010).

An example of the use of Roy's model was used in a group of young women contemplating quitting smoking. The women's thoughts and feelings were explored as well as their perceptions of stimuli that made them want to smoke. Nursing interventions were focused on the women gaining an understanding of smoking addiction and recognizing behaviors and stresses that triggered them to smoke. In conclusion, with the help of Roy's model, the women were able to move from a precontemplation stage to contemplating quitting smoking (Villareal, 2003).**

*

*

*

*

*The RAM is testable and empirically precise as it has been used in 163 studies since 1970 (McEwen & Wills, 2011). Many qualitative and quantitative studies have observed and tested the concepts and relationships of the RAM. Several nursing programs have adopted this model in their curriculum that include Mount Saint Marys College, the University of Texas, the nurse practitioner program at the University of Florida, Boston College School of Nursing, and in several nursing schools in Japan and France as well (McEwen & Wills, 2011). Roy's model has also stimulated the development of numerous middle range theories and adaptation instruments. Some theories include the theory of psychological adaptation, the Urine Control Theory, and the model of psychosocial determinants of adaptation (McEwen & Wills, 2011). Not only is the RAM used extensively in practice in the United States, but aboard as well (Alligood & Tomey, 2010). *

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